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Purpose: Children's rights must be realized in all children-related settings, such as hospitals. This study aimed to assess children's rights in hospital settings in Afghanistan in 2021., Design and Methods: A cross-sectional survey using the World Health Organization questionnaire was conducted. It was distributed among the randomly selected healthcare providers in the studied hospital. One hundred forty-two hospital managers, physicians, and nurses participated in the study. Descriptive and analytical statistics were used to analyze the results in SPSS., Results: In this study, 54.2% of participants were men, 59.9% had a bachelor's degree, and most were 20-30 years old (56.7%). The total score of the hospital in fulfilling children's rights was 1.71 ± 0.46. Among different children's rights, "equality and non-discrimination" received the highest score (2.01 ± 0.59), and the lowest was for "play and learning" (1.1 ± 0.46). There was a meaningful relationship between education level, years of work experience, and the scores given to children's rights. Various dimensions of the rights had significant relationships (p < 0.05)., Conclusion: The hospital has taken action to fulfill children's rights. The main gaps include the lack of adolescent-friendly health services, opportunities to play and learn, and child protection. Hospital managers, staff, and the public should be educated on children's rights. Moreover, protocols for improving children's rights and a monitoring system are needed., Practical Implications: Children's rights should receive special attention in hospitals. Educating children, parents, service providers, health policymakers, and society about children's rights is essential. They should know their responsibilities regarding children., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Human challenge studies, in which human research subjects are intentionally exposed to pathogens to contribute to scientific knowledge, raise many ethical complexities. One controversial question is whether it is ethically permissible to include children as participants. Commentary of the past decades endorses the exclusion of children, while new guidance suggests that pediatric human challenge studies can be ethically permissible. This paper argues that neither children's exclusion nor their inclusion are well justified. I examine and reject three arguments for exclusion, but suggest that these arguments establish pediatric human challenge studies as a complex ethical category of research that requires caution. I then argue for a strong presumption against children's inclusion, by drawing on an analogy to children's inclusion in phase I trials, emphasizing a requirement of necessity, and suggesting that accommodating children's vulnerability promotes an age de-escalation approach for pediatric human challenge studies research. In the final section, I suggest a procedure for ethics review., (© 2024 The Authors. Ethics & Human Research published by Wiley Periodicals LLC on behalf of The Hastings Center.)

Background: Enrolling children in clinical trials typically requires parental or guardian permission and, when appropriate, child assent. Aligning requirements across jurisdictions would facilitate multisite pediatric trials. Guidance from the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) is the best candidate for a global standard but would benefit from additional specification., Methods: Ethical analysis of ICH guidance for permission and assent for pediatric trials, with recommendations for clarification., Results: ICH guidance regarding permission and assent would be enhanced by additional detail in the following areas: (1) what information should be provided to parents, guardians, and children considering a trial, and how that information should be provided; (2) the definition of "assent," the criteria for when assent should be required, and the need to include children in discussions even when assent is not mandated; (3) criteria for requiring children's signatures indicating agreement; (4) greater specificity regarding children's right to decline or withdraw; and (5) clarification of when children's wish to decline or withdraw from participation may be overridden and of what the overriding process should entail., Conclusion: ICH guidance provides a global standard for decision making regarding children's participation in trials. Several clarifications would facilitate the conduct of multinational pediatric research., Impact: Enrolling children in clinical trials requires the permission of a parent/guardian ± the assent of the minor. Differing global regulatory requirements for enrolling children complicate the conduct of multicenter and multinational trials. The authors identify points of ambiguity and/or contradiction in the International Council for Harmonization guidelines and offer recommendations for a common ethical platform for conducting global pediatric research., (© 2023. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Competing Interests: Competing interests: none declared

There is a current outbreak of coronavirus disease 2019 (COVID-19), with a global spread. With the rapid increase in the number of infections, an increase is observed in the number of children with COVID-19. Most research findings are regarding adult cases, which are not always transferrable to children. Evidence-based studies are still expected to formulate clinical decisions for pediatric patients. In this review, we included 2597 pediatric patients that reported recently and evaluated the demographic, clinical, laboratory, and imaging features of children with COVID-19. We found that even lymphopenia was the most common lab finding in adults; it infrequently occurred in children (9.8%). Moreover, elevated creatine kinase MB isoenzyme was much more commonly observed in children (27.0%) than that in adults, suggesting that heart injury would be more likely to occur in pediatric patients. Our analysis may contribute to determine the spectrum of disease in children and to develop strategies to control the disease transmission., (© 2020 Wiley Periodicals LLC.)

