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Kawasaki disease, an acute systemic small- and medium-vessel vasculitis, is mostly detected in children under 5 years old.
Objective:
We aimed to explore the predictive value of long non-coding ribonucleic acid small nucleolar RNA host gene 5 (SNHG5) and microRNA (miRNA)-27a for the effect of standard intravenous immunoglobulintherapy on children with Kawasaki disease.
Methods:
The study included 182 children undergoing standard intravenous immunoglobulin therapy for Kawasaki disease and another 182 healthy children receiving physical examinations as a control group. LncRNA SNHG5 and miRNA-27a expression levels were determined at admission.
Results:
The ineffective group had higher levels of interleukin-6, C-reactive protein, procalcitonin, lncRNA SNHG5, and miRNA-27a and Kobayashi score than those of the effective group (P < 0.05). Multivariate regression analysis showed that Kobayashi score, interleukin-6, C-reactive protein, procalcitonin, lncRNA SNHG5, and miRNA-27a were associated with the treatment outcomes (P < 0.05). LncRNA SNHG5 and miRNA-27a levels were positively correlated with Kobayashi score, interleukin-6, receiver operating characteristic and procalcitonin levels (r > 0, P < 0.05). High Kobayashi score and levels of interleukin-6, c-reactive roe, procalcitonin, lncRNA SNHG5, and miRNA-27a were influencing factors for treatment failure (odds ratio > 1, P < 0.05). The areas under the curves of lncRNA SNHG5, miRNA-27a, and their combination were 0.757, 0.766, and 0.831, respectively.
Conclusion:
LncRNA SNHG5 and miRNA-27a are highly expressed in children with Kawasaki disease, and their levels are closely correlated with the efficacy of standard immunoglobulin therapy.
Limited studies have examined the association between the whole range of parental psychopathology and offspring major depression (MD). No previous study has examined this association by age of onset of offspring MD, or restricting to parental psychiatric diagnoses before offspring birth.
Methods
This nested case–control study included 37,677 cases of MD and 145,068 controls, identified from Finnish national registers. Conditional logistic regression models examined the association between parental psychopathology and MD, adjusting for potential confounders.
Results
Increased risk of MD, expressed as adjusted odds ratio and 95% confidence interval (aOR [95% CI]) were most strongly observed for maternal diagnoses of schizophrenia and schizoaffective disorders (2.51 [2.24–2.82]) and depression (2.19 [2.11–2.28]), and paternal diagnoses of schizophrenia and schizoaffective disorders (2.0 [1.75–2.29]) and conduct disorders (1.90 [1.40–2.59]). The aORs for any psychiatric diagnosis were (2.66 [2.54–2.78]) for mothers, (1.95 [1.86–2.04]) for fathers, and (4.50 [4.24–4.79]) for both parents. When both parents had any psychiatric diagnosis, the highest risk was for MD diagnosed at the age of 5–12 years (7.66 [6.60–8.89]); versus at 13–18 years (4.13 [3.85–4.44]) or 19–25 years (3.37 [2.78–4.07]). A stronger association with parental psychopathology and offspring MD was seen among boys than girls, especially among 13–19 years and 19–25 years.
Conclusions
Parental psychiatric disorders, including those diagnosed before offspring birth, were associated with offspring MD, indicating potential genetic and environmental factors in the development of the disorder.
Chapter 7 considers the boundary for the end of girlhood under international law. It applies Welby’s Meaning Triad to discuss the sense, meaning and significance of the current definition of child in the CRC. It argues that this definition is problematic on several grounds: absence of a minimum age for the end of girlhood, discrepancy between the end of girlhood and emancipation, possibility of unequal treatment on the grounds of gender, national domicile, and between girls under domestic law. It examines positive features of the CRC and the benefit for girls to be covered until eighteen years. It also analyzes ‘childist’ provisions of the CRC and empowering provisions of other treaties, and whether girls should reach majority before eighteen years. It conducts case studies of child justice and child marriage. Finally, it employs semioethics to identify amendments to the definition of child in the CRC that would tackle its shortcomings.
