Outdoor time in early childhood education and care (ECEC) settings provides important opportunities for children's physical activity. Evidence is limited on whether different organizational outdoor conditions influence not only activity intensity but also the contextual characteristics of children's movement. An observational study was conducted using the Observational System for Recording Physical Activity in Children-Preschool Version (OSRAC-P). The study was conducted in two public ECEC centers. Not all children were observed across all three conditions due to the field-based design. A total of 7440 observation intervals were analyzed from preschool children across three outdoor conditions (structured educator-led physical activity, outdoor free play, and outdoor free play with additional portable equipment) using a momentary time-sampling protocol (10 s observation + 50 s recording), resulting in one interval per minute. Physical activity intensity, activity type, equipment use, and social context were coded. Contextual differences were analyzed using chi-square tests with standardized residuals, and activity intensity using linear mixed-effects models. No significant differences were found between outdoor conditions in physical activity intensity, sedentary behavior, and moderate-to-vigorous physical activity (all p > 0.05). About one-third of the variance in activity intensity was attributable to individual differences between children (ICC ≈ 33%). Differences were observed in contextual characteristics. Structured activity involved more locomotor activities and greater adult involvement, with 49.4% of intervals occurring in groups with an educator present. Free play with portable equipment showed more manipulative activities, greater equipment use, and mostly peer interactions without adult presence (55.5%), while free play without additional equipment involved more stationary behavior and activities without equipment (46.9%). Although physical activity intensity did not differ across conditions, the structure, material context, and social organization of children's activity varied, highlighting the practical importance of intentionally combining different outdoor activity formats to support diverse movement patterns in ECEC settings.

Background/Objectives: Few studies focus on essential information and training for responsible caregivers in the operating theatre (OT). Our study explored challenges, opportunities and critical information for caregivers close to the child until induction, drawing on the experiences of nurses and caregivers. Methods: A mixed-method exploratory sequential design was adopted in the OT and surgery wards of a maternal and child health hospital in Italy (2021-2023). Results: Twelve nurses were involved in 2 focus groups. The content analysis yielded 3 themes and 6 subthemes. Two questionnaires were developed for nurses and caregivers based on qualitative findings. The quantitative phase included 25 nurses and 140 caregivers. Results from the quantitative strand confirm findings from the qualitative strand. However, discrepancies in information needs highlight gaps. Conclusions: Optimizing family comfort and workflows in the OT depends on caregivers' awareness of their role near the child, emphasizing mindful presence and awareness of their body movements-watching, touching and fidgeting.

Objective: The fetal-to-neonatal transition is marked by profound cardio-respiratory changes. Infections emerging within the first 48 h after birth may influence early cardiovascular adaptation. We aimed to evaluate the association between early infection/inflammation markers and vital parameters in neonates during the first 15 min after birth. Methods: This is a secondary outcome parameter post-hoc analysis of data derived from a prospective observation study. Preterm and term neonates with cerebral oxygen saturation (crSO2) monitoring (INVOS 5100C) during the first 15 min after birth and available inflammatory markers (C-reactive protein [CRP], leukocytes, immature-to-total neutrophils ratio [IT ratio]) within 48 h after birth were included. Heart rate (HR) and arterial oxygen saturation (SpO2) were continuously recorded during the first 15 min. Inflammatory markers obtained at 16-24 and 24-48 h after birth were correlated with crSO2, SpO2, and HR at minute 5, 10 and 15. Results: Sixty-eight neonates were included (median (IQR) gestational age 34.0 (32.0; 35.9) weeks, birth weight 1900 (1488; 2542) grams). CRP within the first 24 h correlated negatively with crSO2 (r = -0.314; p = 0.011) and with SpO2 (r = -0.393; p = 0.001) at minute 15. IT ratio within 24 h correlated negatively with crSO2 at minute 5 (r = -0.367; p = 0.005), 10 (r = -0.273; p = 0.035), and 15 (r = -0.306; p = 0.013), and with SpO2 at minute 5 (r = -0.327; p = 0.008). IT ratio at 24-48 h correlated negatively with crSO2 at minute 15 (r = -0.384, p = 0.012). No significant correlations were observed with HR. Leukocytes within the first 24 h after birth correlated negatively with crSO2 at minute 5 (r = -0.265; p = 0.046). Conclusions: Early inflammatory markers, particularly CRP and the IT ratio, are associated with cerebral and systemic oxygenation during immediate postnatal transition. These findings suggest a potential association between early inflammatory activation and oxygenation dynamics; however, given the observational design and modest correlation strength, the results should be interpreted cautiously and do not allow conclusions regarding causality or underlying mechanisms.

