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This second roundtable discussion was convened at the 56th European Society of Paediatric Radiology (ESPR) 2022 Annual Meeting in Marseille, France, to discuss controversial aspects of imaging in child abuse. The following topics were discussed: Fracture dating—the published literature is broadly similar with respect to the identification of the radiographic stages of bony healing. The non-expert/general radiologist is encouraged to use broad descriptors of fracture healing (acute, healing or old) within their reports, rather than attempting to date fractures. The more experienced/expert radiologist, who may provide a timeframe/range to assist the courts, should be aware that any published timeframes are not absolute and that recent research indicates that the rate of healing may differ according to the bone affected and the age of the patient. Whole spine imaging in suspected abusive head trauma—this is recommended to enable a complete assessment of the neuraxis when abusive head trauma is suspected or diagnosed, particularly in the presence of intracranial and cervical subdural haemorrhage and cervical ligamentous injury. Cranial imaging in suspected physical abuse—both computed tomography (CT) and magnetic resonance imaging (MRI) remain complimentary depending on the clinical context in which they are used with CT remaining first-line in the assessment of children with (suspected abusive) head trauma prior to an early MRI. MRI is superior in its assessment of parenchymal injury and may be employed as first-line in age appropriate asymptomatic siblings of a child with suspected physical abuse.

Aims: Patient-reported outcomes (PROs) are increasingly important for assessing patient satisfaction with diabetes technologies. PROs must be assessed with validated questionnaires in clinical practice and research studies. Our aim was to translate and validate the Italian version of the continuous glucose monitoring (CGM) Satisfaction (CGM-SAT) scale questionnaire. Methods: Questionnaire validation followed MAPI Research Trust guidelines and included forward translation, reconciliation, backward translation, and cognitive debriefing. Results: The final version of the questionnaire was administered to 210 patients with type 1 diabetes (T1D) and 232 parents. The completion rate was excellent, with almost 100% of items answered. The overall Cronbach’s coefficient was 0.71 and 0.85 for young people (patients) and parents indicating moderate and good internal consistency, respectively. Parent–young people agreement was 0.404 (95% confidence interval: 0.391–0.417), indicating moderate agreement between the two assessments. Factor analysis identified that factors assessing the “benefits” and “hassles” of CGM accounted for 33.9% and 12.9% of score variance in young people and 29.6% and 19.8% in parents, respectively. Discussion: We present the successful Italian translation and validation of the CGM-SAT scale questionnaire, which will be useful for assessing satisfaction with Italian T1D patients using CGM systems.

School-based sex education is essential to improve the knowledge and behavior of young people. Unlike most European countries, sex education in Italy is not compulsory in the school curriculum. Therefore, to assess potential gaps, the main aim of this study was to explore Italian regional initiatives about sex education. A review of gray literature from 2006 to 2021 was conducted in December 2021 on national databases and institutional websites of each Italian region, during which official documents on regional sex education programs were selected. Moreover, a rapid systematic review was carried out in scientific databases to find more information. For both reviews, the sex education topics recommended by UNESCO were used for extracting and analyzing data. A total of 12 Italian regions out of 20 had at least one sex education program, for a total of 39 projects. Overall, all the topics identified by UNESCO have been covered, with considerable differences between northern, central, and southern Italy. Contraception, love, marriage, partnerships, and family were the main topics discussed (hosted in 92% of the regions). Only 25% of the regions discussed pregnancy and birth. Disability was the least debated topic (17%). The rapid systematic review showed that relevant improvements were achieved after sex education interventions. In conclusion, this study underlined important limitations to the implementation of school-based sex education in Italy. Hence, it is necessary to increase sex education interventions to reach adequate standards and flatten the differences not only between Italian regions but also between Italy and other European countries.

Various authors see human flourishing as the overarching aim to which education should contribute. We ask whether fostering wonder can help education attain this aim. We discuss two possibilities: firstly, it may be that having a sense of wonder as adults (possibly fostered by and/or refined due to education) contributes to flourishing itself. Secondly, it may be that fostering wonder in education increases the likelihood that education promotes flourishing, which it might do simply by increasing children’s intrinsic interest in what they learn. We argue that there are many plausible connections between wonder and human flourishing (relating to its epistemic and aesthetic dimensions, among others), and that we have reason to believe that early experiences can influence adults’ capacity for wonder. Furthermore, wonder increases the likelihood that education ‘succeeds’; and it supports people’s ability to live well by heightening their appreciation for the world, helping to uncover baseless beliefs, and increasing their awareness of possible goods. In sum, while having a sense of wonder may not be a constitutive element of human flourishing, it is hard to imagine education for human flourishing that is not also wonder-full education.

Aguarda publicação impressa. Children’s participation in decisions about their lives is a crucial point of the UN Convention on the Rights of the Child, which is the basis of child welfare and protection worldwide. Despite these clear guidelines, there is evidence that children’s voices may be heard but often with little impact on the decisions made by professionals in the childcare system. This study seeks to ascertain whether the voice of children living in foster care is considered and respected when making decisions that concern them, whether the children effectively exercise it, and what factors impact their participation. A systematic scoping review was performed to clarify concepts and unveil research gaps, using eleven scientific databases and publishers that allowed us to identify twelve recent studies in critical journals. In the light of the Bouma et al., (2018) model, the findings showed that there is, in general, a lack of effective children’s participation, namely in terms of information, listening, and involvement. Children’s voices still have a minimum impact on the decisions made in the childcare system. It will be necessary to avoid the bureaucratic assumption that there is an age cut-off point to promote participation. More, it is stressed the importance of a trusting, sincere and confidential relationship between the child and the social worker and the need to ensure training for professionals who intervene in review/statutory meetings or judicial proceedings, namely in the court of law.

Purpose The management of pediatric ovarian neoplasms (ON) is based on finding a balance between adequate surgical treatment and future reproductive capacity. We aimed to evaluate long-term results of patients who underwent surgery for ON. Methods A retrospective cohort study design was used. Medical records of patients with ON were reviewed. They were invited to participate in a telephone-based survey assessing complaints, menstrual status, and post-surgical recurrence. Results Eighty-five patients were operated for ON between 1995 and 2015. Median age at surgery was 14.7 years. 62.4% of patients had ovary-sparing surgery (OSS). Median tumor size in oophorectomy group was significantly larger than OSS group (p = 0.029). Median length of follow-up was 5.1 years. Recurrent/metachronous disease was not significantly different between OSS and oophorectomy groups (p = 1.000). In OSS group, irregular menses (p = 0.004) and painful menses (p = 0.002) were significantly higher than oophorectomy group. Conclusion The main goal of treatment in pediatric ON is to find the right balance between adequate and appropriate tumor resection and maximal effort for fertility preservation. Our results showed no difference between oophorectomy and OSS in the terms of recurrence. Although irregular and painful menses were found to be significantly higher in the OSS group, longer follow-up and prospective studies are needed to clarify this issue.

The pharmacokinetic and pharmacodynamic properties of the second-generation basal insulin glargine 300 Units/mL (Gla-300) may be of benefit in the treatment of type 1 diabetes mellitus (T1DM). Gla-300 provides a stable and sustained time-action profile, which is associated with glycaemic control and flexible dosing schedule. This review summarises the available evidence on the safety and efficacy of Gla-300 in children and adolescents with T1DM. Gla-300 is as effective as the first-generation basal insulin glargine 100 Units/mL (Gla-100), a standard of care for patients with diabetes in reducing HbA1c, and shows a lower risk of severe hypoglycaemia and hyperglycaemia in children and adolescents with T1DM. However, Gla-300 and Gla-100 are not bioequivalent and are not directly interchangeable. Real-world studies on patients aged 6-17 years are limited. To date, only one small study assessed the effectiveness and safety of Gla-300 versus Gla-100 in newly diagnosed T1DM paediatric patients, confirming the treatment safety and effectiveness of Gla-300 in clinical practice. Gla-300 is a longer-acting basal insulin alternative in the management of children (aged ≥ 6 years) and adolescents with T1DM.The smooth and prolonged activity of insulin glargine 300 Units/mL (Gla-300), a second-generation basal insulin, results in a stable and sustained glycaemic control while allowing flexible dosing times. In children aged ≥ 6 years and adolescents with type 1 diabetes mellitus (T1DM), Gla-300 provides a glycaemic control comparable to that of glargine 100 Units/mL (Gla-100), a standard of care in patients with T1DM. Gla-300 and Gla-100 show similar safety profiles, with Gla-300 resulting in a clinically relevant trend towards a lower incidence of hyperglycaemia with ketosis and a lower incidence and event rate of severe hypoglycaemia in children and adolescents with T1DM. Overall, these two insulins are similar, but not interchangeable. To the best of our knowledge, only one real-world study has addressed the effectiveness and safety of Gla-300 compared to Gla-100 in newly diagnosed T1DM paediatric patients, and it has shown the therapeutic benefits of Gla-300 in clinical practice.