Chapter 2 provides a history of the recognition of the girl child in the international legal framework, from the universalist to the qualified universalist approach, and finally to the girl child as a distinct rights holder under international law. Chapter 2 thereafter conducts an examination of the definition of girl child in the English language. It critically studies the terminology presently used to define her and explores the etymology of the expression ‘girl’ and its semiotics of inferiority and subordination throughout history. The chapter analyzes the two vectors of identity of the girl child: femalehood and childhood. It examines the conceptions of girlhood and its 1) dimensions, 2) boundaries and 3) divisions. It discusses age-based and competence-based boundaries, and parameters for the end of girlhood in the English language and in the law, including definitions concerning puberty, youth and majority. It also suggests divisions within girlhood, namely young girls and adolescent girls.
The Lost Sheep parable’s straying sheep are comparable to Joseph when he wandered in the wilderness in search of his brothers, who treated him badly. Although Joseph later acted on his own vengeful feelings against the brothers, joyful reconciliation ensued, the positive moment being reflected in the parable. The Lost Coin parable puzzlingly associates a woman’s joy at finding a lost coin in her home with a call for repentance for sin. Evoked are developments in the Judah and Tamar story that include questionable behavior on both their parts and resulted in the birth of Perez, ancestor of Jesus.
Sinus tachycardia due to hyperthyroidism is generally treated with beta-blockers. But some patients do not respond to beta-blockers or may have non-tolerable side effects or have contraindications. We presented a case with persistent sinus tachycardia secondary to hyperthyroidism refractory to maximal doses of propranolol. After ivabradine treatment, her heart rate was < 100 bpm within 24 hours. There were no electrocardiogram changes or side effects. The use of ivabradine is promising and can be considered in cases where tachycardia cannot be controlled in children with hyperthyroidism.
Parents’ experiences of loss and grief in the context of caring for a child with life-limiting severe neurological conditions are complex. Supportive interventions delivered by multidisciplinary teams have the potential to mitigate illness-related and anticipatory grief before and after bereavement. To date, the literature on professionals’ discussion of loss and grief with parents has not been synthesized. This systematic review aims to synthesize the evidence to establish what is known about professionals’ experience of these discussions with this population, with particular emphasis on timing, frequency, and the setting in which discussions occur.
Methods
A scoping review was developed, informed by the Preferred Reporting Items for Systematic Reviews and Meta analyses – Scoping Extension guidelines and the PCC (Population, Concept, Context) framework. Three electronic databases (PsycINFO, CINAHL, and PubMED) were searched using medical subject heading (MeSH) terms and keywords search strings in January 2023. The search was not limited to year of publication. Overall, 35 articles were analyzed using a combination of descriptive analysis and thematic synthesis.
Results
Two overarching themes were identified, “loss and grief are part of this context” and “lack of recognition of loss and grief,” illustrating that despite the lack of evidence of explicit discussion of these issues, some aspects of loss and grief appeared to guide or implicitly influence healthcare professionals’ practice. Failure to acknowledge loss and grief was associated with an increase in parental distress and had implications for future care planning.
Significance of results
Healthcare professionals are well placed to discuss loss and grief with parents of children with life-limiting severe neurological conditions. However, these discussions are only implicitly reported in the literature. Findings suggest that some professionals avoided discussing loss and grief. Bereavement outcomes are not typically considered in findings of the papers reviewed. Based on these findings, future research should focus on what this means for understanding professionals’ capacity to engage with loss and grief.
Children with congenital heart defects (CHD) are often short/lightweight relative to peers. Limited growth, particularly height, may reflect energy deficits impacting physical activity. Latent class analyses of growth from birth and Bruce treadmill exercise data retrospectively identified for height, weight, and body mass index z-scores growth trajectories. Linear regression models examined exercise parameters by growth trajectory, adjusting for age/sex/CHD severity. A total of 213 children with CHD (39% female, 12.1 ± 2.9 years) achieved 85.8 ± 10.1% of the predicted peak heart rate. Peak heart rate among children whose height was consistently below average (class 1) was 15.2 ± 4.9 beats/min lower than children with other height trajectories. These children also attained a lower percentage of predicted peak heart rate. Children whose weight (p = 0.03) or body mass index (p < 0.001) z-score increased throughout childhood had significantly lower exercise duration (mean difference 1–2 min) than children whose growth trajectories were stable or declined. Children with above-average weight or an increasing body mass index also used a higher percentage of their heart rate reserve at each submaximal exercise stage. A very low height z-score trajectory is associated with decreased exercise capacity that may increase the risk for morbidities associated with a sedentary lifestyle. Future studies should examine potential mechanisms for the observed height deficits, such as an inadequate energy supply that could impact physical activity participation, congestive heart failure, cyanosis, pubertal stage, supplemental feeding history, or familial growth patterns. Prospective studies examining growth in relation to objective measures of daily physical activity are required.
