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• Sensitive endpoints are needed in the new era of mild cystic fibrosis lung disease. • MBW and MRI sensitively assess small airway disease in children with cystic fibrosis. • Lung MRI outcomes were more sensitive to early lung disease than lung function. Non-invasive and sensitive clinical endpoints are needed to monitor onset and progression of early lung disease in children with cystic fibrosis (CF). We compared lung clearance index (LCI), FEV 1 , functional and structural lung magnetic resonance imaging (MRI) outcomes in Swiss children with CF diagnosed following newborn screening. Lung function (LCI, FEV 1) and unsedated functional and structural lung MRI was performed in 79 clinically stable children with CF (3 – 8 years) and 75 age-matched healthy controls. Clinical information was collected throughout childhood. LCI, ventilation and perfusion defects, and structural MRI scores were significantly higher in children with CF compared with controls, but FEV 1 was not different between groups. Lung MRI outcomes correlated significantly with LCI (morphology score (r = 0.56, p < 0.001); ventilation defects (r = 0.43, p = 0.001); perfusion defects (r = 0.64, p < 0.001), but not with FEV 1. Lung MRI outcomes were more sensitive to detect impairments in children with CF (abnormal ventilation and perfusion outcomes in 47 %, morphology score in 30 %) compared with lung function (abnormal LCI in 21 % and FEV 1 in 4.8 %). Pulmonary exacerbations, respiratory hospitalizations, and increase in patient-reported cough was associated with higher LCI and higher structural and functional MRI outcomes. The LCI and lung MRI outcomes non-invasively detect even mild early lung disease in young children with CF diagnosed following newborn screening. Pulmonary exacerbations and early respiratory symptoms were risk factors for structural and functional impairment in childhood. [ABSTRACT FROM AUTHOR]

• Nasal nitric oxide (nNO) is reduced in people with cystic fibrosis (PwCF). • PwCF treated with elexacaftor/tezacaftor/ivacaftor (ETI) show reduced sinonasal symptoms. • We show that ETI treatment increases nNO in PwCF. • nNO may be a potential marker for sinonasal disease in CF. In health, nitric oxide (NO) shows high concentrations in the upper airways, while nasal NO (nNO) is significantly lower in patients with sinonasal inflammation, such as people with cystic fibrosis (PwCF). In PwCF treated with elexacaftor/tezacaftor/ivacaftor (ETI; PwCF-ETI), clinical improvement of sinonasal symptoms and inflammation was observed. We therefore hypothesised that ETI may increase nNO in PwCF. 25 PwCF-ETI underwent nNO measurement at baseline and after 3 to 24 months of ETI treatment. NNO was measured using velum closure (VC) techniques in cooperative patients and tidal breathing (TB) for all patients. As controls, 7 CF patients not eligible for ETI (PwCF-non ETI) and 32 healthy controls (HC) were also repeatedly investigated. In PwCF-ETI, sinonasal symptoms, lung function parameters and sweat chloride levels improved from baseline to follow-up whereas there was no change in PwCF-non ETI and HC. NNO increased from a median (IQR) value at baseline to follow-up from 348.2 (274.4) ppb to 779.6 (364.7) ppb for VC (P < 0.001) and from 198.2 (107.0) ppb to 408.3 (236.1) ppb for TB (P < 0.001). At follow-up, PwCF-ETI reached nNO values in the normal range. In PwCF-non ETI as well as HC, nNO did not change between baseline and follow-up. In PwCF-ETI, the nNO values significantly increased after several months of ETI treatment in comparison to baseline and reached values in the normal range. This suggests that nNO is a potential non-invasive biomarker to examine sinonasal inflammatory disease in PwCF and supports the observation of clinical improvement in these patients. [ABSTRACT FROM AUTHOR]

Congenital myelomeningocele, or spina bifida (SB), is the predominant congenital anomaly of the central nervous system. Beyond its implications on neonatal mortality, SB impacts the long-term quality of life in affected children. This study sought to investigate the health-related quality of life (HRQoL) among children with SB treated at Ethiopia's leading pediatric neurosurgical facility. Set at Zewditu Memorial Hospital in Addis Ababa, Ethiopia, this hospital-based cross-sectional study spanned from June 30 to September 30, 2022. It incorporated 232 children, using data gathered through interviewer-led questionnaires. The HRQoL was measured using the PedsQL 4.0, a 23-item generic scale. The study's participants had a median age of 5 years (interquartile range = 3 to 6 years). The aggregate mean scores on the PedsQL 4.0 tallied at 68.59 ± 18.01. The lowest scores emerged from queries on school participation, whereas physical and emotional functioning registered the highest scores. Through multiple regression analyses, variables such as family income, monthly household income, number of children, and the presence of a neurogenic bladder showed strong association with HRQoL. This study fills a gap in the literature providing information on the HRQoL and its associated factors for children with SB in low-resourced settings. We champion the proactive integration of quality-of-life metrics into neurosurgical care policy and practice. Given the enduring consequences of SB, interventions honing the HRQoL can steer children toward realizing their intrinsic and enhance societal participation and contribution. [ABSTRACT FROM AUTHOR]

Physical activity and sedentary behaviour are usually described using daily volume indicators. However, for young children (6–12 years) and specifically those with conditions such as Cerebral Palsy, exploration of how physical behaviours are accumulated may provide valuable insight for behaviour change intervention planning. How are physical activity and sedentary behaviour accumulated by 6–12 year old children with Cerebral Palsy and is this different from their typically developing peers? A cross-sectional study of a convenience sample of ambulatory children with CP (CP) and typically developing (TD) children, 6–12 years, was recruited. Children wore a thigh worn activity monitor (activPAL4) during typical daily activities. Overall volume of daily sedentary, upright and stepping time was characterised as well as how this was accumulated in bouts of activity. There were no differences (p<0.05) in either volume or accumulation measures of physical behaviours between TD (n=14, 8.2±1.8 years) and children with CP (n=15, 8.6±1.4 years). However, there was wide variation in activity accumulation patterns between individuals. The mean proportion of daily time in each physical behaviour, accumulated in bouts above set times was: Upright time: bouts >5 mins 46 % TD & CP, bouts >20 mins 9 % TD & CP; Stepping time: bouts >0.5 mins 50 % TD, 45 % CP, bouts >2 mins 10 % TD, 9 % CP; Sedentary time: bouts >5 mins 77 % TD, 76 % CP, bouts >30 mins 26 % TD, 29 % CP. Young children with CP aged 6–12 years do not appear to have different physical behaviours to their TD peers. However, for individuals, descriptors of accumulation of physical activity and sedentary behaviour bouts provides additional information over and above volume measures, giving insight into behaviour which may be used to inform intervention planning. • Children with Cerebral Palsy have similar physical behaviour to their peers. • Physical behaviour bout accumulation highlights different individual behaviours. • About 25 % of upright time is spent in bouts 10 minutes or more long. • Approximately only 20–25 % of time spent stepping is in bouts longer than one minute. • Over 25 % of sedentary time is spent in bouts longer than 30 minutes. [ABSTRACT FROM AUTHOR]

Many children with cerebral palsy (CP) show impairments in trunk posture control, one crucial factor contributing to impairments in gait and arm manipulation. The goal of this study was to test the feasibility of the cable-driven hippotherapy system on improving trunk posture control and walking function in children with CP. Ten children were recruited in this study with average age 6.4 ± 3.0 years old, and were randomly assigned to the robotic group and the conventional balance training group. A custom designed cable-driven robotic hippotherapy system was used to deliver controlled pelvis perturbations while children were sitting astride. Participants from both groups underwent intensive robotic hippotherapy training or conventional balance training, depending on their group assignment, for 6 weeks (3 time/week). Outcome measures were assessed pre and post 6 weeks of robotic or conventional balance training, and 8 weeks after the end of training (follow-up test). The primary outcome measure was trunk control, which was measured using the Trunk Control Measurement Scale (TCMS). In addition, the Gross Motor Function Measure (GMFM-66), self-selected overground walking speed, and 6-minute walking distance were also assessed. The change in TCMS score from baseline to the post intervention was significantly greater for the robotic group than that for the conventional group (i.e., 6 ± 3 vs. −1 ± 5, p = 0.048, Mann-Whitney test). GMFM scores, self-selected overground walking speed, and 6-minute walking distance showed no significant improvement after robotic hippotherapy and after conventional balance training (p > 0.05). Results from this study indicated that it was feasible to improve trunk posture control in children with CP using a cable-driven robotic hippotherapy system. Knowledge obtained from this study may provide an insight for the development of new perturbation-based intervention approaches for improving trunk posture control in children with CP. • A cable-driven robotic hippotherapy system has been tested in children with CP. • Greater improvement in trunk posture control was observed after robotic hippotherapy. • It was feasible to improve trunk posture control using robotic hippotherapy training. [ABSTRACT FROM AUTHOR]