Hepatitis A virus (HAV) infection is a common cause of acute viral hepatitis in children. Severe complications are rare but may occur, particularly in older children or in the presence of concomitant conditions. We report the case of an 11-year-old girl with acute hepatitis A with severe hepatic derangements who developed life-threatening upper gastrointestinal bleeding due to a previously undiagnosed duodenal ulcer. Emergency endoscopy confirmed active bleeding from a duodenal ulcer, and the patient survived the complications with treatment with a proton pump inhibitor and hemostatic management with blood products. Although hepatitis A is generally benign in children, this case highlights the potential for severe and life-threatening complications.

This study aimed to evaluate psychological and social risk factors associated with IBS in children and to identify correlations with their gastrointestinal symptoms. Children aged 4 to 18 years diagnosed with IBS according to Rome IV criteria were eligible for inclusion. Both patients and parents completed a comprehensive questionnaire detailing gastrointestinal symptom characteristics. Additionally, all children underwent psychological assessment. The study included 24 children with IBS, with a mean age of 12.7 ± 3.4 years. Anxiety was present in 54.2% of cases, and depression in 12.5%. Comparing children with IBS and anxiety to those without these, no statistically significant differences emerged regarding the duration and frequency of abdominal pain; however, abdominal pain intensity was significantly higher in children without anxiety (p = 0.04). The duration of IBS symptoms did not significantly differ in children with or without anxiety (p = 0.21). Impaired emotional self-regulation was identified in 54.2% of participants, and 41.6% exhibited vegetative symptoms in response to stress. Furthermore, 70.8% of parents and/or children reported experiencing a negative family event. The findings suggest that psychological characteristics and adverse family events are important risk factors associated with pediatric IBS. These factors should be systematically considered as integral components of clinical assessment and management.

Background/Objectives: Primary non-refluxing megaureters (PM) are common congenital anomalies of the urinary tract. While spontaneous resolution is frequent, reliable non-invasive predictors of outcome are scarce. Ureteral peristalsis is frequently regarded as a sign of functional maturation and favorable prognosis, although supporting clinical evidence is limited. This study aimed to evaluate whether sonographically visible ureteral peristalsis at initial diagnosis predicts spontaneous resolution, pyelonephritis, or the need for surgery in infants with PM. Methods: In this retrospective single-center study, infants diagnosed with primary non-refluxing megaureters before one year of age between 2012 and 2018 were analyzed. Patients with refluxing, secondary, syndromic, or ectopic megaureters were excluded. Sonographic detection of distal ureteral peristalsis at initial examination was recorded. Clinical outcomes included spontaneous resolution, episodes of pyelonephritis (including breakthrough infections under antibiotic prophylaxis), and surgical intervention. Univariate and multivariate logistic regression analyses were performed. Results: Sixty-three infants were included, with a median follow-up of 34 months. Peristalsis was detected in 52.3% at initial ultrasound. Complete spontaneous resolution occurred in 66% of patients, while 20.9% required surgical reimplantation. The presence of peristalsis at diagnosis was not associated with spontaneous resolution, time to resolution, occurrence of pyelonephritis, breakthrough infections, or surgical intervention. Multivariate analysis confirmed that initial peristalsis was not an independent predictor of outcome. Conclusions: Sonographically visible ureteral peristalsis is a transient and inconsistent finding in infants with primary non-refluxing megaureters and does not predict clinical outcome. Peristalsis observed on initial ultrasound should not be used as a decision-making parameter in the management of PM during the first year of life.

Oral health-related quality of life (OHRQoL) reflects the functional and psychosocial impacts of oral conditions on daily life. In low-resource settings such as rural Tanzania, limited access to dental care and preventive services may increase the burden of oral disease. This study assessed the association between clinical oral health conditions and OHRQoL among schoolchildren in rural Tanzania. A cross-sectional study was conducted among 293 schoolchildren at Igelehezda Primary School, Ilembula, Tanzania. Clinical examinations assessed dental caries using the DMFT index and oral hygiene using the OHI-S index. OHRQoL was measured with the Child Oral Impact on Daily Performances (C-OIDP) questionnaire. Behavioral data included sugar intake, number of daily meals, and toothbrushing-related symptoms. Associations between clinical, behavioral factors and OHRQoL were analyzed using descriptive statistics, bivariate tests, and multiple linear regression (p < 0.05). All 293 children completed the study (mean age 12.2 ± 1.2 years; 157 females, 136 males). Mean DMFT was 2.7 ± 4.1, with 80.5% free of untreated caries, and mean OHI-S indicated good oral hygiene (0.4 ± 0.6). Most participants were periodontally healthy (68.3%). Toothache, gum pain, or bleeding during brushing were reported by 26.0-31.6%. Eating was the most affected daily activity (42.7%). Missing teeth, toothbrushing-related symptoms, and consumption of high-sugar sweets were significantly associated with higher C-OIDP scores (p < 0.05), while a higher number of daily meals was associated with fewer impacts. Missing teeth, toothbrushing-related symptoms, and high sugar intake were associated with greater impairment in daily life, particularly affecting eating. These findings highlight the need for preventive and educational oral health interventions in rural, resource-limited settings.

