This study was designed to extend the literature on multicomponent interventions for the children of deaf adults (CODA) population. This study used two evidence-based behavior intervention strategies: pre-session pairing (PSP) and independent group contingency (GC). These strategies have been successfully used to decrease off-task behavior in elementary school children with various abilities and diverse backgrounds. However, the research on multicomponent interventions has yet to examine their effects on the CODA population in inclusive classrooms. This study used a concurrent multiple baseline design across participants with an ABC sequence to examine teacher-implemented PSP with independent GC in reducing the off-task behavior of three CODAs in an inclusive classroom at a public elementary school. The results show that the intervention successfully decreased off-task behavior for all participating CODAs. The results suggest that CODAs can adapt to classroom rules and expectations when PSP and independent GC are systematically applied to them in classrooms.

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.

Saliva is a promising matrix with several purposes. Our aim is to verify if salivary anti-SARS-CoV-2 antibody determination is suitable for monitoring immune response. One-hundred eighty-seven subjects were enrolled at University-Hospital Padova: 105 females (56.1%) and 82 males (43.9%), 95 (50.8%) children and 92 (49.2%) adults. Subjects self-collected saliva using Salivette; nineteen subjects collected three different samples within the day. A serum sample was obtained for all individuals. The N/S anti-SARS-CoV-2 salivary IgG (sal-IgG) and serum anti-SARS-CoV-2 S-RBD IgG (ser-IgG) were used for determining anti-SARS-CoV-2 antibodies. The mean (min-max) of age was 9.0 (1–18) for children and 42.5 (20–61) for adults. Of 187 samples, 63 were negative for sal-IgG (33.7%), while 7 were negative for ser-IgG (3.7%). Spearman’s correlation was 0.56 (p<0.001). Sal-IgG and ser-IgG levels were correlated with age, but not with gender, comorbidities, prolonged therapy, previous SARS-CoV-2 infection or time from last COVID-19 infection/vaccination. The repeatability ranged from 23.8% (7.4kAU/L) to 4.0% (3.77kAU/L). Linearity of the assay missed in 4/6 samples. No significant intra-subject differences were observed in sal-IgG across samples collected at different time points. Sal-IgG have a good agreement with ser-IgG. Non-invasive saliva collection represents an alternative method for antibody measurement, especially in children.

Background: This study describes the attitudes and practices of Brazilian adults regarding the mandatory vaccination for COVID-19 and the hesitancy to children´s vaccination. Methods: The participants answered an online questionnaire disseminated on social networks. An adaptation of the SAGE-WG questionnaire was used to measure the children's vaccination hesitancy. Results: Among 1,007 participants, 677 (67.4%) believed that vaccination for COVID-19 among adults should be mandatory. Just over half of the participants (51.5%) believe that parents and guardians should be free to decide whether their children should be vaccinated against COVID-19, and 9.1% were unsure about this. Younger, non-religious people who have higher self-perceptions of risk for COVID-19, and who evaluate the federal government's performance in combating the disease as bad or very bad, have a higher agreement with mandatory vaccination, a lower agreement that parents and guardians should be free to vaccinate their children, and lower child vaccination hesitancy scores. Conclusion: In Brazil, mandatory COVID-19 vaccination for adults is far from a consensus, and an expressive part of the population believes that parents and guardians should be free to choose whether or not to vaccinate their children. These perceptions and vaccine hesitancy for children are associated with religious and political inclinations.

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.

Background: The purpose of this review is to clarify the natural course of Benign Paroxysmal Torticollis (BPT) and to update the relationship of this disorder with migraine. BPT belongs to a group of “episodic syndromes that may be associated with migraine” and is diagnosed when according to diagnostic criteria of the International Classification of Headache Disorders, 3rd edition. It is present in infants and young children and it is an underdiagnosed manifestation, because it is not well recognized and in most cases with a benign evolution, but requires careful differential diagnosis. It was first described by Snyder in 1969 as a movement disorder, a cervical dystonia consequent to labyrinthic disorder.Materials and methods: The PubMed and Web of Science databases were consulted from 1968 to 2024, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines ,2020.( PRISMA)Results: 113 articles were identified, 86 selected and 20 considered for the purpose of this review. The clinical studies were considered in relation to evolution, cognitive and motor development, to genetic and not genetic etiology, to the relationship with migraine with and without aura, vestibular migraine, hemiplegic migraine, and paroxysmal vertigo.

Malocclusions have a continuously increasing prevalence from a generation to another as a result of climate changes, soil, atmosphere and water pollution. All of these aspects have unfavorable consequences on the nutritional scheme. Thus, nutrition together with other etiopathogenic factors contribute to complex alterations in the somatic development of the entire organism and, implicitly, of the cephalic extremity. The study included 4147 children from randomly selected schools from Vâlcea County, Romania. The aim of this study is to determine the prevalence of malocclusions in schoolchildren from Vâlcea County, Romania, according to the three main classes of malocclusions (according to Angle’s classification), age groups (from 6 to 10 years old and from 11 to 14 years old), gender (male and female) and place of origin (rural and urban). It is also aimed to compare the results obtained with similar ones from the specialized literature.

The family context has been associated with children's weight status. This study aims to investigate the association between parents' adherence to the Mediterranean diet and family time with the weight status of children. The research is part of the BeE-school, a cluster randomized trial implemented in primary schools located in social vulnerable contexts. A total of 735 children (380 boys), aged 6 to 10, participated in the study. Anthropometrics were assessed during school time, weight status categorized, while parents self-reported sociodemographic variables, adherence to the Mediterranean diet (MEDAS questionnaire), and family time. Children from families with higher education levels whose parents have a high adherence to the Mediterranean diet, have lower odds to have overweight/obesity (odds ratio (OR) 0.301, 95% CI 0.143-0.634, p=0.002). Also, children from families with lower education levels who have more time together with their family, have lower odds to have overweight/obesity (OR 0.731, 95% CI 0.573-0.934, p=0.012). The family environment, mainly family time together and adherence to Mediterranean diet, exerts a significant influence on children’s weight status. Professionals working in children’s health should consider the family when fostering health-promoting behaviors.

In children, the global burden of vaccines-preventable diseases (VPDs) and deaths can be averted by adopting timely immunization practices. Administering immunization to a child within 28 or 30 days of the designated immunization date is referred to as timely immunization. Delaying or missing vaccinations puts children, especially those in urban slums, at a higher risk of getting sick or dying from different diseases. This study was designed to examine the immunization practices and to measure the determinants of immunization non-compliance in children living in urban slums of Karachi, Pakistan. A community-based retrospective cohort was carried out from October-2018- to August-2019 in six different urban slums of Karachi. Immunization status of children aged less than 2 years was assessed by reviewing their vaccination card. Children from each slum were approached via 30x7 multistage stratified cluster sampling technique. Data of each child was analysed descriptively and inferentially using a statistical software, i.e., Jamovi version 1.2.25. The practice of timely immunization was observed in approximately half of children, i.e., 49.8%(n=457). The immunization rate at birth (first-visit) was 100%, of which 95.7% were timely immunized. Following the second immunization visit, a sharp decline in the immunization rate, including timely immunization rate was observed. Lack of knowledge, childhood illnesses, lack of interest, and vaccines unavailability were the main reasons of immunization non-compliance. However, an increase in paternal education was significantly associated to decrease the odds of immunization non-compliance. A decrease in the practice of timely immunization is replaced by either invalid and/or delayed and/or missed immunization practices. Thus, timely immunization is crucial for preventing the infectious diseases and promoting the health of a child.

The causes of pediatric cancers often remain unknown; however, due to the development of medicine and technology, genetic disorders may play a crucial role in the genesis of neoplasms. Over time, the number of cancer predisposition syndromes (CPS) and awareness of them are increasing, providing the possibility of cancer prevention and early detection. In this study, we presented data concerning the number and type of oncological cases and their correlation with CPS occurrence in a cohort of Central and Eastern European pediatric population. The data were collected between 2000 and 2019 at the Karol Jonscher Clinical Hospital of Poznan University of Medical Sciences, resulting in a cohort of 2,190 cases in total, of which 193 children (8.81%) were confirmed to have CPS. CPS occurred most frequently in infancy (22.90% of all children suffering from any diagnosed cancer during the first year of life, p < 0.0001), accounting for more than a quarter of all CPS cases in our cohort. CPS were least likely to be observed in patients aged 14 and 15 years (2.17% and 2.44% of children diagnosed with any of the listed cancers at the exact age, respectively, p < 0.05). Among CPS, the most common were neurofibromatosis type I (NF1), Li-Fraumeni syndrome (LFS), and Down syndrome (DS). To conclude, it is important to emphasize the need for personalized treatment for each patient affected by both CPS and subsequent cancer in order to reduce the toxicity of therapy and improve quality of life by reducing the risk of side effect.

Introduction: Rotavirus-induced acute diarrhoea continues to pose a significant health threat to children under 5 years old worldwide, despite the availability of effective vaccines. This study aimed to assess the prevalence, associated risk factors, and circulating genotypes of rotavirus among children under 5 admitted to Ikom Medical Centre due to diarrhea. Methodology: Stool samples were collected from 294 children under 5 with diarrhoea at Ikom Medical Centre. Rotavirus antigen detection was performed using rapid chromatographic immunoassay. Molecular techniques such as polyacrylamide gel electrophoresis (PAGE), RT-PCR, and semi-nested multiplex RT-PCR were used to analyze rotavirus strains. Data were obtained through questionnaires, and statistical significance was assessed using the chi-square test (P < 0.05). Results: Among the 294 samples, 20.4% (60/294) tested positive for rotavirus. Significant risk factors influencing rotavirus prevalence included feeding status, toilet system, and duration of diarrhoea. The most prevalent genotype for VP7 was G4 (26.7%), and for VP4, it was genotype P[4] (23.3%). Predominant genotype combinations were G4P [4] (11.6%) and G12P[4] (6.7%), while non-typeable P[NT] was observed in 41.7% of cases. Conclusion: This study highlights the circulation of rotavirus in Ikom, Cross River State, emphasizing its neglected status despite its significant global impact on child mortality. Urgent attention is needed to address rotavirus as a serious public health concern, particularly in low-resource settings.

Walking School Buses (WSBs) provide a safe alternative to being driven to school. Children benefit from the contribution the exercise provides towards their daily exercise target, it gives children practical experience with respect to road safety and helps to relieve traffic congestion around the entrance to their school. Walking routes are designed largely based in road safety considerations, catchment need and the availability of parent support. However, little attention is given to the air pollution exposure experienced by children during their journey to school, despite the commuting microenvironment being an important contributor to a child’s daily air pollution exposure. This study aims to quantify the air pollution exposure experienced by children walking to school and those being driven by car. A school was chosen in Bradford, UK. Three adult participants carried out the journey to and from school each carrying a P-Trak ultrafine particle (UFP) count monitor. One participant travelled the journey to school by car while the other two walked, each on opposite sides of the road for the majority of the journey. Data collection was carried out over a period of two weeks, for a total of five journeys to school in the morning and five on the way home at the end of the school day. Results of the study suggest that car commuters experience lower levels of air pollution dose due to lower exposures and reduced commute times. The largest reductions in exposure for pedestrians can be achieved by avoiding close proximity to traffic queuing up to intersections, and, where possible, walking on the side of the road opposite the traffic, especially during the morning commuting period. Major intersections should also be avoided as they were associated with peak exposures. Steps to ensure that the phasing of lights is optimized to minimize pedestrian waiting time would also help reduce exposures. If possible, busy roads should be avoided altogether. By the careful design of WSB routes, taking into account air pollution, children will be able to experience the benefits that walking to school brings while minimizing their air pollution exposure during their commute to and from school.

Antiviral therapy such as Oseltamivir has been recommended for hospitalized children with suspected and confirmed influenza for almost 20 years. The therapy is officially authorized for newborns two weeks of age or older, however, questions about its safety and effectiveness still surround it. Our goal was to assess the epidemiological features of two consecutive seasonal in-fluenza cases in children following the COVID-19 pandemic and also to observe the clinical ef-fectiveness and tolerability of oseltamivir in hospitalized children who were not vaccinated against influenza and who had different influenza subtypes, including A (H1N1), A (H3N2), and influenza B, and to identify specific comorbidities associated with influenza in children. We performed an observational study on 1300 children, enrolled between 1st October 2022 and 30th May 2023 and 1st October 2023-4th of May 2024, to the IX Pediatric Infectious Diseases Clinical Section of the National Institute of Infectious Diseases "Prof. Dr. Matei Balș". During the 2022-2023 influenza sea-son, 791 pediatric patients tested positive for influenza and received Oseltamivir. Of these, 89% (704/791) had influenza A, with 86.4% subtypes A(H1N1) and 13.6% of cases had A(H3N2), and influ-enza B 11%(87/791) pediatric patients. Of the total group, 59% were male, and the median age was 2,4 years (1.02-9.28). For the 2023-2024 influenza season, 509 pediatric patients tested positive for influen-za, 56.9% were male gender and were treated with Oseltamivir. 81.6 % had Influenza A, and 18.4% had influenza B. Treatment with neuraminidase inhibitors like Oseltamivir, 2mg/kg/dose twice daily for 5 days, was well tolerated by the children, and we recorded no deaths. The duration of fever hospitaliza-tion after the Oseltamivir administration was significantly longer for patients with A(H1N1) infection than A(H3N2), during both seasons. We identified more complications in the 2022-2023 season and a decreasing number of Influenza B for the 2023-2024 season. Among children with comorbidities, the most common were asthma, gastrointestinal disorders, and metabolic and endocrine diseases. In terms of effectiveness, oseltamivir significantly reduced the intensity of influenza symptoms, thus reducing the number of days of hospitalization (p=0.001) as well as post-infection complications (p=0.005) in both groups. Oseltamivir was less effective in Influenza A (H1N1) than A(H3N2), (p=0.0035). In this study, we evaluated the clinical effectiveness of oseltamivir therapy for all influenza types/subtypes in children, and the length of hospitalization. We identified comorbidities associated with prolonged dura-tion of hospitalisation. Influenza vaccination should be the main tool in the prevention of influenza and its complications in children, especially with comorbidities.