This essay reflects on arguments by Paul Ramsey, in The Patient as Person: Explorations in Medical Ethics (1970) and elsewhere, that continue to challenge policy-makers and those doing clinical and translational research involving children. Ramsey argued that parents cannot morally authorize their child's participation in research unless the research is designed to benefit the child. He acknowledged that abiding by this position could have adverse impacts on improving child health, and he concluded, in a 1976 Hastings Center Report piece, that researchers must "sin bravely." Many philosophers and theologians, including Richard McCormick, have argued against Ramsey. The Ramsey-McCormick debate played out in the bioethics literature and, by invitation, at the deliberations of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, which was tasked with developing an ethics framework and policies for human subjects protections. Although in its final recommendations, the commission sided with McCormick, the strict limitations on risks and harms to which a child can be exposed were clearly influenced by Ramsey., (© 2020 The Hastings Center.)

Despite reports that over 1.3 million school-age children (ages 5-18) were homeless in 2019, little is known about the effects of homelessness on their overall health and well-being. To better understand where gaps exist, a scoping review of the literature was conducted to identify studies of the physical, mental, and behavioral health risks and outcomes of school-age children experiencing homelessness or housing instability. Following the Joanna Briggs Institute framework and Preferred Reporting Items (PRISMA) guidelines, seven electronic databases were searched using key words: homelessness, children, health, and well-being. Of the 4,372 records, 23 articles met inclusion criteria. Most examined mental health and high-risk activities or behavioral risks related to school achievement. Few studies tracked the long-term health outcomes of homeless school-age children. Findings have implications for school nurses who have contact with children experiencing homelessness and are in position to intervene to prevent negative health sequelae in this vulnerable population.

In total, 74 pediatric oncology patients with hematologic malignancies (n=56) or solid tumors (n=18) and a median age of 78.5 months were included in this prospective study. The aims were to assess malnutrition risks and nutritional status over a 6-month treatment period measured at regular intervals. The rate of patients with high risk for malnutrition at diagnosis was 28.4% by Screening Tool for Risk of Impaired Nutritional Status and Growth tool and 36.5% by Pediatric Yorkhill Malnutrition Score. Body mass index (BMI) z-scores at diagnosis showed 12.3% undernutrition (<-2 SD) and 6.8% overnutrition (>2 SD), which changed to 6.7% and 11.1% at the sixth month, respectively. Malnutrition (BMI<5th age percentile) was detected in 13.7% at diagnosis. Despite an initial deterioration noted in BMI, BMI for age percentile, and z-scores at month 1 in all malignancy subgroups (at month 3 for acute lymphoblastic leukemia), the scores improved later on. There was an increase in weight from baseline in 88.2% of patients over 6 months. This study revealed a decrease in the prevalence of undernutrition and malnutrition over a 6-month treatment period with improved anthropometrics despite an initial deterioration in all malignancy subgroups and even in patients with high risk for malnutrition at baseline screening. Solid tumors and acute lymphoblastic leukemia seem to be associated with higher likelihood of undernutrition and overnutrition, respectively, during treatment.

