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Background: LHX3 is a gene encoding a LIM-homeodomain transcription factor important for the fetal development of several organs, such as the pituitary gland, spinal motor neurons and the inner ear. Pathogenic and likely pathogenic variants in the LHX3 gene are infrequent and result in a rare syndrome known as combined pituitary hormone deficiency-3, CPHD3. Methods: We have studied hearing and vestibular functions in a group of eight individuals, aged 8–36 years, all of whom were homozygous for a specific variant in the LHX3 gene at chromosome 9q34. We reexamined the results of consecutive hearing tests from newborn until April 2024. Results: Our data showed that all the tested patients had progressive sensorineural hearing deficiency ranging from moderately severe to complete loss. We have performed vestibular testing in six patients and, for the first time, demonstrated that a mutation in the LHX3 gene not only affects hearing, but is also associated with vestibular impairment. Conclusion: The human pathogenic variant c.455-2A > G in the LHX3 gene on chromosome 9q34, which present as a founder mutation in the population in northern Sweden, is responsible for phenotypes associated with progressive hearing loss and balance impairment. These findings prove that the LHX3 gene is crucial for the function of both the cochlear and vestibular organs. [ABSTRACT FROM AUTHOR]

Purpose: There is some evidence that trace element and mineral deficiencies may promote the occurrence of febrile seizures. However, the role of these elements in the occurrence of complex seizures in children with FS has not been comprehensively investigated. The present study was conducted to evaluate this issue. Methods: In a cross-sectional study, 220 patients including 110 febrile and 110 FS children aged 6–60 months were studied. Blood samples were taken and serum zinc, potassium, sodium, magnesium and calcium levels were measured. Demographic and clinical characteristics were also recorded. Results: The patients were similar in age and sex. Higher serum zinc levels decreased the risk of seizure (RR = 0.95, p-value = 0.0001) and complex seizure (OR = 0.96, p-value = 0.03). Higher serum sodium levels decreased the risk of complex seizures (OR = 0.85, p-value = 0.023). Higher serum potassium levels were associated with a lower risk of seizure (OR = 0.55, p-value = 0.035). Serum calcium and magnesium levels were not associated with the risk of seizure and complex seizure. A BMI at the upper end of the normal range decreased the risk of complex seizures (OR = 0.83, p-value = 0.05). Male sex increased the risk of complex seizure (OR = 4.14, p-value = 0.016). Conclusions: Low serum levels of zinc, potassium and sodium are risk factors for seizure and complex seizure in febrile children. Male sex is also a risk factor for complex seizures. The time from fever to seizure was shorter in younger children. Children with a BMI at the upper end of the normal range have a lower risk of having a complex seizure. [ABSTRACT FROM AUTHOR]

Background: Streptococcus pyogenes is a common gram-positive bacterium, belonging to group A Streptococcus (GAS), and is responsible for causing a range of clinical conditions. Brain abscess caused by GAS is uncommon in pediatric infectious diseases, and GAS brain abscess without acute infectious symptoms has been rarely reported. Case presentation: We present a case of one GAS brain abscess in a previously healthy child with unusual clinical manifestations of decreased muscle strength in the left limbs. The right frontal lobe mass lesion was resected using a microscope-based neuronavigation system. A sole defectively beta-hemolytic Streptococcus pyogenes was isolated from the lesion. The patient's peripheral blood whole-exome and the pathogen's whole-genome sequencing were performed respectively, revealing a heterozygous mutation in the interferon regulatory factor-8 (IRF8) gene in the patient and lack of hyaluronic acid capsules in Streptococcus pyogenes (genotype emm22). The patient eventually recovered after prompt surgical drainage of the abscess and appropriate antibiotic treatment. Conclusions: It is important to pay attention to Streptococcus pyogenes brain abscesses with mild clinical manifestations. Upon reviewing all the cases of pediatric GAS brain abscess reported in the published literature, we discovered that early diagnosis and treatment are crucial factors that impact the prognosis of GAS brain abscess. [ABSTRACT FROM AUTHOR]

Background: Malaria is a major cause of ill health and death in children in Africa. The disease also imposes a severe social and economic burden on households and health systems and is strongly associated with poverty. This study summarizes the most up-to-date cost of treating severe malaria in children in Africa. Methods: A systematic search was conducted in PubMed, Embase, Cinahl, and Web of Science databases. Google and Google Scholar were searched for grey literature followed by scanning of the reference lists of the previous systematic reviews. The search was limited to children < 12 years, malaria-endemic countries in Africa, and the English language. All costs were adjusted to the year 2023. Results: 19 studies conducted in 12 countries were identified: 14 reported provider costs, and 11 household costs. Out of the 19 studies found, 11 were published before 2018 while 11 reported data that are currently more than ten years old. Studies varied methodologically and in the scope of resources included to estimate the cost. The provider costs ranged from USD 27 in Uganda to USD 165 per patient in Kenya (median value USD 90), while household costs ranged from USD 13 in Kenya to USD 245 per patient in Gabon (median value USD 50). All identified household malaria treatment costs except one represented catastrophic health expenditure, making out more than 10% of the monthly Gross National Income per capita in the respective countries. Conclusion: Evidence on the cost of treating severe malaria in children in Africa is scarce. However, the few existing studies show that severe malaria in children imposes a significant economic burden on the providers and households. More studies are needed, particularly in high-burden high-impact countries, to inform resource allocation decisions. [ABSTRACT FROM AUTHOR]

Background: Malnutrition remains a significant concern in many societies. This study systematically reviewed the effects of probiotics, prebiotics, and synbiotics on anthropometric measures in malnourished children, focusing on changes in weight, height, and respiratory infections (primary outcomes), and head circumference, hemoglobin, hematocrit, and body mass index (BMI) as secondary outcomes. Methods: This systematic review and meta-analysis involved searching various databases in both Persian and English, including Scopus, Web of Science Core Collection, Cochrane Library, Science Direct, and PubMed up to October 5, 2024. Non-randomized controlled trials (RCTs) were excluded. The Cochrane Handbook Risk of Bias Version 2 tool was used to assess risk of bias, and RevMan 5.3 software was employed for analysis. Subgroup analyses were conducted based on the type of supplement received. Meta-regression was applied to identify factors influencing results, and the GRADE approach was used to evaluate evidence certainty. Results: Twelve studies with a total of 3,086 children (aged up to 6 years, equally distributed between boys and girls) were included. All children were malnourished without underlying illnesses. Limitations of the study included variations in intervention type, dose, duration, and timing of outcome measurement. Meta-analysis revealed that probiotics, prebiotics, and synbiotics may increase weight (6 trials, mean difference: 0.33 kg, 95% CI: 0.15 to 0.50, low certainty of evidence), while probiotics and synbiotics may increase height compared to control groups (5 trials, mean difference: 0.44 cm, 95% CI: 0.02 to 0.85, low certainty of evidence). However, probiotics and synbiotics did not show a statistically significant effect on lower respiratory tract infections (5 trials, risk ratio: 0.84, 95% CI: 0.68 to 1.04, moderate certainty of evidence). Meta-regression indicated that intervention type, sample size, and follow-up duration were not significant moderators for outcomes related to weight, height, or respiratory infections. Conclusion: The current evidence suggests that probiotics, prebiotics, and synbiotics supplements may help manage malnutrition-related outcomes in malnourished children, but further research with stronger study designs is needed to confirm these findings due to the low certainty of evidence. [ABSTRACT FROM AUTHOR]

Background: Oral sensory hypersensitivity has been linked with fussy eating predominantly in non-typically developing children. We hypothesized that child 'Oral' (touch, smell and taste in the mouth) and 'Social-Emotional' (response to social expectations) sensory processing are associated with child appetitive traits in typically developing preteen children. Additionally, we explored relationships between maternal sensory profiles and their offspring's sensory profile. Methods: This is secondary analysis of 130 mother-child dyads from the 9–11-year-old follow-up of the ROLO longitudinal birth cohort study. The Dunn Sensory Profile (Adolescent/Adult) and the Dunn Child Sensory Profile 2 were used to assess maternal and child sensory profiles, respectively. The Children's Eating Behaviour Questionnaire was used to assess child appetitive traits. Multiple linear regression examined associations between 'Oral' and 'Social-Emotional' segments of the child sensory profile and child appetitive traits. Associations between maternal and child sensory profiles were examined using sensory profile quadrants (Dunn's sensory processing framework). These refer to four distinct patterns of sensory processing that indicate how an individual responds to sensory input. Results: In total, 130 mother-child dyads were included. In adjusted analysis child 'Oral' sensory processing was associated with higher mean scores in the appetitive traits 'Desire to Drink' (B = 0.044, 95% CI = 0.025,0.062) and 'Food Fussiness' (B = 0.080, 95% CI = 0.059,0.101) and with lower mean scores in 'Enjoyment of Food' (B=-0.038, 95% CI -0.055,-0.022). Child 'Social-Emotional' responses were associated with higher mean scores in 'Desire to Drink' and 'Food Fussiness'. Higher scores in the maternal sensory profile quadrants of 'Sensitivity', 'Avoiding' and 'Registration' were positively associated with higher scores in the corresponding child sensory profile quadrants. Conclusion: Our findings suggest that in typically developing children presenting with fussy eating, oral sensory hypersensitivity and higher scores in social-emotional responses to sensory processing may be an underlying determinant. The relationship observed between 'Oral' and 'Social-Emotional' sensory processing segments and 'Desire to Drink' requires further research to ascertain the type of drinks being consumed and how this impacts appetite. Further research is also required to explore the influence of maternal sensory profile on their offsprings response to sensory input. [ABSTRACT FROM AUTHOR]