Background & Aims: Reports of a rise in childhood cancer incidence in Australia and globally prompted the investigation of cancer incidence and survival in South Australia (SA) and the Northern Territory (NT) over a 28-year period, with emphasis on Indigenous peoples. Methods: This cross-sectional analysis of two prospective longitudinal databases, the SA and NT Cancer Registries (1990-2017), included all reported cases of childhood cancers. Poisson regression provided estimates of incidence rate ratios and survival was modelled using Cox proportional hazard models for children aged 0.05). With reference to the 1990-1999 era, overall survival improved in subsequent eras in SA (2000-2009: HR 0.53 [0.38-0.73]; 2010-2017: 0.44 [0.28-0.68]); however, remained unchanged in the NT (2000-2009: 0.78 [0.40-1.51]; 2010-2017: 0.50 [0.24-1.05]). In the NT, overall survival of Indigenous patients was significantly lower compared with the non-Indigenous cohort (3.42 [1.92-6.10]). While the survival of Indigenous children with cancer significantly improved in the last two eras (p0.05). Conclusions: The incidence of childhood cancers has remained unchanged over 28-years in SA and the NT. Encouragingly, improved survival rates over time were observed in SA and amongst Indigenous children of the NT. Nevertheless, survival rates in Indigenous children remain lower than non-Indigenous children.

Button batteries pose a significant threat to young children and are found in many household items and children’s toys. Along with product manufacturers and retailers, parents and caregivers have a role in button battery ingestion prevention through vigilance regarding items containing button batteries in the home, and knowledge of button battery ingestion symptoms. There is limited information available about parent and caregiver perspectives towards button battery safety. Identifying the areas where increased education is required is important for informing safety campaigns and delivering targeted education. This study aimed to examine parent and caregiver elemental perspectives on button battery safety. One hundred and seventy-four parents and caregivers of children aged 0 to 5 completed a cross-sectional online survey. Distribution occurred via social media. The survey contained multiple-choice questions pertaining to button battery perspectives, and one open-ended question. Respondents recognized the dangers of button battery ingestion, yet only 37% reported being familiar with button battery ingestion symptoms. While 68% knew of household items containing button batteries, only 21% were aware of product recall information sources. Approximately 64% understood immediate post-ingestion steps and 17% found current safety labels unsatisfactory. In an open-ended question, parents and caregivers provided comments about button battery safety that revealed five broad themes; supervision and education; safe storage of button batteries in the home; ensuring children cannot access button batteries; disposing of button batteries safely; and avoiding purchasing items containing button batteries. This study provides a foundation for ongoing investigation of parent and caregiver perspectives on button battery home safety.

Severe inherited alpha-1 antitrypsin deficiency (AATD) is an autosomal genetic condition linked to chronic obstructive pulmonary disease (COPD). The significance of heterozygous, milder deficiency variants (Pi*M, Pi*S, Pi*Z) is less clear. We studied AATD genotypes in 145 children (up to 72 months old) with assessed wheezing severity using the Pediatric Respiratory Assessment Measure (BCCH PRAM score). A control group of 74 children without airway obstruction was included. AAT concentration and Pi phenotype were determined from dry blood spot samples using nephelometry and real-time PCR; PiS and PiZ alleles were identified by isoelectrofocusing. Among the wheezers, the Pi*S allele incidence was 2.07% (3 cases) and Pi*Z allele was 6.9% (10 cases). The Pi*Z allele frequency was higher in wheezers compared to controls (44.8% vs. 20.27%) and the general Lithuanian population (44.8% vs. 13.6%) and was similar to adult COPD patients in Lithuania: Pi*S 10.3% vs. 15.8% and Pi*Z 44.8% vs. 46.1%. No association was found between AAT genotypes and wheezing severity. Finding that wheezer children exhibit a frequency of Z* and S* alleles like that found in adults with COPD suggests a potential genetic predisposition that links early wheezing in children to the development of COPD in adulthood. Larger cohort studies are needed to confirm this finding.

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by renal tubular cystic dilatations. The cysts can develop anywhere along the nephron and over time the cystic dilatation lead to kidney enlargement. On the other hand, the cysts begin to reduce the number of functional nephrons as a consequence of cystic expansion that further contributes to the decline in renal function over the years. The pressure exerted by the dilated cysts lead to compensatory mechanisms that further contribute to the decline in renal function. These structural changes are responsible of glomerular hyperfiltration states, albuminuria, proteinuria, and haematuria. However, the presentation of ADPKD varies in children from a completely asymptomatic child with incidental ultrasound detection of cysts to a rapidly progressive disease. There have been reports of early onset of ADPKD in children younger than 2 years that showed a more rapid decline in renal function. ADPKD is caused by mutation in PKD1 and PKD2 genes. Today, the PKD1 gene mutation seems to account for up to 85% of the cases worldwide, and it is associated with worse renal outcomes. Individuals with PKD2 gene mutation seem to present a milder form of the disease, with a more delayed onset of end stage kidney disease. The cardinal sign of ADPKD is the presence of renal cysts during renal ultrasound. The current guidelines provide the clinicians the recommendations for genetic testing in children with a positive family history. Given that the vast majority of children with ADPKD present with normal or supra normal kidney function we explored the glomerular filtration rates dynamics and the renal ultrasound adjusted percentiles. 14 out of 16 patients had kidney percentile over 90%. The gene mutations were equally distributed among our cohort. In addition, we compared the modified Schwartz formula to the quadratic equation after adjusting the serum creatinine measurements. It seems that even though children with ADPKD have enlarged kidneys, the renal function is more likely normal or near normal when the quadratic estimation of glomerular filtration rate is used (qGFR tended to be lower, 111.95 ± 12.43 ml/min/1.73m2 compared to Schwartz eGFR 126.28 ± 33.07ml/min/1.73m2, p=0.14). Also, when the quadratic equation was employed, not even a patient reached the glomerular hyperfiltration thresholds. The quadratic formula showed that glomerular filtration rates are linear or slightly decreasing after 1-year of follow-up (Quadratic ΔeGFR=0.32±5.78ml/min/1.73m2) as opposed to Schwartz formula that can falsely classify children in a hyperfiltration state ΔeGFR=7.51±19.46ml/min/1.73m2), p=0.019.

Background: Infantile haemangiomas (IH) may require treatment with propranolol. Sleep disturbances are the most fre-quently reported side effects. Monitoring drug adverse events necessitates repeated hospital visits, despite the SARS-CoV-2 pandemic. Objectives: To explore the effectiveness of a new electronic questionnaire in identifying sleep disturbances as adverse events to treatment and potential confounders. To evaluate the response rate to the questionnaire. To report the propor-tion of patients on propranolol with sleep disturbances. Methods: In an observational, prospective cohort study, caregivers provided clinical information at office visits and via an electronic questionnaire after an 8-week treatment course and at treatment interruption. Adverse drug reaction (ADR) reporting forms were evaluated for causality assessment. Results: The questionnaire response rate was 91%, and the completion rate was 100%. The prevalence of sleep disturb-ances as adverse reactions was 59%. Sleep disorders were more frequent during sleep regression phases and in subjects who fell asleep with physical contact with caregivers or bed-sharing with parents. Conclusion: The application of this questionnaire allows for identifying sleep-adverse events associated with propranolol in IH and potential confounders. Counselling on sleep hygiene is recommended before treatment onset

Background: Acute kidney disease (AKD) is a known risk factor for increased mortality and evolution towards chronic kidney disease (CKD) in adults. The data regarding children are scarce. The purpose of our study is to explore the risk factor for AKD and impact of AKD following an acute kidney injury (AKI) episode in children on mortality and new-onset CKD. Methods: We retrospectively evaluated 736 children with ages between 2 and 18 years old with AKI admitted in a tertiary care hospital from the west Romania over a 9 years period. Results: AKD incidence following AKI was 17%. Patients that developed AKD were older, with higher baseline serum creatinine values, urea, C reactive protein and lower proteins, haemoglobin and sodium. They were more often exposed to sepsis, critical illness and nephrotoxic medications and presented certain susceptibilities like CKD, neoplasia, anemia, heart failure, arterial hypertension, stem cell transplant and female gender. AKI causes that increased the risk of AKD were intrinsic ones. AKD increased the overall mortality by three times. The factors that independently increased the risk of evolution towards CKD were AKD, acute tubular necrosis and higher baseline serum creatinine values. Conclusions: AKD is an independent risk factor for mortality and new-onset CKD in children.

The presenting pattern of celiac disease (CD) at diagnosis in children has changed over time, with a reduction of malabsorption-related phenotypes and an increase in regular or even excessive growth patterns. We retrospectively reviewed the body mass index (BMI) distribution of all patients with a new diagnosis of CD made in a Pediatric Gastroenterology Outpatient Clinic in 1990-2011, compared to those diagnosed in 2012-2022, according to their clinical and serological characteristics. The 1990-2011 and 2012-2022 cohorts included 250 (M:F=90:160, mean age 7.3±6.1 years) and 243 children (M:F=81:162, mean age 7.1±3.7 years, NS), respectively. The prevalence of underweight (UW) was higher in the 1990-2011 cohort (61/250, 24.4% in 1990-2011 vs. 31/243, 12.7% in 2012-2022, p=0.0001), whereas that of overweight (OW) and obese (OB) subjects was significantly higher in 2012-2022 (10/250, 4% in 1990-2011 vs. 24/243, 9.9% in 2012-2022, p=0.012, and 1/250, 0.4% in 1990-2011 vs 8/243, 3.3% in 2012-2022, p=0.018, respectively). In both cohorts, gastrointestinal symptoms were more frequent in OW/OB than in UW children (6/11, 54.5% vs. 5/61, 8.2% in 1990-2011, p<0.0001, and 24/32, 75% vs. 10/31, 32.3%, p<0.0001 in 2012-2022) and the extent of anti-transglutaminase antibodies increase was similar in OW/OB and UW subjects. The prevalence of children with a normal or even high BMI at CD diagnosis has increased in the past three decades, therefore CD should be suspected regardless of the BMI status.

The COVID-19 pandemic halted progress in global vaccine coverage and disrupted routine childhood vaccination practices worldwide. While there is ample evidence of vaccination declines experienced during the pandemic, it is less clear how low-income countries were affected. We executed a systematic review to synthesize the current literature on impacts to routine childhood vaccinations in low-income countries from January 1, 2020 to February 8, 2023. We collected data using an extraction form on Covidence and assessed the quality of studies included in the review using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Effect estimates for changes in vaccination during the pandemic were reported and summarized. Factors that influenced changes were grouped into descriptive themes. Thirteen studies, encompassing 18 low-income countries and evaluating 15 vaccines at varying doses, were included in the final review. We found that routine childhood vaccinations during the COVID-19 pandemic varied considerably by vaccine type, location, and phase of the pandemic. Nine different themes were identified as factors that influenced changes in vaccination. Documenting past experiences and lessons learned is crucial for informing preparedness efforts in anticipation of future public health emergencies. Failure to effectively address these things in the next public health emergency could result in a recurrence of declining routine childhood vaccinations.

Background: Ventilator-associated pneumonia (VAP) is among the most common healthcare-associated infections in Pediatric Intensive Care Units (PICUs). Because of the lack of a gold-standard diagnostic test, early diagnosis of VAP is challenging. We investigated whether bronchial biomarkers interleukin-4 (IL-4), plasminogen activator inhibitor-1 (PAI-1) and soluble receptor for advanced glycation end products (RAGE) could contribute in early VAP diagnosis through their fluctuation in time in critically ill pediatric patients. Methods: Bronchial secretions were collected from PICU patients with VAP on days 1 and 6. PAI-1, RAGE and IL-4 levels were measured by ELISA. Protein concentrations between high and low VAP suspicion patients were compared using unpaired Student’s t or Mann–Whitney U tests. Results: Twenty PICU patients, with median age 7.75yrs (range 0.5-15.3), mechanically ventilated for ≥48hrs with increased oxygenation requirements and VAP clinical/laboratory signs were enrolled. They were divided in VAP high-suspicion (n=12) or low-suspicion (n=8) groups based on Clinical Pulmonary Infection Score (cutoff:6). ΡΑΙ-1 και RAGE levels did not differ between high- or low-VAP suspicion groups the 1st or 6th days (p-value&gt;0.05). IL-4 was not detected in bronchial secretions. Conclusion: Bronchial concentrations of IL-4, PAI-1 and RAGE in critically ill children are not correlated with high- or low-VAP suspicion.

Background and Objectives: Down syndrome (DS) is the most common chromosomal disorder in the world. It is caused by the imbalance of the chromosomal constitution of 21, by free trisomy, translocation or mosaicism. Children and adolescents with Down syndrome have immune dysregulation and are more susceptible to infections. This study aims to evaluate hospitalizations of children and adolescents with DS in the pediatric ward of Botucatu Clinics Hospital (HCFMB), to classify the population of children included in the study regarding age, diagnosis, outpatient follow-up, length of stay and need for Intensive Care Unit (ICU). Thus, it will be possible to improve care for these children, aiming to reduce these hospitalizations. Materials and Methods: It was an observational, cross-sectional study, with retrospective data collection from the last 10 years of hospitalization, from January 2013 to December 2021, of children and adolescents with DS, in the pediatric ward, emergency room and ICU of HCFMB. Children hospitalized in this period in the pediatric ward and ICU, in the age range of 30 days to 15 years (age of acceptance for admission to this service) were included in this study. Those who at some point had the exclusion of the diagnosis of DS were excluded. The evaluation of comorbidities that culminated in the need for hospitalization in this population can be the focus of actions to improve diagnoses and conducts for this population, to prevent worsening and hospitalizations in future populations. Results: The statistical analysis of the data was performed. In this analysis, 80 children with DS were evaluated, with a total of 283 hospitalizations and it was noticed that 46 of them had more than one hospitalization in this period. The most prevalent age group was 1 to 3 years, and the main cause was due to problems in respiratory system (99 cases). Among respiratory causes, the main cause of hospitalization was due to pneumonia, in 50% of cases, followed by acute respiratory failure, in 14%. The average hospitalization time was 8 days and in 49 hospitalizations the children required the ICU. The main cause of hospitalization in the ICU was due to respiratory causes (36%), followed by cardiac malformations (14%). During the ICU hospitalizations, there were 13 deaths, and we observed a higher prevalence of heart conditions and, in some cases, positive urine cultures in these children. Conclusions: preventive actions, such as vaccinations and improved monitoring of these children, without outpatient follow-up or during hospitalization, should be carried out. Thus, it has been developed a proposal for a risk score for mortality in children and adolescents with DS admitted to the ICU, and those patients with five or more points should be monitored more closely. A meeting will be held with the genetics, cardiology, and pediatric ICU teams to discuss this score and propose a surveillance plan for these patients at the HCFMB and potentially for the pediatric community in the future.