Objectives As prevalence of molar-incisor hypomineralisation varies considerably in different countries and regions, the aim of this study was to obtain representative epidemiological data for schoolchildren living in the canton of Basel-Landschaft, Switzerland. Material and methods A representative population of schoolchildren of three different age groups, i.e. 1st grade (mean age: 7.4 years), 6th grade (mean age: 12.6 years), and 9th grade (mean age: 15.7 years) visiting compulsory schools in the canton of Basel-Landschaft, Switzerland, was examined. The presence or absence of molar-incisor hypomineralisation at time of examination was recorded as well as potential influencing factors such as age group, gender, nationality, or the children’s place of residence. Results A total of 1252 schoolchildren could be included. On average, the prevalence of MIH in the study population was 14.8%. No statistically significant differences were found for nationality, gender, or place of residence. Although not statistically significant, children from the youngest age group had the highest while children from the oldest age group had the lowest MIH prevalence. Conclusion With a mean value of 14.8%, MIH prevalence among schoolchildren living in the canton of Basel-Landschaft, Switzerland, is comparable to mean values recorded globally. Clinical relevance This study represents the first study on MIH prevalence in Switzerland and also provides further evidence on potential influencing factors.

Background Prematurity and perinatal risk factors may influence white matter microstructure. In turn, these maturational changes may influence language development in this high-risk population of children. Objective To evaluate differences in the microstructure of association tracts between preterm and term children and between preterm children with appropriate growth and those with fetal growth restriction and to study whether the diffusion tensor metrics of these tracts correlate with language abilities in schoolchildren with no severe neurological impairment. Materials and methods This study prospectively followed 56 very preterm children (mean gestational age: 28.7 weeks) and 21 age- and gender-matched term children who underwent diffusion tensor imaging at a mean age of 9 years. We used automated probabilistic tractography and measured fractional anisotropy in seven bilateral association tracts known to belong to the white matter language network. Both groups participated in language assessment using five standardised tests at the same age. Results Preterm children had lower fractional anisotropy in the right superior longitudinal fasciculus 1 compared to term children (P P P Conclusion There were some microstructural differences in language-related tracts between preterm and term children and between preterm children with appropriate and those with restricted fetal growth. Children with better language abilities had a higher fractional anisotropy in distinct white matter tracts.

Posterior fossa syndrome (PFS) is a set of debilitating complications that can occur after surgery for posterior fossa tumors. This study aimed to assess the preoperative radiological and surgical risk factors for the onset of PFS in a histologically homogeneous population of children with medulloblastoma and compare it to a similar population of young adults.Included patients underwent posterior fossa surgery for medulloblastoma at 11 Italian neurosurgical wards (2003-2019) and were referred to Fondazione IRCCS Istituto Nazionale dei Tumori in Milan (INT) for postoperative treatments. We collected patients' pre- and post-operative clinical, surgical and radiological data from the INT charts. To compare the distribution of variables, we used the Mann-Whitney and Fisher tests for continuous and categorical variables, respectively.136 patients (109 children and 27 young adults) were included in the study. Among children, 29 (27%) developed PFS, and all of them had tumors at midline site with invasion of the fourth ventricle. Radiological evidence of involvement of the right superior (39% versus 12%; p = 0.011) or middle cerebellar peduncles (52% versus 18%; p = 0.002) seemed more common in children who developed PFS. Young adults showed an expected lower incidence of PFS (4 out of 27; 15%), that may be due to anatomical, physiological and oncological elements.This study confirmed some factors known to be associated with PFS onset and shed light on other debated issues. Our findings enhance an already hypothesized role of cerebellar language lateralization. The analysis of a population of young adults may shed more light on the often-neglected existence of PFS in non-pediatric patients.

ObjectivesInterventions involving kindness- and compassion-based meditation (KCBM) have been shown to have various benefits for adults, and there is growing interest in using KCBMs with children. This systematic review explores the effects of KCBM on wellbeing, prosociality, and cognitive functioning in children and adolescents.MethodsStudies were eligible if they examined interventions that contained a proportion of KCBM above a set threshold, included child participants only, used any or no control group, and included at least one outcome measure related to wellbeing, prosociality, or cognitive functioning. Studies were assessed for quality using the Quality Assessment Tool for Quantitative Studies, and findings were synthesised narratively.ResultsA systematic literature search of 11 databases up to February 2020 identified 3,073 papers. Ten studies were eligible for inclusion in the review, including 807 children. There was evidence of improvements in wellbeing in 47% of wellbeing outcome measures (including stress, anxiety, depression, negative affect, markers of inflammation, mindfulness, and self-compassion). Prosociality and cognitive functioning (visual perception and motor accuracy) were examined in 1 study each, and there was evidence of improvements in both outcomes. Effect sizes ranged from small to large. There was some evidence that interventions were more effective with younger, non-clinical populations and where intervention teachers were experienced. Study quality was generally weak.ConclusionsThere was no strong evidence base for positive effects of KCBM with children. However, the findings of the review are encouraging given the early stage of development of the field, and further research is warranted. Recommendations for future research include more robust methodological design, improved reporting, and a focus on developmental mechanisms of change.Systematic Review RegistrationPROSPERO CRD42014013065.

The diagnosis of brain death is primarily clinical. Sometimes ancillary tests are needed.This study compared sensitivity and interobserver agreement of the 10-, 7- and 4-point CT angiography scoring systems for the diagnosis of brain death in children.CT angiography examinations of 50 pediatric patients with a clinical diagnosis of brain death were evaluated according to 10-, 7- and 4-point scoring systems. Images were evaluated by two radiologists who considered the vessel opacification first in the arterial phase (AUsing the clinical exam as the reference standard, we found sensitivities for 10-, 7- and 4-point scoring systems to be 70%, 88% and 92% in the AJust as in adult age groups, in children the 4-point scale appears to be more sensitive than the 10- and 7-point scales for CT angiography-based assessment of brain death. Because the scoring systems have similar sensitivities, they could be used as ancillary tests in pediatric cases.

Assessing the body composition of children and adolescents is important to monitor their health status. Anthropometric measurements are feasible and less-expensive than other techniques for body composition assessment. This study aimed to systematically map anthropometric equations to predict adipose tissue, body fat, or density in children and adolescents, and to analyze methodological aspects of the development of anthropometric equations using skinfolds. Methods: A scoping review was carried out following the PRISMA-ScR criteria. The search was carried out in eight databases. The methodological structure protocol of this scoping review was retrospectively registered in the Open Science Framework (https://osf.io/35uhc/). Results: We included 78 reports and 593 anthropometric equations. The samples consisted of healthy individuals, people with different diseases or disabilities, and athletes from different sports. Dual-energy X-ray absorptiometry (DXA) was the reference method most commonly used in developing equations. Triceps and subscapular skinfolds were the anthropometric measurements most frequently used as predictors in the equations. Age, stage of sexual maturation, and peak height velocity were used as complementary variables in the equations. Conclusion: Our scoping review identified equations proposed for children and adolescents with a great diversity of characteristics. In many of the reports, important methodological aspects were not addressed, a factor that may be associated with equation bias. Level IV: Evidence obtained from multiple time series analysis such as case studies. (NB: dramatic results in uncontrolled trials might also be regarded as this type of evidence). info:eu-repo/semantics/publishedVersion

Anorectal and cloacal malformations are a broad mix of congenital abnormalities related to the distal rectum and anus. Confusion exists between all the forms in this large and heterogeneous group. The spectrum includes everything from anal stenosis, ventral anus, anal atresia (with and without fistula) and the full spectrum of cloacal malformations. Imaging in these conditions is done through the whole armamentarium of radiologic modalities, with very different imaging strategies seen across the centres where these conditions are managed. In 2017, the European Society of Paediatric Radiology (ESPR) abdominal imaging task force issued recommendations on the imaging algorithm and standards for imaging anorectal malformations. This was followed by further letters and clarifications together with an active multispecialty session on the different imaging modalities for anorectal malformations at the 2018 ESPR meeting in Berlin. Through this paper, the abdominal task force updates its guidelines and recommended imaging algorithm for anorectal malformations.Other Information Published in: Pediatric Radiology License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1007/s00247-022-05395-7

An estimated 41% of all forcibly displaced people are children [1]. Many of these children may live in refugee camps, under poor conditions, for years. The health status of children when arriving in these camps is often not recorded, nor is there a good insight into the impact of camp life on their health. We systematically reviewed the evidence concerning the nutritional status of children living in refugee camps in the European and Middle East and North Africa (MENA) regions. We searched Pubmed, Embase, and Global Index Medicus. The primary outcome was the prevalence of stunting, and the secondary outcome was the prevalence of wasting and being overweight. Out of 1385 studies identified, 12 studies were selected, covering 7009 children from fourteen different refugee camps in the Europe and MENA region. There was great heterogeneity among the included studies, which showed that there was a pooled prevalence of stunting of 16% (95% confidence interval 9.9–23%, I2 95%, p I2 97%, p Conclusion: This review showed that there is a relatively high prevalence of stunting and a low prevalence of wasting among refugee children. However, the nutritional status of children when entering the camp and the effect of camp life on their health is not known. This information is critical in order to inform policymakers and to create awareness concerning the health of the most vulnerable group of refugees. What is Known: • Migration is a core determinant of health for children. • There are risk factors at every stage of a refugee child’s journey that lead to compromised health. What is New: • There is a relatively high prevalence of stunting (16%) and a low prevalence of wasting (4.2%) among refugee children living in refugee camps in Europe and the Middle East and North Africa region.

