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Abstract Background Although prior studies have demonstrated that children with high levels of fundamental movement skill (FMS) are more active throughout the day, little is known about children’s FMS and their physical activity (PA) during different segments of the school day (e.g., recess, lunch break, and physical education). The present study focused on FMS and moderate-to-vigorous PA (MVPA) during school day and identifies the association between children’s FMS and MVPA during different segments of the school day in China. Methods A total of 322 children (boys n = 163, girls n = 159; Mage = 8.12, SD = 1.22 years) from four elementary schools involved in this study. Children’s FMS and MVPA were measured using the Test of Gross Motor Development-2nd edition (TGMD-2) and hip-mounted accelerometers. Data such as height, weight, and socio-economic status (SES) were also obtained. Multilevel mixed regression models were used to examine the cross-sectional associations between FMS and MVPA. Models were adjusted for gender, age, standardized body mass index, and SES. Results Children engaged in 32.19 min of MVPA during the whole school day. Boys were more active than girls and had higher object-control skills competency. Locomotor skills were positively associated with children’s long recess (B = 1.063) and short recess time (B = 1.502) MVPA. Object-control skills were positively correlated with children’s MVPA time during long recess (B = 1.244) and physical education (PE) lessons (B = 1.171). Conclusion The findings highlight the importance of developing both locomotor and object-control skills in elementary schools to lead more MVPA engagement during different segments of the school day.

Abstract Background Globally, families experience challenges caring for and raising children with intellectual disability (ID). Family caregivers in rural states are mostly known for lacking support resources, including information on understanding the care of ID. Lack of adequate information on understanding of ID compromises the provision of life-long care and support of the children with ID’s physical, emotional, psychological and social developmental well-being. The study aimed to explore the information needs of family caregivers regarding the care of children with ID in rural areas of Limpopo Province, South Africa. Methods This qualitative explorative research conducted 16 in-depth individual interviews and one focus group discussion with ten family members. The participants shared their experiences of raising children with ID in rural communities. Inductive thematic analysis using Atlas Ti software categorised emerging themes and subthemes of this study from merged data sets on information needs regarding the care of children with ID among family caregivers. Results The findings highlighted the need for information regarding ID care among family caregivers raising children with ID in the home environment. The information challenges experienced by family caregivers include caring for the challenging behaviour of children with ID and available support resources and services for the children and their families. These challenges impact the care and support required to meet the developmental needs of children with ID. Furthermore, inadequate information on ID among family caregivers in rural communities with a lack of resources restricts the children from accessing required support services. Conclusions Given the information challenges these families face on ID, the stakeholders must develop continuous training programmes that will equip, empower, and further monitor ID care and management among family caregivers to enhance care and the raising of children with dignity.

Abstract Background Many adolescents experience depression that often goes undetected and untreated. Identifying children and adolescents at a high risk of depression in a timely manner is an urgent concern. While the Children’s Depression Inventory (CDI) is widely utilized in China, it lacks a localized revision or simplified version. With its 27 items requiring professional administration, the original CDI proves to be a time-consuming method for predicting children and adolescents with high depression risk. Hence, this study aimed to develop a shortened version of the CDI to predict high depression risk, thereby enhancing the efficiency of prediction and intervention. Methods Initially, backward elimination is conducted to identify various version of the short-form scales (e.g., three-item and five-item versions). Subsequently, the performance of five machine learning (ML) algorithms on these versions is evaluated using the area under the ROC curve (AUC) to determine the best algorithm. The chosen algorithm is then utilized to model the short-form scales, facilitating the identification of the optimal short-form scale based on predefined evaluation metrics. Following this, evaluation metrics are computed for all potential decision thresholds of the optimal short-form scale, and the threshold value is determined. Finally, the reliability and validity of the optimal short-form scale are assessed using a new sample. Results The study identified a five-item short-form CDI with a decision threshold of 4 as the most appropriate scale considering all assessment indicators. The scale had 81.48% fewer items than the original version, indicating good predictive performance (AUC = 0.81, Accuracy = 0.83, Recall = 0.76, Precision = 0.71). Based on the test of 315 middle school students, the results showed that the five-item CDI had good measurement indexes (Cronbach’s alpha = 0.72, criterion-related validity = 0.77). Conclusions This five-item short-form CDI is the first shortened and revised version of the CDI in China based on large local data samples.

Abstract Background Physical activity (PA) promotes health in adults as well as children. At the same time, a large proportion of children do not meet the recommendations for PA, and more school-based efforts to increase PA are needed. This study investigates the effectiveness and feasibility of lesson-integrated PA in a Swedish primary school. Methods We evaluate a new method called ‘Physical Activity and Lesson in Combination’ (abbreviated FALK in Swedish) using a mixed methods approach; a quasi-experimental study followed by qualitative interviews. Two schools participated in the study, one constituting the intervention group (I-school, n = 83) and the other the control group (C-school, n = 81). In addition to regular physical education, the I-school had three 30-minute FALK lessons each week. A total of 164 students aged 7–9 years wore pedometers for a whole week, four times over two semesters, and the number of steps per day (SPD) and the proportion of students with

Abstract Background There is limited evidence of the associations between postural-derived sitting time, waist-worn derived sedentary time and children’s health and the moderation effect of physical activity (PA). This study examined associations of children’s device-measured sitting time with cardiometabolic health risk factors, including moderation by physical activity. Methods Cross-sectional baseline data from children (mean-age 8.2 ± 0.5 years) in Melbourne, Australia (2010) participating in the TransformUs program were used. Children simultaneously wore an activPAL to assess sitting time and an ActiGraph GT3X to assess sedentary time and physical activity intensity. Cardiometabolic health risk factors included: adiposity (body mass index [BMI], waist circumference [WC]), systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, triglycerides, fasting plasma glucose (FPG), serum insulin, and 25-hydroxyvitaminD (25[OH]D). Linear regression models (n = 71–113) assessed associations between sitting time with each health risk factor, adjusted for different PA intensities (i.e. light [LIPA], moderate-vigorous intensities [MVPA], separately on each model), age, sex, adiposity, and clustering by school. Interaction terms examined moderation. The analyses were repeated using device-measured sedentary time (i.e. ActiGraph GT3X) for comparison. Results Sitting time was positively associated with SBP (b = 0.015; 95%CI: 0.004, 0.026), DBP (b = 0.012; 95%CI:0.004, 0.020), and FPG (b = 0.001; 95%CI: 0.000, 0.000), after adjusting for higher PA intensities. The association between sitting time and insulin (b = 0.003; 95%CI: 0.000, 0.006) was attenuated after adjusting for higher PA intensities. When the models were adjusted for LIPA and MVPA, there was a negative association with LDL (b=-0.001; 95%CI: -0.002, -0.000 and b=-0.001; 95%CI: -0.003, -0.000, respectively). There was a negative association of sedentary time with WCz (b=-0.003; 95%CI: -0.005, 0.000) and BMIz (b=-0.003; 95%CI: -0.006, -0.000) when the models were adjusted by MVPA. Sedentary time was positively associated with triglycerides (b = 0.001; 95%CI: 0.000, 0.001) but attenuated after adjusting for MVPA. No evidence of moderation effects was found. Conclusions Higher volumes of sitting and sedentary time were associated with some adverse associations on some cardiometabolic health risk factors in children. These associations were more evident when sitting time was the predictor. This suggests that reducing time spent sitting may benefit some cardiometabolic health outcomes, but future experimental research is needed to confirm causal relationships and identify the biological mechanisms that might be involved. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12609000715279.

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the neurodevelopment of children. However, the precise effects of the virus and the social consequences of the pandemic on pediatric neurodevelopment are not yet fully understood. We aimed to compare the neurodevelopment of children between before and during the COVID-19 pandemic, as well as examine the impact of socioeconomic status (SES) and regional differences on the development. Methods The study used the Korean Developmental Screening Test to compare the difference in the risk of neurodevelopmental delay between before and during the COVID-19 pandemic. Multivariable logistic regression analysis was conducted to identify the relationship between experiencing the COVID-19 pandemic and the risk of neurodevelopmental delay. Stratified analyses were performed to determine whether the developmental delays caused by the pandemic’s impact varied depending on SES or regional inequality. Results This study found an association between the experience of COVID-19 and a higher risk of neurodevelopmental delay in communication (adjusted OR [aOR]: 1.21, 95% confidence interval [CI]: 1.19, 1.22; P-value: < 0.0001) and social interaction (aOR: 1.15, 95% CI: 1.13, 1.17; P-value: < 0.0001) domains among children of 30–36 months’ ages. Notably, the observed association in the Medicaid group of children indicates a higher risk of neurodevelopmental delay compared to those in the non-Medicaid group. Conclusions These findings highlight the need to be concerned about the neurodevelopment of children who experienced the COVID-19 pandemic. The study also calls for increased training and support for Medicaid children, parents, teachers, and healthcare practitioners. Additionally, policy programs focused on groups vulnerable to developmental delays are required.

Abstract Background Increasing health literacy (HL) in children could be an opportunity for a more health literate future generation. The aim of this scoping review is to provide an overview of how HL is conceptualized and described in the context of health promotion in 9–12-year-old children. Methods A systematic and comprehensive search for ‘health literacy’ and ‘children’ and ‘measure’ was performed in accordance with PRISMA ScR in PubMed, Embase.com and via Ebsco in CINAHL, APA PsycInfo and ERIC. Two reviewers independently screened titles and abstracts and evaluated full-text publications regarding eligibility. Data was extracted systematically, and the extracted descriptions of HL were analyzed qualitatively using deductive analysis based on previously published HL definitions. Results The search provided 5,401 original titles, of which 26 eligible publications were included. We found a wide variation of descriptions of learning outcomes as well as competencies for HL. Most HL descriptions could be linked to commonly used definitions of HL in the literature, and some combined several HL dimensions. The descriptions varied between HL dimensions and were not always relevant to health promotion. The educational setting plays a prominent role in HL regarding health promotion. Conclusion The description of HL is truly diverse and complex encompassing a wide range of topics. We recommend adopting a comprehensive and integrated approach to describe HL dimensions, particularly in the context of health promotion for children. By considering the diverse dimensions of HL and its integration within educational programs, children can learn HL skills and competencies from an early age.