Childhood obesity has become a global epidemic, with significant increases in prevalence over recent decades. While excessive calorie consumption and physical inactivity are known factors, emerging research highlights the role of Endocrine-Disrupting Chemicals (EDCs), particularly obesogens, in obesity's pathogenesis. This review explores the historical context of the environmental obesogens hypothesis, their sources, mechanism of action, impact on prenatal and postnatal development and epigenetics. Additionally, it discusses the long-term consequences of childhood obesity and proposes prevention strategies that will mitigate the negative health effects. Obesogens were found to disrupt hormonal balance and metabolic processes through various mechanisms such as altering gene expression, hormonal interference, and inflammation. Especially significant, was exposure during critical windows of development which correlates with increased risk of obesity in childhood or adolescence. Long-term effects of childhood obesity include chronic health conditions and psychosocial issues. A comprehensive approach is necessary to address childhood obesity, encompassing genetic, environmental, and lifestyle factors. Prevention strategies should focus on reducing obesogens exposure, promoting healthy lifestyles, and implementing regulatory policies. Future research should investigate obesogens-diet interactions, microbiome impacts, and combined obesogens effects. Long-term human studies are also crucial for validating findings from animal models and allow for inform decision-making to combat the obesity pandemic.

Transmission of values and religious concepts to children is one of the most important issues in the third millennium and it has drawn varied and different views among experts and scholars in the world. Research specialized in religious literature for children and adolescents create new capacities in the presentation of religious concepts to the group. Plans have been considered to transfer values and religious concepts in the curricula of primary school children in the group in Iran. It is one of the topics that the authors note to the introduction of the minutiae of religion in the first three elementary grades. In this study, the collection and analysis methods providing content related to the minutiae of religion in reading books the first till third sections of the years 2013-2015. In addition, the plan includes aspects of other branches of religion in these books on information collected from text books that collected and classified. The result is that "definitely good and forbidding the evil" and "prayer" have the highest frequency of applications in the selected books. Further branches made of branches of religion in these books, represents the values of religious, moral and social as well.

BACKGROUND Studies concerning multisystem inflammatory syndrome in children (MIS-C) and how those patients present to the Emergency Department (ED) are scarce. Our study sought to investigate whether abnormal laboratory values were associated with worse outcomes. METHODSThis was a retrospective case-control study from March 2020 to June 2020. Patients with MIS-C were compared to a control group. Laboratory values were compared whether admitted to PICU or not. The Pearson’s Chi-square test and Fisher’s exact test were conducted for associations. RESULTSA total of 80 patients were included in the study (41MISC, 39 control). There were significant associations between patients admitted to the PICU and neutrophilia (p = 0.03) and elevated troponin (p = 0.01). There were no significant associations between having a non-good outcome and obesity, neutrophilia, lymphopenia, or elevated troponin. When MIS-C patients were compared to the control group MISC-C patients had more obesity and elevated troponin. CONCLUSIONSPatients admitted to the PICU had more neutrophilia and elevated troponin yet had a fairly good outcome. When compared to control patients, there was a significant association with obesity and elevated troponin in the MIS-C group.

To elucidate the cellular immune response to coronavirus disease (COVID-19) among children, we assessed cellular immunity in 8 children post-vaccination for COVID-19 and 11 children after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, using the T-SPOT®.COVID assay for both the spike (S) and nucleocapsid (N) proteins. In the vaccinated group, the T-SPOT®.COVID assay for the S protein yielded positive results in all eight children. In contrast, in the post-infection group, the assay for the N protein was positive in 5 of 11 children, with 3 of these 5 children requiring hospital admission, including 2 who needed mechanical ventilation. Therefore, the T-SPOT®.COVID assay is valuable for assessing cellular immunity against COVID-19, and most children infected with COVID-19 may not develop such immunity unless the disease severity is significant.

Background: The utilization of nutrient supplementation as a tool to address issues such as iron and vitamin A deficiencies among children in Sub–Saharan Africa (SSA) has been beneficial. Nevertheless, there is a dearth of evidence on the effect of vitamin A and iron supplementation on infectious diseases in pre–school children in SSA. We aimed to assess the association of vitamin A and iron supplementation on the incidence of major clinical features of infectious diseases (diarrhea, cough, and fever) in children aged 6–59 months in Ghana. Methods: A cross–sectional study that utilized data from the Ghana Demographic and Health Survey, involving a sample size of 2,408 children. The collected data was analyzed using binomial logistic regression. Results: Dual supplementation with vitamin A and iron was associated with an increased risk of fever (OR: 1.68 95% CI: 1.22–2.32) and cough (OR: 1.43, 95% CI: 1.02–1.99) in children 6–59 months. Iron supplementation alone was associated with an increased risk of fever (OR: 1.32, 95% CI: 1.01–1.72) while Vitamin A alone significantly increased the risk of diarrhea (OR: 1.73, 95% CI: 1.03–2.92). Conclusions: Dual supplementation of vitamin A and iron is associated with an increase in childhood morbidity, endorsement of combined supplementation should be done with caution.

Children—Dependents in Social Construction Theory—are assessed within democracies regarding their ability to self-direct their behavior concerning their associated society. In this regard, childhood represents a lack of self-direction, a life period when people require the guidance and protection of adults. The assumed necessity of adults supervising children in democracies requires substantial social resources, reducing the self-direction of those charged with overseeing children. Given that self-direction defines the optimal experience of people within democratic society, finding ways to increase the self-direction of children is an individual and a social benefit. In this regard, smartphones have improved self-direction in children. How children have become empowered to self-direct their lives with smartphone use considering Social Construction Theory—as Advantaged, Contenders, or Deviants—is the focus of a scoping review conducted on “children, empowerment, smartphones” of the following databases: OVID, JSTOR, ProQuest, PubMed, Scopus, and Web of Science. The result is that children permitted to self-direct their activities aided by smartphone technology have comparable social behavior to adults positioned as Advantaged, Contenders, or Deviants and, as such they should be encouraged to utilize smartphone technology to improve their self-direction, as doing so will augment individual and caregiver self-direction, providing increased social benefit.

The aim of this study is to assess of rare earth elements (REE) content in hair samples in children, living in Lovozero village, near REE mining site, and possible effects of REEs on the prevalence of nervous system diseases in the Lovozersky district (Murmansk region, Kola Peninsula). School-age children (53 persons) were recruited for analysis of REE content in their hair samples. REEs (Y, La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb, Lu) content was estimated by inductively coupled plasma mass spectrometry (ICP-MS). Analysis of REE content in the hair of children living in the Russia, Kazakhstan and China indicates REEs intake from environment. A possible contribution of REEs to the nervous system disorders is supported by the link between REE content in the hair samples of children, living near REE mining (China) and by manifesting cognitive disorders in these children. It also turn out that highest prevalence of the nervous system diseases in children 15-17 years old manifested in the Lovozersky district then in other area in the Murmansk region. The paper discusses the possible contribution of REEs to the prevalence of episodic paroxysmal disorders (G40-G47), cerebral palsy (G80-G83), epilepsy and status epilepticus (G40-G41).

In recent years, the prevalence of tobacco and electronic cigarette (e-cigarette) use among adolescents has raised significant public health concerns worldwide. This study aims to investigate respiratory symptoms among Polish adolescents. We conducted an online survey among Polish school students from all provinces, collecting data over two months in Spring 2021. Students voluntarily complete the anonymous survey, answering questions about respiratory symptoms, smoking habits (both traditional and electronic cigarettes), and demographic information. Analysis focused on four subgroups: non-tobacco users, traditional cigarette smokers, e-cigarette users, and dual users, totaling 10,388 pupils aged 12-18 years, predominantly attending secondary technical and comprehensive schools. A total of 10388 pupils participated in the study, 55.6 % (5778) of whom were girls and 44.4 % (4610) boys. Adolescents, who admitted using both e-cigarettes and traditional cigarettes experienced more frequent episodes of cough during the day (39.70%) and at night (18.40%) compared to their peers in other groups. Chest discomfort, including pain and pressure, was also reported more often by adolescents, who used e-cigarettes and traditional cigarettes concurrently (27.60%) compared to their peers in other groups. Chest pressure was experienced less commonly by non-smoking adolescents (14.40%) than by smokers (18.90%). Higher severity of cough during the day and at night was observed in the group of adolescents using traditional cigarettes and e-cigarettes concurrently compared to the other groups. The adolescents in the dual user group experienced more severe dyspnoea and wheezing compared to the other groups included in the comparison. The results of this study confirm the correlation between the occurrence of respiratory symptoms in adolescents who smoke cigarettes, use e-cigarettes and in dual users. The respiratory symptoms occur most frequently and are the most severe in the group of adolescents who use e-cigarettes and traditional cigarettes

Background: By 2025, road traffic injuries are projected to rank third in the global burden of disease, posing a significant challenge that affects health, social well-being, and economic aspects. According to data from the Romanian Police National Statistics Center, there has been an average of 342 traffic accidents per year involving pediatric patients over the past 10 years. Materials and Methods: A retrospective research study was conducted, encompassing 358 cases of road traffic accidents identified for the study. Data collection was conducted at "St. Mary’s" Emergency Hospital for Children in Iasi, Romania, from January 2015 to December 2022. To facilitate statistical analyses, participants were categorized into three specific age groups, correlating between the anatomical region affected and different types of accidents was examined, and the classification of injury types was determined based on the characteristics of the harm inflicted. Results: An oscillating trend is observed from 2015 to 2020, with its lowest value recorded in 2017 at around 6.8% and its peak in 2019 at 20.1%. Notably, post-pandemic (Covid-19), the cases underwent a substantial decline of approximately 50%. At least 78.7% of those who did not undergo orthopedic reduction required surgery, whereas among those who underwent orthopedic reduction, only 23.4% needed surgery. Regarding the frequency of complications 7,9% of the total cases experienced complications. Conclusion: The increased frequency of pediatric traffic accidents is attributed to the extensive services provided by "St. Mary’s" Emergency Hospital for Children, Iasi, to a significant number of patients from both rural and urban areas across the seven counties of the Moldova, Romania.

Introduction: During the COVID-19 pandemic, many countries implemented restrictions, social distancing measures, and lockdowns to limit the spread of the disease. The lockdowns have affected children’s screen time (ST), pain, and physical activity (PA) levels. The present study aimed to explore the relationships between several personal factors during the COVID-19 pandemic. Methods: The caregivers of 329 children (median age=8 years) filled out an online self-reported survey about the children’s PA, ST, and pain before, during, and after the COVID-19 curfew. Spearman’s rank correlation coefficient was used to explore the associations between these variables. Results: After the curfew, pain that existed before the pandemic had a weak negative relationship with PA intensity (-0.11, p=0.04) and a weak positive relationship with ST (r=+0.12, p=0.04). There was a strong positive relationship between ST in all time periods (p&gt;0.01). PA and ST had a weak negative relationship (p&gt;0.05) during the curfew and after the curfew but not before the COVID-19 pandemic. Age had a weak positive correlation with ST in all time periods (p&gt;0.01). In addition, ST was affected by the curfew. Conclusion: The study findings indicated that young children had longer ST during the curfew and after the curfew compared with before the curfew. Increasing PA could lessen children’s ST, which could, in turn, increase the probability that their general pain would decrease.

Objectives: This study aimed to compare the similarities and differences between the Kawasaki disease (KD) during the SARS-CoV-2 pandemic and multisystem inflammatory syndrome in children (MIS-C). Methods: The medical records of patients diagnosed with KD and MIS-C at a single center between July 2020 and November 2021 were retrospectively reviewed. Results: The study included 39 MIS-C patients (84.6% male) with a median age of 138 months and 17 KD patients (58.8% male) with a median age of 36 months. Compared with the KD patients, MIS-C patients were older (p<0.001), had longer hospital stays (p=0.023), elevated neutrophil count (p<0.001), C-reactive protein (p<0.001), procalcitonin (p<0.001), interleukin-6 (p<0.014), ferritin (p<0.001), fibrinogen (p<0.001), troponin I (p=0.001), NT-proBNP (p<0.001), and, D-dimer levels (p<0.001). They had more hypotension (p=0.024), decreased left ventricular function (p=0.023), and a greater need for corticosteroids (p<0.001), enoxaparin (p=0.045), and therapeutic plasma exchange (p<0.001). Patients with KD displayed a higher frequency of rash (p<0.001), oral mucosal changes (p<0.001), conjunctival injection (p<0.001), extremity changes (p<0.001), and cervical lymphadenopathy (p<0.001). They had a longer duration of fever (p<0.001), elevated white blood cell count (p<0.001), platelet count (p<0.001), and alanine aminotransferase level (p<0.001). The two groups were similar in terms of hemoglobin levels, erythrocyte sedimentation rate, albumin levels, or the frequency of coronary dilation/aneurysm, myocarditis, pericarditis, invasive mechanical ventilatory support, and intravenous immunoglobulin treatment. Conclusions: Older patient age, a greater presence of gastrointestinal and cardiac findings associated with hypotension, increased NT-proBNP levels, decreased left ventricular function, the use of various treatment modalities, and longer hospital stays suggest MIS-C, whereas a longer duration of fever and classical clinical features of KD favor KD.

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.

IgE-mediated wheat allergy is a gluten-related disorder. Wheat is one of the five most common food allergens in children. However, the natural history of IgE-mediated wheat allergy has seldom been described in the research literature. This study presents the current state of knowledge about the IgE-mediated wheat allergy in children.