En France, pour bénéficier d'une prise en charge médicosociale et éducative adaptée, les enfants ayant un trouble du spectre de l'autisme doivent obtenir une orientation par la maison départementale des personnes handicapées (MDPH) et que ces notifications soient appliquées. En Guyane, les inégalités sociales et territoriales de santé sont omniprésentes. Il n'existe pourtant aucune donnée sur la prise en charge des adolescents avec un trouble du spectre de l'autisme en Guyane. L'objectif du projet était de connaître le parcours scolaire et médicosocial des enfants inclus dans le registre des troubles du spectre de l'autisme de Guyane depuis 2016 (qui vivaient en Guyane en 2016 et dont leur TSA avait été diagnostiqué avant leurs 8 ans) au moyen d'une interview téléphonique et d'un recueil de données à la MDPH. Nous avons inclus 52 jeunes âgés de 11 à 18 ans dont 40 familles jointes par téléphone. Les résultats obtenus à travers les variables recueillies montrent que, malgré un diagnostic posé avant 8 ans, seulement 29 jeunes (sur 47 renseignés) bénéficient d'une prise en charge médicosociale et éducative coïncidente avec les préconisations de la Commission des droits et de l'autonomie des personnes handicapées en cours (CDAPH). Parmi les 52 jeunes suivis, il y en avait au moins 9 – soit 17,3 % – qui ne recevaient aucune forme d'éducation. Trente et un jeunes bénéficiaient d'une prise en charge médicosociale, sanitaire et/ou éducative au moment de l'enquête contre 16 qui n'en recevaient aucune, notamment parce qu'ils étaient sur liste d'attente, depuis 5 ans en moyenne. Par ailleurs, 34 % des familles interrogées disaient ne pas être satisfaites de la prise en charge globale promulguée à leur enfant, surtout du fait du manque de personnel. En conclusion, il existe en Guyane un décalage important et mal vécu entre ce qui est recommandé aux parents pour la prise en charge de leur enfant adolescent et ce qui est en réalité possible. In France, to benefit from appropriate medical, social and educational care, children with autism spectrum disorders must obtain a referral from the Maison Départementale des Personnes Handicapées (MDPH), and these notifications must then be implemented. In French Guiana, social and territorial inequalities in health are omnipresent. However, there are no data on the care of adolescents with Autism Spectrum Disorder in French Guiana. The aim of the project was to explore the educational and medico-social pathways of children included in Guiana's autism spectrum disorder register since 2016 (who were living in Guiana in 2016 and whose ASD had been diagnosed before their 8th birthday) by means of a telephone interview and data collection at the MDPH. We included 52 young people aged 11 to 18, including 40 families contacted by telephone. The results obtained through the variables collected show that, despite a diagnosis made before the age of 8, only 29 young people (out of 47 completed) benefit from medical, social and educational care that coincides with the recommendations of the current Commission des droits et de l'autonomie des personnes handicapées (CDAPH). Of the 52 young people monitored, at least nine – or 17.3% – were not receiving any form of education. Thirty one young people were receiving medical, social, health and/or educational care at the time of the survey, compared with 16 who were not receiving any, mainly because they had been on a waiting list for an average of five years. In addition, 34% said they were not satisfied with the overall care their child received, mainly because of staff shortages. In conclusion, in French Guiana, there is a significant gap between what is recommended to parents for their teenage child's care and what is actually possible. [ABSTRACT FROM AUTHOR]

Suicidal thoughts and behaviors (STBs) in children are an escalating public health concern. This study focused on 1 understudied candidate risk factor, namely, preschool-onset major depressive disorder (PO-MDD), as a predictor of persistent and emerging STBs from early childhood into preadolescence. Participants were 137 children 8 to 12 years of age who met criteria for PO-MDD when they were 3 to 6 years of age, and a nondepressed sample of 53 age-, income-, and sex-matched peers. STBs were reported by caregivers (preschool, preadolescence) and children (preadolescence) using age-appropriate diagnostic interviews. By preadolescence, children who had PO-MDD were 7.38 times more likely than their peers to have endorsed STBs after early childhood (p <.001; 67.9% vs 22.6%), including 6.71 times more likely to have engaged in suicide behaviors/attempts (p =.012; 21.9% vs 3.8%); they were also 8.98 times more likely to have endorsed STBs over the prior month (p =.005; 26.3% vs 3.8%). Similar findings emerged when limiting the PO-MDD group to children without preschool STBs, and when controlling for externalizing comorbidities, implicating PO-MDD as a unique diagnostic predictive risk factor. However, children who had PO-MDD with STBs were 3.46 times more likely than children who had PO-MDD without STBs to endorse later STBs (p =.018; 83.1% vs 54.2%), indicating substantial continuity of preschool STBs alongside strikingly high rates of emerging STBs into preadolescence. This longitudinal study explores preschool onset major depressive disorder (PO-MDD) as a predictor of having suicidal thoughts or attempting suicide by age 12. 137 children aged 8 to 12 years who met criteria for PO-MDD when they were 3 to 6 years of age and 53 non-depressed peers were included in the study. The study found that preadolescents who had experienced preschool-onset depression were 6.14 times more likely to experience active suicidal thoughts and 8.03 times more likely to have made a suicide attempt by age 12 when compared to preadolescents who did not experience preschool depression. Results suggest that children with preschool-onset depression would likely benefit from increased suicide screening, proactive safety planning and early interventions. PO-MDD is a strong risk factor for the emergence and persistence of STBs into preadolescence. Children with PO-MDD would likely benefit from increased suicide screening, proactive safety planning, and early interventions. [ABSTRACT FROM AUTHOR]

Self-injurious thoughts and behaviors (SITB) among preteen children have risen to the attention of researchers, practitioners, and policymakers. To shed light on potential treatment/prevention targets, we sought to identify empirically derived emotional and behavioral problem profiles of preteens with SITB, and to determine whether these profiles differ by age, gender and society. Caregivers of 46,719 children aged 6 to 12 years from 42 societies across the world completed the Child Behavior Checklist for ages 6-18 (CBCL/6-18). There were 1,656 children whose caregivers indicated that their child experienced SITB. We conducted a latent profile analysis (LPA) using scores from eight CBCL/6-18 problem scales to derive problem profiles of children with SITB. Multilevel modelling was used to estimate differences in the profiles by SITB, society, sex, and age. A 4-profile model provided the best fit to the data, with profiles reflecting low problems (39.7%), mild problems (42.6%), moderate problems (15.4%), and rule-breaking/thought problems (2.3%). The low problems profile had CBCL problem scale scores nearly indistinguishable from those of children without SITB. Children in the rule-breaking/thought problems group were mostly female, whereas children in the other profile groups were mostly male. Children with the rule-breaking/thought problems profile also were most likely to have both suicidal thoughts and self-harm behaviors. In this study, authors analyzed emotional and behavioral profile of preteens who experienced self-injurious thoughts and behaviors (SITB). Caregivers of over 46,000 children aged 6-12 from 42 countries completed the Child Behavior Checklist. The authors found that most preteens with SITB had low levels of other mental health problems. This study highlights the needs to screen all children for SITBs, not just those who have have significant mental health problems. Problem profiles of preteens with SITB are heterogeneous, with most having relatively low levels of other psychopathology. Selectively screening only children with clinically significant mental health problems for suicidal thoughts and self-harm behaviors (eg, asking about suicidal thoughts only among children with depression) risks missing many children experiencing SITB. [ABSTRACT FROM AUTHOR]

Sleep is essential in the process of memory consolidation. Children and adolescents with epilepsy hold a significantly higher risk for memory impairment. Understanding the relationship between sleep and memory impairment in adolescents with epilepsy will help us to develop effective support services for this patient population. The present study provides a summary of the current research on the influence of epilepsy-related altered sleep patterns on memory consolidation in children and adolescents with epilepsy. The aim of this systematic review is to investigate the influence of epilepsy-related altered sleep conditions in children and adolescents and their impact on memory performance. A systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses using the search terms "memory," "sleep," "epilepsy," "children," and "adolescents." A total of 4 studies met the inclusion criteria. The review focused on the association of sleep disorders and memory performance in children and adolescents aged up to 21 years without psychiatric comorbidities. The reviewed studies highlight a higher risk of sleep disturbance and lower sleep quality in children with epilepsy in comparison to control groups. Group differences in memory consolidation were found before, but not after one night of sleep. Three studies reported a significant association between sleep and memory performance. Two studies demonstrated an association between nocturnal interictal epileptiform discharges and memory performance in adolescents. Children and adolescents with epilepsy have a higher risk of sleep and memory disorders. Nocturnal interictal epileptiform discharges have been shown to interfere with memory consolidation. Conclusions on underlying mechanisms remain unclear. Further case-control studies addressing sleep and its influence on memory problems in pediatric epilepsy patients are needed. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether family poverty over the early childhood, adolescent, and adult periods of the life course independently predicts experiences of intimate partner violence (IPV) in adulthood. This was a birth cohort study in Brisbane, Australia, with pregnant women recruited at their first booking-in visit and their children, followed up to 30 and 40 years of age. Family income was obtained from the mother when the child was 6 months, 5 and 14 years of age. Offspring reported their own family income at 21, 30, and 40 years of age. The offspring completed the Composite Abuse Scale at 30 and 40 years. Adjusted logistic regression models are used to predict experiences of IPV at 30 (n = 2157) and 40 (n = 1438) years. The findings at 30 and 40 years of age are consistent. Only poverty experienced concurrently with the assessment of IPV is strongly associated. At the 40-year follow-up, family poverty predicts higher ratios of all four forms of IPV; severe combined abuse (odds ratio [OR] = 2.24, 95% confidence interval [CI] = 1.24, 4.05), physical abuse (OR = 3.37, 95% CI = 1.95, 5.82), emotional abuse (OR = 2.09, 95% CI = 2.58, 8.57) and harassment (OR = 4.70, 95% CI = 2.58, 8.57). Concurrent family poverty is strongly and consistently associated with patterns of IPV. These associations are for cross-sectionally collected data with the prospectively collected data not replicating these findings. Although it is not possible to identify a specific causal pathway, the findings suggest that the immediate consequences of poverty are strongly associated with IPV. Programmes that address poverty reduction provide the best prospect for reducing societal levels of IPV. [ABSTRACT FROM AUTHOR]