The most common cause of morbidity and mortality in type 1 diabetes mellitus is cardiovascular system involvement. Sudden death has been reported in type 1 diabetes mellitus patients. To analyse the use of the cardiac electrophysiological balance index in predicting ventricular arrhythmias in children with type 1 diabetes mellitus disease.
Methods:
One hundred type 1 diabetes mellitus paediatric patients and 100 healthy children, divided into three groups according to their haemoglobin A1C levels, were included in the study. All participants were evaluated with transthoracic echocardiography, 12-lead electrocardiography, and 24-h Holter after a detailed physical examination. Systolic and diastolic function parameters, electrocardiography intervals, and heart rate variability parameters were evaluated.
Results:
The mean age in the type 1 diabetes mellitus and control groups was 11.52 (± 3.52) and 11.78 (± 3.45) years, respectively. In total, 57% of the type 1 diabetes mellitus group and 56% of the control group were male. The mean haemoglobin A1C value was 9.14% (± 1.79) and the disease duration was 3.71 years (± 3.13). The type 1 diabetes mellitus group had a higher QTc duration, deceleration time duration, A velocity, and a lower E/A ratio than the control group. In the type 1 diabetes mellitus group, Tpe, Tpe/QT ratio, QTc/QRS ratio, Tpe/QRS ratio, Tpe/(QT × QRS) ratio values were significantly higher than in the control group.
Conclusion:
Children with type 1 diabetes mellitus are at risk for atrial and ventricular arrhythmias without valvular disease, ischemic heart disease, or diastolic dysfunction despite normal systolic function. No correlation was found between disease duration, metabolic control, autonomic function parameters, and arrhythmia risk; however, it was associated with diastolic function parameters.
Intensifying storms and inter-annual El Niño events may increase psychological stress and worsen mental health. This study examines the relationship between flood exposure and long-term mental health symptoms among adolescents and young people in Peru, the world’s most affected country by El Niño. We analyzed community and self-reported survey data from the Young Lives Study to contrast mental health in 2016 among youth who lived in communities that experienced or did not experience flooding between 2013 and 2016. We pre-processed data on 1344 individuals in 93 communities, using optimal full matching on Mahalanobis distance with a propensity score caliper, and estimated relative risks to mental health scores in the general population of young people and among gender-stratified groups via quasi-Poisson regression. Exposure to floods did not yield conclusive differences in mental health scores in this sample. Further evidence is needed on mental health patterns over time, the influence of exposure severity, and the impact of disaster relief on symptomology in mounting an effective global health response.
To characterise children’s lunchbox contents for food, waste and packaging.
Design:
A cross-sectional study was conducted. Lunchboxes were photographed at two time points on the same day: before first morning break to capture food and packaging and post-lunch break to capture food waste. Contents were coded using an audit tool developed using REDCap.
Setting:
Twenty-three sites across metropolitan Adelaide, South Australia including fourteen preschools and nine primary schools in low (n 8), medium (n 7) and high (n 8) socioeconomic areas.
Participants:
Preschool (ages 3–5 years) to Grade 7 primary school (ages 6–13 years) students.
Results:
673 lunchboxes were analysed. Grain foods dominated (with at least half of them being discretionary varieties), with 92 % of lunchboxes having at least one item from that category, followed by fruits (78 %), snacks (62 %), dairy (32 %) and vegetables (26 %). Lunchboxes of preschool children contained more fruits (92 % v. 65 %; χ2(1) = 73·3, P < 0·01), vegetables (36 % v. 16 %; χ2(1) = 34·0, P < 0·01) and dairy items (45 % v. 19 %; χ2(1) = 53·6, P < 0·01), compared to lunchboxes of primary school children. Snack foods were more prevalent in primary school (68 %) than preschool (55 %; χ2(1) = 11·2, P < 0·01). Discretionary foods appeared more frequently, and single-use packaging accounted for half (53 %) of all packaging in lunchboxes, primarily from snacks and grain foods. Preschool children had less single-use packaging but more food waste. Vegetables were the most wasted food group.