Parents play an important role in shaping the eating habits of their children through: appropriate selection of food products, snacking between meals and appropriate exposure to information from television advertisements, the press or the Internet. The level of parents' knowledge about proper nutrition and substances added to food is therefore crucial in promoting appropriate dietary choices in children and adolescents in order to prevent diet-related diseases. Objectives: Assessment of the consumption of snack foods by children and adolescents according to the surveyed parents and analysis of parents' knowledge about additional substances in food. Methods: The study was conducted among 129 parents of students from selected primary schools. The research tool was an original survey questionnaire consisting of 24 questions. Survey interviews were conducted with parents during meetings at schools. Statistical analysis was performed using the Pearson ch2 test, the significance level was set to p&lt;0.05. Results: Parents most often indicated sweets, confectionery products and sweetened drinks (25%) and vegetables or fruit (21%) as the form of snack for their children. 46% of children and adolescents drank sweetened drinks at least once a day. Parents had an average level of knowledge about food additives. Significant correlations were found between the level of knowledge of parents of school-age children about food additives and their level of education. Parents' knowledge and education did not significantly influence the level of snack consumption by their children. Children's eating behavior should be considered unsatisfactory. Conclusions: Research has shown the need for parents to be educated about food additives and to pay more attention to reading food labels so that they can reliably prepare their children to make the right food choices. Measures should be implemented to improve the eating habits of children and adolescents.

Children and adolescents (C&A) with congenital heart defects (CHD) have decreased functional capacity and executive functioning (EF) due to brain abnormalities and decreased oxygen saturation. Exercise may improve EF via increased cognitive demands and cerebral blood supply. The purpose of this review was to identify current evidence describing the impact of physical activity (PA) interventions on EF in C&A with CHD. The following databases were searched from 2014-present: MEDLINE, EMBASE, CINAHL, Scopus, CENTRAL, and PsycInfo. Article inclusion criteria consisted of participants from birth to 18 years with CHD, interventions related to PA, and EF as an outcome. Articles were excluded if: adults were included, translation to English was impossible, and full access was unavailable. As a result of the review, 431 studies were screened. Three articles underwent full analyzation and only one met all criteria and this study found that with exercise there were significant improvements on self-reported cognitive functioning and parent-reported social functioning. Despite theoretical benefits, only one published study has investigated the role that PA interventions have on EF in C&A with CHD. Further investigation of the effect PA interventions have on EF in C&A with CHD is needed.

This survey of research literature is an overview of the current state of science addressing DSM-5 diagnostic criteria as it relates to identifying Autism Spectrum Disorder (ASD) in young children. Selected sources are of high quality and have been published since 2020 in peer-reviewed journals relevant to children’s health. The narrative is organized from the earliest to the most recent publications and is divided into sections around categories and themes that highlight the main arguments, findings, and controversies identified by researchers. There are indications in the literature that while ASD can be identified and differentiated from other developmental disorders in young children, doing so requires that clinicians who have relied on the DSM-5 should also use multiple measures, including other formalized screening tools as assessments that gather observational input from parents and caregivers, as well as findings from physical examinations, laboratory investigations, and magnetic resonance imagining (MRI). This high level of corroboration points to an emerging diagnosis paradigm through which transdiagnostic approaches to early diagnosis and intervention may exist.

One of the robust explanation related to sociological educational inequality is Bourdieu’s cultural reproduction theory. Admittedly, prior work investigated that children’s cultural capital (CC) have significant effects on educational success. Although, it remain unclear in the context of developing countries specifically Vietnam. Also, how children’s conversion mechanism of CC works and drive educational success. Meanwhile, Bourdieu theory argue that CC effects educations outcomes largely via teachers biasness by using support of school grades, in contrast some of the scholars argue that absorption of children’s CC may directly transmit into educational abilities and skill development. This study employed partial least square structural equation modelling to analyze 5th grades students’ data collected from educational policy and data center. This study argue that conversion mechanism grounded on CC dimensions. This study provide implications for the policy makers and future researchers.

Background: There has been a lack of tools to identify listening difficulties in school settings for both hearing and hearing-impaired Italian students. Thus, the present study aimed to realize cross-cultural adaptation and validation of the Listening Inventory for Education-Revised for Italian students (LIFE-R-ITA). Methods: Following the validation of two forward-backward translations by a multidisciplinary committee, the content validation for the LIFE-R-ITA was performed by pre-testing six implanted children (8-18 years old). After minor cross-cultural adaptations, normative data were collected from a sample of 223 hearing students enrolled in different school settings and educational degrees. Results: For the LIFE-R-ITA, hearing students showed an average score of 72.26% (SD=11.93), reflecting some listening difficulties. The subscales (LIFE total, LIFE class, and LIFE social) indicated good internal consistency. All items were shown to be relevant. Most challenging situations happened when listening in large rooms, especially when other students made noise. LIFE social scores were significantly worse than those of LIFE class (p &lt; 0.001). Conclusions: The LIFE-R-ITA may support teachers and clinicians in assessing students’ self-perception of listening at school. Such understanding may help students overcome their listening difficulties, by planning and selecting the most effective strategies among classroom interventions.

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.

We analyzed data of pediatric invasive fungal diseases of the central nervous system (CNS-IFDs) reported by five of total eight Pediatric Hematology-Oncology Departments in Greece for 15 years (2007-2022). A total of twelve patients (11 boys, median age: 9.5yrs range: 2-16) were reported suffering from CNS-IFDs. Underlying malignancy was acute lymphoblastic leukemia in 9/12, and acute myeloid leukemia, Ewing sarcoma and rhabdomyosarcoma in one each. Eleven patients presented with CNS-related symptoms (i.e seizures, headache, cerebral palsy, ataxia, hallucination, seizures, blurred vision, amaurosis). All patients had pathological MRI findings. Multifocal fungal disease was observed in 6/12 patients. Nine proven and three probable CNS-IFD cases were diagnosed. Causative pathogens in proven cases were Aspergillus spp. and Candida albicans (n=2 each), Mucor spp., Rhizopus arrhizus, Absidia spp., Fusarium oxysporum and Cryptococcus neoformans (n=1 each). Causative pathogens in probable cases were Aspergillus spp. (n=2) and Candida spp. (n=1). All patients received appropriate antifungal therapy (median duration: 69.5 days, range 19-364). Two patients underwent additional surgical treatment. Six patients admitted to ICU due to complications. Three patients (25%) died, two due to IFD and one due to underlying disease. Early recognition and prompt intervention of CNS-IFDs may rescue the patients and improve overall survival.

Throughout the Covid19 period, families were forced to stay indoors, adapting to online school-ing, remote work, and virtual social engagements, inevitably altering the dynamics within households. There is a notable increase in mental health challenges in terms of anxiety and de-pression in children and adolescents. This study intends to explore the psychosocial effects of the Covid-19 pandemic in Italian families adopting self- and proxy-report questionnaires on anxiety, anger, and health-related quality of life. The results showed that approximately 20% obtained a clinical anxiety score and only 10% obtained a clinical anger score. There was found a difference in the perception of the quality of life reported by the child and that perceived by the parent. The stepwise regression model showed that total anxiety scores were predicted by sex, quality of life scores from the parents' self-report version and total anger score. Another stepwise regression model identified physiological and social anxiety as the best predictors that impact the quality of life. Parental well-being actively influences the well-being of children, so it is fundamental to implement preventive programmes and promote child well-being providing parents the most adequate support possible.

Research has shown that unsociability, reflecting as a personal choice, is not necessarily associated with socio-emotional problems in Western countries, and the associations between unsociability and peer problems are consistently evident in Chinese culture. Yet the strength and direction of the associations were mixed. The present study aimed to examine whether unsociability is associated with peer problems and explored the potential moderators among the associations. A meta-analysis was conducted using publications that measured unsociability and peer problems. A total of 21 articles involving 43 effect sizes from 12,696 Chinese children and adolescents were included. The results revealed that (1) unsociability was positively associated with peer problems (r = .32, p &lt; .001) among children and adolescents. (2) informants (i.e., self-reports, peer nominations, teacher ratings, parent ratings) and living areas (i.e., urban, suburban, and rural areas) significantly moderated the associations between unsociability and peer problems. Specifically, the associations were stronger for peer-nominated unsociability, self-reported peer problems, and samples in suburban areas. These findings shed light on unsociability linked to higher levels of peer problems among Chinese children and adolescents. Still, the influences are unique to peer problems and moderated by both data sources and environmental factors.

Background: The study aimed to investigate the association between environmental tobacco smoke exposure and the risk of wheezing among rural and urban preschool children in Mpumalanga province, South Africa, an area associated with poor air quality. Methods: In this study, parents/caregivers of preschool children (n=3145) completed a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Data were analysed using multiple logistic regression models. Results: The overall prevalence of Wheeze ever was 15.14%, with a higher prevalence in urban pre-schoolers than rural pre-schoolers (20.71% vs 13.30 %, P<0.000). Moreover, the total prevalence of asthma ever was 2.34%. The prevalence was greater in urban pre-schoolers than in rural pre-schoolers (3.92% vs 1.81%, P<0.001). In the final adjusted model, both urban and rural area children who lived with one or more people who smoked in the same household (WE: OR 1.44, 95% CI 1.11-1.86) (CW: OR 2.09, 95% CI 1.38-3.16) and (AE: OR 2.49, 95% CI 1.12-5.54) were found to have an increased likelihood of having Wheeze Ever, Current Wheeze and Asthma Ever as compared to those who lived with non-smokers. Conclusions: The implementation of smoking limits and prohibition is crucial in areas that are frequented or utilized by children. Hence, it is imperative for healthcare providers to actively champion the rights of those who do not smoke within the society, while also endorsing legislative measures aimed at curtailing the extent of tobacco smoke exposure.

Myocardial hypertrophy is the most common condition that accompanies heart changings in children. Transcriptional pathways regulating gene expression playing a critical role both in cardiac embryogenesis and in the pathogenesis of congenital hypertrophic cardiomyopathy, neonatal posthypoxic myocardial hypertrophy and congenital heart diseases. This paper describes the state of cardiac gene expression and potential pharmacological modulators at different transcriptional levels. An experimental model of perinatal cardiac hypoxia showed downregulated expression of genes responsible for cardiac muscle integrity and overexpressed genes associated with energy metabolism and apoptosis, which may provide a basis for a therapeutic approach. Current evidence suggests that RNA drugs, theaflavin, neuraminidase, proton pump and histone deacetylase inhibitors are promising pharmacological agents in progressive cardiac hypertrophy. The different points of application of the above drugs makes combined use possible, potentiating the effects of inhibition in specific signaling pathways. The special role of N-acetyl cysteine in both the inhibition of several signaling pathways and the reduction of oxidative stress was emphasized.

Purpose: This study aimed to identify the risk factors for acute pancreatitis (AP) and its impact on outcomes in Polish children treated for ALL. Methods: The study group included 2303 children who received intensive chemotherapy for ALL. The group was subdivided into patients with at least one episode of AP and those who did not develop AP following treatment for ALL. Results: The cumulative incidence of AP in the study group was 4.08%. Older age was an independent risk factor for AP development (OR 1.05; 95%CI: 1.006 – 1.098; p=0.03). The overall mortality related to AP was 2.13%. The probabilities of disease-free survival (p-DFS) and event-free survival (p-EFS) were 0.84 vs. 0.86, log-rank: p=0.65 and 0.75 vs. 0.80, log-rank: p=0.12, respectively in both subgroups. A total of 22 out of 94 patients (23.4%) with AP were re-exposed to asparaginase (ASP) during the subsequent phases of the treatment. Only one re-exposed to ASP patient (4.5%) developed a second episode of AP. There were no significant differences in p-DFS and p-EFS between patients re-exposed and not re-exposed to asparaginase (0.78 vs. 0.86, log-rank p=0.27 and 0.63 vs. 0.79, log-rank p=0.09 respectively). Conclusions: The incidence of AP in children with ALL is low and related to the patient’s age. AP development doesn’t seem to impact p-DFS and p-EFS in children with ALL. The recurrence of AP following re-exposure to asparaginase in patients with ALL and a history of AP is low (4.5%). Re-exposure to asparaginase after the first episode of AP doesn’t improve either p-DFS or p-EFS in children with ALL.

The spread of the infection caused by the new coronavirus SARS-CoV-2 (COVID-19) became pandemic on March 11, 2020. From the time of the first cases (in November 2019, Wuhan, China), to date, a large number of COVID-19 observations have been accumulated in different age groups of patients both in China and abroad. Published scientific data allows us to conclude that children suffer from COVID-19 much less often than adults and tolerate the disease in a milder form, often appear to be asymptomatic. There is currently no final answer why children are less susceptible to this virus; however, scientists are increasingly inclined to consider a complex effect of the immune response and components of the renin-angiotensin system (RAS), which according to recent studies affects not only the cardiovascular system, but is also responsible for the activation of inflammatory reactions. A hypothesis of genetic predisposition to the development of severe forms of COVID-19 has recently been made. We conducted a search for publications in the databases and showed current scientific ideas about COVID-19 pathogenesis and factors influencing the disease development in childhood. Childhood immunity may have several protective features against SARS-CoV-2: immaturity of particular elements of the innate immune response, constitutional lymphocytosis with a shift towards anti-inflammatory Th2-response, as well as "trained" immunity. The influence of renin-angiotensin system reactions in this review is shown from two perspectives: expression of ACE2 receptors and polymorphisms of certain genes of this system. It was established that ACE2 transmembrane protein is not only the entry point for the virus but also plays a regulatory role, turning the pro-inflammatory vasoconstrictor angiotensin II into anti-inflammatory angiotensin (1-7), which has vasodilating properties. Higher ACE2 content in children compared with adults helps maintain balance in the renin-angiotensin system and prevents the development of complications. It was also shown that the presence of certain genetic polymorphisms (AGTR1, AGTR2, ACE2, ACE) could determine the imbalance inside the RAS, leading to more pronounced reactions of alveolocytes, vascular endothelium and smooth muscle fibers in response to SARS-CoV-2 infection due to a shift towards vasoconstrictor, proliferative and profibrotic mechanisms.