Hutchinson-Gilford Progeria Syndrome results in rapid aging and severe cardiovascular sequelae that accelerate near end-of-life. We found a progressive disease process in proximal elastic arteries that was less evident in distal muscular arteries. Changes in aortic structure and function were then associated with changes in transcriptomics assessed via both bulk and single cell RNA sequencing, which suggested a novel sequence of progressive aortic disease: adverse extracellular matrix remodeling followed by mechanical stress-induced smooth muscle cell death, leading a subset of remnant smooth muscle cells to an osteochondrogenic phenotype that results in an accumulation of proteoglycans that thickens the aortic wall and increases pulse wave velocity, with late calcification exacerbating these effects. Increased central artery pulse wave velocity is known to drive left ventricular diastolic dysfunction, the primary diagnosis in progeria children. It appears that mechanical stresses above similar to 80 kPa initiate this progressive aortic disease process, explaining why elastic lamellar structures that are organized early in development under low wall stresses appear to be nearly normal whereas other medial constituents worsen progressively in adulthood. Mitigating early mechanical stress-driven smooth muscle cell loss/phenotypic modulation promises to have important cardiovascular implications in progeria patients.

Chronic liver disease (CLD) is a serious condition where various toxins present in the blood affect the brain leading to type C hepatic encephalopathy (HE). Both adults and children are impacted, while children may display unique vulnerabilities depending on the affected window of brain development.We aimed to use the advantages of high field proton Magnetic Resonance Spectroscopy (1H MRS) to study longitudinally the neurometabolic and behavioural effects of Bile Duct Ligation (animal model of CLD-induced type C HE) on rats at post-natal day 15 (p15) to get closer to neonatal onset liver disease. Furthermore, we compared two sets of animals (p15 and p21-previously published) to evaluate whether the brain responds differently to CLD according to age onset.We showed for the first time that when CLD was acquired at p15, the rats presented the typical signs of CLD, i.e. rise in plasma bilirubin and ammonium, and developed the characteristic brain metabolic changes associated with type C HE (e.g. glutamine increase and osmolytes decrease). When compared to rats that acquired CLD at p21, p15 rats did not show any significant difference in plasma biochemistry, but displayed a delayed increase in brain glutamine and decrease in total-choline. The changes in neurotransmitters were milder than in p21 rats. Moreover, p15 rats showed an earlier increase in brain lactate and a different antioxidant response. These findings offer tentative pointers as to which neurodevelopmental processes may be impacted and raise the question of whether similar changes might exist in humans but are missed owing to 1H MRS methodological limitations in field strength of clinical magnet.

The objective of the present study was to examine gender stereotypes and sexualization in Italian television advertisements aimed at children. For this purpose, content analysis method was used to analyze 185 commercials broadcast from 6 pm to 8:30 pm over the three Italian television channels dedicated to children which attract the largest audience share. In order to allow comparison with previous research on gender stereotyping, two raters coded a series of variables common to similar investigations (i.e., verbs used in the ads, voice-over, voice-over message, setting, pace of the ads, activities performed by the main characters). Results indicate that gender stereotypes are still prevalent in Italian children’s television commercials. Furthermore, although the level of sexualization of children is low, we found that girls tend to be more sexualized than boys, especially in terms of “adultification.” Our findings provide an updated picture of children’s advertising in Italy by also expanding the literature on gender role stereotyping and sexualization in television commercials.

This study aims to investigate the relationship between motor skills at age 7 and spinal pain at age 11. The study included participants from the Danish National Birth Cohort. Data on motor skills were obtained from the Developmental Coordination Disorder Questionnaire, completed by the mothers when the children were 7 years old, and spinal pain was self-reported at age 11 for frequency and intensity of neck, mid back, and low back pain. This was categorized into “no,” “moderate,” or “severe” pain, based on frequency and pain intensity. Associations were estimated using multinomial logistic regression models. Data on both motor skills and spinal pain was available for 25,000 children. There was a consistent pattern of reporting more neck or mid back pain at age 11 for those with lower levels of fine motor skills and coordination scores at age 11. The relationship was significant for severe pain (the highest relative risk ratio being 1.87 and the lowest 1.18), but not for moderate pain (the highest relative risk ratio being 1.22 and the lowest 1.07). Gross motor skills were not associated with spinal pain, and there was no relationship between low back pain and motor skills. Conclusion: Our results indicate a link between motor development at 7 years of age and neck and mid back pain, but not low back pain, at 11 years of age. Improvement of motor skills in young children might reduce the future burden of neck and mid back pain and should be a target of future research. What is Known: • Spinal pain in preadolescence and adolescence is common and predisposes to spinal pain in adulthood. • Motor skills influence the biomechanics of movement and therefore has a potential impact on musculoskeletal health. What is New: • Poor fine motor- and coordination skills in childhood were associated with increased risk of severe neck- or mid back pain, but not low back pain, four 4 years later. • Poor gross motor skills were not associated with higher risk of later spinal pain.

Background Diabetes mellitus is one of the most common chronic diseases in childhood. With more advanced care options including ever-evolving technology, allocation of resources becomes increasingly important to guarantee equal care for all. Therefore, we investigated healthcare resource utilization, hospital costs, and its determinants in Dutch children with diabetes. Methods We conducted a retrospective, observational analysis with hospital claims data of 5,474 children with diabetes mellitus treated in 64 hospitals across the Netherlands between 2019–2020. Results Total hospital costs were €33,002,652 per year, and most of these costs were diabetes-associated (€28,151,381; 85.3%). Mean annual diabetes costs were €5,143 per child, and treatment-related costs determined 61.8%. Diabetes technology significantly increased yearly diabetes costs compared to no technology: insulin pumps € 4,759 (28.7% of children), Real-Time Continuous Glucose Monitoring € 7,259 (2.1% of children), and the combination of these treatment modalities € 9,579 (27.3% of children). Technology use increased treatment costs significantly (5.9 – 15.3 times), but lower all-cause hospitalisation rates were observed. In all age groups, diabetes technology use influenced healthcare consumption, yet in adolescence usage decreased and consumption patterns changed. Conclusions These findings suggest that contemporary hospital costs of children with diabetes of all ages are driven primarily by the treatment of diabetes, with technology use as an important additive factor. The expected rise in technology use in the near future underlines the importance of insight into resource use and cost-effectiveness studies to evaluate if improved outcomes balance out these short-term costs of modern technology.

Oculocutaneous albinism (OCA) is a group of rare, genetic disorders caused by absent/reduced melanin biosynthesis. The aim of this study was to explore the neurovisual, cognitive, adaptive, and behavioral profile of children affected by OCA, also evaluating any possible effect of the visual acuity deficit on the clinical profile and genotype–phenotype correlations. Eighteen children (9 males, mean age 84 months ± 41; range 18–181 months) with a molecular confirmed diagnosis of OCA were enrolled in the study. We collected data on clinical history, neurodevelopmental profile, neurological and neurovisual examination, and cognitive, adaptive, and emotional/behavioral functioning. A global neurodevelopmental impairment was detected in 56% of the children, without evolving into an intellectual disability. All the patients showed signs and symptoms of visual impairment. Low adaptive functioning was observed in 3 cases (17%). A risk for internalizing behavioral problems was documented in 6 cases (33%), for externalizing problems in 2 (11%), and for both in 5 (28%). Twelve children (67%) showed one or more autistic-like features. Correlation analyses revealed significant associations between the visual acuity level and performance intelligence quotient (p = 0.001), processing speed index (p = 0.021), Vineland total score (p = 0.020), Vineland communication (p = 0.020), and socialization (p = 0.037) domains. No significant correlations were found between genotype and phenotype.Conclusion: Children with OCA may present a global neurodevelopmental delay that seems to improve with age and emotional/behavioral difficulties, along with the well-known visual impairment. An early neuropsychiatric evaluation and habilitative training are recommended to improve vision-related performance, neurodevelopment, and any psychological difficulties. What is Known:• Children with oculocutaneous albinism show dermatological and ophthalmological problems.• An early visual impairment may have negative implications on motor, emotional, and cognitive processes that would allow the child to organize his or her experiences. What is New:• In addition to a variable combination of ocular signs and symptoms, children with oculocutaneous albinism may present an early neurodevelopmental delay and emotional/behavioral difficulties.• An early visual treatment is recommended to improve vision-related performance, neurodevelopment, and any psychological difficulties.