Objective: To systematically synthesise qualitative research that explores children's and caregivers' perceptions of mandatory reporting., Design: We conducted a meta-synthesis of qualitative studies., Data Sources: Searches were conducted in Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Criminal Justice Abstracts, Education Resources Information Center, Sociological Abstracts and Cochrane Libraries., Eligibility Criteria: English-language, primary, qualitative studies that investigated children's or caregivers' perceptions of reporting child maltreatment were included. All healthcare and social service settings implicated by mandatory reporting laws were included., Data Extraction and Synthesis: Critical appraisal of included studies involved a modified checklist from the Critical Appraisal Skills Programme (CASP). Two independent reviewers extracted data, including direct quotations from children and caregivers (first-order constructs) and interpretations by study authors (second-order constructs). Third-order constructs (the findings of this meta-synthesis) involved synthesising second-order constructs that addressed strategies to improve the mandatory reporting processes for children or caregivers-especially when these themes addressed concerns raised by children or caregivers in relation to the reporting process., Results: Over 7935 citations were retrieved and 35 articles were included in this meta-synthesis. The studies represent the views of 821 caregivers, 50 adults with histories of child maltreatment and 28 children. Findings suggest that children and caregivers fear being reported, as well as the responses to reports. Children and caregivers identified a need for improvement in communication from healthcare providers about mandatory reporting, offering preliminary insight into child-driven and caregiver-driven strategies to mitigate potential harms associated with reporting processes., Conclusion: Research on strategies to mitigate potential harms linked to mandatory reporting is urgently needed, as is research that explores children's experiences with this process., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Melanoma, the deadliest form of skin cancer, is the second most common cancer diagnosed before age 30. Little is known about potentially modifiable or intervenable risk factors specific to developing melanoma at a young age. The objective was to determine if high birth weight or higher early-life ultraviolet (UV) radiation exposure would be associated with increased risk of melanoma in young patients., Methods: Population-based, case-control study of 1,396 cases of melanoma diagnosed before age 30 in 1988-2013 and 27,920 controls, obtained by linking cancer registry data to birth records in California., Results: High birth weight (>4,000 g) was associated with 19% higher risk of melanoma (OR = 1.19; 95% CI = 1.02, 1.39), while low birth weight (<2,500 g) was associated with 41% lower risk (OR = 0.59; 95% CI = 0.43, 0.82), compared with normal birth weight (2,500-4,000 g); dose-response per 1,000 g increase was also evident (OR = 1.24; 95% CI = 1.13, 1.36). All quartiles of birthplace UV greater than the lowest quartile were associated with increased melanoma risk. The strongest relation between birthplace UV and melanoma was for 15-19 years of age at diagnosis., Conclusions: High birth weight and high early-life UV exposure may be important independent risk factors for melanoma diagnosis before age 30. The implication is that adopting skin-protective behaviors as early as infancy could be important for primary prevention of melanoma in younger people. However, research that accounts for early-life behavioral patterns of skin protection during infancy is needed to advance our understanding of how birth weight and early-life UV may influence the development of early-onset melanoma.

The Universal Declaration of Human Rights elaborated for children through the United Nations Convention on the Rights of the Child, mandates each child's right to participate in all matters affecting them. In particular, Article 19 includes the child's right to freedom of expression and opinion, access to information and communication choice. However, many barriers placed on children's daily lives often restrict or limit the enactment of children's participatory rights in practice, most noticeably in education. It is often the adult who decides what, when and how children can communicate, and the extent children's views and opinions are sought, considered or incorporated. This paper explores how children's daily lives are mediated in ways that restrict their expression, voice and communication rights. Children spend a significant proportion of their daily lives in education settings yet the restrictions on children's access to information and communication choices do not reflect contemporary pedagogical thinking. Many school settings perpetuate the key participation barriers of adult attitude and knowledge, pedagogical tradition, organisational structure and technological advancement. Such barriers to engagement stifle the realisation of the child's communication rights that then limits educational enhancement. Supporting children's right to communicate via a range of media enables pedagogy supporting voice-inclusive practice.

Objective: Presentation of a rare finding non-Hodgkin´s B-lymphoma of the ovary in a patient during caesarean section., Design: Case report., Settings: Department of Obstetrics and Gynaecology, Regional Hospital Liberec, a.s.; First Internal Clinic - Clinic of Hematology, First Faculty of Medicine and General University Hospital, Charles University in Prague; Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University in Praque and Motol University Hospital., Results: Pregnant woman, 31-years old, primiparous, with a history of caesarean section was examinated in our department due to nonspecific abdominal pain during her pregnancy. During the caesarean section of fetal indication we found bilateral ovarian tumours. We performed unilateral adnexectomy. Preliminary diagnosis from frozen section was thecoma, but final diagnosis (after definitive histology, imunohistochemistry and molecular investigation) was high-grade B-cell non-Hodgkin´s lymphoma with c-myc and bcl-6 gene rearrangement (double-hit lymphoma) resulting in an unfavourable prognosis. The patient consequently completed 6 cycles of chemotherapy with a biological treatment, and achieved a complete remission. However, after 6 months, an early generalisation to the CNS appeared, leading to intracranial hypertension refractory to anithypertensive and anti-oedematous therapy, consequently leading to death., Conclusion: Non-Hodgkin´s lymphoma of the ovary in pregnancy is a rare adnexal tumour whose treatment requires interdisciplinary cooperation.