Lower urinary tract dysfunction is clinically important because it may cause urinary tract infections, mainly due to accumulation of residual urine, and adversely affect renal function. In addition, it may cause urinary incontinence, strongly affecting the child’s quality of life. The function of the lower urinary tract is closely associated with function of the bowel because constipation is commonly present with bladder dysfunction. The interplay between the lower urinary tract and bowel function, coupled with common conditions such as detrusor overactivity and voiding dysfunction, requires a nuanced diagnostic approach. Detrusor overactivity, a benign but socially harmful condition, is the principal cause of daytime urinary incontinence in childhood. It needs to be differentiated from more serious conditions such as neurogenic bladder dysfunction or urethral obstruction. Voiding dysfunction, a habitual sphincter contraction during voiding, is common in children with detrusor overactivity, may be selflimiting but may also result in residual urine and urinary tract infections. It may resemble, in severe cases, the neurogenic bladder dysfunction, most often caused by spinal dysraphism which very often leads to recurrent urinary tract infections and high intravesical pressures, jeopardizing renal function. Voiding diary is crucial in the initial evaluation of lower urinary tract function in children.

1) Background: Overweight children usually have lower levels of physical activity (PA) than their normal-weight peers. Low PA predisposes to increase fat mass in the body. The aim of this study was to evaluate the effectiveness of school-based PA intervention on anthropometric indicators and body composition of overweight and obese children during a two-year observation period, from the age of 10 to 12. (2) Materials and methods: The research included 148 children with overweight or obesity who were born in 2007. There were two groups of children of standard and elevated PA at school (SPA and EPA, 4 and 10 hours of physical education lessons a week, respectively). An anthropometric and body composition measurements were done. Body mass index (BMI), fat mass (FM), fat-free mass (FFM), skeletal muscle mass (SMM) and total body water (TBW) were determined. Totally, 5 measurements were done at intervals of 5–6 months. (3) Results: In EPA, the percentage of obese children decreased from 46% to 35.25%, and in SPA increased from 42.75% to 46%. In EPA, FM decreased from 28.65% to 26.41%, and in SPA increased from 30.31% to 31.75%. The highest increase in FFM was in EPA boys, while SPA boys recorded the highest decrease. In SPA, SMM increased by 0.43% from 38.85% to 39.28%, and in EPA by 2.51% from 40.27% to 42.78%. TBW In EPA slightly increased from 53.26% to 53.59%, and in SPA decreased from 50.70% to 49.93%. (4) Conclusions: The elevated PA at school has a positive effect on the BMI and body composition of children who are overweight or obese. Increasing the mandatory number of physical education lessons in school curricula is an efficient strategy for reducing obesity in school-aged children.

This study evaluates the R3THA™ technology-supported assessment protocol for home-based rehabilitation in children with cerebral palsy (CP). It focuses on the reliability and validity of R3THA™ in assessing hand and arm function, comparing kinematic assessments with standard clinical assessments. Conducted during a 4-week summer camp, the study involved children with CP aged 3-18, assessing their functional and impairment levels. The findings suggest that R3THA™ is more reliable for children aged 8 and older, indicating that age significantly influences the protocol's effectiveness. Results also showed that R3THA-AP's kinematic measurements of hand and wrist movements were positively correlated with the Box and Blocks Test Index (BBTI), reflecting hand function and dexterity. Additionally, R3THA-AP's accuracy metrics for hand and wrist activities aligned with the Melbourne Assessment 2's Range of Motion (MA2-ROM) scores, suggesting a meaningful relationship between R3THA-AP data and clinical assessments of motor skills. However, no significant correlations were observed between R3THA-AP and MA2's accuracy and dexterity measures, indicating areas for further research. These findings validate R3THA-AP's utility in assessing motor abilities in CP, supporting its integration into clinical practice.

How hands-on gardening impacts behaviors including healthy eating and physical activity during early childhood can be of critical importance for preventing early onsets of obesity. This research investigates how participating in hands-on gardening impacts preschoolers’ (3-5 years old) physical activity (measured by accelerometers) in childcare centers in the Semi-Arid Climate Zone. The research was conducted in eight licensed childcare centers located in West Texas with 149 children (n=149). Four childcare centers in the experimental group received hands-on garden interventions; the other four in the control group did not. In both experimental (intervention) and control (non-intervention) centers, children wore Actigraph GT3X+ accelerometers continuously for 5 days before and for 5 days after intervention (a total of 10 days). Results show that the duration of sedentary behavior of children in the experimental (intervention) group significantly decreased compared to children in the control (non-intervention) group. The finding suggests that the positive effects of childcare hands-on gardening on physical activity extend to semi-arid climate zones where gardening is challenging due to high temperatures and lack of annual rainfall. The research emphasizes the critical need to incorporate hands-on gardening in childcare centers as an obesity prevention strategy nationally in the U.S. and beyond.

Abdominal injuries in children caused by guns are a rare clinical entity globally. But, in countries with undefined legal regulations and in the war zones urban violence is a great social problem among older children and adolescents. This manuscript provides details regarding two cases of severe gunshot injuries in young children. The injuries were very complicated and included damage to the parenchymatous and hollow organs as well as major blood vessels. The clinical presentation on admission was very serious and dramatic, but the patients survived. However, one patient developed numerous complications that required repeated surgical interventions and long treatment. The article provides a detailed description of injuries and how to treat them. Patient care requires a multidisciplinary approach, and the initial decision on further treatment depends on the patient's hemodynamic stability.

The importance of cognitive health for academic success is well-recognized. However, longitudinal data regarding the associations of body fatness, physical fitness and cognition are relatively scarce and mixed. The purpose of this study was to investigate whether body fatness, cardiorespiratory fitness (CRF) and muscular fitness (MF) in preschool are associated with cognitive skills in first grade at school. 133 South Estonian children aged 6-7 years were recruited from 13 kindergartens and again at 7-8 years when they had entered school. Body fat percentage (BF%), CRF, MF as the mean of z-scores of relative handgrip strength and standing long jump tests, and cognitive skills (verbal, conceptual, perceptual) were studied. There were no associations between BF% and CRF in pre-school with perceptual, conceptual or verbal skills in school in boys and girls. In boys, higher MF in preschool predicted higher verbal skills (β = 0.293, p = 0.021) in school after adjustment for con-founders. Cognitive skills at baseline seemed predominantly predict later cognitive performance in school. In conclusion, higher muscular fitness in preschool predicted better verbal skills in first grade at school in boys but not in girls. Body fatness and cardiorespiratory fitness in preschool were not associated with cognitive skills in school.

Objective: In this study, we investigated vitamin D, inflammatory hematologic ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), MHR and plasma atherogenic index (PAI) and possible relationships with insulin resistance in children. Methods: A total of 210 individuals, including 96 children with insulin resistance and 114 children without insulin resistance, aged 6-18 years, who were admitted to the Pediatric Endocrinology Outpatient Clinic at Medicine Hospital, Istanbul Atlas University were included in our study. Result: NLR, PLR, SII and MHR were significantly higher in patients with insulin resistance compared to those without. Fasting insulin, PAI, HOMA-IR, HOMA- were significantly higher and QUICKI was significantly lower in patients with insulin resistance compared to those without insulin resistance. NLR, SII and MHR were lower in normal vitamin D groups than the others were (p

Primary care pediatricians encounter a wide range of complex conditions in their daily clinical practice. It is not uncommon for their patients to get exposed to medical errors. Diagnostic errors, defined as missed, delayed, or wrong diagnosis, are of great importance as they may cause significant harm to the pediatric patient with severe disease. These errors often occur when the symptoms and signs of a disease are atypical or missing. Data on the most frequent misdiagnosed situations in pediatrics is scarce. One of these groups of conditions is that regarding cardiac diseases. The pediatric cardiology field has met rapid development over the past few decades. Primary care providers play a key role in diagnosis, management, and referral of children with heart disease, both congenital and acquired, because many common cardiac complaints are first addressed in the primary care setting. The scope of this review is to investigate the cardiac entities that are often missed by the general pediatricians. In particular, it aims to spot the most common of them, to describe their clinical presentation, their diagnostic options, red flags, and tips, and to provide the ways to avoid erroneous, delayed, or missed diagnosis.

Recent studies have demonstrated a relationship between poor vitamin D status and respiratory infections and diarrhea among young children. Acute lower respiratory infections (ALRI) and diarrhea are among the two most important causes of death in under-5 children. In this analysis, we examine the extent to which vitamin-D deficiency (<10 ng/ml) predicts these outcomes using data from a randomized controlled trial (RCT) of daily folic acid and/ or vitamin B12 supplementation for six months in 6 to 30 months old children conducted in Delhi, India. Of the 960 subjects who had vitamin-D concentrations measured, 331(34.5%) were vitamin-D deficient. We found, after controlling for relevant potential confounders (age, sex, breastfeeding status, wasting, stunting, underweight, anemia status at base line and season), the risk of ALRI was significantly higher among vitamin-D deficient (OR 1.26; 95% CI: 1.03 to 1.55) compared to vitamin-D-replete children in the six months follow-up period. Vitamin-D status was not significantly associated with episodes of diarrhea and clinical pneumonia. The extent of causal relationship of vitamin-D status and ALRI needs to be explored in further studies.

Furthermore, the nasal congestion typical of rhinitis can contribute to upper airway obstruction and sleep-disordered breathing. A vicious circle is created between asthma and sleep-disordered breathing: uncontrolled asthma and sleep-disordered breathing can worsen each other. In children with genetic obesity, despite alterations in the immune system, fewer allergies are found compared to the general population. The causes of this reduced allergenicity are unclear but probably involve genetic, immunological, and environmental factors. Further studies are needed to understand the mechanisms. The study emphasizes the importance of jointly evaluating and managing allergies, obesity, and sleep-disordered breathing in children, considering their close interconnection.

(1) Background: Cardiorespiratory fitness (CRF) is a prognostic factor regarding long time morbidity and mortality. To assess CRF the well-known gold standard is cardiopulmonary exercise testing (CPET), which is a time consuming and expensive test. Therefore, alternative methods for routine evaluation of CRF are needed for the general population as well as for specific patient groups such as children and young adults with congenital heart disease. The Stair Climbing Test (SCT) is a simple and resource saving test reported in the current literature. This test is used in various settings to assess different health associated risk factors including cardiorespiratory fitness, muscular resilience, therapy effectiveness or pre- and postoperative morbidity and mortality.

Rabies is a life-threatening and vaccine-preventable infectious disease and is triggered by an RNA virus, part of the Rhabdoviridae family, Lyssavirus genus. It is transmitted from infected saliva due to biting, but also from contact with infected blood or organs from rabid animals to humans. Children are at high risk due to their inability to defend themselves from infected animals and most deaths occur with a particularly high incidence in this category (under the age of 15 years). Postexposure prophylaxis (PEP) is standard and life-saving if given early after exposure. We are reporting the case of a ten-year-old female child, who was bitten by an unvaccinated cat ten days before admission to the Paediatric Intensive Care Unit at National Institute for Infectious Diseases „Prof. Dr Matei Bals”, Bucharest. The child had category III cat bites and did not receive PEP. Suggestive clinical manifestations such as an altered general state, psychomotor agitation, auditory and visual hallucinations, and hypersomnia followed by aerophobia and hydrophobia were present. Despite the maximal treatment introduced from early admission (Human Rabies Immunoglobulin, anti-rabies vaccination, orotracheal intubation plus mechanical ventilation, vital functions’ support, parenteral feeding, symptomatic drugs) the evolution of the patient was unfavourable, namely death two months after admission. The diagnosis was established in both pre-mortem by identifying the rabies virus in the cerebrospinal fluid based on reverse transcription-polymerase chain reaction (RT-PCR) and post-mortem by a histopathological examination (which reveals the presence of Babes-Negri bodies in the hippocampus). The objective is to understand the mechanism of infection and mortality from rabies virus in children. Conclusion: The most effective prevention methods are early administration of specific prophylaxis (immunoglobulin and vaccination) and, most importantly, early elimination of animal rabies outbreaks, while rapid diagnosis is helpful in the management of human rabies in humans. The rate of human exposure may be significantly decreased by controlling rabies through pet immunization programs.

Background: Endoscopic sphincterotomy (EST) has been employed for the endoscopic treatment of common bile duct stones (CBDSs), and a high success rate of stone removal has been reported. However, EST is associated with the risk of bleeding, perforation, and sphincter of Oddi function disruption. To avoid these risks, endoscopic papillary balloon dilation (EPBD) is an option for CBDS. Sphincter of Oddi function preservation decreases long-term biliary infection and gallstone recurrence. EPBD may have advantages in children who require a long follow-up. However, there have been few reports on pediatric cases, particularly in infants. Methods: From September 2017 to December 2023, we performed EPBD for four pediatric CBDSs. The patients were aged from 5 months to 8 years; including two infants aged 5 and 6 months. Furthermore, we reviewed the stone removal rate and complications of 545 ESTs performed at high-volume centers and 13 EPBD-reported cases in children with CBDSs. Results: CBDSs of all patients who underwent EPBD in our institution were successfully removed. No bleeding or perforation was noted, and pancreatitis was observed in three patients. In an analysis of 545 ESTs in children, the stone removal rate was high, ranging from 83% to 100% (mean, 96%). The incidence of pancreatitis was 0%–9.6% (mean, 4.4%), and the grade of pancreatitis was almost mild. The bleeding frequency was 1.3%–5.4% (mean, 2.7%). According to the grade of bleeding, seven and four cases were mild (64%) and moderate (36%), respectively, Compared with adult cases who underwent EST, the frequency of pancreatitis and bleeding was almost similar in children.; however once bleeding occur, it has a higher risk of leading to blood transfusion in children. Stone removal by EPBD in children was 100% successful. All complications were pancreatitis, and its frequency was 46% (6/13 patients, including five mild cases and one moderate case), which is higher than that of EST and adult cases who underwent EPBD. In most children with pancreatitis, pancreatic enzyme levels returned to normal within 2–3 days following EPBD, and no severe cases caused by EPBD were reported. Conclusions: CBDS removal by EPBD in children has a high success rate with very low risk of bleeding and perforation. Although pancreatitis frequently occurs, most cases are mild. Sphincter of Oddi function preservation by EPBD is expected to prevent long-term stone recurrence and biliary tract infection, and EPBD is considered an effective method for CBDS removal in children.

Urolithiasis is an increasingly common clinical problem worldwide. The formation of stones is a combination of metabolic status, environmental factors, family history and many other aspects. It’s important to find new ways to quickly detect and assess urolithiasis because it causes sudden, severe pain and often comes back. One way to do this is by exploring new biomarkers. Current advances in proteomic studies provide a great opportunity for breakthroughs in this field. The study focuses on protein biomarkers and their connection to kidney damage and inflammation during urolithiasis.