Septic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes. The clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared. Thirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L. Culture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip. Level II, retrospective study. [ABSTRACT FROM AUTHOR]

Exploring networks of mental and behavioral problems in children and adolescents may identify differences between one-child and multi-child families. This study compared the network structures of mental and behavioral problems in children and adolescents in one-child families versus multi-child families based on a nationwide survey. Propensity score matching (PSM) was used to match children and adolescents from one-child families with those from multi-child families. Mental and behavioral problems were assessed using the Achenbach's Child Behavior Checklist (CBCL) with eight syndromal subscales. In the network analysis, strength centrality index was used to estimate central symptoms, and case-dropping bootstrap method was used to assess network stability. The study included 39,648 children and adolescents (19,824 from one-child families and 19,824 from multi-child families). Children and adolescents from multi-child families exhibited different network structure and higher global strength compared to those from one-child families. In one-child families, the most central symptoms were "Social problems", "Anxious/depressed" and "Withdrawn/depressed", while in multi-child families, the most central symptoms were "Social problems", "Rule-breaking behavior" and "Anxious/depressed". Differences in mental and behavioral problems among children and adolescents between one-child and multi-child families were found. To address these problems, interventions targeting "Social problems" and "Anxious/depressed" symptoms should be developed for children and adolescents in both one-child and multi-child families, while other interventions targeting "Withdrawn/depressed" and "Rule-breaking behavior" symptoms could be useful for those in one-child and multi-child families, respectively. • This study was based on a nationwide survey, using propensity score matching for balancing baseline characteristics. • Children and adolescents from multi-child families were more inclined to externalize psychological problems. • Children and adolescents from one-child families were more prone to internalize psychological problems. • There are obvious gender and age differences in network of mental and behavioral problems in children and adolescents. [ABSTRACT FROM AUTHOR]

Pediatric posterior fossa tumor (PFT) survivors experience long-term cognitive sequelae, including memory disorders, for which irradiation is one of the main risk factors. The aims of the present study were to (1) explore the profile of impairment in episodic, semantic, working and procedural memory systems in irradiated versus nonirradiated PFT survivors, and (2) test whether an autobiographical questionnaire and a two-phase ecological test (Epireal) assessing episodic memory are more sensitive to radiation-induced hippocampal damage than commonly used tests. A total of 60 participants (22 irradiated PFT survivors, 17 nonirradiated PFT survivors, and 21 controls) were included in the prospective IMPALA study. They all underwent a broad battery of tests assessing the different memory systems in two 2-day sessions 3 weeks apart. We performed between-groups comparisons and analyzed impairment profiles, using -1.65 SD s as a cut-off. For irradiated patients, correlations were calculated between mean radiation doses to key brain structures involved in memory (hippocampus, cerebellum, and striatum) and corresponding memory scores. PBT survivors performed significantly more poorly than controls (p < 0.001) on conventional tests of episodic, semantic and working memory: 64% of irradiated patients and 35% of nonirradiated patients had a deficit in at least two memory systems, with episodic memory impairment being more specific to the irradiated group. Epireal had a larger effect size than the other episodic memory tests, allowing us to detect deficits in a further 18% of irradiated patients. These deficits were correlated with the mean radiation dose to the left hippocampus. Memory impairment is a frequent long-term cognitive sequela in PFT survivors, especially after radiation therapy. New ecological tests of episodic memory that are more sensitive to radiation-induced deficits than conventional tests could yield specific markers of the toxicity of medial temporal lobe irradiation. • 86% of irradiated patients had a deficit in at least one memory system. • 65% of nonirradiated patients had a deficit in at least one memory system. • Episodic memory was specifically impaired in irradiated patients. • Episodic tests were more sensitive to radiation toxicity on the left hippocampus. [ABSTRACT FROM AUTHOR]

The reader will come to appreciate the: • Excellent correlation between peak cough flow [PCF] and peak expiratory flow derived from using the same spirometer. • Benefits of repeated testing to achieve reproducible spirometry to better inform and guide clinical care. • PCF testing can be utilised for children where performing technically acceptable spirometry is not possible. Spirometry and peak cough flow testing (PCF) are commonly used in the respiratory assessment of children with a neuromuscular disorder (NMD). Testing uses two different machines, increases laboratory time, costs and resource utilisation. No studies have assessed the correlation between peak expiratory flow (PEF) obtained from spirometry and PCF in children with NMD using one device. An audit of children with a NMD managed at the Children's Hospital at Westmead in 2022–2024 aged < 20 years who performed spirometry and PCF testing on the same device (Vyaire Body BoxTM, Ultrasonic flow meter-based, or Vyaire PneumotachographTM, Pneumotach flow meter-based; Germany) was conducted to assess the correlation between PCF and PEF. Fifty-one sets of testing were identified, and 40 subjects (9F) had reproducible testing and were included. Median (range) age was 14.95 (7.20–19.00) years. Median PEF (L/min) was 4.05 (1.22–10.26) and median PCF (L/min) was 4.29 (1.69–10.82). PEF and PCF had a strong Pearson's correlation coefficient, (R = 0.97, p = 0.03). The coefficient of determination was 0.93. If laboratory resources permit, spirometry should be the test of choice for children with NMD. On average, spirometry required multiple practices to achieve reproducibility to meet ATS/ERS standards. PCF testing can be utilised for children where performing technically acceptable spirometry is not possible. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes acute necrotizing encephalopathy (ANE), which has a high mortality rate and severe sequelae. This study aimed to identify ANE early and evaluate the usefulness of tocilizumab in ANE treatment. We retrospectively included eight paeefediatric ANE cases infected with SARS-CoV-2 at Xi'an Children's Hospital, China, from December 1, 2022 to May 1, 2023. A literature search was performed using the PUBMED, SPRING, SCOPUS, and EMBASE databases. This study included eleven patients. Clinical characteristics, laboratory test results, imaging features, and treatment options were analysed. Eight of the 19 cases (42 %) died, one (5 %) recovered, and nine (47 %) improved with residual neurological dysfunction. Eighteen patients presented with fever, with 56 % having ≥40 °C. Twelve patients (63 %) presented with dysfunction consciousness. Eight (42 %) patients experienced frequent convulsions. All eight patients in our hospital had elevated procalcitonin levels (mean: 21.32 ng/mL, range: 0.10–89.40 ng/mL). Alanine aminotransferase levels were elevated (mean: 632.81 U/L, range: 13.00–2251.00 U/L) in six patients. Seven patients showed elevated uric acid levels(mean: 396.50 μmol/L, range: 157.00–660.00 μmol/L). Brain imaging indicated that all the patients had symmetrical injuries to the bilateral thalami, accompanied by symmetrical injuries in the cerebrum, cerebellum, basal ganglia, and brain stem. Compared with the classical treatment (n = 9), the combination with tocilizumab (n = 6) showed a statistically difference in mortality (p = 0.028 < 0.05). The typical clinical manifestations of ANE in children with SARS-CoV-2 infection are acute onset with high fever, frequent convulsions and rapidly worsening disturbance of consciousness. Tocilizumab treatment could reduces mortality in ANE. • The mortality rate of ANE caused by SARS-CoV-2 was 42 %. • Main symptoms are high fever, frequent convulsions and rapidly worsening consciousness. • The thalamus and brainstem are the most common sites of injury. • Treatment with tocilizumab can help reduce the mortality. [ABSTRACT FROM AUTHOR]

On February 6, 2023, a catastrophic earthquake struck the Kahramanmaras region in Turkey. Among the most vulnerable demographic groups in the wake of such disasters are children. To provide effective psychosocial support to these young individuals, it is crucial to gain a comprehensive understanding of their specific needs resulting from the earthquake experience. This study aimed to determine the disaster experiences and psychosocial support needs of children between the ages of 7 and 12 who were affected by the Kahramanmaraş earthquake in Turkey with drawings. This research used a descriptive qualitative design, employing purposive and snowball sampling approaches to select 32 children aged 7–12 for the study. Thematic analysis approach was used to analyze the data, revealing six distinct themes as expressed through the drawings of school-aged children. The reporting in this study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). These six themes are associating precipitation with earthquakes, security and relocation, emotional chaos, expressing the earthquake symbolically, death and physical damage and longing for normalcy. This study highlights the importance of acknowledging and attending to children's requirements through psychosocial interventions tailored to their age. It underscores the complex nature of the psychosocial needs of children impacted by earthquakes and promotes collaborative efforts among healthcare professionals and nurses to provide more effective support to these children during challenging circumstances. • Children's disaster experiences and psychosocial needs through drawings were explored. • Psychological reactions of children to the earthquake were revealed with drawings. • Drawing is effective method for children to express their experiences and emotions. • Multidisciplinary approach should be adopted to increase resilience in children. [ABSTRACT FROM AUTHOR]