Background: Earthquakes are potentially traumatic natural disasters due to their destructive nature, and huge impacts, producing scenes of horror, undesirable and uncontrollable results. Children are affected mainly by earthquakes not only physically but also psychologically. We aimed to evaluate the rates of probable PTSD and related factors in children and adolescents after the February 6 Kahramanmaras earthquake. Methods: In this cross-sectional study, 246 children and adolescents were included. The research was conducted in Hatay, one of the most affected provinces, between 06/07/2023-06/08/2023. Sociodemographic form, Children's Depression Inventory, Children's Posttraumatic Response Reaction Index, Screen for Child Anxiety Related Emotional Disorders, Child and Youth Resilience Measure and Social Support Appraisals Scale for Children were applied by face-to-face survey method. Results: The median age of the participants was 12 (8-18). 133 (54%) of the participants were girls. Probable depression rate was 98%, and probable anxiety disorder rate was 63%. Probable mild, moderate, severe and very severe PTSD rates were 18%, 29%, 43% and 8%, respectively. The probable severe PTSD rate was higher in children who were injured in the earthquake (p = 0.032), who received outpatient treatment (p = 0.016), and who saw people trapped under the collapse (p = 0.012). Also, the children whose sleep routines have changed post-earthquake were found to have more probable severe PTSD (p < 0.001). Access time to the potable water supply (p = 0.045), toilet facilities (p = 0.045), shelter facilities (p = 0.004), heating facilities (p = 0.001), clothing supply (p < 0.001) and healthcare services (p = 0.009) were found to be associated with probable severe PTSD right after the earthquake. In the fifth month of the earthquake, inadequate meeting of clothing needs (p = 0.018), educational services (p = 0.028) and social activity opportunities (p < 0.001) were significantly associated with probable severe PTSD. In the multivariate analysis, the risk of probable severe PTSD was increased 2.9 times in those with post-earthquake sleep changes (p = 0.001) and 11.1 times in those with probable anxiety disorders (p < 0.001). Also, it has been shown that each unit increase in the APP-family score reduces probable severe PTSD risk by 2% (p = 0.002). Conclusion: In the current study, the rates of probable PTSD, depression and anxiety disorders were considerably high. Probable anxiety disorder and sleep disturbance were significant predictors of probable severe PTSD. On the other hand, social support from family was found to be a significant protective factor for severe PTSD risk. We conclude that the lack of meeting needs that increase the risk of probable severe PTSD differs in the acute and subacute phases. [ABSTRACT FROM AUTHOR]

Background: Forearm shaft fractures are common injuries, often caused by falling from a fully-upright position or falling off a bike. They can be treated nonoperatively or surgically with intramedullary nailing or plates. The method of choice for treating pediatric forearm shaft fractures is the application of elastic stable intramedullary nailing (ESIN)|. The aim of the study was to evaluate ESIN in pediatric patients with forearm shaft fractures based on radiological images, and determine the etiology and complication rate associated with the injury. Methods: The study included 201 patients, 30.5% female 69.5% male, aged 1 to 17 years (mean 9.1 years; SD = 3.2), all had been diagnosed with a fracture of the forearm shaft and had been treated surgically with ESIN. In addition, all possessed a complete set of X-ray images and had attended a minimum six-month follow-up examination of the forearm. Axial alignment was evaluated retrospectively in the anatomical (AP) and lateral (LAT) positions. In total, 402 radiographs were examined. Of the injuries, 68% occurred during sports activity and 75% involved both the radius and the ulna. Results: Union was observed in all cases. Mean axial alignment values in AP and LAT X-ray or both the ulna and radius were satisfactory. Axial alignment values were not influenced significantly by age, type of surgery, type of fracture or etiology. Plaster cast application (9.8% of cases) significantly influenced radius axial alignment. The complication rate was 11.4% (n = 23). Significantly more complications were observed in patients receiving open reduction internal fixation (ORIF) (p = 0.0025). Conclusion: The ESIN technique is an effective treatment for forearm diaphyseal fractures in children, with good results regarding reduction and bone healing, indicated by x-ray. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the impact of web-based education on enhancing mothers' awareness of oral health care for children aged 9 and 12 years. It focused on the crucial role of mothers in educating about oral health to prevent dental diseases and reduce long-term healthcare costs. Methods: Mothers were divided into three groups: control, intervention with a web system, and intervention with a brochure. Over one month, their knowledge about their children's oral health was assessed before and after the intervention. Results: Data were analyzed using parametric t-tests and non-parametric Mann-Whitney U tests. The findings indicated a significant increase in parental awareness in both intervention groups. Conclusion: It is recommended that parent education be done using web-based systems or mobile apps, which are better choices due to greater accessibility and interactivity. [ABSTRACT FROM AUTHOR]

Background: Latinx children in the United States experience disparities in asthma control and asthma-related functional outcomes compared to non-Latinx White children, including more school absences, emergency department visits, and hospitalizations for asthma. Stress appears to play a role in asthma control, but interventions designed to address the role of stress in asthma control for Latinx children are limited. Method: The current randomized controlled trial tests the effects of Adapt 2 Asthma (A2A), a family-based coping skills and asthma management intervention tailored to the stressors, strengths, and cultural beliefs of Latinx families, compared to an asthma self-management control arm (the Asthma Plan for Kids; APK). Latinx families of children ages 8 to 14 years old with asthma (target N = 280) are identified and enrolled from primary care clinics and randomly assigned to either A2A or APK. The intervention is delivered by lay health workers trained and receiving ongoing consultation from the study team. The primary outcome is child- and parent-reported asthma control, while secondary outcomes are child's quality of life, lung function, school absences, and emergency department visits, and child and parent coping and family asthma management behaviors. Participants will be assessed at baseline, post-intervention, and at 6- and 12-month follow-up timepoints. Discussion: This study has the potential to provide new evidence regarding the effects of culturally relevant coping and asthma management intervention strategies for Latinx children with asthma. Trial Registration: Clinicaltrials.gov NCT05118282. Registered on 11 November 2021. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the acceptability of removable acrylic appliances (RA) and Invisalign First (IF) clear aligners (Aligntech, USA) among children undergoing orthodontic treatment during the mixed dentition period, considering the severity of malocclusions. Methods: A total of 40 patients, aged 6 to 13 years, were recruited for the study. Malocclusion severity was evaluated using the Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC). Patients completed the "Acceptance of Orthodontic Appliance Scale (AOAS)" via a face-to-face Google survey. To assess the reliability of the AOAS, the survey was resent to five patients after three months for a second response, and reliability analysis was conducted. Additionally, inter-rater reliability was evaluated by having all patients independently assessed by a second researcher. Data were analyzed using SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA), with statistical significance set at p < 0.05. Results: Although no significant difference was found in IOTN-DHC scores, the IF group demonstrated significantly higher AOAS scores compared to the RA group (p = 0.014). Survey responses revealed noticeable distinctions between groups regarding speaking discomfort, preference for orthodontic appliances, and facial appearance comfort. A negative correlation (r = -0.477, p = 0.034) was observed between malocclusion severity and appliance acceptance. Clinical significance: This study underscores the significant superiority and advantage of IF over RA among pediatric orthodontic patients during the mixed dentition period. [ABSTRACT FROM AUTHOR]

Introduction: Childhood malnutrition is a complex issue with a range of contributing factors. The consequences of malnutrition are severe, particularly for children. This study aims to identify the factors contributing to inequality gaps in childhood malnutrition. Our study provides insights into modifiable elements to inform interventions targeted at distinct contexts and populations to improve child nutrition. Methods: This study utilized data from the Demographic and Health Surveys (DHS) of 27 countries. First, the risk differences (RDs) between the prevalence of childhood malnutrition among the determinant variables, household income, and maternal education categories were calculated. The Blinder‒Oaxaca decomposition was subsequently used to determine the extent to which the difference in childhood malnutrition prevalence between low-income and high-income groups and maternal education levels results from the contributory effects of the explanatory variables: child and maternal individual-level compositional factors. Results: We examined data from 138,782 children in 27 countries from 2015 to 2020. The prevalence of childhood malnutrition (10.5%) varied across countries, ranging from 6.5% in Burundi to 29.5% in Timor Leste. On average, the prevalence of childhood malnutrition was 11.0% in low-income households and 10.7% among mothers without education. Some nations had pro-low-income (i.e., malnutrition concentrated among children from poor households) or pro-no-maternal education (i.e., malnutrition concentrated among children from mothers with no formal education) inequality in childhood malnutrition, but most did not. We found a complex interplay of compositional effects, such as the child's age, maternal education, maternal health behavior, and place of residence, that influence the inequality in childhood malnutrition rates across 10 pro-low-income countries. In addition, we also found that a complex mix of compositional effects, such as the household wealth index, maternal health behavior, and maternal age, contribute to childhood malnutrition inequality between educated and uneducated mothers across the 7 pro-no maternal education countries. Conclusion: The prevalence of childhood malnutrition varies among low-income, high-income, and no maternal education-maternal education groups. This study highlights the need for a country-specific approach to addressing childhood malnutrition, with policies and interventions tailored to each country's specific context. [ABSTRACT FROM AUTHOR]

Background: Common clinical sense would suggest that individuals with milder obsessive-compulsive disorder (OCD) symptoms should be the most suitable for guided internet-delivered cognitive behaviour therapy (CBT), with more intensive forms of treatment reserved for more severe or complex cases. Results: In this secondary data analysis of a non-inferiority clinical trial comparing internet-delivered CBT with in-person CBT for young people with OCD (N = 152), we found that higher baseline symptom severity predicted worse treatment outcomes in the in-person group but not the internet-delivered CBT group. Additional analyses showed that among individuals with milder symptoms, internet-delivered CBT was associated with worse outcomes than in-person CBT. Conclusions: If replicated, these results would question the axiom that internet-delivered CBT is most suitable for milder cases. Trial registration: The original trial was registered at ClinicalTrials.gov ID NCT03263546. Date of registration 2017–08–28. [ABSTRACT FROM AUTHOR]

Background: The 13-valent pneumococcal conjugate vaccine (PCV-13) was introduced in Malawi in 2011 with an expected impact of reducing pneumococcal pneumonia in children. We aimed to describe clinical characteristics and nasopharyngeal (NP) carriage of pneumococcus by serotype in children hospitalized with primary end-point pneumonia (PEP) between 2013 and 19 after the introduction of PCV-13. Methods: We conducted a secondary analysis of children aged under-5-years hospitalized with acute respiratory illness (ARI) in Malawi. Chest radiographs conducted at admission were read by two independent clinicians according to WHO criteria for PEP, and a third reviewer resolved discordant diagnoses. NP swab specimens were processed and Streptococcus pneumoniae growth was serotyped. Multivariable regression analysis was conducted to assess the association between clinical characteristics, NP serotypes, and PEP. Results: We had complete radiographic and NP serotype data for 500 children, of which 54 isolates were vaccine-type (VT) (10.8%), 165 were non-VT (NVT; 33.0%), and 281 had no pneumococcal growth (56.2%). Among these, 176 (35.2%) had PEP on chest x-ray. Among those with PEP, pneumococcal carriage was documented in 43.8% of cases, and VT serotypes accounted for 10.8%. For children with PEP, we found no association between clinical characteristics and carrying either VT, NVT, or no pneumococcus. Conclusion: Carriage of S. pneumoniae remains high among children hospitalized with ARI in Malawi, but children with VT carriage were no more likely to have PEP than children carrying no pneumococcus or those with NVT carriage. There were no differences in clinical characteristics between those carrying VT, NVT, or no pneumococcus. [ABSTRACT FROM AUTHOR]