Introduction: The purpose of this study was to assess the effectiveness of animal therapy in alleviation of anxiety in pre-school children.Method: The study was carried out as a quasi-experimental study with pre-test and post-test design and control group. The study population consisted of 33 anxious 5-7years old children (participated in a welfare anxiety screening plan held by Counseling Center, Tehran-Iran) between 2018 and 2019. The participants took part in the study voluntarily.The subjects were randomly divided into experimental and control groups (10 in each group). The experimental group was exposed to 8 sessions of animal therapy. The research instrument was Spence Preschool Anxiety Scale (Parent Form) and the data were analyzed on SPSS 21 software.Results: The results showed that animal therapy had a significant effect on general anxiety score after adjusting for post-test scores (f= 32.49 and p= 0.001) with the effect equal to 0.70. In addition, the effect of animal therapy on anxiety of separation (f= 5.63, p= 0.03), generalized anxiety disorder (f= 8.56, p= 0.01), social phobia (f= 14.58, p= 0.002) and specific anxiety (f= 11.63, p= 0.005) was significant with effects equal to 0.30, 0.40, 0.53, and 0.47, respectively. The results also showed that the effect of animal therapy on obsession was not significant (p>0.05).Conclusion: Therefore, it can be concluded that Animal therapy is effective in alleviating anxiety in children.

Seventy-seven percent of Irish primary school children do not meet recommended physical activity (PA) guidelines [1]. The Daily Mile (TDM) is a primary school initiative designed to increase children’s PA output. This study evaluates TDM’s perceived effect on Irish primary school children’s health-related metrics. A mixed-methods study, comprising two data collection phases, used the RE-AIM framework to evaluate TDM [2]. Phase one involved teachers, principals and classroom assistants (n = 191) from TDM-registered schools completing a questionnaire. Two TDM-registered schools participated in phase two where, (i) interviews were conducted with each principal, (ii) a teacher sub-sample (n = 4) participated in a focus group and (iii) a child sub-sample (n = 14) participated in separate focus groups. TDM was perceived to positively impact markers of children’s health, including their PA behaviour, physical fitness and social wellbeing. Inclement weather (66.5%) and a lack of time (56.5%) were reported as the top-ranked implementation barriers. Moreover, TDM’s repetitive nature often left children feeling disinterested and resulted in some teachers modifying the initiative to maintain engagement levels. Maintaining the long-term implementation of TDM and its health benefits in primary schools may require bespoke amendments to the original format to preserve children’s engagement.

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.

(1) Background: Sudden Infant Death Syndrome (SIDS) represents unexplained and sudden deaths during the sleep of infants under one year of age, despite thorough investigation. Screening for prolonged QTc or Long QT Syndrome (LQTS) should be conducted on all newborns to reduce the incidence of SIDS. Neonatal electrocardiogram (ECG) could identify congenital heart defects (CHD) early, especially those not detected at birth. Infants with prolonged QT intervals typically undergo genetic analysis for Long QT Syndrome; (2) Methods: The study involved infants aged 20-40 days, born clinically healthy, with initial ECG screening. Infants with prenatal diagnoses or signs/symptoms of CHD identified immediately after birth, as well as those who underwent ECG or echocardiogram for other clinical or historical indications, were excluded from the study. The data were analyzed using SPSS version 22.0; (3) Results: Of the 42,200 infants involved, 2,245 were enrolled, with 39.9% being males. Subsequently, 164 children (37.8% males) with prolonged QT intervals underwent further diagnostic investigations. Genetic mutations were identified in 11 out of 18 tested children. The most common mutations were LQT1 (54.5%), LQT2 (36.4%), and LQT3 (1 patient). Medications used included propranolol (39.8%), nadolol (22.2%), inderal (11.1%), metoprolol (11.1%), and no treatment (16.7%). The most common abnormalities were focal right bundle branch block (54.5%), left axis deviation (9.2%), and nonspecific ventricular repolarization abnormalities (7.1%). Multiple anomalies were found in 0.47% of children with focal right bundle branch block. Structural abnormalities were associated with specific features in 267 patients (11.9%), primarily isolated patent foramen ovale (PFO) at 61.4%; (4) Conclusions: The screening has proven effective in early diagnosing Long QT Syndrome and other cardiac rhythm anomalies, with additional benefits in detecting mutations and/or QTc prolongations in family members. Identifying other ECG abnormalities and congenital heart malformations further enhances the benefits of the screening.

Preschoolers with disabilities and their caregivers have been neglected in health and social service provision in most low-income countries and arguably too in low resourced areas of more affluent nations. Yet as this rapid review of published literature identifies, there are low-cost, evidence-based strategies to address their needs that can be implemented in communities by local people. Five key features of the necessary supports are examined. First the leadership functions required to create and implement the support services. Second, the family-centred, home-based support provided to caregivers and the personnel undertaking this form of support. Third, providing opportunities for peer support to flourish and encouraging the formation of advocacy groups across families. Fourth, mobilizing the support of significant groups within the community; notably traditional healers and leaders; health services and poverty alleviation initiatives. Fifth, devising ways in which preschool educational opportunities can be offered to children as a prelude to their inclusion in primary schools. The review serves a further purpose. It provides an example of how public health researchers and academics could achieve more rapid implementation of evidence-based knowledge into existing and new support services through dissemination to community practitioners.

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.

(1) Background: Sleep disordered breathing represent a growing public health concern, especially among children and adolescents. Full-night polysomnography is considered the gold standard for diagnosing obstructive sleep apnea. Our goals are to identify personal and environmental risk factors for the onset and persistence of sleep respiratory disorders. We also want to investigate the differences in neuropsychological profiles; (2) Methods: This is an observational, retrospective cohort study. We collected information on adenoidectomy or adenotonsillectomy. We reviewed the clinical history and preoperative visits and collected data through a telephone questionnaire. Pediatric Sleep Questionnaire (PSQ) and the Pediatric Quality of Life Inventory (PedsQL) are questionnaires used for screening sleep respiratory disorders in children. The data were statistically analyzed it using SPSS version 22.0 for Windows (SPSS Inc., Chicago, IL); (3) Results: The study involved 138 patients, but only 100 parents participated. A higher percentage of patients with sleep disordered breathing were observed to have mothers who smoked during pregnancy. A smaller proportion of patients with sleep disordered breathing had a habit of using a pacifier. A rise in physical results is associated with a reduction in the PSQ at follow-up (p=0.051). An increase of overall academic achievement is associated with an average decrease in the PSQ at follow-up (p&lt;0.0001). A more significant proportion of patients undergoing adenotonsillectomy were observed to have a history of prematurity and cesarean birth (4) Conclusions: These results provide essential information on the effectiveness and effects of adenotonsillectomy intervention compared to adenoidectomy intervention and the factors associated with SDB in children undergoing these interventions.

Teicoplanin is now increasingly used as a first-line prophylactic therapy for major surgical procedures, treatment of methicillin-resistant Staphylococcus aureus infections, and for those with reported penicillin allergy. Teicoplanin is rarely associated with anaphylaxis and there is limited information on the prevalence of teicoplanin- induced perioperative anaphylaxis. Here, we describe a case of a 12-year-old child with teicoplanin anaphylaxis peri-operatively.

Systemic inflammation plays a central role in many diseases and is, therefore, an important therapeutic target. In a scoping review, we assessed the evidence base for anti-inflammatory effects of pre-, pro- and synbiotics in children. Of 1254 clinical trials published in English in Ovid Medline and Cochrane Library PubMed from January 2003 through September 2022, 29 were included in the review. In 6 studies of healthy children (n=1552), one reported that fructo-oligosaccharides added to infant formula significantly reduced pro-inflammatory biomarkers and one study of a single strain probiotic reported both anti- and pro-inflammatory effects. No effects were seen in the remaining two single-strain and one multi-strain probiotic and one synbiotic study. In 23 studies of children with diseases (n=1550), prebiotics were tested in 3, single-strain in 16 and multi-strain probiotics in 6 and synbiotics in 2 studies. Significantly reduced inflammatory biomarkers were reported in 7/10 studies of atopic/allergic conditions, 3/5 studies of auto-immune diseases, 1/2 studies of preterm infants, 1 study of overweight/obesity, 2/2 studies of severe illness and 2/3 studies of other diseases. However, often only one or two of several biomarkers were improved, increased pro-inflammatory biomarkers occurred in 5 of these studies and a probiotic increased inflammatory biomarkers in a study of newborns with congenital heart disease. The evidence base for the effects of pre-, pro- and synbiotics on systemic inflammation in children is weak. Further research is needed to determine if anti-inflammatory effects depend on the specific pre-, pro- and synbiotic preparations, health status and biomarkers studied.

Background: Routine childhood vaccination, e.g., for diphtheria-tetanus-pertussis (DTP), might provide an additional protection towards SARS-CoV-2 infection. This concept of heterologous immunity was explored in healthy children receiving both DTP and inactivated SARS-CoV-2 vaccines. Methods: A cross-sectional study was performed on 154 healthy children aged 6–8 years old in Jakarta, Indonesia. Their vaccination status of DTP (including diphtheria-tetanus booster vaccine at 5 years old) and CoronaVac (from 6 years old) were recorded. Peripheral blood samples were collected from all participants, in which anti-diphtheria toxoid IgG, anti-SARS-CoV-2 S-RBD antibodies and T cell-derived IFN-g were measured. Results: Study participants with complete DTP vaccination had significantly higher titer of anti-diphtheria toxoid IgG than the ones without (median=0.9349 versus 0.2113 IU/mL; p<0.0001). Upon stratification based on DTP and CoronaVac vaccination statuses, participants with complete DTP and CoronaVac vaccinations had the highest titer of anti-SARS-CoV-2 S-RBD antibodies (median=1,196 U/mL) and the highest concentration of SARS-CoV-2-specific T cell-derived IFN-g (median=560.9 mIU/mL) among all groups. Conclusion: Healthy children aged 6-8 years old with complete DTP and CoronaVac vaccinations exhibited higher SARS-CoV-2-specific adaptive immune responses, particularly on their T-cell response. This suggests an additional benefit of routine childhood vaccination to generate protection against novel pathogens, presumably via heterologous immunity.

Diarrhea and fever are prevalent childhood illnesses with potentially severe consequences, especially when they co-occur. This study investigates the prevalence and determinants of diarrhea, fever, and their coexistence among children under-five in Bangladesh. Data from the 2017-18 Bangladesh Demography and Health Survey (BDHS) were analyzed using multivariable stepwise logistic regression with backward selection. This study found that 5.0% for diarrhea, 34.0% for fever, and 3.0% for the coexistence of both illnesses. Common factors associated with childhood diarrhea and fever included the mother's education, her attitude toward wife-beating, and the child’s age (12-23 months). Diarrhea was associated with households with improved water sources and children in the Barisal division, while fever was linked to underweight children and those from more affluent backgrounds. The coexistence of both was significantly linked to underweight children, higher birth orders, and children from the Rajshahi division. Notably, child illnesses were associated with parental education, higher socio-economic status, and access to improved drinking water sources. Diarrhea affects one in 20 children, fever affects one in three, and the coexistence of both conditions affects one in 35 children in Bangladesh. The findings need further research and policy reviews to develop effective interventions and improve child health in Bangladesh.

The use of omega-3 fatty acids (omega-3 FA) in the treatment of atopic dermatitis (AD) is an area of ongoing research. Some studies suggest that dietary supplementation with omega-3 FA can help manage symptoms of AD by reducing lesion severity, skin inflammation, dryness and itching, while other show no significant beneficial effect. The aim of this study was to evaluate the effect of omega-3 FA form fish oil in combination with GLA form blackcurrant seed oil in children with AD. This is a longitudinal, prospective, randomized, triple blind, placebo-controlled parallel clinical trial. The study was conducted during the 2-year period from autumn, winter, and spring avoiding the summer when AD usually improves. Children were randomized to receive the active study product (Mega Kid®) containing specific blend of omega-3 and omega-6 fatty acids or placebo. Primary outcomes were change in severity of AD measured using SCORing Atopic Dermatitis (SCORAD) patient oriented SCORAD (PO-SCORAD) and the difference in TCS use. Secondary outcomes were change in itch intensity, sleep quality and Family Dermatology Life Quality Index (FDLQI). Data were analyzed for 52 children (26 in the intervention group and 26 in the placebo group). In children receiving active product intention-to-treat analysis showed that after 4 months of treatment, there was a significant decrease in the SCORAD index (from median 42 to 25, p < 0.001) and use of topical corticosteroids (from median 30 to 10 mg/day, p < 0.001) but also significant improvement in itch, sleep quality and overall quality of life. Omega-3 fatty acids in combination with GLA and vitamin D has a great beneficial effect in treatment of atopic dermatitis in children. Therefore, we can conclude that supplementation with this specific combination could be considered a safe and effective intervention that can significantly reduce the severity of AD in pediatric patients.

Background: As a result of the pandemic, families and children have faced physical, emotional, and mental challenges. However, there has been little attention given to the relationship between the COVID-19 pandemic and child development. This systematic review aims to identify the impact of the pandemic on child development, globally. Methods: This study follows the PRISMA guidelines for the systematic review of 16 quantitative and qualitative studies conducted between 2020-2023. Results: This systematic review suggest that the COVID-19 pandemic played a crucial role in hindering child development in early childhood. Conclusion: Therefore, it is important to promote and implement the use of policies and strategies to overcome these obstacles.

Undernutrition is a significant public health issue in Colombia and globally, influenced by multiple factors. The relationship between food insecurity and acute undernutrition in children has been insufficiently explored. To address this, a descriptive, observational, cross-sectional study was conducted involving 70 children under the age of 5, who presented with moderate to severe acute malnutrition. The study assessed family and child food security using the Latin American and Caribbean Food Security Scale (ELCSA). Analysis of the data revealed that when households face challenges in meeting their basic needs, children are generally the least affected. Caregivers tend to prioritize children's diets, opting to reduce food intake among adults over 18 years of age instead. The causes of malnutrition were explored through the perceptions of guardians, who reported that in 30.2% of cases, malnutrition is linked to inadequate feeding and parenting practices. Specific issues noted by parents included children being too lazy to chew, preferring ultra-processed foods, or refusing to eat altogether. The study found that not all children with acute malnutrition experience food insecurity; in fact, the proportion of children suffering from hunger was very low. The findings suggest that malnutrition in children under 5 years of age is not solely determined by food insecurity but also by other factors such as parenting practices and poor feeding habits. Further research is needed to evaluate food access and quality, particularly in terms of dietary diversity, to better understand the needs of each population. Such studies will be essential in guiding public health interventions aimed at preventing, managing, and addressing malnutrition in children.