Children's vaccination mainly depends on their parents' decisions. Therefore, it is important to understand parents' acceptance and attitudes toward vaccinating their children against COVID-19. The study aimed to assess the pediatric nurses' acceptance and attitudes toward COVID-19 vaccines for their children at Assiut University Children Hospital. A cross-sectional descriptive design was used on a convenience sample of 270 nurses who worked at Assiut University Children Hospital. Tool one involved the demographic characteristics of pediatric nurses and their children. Tool two consisted of pediatric nurses' acceptance and attitudes toward COVID-19 vaccines for their children: The results indicated that 79.3% of pediatric nurses had higher acceptance of vaccines and immunization of their children. Results also revealed that 80.0% of pediatric nurses had positive attitudes toward vaccines and their children's immunizations. It was concluded that most of pediatric nurses had high acceptance and positive attitudes toward vaccines and immunization of their children. Also, it was clarified that there was a positive statistically significant correlation between nurses' acceptance of vaccines and immunization of their children and their attitudes. Continuing education and tailored intervention should be implemented to correct misinformation and negative conceptions about the safety of vaccines for children. • Pediatric nurses have higher acceptance to COVID-19 immunization of their children. • Pediatric nurses have positive attitude to COVID-19 immunization of their children. • Vaccinating children is important for the health of the community. • Knowledge regarding new vaccination improves acceptance and attitudes to it. • Health care professionals have good acceptance and attitudes toward vaccination. [ABSTRACT FROM AUTHOR]

Needle-related procedures are quite common throughout life, especially during childhood. Pain caused by these procedures is the most common complication. ShotBlocker is an alternative non-pharmacological method to reduce pain during injection-related procedures. However, the effectiveness of the ShotBlocker application in children for reducing pain needle-related procedures remains unclear. This review aimed to evaluate the effectiveness of ShotBlocker application on pain during needle-related procedures in children from Randomized Controlled Trials. Eight electronic databases were searched until November 2023 for articles published in English. The methodological quality and evidence strength were appraised using the Cochrane Risk of Bias 2 tool and the GRADE approach. A random-effects model was used to determine the effect of the ShotBlocker application on pain levels. The review included results involving assessments from the child, parents, and an observer in pain evaluation. A total of nine studies with 1205 children patients were included. The evaluation data showed that ShotBlocker application significantly reduced the pain caused by needle-related procedures in children. The Cochrane GRADE approach showed moderate level evidence for the effect of ShotBlocker application on pain during needle procedures. As a result of the studies included in this meta-analysis, it was determined that ShotBlocker application significantly reduced the pain caused by needle-related procedures in children. ShotBlocker, a non-pharmacological method, can be used by pediatric nurses to reduce pain during needle-related procedures in children. Randomized controlled studies with well-designed methods are needed to create strong evidence in this field. • This review was the first to evaluate the impact of the ShotBlocker application during needle-related procedures in children. • The ShotBlocker can be used as a non-pharmacological intervention to reduce pain during needle-related procedures in children. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) is used as a novel intervention technique to alleviate uncomfortable experiences such as anxiety and pain in children. Recently, VR distraction has gained prominence in pediatric medical procedures. However, no studies have yet conducted a further quantitative analysis of the intervention effects of virtual reality exposure (VRE). This systematic review aims to analyse the effect of VRE on anxiety and pain levels in paediatric patients undergoing medical procedures. Relevant studies were searched from four databases, including PubMed, Cochrane Library, Embase, and Web of Science. This systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). The meta-analysis incorporated a total of 11 articles, encompassing 1,099 pediatric patients. The results showed that VRE relieved children's anxiety [SMD = -0.61, 95% CI (-0.93, -0.28), p < 0.001], but there was no significant difference in alleviating pain in children [SMD = -1.48, 95% CI (-3.40, 0.44), p = 0.131]. The results suggest that VRE is effective in reducing children's anxiety during medical procedures. However, 7 of the 11 original studies included in this review were from the same research project, which may increase the risk of reporting bias. Also, more high-quality studies are needed in the future to verify its effectiveness for pain levels. VRE can help children become familiar with the medical environment, overcome anxiety and fear, and learn about medical procedures in advance. This can enhance their cooperation during medical process, leading to a more positive medical experience. • Virtual reality exposure (VRE) reduced anxiety in children but had no effect on pain levels. • VRE was more effective than virtual reality distraction in relieving anxiety in children. • Shortening the interval between VRE and medical procedures can improve the effectiveness of the intervention. [ABSTRACT FROM AUTHOR]

This study aimed to explore the experiences of Jordanian mothers of children with cerebral palsy (CP) in order to better understand the challenges they face while caring for their children. A qualitative descriptive study was applied, using semi-structured face to face interviews with a purposive sample of 10 mothers of children with CP. Mothers caring for children with CP embark on a challenging journey. Navigating the diagnosis begins with shock and disbelief, followed by emotional struggles as they deal with the new reality. This initial phase also involves caregiving challenges and hardships. Mothers may experience societal stigma and feelings of rejection, which can contribute to social isolation. Additionally, the physical demands of care can lead to financial hardships. These financial constraints can further limit access to specialized care, creating a frustrating cycle for mothers. Throughout this process, mothers demonstrate resilience by adapting to the illness . This encompasses making changes in their lives, actively seeking support, and developing expertise in managing their child's specific needs. The results shed light on the emotional, physical, and social challenges faced by mothers of children with CP. The findings show a narrative of adaptation, resilience, and strength, encompassing adjustments to the diagnosis, substantial life changes, seeking support, and addressing challenges such as social stigma, isolation, and various hardships. Our findings lay the foundation for tailored interventions and empathic support for mothers caring for a child with CP. • Jordanian mothers face shock, disbelief, & challenges adjusting to child's CP diagnosis. • Mothers navigate stigma, rejection, isolation, and limited care access. • Mothers show resilience, adapting life, seeking support, and managing child's needs. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the effects of preoperative therapeutic play on fear and anxiety levels in preschool children. The study had an experimental pre-intervention-post-intervention design with a control group. The study was carried out with 37 children aged 3–6 years who were brought for surgical procedures at XX Research and Training Hospital between July 2020 and January 2021. While a therapeutic play intervention was performed with the children in the experimental group (n = 20), routine preoperative practices were performed in the control group (n = 17). Data were analyzed using chi-squared tests, the Mann-Whitney U test, and the Wilcoxon test. p < 0.05 was considered significant. The fear and anxiety levels of the children in the experimental and control groups were similar pre-intervention (p > 0.05). In the post-intervention, the mean anxiety and fear scores of the experimental group were 2.15 ± 1.63 and 1.15 ± 0.58, their mean ranks were 10.80 and 12.65, while the mean anxiety and fear scores of the control group were 7.94 ± 2.07 and 2.53 ± 1.00, their mean ranks were 28.65 and 26.47, respectively, and the difference between the groups was statistically significant (respectively, MU = 6.00 p = 0.000, MU = 43.00 p = 0.000). It was determined that the therapeutic play method applied before surgery reduced the anxiety and fear levels of children. Considering this situation, improving the skills of nurses in therapeutic play and increasing the number of personnel certified for interactive therapeutic games can reduce the risk of preoperative emotional trauma in children. The therapeutic play method applied before surgery reduced the anxiety and fear levels of children. The routine use of therapeutic play in pediatric surgery clinics is recommended. • Surgical procedures performed on children affect their anxiety and fear levels. • Therapeutic play opportunities provided before surgery reduces the anxiety and fear levels of children. • The routine use of therapeutic play in pediatric surgery clinics is recommended. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) distraction can be used during peripheral intravenous catheter (PIC) insertion. The vein imaging devices are recommended for increasing PIC success. This study aimed to evaluate the effect of a Veinlite PEDI2 and passive VR distraction on the first attempt at PIC insertion success, duration of insertion, emotional behavior, pain, fear, and anxiety associated with PIC insertion in children aged 4–10 years in the pediatric emergency department. The study was conducted with a total of 160 children who were assigned to groups (control, vein imaging, VR, and vein imaging with VR) through stratified randomization. The duration and number of attempts for PIC insertion were recorded. The children's emotional state, fear, and anxiety were evaluated before and after the procedure. After the procedure, pain was evaluated using the Wong-Baker FACES and Color Analog Scale. The mean scores obtained from the scales were compared using the Kruskal-Wallis test. The PIC success rate on the first attempt was 80–85% in the groups. A significant difference was found between the groups in terms of total emotional behavior scores (KW = 21.608, df = 3, p < 0.001). There were statistically significant differences among the groups in emotional behavior, pain, and anxiety scores after the procedure, while no difference was observed in fear scores (KW = 6.485, df = 3, p = 0.09). VR distraction effectively reduced pain and anxiety, while the Veinlite PEDI2 did not affect the first attempt at PIC insertion or duration. VR and Veinlite PEDI2 can be used for PIC insertion-related pain and anxiety (ClinicalTrials.gov : NCT06243419). [ABSTRACT FROM AUTHOR]

The terminal phase of childhood cancer poses profound physical and mental challenges for children, simultaneously influencing parents and rendering them particularly susceptible to psychosocial issues. This review included studies exploring the experiences of either: (1) paediatric terminal oncology patients aged under 18 years, (2) parents with a child facing terminal cancer undergoing palliative care, or (3) parents with a child who had undergone palliative care and died. English language, qualitative journal studies or grey literature of any care settings, geographical locations and publication years were included. Studies exploring the experiences of (1) paediatric terminal oncology not receiving palliative care from qualified healthcare professionals, and (3) non-biological parents or non-parental family members, were excluded. A total of 22 studies were included, published between January 2000 and December 2023. Seventy-two children (aged between 5 and 18 years old) and 236 parents (aged between 24 and 57 years old) participated across all studies. Palliative care settings mostly comprised oncology centres, hospitals and homes. Two themes were identified from the 22 included studies: (1) Navigating rough waters and enduring hardships, and (2) Preparing for end-of-life amidst the looming threat of death. This review underscored the importance of integrating palliative childhood cancer care in a holistic, age-specific, family-centred, person-centred and timely manner. Paediatric oncology nurses should attend to physical and psychosocial needs of children and parents, fostering familial and social ties while recognising cultural and spiritual needs. Future research could recruit participants of varying ages, genders, and cultures. • Children faced psychosocial strains, notably loneliness and fear of separation, alongside pain. • Children drew strength from being with loved ones and should be engaged in open conversations. • Parents sought solace in home caregiving, support systems and spiritual beliefs amid sacrifices. • Holistic care should foster familial and social connections while addressing individual needs. • Future research could explore experiences among various cultures and stakeholders and low- and middle-income countries. [ABSTRACT FROM AUTHOR]