Abstract Background Active commuting to school can be a meaningful contributor to overall physical activity in children. To inform better micro-level urban design near schools that can support active commuting to school, there is a need for measures that capture these elements. This paper describes the adaptation of an observational instrument for use in assessing micro-scale environments around urban elementary schools in the United States. Methods The Micro-scale Audit of Pedestrian Streetscapes for Safe Routes to School (MAPS-SRTS) was developed from existing audit instruments not designed for school travel environments and modifications for the MAPS-SRTS instrument include the structure of the audit tool sections, the content, the observation route, and addition of new subscales. Subscales were analyzed for inter-rater reliability in a sample of 36 schools in Austin, TX. To assess reliability for each subscale, one-way random effects single-measure intraclass correlation coefficients (ICC) were used. Results Compared to the 30 original subscales, the adapted MAPS-SRTS included 26 (86.6%) subscales with revised scoring algorithms. Most MAPS-SRTS subscales had acceptable inter-rater reliability, with an ICC of 0.97 for the revised audit tool. Conclusions The MAPS-SRTS audit tool is a reliable instrument for measuring the school travel environment for research and evaluation purposes, such as assessing human-scale determinants of active commuting to school behavior and documenting built environment changes from infrastructure interventions.

Abstract Background Environmentally sustainable food initiatives accompanying nutrition education, such as the Food Education and Sustainability Training (FEAST) program, have gained traction in school settings. The aim of this trial was to conduct an impact and process evaluation of FEAST, to evaluate its effect on children’s fruit and vegetable (F&V) intakes, and secondary outcomes: F&V variety consumed, nutrition knowledge, food preparation/cooking skills, self-efficacy and behaviours, food waste knowledge and behaviours, and food production knowledge. Methods FEAST was a 10-week curriculum-aligned program, designed to educate children about healthy eating, food waste, and sustainability, while teaching cooking skills. It was implemented by classroom teachers, face-to-face and online, during COVID-19 school closures, in Australia in 2021. A custom designed survey was used to collect baseline and post-intervention data from students. Generalised linear mixed models (GLMM) estimated group differences in pre-post changes for primary and secondary outcomes. Surveys were also administered to students and teachers to evaluate intervention implementation. Results Twenty schools participated and self-selected to be either intervention schools (n = 10) or wait-list control (WLC) schools (n = 10). A total of 977, 5th and 6th grade children participated in the trial with a mean age of 11.1 years (SD ± 0.7). The FEAST intervention, compared to WLC, did not result in significant increases in primary outcomes nor secondary outcomes. The process evaluation revealed FEAST was well-received by students and teachers, but COVID-19 school closures hindered implementation fidelity with a less intense program delivered under the constraints of pandemic lockdowns. Conclusions This is the first cluster non-randomized controlled trial designed to independently evaluate FEAST in the primary-school setting. No evidence was found for improved F&V intakes in children, nor secondary outcomes. However, the positive process evaluation results suggest that further trials of the program are warranted. If implemented as originally designed (pre-pandemic), with increased duration and complemented by supporting school policies, such programs have the potential to improve children’s daily F&V intakes, cooking skills and food waste behaviours. This would support the Australian curriculum and contribute to: health promotion within schools and sustainable schools initiatives, the national agenda to reduce food waste and sustainable development goals. Australian and New Zealand Clinical Trials Registry [ACTRN12620001347954]- Registered prospectively on 14/12/2020.

Background: Globally, families experience challenges caring for and raising children with intellectual disability (ID). Family caregivers in rural states are mostly known for lacking support resources, including information on understanding the care of ID. Lack of adequate information on understanding of ID compromises the provision of life-long care and support of the children with ID's physical, emotional, psychological and social developmental well-being. The study aimed to explore the information needs of family caregivers regarding the care of children with ID in rural areas of Limpopo Province, South Africa. Methods: This qualitative explorative research conducted 16 in-depth individual interviews and one focus group discussion with ten family members. The participants shared their experiences of raising children with ID in rural communities. Inductive thematic analysis using Atlas Ti software categorised emerging themes and subthemes of this study from merged data sets on information needs regarding the care of children with ID among family caregivers. Results: The findings highlighted the need for information regarding ID care among family caregivers raising children with ID in the home environment. The information challenges experienced by family caregivers include caring for the challenging behaviour of children with ID and available support resources and services for the children and their families. These challenges impact the care and support required to meet the developmental needs of children with ID. Furthermore, inadequate information on ID among family caregivers in rural communities with a lack of resources restricts the children from accessing required support services. Conclusions: Given the information challenges these families face on ID, the stakeholders must develop continuous training programmes that will equip, empower, and further monitor ID care and management among family caregivers to enhance care and the raising of children with dignity. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) promotes health in adults as well as children. At the same time, a large proportion of children do not meet the recommendations for PA, and more school-based efforts to increase PA are needed. This study investigates the effectiveness and feasibility of lesson-integrated PA in a Swedish primary school. Methods: We evaluate a new method called ‘Physical Activity and Lesson in Combination’ (abbreviated FALK in Swedish) using a mixed methods approach; a quasi-experimental study followed by qualitative interviews. Two schools participated in the study, one constituting the intervention group (I-school, n = 83) and the other the control group (C-school, n = 81). In addition to regular physical education, the I-school had three 30-minute FALK lessons each week. A total of 164 students aged 7–9 years wore pedometers for a whole week, four times over two semesters, and the number of steps per day (SPD) and the proportion of students with < 10,000 SPD were compared. Statistical differences between the schools were tested with ANOVA, Chi2, t-tests, and ANCOVA. Interviews with students (n = 17), parents (n = 9) and teachers (n = 9) were conducted and analysed using qualitative content analysis. Results: The results show that FALK led to the I-school getting more SPD and fewer students with < 10,000 SPD. Also, FALK was experienced as a positive, clear, and flexible method, simultaneously encouraging PA and learning. Challenges experienced concerned the teachers’ work situation, time, finding suitable learning activities, outdoor school environment changes, and extreme weather conditions. Conclusions: This study indicates that FALK has the desired effects on PA and is a feasible method of integrating PA into theoretical teaching. We conclude that FALK is worth testing at more schools, given that implementation and sustainment of FALK considers both general enablers and barriers, as well as context-specific factors at the individual school. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence of the associations between postural-derived sitting time, waist-worn derived sedentary time and children's health and the moderation effect of physical activity (PA). This study examined associations of children's device-measured sitting time with cardiometabolic health risk factors, including moderation by physical activity. Methods: Cross-sectional baseline data from children (mean-age 8.2 ± 0.5 years) in Melbourne, Australia (2010) participating in the TransformUs program were used. Children simultaneously wore an activPAL to assess sitting time and an ActiGraph GT3X to assess sedentary time and physical activity intensity. Cardiometabolic health risk factors included: adiposity (body mass index [BMI], waist circumference [WC]), systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, triglycerides, fasting plasma glucose (FPG), serum insulin, and 25-hydroxyvitaminD (25[OH]D). Linear regression models (n = 71–113) assessed associations between sitting time with each health risk factor, adjusted for different PA intensities (i.e. light [LIPA], moderate-vigorous intensities [MVPA], separately on each model), age, sex, adiposity, and clustering by school. Interaction terms examined moderation. The analyses were repeated using device-measured sedentary time (i.e. ActiGraph GT3X) for comparison. Results: Sitting time was positively associated with SBP (b = 0.015; 95%CI: 0.004, 0.026), DBP (b = 0.012; 95%CI:0.004, 0.020), and FPG (b = 0.001; 95%CI: 0.000, 0.000), after adjusting for higher PA intensities. The association between sitting time and insulin (b = 0.003; 95%CI: 0.000, 0.006) was attenuated after adjusting for higher PA intensities. When the models were adjusted for LIPA and MVPA, there was a negative association with LDL (b=-0.001; 95%CI: -0.002, -0.000 and b=-0.001; 95%CI: -0.003, -0.000, respectively). There was a negative association of sedentary time with WCz (b=-0.003; 95%CI: -0.005, 0.000) and BMIz (b=-0.003; 95%CI: -0.006, -0.000) when the models were adjusted by MVPA. Sedentary time was positively associated with triglycerides (b = 0.001; 95%CI: 0.000, 0.001) but attenuated after adjusting for MVPA. No evidence of moderation effects was found. Conclusions: Higher volumes of sitting and sedentary time were associated with some adverse associations on some cardiometabolic health risk factors in children. These associations were more evident when sitting time was the predictor. This suggests that reducing time spent sitting may benefit some cardiometabolic health outcomes, but future experimental research is needed to confirm causal relationships and identify the biological mechanisms that might be involved. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12609000715279. [ABSTRACT FROM AUTHOR]