Asthma, like other chronic diseases, affects children prone to transitions of various aspects of their lives. The purpose of this thesis is to investigate the level quality of life of children with bronchial asthma and to what extent the disease affects them their everyday life. The literature search was conducted a review of the articles was done in Greek and English, through electronic databases PubMed, Google Scholar and Scopus. The terms and conditions their combinations used for the search were: “kids”, “children”, "pediatric asthma", "quality of life (QOL)", "health", "adolescents". The search was limited to the last five years (2015 – 2020) and finally 12 were selected articles. The most important areas negatively affected by quality of life of children with asthma are physical activity, their emotional state, school performance and sleep quality when it is connected to other factors. Important role in quality of life of these children has asthma management, disease severity and other environmental factors. Medical and nursing staff need to guide them asthmatic children and their families to have a good everyday life. Having the necessary knowledge needed for the quality-of-life health professionals should include in their medical nursing caring methods of achieving and maintaining a lifestyle that is no different than that of healthy children.

This study aimed to explore the factors that influence parental involvement in supporting 7 the education of children with disabilities in Malawi, thereby generating insights into the barriers 8 and facilitators they face. We conducted focus groups and in-depth interviews with 25 participants 9 from the Nkhata Bay District: teachers, parents, and children with disabilities. We used the COM-B 10 model to analyse how parents' capabilities, opportunities, and behaviours influence their involve- 11 ment in their children's education. The study revealed that parents of children with disabilities 12 showed willingness, optimism about their children's future, and a strong sense of responsibility for 13 their education. However, factors such as the limited knowledge of children's learning needs, time, 14 low confidence, and financial challenges have constrained their involvement. Schools and commu- 15 nities frequently limit participation opportunities by not consistently practicing or championing pa- 16 rental involvement in policies or actions. The study sheds light on the complex interplay between 17 knowledge, practical constraints, and external support systems that shape parental involvement in 18 the education of children with disabilities. Further research aimed at creating tailored and context- 19 relevant interventions to improve parental involvement in the education of children with disabilities 20 in low-income settings is required.

Human bocavirus (HBoV) is an emerging virus that has been detected worldwide that could be associated with cases of acute gastroenteritis (AGE). However, its contribution to AGE has not been elucidated. This study aimed to describe the frequency, clinical features, and HBoV genotypes circulation in children up to 5 years with or without AGE symptoms in Acre, Northern Brazil. A total of 480 stool samples were collected between January and December 2012. Fecal samples were used for extraction, nested PCR amplification, and sequencing for genotyping. Statistical analysis was applied to verify the association between epidemiological and clinical characteristics. Overall HBoV-positivity was 10% (48/480), being HBoV-positivity rates of 8.4% (19/226) and 11.4% (29/254) recorded among diarrheic and non-diarrheic children, respectively. The most affected age group was between 7 and 24 months (50%). HBoV infection was more frequent in children living in urban areas (85.4%), using water from the public network (56.2%), and living with adequate sewage facilities (50%). Co-infection with other enteric viruses was 16.7% (8/48) and the most prevalent coinfection was RVA+ HBoV (50%, 4/8). HBoV‐1 was the most frequent species detected, responsible for 43.8% (21/48) of cases, followed by HBoV-3 (29.2%, 14/48) and HBoV-2 (25%, 12/48). In the present study, HBoV infections are not associated with AGE, as most HBoV cases belonged to the non-diarrheal group without AGE symptoms. Future studies are warranted to determine the role of HBoV in causing acute diarrhea disease.

The study examines malnutrition's triple burden, including anaemia, overweight, and stunting, among children aged 6-59 months. Using data from the National Family Health Survey-5 (2019-21), the study identifies risk factors and assesses the contribution at different levels to existing malnutrition burden. A random intercept multilevel logistic regression model and spatial analysis are employed to identify child, maternal, and household level risk factors for stunting, overweight, and anaemia. The study finds that 34% of children were stunted, 4% overweight, and 66% anaemic. Stunting and anaemia prevalence were higher in central and eastern regions, while overweight was more prevalent in the north-eastern and northern regions. At macro-level, the coexistence of stunting, overweight, and anaemia circumstantiates the triple burden of childhood malnutrition with substantial spatial variation (Moran’s I: stunting-0.53, overweight-0.41 and anaemia-0.53). Multilevel analysis reveals that child, maternal, and household variables play a substantial role in determining malnutrition burden in India. The nutritional health is significantly influenced by a wide range of determinants, necessitating multilevel treatments targeting households to address this diverse group of coexisting factors. Given the intra-country spatial heterogeneity, the treatment also needs to be tailor-made for various disaggregated levels.

Assessment of health-related quality of life (HRQoL) after pediatric traumatic brain injury (TBI) has been limited in children and adolescents due to a lack of disease-specific instruments. To fill this gap, the Quality of Life after Traumatic Brain Injury for Children and Adolescents (QOLIBRI-KID/ADO) was developed for the German-speaking population. Reference values from a comparable general population are essential for comprehending the impact of TBI on health and well-being. This study examines the validity of the German QOLIBRI-KID/ADO in a general pediatric population in Germany and provides reference values for use in clinical practice. Overall, 1997 children and adolescents aged 8-17 years from the general population and 300 from the TBI population participated in the study. The questionnaire was tested for reliability and validity. A measurement invariance (MI) approach was used to assess the comparability of the HRQoL construct between both samples. Reference values were determined by percentile-based stratification according to factors that significantly influenced HRQoL in regression analyses. The QOLIBRI-KID/ADO demonstrated strong psychometric properties. The HRQoL construct was measured largely equivalently in both samples, and reference values could be provided. The QOLIBRI-KID/ADO was considered reliable and valid for assessing HRQoL in a general German-speaking pediatric population, allowing for clinically meaningful comparisons between general and TBI populations.

Background: COVID-19 is currently one of the most important medical challenges as it affects the entire population with children being infected as easily as adults. Objective: The study evaluated the mortality of under 17-year-olds and compare the frequency with that of adults in a cohort of 8986 COVID-19 positive patients hospitalized in a single care center. Design: retrospective clinical trial, all hospitalizations of COVID-19 positive patients as diagnosed by RT-qPCR were analyzed by revisiting their medical records. Setting: 8986 COVID-19 positive patients hospitalized in a Hospital de Base and the Infant and Maternal Hospital of São Jose do Rio Preto, SP, Brazil (HB/HCM) being these totals of 383 COVID-19 positive under 17-patients. Patients: patients COVID-19 positive under 17-year-olds were grouped by age and evaluated by analyzing their medical records. They were categorized as Group I, children, and adolescents under 19 years old and Group II, adults over 19 years. Results: Overall mortality in under 19-year-olds was 12 deaths, that is, 3.13% of the patients in this age group and 0.55% of the overall mortality from COVID-19. Mortality in the group of adults was 2197 equivalent to 24.45% of the hospitalized adults and 99.45% of overall deaths. Mortality was significantly higher for adults than for under 19-year olds (p-value < 0.0001). Regarding the different ages of children and adolescents, the number of deaths of under 1-year olds was 2/123 (1.62%), of 1-4 years it was 4/95 (2.11%), of 5-9 years it was 1/47 (2.13%), of 10-14 years it was 1/40 (2.5%) and of 15-19 years it was 4/78 (5.13%). There were no statistical differences between the different age groups ( p-value = 0.3). Conclusion: Mortality from COVID-19 in children and adolescents was lower than in adults and generally associated with other comorbidities with the main association being with heart disease.

Play therapy is an approach to providing assistance in overcoming problems using media such as toys, art media, games, and communication. The purpose of this paper is to find out that play therapy can reduce anxiety in children. The research design used in this study was a study-literature review. The data used in this research comes from the results of research that have been conducted and published in national and international online journals. The method of analysis used in this study is the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) method.

Objectives- We prospectively analyzed children with acute chest pain and clinical suspicion of pneumothorax (PNX) evaluated at the pediatric Emergency Department. Methods- After clinical examination and before Chest X-Ray, children underwent LUS to evaluate the presence of PNX. We enrolled 70 children, 13 (18,57%) received a final diagnosis of PNX. Results- In all 13 (100%) patients LUS showed the “bar-code sign”, the absence of lung sliding and the absence of B lines while in 12 (92,3%) there was the lung point, giving a diagnosis of PNX. All cases had PNX features on CXR. The “bar-code sign”, the absence of lung sliding and the absence of B lines had a sensitivity of 100% and a specificity of 100%. The “bar-code sign” had a positive predictive value of 100% and a negative predictive value of 100% for the detection of PNX. Conclusions- LUS is highly accurate in detecting or excluding pneumothorax in children with acute chest pain evaluated in the pediatric emergency department.

Seizures are defined as a transient occurrence of signs and symptoms due to the abnormal, excessive or synchronous neuronal activity in the brain characterized by an abrupt and involuntary skeletal muscles activity. An early diagnosis, treatment and specific medical support must be performed to prevent Status Epilepticus (SE). Seizures’ onset, especially in children population, is related to specific risk factors like positive family history, fever, infections, neurological comorbidity, premature birth, mother’s alcohol abuse and smoke in pregnancy. Early death risk in children without neurological comorbidity is similar to the general population. Diagnosis is generally based on the identification of continuous or recurrent seizures but EEG evaluation could be useful if SE condition in suspected. The main goal of therapy is to contrast pathological mechanism which occurs in SE before neural cells are irreversibly damaged. According to latest International Guidelines and Recommendations of seizures’ related diseases, it is proposed a schematic and multi-stage pharmacological and diagnostic approach especially in the management of SE and its related causes in children. First measures should focus on early and appropriate drugs administration at adequate dosage, airway management, monitoring vital signs, PICU admission and management of parents’ anxiety.

Reducing sedentary behaviours can help prevent non-communicable diseases, particularly among young adolescents with long term illnesses or disabilities (LTID). Much of young people’s voluntary sedentary time is related to screen-time behaviours (STBs) such as TV viewing, playing computer games, and using the computer for other activities. Although public health data on adolescents’ STB is growing, information about adolescents with LTID is currently lacking in a European context. The purpose of this study is to compare time on STBs between adolescents with and without LTID in European Countries through the HBSC 2013/14 study. Young adolescents (n = 61,329; boys 47.8%) from 15 European countries reported the time spent on TV viewing, playing computer games, and using the computer for other purposes on weekdays and the weekend. STBs were dichotomised based on international recommendations of less than 2 h per day, and Chi-square tests of independence were performed to investigate differences. STB time was combined to produce a sum score as dependent variable in multiple analysis of covariance with age and family affluence as covariates. There were statistically significant differences in computer gaming among boys and other computer use among girls for both weekdays and weekends, whereby adolescents with LTID reported higher use. In addition, both boys and girls with LTID spent more time on STBs than their same sex peers without LTID (Boys, F = 28.17, p < 0.001; Girls, F = 9.60, p = 0.002). The results of this study indicate a need for preventive strategies to address high levels of STB among young adolescents with LTID and reduce the risk of poor health outcomes associated with higher levels of sedentary behaviour.

The 2022-2023 influenza season in Romania was characterized by high pediatric hospitalization rates, predominated by influenza A subtypes H1N1 and H3N2. Lowered population immunity to influenza after the SARS-CoV-2 pandemic and subsequent stoppage of influenza circulation, particularly in children who had limited pre-pandemic exposures, influenced hospitalization among children immunosuppressed, and patients with concurrent medical conditions who are at increased risk for developing severe forms of influenza. This study focused on the characteristics of influenza issues among paediatric patients, as well as the relationship between different influenza virus types and viral and bacterial coinfections and illness severity in the 2022-2023 season after the SARS-CoV-2 pandemic. We conducted a retrospective clinical analysis on 301 cases of influenza in pediatric inpatients (age ≤ 18 years), hospitalized at the National Institute of Infectious Diseases "Prof. Dr. Matei Balș" IX Pediatric Infectious Diseases Clinical Section between October 2022 and February 2023. The most significant age group was 57.8% representing children between one to four years old and female. The average clinical forms were found in 61.7%, whereas severe versions represented 18.2% of cases. Most of the complications were respiratory (acute interstitial pneumonia, 76.1%), hematological (72.1%), represented by intra-infectious and deficiency anemia, leukopenia, thrombocytopenia), 33.6% were digestive, such as diarrheal disease, liver cytolysis syndrome, and the acute dehydration syndrome associated with electrolyte imbalance (71.4%). Severe complications were associated with a risk of unfavorable evolution: acute respiratory failure and neurological complications (convulsions, encephalitis). No deaths were reported. We noticed that the flu season 2022-2023 was characterized by the association of co-infections (viral, bacterial, fungal and parasitic) more frequent than in previous years (26.2% vs. 16%), which evolved more severely, with prolonged hospitalization and more complications (p<0.05), and time of use of oxygen therapy was statistically significant (p > 0.05); influenza vaccination in this group was zero. In conclusion, coinfections with respiratory viruses increase the severity of the pediatric population's immunity to influenza, especially among young children who are more vulnerable to developing a serious illness. All people above the age of six months should get vaccinated against influenza to prevent the illness and its severe complications.

Making life better for Indigenous peoples is a global priority. Although bullying and oral health have always been a topic of concern, there is limited information regarding the impact of this problem in the general population, with no evidence in this regard among the Australian Indigenous population. Thus, we aimed to quantify the relationship between bullying victimization and oral health problems by remoteness among 766 Australian Indigenous children aged between 10–15-year-olds using data from the LSIC study. Bivariate and multilevel mixed-effect logistic regression analyses were employed. Findings indicated children self-reported bullying more than parents reported their children were being bullied (44% vs 33.6%), with a higher percentage from rural/remote areas than urban areas. Parents reported oral health problem increases the probability (OR 2.20, p<0.05) of being bullied in Indigenous children living in urban areas. Racial discrimination, lower level of parental education and poor child oral hygiene increase the risk of bullying victimization. Parental happiness with life and a safe community was associated with a lower risk of bullying. Dental problems are linked with Australian Indigenous children experiencing bullying victimization. Cultural resilience and eliminating discrimination maybe two modifiable paths to ameliorating health issues associated with bullying in the Australian Indigenous community.