Background In 2016, we performed a one-day investigation to analyze the prevalence of pain, pain intensity, and pain therapy in the Departments of Surgery and Onco-Hematology of the Ospedale Pediatrico Bambino Gesù. To improve the knowledge gap highlighted in the previous study, refresher courses and even personalized audits have been carried out during these years. The purpose of this study is to evaluate if, after 5 years, there have been improvements in the management of pain. Methods The study was conducted on 25 January 2020. Pain assessment, pain therapies, pain prevalence and intensity in the preceding 24 h and during the recovery period were recorded. Pain outcomes were compared with previous audit results. Results Out of the 63 children with at least one documented pain assessment (starting from 100 eligible), 35 (55.4%) experienced pain: 32 children (50.7%) experienced moderate /severe pain while 3 patients (4%) felt mild pain. In the preceding 24 h, 20 patients (31.7%) reported moderate/severe pain while 10 (16%) reported moderate or severe pain during the interview. The average value of the Pain Management Index (PMI) was − 1.3 ± 0.9 with a minimum of -3 and a maximum of 0. 28 patients (87%) undergoing analgesic therapy for moderate/severe pain had a PMI of less than 0 (undertreated pain), while 3 patients (13%) scored value of 0 or higher (adequate pain therapy), 4 patients (12.5%) received multimodal analgesia with opioids and 2 patients (6%) opioids alone. Time-based therapy was prescribed to 20 patients (62.5%), intermittent therapy was prescribed to 7 patients (22%) and 5 patients (15.5%) did not receive any therapy. The prevalence of pain was higher during hospitalization and 24 h before the interview, while at the time of the interview, the proportion was the same. In this audit, the daily prescription modality of the therapy had some improvements (time-based: 62.5% vs. 44%; intermittent: 22%vs 25%; no therapy: 15.5% vs. 31%). Conclusion Pain management in hospitalized children constantly requires special daily attention from health professionals aimed at mitigating the components of intractable pain and resolving those of treatable pain. Trial registration : This study is registered with ClinicalTrials.gov, number (NCT04209764), registered 24 December 2019, https://clinicaltrials.gov/ct2/show/NCT04209764?term=NCT04209764&draw=2&rank=1.

Background Celiac disease (CD) is characterized by elevated serum titers of autoantibodies IgA anti-tissue transglutaminase 2 (TGA-IgA) and IgA anti-endomysial (EMA), with small bowel mucosa atrophy. We evaluated age differences between CD children exhibiting variable antibody titers at diagnosis. Methods CD children diagnosed between January 2014 and June 2019, according to 2012 ESPGHAN guidelines were studied. All had EMA and TGA-IgA measurements, while a proportion of them underwent esophagogastroduodenoscopy (EGD). Patients were grouped based on serum TGA-IgA titers normalized to the upper limit of normal (ULN) and differences in median age (years) assessed by analysis of variance (ANOVA) and creation of orthogonal contrasts. Results CD was diagnosed in 295 subjects (median age: 4.4 [IQR: 2.60–8.52]) with a biopsy sparing protocol (high titer: ≥ 10xULN) and in 204 by EGD biopsy. Of the latter, 142 (median age: 8.5 [IQR: 5.81–11.06]) and 62 (median age: 9.5 [IQR: 6.26–12.76]) had a low ((3, 516) = 25.98, p p Conclusion CD patients with greatly elevated antibody titers (≥ 10xULN) were diagnosed at an earlier age than those with lower titers. This may indicate that an increase in TGA-IgA is independent of age and suggests a polarization of autoimmunity in younger individuals with higher serum antibody levels.

In children with congenital heart disease (CHD), pulmonary blood flow (Qp) contributes to alterations of pulmonary mechanics and gas exchange, while cardiopulmonary bypass (CPB) induces lung edema. We aimed to determine the effect of hemodynamics on lung function and lung epithelial lining fluid (ELF) biomarkers in biventricular CHD children undergoing CPB. CHD children were classified as high Qp (n = 43) and low Qp (n = 17), according to preoperative cardiac morphology and arterial oxygen saturation. We measured ELF surfactant protein B (SP-B) and myeloperoxidase activity (MPO) as indexes of lung inflammation and ELF albumin as index of alveolar capillary leak in tracheal aspirate (TA) samples collected before surgery and in 6 hourly intervals within 24 h after surgery. At the same time points, we recorded dynamic compliance and oxygenation index (OI). The same biomarkers were measured in TA samples collected from 16 infants with no cardiorespiratory diseases at the time of endotracheal intubation for elective surgery. Preoperative ELF biomarkers in CHD children were significantly increased than those found in controls. In the high Qp, ELF MPO and SP-B peaked 6 h after surgery and tended to decrease afterward, while they tended to increase within the first 24 h in the low Qp. ELF albumin peaked 6 h after surgery and decreased afterwards in both CHD groups. Dynamic compliance/kg and OI significantly improved after surgery only in the High Qp. Conclusion: In CHD children, lung mechanics, OI, and ELF biomarkers were significantly affected by CPB, according to the preoperative pulmonary hemodynamics. What is Known:• Congenital heart disease children, before cardiopulmonary run, exhibit changes in respiratory mechanics, gas exchange, and lung inflammatory biomarkers that are related to the preoperative pulmonary hemodynamics.• Cardiopulmonary bypass induces alteration of lung function and epithelial lining fluid biomarkers according to preoperative hemodynamics. What is New:• Our findings can help to identify children with congenital heart disease at high risk of postoperative lung injury who may benefit of tailored intensive care strategies, such as non-invasive ventilation techniques, fluid management, and anti-inflammatory drugs that can improve cardiopulmonary interaction in the perioperative period.

Background Schools provide opportunities to improve the quality of children's diet, whilst reducing inequalities in childhood diet and health. Evidence supports whole school approaches, including consistency in food quality, eating culture and food education. However, such approaches are often poorly implemented due to the highly complex environments in which schools operate. We aimed to develop a school food systems map using a systems thinking approach to help identify the key factors influencing primary school children’s dietary choice. Methods Eight workshops were conducted with 80 children (from schools from varying locations (region of England/UK; urban/rural), deprivation levels and prioritisation of school food policies)) and 11 workshops were held with 82 adult stakeholders across the UK (principals, teachers, caterers, school governors, parents, and local and voluntary sector organisations) to identify factors that influence food choice in children across a school day and their inter-relationships. Initial exploratory workshops started with a ‘blank canvas’ using a group model building approach. Later workshops consolidated findings and supported a wider discussion of factors, relationships and influences within the systems map. Strengths of the relationship between factors/nodes were agreed by stakeholders and individually depicted on the map. We facilitated an additional eight interactive, in-person workshops with children to map their activities across a whole school day to enable the production of a journey map which was shared with stakeholders in workshops to facilitate discussion. Results The final ‘CONNECTS-Food’ systems map included 202 factors that were grouped into 27 nodes. Thematic analysis identified four key themes: leadership and curriculum; child food preference; home environment; and school food environment. Network analysis highlighted key factors that influence child diet across a school day, which were largely in keeping with the thematic analysis; including: 'available funds/resources', 'awareness of initiatives and resources', 'child food preference and intake', 'eligibility of free school meals', 'family circumstances and eating behaviours', 'peer/social norms', 'priorities of head teachers and senior leaders'. Conclusions Our systems map demonstrates the need to consider factors external to schools and their food environments. The map supports the identification of potential actions, interventions and policies to facilitate a systems-wide positive impact on children’s diets.

Eighty-five youths with T1D and 176 controls aged 8–19 years were asked to complete online questionnaires (ChEAT and EAT-26) measuring disordered eating behaviors (DEBs) during (baseline) and after (8-month follow-up) the lockdown. DEB symptoms in all participants (especially younger than 13 years), glycemic control, and zBMI were found unchanged from baseline to follow-up (all p > .05). After 8 months, the ChEAT/EAT-26 critical score frequency decreased significantly in controls (p = .004), as was the score for the ChEAT/EAT-26’s Oral Control subscale in both groups (T1D: p = .005; controls: p = .01). Participants with T1D, especially those older than 13 years, had higher ChEAT/EAT-26 Dieting scores (p = .037) and lower ChEAT/EAT-26 Oral Control scores (p = .046) than controls. Unchanged DEB symptoms suggest that the COVID-19 restrictions did not significantly affect participants’ eating behaviors and that a general adaptation to the challenges of lockdown and other pandemic containment measures occurred in both T1D and control participants.

