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Agnogenic practices—designed to create ignorance or doubt—are well-established strategies employed by health-harming industries (HHI). However, little is known about their use by industry-funded organizations delivering youth education programmes. We applied a previously published framework of corporate agnogenic practices to analyse how these organizations used them in three UK gambling industry-funded youth education programmes. Evidential strategies adopted previously by other HHI are prominent in the programmes' practitioner-facing materials, evaluation design and reporting and in public statements about the programmes. We show how agnogenic practices are employed to portray these youth education programmes as 'evidence-based' and 'evaluation-led'. These practices distort the already limited evidence on these educational initiatives while legitimizing industry-favourable policies, which prioritize commercial interests over public health. Given the similarities in political strategies adopted by different industries, these findings are relevant to research and policy on other HHI. [ABSTRACT FROM AUTHOR]

Objective The Movement Assessment Battery for Children-2 (MABC-2) is a popular assessment of children's motor skills in both Western and Eastern countries. Since children's motor skills are strongly influenced by the sociocultural context, it is essential to specifically examine the applicability of the MABC-2 in different cultures. The performance on the MABC-2 age band 1 of children in Taiwan was compared with the standardized sample from the United Kingdom. The sex differences in the performance on the MABC-2 were also investigated. Methods Children aged 3 to 6 years were recruited and categorized into 4 age groups. The researchers assessed the children with the MABC-2 age band 1, containing 8 tasks categorized into 3 components: manual dexterity, aiming and catching, and balance. Z tests and effect sizes were used to examine the cultural differences in the 3 components and in the total scale of the MABC-2. Independent t tests were used to check for sex differences in the MABC-2. Results Data on 615 children with a mean age of 4.95 years (SD = 0.97) were collected. Clinically significant differences (effect size > 0.5) were found in 2 components and the total scale of the MABC-2 across most age groups. Children in Taiwan performed better on manual dexterity, balance, and the total scale. Marginally clinically significant differences (absolute effect size > 0.4) were found in the aiming and catching component for the children aged 3 and 6 years old; children in Taiwan scored lower on aiming and catching than did children in the United Kingdom. Girls had significantly higher scores on manual dexterity, balance, and the total scale, while boys had significantly higher scores on aiming and catching. Conclusions Cultural and sex differences exist in the MABC-2. Constructing a norm for children in Taiwan of different sex and modification of the items are suggested for application of the MABC-2 in Taiwan. [ABSTRACT FROM AUTHOR]

Objectives Clinicians concerned about long-term safety of biologics in JIA may consider tapering or stopping treatment once remission is achieved despite uncertainty in maintaining drug-free remission. This analysis aims to (i) calculate how many patients with JIA stop biologics for remission, (ii) calculate how many later re-start therapy and after how long, and (iii) identify factors associated with re-starting biologics. Methods Patients starting biologics between 1 January 2010 and 7 September 2021 in the UK JIA Biologics Register were included. Patients stopping biologics for physician-reported remission, those re-starting biologics and factors associated with re-starting, were identified. Multiple imputation accounted for missing data. Results Of 1451 patients with median follow-up of 2.7 years (IQR 1.4, 4.0), 269 (19%) stopped biologics for remission after a median of 2.2 years (IQR 1.7, 3.0). Of those with follow-up data (N = 220), 118 (54%) later re-started therapy after a median of 4.7 months, with 84% re-starting the same biologic. Patients on any-line tocilizumab (prior to stopping) were less likely to re-start biologics (vs etanercept; odds ratio [OR] 0.3; 95% CI: 0.2, 0.7), while those with a longer disease duration prior to biologics (OR 1.1 per year increase; 95% CI: 1.0, 1.2) or prior uveitis were more likely to re-start biologics (OR 2.5; 95% CI: 1.3, 4.9). Conclusions This analysis identified factors associated with successful cessation of biologics for remission in JIA as absence of uveitis, prior treatment with tocilizumab and starting biologics earlier in the disease course. Further research is needed to guide clinical recommendations. [ABSTRACT FROM AUTHOR]