Background: Globally, oral diseases remain a major public health problem. However, there is limited information about the oral health status and factors associated with oral disease among children in Uganda. The aim of this study was to examine the oral health status and factors associated with oral health of primary school children in urban and rural areas of the Gulu district of northern Uganda. Methods: A comparative cross-sectional study was conducted among 356 school children aged 11–13 years attending six schools located in urban and rural areas. The children received a clinical oral examination and participated in a questionnaire survey that collected information on sociodemographic and oral health knowledge, attitude, and practices. All data were entered and analysed using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp statistical software. Logistic regression analyses examined factors associated with dental caries and gingival bleeding. Results: Of the 356 children (11–13 years) included, the mean age was 12.2 years, 140 (39.3%) were male and 176 (49.4%) were from urban areas. The proportion of school children with dental caries was 33.6% (n = 119), with the mean decayed, missing due to caries, and filled teeth (DMFT) index of 0.81 (25th percentile = 0; 75th percentile = 1.00). There was no significant difference in caries prevalence between rural and urban children (31.6% versus 35.6%, p = 0.33). Of the children involved in the study, 141(39.8%) had gum bleeding. The mean oral knowledge score was 2.85 ± 1.53 (range, 0–7), while the mean attitude, hygiene practice, frequency of sweets consumption, and oral health related impact scores were 4.25 ± 1.23 (range, 1–6), 5.40 ± 1.81 (range, 0–9), 25.66 ± 4.29 (range 9–54) and 2.1 ± 1.65 (range, 0–6), respectively. Using logistic regression analyses, as oral health knowledge score increased the odds of not having dental caries increased (aOR = 1.19, 95% CI 1.02–1.39). Conclusion: The prevalence of dental caries and gum bleeding of primary school children in Gulu district is high. Children lacked knowledge on causes of oral disease, and behaviour towards oral disease prevention. In addition, oral health knowledge scores were significantly associated with dental caries. Oral health education programs in schools should emphasise providing skills-based education. [ABSTRACT FROM AUTHOR]

Background: Several studies have advocated the use of ultrasound to diagnose distal forearm fractures in children. However, there is limited data on the diagnostic accuracy of ultrasound for distal forearm fractures when conducted by pediatric surgeons or trainees who manage orthopedic injuries in children. The objective of this study was to determine the diagnostic accuracy of point-of-care ultrasound (POCUS) for pediatric distal forearm fractures when conducted by pediatric surgeons and trainees after minimal training. Methods: This diagnostic study was conducted in a tertiary hospital emergency department in Germany. Participants were children and adolescents under 15 years of age who presented to the emergency department with an acute, suspected, isolated distal forearm fracture requiring imaging. Pediatric surgeons and trainees, after minimal training for sonographic fracture diagnosis, performed 6-view distal forearm POCUS on each participant prior to X-ray imaging. All data was retrospectively collected from the hospital's routine digital patient files. The primary outcome was the diagnostic accuracy of POCUS compared to X-ray as the reference standard. Results: From February to June 2021, 146 children under 15 met all inclusion and exclusion criteria, and 106 data sets were available for analysis. Regarding the presence of a fracture, X-ray and Wrist-POCUS showed the same result in 99.1%, with 83/106 (78.3%) fractures detected in both modalities and one suspected buckle fracture on POCUS not confirmed in the radiographs. Wrist-POCUS had a sensitivity of 100% (95% CI [0.956, 1]) and a specificity of 95.8% (95% CI [0.789, 0.999]) compared to radiographs. In 6 cases, there were minor differences regarding a concomitant ulnar buckle. The amount of prior ultrasound training had no influence on the accuracy of Wrist-POCUS for diagnosing distal forearm fractures. All fractures were reliably diagnosed even when captured POCUS images did not meet all quality criteria. Conclusion: Pediatric surgeons and trainees, after minimal training in POCUS, had excellent diagnostic accuracy for distal forearm fractures in children and adolescents using POCUS compared to X-ray. [ABSTRACT FROM AUTHOR]

Background: Child dental anxiety is a prevalent issue in the field of pediatric dentistry. At present, several non-pharmacological interventions are employed to mitigate anxiety during dental treatments for children. The objective of this study is to assess the effectiveness of diverse non-pharmacological interventions in reducing dental anxiety, as well as enhancing heart rate during pediatric dental treatments. To achieve this, we conducted a systematic review and a network meta-analysis (NMA) to compare the efficacy of various outcome indicators. Methods: A thorough search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane Library, Scopus, APA PsycInfo, CINAHL, and AMED to identify all eligible randomized controlled trials (RCTs) from the beginning of the databases up to August 1, 2024. The quality assessment was carried out using the Cochrane Collaboration's bias risk tool. The two outcome measures under consideration were dental anxiety and heart rate. Network graphs, league tables and SUCRA were constructed using R 4.2.3 software and Stata 16 software. This study is registered in PROSPERO under the registration number CRD42023467610. Results: The study examined 12 different non-pharmacological approaches, drawing from a pool of 61 research studies involving 6,113 participants aged 4 to 16 years. The results of the network meta-analysis revealed that music (SUCRAs: 93.60%) proved to be the most effective measure in mitigating dental anxiety, followed by aromatherapy (SUCRAs: 78.58%) and game (SUCRAs: 70.99%). Moreover, hypnosis (SUCRAs: 98.80%), music (SUCRAs: 79.58%), and relaxation (SUCRAs: 72.41%) were identified as the top three interventions for decreasing heart rate. Conclusion: In this NMA, when contemplating dental anxiety outcomes, music is recommended as a priority. For heart rate outcomes, hypnosis may be a preferred measure. However, owing to the limited number of articles, the conclusion of this study still requires additional confirmation or correction through more high-quality primary studies in the future. [ABSTRACT FROM AUTHOR]

Background: Mucopolysaccharidosis (MPS) comprises a group of metabolic diseases with a disorder in the function of lysosomal enzymes that lead to the accumulation of glycosaminoglycans (mucopolysaccharides) (Kubaski et al. in Diagnostics 10:161, 2020; Hampe et al. in Cells 9:1838, 2020; Tomatsu et al. Mol Genet Metab 110(1–2):42–53, 2013). At least seven variants of this disorder have been identified to date (Muenzer et al. in Pediatrics 124(6):e1228–e1239, 2009; Muenzer et al. in Eur J Pediatr 171:181–8, 2012). this study aims to report a case of mucopolysaccharidosis in a 9-year-old child. Also, the treatments and dental observations made for the child have been described. Also, a review of past articles has been done to report the types of diseases, medical and dental considerations, etc. of this disease. Case description: the present case report describes the orofacial and systemic characteristics, diagnostic methods, and dental management of a 9-year-old boy with MPS with a one-year follow-up in association with a brief review of past articles. Conclusion: Since MPS patients have many changes in their oral and dental structures, they pose many challenges for dentists. Also, these patients need considerations in dentistry due to the involvement of different body organs. Knowing the oral-dental and systemic problems of these patients can help their dentists to provide effective and safe treatment for them. [ABSTRACT FROM AUTHOR]

Background: The latent tuberculosis infection (LTBI) burden is still unclear in schoolchildren and adolescents in China. Previous study and daily surveillance data indicate a LTBI detection gap. The research objective was to evaluate the LTBI burden and detection gap among schoolchildren and adolescents in China. Methods: A cross-sectional study was conducted among 69,667 schoolchildren and adolescents in Chongqing, China between September 2022 and December 2023 implemented by Chongqing Municipal Institute of Tuberculosis using tuberculin skin test (TST) and creation tuberculin skin test (C-TST). To evaluate the LTBI detection gap, the pulmonary tuberculosis (PTB) screening data implemented by Chongqing Municipal Institute of Tuberculosis have been compared with the data in 2021 implemented by community-level medical and health care institutions. Results: The LTBI prevalence rate using TST and C-TST implemented by Chongqing Municipal Institute of Tuberculosis was 12.8% (95%CI, 12.5-13%) and 6.4% (95%CI, 6-6.8%) respectively. The LTBI prevalence rate by Chongqing Municipal Institute of Tuberculosis was 9.6% higher than that by community-level medical and health care institutions (χ2 = 2931.9, P < 0.001). Conclusions: The LTBI detection gap existed among schoolchildren and adolescents in Chongqing, and it also may exist in other similar countries and regions. National screening strategy needs improvement. Regular training and quality assurance could improve the performance of TST and C-TST and close the detection gap of LTBI. [ABSTRACT FROM AUTHOR]

Background: Hesitancy rates for childhood vaccines are increasing on a global scale. It was reported in previous studies that many factors affect vaccine hesitancy. The present study was designed to determine the prevalence of childhood vaccination hesitancy in parents and to determine the factors affecting it. Methods: This descriptive, cross-sectional study was conducted with 350 parents who had at least one child aged two years and younger, who applied to Family Health Centers in the city of Mardin in the Southeastern Anatolia Region of Turkey, between January and March 2022. The "Parental Attitudes Towards Childhood Vaccines (PATCV) Questionnaire" was used to collect the data, which were analyzed by using the SPSS (Statistical Package for Social Sciences) for Windows 22.0 program. The Logistic Regression Analysis was used to determine the factors affecting parental attitudes toward childhood vaccines. Results: A total of 32.0% of the parents were found to be hesitant about vaccinations and 3.4% did not have at least one vaccination for their children. Significant relationships were detected between income status, education status, thoughts about vaccinations, parents having adult vaccinations, hesitant to have self-vaccination, considering vaccine necessary, and parental attitudes towards childhood vaccinations (p < 0.05). According to the Regression Analysis, parents who had adult vaccinations had reduced hesitation about childhood vaccines 0.506 times (p = 0.032; OR = 0.506; 95%CI = 0.271–0.943). Considering the vaccine necessary reduced the hesitation about childhood vaccines by 0.440 times (p = 0.011; OR = 0.440; 95%CI = 0.234–0.828). Conclusions: The hesitations of parents about childhood vaccines were found to be high. The reasons for vaccine hesitancy must be examined in detail and strategies must be developed in this regard. [ABSTRACT FROM AUTHOR]