Conclusions:
Sandwiches, fruits and various snacks are typical lunchbox foods, often accompanied by single-use packaging. Considering both health and environmental factors in lunchbox choices could benefit children and sustainability efforts in schools.
Child and adolescent psychiatry (CAP) is a complex and challenging subspecialty in psychiatry that developed immensely in the last century. In this chapter, we present a brief overview of development and specific aspects of the assessment, diagnosis, and treatment of children and adolescents.
Earthquakes cause great destruction due to their suddenness and intensity. Although all people are affected by earthquakes, children are among those most affected. Every year, millions of children and young people are exposed to many natural disasters and are affected differently. Earthquakes can cause physical, mental, and sleep disorders in children. The aim of this study is to investigate the post-traumatic response and its effects on sleep on child and adolescent earthquake survivors living in the earthquake zone in Turkey.
Methods
This research was carried out between June and August 2023 as a descriptive and cross-sectional study. A total of 230 earthquake survivor children from Adıyaman were included in the study. Personal information forms, the Child Posttraumatic Stress Reaction Index (CPTS-RI), and the Sleep Disturbance Scale for Children (SDSC) were used to collect data.
Results
It was determined that the scale scores of the children who were financially affected by the earthquake, who were injured, and who were under the rubble were higher (P < 0.05).
Conclusions
It was observed that more than half of the children had severe trauma and had sleep disorders. Children who experience trauma from an earthquake have more sleep disorders. For this reason, in addition to emergency aid and interventions in earthquakes, arrangements should be made for the mental health of children and social and psychological support should be provided.
Household income and caregiver mental health are important drivers of children’s health and development. The COVID-19 pandemic created huge economic and mental health disruptions. This study examines financial hardship and its relationship with caregiver and child mental health using Australia’s only representative data spanning three years of the pandemic. Analysis of the repeated, cross-sectional National Child Health Poll included 12,408 caregivers and 20,339 children over six waves (June 2020–April 2023). Caregivers reported their income (dichotomised into low versus not) and deprivation (missing one or more of eight essential items, versus not) and mental health for themselves (Kessler-6, poor versus not) and each child (Self-Rated Mental Health, poor/fair versus good/very good/excellent). Binary logistic models were fitted to predict marginal probabilities of mental health measures by low income and deprivation, over time. Results show that while low income decreased from 41% to 34% over the study period, deprivation increased from 30% to 35%. Poor mental health peaked with stay-at-home orders in 2021 before recovering. Caregivers experiencing low income or deprivation had higher rates of poor mental health throughout the study and slower recovery compared to those without financial hardship. Children in families experiencing financial hardship had slightly higher proportions of poor/fair mental health in 2021–2022, but they were mostly equivalent in June 2020 and April 2023 (range 6–8%). Addressing financial hardship may offer an avenue for improving caregiver mental health. This has implications for post-pandemic recovery and addressing contemporary issues of increasing cost of living and limited mental health supports and services.
This commentary highlights the release of findings now available in the report International Food Policy Study Youth Surveys: Summary of Findings 2019–2021.
Design:
The survey data described in this commentary consist of repeated cross-sectional surveys conducted annually beginning in 2019.
Setting:
Online surveys were conducted in 2019 to 2021 among respondents living in Australia, Canada, Chile, Mexico, the United Kingdom and the USA.
Participants:
Survey respondents were youth aged 10–17 years in 2019 (n 12 031), 2020 (n 11 108) and 2021 (n 10 459).
Results:
The report described in this commentary summarises findings on food and nutrition behaviours, attitudes and knowledge among youth, including their diet sources and patterns, school nutrition environments, food security, diet intentions, weight perceptions and weight loss behaviours, sugary drink perceptions, awareness of public education and mass media campaigns, perceptions of food labels and exposure to food and beverage marketing.
Conclusion:
Results from the IFPS Youth surveys provide important insights into key policies of global interest, including front-of-package nutrition labelling, levies on sugary beverages and restrictions on marketing unhealthy food and beverages to children. As policymakers continue to seek effective strategies to improve adolescent health outcomes, ongoing cross-country monitoring of food and nutrition-related indicators, such as the data from the International Food Policy Study, will be critical in assessing dietary trends and evaluating upcoming policies.