Competing Interests: The authors have no competing interests to declare.

Children with autism spectrum disorders (ASD) often suffer gastrointestinal problems consistent with imbalances in the gut microbial population. Treatment with antibiotics or pro/prebiotics has been postulated to regulate microbiota and improve gut symptoms, but there is a lack of evidence for such approaches, especially for prebiotics. This study assessed the influence of a prebiotic galactooligosaccharide (B-GOS) on gut microbial ecology and metabolic function using faecal samples from autistic and non-autistic children in an in vitro gut model system. Bacteriology was analysed using flow cytometry combined with fluorescence in situ hybridization and metabolic activity by HPLC and 1 H-NMR. Consistent with previous studies, the microbiota of children with ASD contained a higher number of Clostridium spp. and a lower number of bifidobacteria compared with non-autistic children. B-GOS administration significantly increased bifidobacterial populations in each compartment of the models, both with autistic and non-autistic-derived samples, and lactobacilli in the final vessel of non-autistic models. In addition, changes in other bacterial population have been seen in particular for Clostridium, Rosburia, Bacteroides, Atopobium, Faecalibacterium prausnitzii, Sutterella spp. and Veillonellaceae. Furthermore, the addition of B-GOS to the models significantly altered short-chain fatty acid production in both groups, and increased ethanol and lactate in autistic children., (© FEMS 2016.)

The article analyzes the impact of a documentary on the daily lives of mothers and children with disabilities, exhibited at conferences, festivals, universities and schools in Brazil, Colombia and Japan. Produced by film and health professionals, social scientists and a women's network, the feature film "A special day" was awarded at Assim Vivemos VI International Disability Film Festival (2013-2014). The objective is to analyze the impact of the film and its diffusion among professionals and students from health and education areas. We adopted a methodology of cine debates that were recorded, transcribed and coded. The circuit toured 22 locations with one or more exhibitions for 3.370 people, of which nine presentations were analyzed. Our interpretations were guided by the notions as life account, biographical pact, imaginary and social representation. We analyzed gender issues, family and maternal care; reactions, adaptations and life after the diagnosis of disabilities; discrimination and prejudice; school and inclusion. The study showed that the communicative and expressive power of film becomes a powerful social technology to address gender, maternity and disability as an important and strategic issue for public health in the country.

In the imaginary of Italian people, the Island of Lampedusa (Italy) has always been considered a paradise destination for summer holidays. The beauty of this small island at the heart of the Mediterranean Sea, far from big harbors and cities, with its rich biodiversity and unspoilt nature, has made it a national and international tourist attraction. However, in recent years its name become associated with scenes of tragic, desperate journeys made by people of different origins trying to reach Europe from North African coasts. This shift exists not only in Italian people’s perception, but also all over the world, as the news related to Lampedusa and other Italian areas affected by this phenomenon often finds a place in major foreign newspapers. Even if migrants have been reaching Italian (and, more generally, South European) coasts for the last 20 years, the date of 3 October 2013 constitutes a significant turning point, as the shipwreck that occurred on this day lead to numerous deaths and the Italian coast guard has been accused of an unsuccessful, belated rescue of the people on the vessel. In recent months the number of people, especially unaccompanied children, arriving by boat has increased. Most of them are fleeing from wars and persecution, and even if they are aware of the risk of crossing the Mediterranean Sea, they still decide to try. The paper presents the results of an ethnographic research conducted with unaccompanied and separated children in Sicily, in order to point out their oral memories.

Unlabelled: The aim of the study was to evaluate the expression of EGFR and Bcl-2 proteins as inhibitory markers of apoptosis in surface epithelial cells and gland cells of antral gastric mucosa in children infected with Helicobacter pylori according to the severity and activity of antral gastritis and to assess the correlation between the number of cells expressing EGFR and the number of cells expressing Bcl-2 in H. pylori infected children., Materials and Methods: The study included 44 children: 68.2% with chronic gastritis and positive IgG against H. pylori, and 31.8% with functional disorders of the gastrointestinal tract and with normal IgG against H. pylori. The evaluation of EGFR expression in gastric mucosa was performed immunohistochemically using monoclonal mouse anti-EGFR antibody. The polyclonal antibody was used to determine the expression of anti-Bcl-2., Results: A significant increase in the number of cells expressing EGFR and Bcl-2 protein was found in the epithelial cells in severe as well as mild and moderate gastritis in the group of children infected with H. pylori. An increase in the number of cells expressing EGFR and Bcl-2 protein was also found in the epithelial cells in group I according to the activity of gastritis. There was a statistically significant positive correlation between the numbers of cells expressing EGFR and Bcl-2 in H. pylori infected children., Conclusion: Increased expression of EGFR and Bcl-2 proteins in the epithelial cells and a statistically significant positive correlation between the numbers of cells expressing EGFR and Bcl-2 in H. pylori infected children could suggest increased regeneration abilities of gastric mucosa.