Background: Active commuting to school can be a meaningful contributor to overall physical activity in children. To inform better micro-level urban design near schools that can support active commuting to school, there is a need for measures that capture these elements. This paper describes the adaptation of an observational instrument for use in assessing micro-scale environments around urban elementary schools in the United States. Methods: The Micro-scale Audit of Pedestrian Streetscapes for Safe Routes to School (MAPS-SRTS) was developed from existing audit instruments not designed for school travel environments and modifications for the MAPS-SRTS instrument include the structure of the audit tool sections, the content, the observation route, and addition of new subscales. Subscales were analyzed for inter-rater reliability in a sample of 36 schools in Austin, TX. To assess reliability for each subscale, one-way random effects single-measure intraclass correlation coefficients (ICC) were used. Results: Compared to the 30 original subscales, the adapted MAPS-SRTS included 26 (86.6%) subscales with revised scoring algorithms. Most MAPS-SRTS subscales had acceptable inter-rater reliability, with an ICC of 0.97 for the revised audit tool. Conclusions: The MAPS-SRTS audit tool is a reliable instrument for measuring the school travel environment for research and evaluation purposes, such as assessing human-scale determinants of active commuting to school behavior and documenting built environment changes from infrastructure interventions. [ABSTRACT FROM AUTHOR]

Background: In Chad, malaria remains a significant public health concern, particularly among nomadic populations. Geographical factors and the mobility of human populations have shown to be associated with the diversity of Plasmodium species. The study aims to describe the malaria prevalence among nomadic children and to investigate its associated factors. Methods: A cross-sectional study was conducted in February and October 2021 among nomadic communities in Chad. Blood sample were collected and tested from 187 Arab, Fulani and Dazagada nomadic children aged 3–59 months using malaria rapid diagnostic test (RDT). A structured electronic questionnaire was administered to their parents to collect information about the socio‑economic data. Malaria testing results were categorized according to the SD BIOLINE Malaria Ag Pf/Pan RDT procedures. Logistic regression analysis was used to determine key risk factors explaining the prevalence of malaria. STATA version IC 13 was used for statistical analysis. Results: The overall malaria prevalence in nomadic children was 24.60%, with 65.20% being Plasmodium falciparum species and 34.8% mixed species. Boys were twice as likely (COR = 1.83; 95% CI, 0.92–3.62; p = 0.083) to have malaria than girls. Children whose parents used to seek traditional drugs were five times more likely (AOR = 5.59; 95% CI, 1.40–22.30, p = 0.015) to have malaria than children whose parents used to seek health facilities. Children whose parents reported spending the last night under a mosquito net were one-fifth as likely (AOR = 0.17; 95% CI, 0.03–0.90, p = 0.037) to have malaria compared to children whose parents did not used a mosquito net. Furthermore, Daza children were seventeen times (1/0.06) less likely (AOR = 0.06; 95% CI, 0.01–0.70, p = 0.024) to have malaria than Fulani children and children from households piped water as the main source were seven times more likely (AOR = 7.05; 95% CI, 1.69–29.45; p = 0.007) to have malaria than those using surface water. Conclusions: Malaria remains a significant public health issue in the nomadic communities of Chad. Community education and sensitization programs within nomad communities are recommended to raise awareness about malaria transmission and control methods, particularly among those living in remote rural areas. The National Malaria Control Program (NMCP) should increase both the coverage and use of long-lasting insecticidal nets (LLINs) and seasonal malaria chemoprevention (SMC) in addition to promoting treatment-seeking behaviors in nomadic communities. [ABSTRACT FROM AUTHOR]

Background: Increasing health literacy (HL) in children could be an opportunity for a more health literate future generation. The aim of this scoping review is to provide an overview of how HL is conceptualized and described in the context of health promotion in 9–12-year-old children. Methods: A systematic and comprehensive search for 'health literacy' and 'children' and 'measure' was performed in accordance with PRISMA ScR in PubMed, Embase.com and via Ebsco in CINAHL, APA PsycInfo and ERIC. Two reviewers independently screened titles and abstracts and evaluated full-text publications regarding eligibility. Data was extracted systematically, and the extracted descriptions of HL were analyzed qualitatively using deductive analysis based on previously published HL definitions. Results: The search provided 5,401 original titles, of which 26 eligible publications were included. We found a wide variation of descriptions of learning outcomes as well as competencies for HL. Most HL descriptions could be linked to commonly used definitions of HL in the literature, and some combined several HL dimensions. The descriptions varied between HL dimensions and were not always relevant to health promotion. The educational setting plays a prominent role in HL regarding health promotion. Conclusion: The description of HL is truly diverse and complex encompassing a wide range of topics. We recommend adopting a comprehensive and integrated approach to describe HL dimensions, particularly in the context of health promotion for children. By considering the diverse dimensions of HL and its integration within educational programs, children can learn HL skills and competencies from an early age. [ABSTRACT FROM AUTHOR]

Background: Environmentally sustainable food initiatives accompanying nutrition education, such as the Food Education and Sustainability Training (FEAST) program, have gained traction in school settings. The aim of this trial was to conduct an impact and process evaluation of FEAST, to evaluate its effect on children's fruit and vegetable (F&V) intakes, and secondary outcomes: F&V variety consumed, nutrition knowledge, food preparation/cooking skills, self-efficacy and behaviours, food waste knowledge and behaviours, and food production knowledge. Methods: FEAST was a 10-week curriculum-aligned program, designed to educate children about healthy eating, food waste, and sustainability, while teaching cooking skills. It was implemented by classroom teachers, face-to-face and online, during COVID-19 school closures, in Australia in 2021. A custom designed survey was used to collect baseline and post-intervention data from students. Generalised linear mixed models (GLMM) estimated group differences in pre-post changes for primary and secondary outcomes. Surveys were also administered to students and teachers to evaluate intervention implementation. Results: Twenty schools participated and self-selected to be either intervention schools (n = 10) or wait-list control (WLC) schools (n = 10). A total of 977, 5th and 6th grade children participated in the trial with a mean age of 11.1 years (SD ± 0.7). The FEAST intervention, compared to WLC, did not result in significant increases in primary outcomes nor secondary outcomes. The process evaluation revealed FEAST was well-received by students and teachers, but COVID-19 school closures hindered implementation fidelity with a less intense program delivered under the constraints of pandemic lockdowns. Conclusions: This is the first cluster non-randomized controlled trial designed to independently evaluate FEAST in the primary-school setting. No evidence was found for improved F&V intakes in children, nor secondary outcomes. However, the positive process evaluation results suggest that further trials of the program are warranted. If implemented as originally designed (pre-pandemic), with increased duration and complemented by supporting school policies, such programs have the potential to improve children's daily F&V intakes, cooking skills and food waste behaviours. This would support the Australian curriculum and contribute to: health promotion within schools and sustainable schools initiatives, the national agenda to reduce food waste and sustainable development goals. Australian and New Zealand Clinical Trials Registry: [ACTRN12620001347954]- Registered prospectively on 14/12/2020. [ABSTRACT FROM AUTHOR]

Abstract Background The first 3 years of life are a critical period for the development of socio-emotional skills, highlighting the importance of socio-emotional development in early childhood. This study aimed to evaluate the effectiveness of a health promotion intervention program on the socio-emotional development of children aged 12 to 42 months during the COVID-19 pandemic. Methods A total of 344 children from 15 childcare centers participated in this study, with six centers in the intervention group and nine in the control group. Childcare teachers in the intervention group received a 6-month training program aimed at promoting healthy lifestyles, including topics such as diet, sleep, physical activity, and sedentary behavior. Sociodemographic and anthropometric measures were assessed at baseline, and socio-emotional development was assessed using the Bayley Scales of Infant and Toddler Development – Third Edition (Bayley-III) at baseline and post-intervention. Results After the intervention, a significant difference in socio-emotional development was observed between children with mothers of varying education levels. Specifically, children whose mothers had lower education levels demonstrated significantly greater socio-emotional development (B = 19.000, p = 0.028) compared to the control group. In contrast, there was no significant difference in socio-emotional development among children with mothers from higher education levels. Conclusion These findings suggest that intervention programs for childcare teachers can effectively promote healthy socio-emotional development in children from socioeconomically disadvantaged backgrounds. Future intervention programs should consider tailoring their approaches to target disadvantaged populations. Trial registration This cluster randomized controlled trial was registered in the Clinical Trials database/platform on 09/09/2019 (number NCT04082247).

Abstract Background Although studies have indicated that extreme temperature is strongly associated with respiratory diseases, there is a dearth of studies focused on children, especially in China. We aimed to explore the association between extreme temperature and children’s outpatient visits for respiratory diseases and seasonal modification effects in Harbin, China. Methods A distributed lag nonlinear model (DLNM) was used to explore the effect of extreme temperature on daily outpatient visits for respiratory diseases among children, as well as lag effects and seasonal modification effects. Results Extremely low temperatures were defined as the 1st percentile and 2.5th percentile of temperature. Extremely high temperatures were defined as the 97.5th percentile and 99th percentile of temperature. At extremely high temperatures, both 26 °C (97.5th) and 27 °C (99th) showed adverse effects at lag 0–6 days, with relative risks (RRs) of 1.34 [95% confidence interval (CI): 1.21–1.48] and 1.38 (95% CI: 1.24–1.53), respectively. However, at extremely low temperatures, both − 26 °C (1st) and − 23 °C (2.5th) showed protective effects on children’s outpatient visits for respiratory diseases at lag 0–10 days, with RRs of 0.86 (95% CI: 0.76–0.97) and 0.85 (95% CI: 0.75–0.95), respectively. We also found seasonal modification effects, with the association being stronger in the warm season than in the cold season at extremely high temperatures. Conclusions Our study indicated that extremely hot temperatures increase the risk of children’s outpatient visits for respiratory diseases. Efforts to reduce the exposure of children to extremely high temperatures could potentially alleviate the burden of pediatric respiratory diseases, especially during the warm season.

