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BACKGROUND Some children and adolescents suffer from late effects of a SARS-CoV-2 infection despite a frequently mild course of the disease. Nevertheless, extensive care for post–COVID-19 condition, also known as post–COVID-19 syndrome, in children and young people is not yet available. A comprehensive care network, Post-COVID Kids Bavaria (PoCo), for children and adolescents with post–COVID-19 condition has been set up as a model project in Bavaria, Germany. OBJECTIVE The aim of this study is to evaluate the health care services provided within this network structure of care for children and adolescents with post–COVID-19 condition in a pre-post study design. METHODS We have already recruited 117 children and adolescents aged up to 17 years with post–COVID-19 condition who were diagnosed and treated in 16 participating outpatient clinics. Health care use, treatment satisfaction, patient-reported outcomes related to health-related quality of life (the primary endpoint), fatigue, postexertional malaise, and mental health are being assessed at different time points (at baseline and after 4 weeks, 3 months, and 6 months) using routine data, interviews, and self-report questionnaires. RESULTS The study recruitment process ran from April 2022 until December 2022. Interim analyses will be carried out. A full analysis of the data will be conducted after follow-up assessment is completed, and the results will be published. CONCLUSIONS The results will contribute to the evaluation of therapeutic services provided for post–COVID-19 condition in children and adolescents, and avenues for optimizing care may be identified. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/41010

With the start of the vaccination campaign, a new phase in the management of the coronavirus pandemic has begun. Approval and recommendation for COVID-19 vaccination of children followed gradually; to date (4 October 2022), vaccination for children under five years of age has not been approved in Germany.The aim was to investigate how parents' intention to vaccinate their children against COVID-19 developed from May 2020 to February 2021 (from the first to the second wave of the COVID-19 pandemic) and to analyse the determinants of the intention to vaccinate.In May 2020, 612 families participating with their children aged 1.5-6 years in the KUNO Kids Health Study completed an online survey (participation rate 51%), and 507 completed the second survey in February 2021. Determinants of the intention to vaccinate were analysed for both time points using univariable and multivariable logistic regression models.While 51% of parents reported wanting their children vaccinated against COVID-19 in May 2020, this proportion decreased to 41% by February 2021. At least at one of the two time points, health literacy and perceived competence regarding protective measures against the virus were significantly positively associated with higher vaccination intentions, while belonging to a risk group and the perception that the political measures were exaggerated were associated with lower vaccination intentions.Parents' intention to have their children vaccinated against COVID-19 was low and decreased further from the first to the second wave of the coronavirus pandemic. Attitudinal and competence-related determinants were important at both time points and could be targeted in a future vaccination campaign addressing parents of younger children.HINTERGRUND: Mit Beginn der Impfkampagne hat eine neue Phase der Bewältigung der Coronapandemie begonnen. Zulassung und Empfehlung für die COVID-19-Impfung von Kindern folgten schrittweise; bis heute (mit Stand vom 04.10.2022) sind in Deutschland Impfungen für Kinder unter 5 Jahren nicht zugelassen.Ziel war es, zu untersuchen, wie sich die COVID-19-Impfintention von Eltern bezogen auf ihre Kinder von Mai 2020 bis Februar 2021 (von der ersten zur zweiten Coronawelle) entwickelte und welche Determinanten der Impfintention es gibt.612 Familien, die mit ihrem Kind im Alter zwischen 1,5 und 6 Jahren an der KUNO Kids Gesundheitsstudie teilnehmen, beantworteten im Mai 2020 Fragen eines Online-Surveys (Teilnahmerate 51 %), 507 nahmen an der Wiederholungsbefragung im Februar 2021 teil. Determinanten der Impfintention wurden für beide Zeitpunkte in uni- und multivariablen logistischen Regressionsmodellen analysiert.Während 51 % der Eltern im Mai 2020 angaben, ihr Kind gegen COVID-19 impfen lassen zu wollen, reduzierte sich dieser Anteil bis Februar 2021 auf 41 %. Zu mindestens einem der beiden Zeitpunkte waren Gesundheitskompetenz sowie die wahrgenommene Kompetenz bzgl. Schutzmaßnahmen gegen das Virus signifikant positiv mit einer höheren Impfintention assoziiert, die Zugehörigkeit von Angehörigen zu einer Risikogruppe sowie der Eindruck, dass die politischen Maßnahmen übertrieben seien, ging mit einer niedrigeren Impfintention einher.Die Intention, das Kind gegen COVID-19 impfen zu lassen, war nur mäßig ausgeprägt und nahm zur zweiten Coronawelle weiter ab. Einstellungs- und kompetenzbezogene Determinanten waren zu beiden Zeitpunkten wichtig und könnten in einer künftigen Impfkampagne, die Eltern jüngerer Kinder adressiert, gezielt berücksichtigt werden.