Background Microscopy is the gold standard for malaria diagnosis but is dependent on trained personnel. Rapid diagnostic tests (RDTs) form the mainstay of diagnosis in endemic areas without access to high-quality microscopy. We aimed to evaluate whether RDT alone could rule out imported malaria in children presenting to UK emergency departments (EDs). Methods UK-based, multi-center, retrospective, diagnostic accuracy study. Included : any child <16 years presenting to ED with history of fever and travel to a malaria-endemic country, between 01/01/2016 and 31/12/2017. Diagnosis: microscopy for malarial parasites (clinical reference standard) and RDT (index test). UK Health Research Authority approval: 20/HRA/1341. Results There were 47 cases of malaria out of 1,414 eligible cases (prevalence 3.3%) in a cohort of children whose median age was 4 years (IQR 2–9), of whom 43% were female. Cases of Plasmodium falciparum totaled 36 (77%, prevalence 2.5%). The sensitivity of RDT alone to detect malaria infection due to any Plasmodium species was 93.6% (95% CI 82.5–98.7%), specificity 99.4% (95% CI 98.9–99.7%), positive predictive value 84.6% (95% CI 71.9–93.1%) and negative predictive value 99.8% (95% CI 99.4–100.0%). Sensitivity of RDT to detect P. falciparum infection was 100% (90.3–100%), specificity 98.8% (98.1–99.3%), positive predictive value 69.2% (54.9–81.2%, n = 46/52) and negative predictive value 100% (99.7–100%, n = 1,362/1,362). Conclusions RDTs were 100% sensitive in detecting P. falciparum malaria. However, lower sensitivity for other malaria species and the rise of pfhrp2 and pfhrp3 (pfhrp2/3) gene deletions in the P. falciparum parasite mandate the continued use of microscopy for diagnosing malaria. [ABSTRACT FROM AUTHOR]

The alarming epidemic of obesity and physical inactivity at paediatric age urges societies to rise to the challenge of ensuring an active lifestyle. As one response to this, business enterprises are increasingly engaged in promoting sport and physical activity (PA) initiatives within the frame of corporate social responsibility (CSR). However, comparative analyses among industry sectors of CSR strategies for PA promotion with a particular focus on children are still lacking. This study aimed to explore (i) what are the CSR strategies for PA promotion adopted in different industry sectors and (ii) whether corporate engagement in promoting PA for children is supportive of children's rights to play and be physically active. Corporate pledges pertaining to CSR initiatives to promote PA were analysed. The hypothesis was that companies from different sectors employ different CSR strategies and that companies with a higher profile as regard to public health concerns for children tend to legitimate their action by adopting a compensatory strategy. Results show that the issue of PA promotion is largely represented within CSR commitments. CSR strategies for PA promotion vary across industry sectors and the adoption of a compensatory strategy for rising childhood obesity allows only a limited exploitation of the potential of CSR commitments for the provision of children's rights to play and be physically active. Actors within the fields of public health ethics, human rights and CSR should be considered complementary to develop mainstreaming strategies and improve monitoring systems of PA promotion in children. [ABSTRACT FROM AUTHOR]

Background: Development of verbal skills during early childhood and school age years is consequential for children's educational achievement and adult outcomes. We examine ethnic differences in longitudinal latent verbal profiles and assess the contribution of family process and family resource factors to observed differences. Methods: Using data from the UK Millennium Cohort Study and the latent profile analysis, we estimate longitudinal latent verbal profiles using verbal skills measured 4 times from age 3-11 years. We investigate the odds of verbal profiles by ethnicity (reported in infancy), and the extent observed differences are mediated by the home learning environment, family routines, and psychosocial environment (measured at age 3). Results: Indian children were twice as likely (OR = 2.14, CI: 1.37-3.33) to be in the high achieving profile, compared to White children. Socioeconomic markers attenuated this advantage to nonsignificance. Pakistani and Bangladeshi children were significantly more likely to be in the low performing group (OR = 2.23, CI: 1.61- 3.11; OR = 3.37, CI: 2.20-5.17, respectively). Socioeconomic and psychosocial factors had the strongest mediating influence on the association between lower achieving profiles and Pakistani children, whereas for Bangladeshi children, there was mediation by the home learning environment, family routines, and psychosocial factors. Conclusion: Family process and resource factors explain ethnic differences in longitudinal latent verbal profiles. Family resources explain verbal advantages for Indian children, whereas a range of home environment and socioeconomic factors explain disparities for Pakistani and Bangladeshi children. Future policy initiatives focused on reducing ethnic disparities in children's development should consider supporting and enhancing family resources and processes. [ABSTRACT FROM AUTHOR]