Abstract Background Chronic malnutrition is a condition associated with negative impacts on physical and cognitive development. It is multi-causal and can start very early in life, already in utero, thus it is especially challenging to find appropriate interventions to tackle it. The government of Angola is implementing a standard of care program with potential to prevent it, and the provision of cash transfers and the supplementation with small quantity lipid-based nutrients (SQ-LNS) are also promising interventions. We aimed to evaluate the impact of the standard of care program alone and of the standard of care plus a cash transfer intervention in the lineal growth of children less than 2 years old and compare it to the effectiveness of a nutrition supplementation plus standard of care program in Southern Angola. Methods/design The three-arm parallel cluster randomised controlled trial is set in four communes of Huila and Cunene provinces. Clusters are villages or neighbourhoods with a population around 1075 people. A total of twelve clusters were selected per arm and forty pregnant women are expected to be recruited in each cluster. Pregnant women receive the standard of care alone, or the standard of care plus unconditional cash transfer or plus nutritional supplementation during the first 1000 days, from pregnancy to the child reaching 24 months. The primary outcome is the prevalence of stunting measured as height-for-age Z-score (HAZ) < -2 in children below 2 years. Impact will be assessed at 3, 6, 12, 18 and 24 months of children’s age. Secondary outcomes include mortality, morbidity, caring, hygiene and nutrition behaviours and practices, and women and children’s dietary diversity. Quantitative data are also collected on women’s empowerment, household food security, expenditure and relevant clinical and social events at baseline, endline and intermediate time points. Discussion The results will provide valuable information on the impact of the standard of care intervention alone as well as combined with an unconditional cash transfer intervention compared to a nutrition supplementation plus standard of care intervention, carried out during the first 1000 days, in the children´s growth up to 2 years and related outcomes in Southern Angola. Trial registration Clinical Trials NCT05571280. Registered 7 October 2022.

Abstract Background Families’ understanding towards oral health problems among young children is poorly studied. More insight into parents’ experiences, especially of those living in disadvantaged neighbourhoods, is needed to address persistent oral health inequalities. This qualitative study aims to explore parental perspectives on children’s oral health (≤ 4 years) and the opportunities they see to improve children’s oral health. Methods Forty-seven mothers and five fathers with different migration backgrounds from a disadvantaged neighbourhood in Amsterdam, the Netherlands, participated in our study. Semi-structured interviews (n = 27), participant observations (n = 7) and one focus group discussion were conducted. A thematic data analysis was used. Results Parents describe their daily life with young children as busy, hectic and unpredictable. Parents seem to be most concerned about parenting. Mothers, in particular, feel fully responsible for raising their children and managing daily complexities. While most parents value their children’s oral health, they all experience challenges. Parents find it hard to limit daily candy intake and to handle unwilling children during tooth brushing. They feel limited support for these issues from their household, social network and professionals. Conclusion Parental struggles in children’s oral health are complex and interrelated as they occur across family, societal, community and professional levels. Given the complex daily reality of families with young children, establishing and maintaining healthy oral health habits seems not at the top of parents’ minds. They ask for advice in the upbringing of their children backed up by social support, increased attention to children’s oral health within the community and professional assistance. Collaborating with parents as knowledgeable partners might be the first step in acting upon the endeavour to address oral health inequality among young children.

Abstract Background Stunting in children is the term for reduced linear growth and development, which is frequently brought on by a persistently inadequate diet, recurrent infections and chronic diseases or poor health conditions. Apart from the classic covariates of stunting, which include diet and illness, the relative contribution of household air pollution to chronic nutrition conditions is least studied. Hence, this study is conducted to investigate the impact of household air pollution on the linear growth of under-five children in Jimma town, Ethiopia. Methods A prospective cohort study was employed to collect data from 280 under-five children who lived in households using solid fuel (exposed group, n = 140) and clean fuel (unexposed group, n = 140). Height-for-age Z scores were compared in both groups over a 12-month follow-up period. The difference in differences estimators were used for comparison of changes in the height-for-age Z scores from baseline to end line in exposed and non-exposed groups. The independent effect of the use of solid fuels on height-for-age Z scores was analyzed through a multivariable linear regression model. Statistical Significances were declared at P

Abstract Background An increased risk of cardiovascular diseases (CVD) has been associated with women’s parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association. Methods The study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders. Results CVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02–1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10–1.83; and HR = 1.39, 95% CI: 1.03–1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed. Conclusions Taken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded.

Abstract Background Pertussis is a highly contagious and dangerous respiratory disease that threatens children’s health in many countries, including Vietnam, despite vaccine coverage. From 2015 to 2018, Vietnam experienced an increasing number of pertussis patients. Therefore, this study aimed to investigate the trend and examine the seasonal variations of pertussis in North Vietnam. Methods Data were collected from medical records of all under-5-year-old inpatients admitted to the National Children’s Hospital in Hanoi, Vietnam (VNCH) 2015–2018. A descriptive analysis was performed to describe the distribution of incident cases by year and season. Linear multivariable regression was conducted to investigate the association between the incidence of cases and seasonality adjusted by age and vaccination status. Results We identified 1063 laboratory-confirmed patients during 2015–2018, including 247 (23.2%) severe patients. The number of pertussis patients admitted to VNCH per 1000 hospitalizations was 3.2 in 2015, compared to 1.9, 3.1, and 2.1 in 2016, 2017, and 2018, respectively. Outbreaks occurred biennially; however, there was no significant difference in the number of severe patients over this period. Most cases occurred in the hot season (509 patients, or nearly half of the study population). With the adjustment of the vaccination rate and average age, the risk of pertussis-associated hospitalization in the mild season and the hot season was 21% (95% CI [0.12; 0.3]) and 15% (95% CI [0.05; 0.25]) higher than that in the warm season, respectively. The rate of hospitalizations was high in the mild season (28.9%) and the warm season (30.8%), nearly twice as much as that in the hot season; nevertheless, the death rate was only striking high in the mild season, about 5–6 times as much as those in the other seasons. Conclusion The pertussis incidence in Northern Vietnam varied between seasons, peaking in the hot season (April-July). However, severe patients and deaths increased in the mild season (December-March). Interventions, for example, communication activities on pertussis and vaccination, are of immense importance in lowering the prevalence of pertussis. In addition, early diagnoses and early warnings performed by health professionals should be encouraged.

Abstract Background Cooking and consuming a homemade meal is associated with health benefits. Home-delivered meal boxes can support families in cooking this fresh meal. The current study aimed to gain a deeper understanding of the determinants of meal box use, and of the perceived impact on meal practices of parents with younger (i.e., aged 6–12 years) and older children (i.e., 13–18 years). Methods Four focus groups were conducted (n = 19); two with parents of younger children, and two with parents of older children. A semi-structured interview guide was developed and interviews were recorded and transcribed. Reflexive thematic analysis was performed using NVivo 1.4. Results Most parents mentioned practical reasons like saving time and money, as well as inspiration, as reasons to choose a home-delivered meal box. Also, tastiness and menu variation were often mentioned as determining factors by both parent groups. However, a few parents stated to stop using the meal boxes because of returning menus or too small portion sizes. Meal box providers were chosen based on the price, the freshness and the quality of the products. Moreover, positive effects on parents’ perceived cooking skills and knowledge were reported. Also, some parents mentioned positively changed attitudes towards vegetarian dishes. Lastly, parents reported healthier eating due to more appropriate portion sizes and more vegetables. A prominent difference between parent groups was that older children played a role in continuing the use of meal boxes, and helped to prepare the meals (contrary to younger children). Conclusions Home-delivered meal boxes might be promising to enhance families’ meal practices. This study could inform social marketeers and health promotors to adopt an optimal strategy to reach families.

Abstract Background Globally, there is a concerning surge in the prevalence of substance use among adolescents and children, creating a substantial public health problem. Despite the magnitude of this issue, accessing healthcare explicitly for substance use remains challenging, even though many substance users frequently visit healthcare institutions for other health-related issues. To address this gap, proactive screening for substance use disorders has emerged as a critical strategy for identifying and engaging patients at risk of substance use. The purpose of this study was to investigate the prevalence of probable alcohol and other substance use disorders, and associated factors, among children aged 6 to 17 years old attending health facilities in Mbale, Uganda. Methods We conducted a health facility cross-sectional study, involving 854 children aged 6–17 years. The prevalence of probable alcohol and other substance use disorders was assessed using a validated Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. Univariable and multivariable modified Poisson regression analyses were performed using STATA 15 software. Results The overall prevalence of probable alcohol use disorders (AUD) and other substance use disorders (SUD) was 27.8% (95% CI 1.24–1.31) while that of probable AUD alone was 25.3% (95% CI 1.22–1.28). Peer substance use (APR = 1.24, 95% CI 1.10–1.32), sibling substance use (APR = 1.14, 95% CI 1.06–1.23), catholic caregiver religion (APR = 1.07 95% CI 1.01–1.13), caregiver income of more than $128 (APR = 0.90, 95% CI 0.82–0.98), having no parental reprimand for substance use (APR = 1.05, 95% CI 1.01–1.10) and having no knowledge of how to decline an offer to use substances (APR = 1.06, 95% CI 1.01–1.12) were found to be significantly associated with probable AUD/SUD. Conclusions Our findings suggest a high prevalence of probable AUD and SUD among children and adolescents visiting healthcare facilities for other conditions, along with a strong link between AUD and SUD prevalence and social factors. The implication for our healthcare system is to actively screen for and treat these conditions at primary healthcare facilities.