The Parenting Sense of Competence (PSOC) scale is one of the most widely used instruments to assess perceived parental competence, understood as the degree to which parents feel capable of adequately fulfilling their parental role. Despite its widespread use, studies seeking to determine PSOC normative scores are scarce, especially in specific populations such as mothers with infants younger than 9 months, which limits the interpretation of its scores in applied contexts. This study establishes PSOC normative scores in a nonclinical sample of 522 Spanish mothers with infants aged between 3 and 37 weeks who attended a public early intervention program. Regression and ANOVA analyses were performed to examine the effect of infant and maternal age, as well as educational level and occupation, on the dimensions of Efficacy, Satisfaction, and Total score of the PSOC. The results show a significant decline in parental competence starting when their infants reach 9 months of age, and lower levels of self-efficacy in mothers over 35 years of age. No significant differences were found according to the educational level or occupation of the mothers. Normative scores are presented by percentiles, offering specific criteria for this stage of child development. Z- and T-scores are included, useful for standardized comparisons between subscale and studies. These findings provide useful information for early detection and psychoeducational interventions within the framework of early intervention.

Background: Guillain-Barré syndrome (GBS) is a rare, immune-mediated disorder affecting the peripheral nerves, often presenting with ascending muscle weakness and possible respiratory failure, usually following an infection. Borrelia burgdorferi, the causative agent of Lyme neuroborreliosis, is an uncommon trigger of GBS. Case presentation: We report the case of a 13-year-old girl with Lyme neuroborreliosis who developed sensorimotor GBS. She presented with progressive, symmetrical weakness, initially in the lower limbs and subsequently in the upper limbs, accompanied by absent deep tendon reflexes. Peripheral demyelination, confirmed in this case, is exceptionally rare. Results: Prompt diagnosis and appropriate treatment, together with rehabilitation measures, prevented further nerve damage. Seven months after onset, she was able to walk with support and had no sensory or cognitive deficits. Conclusions: Lyme neuroborreliosis can rarely trigger GBS with peripheral demyelination. Early recognition, timely intervention, and effective interprofessional collaboration limited the extent of nerve damage and promoted neurological recovery.

Introduction: Adolescent suicide behavior is a global concern and a leading cause of morbidity and mortality in this age group. Pharmaceutical ingestion is a frequent method of suicide attempts, requiring toxicology and psychiatric interventions. This study analyzed data from a pediatric tertiary hospital to elucidate the trends, demographics, and methods used. Methods: This retrospective study was conducted at a single tertiary pediatric hospital in Romania and included adolescents aged 10-18 years admitted for suicide attempts between 2014 and 2024. Data extracted from electronic medical records included age, sex, residence, suicide method, psychiatric history, and clinical outcomes. Temporal trends were analyzed using regression-based methods, and group comparisons were performed using chi-square tests, with statistical significance set at p < 0.05. Results: The study included 1840 adolescents, with a significant increasing trend over time (p < 0.0001), but with a transient decline in 2020. The female-to-male ratio was 5.4:1 (p < 0.0001). The median age of the patients was 15.2 years. The suicide attempt methods were pharmaceutical poisoning (95%), chemical ingestion (4%), and violent methods (1%). Females were more prone to pharmaceutical poisoning, while males were associated with chemical ingestion and violent methods (p < 0.0001). Previously documented psychiatric disorders were present in 32.8% of patients, while 9.6% had a history of prior suicide attempts. Two fatalities (0.1%) were recorded, both involving defenestration. Conclusions: Hospital-treated suicide attempts among Romanian adolescents increased over time, mainly affecting females through pharmaceutical poisoning. Adolescents without prior psychiatric diagnoses reveal gaps in early identification and prevention. These findings highlight important patterns among hospital-treated adolescents and may inform targeted prevention efforts.