Context: Malnutrition in pediatric cancer is common worldwide, yet its prevalence and effects on clinical outcomes remain unclear. Objective: The aim of this review was to evaluate primary research reporting the prevalence of malnutrition in pediatric cancer patients and to assess the effects of pediatric cancer and its treatment on nutritional status. Data Sources: Electronic databases of MEDLINE, CINHAL, and PubMed were searched (January 1990-February 2013). Study Selection: Studies of patients aged <18 years who were diagnosed with and treated for cancer and for whom measurements of anthropometry were reported and included. The primary outcome was the prevalence of malnutrition (undernutrition and overnutrition), expressed as body mass index (BMI), in children diagnosed with and treated for cancer. Data Extraction: Evidence was appraised critically by employing the Critical Appraisal Skills Program tool, and data was extracted from original articles. Data Synthesis: A total of 46 studies were included, most of which were considered to be of low quality on the basis of heterogeneity in both the criteria and the measurements used to define malnutrition. Undernutrition was identified by measuring BMI, weight loss, mid-upper arm circumference, and triceps skinfold thickness, while overnutrition was assessed using BMI. Overall, the prevalence of undernutrition ranged from 0% to 65% and overnutrition from 8% to 78%. Finally, undernutrition in pediatric cancer at diagnosis was associated with poor clinical outcomes in 6 of 9 studies. Conclusion: The possibility of a high prevalence of malnutrition in childhood cancer, indicated by the studies reviewed, highlights the need for high-quality, populationbased, longitudinal studies using standard criteria to identify malnutrition. [ABSTRACT FROM AUTHOR]

Much adult physical inactivity research ignores early-life factors from which later influences may originate. In the 1958 British birth cohort (followed from 1958 to 2008), leisure-time inactivity, defined as activity frequency of less than once a week, was assessed at ages 33, 42, and 50 years (n = 12,776). Early-life factors (at ages 0–16 years) were categorized into 3 domains (i.e., physical, social, and behavioral). We assessed associations of adult inactivity 1) with factors within domains, 2) with the 3 domains combined, and 3) allowing for adult factors. At each age, approximately 32% of subjects were inactive. When domains were combined, factors associated with inactivity (e.g., at age 50 years) were prepubertal stature (5% lower odds per 1–standard deviation higher height), hand control/coordination problems (14% higher odds per 1-point increase on a 4-point scale), cognition (10% lower odds per 1–standard deviation greater ability), parental divorce (21% higher odds), institutional care (29% higher odds), parental social class at child's birth (9% higher odds per 1-point reduction on a 4-point scale), minimal parental education (13% higher odds), household amenities (2% higher odds per increase (representing poorer amenities) on a 19-point scale), inactivity (8% higher odds per 1-point reduction in activity on a 4-point scale), low sports aptitude (13% higher odds), and externalizing behaviors (i.e., conduct problems) (5% higher odds per 1–standard deviation higher score). Adjustment for adult covariates weakened associations slightly. Factors from early life were associated with adult leisure-time inactivity, allowing for early identification of groups vulnerable to inactivity. [ABSTRACT FROM PUBLISHER]

Children born after an unplanned pregnancy have poorer developmental scores. This could arise from less favorable parenting but also could reflect confounding from the socioeconomic circumstances. In a large representative sample in the United Kingdom, the Millennium Cohort Study (2001-2005), cognitive delay at 3 years was explored with the Bracken Assessment. Its association with unplanned pregnancy was studied in logistic models controlling for demographic and socioeconomic characteristics of the family, the child's characteristics, and parenting behavior. Stratification by the mother's educational level (grouped into 3 categories) was explored. Of 12,182 children included in the analysis, 41% were born after a pregnancy reported by the mother to have been a "surprise." Such unplanned pregnancies were associated in univariate analysis with more cognitive delay. Among mothers with a low or middle level of education, this association vanished when socioeconomic circumstances were controlled. Among mothers with a high level of education, the risk of cognitive delay remained significantly and unexplainedly raised after unplanned pregnancies, despite controlling for socioeconomic characteristics and parental behavior. In conclusion, for socially disadvantaged children, having resulted from an unplanned pregnancy does not seem to increase their already disproportionate risk of cognitive delay. Births after unplanned conceptions are mainly a symptom rather than a source of disadvantage. [ABSTRACT FROM AUTHOR]