Attending to a stimulus enhances the neuronal responses to it, while responses to nonattended stimuli are not enhanced and may even be suppressed. Although the neural mechanisms of response enhancement for attended stimuli have been intensely studied, the neural mechanisms underlying attentional suppression remain largely unknown. It is uncertain whether attention acts to suppress the processing in sensory cortical areas that would otherwise process the nonattended stimulus or the subcortical input to these cortical areas. Moreover, the neurochemical mechanisms inducing a reduction or suppression of neuronal responses to nonattended stimuli are as yet unknown. Here, we investigated how attention directed toward visual processing cross-modally acts to suppress vestibular responses in the human brain. By using functional magnetic resonance spectroscopy in a group of female and male subjects, we find that attention to visual motion downregulates in a load-dependent manner the concentration of excitatory neurotransmitter (glutamate and its precursor glutamine, referred to together as Glx) within the parietoinsular vestibular cortex (PIVC), a core cortical area of the vestibular system, while leaving the concentration of inhibitory neurotransmitter (GABA) in PIVC unchanged. This makes PIVC less responsive to excitatory thalamic vestibular input, as corroborated by functional magnetic resonance imaging. Together, our results suggest that attention acts to suppress the processing of nonattended sensory cues cortically by neurochemically rendering the core cortical area of the nonattended sensory modality less responsive to excitatory thalamic input.SIGNIFICANCE STATEMENTHere, we address a fundamental problem that has eluded attention research for decades, namely, how the brain ignores irrelevant stimuli. To date, three classes of solutions to this problem have been proposed: (1) enhancement of GABAergic interneuron activity in cortex, (2) downregulation of glutamatergic cell activity in cortex; and (3) downregulation of neural activity in thalamic projection areas, which would then provide the cortex with less input. Here, we use magnetic resonance spectroscopy in humans and find support for the second hypothesis, implying that attention to one sensory modality involves the suppression of irrelevant stimuli of another sensory modality by downregulating glutamate in the cortex.

Health literacy (HL) is thought to be crucial for the management of the manifold demands relating to child health which parents are faced with. Albeit many studies have investigated parental HL and health behaviours (HBs) directed at the child, knowledge about the pathways which link parental HL with HB is scarce. The aim of this scoping review was to identify and comprehensively describe the variety of pathways linking parental HL with HBs directed at the child which were empirically analysed in previous studies. Following established scoping review methods database searches were conducted in MEDLINE, EMBASE, PsycINFO and WebofScience on 5 March 2020. Eligibility criteria included primary, empirical studies assessing parental HL and HB directed at the child in the general parent population. Titles and abstracts were screened independently by six reviewers for potentially relevant publications and data were extracted using standardized data extraction forms. The search identified 6916 articles for title and abstract screening. After full-text review, 50 studies were included in this review. Most studies (N = 24) assumed a direct association between HL and HBs and only few studies (N = 4) used more complex models investigating different pathways or mediation and/or moderation models. Overall, the evidence on the underlying pathways linking parental HL and HBs directed at the child is mixed and fairly limited. Therefore, hypothesis-driven research and integration of results into theoretical frameworks is needed for advancing both the research on HL and public health practice.This systematic overview of existing literature aimed at comprehensively describing the association between parental health literacy (HL) and health behaviours (HBs) directed at the child and how this linkage was analysed in previous studies. HL can be defined as the capacity an individual has to access and effectively use health-related information, in order to promote and maintain good health. A particularly relevant group is the parent population as prior to and during parenthood they are confronted with manifold information regarding child health care. Many studies investigated parental HL and HBs directed at the child but knowledge about how they are connected with each other is scarce. The 50 studies included in this review varied widely in how they measured HL and HBs and how data were analysed. Overall, most studies (24 studies) assumed a direct association between HL and HBs and only few studies (4 studies) used more complex models looking at other important variables. More research is needed to understand the underlying relation between HL and HBs and how this can be integrated into theoretical frameworks.

Previous studies in human subjects reported that the parieto-insular vestibular cortex (PIVC), a core area of the vestibular cortex, is inhibited when visual processing is prioritized. However, it has remained unclear which networks in the brain modulate this inhibition of PIVC. Based on previous results showing that the inhibition of PIVC is strongly influenced by visual attention, we here examined whether attention networks in the parietooccipital cortex modulate the inhibition of PIVC. Using diffusion-weighted and resting-state fMRI in a group of female and male subjects, we found structural and functional connections between PIVC and the posterior parietal cortex (PPC), a major brain region of the cortical attention network. We then temporarily inhibited PPC by repetitive transcranial magnetic stimulation (rTMS) and hypothesized that the modulatory influence of PPC over PIVC would be reduced; and, as a result, PIVC would be less inhibited. Subjects performed a visual attentional tracking task immediately after rTMS, and the inhibition of PIVC during attentive tracking was measured with fMRI. The results showed that the inhibition of PIVC during attentive tracking was less pronounced compared with sham rTMS. We also examined the effects of inhibitory rTMS over the occipital cortex and found that the visual-vestibular posterior insular cortex area was less activated during attentive tracking compared with sham rTMS or rTMS over PPC. Together, these results suggest that attention networks in the parietooccipital cortex modulate activity in core areas of the vestibular cortex during attentive visual processing.SIGNIFICANCE STATEMENTAlthough multisensory integration is generally considered beneficial, it can become detrimental when cues from different senses are in conflict. The occurrence of such multisensory conflicts can be minimized by inhibiting core cortical areas of the subordinate sensory system (e.g., vestibular), thus reducing potential conflict with ongoing processing of the prevailing sensory (e.g., visual) cues. However, it has remained unclear which networks in the brain modulate the magnitude of inhibition of the subordinate sensory system. Here, by investigating the inhibition of the vestibular sensory system when visual processing is prioritized, we show that attention networks in the parietooccipital cortex modulate the magnitude of inhibition of the vestibular cortex.