Background: Youth mental health is a growing concern in research, practice, and policy. Practice standards, guidelines, or strategies provide an invisible infrastructure that fosters equity, quality, and safety, potentially addressing inconsistencies and more effectively attending to the mental wellness of Black youth as a particular population of concern. This scoping review aimed to address the following question: What standards exist for the delivery of mental health services to Black youth in community, primary care, and educational settings? Due to a limited initial search yield on publications about standards for the delivery of mental health services for Black youth population, our goal was then to identify and map mental health standards, recommendations, or guidelines for the delivery of mental health services using the same settings to all youth. Methods: Searches were conducted in various databases, including PubMed/MEDLINE, PsycINFO, Embase, SocINDEX, CINAHL, Gender Studies Database, Social Services Abstracts, Sociological Abstracts, Scopus, Web of Science, and Google Scholar. Screening was independently conducted by two reviewers, with disagreements resolved by a third. Information extraction was performed by two independent reviewers. Results: Out of the 2,701 screened publications, 54 were included in this scoping review. Among them, 38.9% were published between 2020 and 2023, with 40.7% originating from the United States of America, 20.4% from the United Kingdom, and 13% from Canada. Concerning the settings, 25.9% of the publications focused on primary care, 24.1% on health care services, 20.4% on educational settings, and 3.7% on the community. Additionally, 25.9% were classified as general because recommendations were applicable to various settings. Attention-deficit/hyperactivity disorder (11.1%) was the most frequently considered specific condition, followed by autism spectrum disorder (9.3%) and depression (9.3%). However, 31.5% of the included references addressed mental health in general. Only three references provided specific recommendations for the Black population. Conclusions: Recommendations, guidelines, or standards for Black youth mental health services in community, primary care, or educational settings are scarce and limited to North American countries. This scoping review emphasizes the need to consider ethnicity when developing guidelines or standards to improve racial equity and reduce disparities in access to mental health services. [ABSTRACT FROM AUTHOR]

Background: Parents can engage in several behaviours with regard to early childhood allergy prevention (ECAP). These can be related to diet of mother/child and the modification of the home environment; not all of them are justified by current evidence. Previous studies showed that parental health literacy (HL) is related to favourable health behaviours directed at the child. This study aimed to investigate the causal effect of mothers' HL on ECAP behaviours and to test different moderators of this effect. Methods: One thousand six hundred sixty-two mothers participating in the KUNO-Kids health study in the area of Regensburg, Germany were surveyed on HL (assessed via the health care scale of the Health Literacy Survey-EU questionnaire, HLS-EU-Q47) and ECAP behaviours implemented during pregnancy and the child's first year of life. Patterns in ECAP behaviours were identified by latent class analysis. Multinomial regression modelling was performed with HL as exposure, ECAP as outcome variable, allergy risk, parental competence and bonding, anxiety and depression as moderators as well as potentially confounding variables. Results: We identified three classes of ECAP behaviours (class 1: „breastfeeding " N = 871; class 2: „allergen-avoidance " N = 490; class 3: „mixed behaviours " N = 301). In univariable as well as fully adjusted regression models, compared to class 1, class 2 was negatively, and class 3 was not associated with HL. None of the tested moderating variables altered the association between HL and ECAP significantly. Conclusions: We found an effect of mothers' HL on ECAP behaviours: lower HL of mothers increased allergen-avoiding behaviour directed at their child, while decreasing the chance of exclusive breastfeeding. Improving HL could contribute to the implementation of recommended ECAP behaviours in families, especially to the reduction of allergen-avoiding behaviours. [ABSTRACT FROM AUTHOR]

Background: Much remains unknown about how complex community-based programmes can successfully achieve long-term impact. More insight is needed to understand the key mechanisms through which these programmes work. Therefore, we conducted an in-depth study in five communities that implemented the Healthy Youth, Healthy Future (JOGG) approach, a Dutch community-based obesity prevention programme. We aimed to identify perceived outcomes and long-term impacts among local stakeholders and explore potential causal pathways and working mechanisms. Methods: We used ripple effects mapping (REM), a qualitative participatory method to map outcomes and identify causal pathways, in five communities. We involved 26 stakeholders, professionals and policy-makers affiliated with the local JOGG approach, spread over eight REM sessions and conducted individual interviews with 24 additional stakeholders. To uncover working mechanisms, we compared outcomes and causal pathways across communities. Results: Over 5–9 years of implementation, participants perceived that JOGG had improved ownership of local stakeholders, health policies, intersectoral collaboration and social norms towards promoting healthy lifestyles. Causal pathways comprised small initial outcomes that created the preconditions to enable the achievement of long-term impact. Although exact JOGG actions varied widely between communities, we identified five common working mechanisms through which the JOGG approach contributed to causal pathways: (1) creating a positive connotation with JOGG, (2) mobilizing stakeholders to participate in the JOGG approach, (3) facilitating projects to promote knowledge and awareness among stakeholders while creating successful experiences with promoting healthy lifestyles, (4) connecting stakeholders, thereby stimulating intersectoral collaboration and (5) sharing stakeholder successes that promote healthy lifestyles, which gradually created a social norm of participation. Conclusions: The JOGG approach seems to work through activating initial stakeholder participation and bolstering the process towards ownership, policy change, and intersectoral collaboration to promote healthy lifestyles. Key working mechanisms can inform further development of JOGG as well as other complex community-based prevention programmes. [ABSTRACT FROM AUTHOR]

Background: Poverty is a well-known risk factor for poor health. This scoping review (ScR) mapped research linking early childhood caries (ECC) and poverty using the targets and indicators of the Sustainable Development Goal 1 (SDG1). Methods: We searched PubMed, Web of Science, and Scopus in December 2023 using search terms derived from SDG1. Studies were included if they addressed clinically assessed or reported ECC, used indicators of monetary or multidimensional poverty or both, and were published in English with no date restriction. We excluded books and studies where data of children under 6 years of age could not be extracted. We charted the publication year, study location (categorized into income levels and continents), children age, sample size, study design, measures of ECC, types and levels of poverty indicators and adjusted analysis. The publications were also classified based on how the relation between poverty and ECC was conceptualized. Results: In total, 193 publications were included with 3.4 million children. The studies were published from 1989 to 2023. Europe and North America produced the highest number of publications, predominantly from the UK and the US, respectively. Age-wise, 3–5-year-olds were the most studied (62.2%). Primary studies (83.9%) were the majority, primarily of cross-sectional design (69.8%). Non-primary studies (16.1%) included reviews and systematic reviews. ECC was mainly measured using the dmf indices (79.3%), while poverty indicators varied, with the most common used indicator being income (46.1%). Most studies measured poverty at family (48.7%) and individual (30.1%) levels. The greatest percentage of publications addressed poverty as an exposure or confounder (53.4%), with some studies using poverty to describe groups (11.9%) or report policies or programs addressing ECC in disadvantaged communities (11.4%). In addition, 24.1% of studies requiring adjusted analysis lacked it. Only 13% of publications aligned with SDG1 indicators and targets. Conclusion: The ScR highlight the need for studies to use indicators that provide a comprehensive understanding of poverty and thoroughly examine the social, political, and economic determinants and impact of ECC. More studies in low and middle-income countries and country-level studies may help design interventions that are setting- and economic context-relevant. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is increasingly being recognized in children, mostly secondary to systemic underlying conditions or medication. However, no imaging modality currently provides a full evaluation of bone health in children. We compared DXA, a radiographic bone health index (BHI (BoneXpert) and cone-beam CT for the assessment of low bone mass in children with juvenile idiopathic arthritis (JIA). Methods: Data used in the present study was drawn from a large multicentre study including 228 children aged 4–16 years, examined between 2015 and 2020. All had a radiograph of the left hand, a DXA scan and a cone-beam CT of the temporomandibular joints within four weeks of each other. For the present study, we included 120 subjects, selected based on DXA BMD and BoneXpert BHI to secure values across the whole range to be tested. Results: One hundred and twenty children (60.0% females) were included, mean age 11.6 years (SD 3.1 years). There was a strong correlation between the absolute values of BHI and BMD for both total body less head (TBLH) (r = 0.75, p < 0.001) and lumbar spine (L1-L4) (r = 0.77, p < 0.001). The correlation between BHI standard deviation score (SDS) and BMD TBLH Z-scores was weak (r = 0.34) but significant (0 = 0.001), varying from weak (r = 0.31) to moderate (r = 0.42) between the three study sites. Categorizing BHI SDS and DXA BMD Z-scores on a 0–5 scale yielded a weak agreement between the two for both TBLH and LS, with w-kappa of 0.2, increasing to 0.3 when using quadratic weights. The agreement was notably higher for one of the three study sites as compared to the two others, particularly for spine assessment, yielding a moderate kappa value of 0.4 – 0.5. For cone-beam CT, based on a 1–3 scale, 59 out of 94 left TMJ's were scored as 1 and 31 as score 2 by the first observer vs. 87 and 7 by the second observer yielding a poor agreement (kappa 0.1). Conclusions: Categorizing DXA LS and automated radiographic Z-scores on a 0–5 scale gave a weak to moderate agreement between the two methods, indicating that a hand radiograph might provide an adjuvant tool to DXA when assessing bone health children with JIA, given thorough calibration is performed. [ABSTRACT FROM AUTHOR]