Although there is increasing evidence that immune dysregulation in children who develop acute lymphoblastic leukemia (ALL) is detectable from birth, debate about the role of infectious exposures in infancy continues. With the aim of quantifying children's infectious exposures, investigators have used a number of infection exposure proxies, but there is a lack of consistency in findings, with some markers indicating increased ALL risks and others decreased risks, the disparity being evident both within and between studies. Accordingly, the authors conducted an in-depth analysis of key infection exposure proxies used in the United Kingdom Childhood Cancer Study, a national population-based case-control study conducted over the period 1991–1996, which combined data from medical records, parental interview, and population census. This longitudinal approach revealed the marked deterioration in immune response that emerged around 5 months prior to ALL diagnosis and confirmed that infectious diagnoses in the first year of life were significantly increased (P < 0.05) in children who developed leukemia between 2 and 14 years of age, as well as in those who had birth orders >1, were not breastfed, lived in deprived areas, or were diagnosed with eczema. By contrast, no association between infectious illness and preschool activity was detected, the lower infection levels among controls whose mothers reported attendance contributing to a significantly reduced ALL odds ratio. [ABSTRACT FROM PUBLISHER]

Objectives. Our aim was to describe clinical features and pattern of care in children with localized scleroderma presenting to secondary care during a 25-month incidence study.Methods. Eighty-seven patients were identified, and clinical features, serum autoantibodies, current treatment and outcome at 12 months were documented.Results. Fifty-eight (67%) had linear scleroderma, 25 (29%) non-linear morphoea and 4 (4%) a mixed pattern. Of the 58 patients with linear scleroderma, 29 (50%) presented with lesions of the trunk and/or limbs only, 26 (45%) with face–head localization only and 3 (5%) with both. Thirteen (15%) had extracutaneous features and 16 (43%) out of 37 were ANA positive. At 12 months, 59% were on MTX. At 12 months, 51 (65%) were improved/resolved, 14 (18%) were unchanged and 13 (17%) had deteriorated.Conclusion. Key findings included the high prevalence of face–head involvement in those with linear disease, and the high prevalence of extracutaneous disease and of ANA positivity. After 12 months, most patients improved according to clinician's opinion. [ABSTRACT FROM PUBLISHER]

Background: Evidence on the correlates of objectively measured physical activity and sedentary behaviour in childhood is limited. This study aimed to identify correlates of physical activity and sedentary behaviour among 7-year-old children in England. Methods: Physical activity was measured using Actigraph accelerometry in 480 participants as part of the Gateshead Millennium Study during 2006–07. Twenty-two potential correlates across five domains (demographic and biological; psychological, cognitive and emotional; behavioural; social and cultural; physical environmental) were tested for associations with total volume of habitual physical activity, moderate–vigorous intensity physical activity (MVPA) and sedentary behaviour. Multiple linear regression analysis was used. Results: Seven correlates, including four that are potentially modifiable, were significantly associated with total physical activity, MVPA and sedentary behaviour in final models: gender, child weight status, maternal age, child interest in active play, active commuting to school, parenting practice and season. Four of these variables were significantly associated with all three constructs in final models. The final models explained 18, 18 and 24% of variance in total volume of physical activity, MVPA and sedentary behaviour, respectively. Conclusion: A number of potentially modifiable factors are associated with increased physical activity and/or reduced sedentary behaviour in English children. These could be valuable targets of future interventions. [ABSTRACT FROM PUBLISHER]

Background: Since 2006, banning smoking in cars with children has become a rapidly growing tobacco control policy. However, to date, there have been few studies examining support and correlates of support for car smoking bans, and none of the existing studies have been international in nature. We conducted such a study among smokers in four countries. Methods: 6716 adult current smokers from the 2007 Wave of the International Tobacco Control Four Country Survey, a nationally representative, longitudinal cohort telephone survey of smokers in the USA, Canada, UK and Australia. Controlling for demographics, heaviness of smoking, smoking health knowledge/beliefs and quit intentions, we compared support and correlates of support for banning smoking in cars with children across the four countries. Results: The majority of smokers supported banning smoking in cars with children. Support was highest in Australia (83%), followed by the UK (75%) and Canada (74%); support was lower—but still high—in the USA (60%). Support was highest among smokers who: had stronger quit intentions, were lighter smokers, had lower education, had no children in the home, believed that cigarette smoke is dangerous to non-smokers and could cause asthma in children, and were concerned about modelling smoking to children. Conclusions: These findings indicate that a majority of smokers in the four countries support banning smoking in cars with children, and lend support to banning smoking in cars with children. Additionally, they suggest that support may be increased by educating smokers about the dangers of cigarette smoke exposure. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding a study that described children's and parents beliefs about childhood scleroderma using the Revised Illness Perceptions Questionnaire (IPQ-R).