Abstract Background Anaemia continues to be a major public health challenge globally, including in Ethiopia. Previous studies have suggested that improved household environmental conditions may reduce anaemia prevalence; however, population-level evidence of this link is lacking in low-income countries. Therefore, this study aimed to examine the association between environmental factors and childhood anaemia in Ethiopia. Methods In this study, we conducted an analysis of the data from the Ethiopian Demographic and Health Survey (EDHS), a nationally representative population-based survey conducted in Ethiopia between 2005 and 2016. The study included a total of 21,918 children aged 6–59 months. Children were considered anemic if their hemoglobin (Hb) concentration was less than 11.0 g/dl. To examine the association between environmental factors and anemia, we used multilevel mixed-effect models. These models allowed us to control for various confounding factors including: child, maternal, household and community-level variables. The study findings have been reported as adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) at a significance level of p

Abstract Background Parents of children with autism spectrum disorder (ASD) are at a higher risk of depression than parents of typically developing children and those of children with other developmental disorders. Depression affects the well-being and quality of life of parents of children with ASD and has serious consequences for the long-term health outcomes of children with ASD. Therefore, this study explored the current status of depressive symptoms in parents of children with ASD in eastern China and further analyzed multiple aspects of the predictors of depressive symptoms. Methods A multicenter cross-sectional survey was conducted among parents of children with ASD in the rehabilitation department of a large specialized hospital and 10 rehabilitation centers for children with special needs in Lianyungang, Jiangsu Province, Eastern China. A structured questionnaire that focused on child-related factors, parent-related factors, depressive symptoms, courtesy stigma, and social support was used to obtain data. Binary logistic regression was used to identify the independent predictors of depressive symptoms in parents of children with ASD. Results A total of 409 parents of children with ASD were recruited, of whom 18.8% had depressive symptoms. Parents of children with ASD who raised a child who spoke few to no words (odds ratio [OR]: 2.747, 95% confidence interval [CI]: 1.026–7.357), claimed a high economic burden (OR: 3.215, 95% CI: 1.234–8.379), reported no change or increased severity of ASD in their children (OR: 2.518, 95% CI: 1.108–5.720), and those with a higher courtesy stigma score (OR: 1.189, 95% CI: 1.093–1.294) were more likely to have depressive symptoms. Conversely, parents of children with ASD who were employed (OR: 0.427, 95% CI: 0.201–0.907), satisfied with their current marital status (OR: 0.429, 95% CI: 0.221–0.834), and those with a higher social support score (OR: 0.973, 95% CI: 0.950–0.996) were less likely to have depressive symptoms. Conclusions Depressive symptoms are common in parents of children with ASD in eastern China. Therefore, screening and intervention for depressive symptoms in parents of children with ASD is necessary, especially for those with high-risk factors.

Abstract Objective The aim of the study was to analyze gender inequalities in types of physical activity (PA) and in the use of screen-based devices among schoolchildren from both urban and rural areas in Brazil. Methods Data from two population-based surveys conducted in 2019 (urban areas: n = 2,479; 52.6% girls; age = 9.2 ± 1.51 years) and 2022 (rural areas: n = 979; 42.6% girls; age = 9.4 ± 1.52 years) were used. PA (active play, nonactive play, home chores, and structured physical activities) and the use of screen-based devices (TV, cellphone, videogame, and computer) were self-reported in a previous-day-recall online questionnaire (Web-CAAFE). Absolute gender inequalities were evaluated and presented as equiplots. Relative gender inequalities were evaluated by the prevalence ratio (PR) and respective 95% confidence intervals (95% CI), which were estimated by Poisson regression, with adjustments for age and BMI z scores. Results Girls from urban and rural areas presented a lower prevalence of active play and a higher prevalence of home chores. The prevalence of nonactive play among girls from urban areas was also lower; however, their prevalence of structured physical activities was higher, especially among girls aged seven to nine years. Girls in both urban and rural areas presented a higher prevalence of TV viewing and lower use of video games. Conclusion The gender inequalities observed in the types of physical activities and in the use of screen-based devices could be considered potential correlates of the likelihood of girls’ and boys’ compliance with the physical activity guidelines.

Abstract Introduction Loss of follow-up (LTFU) from ART regular follow-up is one of the key acknowledged causes for the development of ART-resistant virus strains currently. It becomes a major weakness for the successful implementation of HIV care and treatment programs mainly in Sub-Saharan Africa but also globally. About 20—40% of children on ART loss their regular ART follow-up annually. Because of the inconsistency of the prior publications' findings, policymakers, programmers, and healthcare providers find it difficult to intervene. Hence, this study was conducted to provide a pooled incidence and identify the predictors of LTFU among children on ART in Ethiopia. Methods Articles were searched from PubMed/ MEDLINE, CINAHL, EMBASE, Google Scholar, and Science Direct, as well as organizational records and websites. This review included both retrospective and prospective follow-up studies published in English. The data were extracted using Microsoft Excel and exported into Stata™ Version 17.0 for further processing and analysis. The presence of heterogeneity was assessed using forest plots with the I2 test. To identify the source of heterogeneity subgroup analysis, meta-regression, publication bias, and sensitivity analysis were computed. The pooled incidence of LTFU was estimated using a random effects meta-analysis model with the DerSimonian-laired method. To identify the predictors, a 95% confidence interval with relative risk was used to declare the presence or absence of an association. Results In this systematic review and Meta-analysis, nine studies with a total of 3336 children were included. The pooled incidence of LTFU from ART was 5.83 (95% CI: 3.94, 7.72) per 100 children-years of observation with I2: 83% & p-value

Abstract Background Evidence of the effects of the built environment on children has mainly focused on disease outcomes; however, quality of life (QoL) has gained increasing attention as an important health and policy endpoint itself. Research on built environment effects on children’s QoL could inform public health programs and urban planning and design. Objective We aimed to review and synthesize the evidence of the relationship between built environment features and children’s QoL. Methods Five research databases were searched for quantitative peer-reviewed studies on children between 2 and 18 years, published in English or German between January 2010 and August 2023. Only primary research was considered. Included studies (n = 17) were coded and methodologically assessed with the Joanna Briggs Critical Appraisal Checklists, and relevant data were extracted, analyzed, and synthesized, using the following built environment framework: (1) neighborhood green and blue space, (2) neighborhood infrastructure, and (3) neighborhood perception. Results Green space was positively associated with children’s QoL. Infrastructure yielded inconclusive results across all measured aspects. Overall neighborhood satisfaction was positively correlated with higher QoL but results on perceived environmental safety were mixed. Conclusions Most studies are correlational, making it difficult to infer causality. While the positive findings of green space on QoL are consistent, specific features of the built environment show inconsistent results. Overall perception of the built environment, such as neighborhood satisfaction, also shows more robust results compared to perceptions of specific features of the built environment. Due to the heterogeneity of both built environment and QoL measures, consistent measures of both concepts will help advance this area of research.

Abstract Background This study aimed to evaluate trends in global, regional, and national burdens of intraocular foreign bodies among children and adolescents (aged 0 − 19 years) between 1990 and 2019 according to age, sex, and socio-demographic index. Methods This study obtained data from the Global Burden of Disease Study 2019 and evaluated the number of cases, rates per 100,000 persons, and average annual percentage changes among children and adolescents. The annual percentage changes in the incidence and years lived with disability rates across various age groups were investigated using joinpoint software. Results For intraocular foreign bodies in children and adolescents, the incidence and year lived with disability rates decreased in all age groups between 1990 and 2019. However, the number of incident cases and years lived with disability increased from 1091.94 [95% uncertainty interval (UI), 610.91–1839.52] and 89,245 (95% UI, 6.65–18.67) in 1990 to 1134.85 (95% UI, 665.01–1867.50) and 92,108 (95% UI, 32,052–192,153) in 2019, respectively. Age was positively correlated with the number of cases, incidence, and years lived with disability rates. However, there were significant decreases in both the incidence and years lived with disability rates among children and adolescents, especially in the 15–18 years age group, males, and most high-income regions. Notably, the incidence and years lived with disability rates were significantly decreased in middle and high-middle socio-demographic index regions but were increased in low and low-middle socio-demographic index regions. Conclusions Despite the remarkable progress between 1990 and 2019 in reducing the global burden of intraocular foreign bodies, there has been an increase in the number of cases, with substantial disparity across age groups, sexes, regions, and countries. Our results could inform more effective strategies for reducing the burden among children and adolescents.

Abstract Objective Early onset of adiposity rebound (AR) is considered an early indicator of obesity risk. Our objective was to investigate the association of birth outcomes and early physical growth patterns with early AR in children. Methods Study subjects (n = 2705) were enrolled from the Ma’anshan birth cohort (MABC). The body mass index (BMI), head circumference, waist circumference, and body fat were collected. Rapid weight gain (RWG) was defined by the change in weight standard-deviation score in the first two years of life. Group-based trajectory modeling (GBTM) was used to determine children’s physical growth trajectories. The age of AR was fitted using fractional polynomial function models. Results Children with very high BMI trajectories (RR = 2.83; 95% CI 2.33 to 1.40), rising BMI trajectories (RR = 3.15; 95% CI 2.66 to 3.72), high waist circumference trajectories (RR = 4.17; 95% CI 3.43 to 5.06), and high body fat trajectories (RR = 3.01; 95% CI 2.62 to 3.46) before 72 months of age were at a greater risk of experiencing early AR. Low birth weight (LBW) (RR = 1.86; 95% CI 1.28 to 2.51), preterm birth (PTB) (RR = 1.50; 95% CI 1.17 to 1.93), and small for gestational age (SGA) (RR = 1.37; 95% CI 1.14 to 1.64) associated with increased risk of early AR. Moreover, infants experiencing RWG (RR = 1.59; 95% CI 1.40 to 1.83), low BMI trajectories (RR = 1.27; 95% CI 1.06 to 1.53) and rising BMI trajectories (RR = 1.50; 95% CI 1.22 to 1.84) in the first two years were at higher risk of developing early AR subsequently. Compared to the group with non-early AR, the BMI of children with early AR tended to be lower first (from birth to 6 months of age) and then higher (from 18 to 72 months of age). Conclusions Children with overall high BMI, high waist circumference, and high body fat before 72 months of age are more likely to experience early AR, but infants with low BMI trajectories, rising BMI trajectories and infants experiencing RWG in the first two years of life similarly increase the risk of early AR. These results can help to understand the early factors and processes that lead to metabolic risks.