A COVID-19 vaccine can be an important key for mitigating the spread of the pandemic, provided that it is accepted by a sufficient proportion of the population. This study investigated parents’ intention to get vaccinated and to have one’s child vaccinated against COVID-19. In May 2020, 612 parents participating with their child in the KUNO-Kids health study completed an online survey. Multivariable logistic regression models were calculated to analyze predictors of intention to vaccinate. Fifty-eight percent of parents intended to get vaccinated against COVID-19, and 51% intended to have their child vaccinated. Significant predictors for the intention to get vaccinated and for having the child vaccinated included stronger parental confidence in one’s knowledge about prevention measures and lower beliefs that policy measures were exaggerated.Conclusion: COVID-19 vaccination hesitancy was considerable in our sample of parents in Germany. However, our study revealed some potentially modifiable factors which should be addressed by a comprehensive and tailored communication and education strategy. What is Known?• A COVID-19 vaccine can mitigate the spread of the pandemic.• Many parents are skeptical about vaccinations in general. What is New?• COVID-19 vaccination hesitancy was considerable in our sample of parents from Germany, not only for getting vaccinated but also for having the child vaccinated.• Negative parental attitudes regarding policy measures to contain the pandemic were associated with a lower intention to vaccinate.

Visual crowding refers to the impairment of recognizing peripherally presented objects flanked by distractors. Crowding effects, exhibiting a certain spatial extent between target and flankers, can be reduced by perceptual learning. In this experiment, we investigated the learning-induced reduction of crowding in normally sighted participants and tested if learning on one optotype (Landolt-C) transfers to another (Tumbling-E) or vice versa. Twenty-three normally sighted participants (18–42 years) trained on a crowding task in the right-upper quadrant (target at 6.5 degrees eccentricity) over four sessions. Half of the participants had the four-alternative forced-choice task to discriminate the orientation of a Landolt-C, the other half of participants had the task to discriminate the orientation of a Tumbling-E, each flanked by distractors. In the fifth session, all participants switched to the other untrained optotype, respectively. Learning success was measured as reduction of the spatial extent of crowding. We found an overall significant and comparable learning-induced reduction of crowding in both conditions (Landolt-C and Tumbling-E). However, only in the group who trained on the Landolt-C task did learning effects transfer to the other optotype. The specific target-flanker-constellations may modulate the transfer effects found here. Perceptual learning of a crowding task with optotypes could be a promising tool in rehabilitation programs to help improve peripheral vision (e.g. in patients with central vision loss), but the dependence of possible transfer effects on the optotype and distractors used requires further clarification.

Purpose One of the diagnostic features of visual crowding, radial–tangential anisotropy, has been observed both in behavioral experiments as well as in responses of the blood-oxygenation-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) signal. As has been shown previously, crowding is stronger for radially arranged flankers, and this tendency is reflected in BOLD signal suppression. In the current study, we examined the effect of practice on the neural correlates of crowding. We expected that training on a crowding task would cause shrinkage of the crowding zone that would be mirrored in corresponding BOLD signal responses. Methods Pre- and post-training fMRI images were acquired in 17 healthy volunteers using a 3-tesla MRI scanner. Participants were trained over 4 consecutive days on a crowding task. Results Comparison of the pre- and post-training behavioral data indicates a significant shrinkage of the crowding zone as a result of training. Moreover, we observed a pronounced radial–tangential anisotropy in the BOLD signal prior to training; that is, radial flankers induced a larger reduction in the BOLD signal compared to equally spaced tangential flankers. After training, this radial–tangential anisotropy in the BOLD signal was significantly reduced. Specifically, we found significant changes in BOLD responses for the radial flanker configuration. Conclusions Our results demonstrate that training-induced changes in the anisotropic shape of the crowding zone are reflected in the BOLD signal in the early visual cortex. Translational Relevance Perceptual learning tasks may have the potential to improve visual performance by promoting neural plasticity. Our results could motivate the development of suitable rehabilitation protocols for patients with central vision loss.