This study was conducted to determine the validity and reliability of the Turkish version of the Resilience Scale for Young Children. This study used a methodological and descriptive design. The study was conducted with 210 parents of children aged 2–6 years at a Family Health Centre in Sakarya from June 2023 to January 2024. Data was collected by face-to-face interviews via a Descriptive Information Form and the Chinese Resilience Scale for Young Children. Translation processes, expert opinions, and content validity were meticulously addressed. Data analysis was utilized by IBM SPSS Statistics and AMOS 24. The mean age of parents was 35.85 ± 6.52 years, and 82.9% of the parents were mothers (n = 174). The item-content validity index (I-CVI) ranged between 0.81 and 0.94, indicating a high level of agreement between the experts. The Cronbach's alpha value for the scale was 0.791. In the exploratory factor analysis, it was determined that the distribution of the items according to the sub-dimensions was consistent with the original scale. Confirmatory factor analysis results are as follows: chi-square/df = 2.395, RMSEA = 0.082, GFI = 0.842, CFI = 0.853, IFI = 0.856, RFI = 0.726, NFI = 0.776 and TLI = 0.820. This study revealed that the Turkish scale with four sub-dimensions and 16 items is a valid and reliable tool. It is recommended to use the Turkish version of the Resilience Scale for Young Children to assess resilience in children aged 2–6 years. • This study was conducted to evaluate the Turkish validity and reliability of the Resilience Scale for Young Children. • The Turkish version of the Resilience Scale for Young Children showed good psychometric properties. • The scale is recommended for assessing resilience in children aged 2–6. [ABSTRACT FROM AUTHOR]

Children of different age groups frequently undergo painful procedures involving needles, which can be a source of significant discomfort. Regrettably, this aspect of care often receives insufficient attention from healthcare professionals. The existing literature proposes several methodologies for managing procedural pain, with nonpharmacological techniques being particularly promising. These techniques should be adapted to the patient's age, but literature predominantly emphasizes their use with infants. Thus, it is necessary to evaluate their effectiveness in diverse age groups. Consequently, the purpose of this systematic review is to identify non-pharmacological interventions used to prevent needle-related procedural pain in children (age group 6–12 years). Primary studies in English language on non-pharmacological interventions in children aged 6–12 years undergoing needle-related procedures found on PubMed, CINAHL and Embase. A total of 18 studies were included. The results indicate the potential application of various non-pharmacological techniques, with distraction methods standing out. These techniques include activities like utilizing cards, watching cartoons, employing virtual reality and playing video games. Children's procedural pain represents a significant challenge in treatment plans. Literature offers several approaches, including nonpharmacologic methods, to control this problem. Prioritizing procedural pain management is critical both at clinical and organizational levels to improve the quality of pediatric care. These findings offer different options to support clinical practice, holding the potential to enhance the quality of patient care. • This study identifies different non-pharmacological options in managing needle-related procedural pain in children aged 6–12 years. • Distraction methods such as cards, cartoon-watching, Virtual Reality and video games are effective in children aged 6–12 years undergoing needle-related procedures which may be source of pain, stress and fear. • These findings may offer opportunities to enhance quality of pediatric care. [ABSTRACT FROM AUTHOR]

This study aimed to explore children's perspective of hope in living with leukemia through the utilization of drawing-based interview technique. This qualitative study was conducted at the Children's Medical Center in Tehran with the participation of children aged 6 to 12 diagnosed with leukemia. The children were asked to prepare a drawing about hope then interviews were conducted face-to-face with each child after completing the drawing. Data analysis was conducted using the qualitative content analysis. In the collection of a total of 20 drawings from school-age children with leukemia, each drawings has different metaphors symbolizing hope. Five themes emerged including positive thinking, embracing the sanctuary of maternal affection and collective caring, the ethereal glow of joy, the melody of resilient soul, and navigating the way back to home. Hope from the child's perspective can be achieved in simple, possible and accessible ways, making it easier for the family, community and healthcare system to inspire hope in their lives with Leukemia. Health providers in pediatric oncology can integrate hope-based care interventions related to the factors influencing children's perspectives. • Hope is an abstract concept that is perceived by school-age children with leukemia as a real component of their disease. • The concept of hope is demonstrated by positive thinking, happiness, care and compassion, resilience, recovery and return home. • Nurses' interventions can be improved according to dimensions of perceived hope among school-aged children with leukemia. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to create and evaluate a care needs scale for mothers of children with congenital heart disease (CHD) to determine its psychometric properties. This methodological research was conducted with 155 mothers whose children were diagnosed with CHD and were treated at a university hospital. The study's methodology included scale development, specialist opinions, and a pilot test. Data analysis involved descriptive statistics, exploratory and confirmatory factor analyses, and reliability assessments. The 11-item scale was created using component analysis, expert comments, and pilot testing. It was divided into two categories: Information Needs Regarding Disease and Treatment and Needs Regarding Care. The Exploratory Factor Analysis revealed a 2-factor structure, explaining 41.5% of the variance. Reliability analysis showed reliable dimensions, and Tukey's scalability test indicated the scale requires separate dimension evaluation. The model fit indices were obtained as CMIN/DF (72.751/41) = 1.774, GFI = 0.925, IFI = 0.923, TLI = 0.893, CFI = 0.920, RMSEA = 0.071, SRMR = 0.063. The Cronbach's alpha coefficient for subdimension 1 was 0.758, and for subdimension 2 was 0.678, indicating reliable dimensions. The developed scale provides a valuable tool for assessing the care needs of mothers of children with CHD, contributing to enhancing maternal support programs in pediatric cardiology clinics. Assessment of the care needs of mothers who have children with CHD is promising for the development of educational programs on this subject and to ensure the competence of mothers for care. • The scale has 11 items covering two domains: 'Information Needs Regarding Disease and Treatment' and 'Needs Regarding Care'. • Each domain represents a cluster of care needs perceived by mothers of children with CHD. • The scale showed adequate evidence of validity and reliability to assess the care needs of mothers of children with CHD. • The scale could be used by pediatric nurses to assess the care needs of these mothers. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the effect of education given with motivational interviewing techniques on mothers of children with allergic asthma aged 4–11 years on asthma control and knowledge level. The research was designed according to the CONSORT checklist with a randomized controlled design. 76 participants were randomly assigned to either an intervention (n = 38) or control group (n = 38). The intervention group received asthma education utilizing motivational interviewing techniques from a pediatric nurse. The control group received no further education. The Childhood Asthma Control Test and Asthma Knowledge Level Questionnaire were used to collect data. The control group received only education at the time of discharge. The mothers' asthma control and asthma knowledge scores in the experimental group were significantly higher than in the control group (p < 0.001). In the experimental group, asthma control scores increased from 14.29 ± 4.27 to 21.37 ± 1.57 after education. The mean score of the asthma knowledge score increased from 54.74 ± 10.89 to 73.47 ± 7.17 after intervention. The study showed that education using motivational interviewing techniques for mothers of children with allergic asthma increased their knowledge and positively affected asthma control. Education is important in improving mothers' knowledge about allergic asthma. Asthma education using motivational interviewing techniques should be provided when their children are newly diagnosed. Education practices should be implemented as a policy in hospitals and pediatric clinics, and nurses should be supported in ensuring the implementation of education practices. • Motivational interviewing can help to mothers to improve their knowledge level about asthma and asthma control. • Lack of knowledge about allergic asthma complicates asthma control and adversely affects treatment management. • Effective treatment management reduces hospital admissions. [ABSTRACT FROM AUTHOR]

We aimed to explore the relationship between media exposure to the Kahramanmaraş earthquakes and its impact on children's mental health difficulties. This cross-sectional study was conducted with 409 parents between March and July 2023. Parents were invited to participate in an online survey through social media platforms. The data was collected using the 'Descriptive Characteristics Form', the 'Media Exposure Form Related to the Earthquake', and the 'Strengths and Difficulties Questionnaire'. The results indicated that exposure to images of earthquake-related events on the first day after the earthquake (p < 0.001), people rescued alive from the rubble on television (p < 0.001), earthquake victims staying on the streets/in tents on television (p = 0.006), and earthquake-related events while alone on the Internet (p = 0.02) were significantly associated with the impact of children's mental difficulties. Furthermore, exposure to images of people pulled deceased from the rubble (p < 0.001), exposure to images of demolished houses on the Internet (p = 0.007), and exposure to images of destroyed roads on the Internet (p = 0.01) were found to significantly predict the impact of children's mental difficulties (r2 = 0.29; p < 0.001). This study has shown that children who are exposed to screen media may experience difficulties in coping mentally, leading to emotional and behavioral problems. Children who have experienced natural disasters may be exposed to distressing images on screen, which can lead to difficulties and stress. To reduce the risk of mental health problems related to disasters, nurses may suggest that victims limit their exposure to television footage. • There is no research about media exposure and mental health in children following Kahramanmaraş earthquakes. • Internet and TV media images of dead people, earthquake victims on the streets/tents negatively affect children. • Internet and TV media images of destroyed houses and roads negatively affect children. [ABSTRACT FROM AUTHOR]