Microbiota composition may play a role in the development, prognosis, or post-infection of COVID-19. There are studies evaluating the microbiota composition at the time of diagnosis and during the course of COVID-19, especially in adults, while studies in children are limited and no study available in children with multisystem inflammatory syndrome in children (MIS-C). This study was planned to compare intestinal microbiota composition in children diagnosed with MIS-C and acute COVID-19 infection with healthy children. In this prospective multicenter study, 25 children diagnosed with MIS-C, 20 with COVID-19 infection, and 19 healthy children were included. Intestinal microbiota composition was evaluated by 16 s rRNA gene sequencing. We observed changes of diversity, richness, and composition of intestinal microbiota in MIS-C cases compared to COVID-19 cases and in the healthy controls. The Shannon index was higher in the MIS-C group than the healthy controls (p

We estimate the association between parental housing wealth and children’s marriage prospects in China by drawing data from the China Health and Retirement Longitudinal Survey (CHARLS). We focus on children aged 16–35 who were unmarried in 2011 and track their marriage outcomes in 2015. Our results show that parental housing wealth acts as a signal for males in the Chinese marriage market, which is characterized by a strongly unbalanced sex ratio. Males are more likely to get married if their parents own high-value houses, especially among rural households. The relationship is not significant for females.

Background Fetal growth restriction caused by placental insufficiency is associated with increased risk of poor neurodevelopment, even in the absence of specific perinatal brain injury. Placental insufficiency leads to chronic hypoxaemia that may alter cerebral tissue organisation and maturation. Objective The aim of this study was to assess the effects fetal growth restriction and fetal haemodynamic abnormalities have on brain volumes and white matter microstructure at early school age. Materials and methods This study examined 32 children born with fetal growth restriction at 24 to 40 gestational weeks, and 27 gestational age-matched children, who were appropriate for gestational age. All children underwent magnetic resonance imaging (MRI) at the age of 8–10 years. Cerebral volumes were analysed, and tract-based spatial statistics and atlas-based analysis of white matter were performed on 17 children born with fetal growth restriction and 14 children with birth weight appropriate for gestational age. Results Children born with fetal growth restriction demonstrated smaller total intracranial volumes compared to children with normal fetal growth, whereas no significant differences in grey or white matter volumes were detected. On atlas-based analysis of white matter, children born with fetal growth restriction demonstrated higher mean and radial diffusivity values in large white matter tracts when compared to children with normal fetal growth. Conclusion Children ages 8–10 years old born with fetal growth restriction demonstrated significant changes in white matter microstructure compared to children who were appropriate for gestational age, even though no differences in grey and white matter volumes were detected. Poor fetal growth may impact white matter maturation and lead to neurodevelopmental impairment later in life.

Previous research has shown that knowledge of the rights of the child and their perceptions about their own participation may contribute to children’s subjective well-being (SWB), and that satisfaction with how adults listen to children and take what they say into account is highly related to children’s SWB in many countries. Thus, the aims of this article are: (a) exploring the contribution to children’s subjective well-being of several items related to their perceptions of their own participation rights in different contexts of their lives; (b) analysing whether or not the ways in which children are listened to and taken into account by adults are mediating the connection to SWB in these children’s participation perceptions; and (c) analysing whether the relationships between these variables differ depending on the country, age group and gender. This article includes the third wave of the Children’s Worlds dataset with 7,570 10- and 12-year-old participants (51% girls) from Brazil, Chile and Spain. There are nine rights-related items and a SWB scale (CW-SWBS) used in this analysis. The main results suggest that perceptions related to children’s rights and the opportunities to participate in decisions affecting them in three different contexts (home, school and area where the child lives) significantly contributed to their SWB. Advancing the research into this matter can provide an opportunity to invest in psychosocial interventions that focus on improving children’s well-being and empowering them through the knowledge of their rights and their role as agents of public policy changes Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature

Minimal but increasing number of assessment instruments for Executive functions (EFs) and adaptive functioning (AF) have either been developed for or adapted and validated for use among children in low and middle income countries (LAMICs). However, the suitability of these tools for this context is unclear. A systematic review of such instruments was thus undertaken. The Systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist (Liberati et al., in BMJ (Clinical Research Ed.), 339, 2009). A search was made for primary research papers reporting psychometric properties for development or adaptation of either EF or AF tools among children in LAMICs, with no date or language restrictions. 14 bibliographic databases were searched, including grey literature. Risk of bias assessment was done following the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) guidelines (Mokkink et al., in Quality of Life Research,63, 32, 2014). For EF, the Behaviour Rating Inventory of Executive Functioning (BRIEF- multiple versions), Wisconsin Card Sorting Test (WCST), Go/No-go and the Rey-Osterrieth complex figure (ROCF) were the most rigorously validated. For AFs, the Vineland Adaptive Behaviour Scales (VABS- multiple versions) and the Child Function Impairment Rating Scale (CFIRS- first edition) were most validated. Most of these tools showed adequate internal consistency and structural validity. However, none of these tools showed acceptable quality of evidence for sufficient psychometric properties across all the measured domains, particularly so for content validity and cross-cultural validity in LAMICs. There is a great need for adequate adaptation of the most popular EF and AF instruments, or alternatively the development of purpose-made instruments for assessing children in LAMICs.Systematic Review Registration numbers: CRD42020202190 (EF tools systematic review) and CRD42020203968 (AF tools systematic review) registered on PROSPERO website (https://www.crd.york.ac.uk/prospero/).

The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents, and fear for personal and family’s safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child’s needs, trauma-informed, and strength- and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child’s mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences.

Treatment-related mortality and morbidity remain a challenge in hematopoietic stem cell transplantation (HSCT). In this retrospective, single-center study, we analyzed endothelial damage as a potential, common denominator and mechanism for the adverse effects. We evaluated the prevalence of key vascular complications and graft-versus-host disease among 122 pediatric patients with an allogeneic HSCT between 2001 and 2013. The spectrum and frequency of acute adverse events emerging ≤100 days post transplant were graded according to the CTCAE 4.03 and analyzed. We identified a total of 19/122 (15.6%) patients with vascular complications, fulfilling the criteria of capillary leak syndrome, veno-occlusive disease/sinusoidal obstruction syndrome or thrombotic microangiopathy. The patients had a poorer overall survival (77% versus 26%, p p = 0.023), thrombocytopenia (p = 0.001), gastrointestinal bleeding (p p p p = 0.027). These endotheliopathy-related adverse events appeared early post HSCT, varied in their clinical phenotype and predicted a poor outcome. An unrelated donor but not previous exposure to leukemia or irradiation-based conditioning was identified as a risk factor for vascular complications and endotheliopathy.

Background The immune system matures throughout childhood; therefore, evidence about the safety and efficacy of vaccines for the prevention of COVID-19 in the paediatric population is important. Efficacy and safety have not been established for COVID-19 vaccines in a large part of the paediatric population at the time of the initial approval for use in adults. This study aims to provide an overview of planned and ongoing paediatric clinical trials investigating the safety and/or efficacy of COVID-19. Methods We identified all paediatric clinical trials investigating the safety and/or efficacy of COVID-19 vaccines in clinicaltrials.gov and clinicaltrialregister.eu, as well as all clinical trials planned in agreed PIPs (Paediatric Investigational Plans) as of 11 June 2021. Information about the study design, the paediatric age groups that they included, and the primary and secondary safety and efficacy outcomes were collected, together with expected timelines for the studies. Results 21 clinical trials were identified through the clinical trial registries and 19 clinical trials were specified in 6 agreed PIPs, 5 of these trials were also in the trial registers. All PIPs stipulated development of the COVID-19 vaccines for the full paediatric population, with a deferral. The earliest expected completion date of a PIPs is March 2024. The majority (14/21) of registered trials are randomised double-blinded studies. All investigated safety, 20 have a surrogate efficacy outcome (immunogenicity), of these 7 also measure clinical efficacy (COVID-19 infections). 18 studies were initiated, of these, all but one is still ongoing and one in adolescents has been finalised. Conclusion Even though several trials have been planned in agreed PIPs, the registered paediatric clinical trials identified are most often not part of a PIP.

Background Children and youth growing up in contexts characterized by political violence are at high risk of developing mental health impairments. In recent years, a growing interest has been directed to the study of children’s well-being after being exposed to political violence in order to develop interventions aimed at preserving and enhancing it. Objective This study provides a synthetic overview of studies that have explored or implemented interventions aimed at improving well-being and life satisfaction in conflict-affected children. Methods We identified peer-reviewed studies relating to children’s well-being in conflict-affected environments through a narrative literature review. An ecological framework was used to organize the studies in relation to the individual, family, social and community factors playing a role in promoting and preserving participants’ well-being. Implications for practices, policies and research were summarized to highlight areas in which they need strengthening. Results Of 1221 unique studies returned from online searches of the literature, 70 qualified for full review, with a total of 22 peer-reviewed studies included in the final synthesis. Results indicate a range of domains and dimensions that mutually interact to either enhance or diminish children’s well-being and life satisfaction. Four studies explicitly focused on assessing the effectiveness of interventions aimed at promoting and assessing children’s well-being and health. Conclusions Researchers were able to identify several dimensions that were contributing to the children’s well-being in situations of significant adversity. The concept of well-being emerged as a combination of personal resources and supportive contexts—such as family, peers, and community—that vary over time or across contexts. Well-being and life satisfaction in children living in contexts of political violence: a narrative literature review.