Objective: This study aimed to investigate the value of child oral health for Chengdu parents, their intentions, and factors influencing their decision to acquire oral insurance coverage for their childrens., Methods: A total of 562 Chengdu parents were interviewed using questionnaires by convenient sampling, and the results were analyzed using SPSS 20.0., Results: The age of children (B = -1.741, P = 0.004), age of parents (B = 2.031, P = 0.003), level of oral discomfort (B = 0.569, P = 0.000), incurring/not incurring oral care expenses in the previous year (B = 1.897, P = 0.014), the last time parents' had teeth cleaned (B = 0.777, P = 0.006), and acquiring/not acquiring commercial insurance coverage (B = 1.632, P = 0.031) significantly influenced the intention of acquiring child oral insurance., Conclusion: Child oral health, health and insurance awareness of parents, and other factors influenced the intention of parents to purchase oral insurance coverage for their children, which were significant to establish pediatric dental insurance.

Objective: To define the profile of ocular and cervical vestibular-evoked myogenic potentials (oVEMPs and cVEMPs) in children with cochlear implant (CI), we studied air-conducted sound (ACS)-evoked responses pre- and postoperatively., Methods: The ACS-evoked oVEMPs and cVEMPs of 31 children with cochlear implantation were investigated. Thresholds, amplitudes, P1 and N1 latencies, and interpeak latencies of VEMPs were measured and analyzed., Results: Before CI, the response rates of oVEMPs and cVEMPs were 71.0% and 67.7%, respectively. The oVEMPs and cVEMPs on the operated side disappeared after CI, which resulted in a decrease in response rates, whether the device was switched on (12.9% and 32. 0%) or off (19.2% and 34.8%). In the case when VEMPs could be elicited on the operated side after CI, the parameters of waveforms showed abnormal changes, including threshold elevation (maximum of 8.34-dB SPL in oVEMP and 8.75-dB SPL in cVEMP) and amplitude decrease (maximum of 4.10μV in oVEMP and 191.82μV in cVEMP)., Conclusions: Disappearance and impairment of VEMPs could be observed after CI, and the waveforms of oVEMP and cVEMP could reflect the degree of damage to the utricle and saccule caused by CI and other related factors., Significance: The oVEMPs and cVEMPs prove to be accurate methods to evaluate vestibular function in children with CI., (Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Individuals often hold strict and erroneous expectations for how others should grieve, yet this issue has been sparsely researched. A total of 161 undergraduates rated the appropriateness of various social and emotional behaviours of a hypothetical bereaved individual as a function of the recency of the death (1 month or 1 year ago), the nature of the loss (death of a spouse or child) and the gender of the bereaved. As expected, subjects deemed it inappropriate to show positive emotions and experiences 1 month after a hypothetical death and more inappropriate to show negative reactions 1 year later and there were generally higher expectations of socially appropriate behaviour for those who lost a child rather than a spouse. Unexpectedly, there were no significant differences regarding the gender of the bereaved. This study is among the first to show experimentally the widespread expectation that grief should be experienced early and be short-lived., (© 2014 International Union of Psychological Science.)

As pre-registration nurse education programmes evolve within the United Kingdom, it is imperative to involve patient/client groups within the research process, as the outcome may invoke a change in the care delivery of the registered nurse (RN). This paper focuses upon children and how children might hypothetically contribute to informing a generic nursing programme in their capacity as a rights holder and expert in their own lives. Even though their contribution and value has been debated around their capacity as research advisor, research participant and co researcher, this paper explores how the child's view of their experience of hospital and of the good nurse could be best captured. Research is a powerful vehicle that can enable their voice to equally inform UK nurse educators and policy makers so that the child's health care needs are effectively met in hospital by RN's who complete a generic programme.