We aimed to explore the concerns of parents when their children had symptoms of infection during the COVID-19 pandemic. Two Norwegian internet forums were searched for parents' experiences when their children had upper respiratory infection symptoms in 2020–2021. A total of 197 posts were included and analyzed using thematic analysis. Parents described COVID-19-related and general worries regarding their children with upper respiratory infection symptoms. The first theme, "It is not 'just a cold' during the pandemic," captures how infection control measures influenced parents' concerns. The second theme, "Concerns and consequences of fever and cold symptoms," describes general parental worries. Varying levels of worries regarding health care services, limitations of family life, and concerns for relatives were highlighted. Knowledge of parents' concerns about cold symptoms may help primary health care providers target individual patient counseling and provide background information when policymakers develop information material for infection prevention and treatment. [ABSTRACT FROM AUTHOR]

• Non-immersive virtual reality (NIVR) interventions are safe and generalizable. • NIVR have been shown to be feasible and acceptable for pediatric healthcare. • NIVR may facilitate a reduction in children's socioemotional and behavioral problems. • This review demonstrates the need for expansion of NIVR in pediatric healthcare. Nonimmersive virtual reality (NIVR), a computer-generated virtual reality experience wherein users are not fully immersed, has been increasingly used in pediatric healthcare. This study aimed to identify the effects of NIVR-based interventions for children. A mixed methods systematic review of relevant studies published until December 2023 was conducted. We included samples of healthy children and those with chronic conditions or disabilities, findings related to self-management or social skills, and the NIVR interventions applied. A convergent-integrated design was used for the synthesis. This review included 22 studies, of which 15 examined children having autism spectrum disorders. Utilizing NIVR was found to be effective in enhancing social skills. Participating in virtual communities with peers having similar conditions was determined to facilitate social support and identity exploration. Healthcare interventions using NIVR need to be explored further to improve self-management and social skills in children with various conditions. [ABSTRACT FROM AUTHOR]

Intravenous fluids are commonly prescribed to children in hospitals. However, there are risks associated with their use. In order to safely prescribe these clinicians should understand the indications for their use, the principles underpinning their use and know the likely complications associated with intravenous fluid administration in children. Intravenous fluids should be prescribed depending on individual needs of each child and with careful monitoring and re-assessment. This review aims to provide a general approach to fluid prescription in children, providing some background of different physiological principles, different fluid composition, and the role of anti-diuretic hormone in fluid homeostasis. Fluid prescription is discussed, with an approach taking into consideration resuscitation boluses, dehydration, replacing ongoing losses and maintenance requirements. Case examples are provided to further facilitate readers' comprehension. Electrolyte abnormalities and an approach to the management of deranged electrolytes is addressed. Complications associated with fluid administration are highlighted, in particular, emphasizing the assessment and emergency management of the child with suspected cerebral oedema or hyponatraemic encephalopathy. Special consideration and discussion is given to the differing approach to fluid management of children in the setting of burns or diabetic ketoacidosis. [ABSTRACT FROM AUTHOR]

End stage kidney disease is rare in children and adolescents. The availability and types of kidney replacement therapy (KRT) vary widely, with a global prevalence of 18–100 per million age-related population (pmarp). Chronic peritoneal dialysis (PD) is considered the dialysis modality of choice in younger children given its almost universal applicability, cost-effectiveness, and the possibility of a home-based treatment. This is most compatible with a child's schooling and social life. Advances in technology have improved outcomes even for the youngest children, but mortality remains high, and the morbidity and burden of care should not be underestimated. Optimal management of children on dialysis requires a multidisciplinary team and consideration of the child and family's expectations. With few high-quality randomised trials, clinicians are reliant on prospective cohort studies and international registries to inform and improve management strategies. Children on dialysis have a lifetime of KRT ahead of them. The selection of dialysis modality and management must consider the principles of dialysis access preservation. This review summarises current epidemiology, principles of dialysis, PD access, modalities, prescriptions, and complications of PD, as well as a brief discussion on PD in infants with their unique ethical and technical considerations. [ABSTRACT FROM AUTHOR]

Kidney replacement therapy (KRT) can provide lifesaving support for children with severely impaired kidney function. The decision about who needs KRT and when is often complex. Many acute kidney problems will resolve with conservative maanagemenent but some children with chronic or acute kidney impairment will find themselves in a position where KRT is required either as a bridge to recovery or kidney transplantation. Less commonly, children with metabolic disorders may find that the ability of their own kidneys is overwhelmed by excessive production of certain metabolites. These children may also benefit from short term KRT. This article aims to help paediatricians in training understand which children need kidney replacement therapy, the various types of treatment available, and when they are used. [ABSTRACT FROM AUTHOR]

We would like the reader to consider the current paediatric point-of-care ultrasound (POCUS) landscape. Even in the most developed European healthcare systems, paediatric POCUS programmes and users mostly operate in silos and are un-, or at best underrepresented by major professional bodies. While international societies focus on the extent and content of POCUS investigations, guidelines and associated evidence, there is little to no established framework for education and clinical governance standards on this explosively advancing field. Borrowing from fluid dynamics, this rapid advancement generates cavitation, leaving providers and educators exposed in certain crucial areas of ongoing clinical practice covered contemporaneously, or worse, post hoc, allowing for clinical governance or medico-legal scrutiny. We give a glimpse into our prospective local POCUS clinical practice initiative and how it complements, advances and affirms our clinical decision making on a daily basis. We'll guide the reader through ward rounds, procedural applications, specialist assessments with allied health professionals, referrals, remote consultations, new patient admissions, and grand rounds. As we are in the process of building a robust, reliable and accountable clinical governance structure around our daily practice, we would also like to demonstrate the need and utility for introductory courses, ongoing educational sessions, established mentorship and regular governance meetings ensuring optimal clinical outcomes. We hope to give insights to clinical practice, deployment, recruitment, education and potential future applications like telemedicine. [ABSTRACT FROM AUTHOR]

Haematuria and proteinuria are common findings on urinalysis in childhood. They usually occur in either children with specific symptoms e.g. macroscopic haematuria or nephrotic syndrome, or in those who have non-specific symptoms (usually when looking to exclude urinary tract infection) and sometimes in asymptomatic children. The majority of children fall into the latter two groups, the finding is temporary and not associated with long term renal disease. If the finding is persistent or patients have specific clinical features then renal abnormalities are more frequent and appropriate investigation is required. This review provides a rationale for an approach that allows reassurance to be given to children and their families in whom the finding is transient and benign, whilst identifying those in whom renal abnormalities are present and treatment required. It describes algorithms for macroscopic haematuria (MaH), asymptomatic microscopic haematuria (MiH) and proteinuria. [ABSTRACT FROM AUTHOR]

Urinary tract infections (UTI) are a common problem in childhood. The clinical presentation is variable depending on age and whether there is pyelonephritis or cystitis. UTI are diagnosed by culturing an appropriately collected urine sample. Most children with UTI can be managed safely with oral antibiotics irrespective of whether they have cystitis or pyelonephritis. Following a single UTI a significant proportion of children will develop recurrent UTI and many of these children will have identifiable risk factors. Treating children with recurrent UTI with repeated courses of antibiotics or long term prophylactic antibiotics puts patients at risk of infections with multi-resistant organisms. Furthermore recurrent UTI are also associated with the risk of renal parenchymal damage with long term health implications. It is therefore essential that management of children with UTI focuses not only on early diagnosis and treatment but also on UTI prevention. [ABSTRACT FROM AUTHOR]

Appropriate assessment of fetal growth is essential for safe clinical care. There have been many recent strategies to improve the detection of aberrant fetal growth patterns, one of which has been to optimize fetal growth centile charts. Over recent years there has been ongoing debates regarding the optimal growth chart for clinical usage. Controversy can arise where growth charts have demonstrated wide variance in the proportion of fetuses classified within the extremities of growth. Standards for growth charts need to be evidenced based and validated against pregnancy outcomes to demonstrate clinical utility and widespread usage. They should be supplied by high quality methodological reasoning and ideally evidenced through large prospective multicentre studies. Given the variable terminology to classify growth centile charts, including the variety of charts available, a complete understanding by healthcare professional can be troublesome to achieve. This practical guide aims to provide clarity on this diverse subject. [ABSTRACT FROM AUTHOR]

With the increasing prevalence of obesity, childhood type 2 diabetes (T2D) is a growing concern in Taiwan. Unlike its adult counterpart, T2D in children exhibits a more aggressive nature and earlier onset of complications. Metformin represents the first line of drug, but if blood sugar levels do not improve, other drugs are used. This retrospective cohort study endeavors to scrutinize and assess the pattern of treatment modification and associate factors among 79 young people with T2D in Taiwan. The study categorized participants into three distinct groups based on their treatment trajectory and outcomes: (1) those maintaining metformin (n = 34); (2) cases achieving remission (n = 7); and (3) individuals experiencing escalation through oral drugs or insulin (n = 38). The average follow-up period spanned 3.48 years. Findings from univariate analysis using a Cox proportional hazards model and propensity score weighting revealed that HbA1c and weight gain correlated with elevated risk of treatment escalation. Conversely, factors such as hypertension, high weight or body mass index (BMI) SDS, leptin levels, c-peptide concentrations, peak c-peptide values during glucagon stimulation test and LDL-cholesterol levels were associated with reduced risk of escalation. However, in multivariate analyses employing stepwise selection, the sole predictive factor for treatment escalation emerged as weight gain one year post-therapy (HR: 1.06, p < 0.001). This study underscores the interconnectedness between weight management and the trajectory toward either treatment escalation or disease remission. Furthermore, it highlights the cost-effective potential of intervening in younger populations. Ultimately, these insights accentuate the considerable opportunity for enhancing health care management strategies concerning pediatric T2D in Taiwan. [ABSTRACT FROM AUTHOR]