A modified Fontan procedure is performed to palliate single ventricle malformations. This hemodynamic arrangement sets systemic venous pressure unphysiologically high which predisposes the patient to severe long-term complications. As a means of self-care, exercise may ease transpulmonary flow. We investigated the effects of 6-month exercise prescription on pediatric Fontan patients. Eighteen stable Fontan patients (14 ± 2.6 years, 160.4 ± 11.3 cm, and 51.4 ± 14.4 kg) were recruited. Baseline fitness was assessed by physical activity questionnaire, body composition, cardiorespiratory performance, and muscle fitness tests. Exercise prescription was individually tailored for a 6-month training period at home. At entrance to the study, Fontan patients had lower than normal maximal oxygen uptake (VO2max) of 28. ± 5.9 ml/kg/min (61 ± 11% of normal). VO2max significantly correlated with weekly amount of habitual exercise and muscle mass of the lower limbs (p p = 0.007, and workload tolerance of 119 ± 39 vs 132.4 ± 44 W, p = 0.001. At EUROFIT tests, the patient muscle fitness was below age-matched reference, but correlations existed between VO2max and lower limb muscle tests. Our patients with Fontan hemodynamics were able to positively respond to an exercise program by enhancing submaximal performance which should be beneficial for getting through daily activities. Future studies should correlate whether hemodynamic findings at Fontan completion influence physical activity and exercise reserves, and whether these predict predisposition to chronic complications.

This study examines changes in labor supply, income, and time allocation during the COVID-19 pandemic in Mexico. Using an event-study design, we show that the COVID-19 recession had severe negative consequences for Mexican households. In the first month of the pandemic, employment declined by 17 percentage points. Men recovered their employment faster than women, where men’s employment approaches original levels by 2021Q2. Women, on the other hand, experienced persistent employment losses. Within-household, men also increased their time spent on household chores while neither gender (persistently) increased their time caring for others. Instead, children reduced their time spent on schoolwork by 25%.

The Secretary General of the United Nations described the impact of COVID-19-related school closures as a “generational catastrophe.” What will be the legacy of the 2020–2021 pandemic-related disruptions in 5, 10, 20 years from now, as regards education and well-being of children and youth? Addressing the disproportionate impact on those growing up in socio-economically disadvantaged areas or on those with pre-existing learning challenges is key to sustainable recovery. This commentary builds on the four literature reviews presented in this Special Section on a Pandemic Recovery Plan for Children and proposes strategies to understand and attenuate the impact of pandemic-related lockdown measures. Importantly, we need a monitoring strategy to assess indicators of child development in three areas of functioning: education and learning, health, and well-being (or mental health). Surveillance needs to begin in the critical prenatal period (with prenatal care to expectant parents), and extend to the end of formal high school/college education. Based on child development indicators, a stepped strategy for intervention, ranging from all-encompassing population-based health and education promotion initiatives to targeted prevention programs and targeted remedial/therapeutic interventions, can be offered. As proposed in the UN plan for recovery, ensuring healthy present and future generations involves a concerted and intensive intersectoral effort from the education, health, psychosocial services, and scientific communities., Selon les Nations Unis, les perturbations scolaires associées à la pandémie de COVID-19 pourraient mener à une « catastrophe générationnelle » en gaspillant un potentiel humain incalculable, sapant des décennies de progrès et exacerbant des inégalités bien ancrées. Le déploiement du vaccin chez les moins de 12 ans n’a pas débuté avant la rentrée scolaire 2021, ce qui laisse présager de nombreuses perturbations pour cette 3e année scolaire pandémique. Quel sera le legs des perturbations entrainées par la pandémie de COVID-19 en matière d’éducation et de bien-être dans 5, 10, ou 20 ans? Une relance durable dépendra des mesures prises pour prévenir l’impact négatif disproportionné sur les enfants/adolescents de milieux socioéconomiques défavorisés et ceux qui ont des défis d’apprentissage préexistants. Ce commentaire propose des stratégies pour comprendre et atténuer l’impact des perturbations pandémiques en se fondant sur les quatre articles de la présente « Section spéciale sur un plan de relance pour les enfants suite à la pandémie ». Trois lignes d’action prioritaires émergent à la lumière des connaissances scientifiques actuelles. Premièrement, le contexte pandémique met en évidence la nécessité d’accéder à données intersectorielles (éducation, santé, services psychosociaux) permettant de distinguer les conséquences à court et à long terme. Deuxièmement, il faut être prêt à déployer une stratégie interventionnelle par étape, avec des interventions universelles en promotion, jusqu’aux interventions plus ciblées et intensives. Troisièmement, il faudra mettre en place des programmes particuliers pour les enfants/adolescents de milieux défavorisés et pour ceux qui présentent des facteurs de risque personnels (défis de santé mentale, retards d’apprentissage). À titre d’exemple, le tutorat scolaire devrait être facilement accessible dans tous les milieux défavorisés. Tel que proposé dans le plan de relance de l’ONU, un effort concerté, intensif et intersectoriel de la part des sciences de l’éducation, de la santé, et des services psychosociaux sera nécessaire pour assurer la santé et l’éducation des générations présentes et futures.

Programmed Cell Death-1 (PD-1) together with Programmed Death Ligand 1 (PDL-1) have crucial roles in anti-tumor immune response, cancer susceptibility and prognosis. Since PD-1 and PDL-1 have been considered as important genetic risk factors in cancer development and their functions can be affected by polymorphic sites, we investigated the effects of PD-1 rs2227981, rs2227982, rs36084323 and PDL-1 rs2282055, rs822336 gene polymorphisms on colorectal cancer (CRC) risk and prognosis in Turkish subjects.Our study group consisted of 5-FU or Capacitabine prescribed CRC diagnosed patients and healthy controls. Genotype analyses of PD1 and PDL-1 polymorphisms were performed with Agena MassARRAY platform. rs36084323 CT genotype frequency was found to be higher in controls compared to cases (p 0.001). rs36084323 CT genotype was highly associated with reduced CRC risk compared to CC genotype (OR 0.068, 95% CI 0.022-0.211, p 0.001). In adjusted analysis, rs2282055 GG genotype was found to be associated with reduced CRC risk (OR 0.271, 95% CI 0.078-0.940, p = 0.040). rs2282055 TT genotype was found to be related to longer progression-free (Bonferroni corrected Log rank p = 0.013) and overall survival (Bonferroni corrected Log rank p = 0.009) to that of GG genotypes. Patients with rs822336 GC+CC genotypes showed longer overall survival times compared to GG (Log rank p = 0.044).According to our results, PD-1 rs822336 G C polymorphism might be useful in predicting CRC prognosis. PDL-1 rs2282055 T G polymorphism might be useful in predicting both CRC risk and prognosis. Further studies should be conducted in larger and different populations to clear the roles of PD-1 and PDL-1 polymorphisms in CRC risk and prognosis.

Zinc has potent immunoregulatory and antiviral effects that are critical for growth, immunity, and neurologic development. The aim of this study was to determine the clinical significance of serum zinc levels in pediatric patients with COVID-19 and to demonstrate its association with disease severity. This prospective observational study was conducted between August 3 and November 15, 2020, in pediatric patients aged 1 month to 18 years with confirmed COVID-19 using reverse transcription-polymerase chain reaction. We defined a control group whose serum zinc levels were determined 1 year ago at the same time as those of patients with COVID-19. We used 70 μg/dL as the cut-off zinc value to define zinc deficiency. Statistical analyses were performed using the SPSS for Windows statistics package program. One hundred children with confirmed COVID-19 and 269 children in the control group participated in the study. The median age was 13.3 (IQR: 8–15.4) years in patients with confirmed COVID-19, 11 patients had low serum zinc levels, and 89 patients had normal serum zinc levels. Patients in the group with low zinc levels had a significantly higher hospitalization rate than the group with normal zinc levels (5 (45.5%) and 10 patients (11.2%), respectively) (p = 0.011). The median serum zinc level in patients with COVID-19 was 88.5 mcg/dL (IQR 77.2–100), which was significantly lower than the median level in the control group, which was 98 mcg/dL (IQR 84–111) (p = 0.001). There was no association between the severity of COVID-19 and the serum zinc levels of the children. Conclusion: Serum zinc levels may be influenced by many factors such as fasting status, diurnal variation, exercise, and sex, and may give an impression of the zinc status of the population rather than reflecting the individual. The fact that the incidence of hospitalization was significantly higher in patients with both COVID-19 and low serum zinc levels suggests that these patients require a detailed assessment of their living environment.What is Known:• Serum zinc levels have been found to be low in adult patients diagnosed with COVID-19.• There was a correlation between the severity of COVID-19 and serum zinc levels in adults.What is New:• Children with low serum zinc levels were found to have a higher number of hospitalizations.• No association was found between the severity of COVID-19 disease and serum zinc levels in children.