Abstract: Medication overuse headaches is a frequent phenomenon observed in individuals suf-fering from chronic headaches. It arises due to the excessive consumption of pain-relief medica-tions, resulting in the escalation and continuous persistence of headache symptoms. Nevertheless, the prevalence and distinctive characteristics of medication overuse headaches in the pediatric population have not been comprehensively explored. The primary objective of this research is to delineate the features of medication overuse headaches in children, particularly emphasizing the investigation of its epidemiology and the diagnostic patterns for headaches. We conducted a ret-rospective study by and analyzed the medical records of children and adolescents who were evaluated at outpatient pediatric headache clinic at the Bnai Zion medical center for headache during the period spanning 2007 to 2017. Our study encompassed a cohort of 1008 patients expe-riencing headaches. Among these participants, 268 individuals (26.6%) were diagnosed with mi-graine, 250 (24.8%) exhibited tension-type headaches (TTH), and 490 (48.6%) were classified as having undifferentiated headaches. Out of the whole group, 65 had chronic headaches: 35 (54%) with migraine, 20 (30%) with tension-type headaches (TTH), and 10 (15%) with undifferentiated headache of childhood, with the majority (73%) being female.In summary, medication overuse headaches are a prevalent issue among children grappling with chronic headaches. Intriguingly, they appear to be more pronounced within the tension-type headache (TTH) group compared to migraine sufferers, and exhibit a higher prevalence among females. This study underscores the significance of early detection and careful management of medication overuse headaches in pedi-atric cases, shedding light on its distinct characteristics in the realm of childhood headache disor-ders. Further research is warranted to elucidate the underlying factors contributing to the ob-served gender disparity and the distinct prevalence rates among different headache subtypes.

The coronavirus disease 2019 (COVID-19) pandemic has disrupted health care worldwide. As the pandemic has been prolonged, quarantine restrictions have been lightened gradu-ally, which can influence outcomes of pediatric patients with chronic disease such as epi-lepsy by increase of susceptibility of the COVID-19 infection. The aim of this study was to determine impacts of COVID-19 pandemic on seizure control and identify potential risk factors that might worsen seizure attacks during the pandemic in children with epilepsy. We performed a retrospective chart review of 48 pediatric patients with epilepsy during the COVID-19 pandemic from January 2016 to July 2022. During the COVID-19 pandemic period, 25% of pediatric patients experienced sei-zure worsening, showing an increase in seizure frequency or duration or both. Factors associated with worsening seizures during pandemic were: diagnosis of epi-lepsy less than one year, comorbid conditions with cerebral palsy or having a tracheosto-my or a PEG, and infection with other viruses (respiratory syncytial virus, influenza virus A, influenza virus B) rather than COVID-19 infection. Our finding highlights the need to proactively monitor and regularly follow up (es-pecially short period of time) patients after they are diagnosed with epilepsy. It is also important to properly manage those who are susceptible to serious illness and keep sea-sonal viral infections under surveillance to manage exacerbated seizure in children with epilepsy. Furthermore, pediatric physicians should not overlook surveillance of seasonal respiratory viruses since quarantine restrictions are getting eased.

Background: Gluten and casein-containing foods could aggravate the symptoms of children and adolescents with autism spectrum disorder (ASD), and subsequently impact their quality of life. However, there is a mixed opinion among researchers concerning the impact of alternative diet on reducing ASD symptoms. Objective: This scoping review aimed at examining the impact of the ‘’gluten-free, casein-free’’ (GFCF) diet on health outcomes and the quality of life among autistic children and adolescents. Methods: A scoping review of the literature was performed following the Joanna Briggs Institute (JBI) guidelines. Four databases including EbscoHost, Medline, CINAHL and ProQuest were used to obtain subject-specific studies relevant to the research question and published between July 2013 and March 2024. A comprehensive search using keywords such as “autism spectrum disorder”, “gluten-free diet”, and “casein-free diet” was conducted to obtain articles related to the research focus area. Only full-text, peer-reviewed, written in English articles were selected. Data extraction and data analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- extension to Scoping Review (PRISMA-ScR) protocol. Results: From the initial 586 studies a total of 27 articles were included in the final analysis of the review. The thematic analysis included ‘GFCF diet and improvement of the core autistic symptoms’’, “the gut-brain link’’, ‘’dietary interventions and autism’’, ‘’possible side effects due to the GCFC diet’’, and ‘’ inconclusive studies and mixed opinions’’. Majority of the studies showed positive effect of the GFCF diet on a variety of autistic symptoms including positive changes in cognitive skills, behaviour, and gastrointestinal symptoms while some showed conflicting evidence. Conclusion: The currently available evidence on the impact of ‘GFCF’’ diet on the quality of life of autistic children and adolescents may warrant potentially effective interventions for alleviating symptoms of autism spectrum disorders. However, this scoping review highlighted the need for more research to provide more reliable evidence on the health outcomes and quality of life of ASD sufferers to guide practice.

(1) Background: Children who are physically active and involved in organized sport report having the unhealthiest diets. Research suggests excessive calories may be attributed to the prevalence of fast food and candy which are often provided as rewards in sport. This study explored the use of food as a reward in youth sport and the perceived impact it has on children’s motivation to participate in recreational soccer and ice hockey; (2) Methods: A multiple instrumental case study approach was utilized. Children aged 4-12 (n = 64), parents (n = 30), and coaches (n = 18) were recruited within central and northeastern Ontario, Canada to participate in focus groups and individual interviews. Transcribed audio recordings underwent inductive thematic analysis; (3) Results: Key themes included: Fun and fast: The culture of food in youth soccer and hockey; (Un)importance of food rewards: The how and why of motivating children in sport; and Youth sport is expensive: Gratitude for sponsorship in youth sport; (4) Children’s participation and effort would continue without food rewards; however, they continue to be offered food to motivate and celebrate performance in youth sport. Findings highlight the need to increase knowledge and awareness among parents and coaches on what truly motivates children to help foster healthier strategies for celebrating success and supporting lifelong physical activity.

Cardiotoxicity remains one of the leading causes of morbidity and mortality in childhood cancer survivors. This study aimed to evaluate cardiotoxic side effects of chemotherapeutic regimens in a pediatric population, as revealed by assessment of baseline end-of-treatment and in follow-up after 1 year. A prospective study was conducted on 39 children, enrolled over a period of 5 years (2017-2022), diagnosed with leukemia and receiving chemotherapy regimens. A multimodal echocardiographic evaluation was done (two-dimensional echocardiography and M-mode, tissue doppler imaging (TDI) and 2D-speckle tracking (2DST) before the initiation of the cytostatic treatment, at the end of the treatment and 1 year after the treatment. Ultrasound-derived parameter values were compared between evaluations and correlated with cumulative doses of chemotherapeutic agents used. There were no significant differences in mean values for any of the imagistic parameters analyzed. However, a significant correlation was found between E’value percentage variation and cumulative dose of both anthracyclines and antimetabolics administered (p=0.03). Moreover, a significant linear regression correlation was found between alkylating agent dose and global longitudinal strain (GLS)(p<0.01). Non-invasive cardiovascular imaging parameter values did not differ significantly from baseline in our study, but some of them seem to be dependent upon cumulative dose of cytostatic agents used. Further studies on larger populations and involving a longer follow-up period might provide more insight into cardiotoxicity of chemotherapy regimens.

Background: Post-traumatic stress disorder (PTSD) is a mental health concern among traumatized children and adolescents. The specific objective is to describe post-traumatic stress disorder in children (6 to 12 years old) and adolescents (12 to 18 years old). This comprehensive review compiles the clinical interventions targeting PTSD in this age group and systematizes the empirical evidence about their efficacy. Methods: The PRISMA method was used to present and evaluate the clinical interventions implemented for PTSD. Results: Significant symptoms of PTSD include avoidance, overstimulation, and flashbacks, typically accompanied by a depressed mood and anxiety. Cognitive Behavioral Therapy (CBT), trauma-focused CBT, Eye Movement Desensitization and Reprocessing (EMDR), Systemic Therapy, Play Therapy, Exposure Therapy, Relaxation Techniques, and Psychodynamic Psychotherapy are essential interventions for the treatment of patients between the ages of 6 and 18. CBT, particularly Trauma-focused CBT, is the most effective and extensively used therapy for dealing with cases of juvenile PTSD, according to the findings of the vast majority of previous research. Conclusions: The present systematic review summarizes the findings of several studies on psychotherapeutic interventions for PTSD in children and adolescents. PTSD in this population differs from PTSD in adults, necessitating various age-appropriate approaches and therapeutic models.

Background and Objective: In the present study, the purpose was to compare the demographic, clinical and laboratory results of pediatric brucella cases who had liver involvement and who had no specific organ involvement. Material and Methods: The data of 248 patients between 2 and 18 years of age diagnosed with Brucellosis between July 2017 and August 2018 were analyzed retrospectively. The patients who had liver involvement and who did not have other specific organ involvement were compared in terms of presentation, physical examination findings, age, gender, hemogram, AST, ALT, GGT, ALP, bilirubines, sedimentation, CRP, clinical and laboratory findings, and culture and relapse rates. Results: No significant differences were detected between the patients who had liver involvement (n=92) and who did not have specific organ involvement (n=156) in terms of diagnosis age and gender. Loss of appetite, nausea and sensitive stomach were higher in the patients who had hepatic involvement, and weariness was determined to be more in the control group patients. In the patients who had hepatic involvement, the hemoglobin and platelet values were lower, and the sedimentation, CRP and blood culture growth were higher. The relapse rates were lower in patients who had liver involvement. Conclusion: In patients who have liver involvement, in addition to elevated hepatomegaly and transaminase levels, the growth rate of the acute-phase reactants and brucella is higher in blood culture; and the relapse rate is lower after treatment. Brucellosis must be considered in the differential diagnosis of hepatomegaly and transaminase elevation where brucellosis is seen endemically. We believe that early diagnosis of brucellosis is important in treatment response.

Introduction: Cerebral palsy is the most common childhood disability Aims: Analyze and determine the main risk factors for the development of cerebral palsy in the population of Kazakhstan Materials and methods: Retrospective, analytical "case" - "control". Core group "case" - medical records of 100 pregnant women whose children at different ages has been diagnosed with cere-bral palsy Results: Thus, a retrospective analysis revealed the following features and complications in the perinatal period, which could promote the formation of cerebral palsy in children. Analytical results of the study are set significant results in cerebral palsy development Conclusion: Premature birth and urinary tract infections turned out to be the largest contribu-tors to the development of cerebral palsy, however, according to statistics, the rate of preterm birth, as well as the detection of infections, stably remains at the same level, while the number of cerebral palsy has been steadily growing since the early 1990s in Kazakhstan.

Applied behavior analysis (ABA) interventions first introduced by Lovas in the 1960s have been proven historically effective in reducing challenging behaviors such as self-harm aggressive behaviors and improving communicative language skills in children with autism. While the interventions have evolved, focusing on restricting punishments and enforcing more reinforcements to teach skills, some concerns are yet to be evaluated. With the boom of ABA in Asia, this review focuses on understanding the techniques used and the progression of ABA by reviewing the existing literature. It aims to critically analyze the ABA strategies used to target challenging behaviors and teach new skills to gauge their long-term impact on children undergoing these interventions.

Background: The COVID 19 pandemic and associated public health measures have disrupted the lives of people around the world. It is already evident that the direct and indirect psychological and social effects of the COVID 19 pandemic are insidious and affect the mental health of young children and adolescents now and will in the future. The aim and objectives of this knowledge-synthesis study were to identify the impact of the pandemic on children’s and adolescent’s mental health and to evaluate the effectiveness of different interventions employed during previous and the current pandemic to promote children’s and adolescent’s mental health. Methodology: We conducted the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included experimental randomized, nonrandomized controlled trials; observational studies; and qualitative studies. Results: Of the 5,828 articles that we retrieved, 18 articles met the inclusion criteria. We thematically analyzed and put up the major findings under the thematic areas of impact of pandemic on children and adolescent’s mental health. These studies reported that pandemics cause stress, worry, helplessness, and social and risky behavioral problems among children and adolescents (e.g., substance abuse, suicide, relationship problems, academic issues, absenteeism from work). Interventions such as art-based programs, support services, and clinician-led mental health and psychosocial services effectively decrease mental health issues among children and adolescents. Conclusion: Children and adolescents are more likely to experience high rates of depression and anxiety during and after a pandemic. It is critical that future researchers explore effective mental health strategies that are tailored to the needs of children and adolescents. Explorations of effective channels regarding the development and delivery of evidence-based, age-appropriate services are vital to lessen the effects and improve long-term capacities for mental health services for children and adolescents.

Background: Previous research studies have suggested the importance of studying the relationship between emotional regulation and sleep habits. Some investigations have especially focused on how emotional regulation could impact sleep habits in children and adolescents. Therefore, these researchers have stated there exists a two-way direction in this relationship. Objective: This study aimed to analyze the influence of emotional regulation on sleep habits in Spanish children and adolescents, and the mediating role of anxiety in this relationship. Method: Participants were 953 Spanish parents who completed the assessment protocol according to their children and adolescents’ information. Results: The results revealed moderate-strong correlations between emotional regulation problems and sleep habits disturbances (r=0.375, p&lt;0.001), trait (r=0.488, p&lt;0.001) and state (r=0.589, p&lt;0.001) anxiety. Also, emotional regulation showed a direct impact on sleep habits (β=0.011, p=0.005). Trait and state anxiety demonstrated a significant mediating role in the relationship between emotional regulation and sleep habits. Conclusions: Emotional regulation may have an impact on sleep habits during childhood and adolescence, suggesting the importance of early intervention focused on the emotions management and the prevention of sleep habits disturbances.