Dysregulation of iron homeostasis is associated with cardiac alterations in a sex-dependent manner in adults. It is unknown whether iron status during pregnancy has long-term impact on cardiovascular health, and if this association is influenced by sex. Therefore, this study aimed to evaluate sex-specific association between maternal iron status during early pregnancy and cardiac outcomes in children aged 10 years. In a population-based cohort study among 1972 mother–child pairs, hemoglobin and ferritin were measured in early pregnancy (<18 weeks) and categorized into anemia (hemoglobin<11 g/dL), elevated hemoglobin (hemoglobin≥13.2 g/dL), iron deficiency (ferritin<15 μg/L), and iron overload (ferritin>150 μg/L). At 10 years of age, cardiac MRI was performed to measure right and left cardiac outcomes of function (ventricular end-diastolic volume (RVEDV and LVEDV) and ejection fraction (RVEF and LVEF)), and structure (left ventricular mass (LVM), and left ventricular mass-to-volume ratio (LMVR)). Results are presented for boys and girls separately and models were adjusted for confounders and multiple testing. In boys, one standard deviation score (SDS) increase in maternal hemoglobin was associated with lower RVEDV and LVEDV (difference (95%CI) −0.10 (−0.17, −0.03) SDS and −0.09 (−0.16, −0.03) SDS, respectively). In boys, maternal anemia, as compared to normal hemoglobin levels, was associated with higher LVEDV (difference 0.34 (0.10, 0.59) SDS). No associations were observed for other cardiac outcomes and for ferritin in boys. No associations were observed in girls. In boys, dysregulated iron status during early pregnancy might permanently alter cardiovascular RVEDV and LVEDV function. Underlying mechanisms need further study. [ABSTRACT FROM AUTHOR]

• Physical activity interventions have been considered one of the key factors of reducing blood pressure. • Integrating physical activity with other components, including nutrition, education, and behavior modification, has been scientifically proven to be more effective compared with utilizing physical activity as a single component intervention. • The results of this network meta-analysis indicate that interventions which integrate physical activity, nutrition, and behavior modification are more effective at lowering blood pressure compared to other physical activity interventions. • Furthermore, interventions with multiple components were the second most effective in reducing blood pressure. High blood pressure (BP) is a major contributor to mortality and cardiovascular diseases. Despite the known benefits of exercise for reducing BP, it is crucial to identify the most effective physical activity (PA) intervention. This systematic review and network meta-analysis (NMA) aimed to evaluate the available evidence on the effectiveness of various PA interventions for reducing BP and to determine their hierarchy based on their impact on BP. A search of PubMed, SPORTDiscus, PsycINFO, Web of Science, CINAHL, Cochrane, and Eric databases was conducted up to December 2022 for this systematic review and NMA. Randomized controlled trials and quasi-experimental studies targeting healthy children and adolescents aged 6–12 years old were included in this study. Only studies that compared controlled and intervention groups using PA or exercise as the major influence were included. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent investigators performed the literature screening, data extraction, and risk of bias assessment. We used Bayesian arm-based NMA to synthesize the data. The primary outcomes were systolic BP and diastolic BP. We calculated the mean differences (MDs) in systolic BP and diastolic BP before and after treatment. Mean treatment differences were estimated using NMA and random-effect models. We synthesized 27 studies involving 15,220 children and adolescents. PA combined with nutrition and behavior change was the most effective intervention for reducing both systolic BP and diastolic BP (MD = –8.64, 95% credible interval (95%CI):–11.44 to –5.84; MD = –6.75, 95%CI: –10.44 to –3.11), followed by interventions with multiple components (MD = –1.39, 95%CI: –1.94 to –0.84; MD = –2.54, 95%CI: –4.89 to –0.29). Our findings suggest that PA interventions incorporating nutrition and behavior change, followed by interventions with multiple components, are most effective for reducing both systolic BP and diastolic BP in children and adolescents. [Display omitted] [ABSTRACT FROM AUTHOR]

Ascites in children is multifactorial and serum ascites albumin gradient (SAAG) ≥1.1 helps differentiate portal hypertension (PHTN) related from non-PHTN ascites. We evaluated the aetiology and diagnostic accuracy of SAAG in children with ascites. Children with ascites were retrospectively evaluated. Etiological diagnosis was based on clinical presentation and investigations. All cases with ascitic fluid analysis and a definite diagnosis were included for calculating the utility of SAAG. We enrolled 878 children (568[64.7%] boys). Majority were PHTN related (638[72.7%]) and secondary to acute viral hepatitis (98,15.4%), acute liver failure (185,29%), chronic liver disease (276,43.3%) and Budd-Chiari syndrome (79,12.4%). Other causes included tubercular (46,5.2%), pancreatic (32,3.6%), chylous (20,2.3%), biliary (12,1.4%), pseudoascites (16,1.8%), infections (46,5.2%), nephrotic (26,2.9%), malignancy (23,2.6%), cardiac (9,1.0%) and others (10,1%). SAAG (n = 305) correctly differentiated PHTN and non-PHTN ascites in 272 (89.2%) cases, with a high sensitivity (97%), specificity (93%) and diagnostic accuracy (95.8%). Reasons for inaccurate SAAG included mixed ascites (n = 9), different day serum and ascitic fluid albumin estimation (n = 5), serum albumin ≤1.1 g/dL (n = 2), chylous ascites (n = 3), hypergammaglobulinemia (n = 1), albumin infusions (n = 1) and unexplained (n = 12). Nearly 27% children had non-PHTN related ascites. SAAG differentiates PHTN from non-PHTN ascites with a diagnostic accuracy of 95%. [ABSTRACT FROM AUTHOR]

Little is known about the association of parental cardiovascular risk factors with the risk of obesity in offspring. We aimed to investigate whether parental ideal cardiovascular health (ICVH) status was associated with the risk of general and central obesity in their young/adult offspring. Of individuals who participated in the 2012-15 phase of the Tehran Lipid and Glucose Study, 2395 pairs of parent-unmarried offspring aged ≥6 years were selected in this cross-sectional study. General and central obesity were defined based on Iranian BMI percentile reference data for offspring aged ≤18 years. For subjects aged ≥19 years, central obesity was defined based on the introduced cut-off points for Iranian adults. We employed the American Heart Association's 2020 impact goal criteria of ICVH. The mean ± SD age of fathers and mothers were respectively 55.4 ± 9.79 and 48.4 ± 9.88. About 55% of offspring were older than 19 years. Higher adherence to ICVH score in mothers was associated with lower risk of overweight/obesity in female offspring (OR for Q1-Q4: 1, 0.56, 0.57, 0.37, P < 0.05 for all quartiles). Among ICVH components, only ideal BMI status in fathers was observed to be associated with a lower risk of overweight/obesity in their male offspring. The risk of abdominal obesity decreased in female offspring with increasing total ICVH score in mothers. Higher adherence of parents to ICVH and its components was positively associated with a lower risk of general and abdominal obesity in their offspring. Our findings demonstrate that maternal-offspring relationship was stronger than paternal-offspring association. • Maternal ideal BMI was related to lower overweight and obesity in female offspring. • Absence of diabetes in mothers was related to lower obesity in female offspring. • Paternal ideal BMI status was related to lower risk of obesity in male offspring. [ABSTRACT FROM AUTHOR]

To explore the safety and feasibility of HuaXi thoracoscopic anatomical lesion resection (HX-TALR) in the treatment of congenital lung malformations (CLMs) in children. A retrospective review of clinical data was conducted for patients who underwent HX-TALR and thoracoscopic lobectomy (TL) in our hospital from October 2017 to March 2023. Intraoperative and postoperative outcomes were compared between the HX-TALR and TL groups. There were 485 patients in this study, 267 of whom underwent HX-TALR and 218 of whom underwent TL. All patients underwent thoracoscopic surgery without conversion to open surgery. No patients had major complications, including bronchopleural fistula, hemorrhage, atelectasis, recurrence or reoperation. The operative time, intraoperative bleeding volume, cases with thoracic drainage tubes, postoperative hospital stay, and cases with postoperative fever in HX-TALR were greater than those in TL (P < 0.05). HX-TALR is safe, feasible, and retains all normal lung tissue while removing the lesion, which is expected to become the preferable operation for the treatment of CLMs. HX-TALR is a new and technically challenging procedure that needs to be carried out after training. Level IV. [ABSTRACT FROM AUTHOR]