Abstract A cornerstone of asthma management is maintaining physical activity (PA), but this may lead to increased exposure to, and deeper inhalation of, pollutants. Furthermore, children and adolescents may be more susceptible to the deleterious impacts of such exposures. Despite the recent air quality campaigns and media coverage surrounding the dangers of air pollution to respiratory health, few target children and their understanding of such issues. Using semi structured interviews, understanding of PA, air pollution and their interaction was explored with 25 youth aged 7—17 years. Utilising NVIVO 12 software, an atheoretical, inductive thematic analysis was conducted to identify key themes which were subsequently presented as pen profiles with the number of common responses within a theme indicative of its strength. The majority (88%) of youth’s indicated traffic-related air pollution and global manufacturing as key sources of air pollution. Whilst all youths were aware of outdoor pollution, only 52% were aware of indoor air pollutants, of which 62% had asthma. Despite some uncertainty, all youths described pollution in a negative fashion, with 52% linking air pollution to undesirable effects on health, specifically respiratory health. PA in a polluted area was thought to be more dangerous than beneficial by 44%, although 24% suggested the benefits of PA would outweigh any detriment from pollution. Youth are aware of, and potentially compensate for, the interaction between air pollution and PA. Strategies are needed to allow youth to make more informed decisions regarding how to promote PA whilst minimising exposure to air pollution.

Background: Chronic malnutrition is a condition associated with negative impacts on physical and cognitive development. It is multi-causal and can start very early in life, already in utero, thus it is especially challenging to find appropriate interventions to tackle it. The government of Angola is implementing a standard of care program with potential to prevent it, and the provision of cash transfers and the supplementation with small quantity lipid-based nutrients (SQ-LNS) are also promising interventions. We aimed to evaluate the impact of the standard of care program alone and of the standard of care plus a cash transfer intervention in the lineal growth of children less than 2 years old and compare it to the effectiveness of a nutrition supplementation plus standard of care program in Southern Angola. Methods/design: The three-arm parallel cluster randomised controlled trial is set in four communes of Huila and Cunene provinces. Clusters are villages or neighbourhoods with a population around 1075 people. A total of twelve clusters were selected per arm and forty pregnant women are expected to be recruited in each cluster. Pregnant women receive the standard of care alone, or the standard of care plus unconditional cash transfer or plus nutritional supplementation during the first 1000 days, from pregnancy to the child reaching 24 months. The primary outcome is the prevalence of stunting measured as height-for-age Z-score (HAZ) < -2 in children below 2 years. Impact will be assessed at 3, 6, 12, 18 and 24 months of children's age. Secondary outcomes include mortality, morbidity, caring, hygiene and nutrition behaviours and practices, and women and children's dietary diversity. Quantitative data are also collected on women's empowerment, household food security, expenditure and relevant clinical and social events at baseline, endline and intermediate time points. Discussion: The results will provide valuable information on the impact of the standard of care intervention alone as well as combined with an unconditional cash transfer intervention compared to a nutrition supplementation plus standard of care intervention, carried out during the first 1000 days, in the children´s growth up to 2 years and related outcomes in Southern Angola. Trial registration: Clinical Trials NCT05571280. Registered 7 October 2022. [ABSTRACT FROM AUTHOR]

Background: The first 3 years of life are a critical period for the development of socio-emotional skills, highlighting the importance of socio-emotional development in early childhood. This study aimed to evaluate the effectiveness of a health promotion intervention program on the socio-emotional development of children aged 12 to 42 months during the COVID-19 pandemic. Methods: A total of 344 children from 15 childcare centers participated in this study, with six centers in the intervention group and nine in the control group. Childcare teachers in the intervention group received a 6-month training program aimed at promoting healthy lifestyles, including topics such as diet, sleep, physical activity, and sedentary behavior. Sociodemographic and anthropometric measures were assessed at baseline, and socio-emotional development was assessed using the Bayley Scales of Infant and Toddler Development – Third Edition (Bayley-III) at baseline and post-intervention. Results: After the intervention, a significant difference in socio-emotional development was observed between children with mothers of varying education levels. Specifically, children whose mothers had lower education levels demonstrated significantly greater socio-emotional development (B = 19.000, p = 0.028) compared to the control group. In contrast, there was no significant difference in socio-emotional development among children with mothers from higher education levels. Conclusion: These findings suggest that intervention programs for childcare teachers can effectively promote healthy socio-emotional development in children from socioeconomically disadvantaged backgrounds. Future intervention programs should consider tailoring their approaches to target disadvantaged populations. Trial registration: This cluster randomized controlled trial was registered in the Clinical Trials database/platform on 09/09/2019 (number NCT04082247). [ABSTRACT FROM AUTHOR]

Background: Although studies have indicated that extreme temperature is strongly associated with respiratory diseases, there is a dearth of studies focused on children, especially in China. We aimed to explore the association between extreme temperature and children's outpatient visits for respiratory diseases and seasonal modification effects in Harbin, China. Methods: A distributed lag nonlinear model (DLNM) was used to explore the effect of extreme temperature on daily outpatient visits for respiratory diseases among children, as well as lag effects and seasonal modification effects. Results: Extremely low temperatures were defined as the 1st percentile and 2.5th percentile of temperature. Extremely high temperatures were defined as the 97.5th percentile and 99th percentile of temperature. At extremely high temperatures, both 26 °C (97.5th) and 27 °C (99th) showed adverse effects at lag 0–6 days, with relative risks (RRs) of 1.34 [95% confidence interval (CI): 1.21–1.48] and 1.38 (95% CI: 1.24–1.53), respectively. However, at extremely low temperatures, both − 26 °C (1st) and − 23 °C (2.5th) showed protective effects on children's outpatient visits for respiratory diseases at lag 0–10 days, with RRs of 0.86 (95% CI: 0.76–0.97) and 0.85 (95% CI: 0.75–0.95), respectively. We also found seasonal modification effects, with the association being stronger in the warm season than in the cold season at extremely high temperatures. Conclusions: Our study indicated that extremely hot temperatures increase the risk of children's outpatient visits for respiratory diseases. Efforts to reduce the exposure of children to extremely high temperatures could potentially alleviate the burden of pediatric respiratory diseases, especially during the warm season. [ABSTRACT FROM AUTHOR]

Background: Anaemia continues to be a major public health challenge globally, including in Ethiopia. Previous studies have suggested that improved household environmental conditions may reduce anaemia prevalence; however, population-level evidence of this link is lacking in low-income countries. Therefore, this study aimed to examine the association between environmental factors and childhood anaemia in Ethiopia. Methods: In this study, we conducted an analysis of the data from the Ethiopian Demographic and Health Survey (EDHS), a nationally representative population-based survey conducted in Ethiopia between 2005 and 2016. The study included a total of 21,918 children aged 6–59 months. Children were considered anemic if their hemoglobin (Hb) concentration was less than 11.0 g/dl. To examine the association between environmental factors and anemia, we used multilevel mixed-effect models. These models allowed us to control for various confounding factors including: child, maternal, household and community-level variables. The study findings have been reported as adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) at a significance level of p < 0.05. Results: The study found the overall prevalence of childhood anaemia to be 49.3% (95%CI: 48.7–49.9) between 2005 and 2016 in Ethiopia. The prevalence was 47.6% (95%CI: 46.1–49.1) in 2005, 42.8% (95%CI: 41.8–43.8) in 2011, and increased to 57.4% (95%CI: 56.3–58.4) in 2016. The pooled data showed that children from households practising open defecation were more likely to be anaemic (AOR: 1.19, 95% CI: 1.05–1.36). In our survey specify analysis, the odds of anaemia were higher among children from households practising open defecation (AOR: 1.33, 95% CI: 1.12–1.58) in the EDHS-2011 and EDHS-2016 (AOR: 1.49, 95% CI: 1.13–1.90). In contrast, neither household water sources nor the time to obtain water was associated with anaemia after controlling for potential confounders. The other variables significantly associated with childhood anaemia include: the child's age (6–35 months), not fully vaccinated (AOR: 1.14, 95%CI: 1.05–1.24), children not dewormed in the last 6 months (AOR: 1.11, 95%CI: 1.01–1.24), children born to mothers not working (AOR: 1.10, 95%CI: 1.02–1.19), children from poor households (AOR: 1.18: 95%CI: 1.06–1.31), and rural residence (AOR: 1.23, 95%CI: 1.06–1.42). Conclusion: In Ethiopia, about fifty percent of children suffer from childhood anemia, making it a serious public health issue. Open defecation is a major contributing factor to this scourge. To address this issue effectively, it is recommended to strengthen initiatives aimed at eliminating open defecation that involve various approaches, including sanitation infrastructure development, behavior change campaigns, and policy interventions. In addition, to reduce the burden of anemia in children, a multi-faceted approach is necessary, involving both prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Globally, there is a concerning surge in the prevalence of substance use among adolescents and children, creating a substantial public health problem. Despite the magnitude of this issue, accessing healthcare explicitly for substance use remains challenging, even though many substance users frequently visit healthcare institutions for other health-related issues. To address this gap, proactive screening for substance use disorders has emerged as a critical strategy for identifying and engaging patients at risk of substance use. The purpose of this study was to investigate the prevalence of probable alcohol and other substance use disorders, and associated factors, among children aged 6 to 17 years old attending health facilities in Mbale, Uganda. Methods: We conducted a health facility cross-sectional study, involving 854 children aged 6–17 years. The prevalence of probable alcohol and other substance use disorders was assessed using a validated Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. Univariable and multivariable modified Poisson regression analyses were performed using STATA 15 software. Results: The overall prevalence of probable alcohol use disorders (AUD) and other substance use disorders (SUD) was 27.8% (95% CI 1.24–1.31) while that of probable AUD alone was 25.3% (95% CI 1.22–1.28). Peer substance use (APR = 1.24, 95% CI 1.10–1.32), sibling substance use (APR = 1.14, 95% CI 1.06–1.23), catholic caregiver religion (APR = 1.07 95% CI 1.01–1.13), caregiver income of more than $128 (APR = 0.90, 95% CI 0.82–0.98), having no parental reprimand for substance use (APR = 1.05, 95% CI 1.01–1.10) and having no knowledge of how to decline an offer to use substances (APR = 1.06, 95% CI 1.01–1.12) were found to be significantly associated with probable AUD/SUD. Conclusions: Our findings suggest a high prevalence of probable AUD and SUD among children and adolescents visiting healthcare facilities for other conditions, along with a strong link between AUD and SUD prevalence and social factors. The implication for our healthcare system is to actively screen for and treat these conditions at primary healthcare facilities. [ABSTRACT FROM AUTHOR]