To clarify the neurological function of the puborectalis muscle (PM) in child patients with soiling after ileal J-pouch-anal anastomosis (IPAA) for ulcerative colitis (UC), we examined the terminal motor latency in the sacral nerves that regulate the PM. Eight patients after IPAA for UC were studied (6 males and 2 females aged 11 to 13 years with a mean age of 12.8 years). All patients 6 months after IPAA showed soiling (group A) and these patients showed continence at 2 years after IPAA (group B). Group C serving as controls consisted of 16 subjects (10 males and 6 females aged 12 to 17 years with a mean age of 14.4 years). Left- and right-sided sacral nerve terminal motor latency (SNTML) tests were performed at 6 months and 2 years after IPAA in order to measure the latency of the response in the bilateral PM following magnetic stimulation of sacral nerve root segments 2 to 4 (S2-S4) of the spinal column overlying the cauda equina. The following results were obtained. (1) Right-sided SNTML: group A exhibited significant prolongation compared with groups B and C (P < 0.0001 and P < 0.0001, respectively). There was no significant difference between groups B and C (P = 0.2329). (2) Left-sided SNTML: group A exhibited significant prolongation compared with groups B and C (P = 0.0002 and P < 0.0001, respectively). There was no significant difference between groups B and C (P = 0.2315). Note that significant differences were not established between SNTML values measured on the right and left sides. Soiling in child patients 6 months after IPAA may be caused by damage to the bilateral sacral nerves during the operation. However, the damage to the sacral motor nerve improves within 2 years after IPAA.

Nowadays, high altitude resorts have become popular destinations for family vacations. Based on a limited number of publications and international guidelines, this article summarizes the effects of high altitude on children and pregnant women. Children also suffer from high altitude-related diseases, however their presentation and clinical significance are different from their adult counterparts. Careful planning of the itinerary with respect to altitude of the overnight stays, access to medical services and potential evacuation routes is the cornerstone of a successful vacation.

When required to walk around a stationary object, adults use the location of the goal to set up their locomotor axis and obstacles presented along the locomotor axis will repel the individual towards the side that affords more space [1]. Research has yet to examine whether children can identify the locomotor axis and choose their paths accordingly. Therefore, the current study examined the factors that influence the direction in which children choose to deviate around a single obstacle and whether the presence or absence of a goal influences path selection and trajectory. Ten children (age: 7.1 years±0.8) walked along a 9 m path and avoided a single obstacle that was located in one of three locations (midline, 15 cm to the right or 15 cm to the left). On half the trials, an end-goal was visible from the start of the path while the other half of the trials had no visible goal. The results demonstrate that: (1) children are able to perceive and move towards more open space but are more variable when the end-goal is not visible; (2) children are capable of maintaining an elliptical-shaped protective envelope when avoiding a single obstacle regardless of whether or not the locomotor axis is established; and (3) although children are capable of choosing paths that afford the most space, the manner in which they arrive at their goal is not driven by factors similar to adults., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Unlabelled: Health benefits from children's independent mobility and active travel beyond school travel are largely unexplored., Objectives: This review synthesized the evidence for associations of independent mobility and active travel to various destinations with physical activity, sedentary behaviour and weight status., Design: Systematic review., Methods: A systematic search in six databases (PubMed, Scopus, CINAHL, SportDiscus, PsychInfo, TRIS) for papers published between January 1990 and March 2012 was undertaken, focussing on children aged 3-18 years. Study inclusion and methodological quality were independently assessed by two reviewers., Results: 52 studies were included. Most studies focussed solely on active travel to and/or from school, and showed significant positive associations with physical activity. The same relationship was detected for active travel to leisure-related places and independent mobility with physical activity. An inverse relationship between active travel to school and weight status was evident but findings were inconsistent. Few studies examined correlations between active travel to school and self-reported screen-time or objectively measured sedentary behaviour, and findings were unclear., Conclusions: Studies on independent mobility suggested that children who have the freedom to play outdoors and travel actively without adult supervision accumulate more physical activity than those who do not. Further investigation of children's active travel to leisure-related destinations, measurement of diverse sedentary behaviour beyond simply screen-based activities, and consistent thresholds for objectively measured sedentary behaviour in children will clarify the inconsistent evidence base on associations of active travel with sedentary behaviour and weight status., (Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objective: The objective of this research was to identify the risk factors for musculoskeletal disorders present when mothers lift normally developing children weighing between 20 and 31 lbs (9-14 kg) in the home., Method: Twenty five mothers aged 28-40 years completed Sanders and Morse's (2005) self-report survey of pain and high-risk practices. In addition, the OMLITH, a structured checklist for observing mothers lifting children in the home, was developed. Criteria to rate variables relating to the load (child), environment, person (mother) and task as low, moderate or high risk were developed, on the basis of published manual handling assessments. The mothers were observed performing 87 lifts, and risk factors were rated., Results: The majority of participants reported low back pain (64%). They self-rated bending while carrying a child as most stressful, and various other tasks involving carrying; prolonged bending, squatting or stooping; and lifting a child as physically stressful. At least one risk factor related to the load was recorded in all 87 observations, with moderate to high risk most frequently related to the child's weight (73.6%) or the mother's grip on the child (93.1%). Common environmental factors presenting a moderate to high risk related to space constraints (59.7% of tasks) and equipment (58.6%). Factors related to the mothers' strength and fitness (57.5% of tasks) commonly posed moderate to high risk, as did horizontal reach distances (82.8%), vertical lift distances (78.2%) and reaches above shoulder height or below mid thigh level (88.5%). Trunk rotation greater than 45° or combining rotation and side bending while lifting resulted in a moderate to high risk rating in 72.4% of tasks. The developmental age of the child interacted with weight to increase or decrease the requirement for lifting., Conclusion: Risk factors for musculoskeletal disorders are present to a significant degree, and further research in this area is warranted., (Copyright © 2012 John Wiley & Sons, Ltd.)