Infant sleep quality is increasingly regarded as an important factor for children long-term functioning and adaptation. The early roots of sleep disturbances are still poorly understood and likely involve a complex interplay between prenatal and postnatal factors. This study investigated whether exclusive breastfeeding during the first 6 months moderated the association between maternal prenatal pandemic-related stress (PRS) and sleep problems in 24-months children born during the COVID-19 pandemic. We also explored the potential contribution of maternal postnatal anxiety in these relations. Seventy-eight infants (50% males) and their mothers provided complete data from birth to 24 months. Between 12 and 48 h from birth, maternal PRS during pregnancy was retrospectively reported as well as maternal anxiety and exclusive breastfeeding. Maternal anxiety and exclusive breastfeeding were also reported at 3 and 6 months after childbirth. Children sleep disturbances were reported at 24 months. Bayesian analyses revealed that maternal PRS was positively associated with sleep problems in children who were not exclusively breastfed from birth to 6 months. Findings add to the growing literature on the lasting impact of early pre- and postnatal experiences on child well-being and development.
This study verified the accuracy of the international BMI references and the allometric BMI reference to diagnose obesity in children and adolescents from the USA. Data from 17 313 subjects were obtained from the National Health and Nutrition Examination Survey between the years 1999–2006 and 2011–2018. Fat Mass Index, Allometric Fat Mass Index and fat mass/fat-free mass were calculated. Receiver operating characteristic curve, AUC, sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were estimated to evaluate the accuracy of the growth references for diagnosing obesity. The International Obesity Task Force, MULT BMI 17 years, MULT BMI 18 years and allometric BMI 19 years achieved the best sensitivity-specificity trade-off for boys, with sensitivities ranging from 0·92 to 0·96 and specificities of 0·94, with positive likelihood ratio of 15·51, 16·17, 13·46 and 18·01, respectively. The negative likelihood ratios were notably low, ranging from 0·04 to 0·08. In girls, the International Obesity Task Force, MULT BMI 17 years and MULT allometric BMI 17 years also demonstrated high sensitivity (0·95–0·97) and specificity (0·92), with positive likelihood ratio values of 11·54, 11·82 and 11·77, respectively and low negative likelihood ratio values (0·03–0·05). In summary, these international growth references presented satisfactory performance to diagnose obesity. However, the MULT growth reference performed better, and the MULT allometric BMI was the only indicator capable of detecting that girls have a higher proportion of fat mass than boys for the same index values. These findings suggest that the MULT growth reference may be a better tool to assess the nutritional status of children and adolescents internationally.
To describe the prevalence of food poverty according to dimensions of socio-economic inequality and the food groups consumed by Brazilian children.
Design:
Dietary data from a structured qualitative questionnaire collected by the Brazilian National Survey on Child Nutrition (ENANI-2019) were used. The new UNICEF indicator classified children who consumed 3–4 and <3 out of the eight food groups as living in moderate and severe food poverty, respectively. The prevalence of consumption of each food group and ultra-processed foods (UPF) was estimated by level of food poverty according to age categories (6–23; 24–59 months). The most frequent combinations of food groups consumed by children living in severe food poverty were calculated. Prevalence of levels of food poverty were explored according to socio-economic variables.
Setting:
123 municipalities of the five Brazilian macro-regions.
Participants:
12 582 children aged 6–59 months.
Results:
The prevalence of moderate and severe food poverty was 32·5 % (95 % CI 30·1, 34·9) and 6·0 % (95 % CI 5·0, 6·9), respectively. Children whose mother/caregiver had lower education (<8 years) and income levels (per capita minimum wage <¼) had the highest severe food poverty prevalence of 8·3 % (95 % CI 6·2, 10·4) and 7·5 % (95 % CI 5·6, 9·4), respectively. The most consumed food groups among children living in food poverty in all age categories were ‘dairy products’, ‘grains, roots, tubers, and plantains’ and ‘ultra-processed foods’.
Conclusion:
Food poverty prevalence was high among Brazilian children. A significant occurrence of milk consumption associated with grains and a considerable prevalence of UPF consumption were found among those living in severe food poverty.