Background: Follistatin-like protein 1 (FSTL1) has been identified as a secreted glycoprotein that plays an important role in obesity. However, its role in children with metabolic-associated fatty liver disease (MAFLD) has not been investigated. This study aimed at characterizing the relationship between serum FSTL1 concentration and MAFLD in children with obesity. Methods: A total of 121 subjects were recruited from the Second Affiliated Hospital of Xi'an Jiaotong University, including 45 obese children with MAFLD, 31 obese children without MAFLD, and 45 healthy controls. Anthropometric parameters, biochemical data were measured and circulating FSTL1 levels were detected by ELISA. Results: The levels of FSTL1 in obese children with MAFLD were higher than that in obese children without MAFLD: 1.31 (0.35–2.29) ng/mL vs. 0.55 (0.36–1.38) ng/mL. Correlation analysis illustrated that FSTL1 was associated with nonesterified free fatty acid and leptin (r = 0.278, P < 0.05 and r = 0.572, P < 0.05, respectively). Binary logistic regression suggested that increased FSTL1 was a risk factor for MAFLD in children (OR = 1.105, 95% CI: 1.066–1.269, P < 0.05). Conclusions: Serum FSTL1 concentrations increase in obese children with MAFLD and may have the potential to be a risk factor for MAFLD in children with obesity. [ABSTRACT FROM AUTHOR]

Brucellosis, a zoonotic ailment induced by the Brucella and some patients may present with joint involvement. This report describes a pediatric patient diagnosed with Brucella arthritis, presenting with swelling and pain in the right knee. The patient had a reoccurrence of fever due to sulfamethoxazole-trimethoprim allergy during treatment. Symptoms improved after adjusting the antimicrobial regimen to ceftriaxone and rifampicin. This case emphasizes the importance of the need for brucellosis as a differential diagnosis for arthralgia and fever in brucellosis- endemic areas. Furthermore, it emphasizes the importance of timely recognition that recurrent fever after effective anti-infective therapy must be considered as a possibility of drug fever. [ABSTRACT FROM AUTHOR]

Background: Interdisciplinary collaboration is known to foster professional innovation and enhance student learning across different domains. However, the research on the effectiveness of integration of interdisciplinary learning in pediatric nursing education is limited. Therefore, this study aimed to examine the effectiveness of integrating game-based learning, an interdisciplinary approach to teaching, into pediatric nursing education's play courses. Methods: We used a mixed methods study with pre-test/post-test quantitative analyses and a descriptive qualitative analysis of students' reflection journals. Data were collected between August 2019 and July 2020 to gauge course effectiveness. Quantitative data obtained from the questionnaires were analyzed using a t-test, correlation, and regression analysis. Qualitative data using students' reflective journals were collected and analyzed using content analysis. One hundred and three second-year nursing students enrolled in a four-year nursing program. Nursing students attended classes in university classrooms and served learning in a kindergarten or hospital in Northern Taiwan. Results: The subscales of Students' Learning Outcome in knowledge, abilities, and attitudes showed significantly higher mean post-test scores compared to pre-test scores: 26.15 (SD = 3.35) vs. 16.82 (SD = 4.49), p <.001; 18.03 (SD = 2.13) vs. 11.43 (SD = 2.95), p <.001; and 12.90 (SD = 2.12) vs. 8.72 (SD = 2.52), p <.001. Furthermore, scores on the Service-Learning Abilities Scale indicated a significant increase in communication, problem-solving, knowledge application, and cross-cultural competence. Integrating instruction to improve problem-solving skills and knowledge application predicts student learning outcomes. Qualitative findings revealed nursing students' reflections on integrating different learning areas, communication, problem-solving, and practical knowledge skills. Conclusions: Integration of interdisciplinary learning effectively stimulates learning among nursing students and enhances their knowledge, abilities, and attitudes toward therapeutic play, benefiting children's health. Our findings demonstrate that integration of interdisciplinary learning significantly enhances nursing students' healthcare-giving competence, particularly in communication, problem-solving, knowledge application, and cross-cultural competence as measured by the Service-Learning Scale. Integrating social service with integration of interdisciplinary learning exposes nursing students to diverse challenges and needs, thereby enhancing their communication skills, knowledge application, and problem-solving abilities. Nursing students can blend knowledge and skills through integrated learning, which is crucial for nursing career preparation. Trial registration: N/A. It was a survey on educational activities. [ABSTRACT FROM AUTHOR]

Background: It is still unclear whether the trabecular structure of the jaw is different in individuals with hypodontia than in those without hypodontia; this is important for clinicians. The aim was to determine whether the mandibular trabecular bone structure of children and adolescents with hypodontia differs from the control group by using the fractal analysis (FA) method in this study. Methods: A total of 138 panoramic radiographs of 69 cases and 69 control subjects (mean age 13.2 ± 10.1) were evaluated. The age and gender of subjects in the case and control groups were matched. Three regions of interest (ROIs) were selected from the panoramic radiographs. ROI1 refers to the center of the ramus rising above the mandibular foramen. ROI2 refers to the area between the apical level of the mandibular molar and the upper border of the mandibular canal. ROI3, the missing tooth region, refers to the apical third of the mesial side of the erupting or fully erupted permanent mandibular first molar. Mann-Whitney U and Wilcoxon tests were used. p < 0.05 was accepted for the significance value. Results: The mean fractal dimension (FD) values of ROI1, ROI2, and ROI3 were 1,25, 1,20, and 1,13, respectively. The means FD values obtained from the ramus region were higher than the other regions (p < 0.05). The FD values did not differ significantly according to gender and age (p > 0.05). The FD values of the case group were lower than the control group for ROI3 (p < 0.05). Conclusion: The results of this study showed that the mandibular trabecular bone quality of pediatric patients with one missing tooth was different from the healthy group. The difference in the mean FD values from the ROIs indicates that the ramus has a denser structure than the mandibular corpus. Clinicians should factor this into their dental treatment planning process. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the effects of two 12-week training intervention experimental ball games combined with standard behavioral rehabilitation against a control group solely utilizing standard behavioral rehabilitation on social communication impairments (SCI) in preschool children with Autism Spectrum Disorder (ASD). Methods: A multi-arm controlled study design was implemented, involving 41 children diagnosed with ASD (mean age: 4.99 ± 0.76 years). 41 participants were randomized assigned to two experimental groups and a control group, The experimental group carried out ball combination training program group (BCTP) and mini-basketball training program group (MBTP) on the basis of routine behavioral rehabilitation, which underwent 12-week training interventions 5 times a week. The control group (n = 14) received only standard behavioral rehabilitation. Evaluations were conducted before and after interventions using the Social Responsiveness Scale, Second Edition (SRS-2). Results: The results suggest that both 12-week interventions, BCTP, and MBTP, led to significant improvements in social communication impairment among children with ASD (p < 0.05). Despite enhancing the overall scores on the SRS-2, these interventions displayed varying impacts across different sub-dimensions. BCTP primarily exhibited significant enhancements in social awareness and behavior pattern (p < 0.05), whereas MBTP significantly improved social cognition and social communication (p < 0.05). Both interventions showed slight improvements in social motivation. Conclusions: The utilization of recreational ball games has showed to be effective in decreasing the impairment levels of children with ASD, while the control group experienced a worsening of outcomes. This suggests that irrespective of the specific ball game strategy employed, both can be employed on a weekly basis to complement standard behavioral rehabilitation and enhance the ability to improve the quality of life for children diagnosed with ASD. Trial registration: The trial is retrospectively registered on the Chinese Clinical Trial Registry (ChiCTR1900024973;August 5, 2019). [ABSTRACT FROM AUTHOR]

Background: Chronic pain often clusters in families, where parents and their offspring both experience chronic pain conditions. Young children of parents with irritable bowel syndrome (IBS) represent an at-risk group for the development of abdominal pain, disability, and excess health care visits in later childhood. Parental solicitous responses to children's expressions of discomfort and maternal modeling of their own illness behavior contribute to a greater focus on somatic sensations, leading to illness behaviors in children. This randomized controlled trial will test the effectiveness of an early preventive web-based psychosocial intervention (REACH)[TM] vs. an educational web-based safety comparison condition delivered to parents with IBS to alter parental responses and lead to improved child health and decreased health care costs. Methods: Parents with IBS who have children ages 4–7 years are recruited via community-based approaches (e.g., social media advertisements, school electronic distribution, research networks) and health care providers. The target sample is 460 parents randomized to REACH, a web-based social learning and cognitive behavior therapy (SLCBT) intervention or an educational web-based safety comparison condition (EC). Participants will be assessed at baseline, 6-week (immediate post-intervention), 6-month, 12-month, and 18-month follow-up periods (months post-completion of intervention). The primary outcome is change in parental solicitous/protective behaviors. Secondary outcomes include parent risk and protective factors, child health and symptom outcomes, and health care utilization and cost savings. Discussion: This study adapts a validated, parent-delivered intervention to treat chronic pain in children to a web-based application designed to prevent the development of chronic pain in very young, high-risk children. If successful, this strategy can both prevent adverse sequelae of this condition from developing as well as be widely accessible. Furthermore, the availability of a prevention model for parent training could result in significant short- and long-term health benefits across a broad spectrum of conditions. Trial registration: ClinicalTrials.gov NCT05730491. Registered on February 15, 2023. [ABSTRACT FROM AUTHOR]

Background: Mental illnesses are common among children and negatively impact wellbeing during childhood as well as later in life. However, many children with these conditions are not able to access needed mental health care. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) was created to reduce gaps in access to care by providing primary care providers with referral resources, access to behavioral health consultations, and training on mental health topics. Objectives: The purpose of this study was 1) to assess the effectiveness of the WI CPCP in Milwaukee County, providing specific insights into provider's ability to care for child mental health, and 2) identify challenges Milwaukee PCPs faced in providing mental health care to child patients and contextualize these challenges in a conceptual framework of access to health care. Methods: A cross-sectional mixed-methods secondary data analysis was conducted using data collected from online baseline and nine-month follow-up surveys completed by providers participating in the program practicing in Milwaukee County from 2014 to 2022. Provider confidence and skill in providing mental health care was analyzed quantitatively using Two-sample Wilcoxon rank-sum (Mann–Whitney) tests (baseline vs. follow-up survey responses) and descriptive statistics (follow-up survey only). Provider challenges to providing mental health care were analyzed qualitatively using a thematic analysis research approach. Results: Results from quantitative analyses showed that provider confidence and skill in treating childhood anxiety and depression improved from baseline to follow-up. Results from qualitative analyses were categorized by factors within and beyond the scope of WI CPCP. Within the scope of WI CPCP, providers reported a lack of knowledge of referral options and a lack of training in mental health care as well as a lack of knowledge in assessing and treating mental disorders. Still, many barriers to mental healthcare access persist that are beyond the scope of WI CPCP, such as long wait times and a lack of insurance coverage. Conclusions: This study supports the effectiveness of the program to improve access to care for children. However, there is a need for additional solutions such as better reimbursement for mental health professionals and expanded insurance coverage. [ABSTRACT FROM AUTHOR]