MEF2C haploinsufficiency syndrome is an emerging neurodevelopmental disorder associated with intellectual disability, autistic features, epilepsy, and abnormal movements. We report 16 new patients with MEF2C haploinsufficiency, including the oldest reported patient with MEF2C deletion at 5q14.3. We detail the neurobehavioral phenotype, epilepsy, and abnormal movements, and compare our subjects with those previously reported in the literature. We also investigate Mef2c expression in the developing mouse forebrain. A spectrum of neurofunctional deficits emerges, with hyperkinesis a consistent finding. Epilepsy varied from absent to severe, and included intractable myoclonic seizures and infantile spasms. Subjects with partial MEF2C deletion were statistically less likely to have epilepsy. Finally, we confirm that Mef2c is present both in dorsal primary neuroblasts and ventral gamma-aminobutyric acid(GABA)ergic interneurons in the forebrain of the developing mouse. Given interactions with several key neurodevelopmental genes such as ARX, FMR1, MECP2, and TBR1, it appears that MEF2C plays a role in several developmental stages of both dorsal and ventral neuronal cell types.

Children's time-location patterns are important determinants of environmental exposure and other health-relevant factors. Building on data of the German Environmental Survey for Children (GerES IV), our study aimed at deriving reference values and distributions for time-location patterns of 3-14-year-old German children. We also investigated if GerES IV data are appropriate for evaluating associations with children's health determinants by linking them to data of the National Health Interview and Examination Survey for Children and Adolescents (KiGGS). Parents reported on the time their children usually spend at home, in other indoor environments, and outdoors. This information was characterized by statistical parameters, which were also calculated for different strata concerning socio-demography and the residential environment. Consequently, group differences were evaluated by t-tests and univariate ANOVA. Reference distributions were fitted to the time-location data by a Maximum Likelihood approach to make them also useable in probabilistic exposure modeling. Finally, associations between data on the children's physical activity as well as body weight and their outdoor time were investigated by bivariate correlation analysis and cross tabulation. On daily average, German children spend 15 h and 31 min at home, 4 h and 46 min in other indoor environments, and 3 h and 43 min outdoors. Time spent at home and outdoors decreases with age while time spent in other indoor environments increases. Differences in time-location patterns were also observed for the socio-economic status (SES) and immigration status. E.g., children with a high SES spend 24 min less outdoors than low SES children. Immigrants spend on daily average 20 min more at home and 15 min less outdoors than non-immigrant children. Outdoor time was associated with parameters of the residential environment like the building development. Children living in 1- or 2-family houses spend more time outdoors than children living in building blocks (3 h 48 min vs. 3 h 29 min). Physical activity correlates with outdoor time. For children with diminished age-specific outdoor time, a higher prevalence of obesity was observed (odds ratio: 3.2, 95% CI: 1.5-7.1). GerES IV provides a compilation of current time-location reference values and distributions on German children. This data hint to substantial differences in time-location patterns within the population to be considered in environmental health risk assessment., (Copyright © 2012 Elsevier GmbH. All rights reserved.)