Currently, graft options for pediatric liver transplantation (PLT) include whole (WL) and partial (P) grafts, in the form of either deceased donor transplantation (DD) or living donor liver transplantation (LD). WL transplants from LD are commonly referred to as domino LT. The objective of this manuscript is to compare the outcomes of PLT performed with each of the available graft options. Retrospective cohort study from Jan. 2010 to Dec. 2022. The variables included data on the recipients' preoperative clinical status, intraoperative technical aspects, post-operative complications, and survival studies. There were 4 groups: SPLIT (17), DD-WL (55), LD-WL (824), and LD-P (22). The median age and BW of the recipients was smaller in SPLIT, LD-P, and LD-WL compared to DDT-WL groups. HVOO (HR 15.87, 95% CI 1.89–133.06, P = 0.01), retransplantation (HR 7.94, 95% CI 2.63–24.02, P < 0.01), and malignancies (HR 3.08, 95% CI 1.29–7.37, P = 0.01) were independently associated with decreased patient survival. HAT (HR 27.54, 95% CI 10.44–72.68, P < 0.01) and malignancies (HR 2.42, 95% CI 1.10–5.34, P = 0.03) increased the risk of graft loss. The overall survival in this series was 91.4% (mean follow-up of 74.3 months). Patient and graft survival were not different among groups. HAT and malignancies were associated with reduced graft survival. Whole liver from living donors with MSUD presented 100% patient survival at 120 months. Even without statistical differences in survival among the studied groups, LD-P and LD-WL recipients presented a trend towards better outcomes. LEVEL III. • Liver transplantation (LT) in infants and small children presents significant challenges and necessitates specific technical refinements. • This paper delves into the outcomes of pediatric LT within a single center, covering more than 900 recipients over the past 12 years. • Notably, this report marks the first instance of comparing the outcomes of all available graft types used in pediatric LT. • The noteworthy addition in this study is the inclusion of whole livers from living donors (LD-WL), often referred to as domino LT. • Unexpectedly, the 10-year survival rate for LD-WL in this series reached 100%, whereas split LT showed lower survival rates during the same follow-up period. [ABSTRACT FROM AUTHOR]

The results of most school-based health promotion initiatives are inconclusive. This trial assessed the effect of time-varying exposures to a multicomponent school-based health promotion intervention (SI! Program) on adiposity markers. A total of 48 schools in Madrid (Spain) were cluster randomized to receive the SI! Program through elementary education grades 1 to 6 (E1-6, 12 schools, 459 children), 1 to 3 (E1-3, 12 schools, 513 children), or 4 to 6 (E4-6, 12 schools, 419 children) or to receive the standard curriculum (control, 12 schools, 379 children). The primary endpoint was the between-group difference at 3- and 6-year follow-up in the change from baseline in adiposity markers and the overall knowledge-attitudes-habits (KAH) score. At 3-year follow-up, children who had the intervention showed significantly lower increases than the control group in z -scores for body mass index (BMI), waist-to-height ratio (WHtR), and waist circumference (WC) (z BMI: −0.09; 95% CI: −0.16 to −0.03; P = 0.003; z WC and z WHtR: −0.19; 95% CI: −0.28 to −0.10; P < 0.001). At 6-year follow-up, the beneficial trend in z WC and z WHtR was maintained in the E1-6 and E1-3 groups: difference z WC control vs E1-6 (−0.19; 95% CI: −0.36 to −0.03; P = 0.020), control vs E1-3 (−0.22; 95% CI: −0.38 to −0.06; P = 0.009); difference z WHtR control vs E1-6 (−0.24; 95% CI: −0.41 to −0.06; P = 0.009), and control vs E1-3 (−0.29; 95% CI: −0.47 to −0.11; P = 0.001). No significant between-group differences were found in the change of overall KAH score. Early elementary school interventions may be more effective than later interventions on abdominal adiposity. Further research should assess the sustainability effects of school-based health promotion programs. [ABSTRACT FROM AUTHOR]

Impulsivity contributes to many clinically relevant behaviors impacting youth. A scoping review was conducted to characterize existing research using the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking (UPPS) Impulsive Behavior Scales in youth populations, to review the psychometric and validity data of UPPS, and to summarize findings related to sex/gender and diagnostic populations of youth. PubMed, Embase, and PsycNET databases were searched from January 1, 2001 (original UPPS publication) through October 2, 2022, according to PRISMA extension for Scoping Reviews guidelines. Articles were reviewed for inclusion/exclusion by 2 authors. Original research articles in English using any UPPS version or subscale in persons aged ≤21 years were included. Inclusion criteria were met by 45 articles, with low bias and moderate-to-high quality. Most were cross-sectional studies; studies investigated diverse community and clinical samples. The UPPS demonstrated consistent factor structure, good reliability, and good external validity with other measures of impulsive behaviors and conditions associated with impaired impulse control. Some studies observed differences in UPPS domain scores between sex/gender groups or differential patterns in relationships between UPPS domains and clinical variables. UPPS subscale scores often differed in youth with attention-deficit/hyperactivity disorder, conduct disorders, substance use, and excess weight/obesity compared with control youth. UPPS domains commonly had interactions with sex/gender, sociodemographic, and diagnosis-related variables. The current literature suggests that the UPPS has utility in measuring distinct components of impulsivity in clinical and nonclinical populations of youth. Specificity in discriminating diagnostic groups and predicting risk currently remains uncertain. Further research is needed to integrate UPPS measures with experimental models and additional neurobiological methods and to assess longitudinal developmental trajectories. Impulsivity contributes to many clinically relevant behaviors and mental health disorders that impact youth. The Urgency, Premeditation, Perseverance, Sensation Seeking (UPPS) Impulsive Behavior Scale has been increasingly used in research to measure deficits in impulse control. In this scoping review the authors examined 45 studies that used versions of the UPPS to measure different domains of impulsivity in youth aged 21 years and younger. The authors found evidence in the literature for the validity and reliability of the UPPS and its variants in measuring impulsivity in youth. Certain patterns of UPPS subscale scores corresponded with clinical behaviors and diagnoses including attention-deficit/hyperactivity disorder (ADHD), conduct disorder, substance use, and excessive weight/obesity. Despite this, there remain gaps in the literature regarding the stability of UPPS measures over time and ability of the UPPS to predict clinical outcomes. [ABSTRACT FROM AUTHOR]

The Shock Index (SI) is emerging as a potentially useful measure among children with injury or suspected sepsis. The aim of this study was to evaluate the distribution of the SI and evaluate its association with clinical outcomes among all children presenting to the emergency department (ED). A complex survey of nonfederal U.S. ED encounters from 2016 through 2021 was analyzed. Among children, the Pediatric Age-Adjusted Shock Index (SIPA), Pediatric Shock Index (PSI), and the Temperature- and Age-Adjusted Shock Index (TAMSI) were analyzed. The association of these criteria with disposition, acuity, medication administration, diagnoses and procedures was analyzed. A survey-weighted 81.5 million ED visits were included for children aged 4–16 years and 117.2 million visits were included for children aged 1–12 years. SI could be calculated for 78.6% of patients aged 4–16 years and 57.9% of patients aged 1–12 years. An abnormal SI was present in 15.9%, 11.1%, and 31.7% when using the SIPA, PSI, and TAMSI, respectively. With all criteria, an elevated SI was associated with greater hospitalization. The SIPA and PSI were associated with triage acuity. All criteria were associated with medical interventions, including provision of IV fluids and acquisition of blood cultures. An elevated SI is indicative of greater resource utilization needs among children in the ED. When using any criteria, an elevated SI was associated with clinically important outcomes. Further research is required to evaluate the distribution of the SI in children and to investigate its potential role within existing triage algorithms for children in the ED. [ABSTRACT FROM AUTHOR]

Validate the Preschool Nutrition Education Practices Survey. Iterative approach combining design-based research and Standards for Educational and Psychological Testing. Los Angeles, CA and Philadelphia, PA Early Care and Education (ECE) classrooms. Expert panel members (n = 7); ECE teachers: interviews (n = 8), pilot survey (n = 31), and final survey (n = 136). Early care and education nutrition education practices used in the classroom either during class time or mealtime. Qualitative content analysis was implemented for content, response process, and consequences of testing validity evidence. Rasch rating scale analysis was conducted for the response process and internal structure validity and reliability evidence. Qualitative field-testing produced strong content, response process, and consequences of testing validity evidence to inform survey modifications. Quantitative field-testing generated a psychometrically sound, well-targeted 12-item survey on a 4-point frequency scale with excellent item and person reliability (0.97 and 0.93 respectively) and separation (5.36 and 3.77 respectively); good Rasch Principal Components Analysis findings (60.3%); and productive item fit statistics (0.50–1.50 logits). Robust validity (content, response process, consequences of testing, internal structure) and reliability evidence were demonstrated for using the Preschool Nutrition Education Practices Survey to assess ECE teachers' use of nutrition education practices. Future research is needed to examine its relationship to other variables, such as nutrition teaching efficacy, and to determine its ability to detect change in ECE nutrition education practices over time and across groups. [ABSTRACT FROM AUTHOR]

The burden of tuberculosis (TB) in migrant children and young people (CYP) is commonly overlooked, despite the increasing incidence of TB in migrant populations in the European region. This study aimed to examine the distribution and disease characteristics of TB among migrant and native-born CYP through analysis of data from the European Centre for Disease Prevention and Control (ECDC) surveillance system (TESSy). Retrospective database analysis. A retrospective database analysis was conducted on all CYP TB cases (0–17 years) reported to TESSy (1995–2017), exploring distribution, site of TB, and presence of MDR-TB using multivariate analysis in R statistical software. Of the 73,176 CYP TB cases reported in the EU/EFTA (1995–2017), 24.4% (n = 17,879) occurred in migrant CYP and 75.6% (n = 55,297) occurred in native-born CYP. Migrant CYP were more likely (P < 0.001) to have pulmonary TB (OR: 1.90; 95% CI: 1.74–2.09) and unsuccessful treatment outcomes (OR: 2.05; 95% CI: 1.74–2.40) compared to native-born CYP. The proportion of extrapulmonary TB, compared to pulmonary TB across total CYP cases was higher than the existing evidence base. Overall, there were significant differences in the site of TB and treatment outcomes between migrant and native-born CYP. To improve outcomes, TB screening and detection practices should focus on facilitating care in migrant CYP. However, to better understand the implications of these findings on broader TB control, TB among CYP should be addressed more frequently in reports and research. [ABSTRACT FROM AUTHOR]