Childhood overweight/obesity is a serious problem that has not been adequately addressed. As a key factor affecting weight gain, the association between dietary intake with childhood overweight and obesity is still unclear. The objective of this study was to analyze the association between sociodemographic, lifestyle factors and dietary intake with overweight or obesity. We used data from a large cross-sectional National Health and Nutrition Examination Survey (NHANES). The U.S. children aged 6–15 years with both weight data and dietary data were included. For univariate analysis of sociodemographic data, t tests was performed for continuous variables and chi-square tests was performed for discrete variables. Dietary intakes were described by median and quartile, and differences in dietary intake between children with normal weight and children with overweight or obesity were compared by rank sum tests. A modern statistical shrinkage technique, LASSO regression was used to examine the association between dietary intake and childhood obesity. Our study confirms that Hispanic ethnicity, increasing age, passive exposure to smoking, higher protein intake, and higher caffeine intake were positively associated with child overweight or obesity. Additionally, non-Hispanic White race, higher physical activity levels, higher household income, and higher vitamin A intake were negatively associated with child overweight or obesity. [ABSTRACT FROM AUTHOR]

Background: The increasing prevalence of allergies and asthma has led to a growing global socioeconomic burden. Since the outbreak of the COVID-19 pandemic, the health and lifestyles of children and adolescents have changed dramatically. It's unclear how this shift impacted allergy and asthma, with limited studies addressing this question. We aim to explore the difference of the prevalence of allergies and asthma among US children and adolescents during and before the COVID-19 pandemic using a nationally representative sample of US children and adolescents. Methods: This cross-sectional study included 31,503 participants in the National Health Interview Survey (NHIS) between 2018 and 2021. Allergies and asthma were defined on an affirmative response in the questionnaire by a parent or guardian. Chi-square tests were used to compare baseline characteristics with allergies and asthma for categorical variables. Differences in prevalence during and before the COVID-19 pandemic were estimated with weighted logistic regression, adjusting for demographic factors. Interaction analyses explored variations across strata. Results: In US children and adolescents aged 0 to 17, prevalence of any allergy was 26.1% (95% CI, 24.8%- 27.4%) in 2018 and 27.1% (95% CI, 25.9%- 28.2%) in 2021. Thereinto, in 2018, prevalence of respiratory allergies, food allergies and skin allergies were 14.0% (95% CI, 13.1%- 15.0%), 6.5% (95% CI, 5.8%- 7.1%) and 12.6% (95% CI, 11.6%- 13.5%), respectively, and in 2021, 18.8% (95% CI, 17.8%- 19.9%), 5.8% (95% CI, 5.2%- 6.4%) and 10.7% (95% CI, 9.9%- 11.5%), respectively. And prevalence of asthma was 11.1% (95% CI, 10.5%- 11.7%) in 2018–2019 and 9.8% (95% CI, 9.2%- 10.4%) in 2020–2021. Prevalence of respiratory allergies, skin allergies and asthma during and before the COVID-19 pandemic in children and adolescents had statistically significant differences. The differences persisted after adjusting for demographic and socioeconomic variables. Conclusion: Prevalence of respiratory allergies increased and the prevalence of both skin allergies and asthma decreased among US children and adolescents during the COVID-19 pandemic compared with the pre-COVID-19 pandemic. Further research is required to explore the association between allergic diseases and the pandemic, with a particular emphasis on the impact of lifestyle changes resulting from measures to prevent COVID-19 infection. [ABSTRACT FROM AUTHOR]

Background: The prevalence of celiac disease (CD) and hypothyroidism exhibit significant variation in different studies among patients with congenital heart disease (CHD). This study evaluated the frequency of laboratory test abnormalities in children and adolescents with CHD in Shiraz, Iran. Methods: This prospective case-control study was conducted on 223 children and adolescents with CHD and healthy individuals referred to the heart clinic affiliated with Shiraz University of Medical Sciences between February 2019 and December 2021. They were classified into case and control groups. Blood tests were performed for total IgA antibody, anti-tissue transglutaminase IgA antibody (anti-TTG Ab), T4, and thyroid stimulating hormone (TSH) and anti-thyroid peroxidase antibodies in serum, along with transthoracic echocardiography. Likewise, demographic characteristics of patients, including age, sex, weight, height, and body mass index (BMI), were recorded. Also, anti-TTG Ab levels were compared among CHD patients according to cyanosis status, gender, age (above and below five years), and BMI (under and over 18.5). Results: Ninety-eight CHD patients and 100 healthy individuals with an average age of 5.32 ± 4.05 years (1–18 years) were examined. In children with CHD, atrial septal defect (27%), ventricular septal defect (20%), and tetralogy of Fallot (13%) were the most prevalent disorders. Only one CHD patient had an anti-TTG Ab level of 16.6 unit/mL, considered borderline for seropositive CD diagnosis. There was no difference in anti-TTG Ab levels between age (above and below five years), BMI (under and over 18.5), cyanosis status, and gender groups. Seven CHD patients had high TSH levels, three had cyanotic CHD, and one had Down syndrome. The TSH levels and non-autoimmune hypothyroidism were significantly higher in CHD patients than in normal subjects (p < 0.05). Conclusions: According to the results of this study, the serum level of TSH and prevalence of non-autoimmune hypothyroidism were higher in patients with CHD than in normal subjects, but the serum level of anti-TTG Ab was not different between the two groups. [ABSTRACT FROM AUTHOR]

Background: Drug-resistant epilepsy is defined as failure of seizure control in spite of using 2 or 3 proper antiepileptic drugs in appropriate time. Mineral elements play important roles in neuronal function; it is believed that mineral deficiency may lead to complications through seizure management. In the present study, serum levels of zinc (Zn), copper (Cu), magnesium (Mg), calcium (Ca), and 25-hydroxy vitamin D (Vit D) in drug-resistant-epilepsy (DRE) patients were evaluated and compared with the controlled patients. Methods: In this cross-sectional study, epileptic patients were included and categorized into two groups of DRE and well-controlled patients. Patients' serum samples were analysed to evaluate Zn, Cu, Mg, Ca, and Vit D levels. The primary objective was comparison of serum levels of different trace elements between the groups. Results: Sixty-four epileptic children including 33 DRE and 31 well-controlled children entered the study. The DRE children showed a significantly earlier onset of disease compared to the other group (p = 0.014). Comparing the frequency of developmental delay between the groups, the results showed this complication was significantly more frequent in the DRE group (p < 0.001). Concerning serum elements, the results showed a significantly higher concentration of Zn in the well-controlled group than the DRE group (p = 0.007). On the other hand, no significant differences were observed between the groups regarding the means of Vit D, Ca, Cu, and Mg levels (p > 0.05). Conclusion: The results of the present study delineated that drug-resistant epilepsy patients had earlier onset of disease and were at higher risk of neurodevelopmental delay compared with well-controlled-epilepsy patients. A significant lower serum levels of Zn were also observed in drug-resistant-epilepsy patients. This finding may suggest the role of zinc supplementation in help to better control of drug-resistant seizures, as well as, the importance of serum zinc monitoring in epileptic patients. [ABSTRACT FROM AUTHOR]

Background and objectives: Electronic media (e-media) has become a universal part of young children's daily lives. Previous studies have found an association between increased screen time and children's psychosocial symptoms. We investigated whether parents' psychological distress and parenting style dimensions explain the association between children's screen time and psychosocial symptoms. Moreover, we investigated whether parents' mental well-being and parenting style dimensions moderate this association. Methods: We used data from the Finnish CHILD-SLEEP birth cohort study. Parents and the child were assessed when the child was 5 years old (N = 671). The measure of screen time included program viewing from TV and other devices. Child's psychosocial problems and parents' depression, stress and parenting style dimensions were assessed by self-reports. Results: A high level of screen time in children was associated with attention and concentration difficulties, hyperactivity and impulsivity symptoms as well as internalizing and externalizing symptoms among 5-year-olds. For the most part, the associations remained significant despite controlling for parents' mental health, parenting style dimensions and multiple background factors, especially associations relating to attention and concentration difficulties and hyperactivity symptoms were robust. Maternal stress and depression moderated the association between children's screen time and psychosocial symptoms, indicating a more pronounced association among stressed or depressed mothers. Conclusion: There is an independent association between children's screen time and psychosocial symptoms which is especially pronounced among those children whose mothers had poorer mental well-being. In clinical practice, the length of screen time should be inquired already at a young age and parents should be offered guidance to reduce the possible ill effects of excessive screen time, as well as help with their own mental health problems. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of and risk factors for overweight and obese among Chinese children and adolescents. Methods: This analytical cross-sectional study included 16,640 children and adolescents aged 6–18 years across four provinces of China in 2016. Physical characteristics and responses to questionnaires were analyzed. Body Mass Index (BMI) and the prevalence of overweight and obesity were calculated. Results: Among children and adolescents, the overall prevalence of overweight and obesity in 2016 in four regions of China was 27.2% and 29.6%, respectively. Among different stages and sexes, the highest prevalence of obesity (15.8%) was observed in adolescent boys. From childhood to adolescence, the obesity rate among boys increased by 0.7% (from 15.1% to 15.8%), while the obesity rate among girls decreased by 0.9% (from 10.8% to 9.9%). Children and adolescents who were overweight or obese had significantly higher systolic blood pressures, larger waist circumferences and larger hip sizes than those with a normal BMI. Logistic regression analyses identified thirteen factors associated with overweight or obesity in children and adolescents. Conclusions: Our results indicate that the prevalence of overweight and obesity is high among children and adolescents, especially among male adolescents in four regions of China. A suitable intervention program should not only help parents understand the serious risk of childhood obesity but also, more importantly, help to encourage a healthy lifestyle among children and adolescents. [ABSTRACT FROM AUTHOR]