This work seeks to introduce and examine different historically relevant theories and propose certain frameworks that allow for the development of a Latin American theoretical approach based in a new discourse regarding childhood and adolescence. In order to undertake the creation of this Latin American approach, understanding the category of childhood as a social and historical construction, the work draws upon the contributions of structuralism (in particular, childhood as a permanent category, its relational dimension with regards to adulthood and its historical and intercultural dimension) and Foucault and Deleuze's concept of the society of control associated with the category of domination, an essential aspect of Latin American thought. The text was presented as a speech in the V World Congress for the Rights of Children and Adolescents held in San Juan, Argentina, from October 15-19, 2012.

Stroke mimics refer to conditions manifesting with neurologic deficits without underlying cerebrovascular diseases. Major causes in the paediatric population under this category include infections, inflammation, demyelination, neoplasm, drug related, phacomatosis, and miscellaneous disorders. These conditions and their respective imaging findings are briefly discussed here.

Objective: to undertake an integrative literature review on the issue of "Children as carers". This is an emerging topic in the provision of health care, but nevertheless has a low profile in the literature., Methodology: this study was based in a survey of nine databases of scientific articles, using as descriptor: child, young, caregivers, lay carer and nursing role, as well as the corresponding terms in Portuguese. 21 articles were analyzed., Results: these were organized into six categories--factors which motivate the child to take on the role of caregiver; these children's characteristics; tasks performed; time spent in caring; consequences of providing care and the role of the nurse in partnership with these children and their families., Conclusion: the children as carers are a focus of attention relevant to nursing practice, this issue representing an opportunity for investigation in Portuguese-speaking countries, as no article was found on the subject in Portuguese. In addition, with this first study in Portuguese, a work of the creation of a bibliography is begun, allowing an awareness of the issue and the identification of ways to respond to the families involved, in line with their needs.

For paediatric medicine to advance, research must be conducted specifically with children. Concern about poor recruitment has led to debate about payments to child research participants. Although concerns about undue influence by such 'compensation' have been expressed, it is useful to determine whether children can relate the time and inconvenience associated with participation to the value of payment offered. This study explores children's ability to determine fair remuneration for research participation, and reviews payments to children participating in research. Forty children were interviewed before outpatient visits at two London Hospitals: Great Ormond Street Children's Hospital and the Whittington Hospital District General Hospital. Children were asked to value their involvement in two hypothetical research scenarios - the first an 'additional blood sample', the second also involving daily oral oil capsules taken for a fortnight before further venesection. Background knowledge about familiarity with money, and experience with hospitalisation was assessed. The mean valuation of involvement in the second scenario (£13.18) was higher than in the first (£2.84) (p<0.001). This higher valuation persisted when children were categorised into groups 'aged 12+' and 'below 12'. Those undergoing a blood test on the day placed a higher valuation on participation in the second scenario (£10.43, £21.67, p=0.044). These children aged 8-16 demonstrated the capacity to discern a fair valuation for participation in medical research. The monetary sums are influenced by the time and inconvenience involved in the research, and by the extent of recent experience with hospital procedures. The authors review current ethical thinking regarding payments to child research participants and suggest that a fair wage model might be an ethically acceptable way to increase participation of children in research.

This policy brief examines the Partners for Children (PFC) program--California's public pediatric community-based palliative care benefit to children living with life-threatening conditions and their families. Preliminary analysis of administrative and survey data indicates that participation in the PFC program improves quality of life for the child and family. In addition, participation in the program resulted in a one-third reduction in the average number of days spent in the hospital. Shifting care from a hospital setting to in-home community-based care resulted in cost savings of $1,677 per child per month on average--an 11% decrease in spending on a traditionally high-cost population. As the three-year pilot program draws to an end, policymakers are considering the advisability of extending the program beyond the 11 counties that now participate. This policy brief provides recommendations that policymakers, families and advocates should consider to ensure sustainability and successful expansion of the program

Census Bureau reports for the 2010 Census detail the slowing overall growth of the number of children, with specific emphasis on the increasing proportion of Hispanic children in the population. A review of these data at the national and state levels, in particular, New York State and its counties, is carried out with regard to potential developments in dental services for children.