Background: Pertussis is a highly contagious and dangerous respiratory disease that threatens children's health in many countries, including Vietnam, despite vaccine coverage. From 2015 to 2018, Vietnam experienced an increasing number of pertussis patients. Therefore, this study aimed to investigate the trend and examine the seasonal variations of pertussis in North Vietnam. Methods: Data were collected from medical records of all under-5-year-old inpatients admitted to the National Children's Hospital in Hanoi, Vietnam (VNCH) 2015–2018. A descriptive analysis was performed to describe the distribution of incident cases by year and season. Linear multivariable regression was conducted to investigate the association between the incidence of cases and seasonality adjusted by age and vaccination status. Results: We identified 1063 laboratory-confirmed patients during 2015–2018, including 247 (23.2%) severe patients. The number of pertussis patients admitted to VNCH per 1000 hospitalizations was 3.2 in 2015, compared to 1.9, 3.1, and 2.1 in 2016, 2017, and 2018, respectively. Outbreaks occurred biennially; however, there was no significant difference in the number of severe patients over this period. Most cases occurred in the hot season (509 patients, or nearly half of the study population). With the adjustment of the vaccination rate and average age, the risk of pertussis-associated hospitalization in the mild season and the hot season was 21% (95% CI [0.12; 0.3]) and 15% (95% CI [0.05; 0.25]) higher than that in the warm season, respectively. The rate of hospitalizations was high in the mild season (28.9%) and the warm season (30.8%), nearly twice as much as that in the hot season; nevertheless, the death rate was only striking high in the mild season, about 5–6 times as much as those in the other seasons. Conclusion: The pertussis incidence in Northern Vietnam varied between seasons, peaking in the hot season (April-July). However, severe patients and deaths increased in the mild season (December-March). Interventions, for example, communication activities on pertussis and vaccination, are of immense importance in lowering the prevalence of pertussis. In addition, early diagnoses and early warnings performed by health professionals should be encouraged. [ABSTRACT FROM AUTHOR]

Introduction: Loss of follow-up (LTFU) from ART regular follow-up is one of the key acknowledged causes for the development of ART-resistant virus strains currently. It becomes a major weakness for the successful implementation of HIV care and treatment programs mainly in Sub-Saharan Africa but also globally. About 20—40% of children on ART loss their regular ART follow-up annually. Because of the inconsistency of the prior publications' findings, policymakers, programmers, and healthcare providers find it difficult to intervene. Hence, this study was conducted to provide a pooled incidence and identify the predictors of LTFU among children on ART in Ethiopia. Methods: Articles were searched from PubMed/ MEDLINE, CINAHL, EMBASE, Google Scholar, and Science Direct, as well as organizational records and websites. This review included both retrospective and prospective follow-up studies published in English. The data were extracted using Microsoft Excel and exported into Stata™ Version 17.0 for further processing and analysis. The presence of heterogeneity was assessed using forest plots with the I2 test. To identify the source of heterogeneity subgroup analysis, meta-regression, publication bias, and sensitivity analysis were computed. The pooled incidence of LTFU was estimated using a random effects meta-analysis model with the DerSimonian-laired method. To identify the predictors, a 95% confidence interval with relative risk was used to declare the presence or absence of an association. Results: In this systematic review and Meta-analysis, nine studies with a total of 3336 children were included. The pooled incidence of LTFU from ART was 5.83 (95% CI: 3.94, 7.72) per 100 children-years of observation with I2: 83% & p-value < 0.001. Those children who were from rural were had a 1.65 (95% CI: 1.06, 2.52) times higher chance of getting LTFU when compared with their counterparts. Children who had poor ART adherence had a 2.03 (95% CI: 1.23, 3.34) times higher chance of experiencing LTFU of ART than children having good ART adherence. Conclusions: Among Ethiopian children on ART, one out of 167 had the risk of experiencing LTFU. Being rural dwellers and having poor ART adherence were the identified predictors of LTFU. Close follow-up and phone message text should be used to have good ART adherence among rural dwellers to meet the predetermined goal of ART. [ABSTRACT FROM AUTHOR]

Background: Cooking and consuming a homemade meal is associated with health benefits. Home-delivered meal boxes can support families in cooking this fresh meal. The current study aimed to gain a deeper understanding of the determinants of meal box use, and of the perceived impact on meal practices of parents with younger (i.e., aged 6–12 years) and older children (i.e., 13–18 years). Methods: Four focus groups were conducted (n = 19); two with parents of younger children, and two with parents of older children. A semi-structured interview guide was developed and interviews were recorded and transcribed. Reflexive thematic analysis was performed using NVivo 1.4. Results: Most parents mentioned practical reasons like saving time and money, as well as inspiration, as reasons to choose a home-delivered meal box. Also, tastiness and menu variation were often mentioned as determining factors by both parent groups. However, a few parents stated to stop using the meal boxes because of returning menus or too small portion sizes. Meal box providers were chosen based on the price, the freshness and the quality of the products. Moreover, positive effects on parents' perceived cooking skills and knowledge were reported. Also, some parents mentioned positively changed attitudes towards vegetarian dishes. Lastly, parents reported healthier eating due to more appropriate portion sizes and more vegetables. A prominent difference between parent groups was that older children played a role in continuing the use of meal boxes, and helped to prepare the meals (contrary to younger children). Conclusions: Home-delivered meal boxes might be promising to enhance families' meal practices. This study could inform social marketeers and health promotors to adopt an optimal strategy to reach families. [ABSTRACT FROM AUTHOR]

Background: An increased risk of cardiovascular diseases (CVD) has been associated with women's parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association. Methods: The study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders. Results: CVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02–1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10–1.83; and HR = 1.39, 95% CI: 1.03–1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed. Conclusions: Taken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded. [ABSTRACT FROM AUTHOR]

Background: Parents of children with autism spectrum disorder (ASD) are at a higher risk of depression than parents of typically developing children and those of children with other developmental disorders. Depression affects the well-being and quality of life of parents of children with ASD and has serious consequences for the long-term health outcomes of children with ASD. Therefore, this study explored the current status of depressive symptoms in parents of children with ASD in eastern China and further analyzed multiple aspects of the predictors of depressive symptoms. Methods: A multicenter cross-sectional survey was conducted among parents of children with ASD in the rehabilitation department of a large specialized hospital and 10 rehabilitation centers for children with special needs in Lianyungang, Jiangsu Province, Eastern China. A structured questionnaire that focused on child-related factors, parent-related factors, depressive symptoms, courtesy stigma, and social support was used to obtain data. Binary logistic regression was used to identify the independent predictors of depressive symptoms in parents of children with ASD. Results: A total of 409 parents of children with ASD were recruited, of whom 18.8% had depressive symptoms. Parents of children with ASD who raised a child who spoke few to no words (odds ratio [OR]: 2.747, 95% confidence interval [CI]: 1.026–7.357), claimed a high economic burden (OR: 3.215, 95% CI: 1.234–8.379), reported no change or increased severity of ASD in their children (OR: 2.518, 95% CI: 1.108–5.720), and those with a higher courtesy stigma score (OR: 1.189, 95% CI: 1.093–1.294) were more likely to have depressive symptoms. Conversely, parents of children with ASD who were employed (OR: 0.427, 95% CI: 0.201–0.907), satisfied with their current marital status (OR: 0.429, 95% CI: 0.221–0.834), and those with a higher social support score (OR: 0.973, 95% CI: 0.950–0.996) were less likely to have depressive symptoms. Conclusions: Depressive symptoms are common in parents of children with ASD in eastern China. Therefore, screening and intervention for depressive symptoms in parents of children with ASD is necessary, especially for those with high-risk factors. [ABSTRACT FROM AUTHOR]