Background: The burden and characteristics of respiratory viral infections in children hospitalized for acute respiratory tract infections (ARTIs) during the post-COVID-19 pandemic era are unclear. We analyzed the epidemiological and clinical characteristics of pediatric patients hospitalized with common respiratory virus infections before and after relaxation of non-pharmaceutical interventions in Hangzhou, China and evaluated the diagnostic value of the six-panel respiratory pathogen detection system. Methods: Six types of respiratory viruses were detected in respiratory samples from children with suspected ARTIs by multiplex real-time quantitative polymerase chain reaction (RT-qPCR). Changes in virus detection rates and epidemiological and clinical characteristics, obtained from electronic health records, were analyzed. Binary logistic regression was used to identify respiratory tract infections risk factors. Multiplex RT-qPCR and targeted next-generation sequencing results were compared in random samples. Results: Among the 11,056 pediatric samples, 3228 tested positive for one or more of six common respiratory pathogens. RSV and PIV-3 detection rates differed significantly across age groups (both P < 0.001), and were more common in younger children. PIV-1 was more common in infants, toddlers, and preschoolers than in school-age children (P < 0.001). FluB was predominantly detected in school-age children (P < 0.001). RSV-, ADV-, and PIV-1-positivity rates were higher in 2022 than in 2023. Seasonal viral patterns differed across years. RSV (OR 9.156. 95% CI 5.905–14.195) and PIV-3 (OR 1.683, 95% CI 1.133–2.501) were risk factors for lower respiratory tract infections. RSV-positivity was associated with severe pneumonia (P = 0.044). PIV-3 (OR 0.391, 95% CI 0.170–0.899), summer season (OR 1.982, 95% CI 1.117–3.519), and younger age (OR 0.938, 95% CI 0.893–0.986) influenced pneumonia severity. Multiplex RT-qPCR showed good diagnostic performance. Conclusion: After changes in COVID-19 prevention and control strategies, six common respiratory viruses in children were prevalent in 2022–2023, with different seasonal epidemic characteristics and age proclivities. RSV and PIV-3 cause lower, and FluA, FluB, and ADV more typically cause upper respiratory tract infections. Infancy and summer season influence severe pneumonia risk. Multiplex RT-qPCR is valuable for accurate and timely detection of respiratory viruses in children, which facilitates management, treatment, and prevention of ARTIs. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to develop and validate a nomogram for predicting the risk of an acute complicated course in pediatric patients with Acute Hematogenous Osteomyelitis (AHO). Methods: A predictive model was developed based on a dataset of 82 pediatric AHO patients. Clinical data, imaging findings, and laboratory results were systematically collected for all patients. Subsequently, biomarker indices were calculated based on the laboratory results to facilitate a comprehensive evaluation. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing early adverse outcomes in AHO. A nomogram model was constructed based on independent factors and validated internally through bootstrap methods. The discriminative ability, calibration, and clinical utility of the nomogram model were assessed using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA), respectively. The developed nomogram model was compared with previously published A-score and Gouveia scoring systems. Results: Logistic regression analysis identified delayed source control, suppurative arthritis, albumin on admission, and platelet to lymphocyte ratio (PLR) as independent predictors of early adverse outcomes in pediatric AHO patients. The logistic regression model was formulated as: Log(P) = 7. 667–1.752 × delayed source control − 1.956 × suppurative arthritis − 0.154 × albumin on admission + 0.009 × PLR. The nomogram's AUC obtained through Bootstrap validation was 0.829 (95% CI: 0.740–0.918). Calibration plots showed good agreement between predictions and observations. Decision curve analysis demonstrated that the model achieved net benefits across all threshold probabilities. The predictive efficacy of our nomogram model for acute complicated course in pediatric AHO patients surpassed that of the A-score and Gouveia scores. Conclusions: A predictive model for the acute complicated course of pediatric AHO was established based on four variables: delayed source control, suppurative arthritis, albumin on admission, and PLR. This model is practical, easy to use for clinicians, and can aid in guiding clinical treatment decisions. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine the associations of physical activity (PA), recreational screen time, and sleep with indicators of poor oral health in youth. Methods: Participants were children and adolescents whose parents completed the 2022 National Survey of Children's Health (N = 34,342; 49% female; Mean age = 11.9 +/- 3.5 years). The dependent variables were three binary response items that indicated the presence of toothaches, bleeding gums, and cavities within the previous 12 months. Independent variables were three items indicating the weekly frequency of 60 min of PA, hours of recreational screen time, and hours of weeknight sleep. Relationships between variables were examined using double-selection logistic regression with demographic, dietary, oral hygiene, and dental service covariates selected using the plug-in method of the least absolute shrinkage and selection operator. Results: Compared to zero days of PA, 4–6 days of PA per week was associated with 30% lower odds of bleeding gums (p = 0.021). Compared to less than 1 h of recreational screen time, 2 h or more hours of recreational screen time were associated with a 1.26 to 1.62 times higher odds of cavities (p < 0.01). Compared to 5 h or less of sleep, 7 to 10 h of sleep was associated with 47–61% lower odds of bleeding gums and 31–47% lower odds of cavities (p < 0.01). Secondary analyses indicated that at least 2 of the movement behavior recommendations had to have been adhered to for positive associations with indicators of oral health to be observed. For toothaches, bleeding gums, and cavities, meeting 2 or 3 recommendations was associated with lower odds of poor oral health; whereas adhering to only one recommendation was not. Conclusion: Children with higher PA and sleep durations had improved oral health indicators and children with longer periods of screen time exposure had poorer oral health indicators. Our findings recommend adhering to multiple movement behavior recommendations to achieve improvements in oral health indicators. [ABSTRACT FROM AUTHOR]

Introduction: The diagnosis and care of children and adolescents with neurodevelopmental disorders presents a public health crisis in China. Attention deficit hyperactivity disorder (ADHD) is one of the most frequent conditions. Many Chinese children and adolescents with ADHD are underdiagnosed and undertreated. This study aimed to evaluate the awareness and attitude parents have about ADHD, and investigated potential factors influencing ADHD medical visit status among school-aged children in Shanghai. Methods: A random cluster sampling method was used, and four primary schools in Shanghai were selected. One class was randomly selected from each grade, including students and their parents. Parents completed the Swanson, Nolan, and Pelham Version IV Questionnaire (SNAP-IV) parent form and questionnaire concerning ADHD awareness, knowledge, attitude and status of ADHD medical visit. Descriptive analysis was conducted on the overall results and logistic regression analysis was performed to explore the influencing factors of ADHD medical visit. Results: We received 617 valid questionnaires. There were 313 boys (50.7%) and 304 girls (49.2%), with a median age of 8 years old (p25 = 7, p75 = 9). 42.4% parents believed they had some knowledge about ADHD, and 73.5% of them thought ADHD was a neurologically based disorder or neurological condition by nature. Parental ADHD information came from the following sources: Internet/TV (n = 458, 74.2%), families/friends (n = 267, 43.2%), print publication (n = 208, 33.7%), psychiatrists/pediatricians (n = 192, 31.1%), schools/teachers (n = 186, 30.1%) and other ADHD patients (n = 48, 7.7%). When children had ADHD-like behaviors, most parents (61.5%) educated children to behave themselves, 59.1% parents tried to get help from psychiatrists/pediatricians, 55.5% of them would ask psychologist for help. In terms of the ADHD prevalence, the SNAP-IV positive screen rate was 4.3% (n = 27). Only 33.3% (9/27) of parents went to the hospital for consultation and treatment. Multivariate logistic regression model showed that parental knowledge about ADHD (OR = 13.67, 95%CI: 1.72, 144.39, P = 0.01) was significantly correlated with the medical visit. Parents with sufficient knowledge of ADHD tend to visit hospital for help when they thought their children had ADHD related symptoms. Conclusions: The majority of parents accepted ADHD as a neurodevelopmental disorder by nature, but some parents still had certain misunderstandings about ADHD. The main source of information for parents to obtain information about ADHD was through the TV/Internet. Parents' perceptions and knowledge were key to whether children received appropriate treatment for their ADHD. However, medical visits to address ADHD among school-aged children were still lower than expected. Government and healthcare institutes should work to improve ADHD public awareness and to help patients and their families gain access to mental health resources. [ABSTRACT FROM AUTHOR]

Background: To assess the reporting of the certainty of the evidence using the GRADE approach in systematic reviews of interventions in pediatric dentistry. Methods: The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and non-randomized studies of interventions (NRSIs) in pediatric dentistry that reported the certainty of the evidence through the GRADE approach. Paired independent reviewers screened the studies, extracted data, and appraised the methodological quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) tool. The certainty of the evidence was extracted for each outcome. A descriptive analysis was conducted. Results: Around 28% of pediatric dentistry reviews of interventions used the GRADE approach (n = 24). Twenty reviews reported 112 evidence outcomes from RCTs and 13 from NRSIs using GRADE evidence profile tables. The methodological quality was high (16.7%), moderate (12.5%), low (37.5%), and critically low (33.3%), fulfilling the majority of the AMSTAR 2 criteria. The certainty of the evidence for outcomes generated from RCTs and NRSIs was very low (40.2% and 84.6%), low (33.1% and 7.7%), moderate (17.8% and 7.7%), and high (9.8% and 0.0%). The main reasons to downgrade the certainty were due to (for RCTs and NRSIs, respectively): risk of bias (68.8% and 84.6%), imprecision (67.8% and 100.0%), inconsistency (18.8% and 23.1%), indirectness (17.8% and 0.0%), and publication bias (7.1% and 0.0%). Conclusion: The proportion of systematic reviews assessing the certainty of the evidence using the GRADE approach was considered small, considering the total initial number of published pediatric dentistry reviews of intervention. The certainty of the evidence was mainly very low and low, and the main problems for downgrading the certainty of evidence were due to risk of bias and imprecision. Registration: PROSPERO database #CRD42022365443. [ABSTRACT FROM AUTHOR]