Asthma is the most common chronic disease of childhood worldwide, and is responsible for significant morbidity and mortality in children and young people (CYP). Given the inherent dangers of a child experiencing even a single asthma attack, it is essential to identify and manage modifiable risk factors at every clinical opportunity. Following an attack, there is an opportunity to prevent future attacks by assessing compliance and optimizing asthma control. Careful questioning will allow physicians to identify asthma triggers, barriers to good asthma control, and health beliefs or socioeconomic obstacles that may have contributed to this attack. The vast majority of children with asthma can achieve good symptom control with appropriate use of low-dose inhaled corticosteroids. Supplementary Information The online version contains supplementary material available at 10.1007/s12098-021-04069-w.

COVID-19 has been reported to have caused more than 286 million cases and 5.4 million deaths till date. COVID variants have appeared at regular intervals—alpha, beta, gamma, delta and now omicron. ‘Omicron’ is driving the current surge of cases in most countries including India and is poised to replace ‘delta’ the world over. This variant with more than 50 mutations is phylogenetically very different from other variants. The omicron variant spreads rapidly with an average doubling time of two days. The disease so far has been mild as compared with delta. Though previous infection and vaccination offer little or no protection against infection with omicron, they do seem to partially protect against hospitalization and severe disease. Booster vaccinations have not made any notable impact on the spread of omicron and have further worsened global vaccine equity. The indirect consequences of omicron from lockdowns, restrictions, travel bans, economic losses, health care worker infections and overwhelming of health care facilities are likely to be enormous. The direct effects of omicron on children are expected to be mild like with the previous variants. However, the indirect effects on child mental, physical, and social health may be considerable owing to school closures, missed vaccinations, neglect of other diseases, etc. It is, therefore, imperative that governments take rational decisions to navigate the world through this latest crisis.

Behavioral teacher training is an effective intervention for children with attention-deficit/hyperactivity disorder (ADHD). Intervention effectiveness may be enhanced by including intervention components that carry the strongest evidence for their effectiveness. A previous article of this group showed that both antecedent- (i.e., stimulus-control) and consequent-based (i.e., contingency management) techniques were highly effective in reducing daily teacher-rated, individually selected problem behaviors in a specific situation of the child. Effects were observed up to three months post intervention. Here, we tested whether effects were also present in teacher-rated and masked DSM-based assessments that comprise the full range of ADHD and oppositional defiant disorder (ODD) symptoms, as well as on teacher-rated impairment. Teachers of 90 children with (subthreshold) ADHD (6-12 years) were randomly assigned to one of three conditions: a short (two sessions), individualized intervention consisting of either a) antecedent-based techniques or b) consequent-based techniques; or c) waitlist. Multilevel analyses showed that both sets of techniques were effective in reducing teacher-rated ADHD symptoms and impairment immediately after the intervention and up to three months later, as compared to waitlist. Masked observations of ADHD behavior were in line with teacher ratings, with effects being most pronounced for inattention. No effects on teacher-rated or masked ODD behavior were found. This study showed that antecedent- and consequent-based techniques were effective in improving classroom ADHD symptoms and impairment. Long-term changes in teacher-rated ADHD are promising. These results extend previous findings and show the potential of short individually tailored interventions in classroom settings as treatment of ADHD symptoms. ispartof: Research on Child and Adolescent Psychopathology vol:50 issue:7 pages:1-14 ispartof: location:United States status: Published online

Psychopathy; Fear conditioning; Children Psicopatía; Condicionamiento del miedo; Niños Psicopatia; Condicionament de la por; Nens Deficits in fear conditioning related to psychopathy have been widely studied in adults. However, evidence in children and adolescents is scarce and inconsistent. This research aimed to expand knowledge about fear conditioning in psychopathy and its dimensions in child and early adolescent clinical populations. Participants were 45 boys (outpatients) aged 6–14 years (M = 10.59, SD = 2.04). They were assessed with the parents’ and teachers’ versions of the Child Problematic Traits Inventory (CPTI). A fear conditioning paradigm (Neumann et al., in Biological Psychology, 79(3), 337–342, 2008) for children and adolescents was used. Conditioned stimuli (CS+ and CS-) were geometric shapes and the unconditioned stimulus (US) was an unpleasant sound of metal scraping on slate (83 dB). Difference scores (CS+ minus CS-) in skin conductance responses (SCR) and self-reported cognitive and affective measures were considered as indices of fear conditioning. Results showed that: a) deficits in fear conditioning were related to some psychopathy dimensions but not to psychopathy as a unitary construct; b) the Impulsivity-Need for Stimulation dimension was a predictor of impaired fear conditioning at a cognitive level; c) the interaction of Callous-Unemotional and Impulsivity-Need for Stimulation dimensions was a significant predictor of impaired electrodermal fear conditioning; d) by contrast, the Grandiose-Deceitful dimension, was marginally associated with a greater electrodermal fear conditioning. In conclusion, psychopathy dimensions and their interactions, but not psychopathy as a whole, predicted deficits in fear conditioning as measured by SCR and cognitive indices. These findings confirm the notion that psychopathic traits are associated with deficits in fear conditioning in child and adolescent clinical populations and provide support for a multidimensional approach to youth psychopathy. Open Access Funding provided by Universitat Autonoma de Barcelona. This research was financially supported by the Ministerio de Economía y Competitividad, Spanish Government (MINECO/FEDER, UE), reference: PSI2015-67441-R and by the AGAUR, Generalitat de Catalunya (2017 SGR1586). A.I. is recipient of a Ph.D. fellowship by the Secretaria d’Universitats i Recerca of Generalitat de Catalunya and European Social Fund (FI-DGR 2017).

Background Venous thromboembolism is a rare, serious complication of idiopathic nephrotic syndrome (INS) in childhood. The mechanisms responsible for the hypercoagulable state in the acute phase of INS are poorly understood, however. This study aimed to assess overall coagulation and fibrinolytic function in pediatric patients with INS. Methods Global coagulation and fibrinolysis were examined in whole blood samples from 22 children with initial onset INS (initial-group), 22 children with relapsed INS (relapse-group), and 15 control pediatric patients using rotational thromboelastometry (ROTEM®). In the initial-group, blood samples were obtained before (week 0) and 1–4 weeks after initiation of corticosteroid therapy. EXTEM and FIBTEM were used to assess coagulation and fibrinolysis, respectively. Clot time (CT), clot formation time (CFT), maximum clot firmness (MCF), and α-angle were determined as coagulation parameters, and lysis index at 30 and 60 min (LI30 and LI60, respectively) were assessed as fibrinolytic parameters. Results CT was significantly shortened, and MCF and α-angle were significantly greater than controls at week 0 and week 1 both in the initial-group and the relapse-group. MCF correlated with serum albumin (r = 0.70, p

Background Malaria deaths among children have been declining worldwide during the last two decades. Despite preventive, epidemiologic and therapy-development work, mortality rate decline has stagnated in western Kenya resulting in persistently high child malaria morbidity and mortality. The aim of this study was to identify public health determinants influencing the high burden of malaria deaths among children in this region. Methods A total of 221,929 children, 111,488 females and 110,441 males, under the age of 5 years were enrolled in the Kenya Medical Research Institute/Center for Disease Control Health and Demographic Surveillance System (KEMRI/CDC HDSS) study area in Siaya County during the period 2003–2013. Cause of death was determined by use of verbal autopsy. Age-specific mortality rates were computed, and cox proportional hazard regression was used to model time to malaria death controlling for the socio-demographic factors. A variety of demographic, social and epidemiologic factors were examined. Results In total 8,696 (3.9%) children died during the study period. Malaria was the most prevalent cause of death and constituted 33.2% of all causes of death, followed by acute respiratory infections (26.7%) and HIV/AIDS related deaths (18.6%). There was a marked decrease in overall mortality rate from 2003 to 2013, except for a spike in the rates in 2008. The hazard of death differed between age groups with the youngest having the highest hazard of death HR 6.07 (95% CI 5.10–7.22). Overall, the risk attenuated with age and mortality risks were limited beyond 4 years of age. Longer distance to healthcare HR of 1.44 (95% CI 1.29–1.60), l ow maternal education HR 3.91 (95% CI 1.86–8.22), and low socioeconomic status HR 1.44 (95% CI 1.26–1.64) were all significantly associated with increased hazard of malaria death among children. Conclusions While child mortality due to malaria in the study area in Western Kenya, has been decreasing, a final step toward significant risk reduction is yet to be accomplished. This study highlights residual proximal determinants of risk which can further inform preventive actions.