The study assessed mothers, children and adolescents’ health (MCAH) outcomes in the context of a Primary Health Care (PHC) project and associated costs in two protracted long-term refugee camps, along the Thai-Myanmar border.
Background:
Myanmar refugees settled in Thailand nearly 40 years ago, in a string of camps along the border, where they fully depend on external support for health and social services. Between 2000 and 2018, a single international NGO has been implementing an integrated PHC project.
Methods:
This retrospective study looked at the trends of MCAH indicators of mortality and morbidity and compared them to the sustainable development goals (SDGs) indicators. A review of programme documents explored and triangulated the evolution and changing context of the PHC services, and associated project costs were analysed. To verify changes over time, interviews with 12 key informants were conducted.
Findings:
While maternal mortality (SDG3.1) remained high at 126.5/100,000 live births, child mortality (SDG 3.2) and infectious diseases in children under 5 (SDG 3.3) fell by 69% and by up to 92%, respectively. Maternal anaemia decreased by 30%; and more than 90% of pregnant women attended four or more antenatal care visits, whereas 80% delivered by a skilled birth attendant; caesarean section rates rose but remained low at an average of 3.7%; the adolescent (15–19 years) birth rate peaked at 188 per 1000 in 2015 but declined to 89/1000 in 2018 (SDG 3.7).
Conclusion:
Comprehensive PHC delivery, with improved health provider competence in MCAH care, together with secured funding is an appropriate strategy to bring MCAH indicators to acceptable levels. However, inequities due to confinement in camps, fragmentation of specific health services, prevent fulfilment of the 2030 SDG Agenda to ‘Leave no one behind’. Costs per birth was 115 EURO in 2018; however, MCAH expenditure requires further exploration over a longer period.
Dietary fat is a major energy source and an essential nutrient that supports healthy growth and development in young children(1). Despite the important role of dietary fat in early childhood, our understanding of fat intake trends during this period is limited, particularly among Australian children. Insufficient evidence has led to the establishment of an Adequate Intake (AI) for infants aged 0-12 months in Australia, while no recommendation is available for children ages 1-5 years. This study aimed to comprehensively describe fat intake and major food sources in young Australian children. The data of children at ages 9 months (n = 393), 18 months (n = 284), 3.5 years (n = 244), and 5 years (n = 240) from the Melbourne InFANT Program were used(2). At each time point, child dietary intake data were collected via three 24-hour recalls. Food measurement booklets were utilised to estimate food portions. Food groups and nutrient intakes per day were calculated using the 2007 AUSNUT Food Composition Database. Daily energy (kJ/d) and fat (g/d) intake, the contribution of fat to total energy intake, and key food sources of fat intake were calculated. Descriptive statistics (mean and SD) were used to summarise all data. The mean daily energy intake increased from 3490 kJ/d at 9 months to 5889 kJ/d at 5 years. The mean (SD) fat intake (g/d) was 33.7 (8.0) (Australian AI is 30 g/d) at 9 months, 37.5 (9.5) at 18 months, 44.6 (13.4) at 3.5 years, and 49.0 (15.1) at 5 years. The WHO/FAO recommends that total fat intakes should constitute a minimum of 35% of energy (%E) for children aged 6-24 months, gradually reducing to a range of 25% to 35 %E for children aged 2 to 5 years(3). Notably, 40% of children at 9 months, 76% at 18 months, 14% at 3.5 years, and 12% at 5 years had fat intakes below the WHO/FAO recommendations. In contrast, 24% of children at 3.5 years and 28% at 5 years exceeded the recommendation. At 9 months, the primary source of fat was formula/breastmilk, while at later ages, the major sources were milk/milk products, cakes/cookies, and breads/cereals. The proportion of fat from discretionary foods, such as cakes/cookies, processed meats, butter, oil or fat spreads, increased with age. The percentage of total fat from fish, nuts, and seeds was low, contributing <4 %E at all time points. The study highlights a significant proportion of children exceeding or falling below fat intake recommendations. Moreover, the results suggest low consumption of healthy fat sources such as fish, nuts, and seeds. The study findings will contribute to the refinement of fat recommendations in young Australian children and contribute to interventions that aims to improve fat intakes.