Background: Attention-deficit/hyperactivity disorder (ADHD) has been shown to pose considerable clinical and economic burden; however, research quantifying the excess burden attributable to common psychiatric comorbidities of ADHD among pediatric patients is scarce. This study assessed the impact of anxiety and depression on healthcare resource utilization (HRU) and healthcare costs in pediatric patients with ADHD in the United States. Methods: Patients with ADHD aged 6–17 years were identified in the IQVIA PharMetrics Plus database (10/01/2015-09/30/2021). The index date was the date of initiation of a randomly selected ADHD treatment. Patients with ≥ 1 diagnosis for anxiety and/or depression during both the baseline (6 months pre-index) and study period (12 months post-index) were classified in the ADHD+anxiety/depression cohort; those without diagnoses for anxiety nor depression during both periods were classified in the ADHD-only cohort. Entropy balancing was used to create reweighted cohorts. All-cause HRU and healthcare costs during the study period were compared using regression analyses. Cost analyses were also performed in subgroups by comorbid conditions. Results: The reweighted ADHD-only cohort (N = 204,723) and ADHD+anxiety/depression cohort (N = 66,231) had similar characteristics (mean age: 11.9 years; 72.8% male; 56.2% had combined inattentive and hyperactive ADHD type). The ADHD+anxiety/depression cohort had higher HRU than the ADHD-only cohort (incidence rate ratios for inpatient admissions: 10.3; emergency room visits: 1.6; outpatient visits: 2.3; specialist visits: 5.3; and psychotherapy visits: 6.1; all p < 0.001). The higher HRU translated to greater all-cause healthcare costs; the mean per-patient-per-year (PPPY) costs in the ADHD-only cohort vs. ADHD+anxiety/depression cohort was $3,988 vs. $8,682 (p < 0.001). All-cause healthcare costs were highest when both comorbidities were present; among patients with ADHD who had only anxiety, only depression, and both anxiety and depression, the mean all-cause healthcare costs were $7,309, $9,901, and $13,785 PPPY, respectively (all p < 0.001). Conclusions: Comorbid anxiety and depression was associated with significantly increased risk of HRU and higher healthcare costs among pediatric patients with ADHD; the presence of both comorbid conditions resulted in 3.5 times higher costs relative to ADHD alone. These findings underscore the need to co-manage ADHD and psychiatric comorbidities to help mitigate the substantial burden borne by patients and the healthcare system. [ABSTRACT FROM AUTHOR]

Background: Physical health inequalities of people with serious mental illness (SMI) have been labelled an international scandal; due to the 15–20-year reduction in life expectancy associated with poor physical health. This occurs at an early stage and evidence shows young people with and at risk for SMI are a particularly vulnerable group requiring intervention and support. However, most work has been conducted with adults and little is known about what affects physical health for young people, specifically those receiving inpatient care. Methods: We conducted semi-structured qualitative interviews with 7 service users and 6 staff members (85% female, age 14–42) on a generic mental health inpatient unit for children and adolescents. Interviews aimed to identify how young people viewed theirphysical health and factors affecting physical health and lifestyle and identify any support needed to improve physical health. Thematic analysis was conducted.. Results: Thematic analysis revealed the main factors affecting physical health and lifestyle for young people. Three main themes were individual factors (subthemes were mental health symptoms, knowledge, attitudes and beliefs), environmental factors (subthemes were opportunities in a restricted environment and food provision), and the influence of others (subthemes were peers, staff, family members). These factors often overlapped and could promote a healthy lifestyle or combine to increase the risk of poor physical health. Young people discussed their preferences for physical health initiatives and what would help them to live a healthier lifestyle. Conclusions: Promoting physical health on inpatient units for young people is an important, yet neglected area of mental health research. We have identified a range of complex factors which have an impact on their physical health, and there is a pervasive need to address the barriers that young people experience to living a healthy lifestyle. There is an increasingly strong evidence base suggesting the benefits of physical health interventions to improve outcomes, and future work should identify ways to implement such interventions considering the barriers discussed in this article. Further collaborative research is needed with young people, clinical teams, caregivers, and commissioners to ensure improvements are made to clinical care provision and optimisation of the inpatient environment. [ABSTRACT FROM AUTHOR]

Background: Plastic bronchitis (PB) is a rare pediatric pulmonary condition characterized by the production of branching bronchial casts that cause partial or total obstruction of the bronchial lumen. Case presentation: We describe a 13-year-old boy with a history of bronchial asthma and left lower lobectomy, with persistent cough and left-sided chest pain when he went to the emergency room. Chest radiography showed complete left lung opacity denoting total left lung collapse, and flexible bronchoscopy revealed cohesive casts totally occluding the left bronchus, with frequent recurrence that finally ended with left pneumonectomy. Conclusion: Plastic bronchitis is a rare, fatal disease in children that requires a high index of suspicion for both diagnosis and treatment. Although bronchoscopic removal of the bronchial casts together with the medical treatment are the main lines of treatment, cases with recurrent formation of casts are at high risk for surgical intervention in the form of either lobectomy or pneumonectomy. [ABSTRACT FROM AUTHOR]

Background: Mothers usually have the primary role in raising children and developing health-related behaviors. This study aims to evaluate the relationship between dental anxiety and oral hygiene status of mothers and children's dental anxiety and gingival health. Methods: The study included 305 children, aged 4–12 years, who came to the dentist for the first time and their mothers. All the demographic and oral hygiene information were collected through a questionnaire. The dental anxiety of the mothers and children was assessed using the Modified Dental Anxiety Scale (MDAS) and Venham Picture Test (VPT), respectively. The oral examination of the mother and children was performed, and their PI, GI, and DMFT scores were recorded. Results: While the correlation between MDAS and VPT was positive and strong in children aged 8–12, it was positive but weak in the 4–7 age group. A significant relationship was detected between the mother's PI, GI, DMFT, and the child's VPT score. According to the mothers' dental anxiety, there were no statistically significant differences in PI, GI, and dmft values in children aged between 4 to 7. A moderately positive and statistically significant relationship between maternal dental anxiety and children's DMFT was identified in children aged 8–12. Conclusions: Children's dental anxiety was significantly influenced by maternal dental anxiety, post-treatment complications experienced by the mother, and the oral health status of the mother. Trial registration: Clinical Trials-ID: NCT05563532; Registration Date: 17.09.2022. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to investigate the muscle differences in children with osteogenesis imperfecta (OI) using opportunistic low-dose chest CT and to compare different methods for the segmentation of muscle in children. Methods: This single center retrospective study enrolled children with OI and controls undergoing opportunistic low-dose chest CT obtained during the COVID pandemic. From the CT images, muscle size (cross-sectional area) and density (mean Hounsfield Units [HU]) of the trunk muscles were measured at the mid-T4 and the mid-T10 level using two methods, the fixed thresholds and the Gaussian mixture model. The Bland-Altman method was also used to compute the strength of agreement between two methods. Comparison of muscle results between OI and controls were analyzed with Student t tests. Results: 20 children with OI (mean age, 9.1 ± 3.3 years, 15 males) and 40 age- and sex-matched controls were enrolled. Mean differences between two methods were good. Children with OI had lower T4 and T10 muscle density than controls measured by the fixed thresholds (41.2 HU vs. 48.0 HU, p < 0.01; 37.3 HU vs. 45.9 HU, p < 0.01). However, children with OI had lower T4 muscle size, T4 muscle density, T10 muscle size and T10 muscle density than controls measured by the Gaussian mixture model (110.9 vs. 127.2 cm2, p = 0.03; 44.6 HU vs. 51.3 HU, p < 0.01; 72.6 vs. 88.0 cm2, p = 0.01; 41.6 HU vs. 50.3 HU, p < 0.01, respectively). Conclusions: Children with OI had lower trunk muscle density indicating that OI might also impair muscle quality. Moreover, the fixed thresholds may not be suitable for segmentation of muscle in children. [ABSTRACT FROM AUTHOR]

Introduction: To explore the diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias (IAHs), and to analyze the potential causes for missed diagnosis and misdiagnosis of IAHs in children. Methods: A retrospective analysis was conducted on 45 children with surgically confirmed IAHs. The diagnostic rate of IAHs by preoperative high-resolution ultrasound combined with MSCT was compared with that of intraoperative examination, and the potential causes for missed diagnosis and misdiagnosis by the combination method were analyzed. Results: Forty-five cases of pediatric IAHs were categorized into primary (25/45, 55.5%) and acquired secondary hernias (20/45, 44.5%). Among children with primary hernias, mesenteric defects were identified as the predominant subtype (40%). Acquired secondary hernias typically resulted from abnormal openings in the abdominal wall or band adhesions due to trauma, surgery, or inflammation. In particular, adhesive band hernias were the major type in children with acquired secondary hernias (40%). The diagnostic rate of high-resolution ultrasound was 77.8%, with "cross sign" as a characteristic ultrasonic feature. Among 10 cases of missed diagnosis or misdiagnosis, 5 were finally diagnosed as IAHs by multi-slice computer tomography (MSCT). Overall, the diagnostic rate of pediatric IAHs by preoperative ultrasound combined with radiological imaging reached 88.9%. Discussion: IAHs in children, particularly mesenteric defects, are prone to strangulated intestinal obstruction and necrosis. High-resolution ultrasound combined with MSCT greatly enhances the diagnostic accuracy of pediatric IAHs. [ABSTRACT FROM AUTHOR]

Background: Using Silver Diamine Fluoride (SDF) may be an effective public health approach for managing dental caries in children. Parental acceptance of SDF has rarely been investigated in low-income and middle-income countries (LMICs). The aim of this study was to evaluate parental acceptance of SDF to manage dental caries in children aged 2–12 in Iran and Tajikistan. Methods: This cross-sectional study was conducted in the Kurdistan province of Iran and Khatlon region of Tajikistan, 2022–2023. Parents watched a video about SDF and its weaknesses and strengths as compared to conventional approaches before completing the questionnaire. We also reported Prevalence Ratios with 95% confidence intervals for the relationship between parental acceptance and associated demographic factors as well as dental attitude and experience. Results: Participants were 245 and 160 parents in Iran and Tajikistan, respectively. In both countries, a majority (Iran: 61.6%, Tajikistan: 77.9%) accepted SDF over conventional treatments for all primary teeth. The majority also accepted SDF only for posterior permanent teeth (Iran: 73.5%, Tajikistan: 78.7%). Black discoloration was the main reason for rejecting SDF. Overall, demographic factors and dental experience and attitude were not significantly associated with SDF acceptance. Conclusions: SDF was widely accepted by Iranian and Tajik parents. Establishing parental acceptance of SDF is an important step toward its application in LMICs where inexpensive solutions are needed. [ABSTRACT FROM AUTHOR]