Background: COVID-19 has challenged the under-resourced health systems of low- and middle-income countries, significantly affecting child health. Available published data on Filipino children with COVID-19 infection are limited. This study aims to describe the epidemiological and clinical characteristics of pediatric patients with confirmed COVID-19 in an infectious disease hospital in Manila, Philippines. Main text: This cross-sectional study reviewed data on patients ages 0 to 18 years with confirmed COVID-19 infection, admitted to San Lazaro Hospital from January 25, 2020 to January 25, 2022. Demographic data and clinical characteristics obtained from COVID-19 case investigation forms were summarized and compared between severe and non-severe cases. Risk factors for disease severity and mortality were analyzed. Of 115 patients, 64% were males. There were 87 patients (75.7%) with asymptomatic, mild, or moderate disease, and 28 cases (24.3%) with severe or critical illness. The median age of all patients was 10 years (interquartile range: 4–15 years). The majority of patients (40.9%) were adolescents ages 13 to 18 years. Predominant symptoms were fever (73.9%) and cough (55.7%). Patients with severe or critical illness were more likely to experience difficulty of breathing (55.2% vs 44.8%, p < 0.001), and have a longer hospital stay (11 days vs 8 days, p = 0.043). Among all patients, 48.7% had at least one underlying disease; and common infectious co-morbidities were tuberculosis (17.4%), dengue (12.2%), and HIV (4.3%). Having tuberculosis (p = 0.008) or at least one co-morbidity (p < 0.001) was associated with disease severity. Ten patients (8.7%) died; and mortality was higher among those with severe or critical illness (80% vs 20%, p < 0.001). Sepsis (p = 0.020) or having at least one co-morbidity (p = 0.007) was associated with death. Conclusion: Children of all ages remain susceptible to COVID-19 infection, and usually present with mild or moderate symptoms. In this study, many adolescents are affected, highlighting the value of COVID-19 vaccination in this age group. Understanding the clinical features of COVID-19 in Filipino children is essential to identifying and optimally managing those at highest risk of severe disease., Tropical Medicine and Health, 51(1), art. no. 9; 2023

Purpose We evaluated the host-response marker score “BV” and its components TRAIL, IP-10, and CRP in SARS-CoV-2 positive children, and estimated the potential impact on clinical decision-making. Methods We prospectively analyzed levels of TRAIL, IP-10, CRP, and the BV score, in children with suspected COVID-19. Classification of infectious etiology was performed by an expert panel. We used a 5-point-questionnaire to evaluate the intention to treat with antibiotics before and after receiving test results. Results We screened 111 children, of whom 6 (5.4%) were positive for SARS-CoV-2. A total of 53 children were included for the exploratory analysis. Median age was 3.1 years (interquartile range [IQR] 1.3–4.3), and 54.7% (n = 29) were girls. A viral and a bacterial biomarker pattern was found in 27/53 (50.9%) and 15/53 (28.3%), respectively. BV scores differed between COVID-19, children with other viral infections, and children with bacterial infections (medians 29.5 vs. 9 vs. 66; p = 0.0006). Similarly, median TRAIL levels were different (65.5 vs. 110 vs. 78; p = 0.037). We found no differences in IP-10 levels (555 vs. 504 vs. 285; p = 0.22). We found a concordance between physicians’ “unlikely intention to treat” children with a viral test result in most cases (n = 19/24, 79.2%). When physicians expressed a “likely intention to treat” (n = 15), BV test revealed 5 bacterial, viral, and equivocal scores each. Antibiotics were withheld in three cases (20%). Overall, 27/42 (64%) of pediatricians appraised the BV test positively, and considered it helpful in clinical practice. Conclusion Host-response based categorization of infectious diseases might help to overcome diagnostic uncertainty, support clinical decision-making and reduce unnecessary antibiotic treatment.

BackgroundPrevious studies have indicated a need for increased psychosocial focus on children and their families to improve children’s wellbeing and mental health. Child developmental assessments could be a place to implement changes to achieve this. A standardised record might be helpful to clinicians trying to increase psychosocial focus. The aim of this study is to investigate clinical barriers and facilitators when introducing standardised child records with increased focus on psychosocial wellbeing and mental health into child developmental assessments.MethodsThis is a qualitative study based on 12 semi-structured interviews with four midwives and nine doctors who carry out child developmental assessments in general practice. Data is analysed in the framework of Normalisation Process Theory.ResultsGeneral practice-based clinicians were positive towards increasing the psychosocial focus in child developmental assessments. The main barriers when clinicians used the standardised child records were: feeling forced to ask certain questions, in turn making the conversation rigid; leaving less room for parents to bring up other issues; making clinicians feel awkward when addressing problems that they cannot solve; the need for extended consultation time; and medico-legal concerns when registering findings. The experience of positive aspects when using the standardised child records facilitated continuous use of the records. Positive aspects included having a standardised approach to recording important findings, thereby uncovering psychosocial problems that could potentially be overlooked. Additionally, structured observation of parent–child interaction and gaining a new vocabulary to describe the findings were valued by clinicians. Balancing a standardised approach with clinicians’ ability to steer the consultation and explore topics in depth while preserving the potential for patients to bring up other issues became an important theme.ConclusionClinicians need to be well-equipped to handle psychosocial problems through coping strategies, referral options and communication techniques in the psychosocial domain. The parent–child-interaction assessment might expose potentially dysfunctional parenting behaviours and could improve communication between health professionals. Implementing standardised child development records with an increased psychosocial focus is feasible but improvements could optimise the use of the records. Parental views on an increased psychosocial focus during child developmental assessments should be investigated prior to further implementation Background: Previous studies have indicated a need for increased psychosocial focus on children and their families to improve children’s wellbeing and mental health. Child developmental assessments could be a place to implement changes to achieve this. A standardised record might be helpful to clinicians trying to increase psychosocial focus. The aim of this study is to investigate clinical barriers and facilitators when introducing standardised child records with increased focus on psychosocial wellbeing and mental health into child developmental assessments. Methods: This is a qualitative study based on 12 semi-structured interviews with four midwives and nine doctors who carry out child developmental assessments in general practice. Data is analysed in the framework of Normalisation Process Theory. Results: General practice-based clinicians were positive towards increasing the psychosocial focus in child developmental assessments. The main barriers when clinicians used the standardised child records were: feeling forced to ask certain questions, in turn making the conversation rigid; leaving less room for parents to bring up other issues; making clinicians feel awkward when addressing problems that they cannot solve; the need for extended consultation time; and medico-legal concerns when registering findings. The experience of positive aspects when using the standardised child records facilitated continuous use of the records. Positive aspects included having a standardised approach to recording important findings, thereby uncovering psychosocial problems that could potentially be overlooked. Additionally, structured observation of parent–child interaction and gaining a new vocabulary to describe the findings were valued by clinicians. Balancing a standardised approach with clinicians’ ability to steer the consultation and explore topics in depth while preserving the potential for patients to bring up other issues became an important theme. Conclusion: Clinicians need to be well-equipped to handle psychosocial problems through coping strategies, referral options and communication techniques in the psychosocial domain. The parent–child-interaction assessment might expose potentially dysfunctional parenting behaviours and could improve communication between health professionals. Implementing standardised child development records with an increased psychosocial focus is feasible but improvements could optimise the use of the records. Parental views on an increased psychosocial focus during child developmental assessments should be investigated prior to further implementation. Trial registration: Trial registry number for the FamilieTrivsel (Family Wellbeing) trial: NCT04129359.

Background This systematic review and meta-analysis examined the effectiveness of orthoses for flexible flatfeet in terms of patient-reported outcomes in children and adults. Methods EMBASE, Medline (OvidSP), Web-of-Science, Scopus, CINAHL, Cochrane Central Register of Controlled Clinical Trials, i.e., Cochrane Central and Pubmed were searched to identify relevant studies since their inception up to February 2021. We included randomized controlled trials (RCT) and prospective studies in which patient reported outcomes at baseline and follow-up in an orthoses group were compared with a no orthoses or sham sole group. Methodological quality of the studies was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I). A meta-analysis was performed where there were multiple studies with the same outcome measures, which was the case for the Visual Analogue Scale (VAS) for pain in adults. Results In total nine studies were included: four RCT in children (N = 353) and four RCT and one prospective study in adults (N = 268) were included. There was considerable heterogeneity between studies. A meta-analysis demonstrated that pain reduction between baseline and follow-up was significantly larger in the orthoses (N = 167) than in the control groups in adults (N = 157; − 4.76, 95% CI [− 9.46, − 0.06], p0.05). Conclusion Due to heterogeneity in study designs, we cannot conclude that foot orthoses are useful for flexible flatfoot in children and adults. However, based on the meta-analysis orthoses might be useful in decreasing pain in adults. The authors did not receive support from any organization for the submitted work.