Background: Early childhood caries (ECC) is one of the most common chronic diseases among children. In Poland 86.9% of six-year-olds have ECC. One of the factors determining adherence to ECC prophylaxis and oral hygiene is mothers' knowledge. The aim of this study was to assess the level of knowledge demonstrated by pregnant women about ECC prevention and oral hygiene, and to analyse the determinants of this knowledge. Methods: A quantitative survey was conducted using Computer Assisted Telephone Interview technique on a randomly selected representative sample of 1,000 women over the age of 18 in their second and third trimesters of pregnancy. The significance level was established at 0.05 and p-values were presented as: p < 0.05, p < 0.01 and p < 0.001. Results: The highest percentage of wrong or "I don't know" answers were related to questions about: the number of free dental check-ups for children (76.8%), the date of the child's first visit to the dentist (66.5%), the age when the child has mixed dentition (72.2%). Women with higher education had better knowledge than women with lower or secondary education. Women with good and very good financial situation showed a higher level of knowledge compared to women with average, bad and very bad financial situation. Conclusions: When developing prevention strategies and educational programs as part of prenatal care for women to reduce the incidence of ECC, it is important to take into account the identified areas that need support and specific target groups (mothers with lower socioeconomic status). [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate trends in global, regional, and national burdens of intraocular foreign bodies among children and adolescents (aged 0 − 19 years) between 1990 and 2019 according to age, sex, and socio-demographic index. Methods: This study obtained data from the Global Burden of Disease Study 2019 and evaluated the number of cases, rates per 100,000 persons, and average annual percentage changes among children and adolescents. The annual percentage changes in the incidence and years lived with disability rates across various age groups were investigated using joinpoint software. Results: For intraocular foreign bodies in children and adolescents, the incidence and year lived with disability rates decreased in all age groups between 1990 and 2019. However, the number of incident cases and years lived with disability increased from 1091.94 [95% uncertainty interval (UI), 610.91–1839.52] and 89,245 (95% UI, 6.65–18.67) in 1990 to 1134.85 (95% UI, 665.01–1867.50) and 92,108 (95% UI, 32,052–192,153) in 2019, respectively. Age was positively correlated with the number of cases, incidence, and years lived with disability rates. However, there were significant decreases in both the incidence and years lived with disability rates among children and adolescents, especially in the 15–18 years age group, males, and most high-income regions. Notably, the incidence and years lived with disability rates were significantly decreased in middle and high-middle socio-demographic index regions but were increased in low and low-middle socio-demographic index regions. Conclusions: Despite the remarkable progress between 1990 and 2019 in reducing the global burden of intraocular foreign bodies, there has been an increase in the number of cases, with substantial disparity across age groups, sexes, regions, and countries. Our results could inform more effective strategies for reducing the burden among children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Evidence of the effects of the built environment on children has mainly focused on disease outcomes; however, quality of life (QoL) has gained increasing attention as an important health and policy endpoint itself. Research on built environment effects on children's QoL could inform public health programs and urban planning and design. Objective: We aimed to review and synthesize the evidence of the relationship between built environment features and children's QoL. Methods: Five research databases were searched for quantitative peer-reviewed studies on children between 2 and 18 years, published in English or German between January 2010 and August 2023. Only primary research was considered. Included studies (n = 17) were coded and methodologically assessed with the Joanna Briggs Critical Appraisal Checklists, and relevant data were extracted, analyzed, and synthesized, using the following built environment framework: (1) neighborhood green and blue space, (2) neighborhood infrastructure, and (3) neighborhood perception. Results: Green space was positively associated with children's QoL. Infrastructure yielded inconclusive results across all measured aspects. Overall neighborhood satisfaction was positively correlated with higher QoL but results on perceived environmental safety were mixed. Conclusions: Most studies are correlational, making it difficult to infer causality. While the positive findings of green space on QoL are consistent, specific features of the built environment show inconsistent results. Overall perception of the built environment, such as neighborhood satisfaction, also shows more robust results compared to perceptions of specific features of the built environment. Due to the heterogeneity of both built environment and QoL measures, consistent measures of both concepts will help advance this area of research. [ABSTRACT FROM AUTHOR]

A cornerstone of asthma management is maintaining physical activity (PA), but this may lead to increased exposure to, and deeper inhalation of, pollutants. Furthermore, children and adolescents may be more susceptible to the deleterious impacts of such exposures. Despite the recent air quality campaigns and media coverage surrounding the dangers of air pollution to respiratory health, few target children and their understanding of such issues. Using semi structured interviews, understanding of PA, air pollution and their interaction was explored with 25 youth aged 7—17 years. Utilising NVIVO 12 software, an atheoretical, inductive thematic analysis was conducted to identify key themes which were subsequently presented as pen profiles with the number of common responses within a theme indicative of its strength. The majority (88%) of youth's indicated traffic-related air pollution and global manufacturing as key sources of air pollution. Whilst all youths were aware of outdoor pollution, only 52% were aware of indoor air pollutants, of which 62% had asthma. Despite some uncertainty, all youths described pollution in a negative fashion, with 52% linking air pollution to undesirable effects on health, specifically respiratory health. PA in a polluted area was thought to be more dangerous than beneficial by 44%, although 24% suggested the benefits of PA would outweigh any detriment from pollution. Youth are aware of, and potentially compensate for, the interaction between air pollution and PA. Strategies are needed to allow youth to make more informed decisions regarding how to promote PA whilst minimising exposure to air pollution. [ABSTRACT FROM AUTHOR]

Objective: Early onset of adiposity rebound (AR) is considered an early indicator of obesity risk. Our objective was to investigate the association of birth outcomes and early physical growth patterns with early AR in children. Methods: Study subjects (n = 2705) were enrolled from the Ma'anshan birth cohort (MABC). The body mass index (BMI), head circumference, waist circumference, and body fat were collected. Rapid weight gain (RWG) was defined by the change in weight standard-deviation score in the first two years of life. Group-based trajectory modeling (GBTM) was used to determine children's physical growth trajectories. The age of AR was fitted using fractional polynomial function models. Results: Children with very high BMI trajectories (RR = 2.83; 95% CI 2.33 to 1.40), rising BMI trajectories (RR = 3.15; 95% CI 2.66 to 3.72), high waist circumference trajectories (RR = 4.17; 95% CI 3.43 to 5.06), and high body fat trajectories (RR = 3.01; 95% CI 2.62 to 3.46) before 72 months of age were at a greater risk of experiencing early AR. Low birth weight (LBW) (RR = 1.86; 95% CI 1.28 to 2.51), preterm birth (PTB) (RR = 1.50; 95% CI 1.17 to 1.93), and small for gestational age (SGA) (RR = 1.37; 95% CI 1.14 to 1.64) associated with increased risk of early AR. Moreover, infants experiencing RWG (RR = 1.59; 95% CI 1.40 to 1.83), low BMI trajectories (RR = 1.27; 95% CI 1.06 to 1.53) and rising BMI trajectories (RR = 1.50; 95% CI 1.22 to 1.84) in the first two years were at higher risk of developing early AR subsequently. Compared to the group with non-early AR, the BMI of children with early AR tended to be lower first (from birth to 6 months of age) and then higher (from 18 to 72 months of age). Conclusions: Children with overall high BMI, high waist circumference, and high body fat before 72 months of age are more likely to experience early AR, but infants with low BMI trajectories, rising BMI trajectories and infants experiencing RWG in the first two years of life similarly increase the risk of early AR. These results can help to understand the early factors and processes that lead to metabolic risks. [ABSTRACT FROM AUTHOR]

Abstract Background In Ghana, it is against the law for children to smoke. Nevertheless, a portion of children in the country do smoke. However, there is a paucity of research on young smokers in Ghana and other sub-Saharan African nations. This study, therefore, investigated the prevalence of smoking, the kinds of substances children smoke, predictors of smoking, reasons for and factors that lead children to smoke, and regulation of smoking among children in Ghana. Methods In total, 5024 children aged 8–17 were studied using a cross-sectional convergent parallel mixed method. Descriptive statistics, Person’s Chi-square test, Fisher Exact test, and binary logistic regression were used to analyse the quantitative data. In contrast, thematic analysis was used to analyse the qualitative data. Results The results showed that 3.2% of children had ever smoked. Male children smoked more often than female children. The prevalence of cigarette, marijuana, and shisha smoking was 78.3%, 18%, and 3.7%, respectively. While more male children than female children smoked cigarettes and marijuana, more female children than male children used shisha. Children mainly smoked for fun and due to group culture. In addition, children were influenced by friends; parents, family members, and neighbours who smoke; curiosity; and advertisements and videos to initiate smoking. Despite the availability of regulations and laws regulating tobacco products in public places, tobacco advertisement, promotion, and sale to persons under 18, children are still smoking. Conclusions Children who have ever engaged in smoking reported using cigarettes, marijuana, and shisha. Policymakers urgently need to strategise and strengthen their policies, programmes, and interventions to address smoking among children.

Abstract Background Two types of rotavirus vaccines (RVs), Rotarix (RV1) and RotaTeq (RV5), were licensed as optional vaccines in 2012 and became part of the National Immunization Program (NIP) in the fiscal year 2020 in Thailand. The main objective was to evaluate the impact of rotavirus vaccines on the burden of acute diarrheal severity ranging from outpatient visits, diarrheal-related admission or deaths in the pre-NIP period (fiscal year 2015–2019) and in the fiscal year 2020. The minor objectives were assessed on the monthly admission rate, rotavirus vaccine coverage rate and rotavirus vaccine completed dose (RotaC). Methods Data regarding OPD, admission, and death cases under the Thailand National Health Coverage (NHC) from fiscal year 2015–2020, which were recorded as International Classification of Diseases and Related Health Problem 10th (ICD-10), were analyzed. Results The burden of diarrheal-related disease diminished after the rotavirus vaccine was introduced in the fiscal year 2020 when compared to the previous 5 fiscal years. The OPD visit rate decreased from 10.1 to 8.3 visits per 100 person-years (P