Aged 1-4years Research Articles

Neospora caninum is not an important contributor to poor reproductive performance of primiparous ewes from southern Australia: evidence from a cross-sectional study.

Neospora caninum has been implicated as a sporadic cause of abortion and perinatal deaths in sheep flocks globally. However, its significance as a reproductive pathogen for sheep in Australia remains unknown. The aims of this study were to (i) determine the seroprevalence of N. caninum in Australian breeding ewes and (ii) examine if natural exposure to N. caninum is associated with poor reproductive performance of primiparous ewes in southern Australia. Thirty flocks of primiparous ewes (aged 1-2years old at lambing) from 28 farms in three states (Western Australia, South Australia and Victoria) were monitored between mating and lamb marking. Blood samples were also collected from multiparous mature ewes (aged 3years or older) at each farm. Seroprevalence for anti-N. caninum IgG using indirect ELISA was determined for a subset of primiparous ewes that were predominantly determined to be pregnant and subsequently failed to rear a lamb (n = 1279) and randomly selected mature multiparous ewes with unknown reproductive status (n = 558). Neopsora caninum apparent seroprevalence was 0.16% (95% confidence interval 0.03%, 0.5%) in primiparous ewes, with seropositivity identified in two ewes from farms located in South Australia and Victoria. There was no evidence of seropositivity in mature ewes with apparent seroprevalence 0% (0%, 0.45%). These findings suggest that N. caninum infection was not widespread in primiparous ewes or mature multiparous ewes on these farms, and exposure to N. caninum infection was unlikely to explain abortion and perinatal mortalities observed for primiparous ewes.

Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care

BackgroundDental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth.MethodThis is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes.DiscussionSCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making.Trial Registration Trial registry: ISRCTN. Trial registration number: ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search.

Benefits of telemedicine in diagnosis of herpes zoster ophthalmicus with timely management and follow-up

Sir, Herpes Zoster is caused by the viral reactivation of Varicella Zoster virus, that enters the cutaneous nerve endings during an earlier episode of chicken pox and travels to the Dorsal Root Ganglia and remains latent. It is characterized by the occurrence of vesicular lesions grouped along the Single Dermatome innervated by Dorsal Root of Sensory Ganglion. Herpes Zoster Ophthalmicus (HZO) is involvement of the ophthalmic division of the fifth cranial nerve. It is the second most common type of Herpes Zoster (HZ), after Thoracic Zoster [1]. We present here, a case of Herpes Zoster in a young girl involving Supraorbital, Maxillary and Mandibular of the Trigeminal nerve. Timely diagnosis of HZO was made. The lesion on the tip of the nose (Hutchinson’s sign) alerted the involvement of Nasociliary nerve and to arrange immediate Ophthalmology consultation. Tele-Dermatology helped in reducing waiting time, fast delivery of care and prevention of visual disability [2]. The patient was monitored, motivated and treated, that could happen because of tele- dermatology. Dramatic improvement in the patient was observed in a very short time. The use of tele-dermatology, especially in times of the COVID – 19 pandemic is invaluable. The patient was a girl aged 12-years, presented through telemedicine with 3 days of lesions on the face mimicking acne. On close examination, there were a few Vesicular Lesions among multiple lesions and there was involvement of tip of the nose. Patient also complained of eye pain. This helped us to consider HZO. Prompt immediate treatment with anti-virus was initiated. It was possible to do continuous monitoring with the help of Tele-Medicine and without the patient having to leave the house in COVID era. Patient was advised to consult an Ophthalmologist for further evaluation. As it was essential, for examination of the eye parameters, patient had to attend in person. This one visit was not through Tele-Medicine. Patient was informed on day-1 of treatment that the condition may initially worsen under proper adequate treatment with a graphic representation (Fig. 1) and then decrease later. And this happened in our case, as seen in the six consecutive photographs as indicated below with date and time of the photographs by the patient, which are presented to illustrate the natural progression of disease under proper adequate treatment. This helped in avoiding panic to the patient. The lesions as seen in the pictures became aggressive in two days which means, the eye could have been affected more but for the immediate treatment given. Patient could get treatment from home by consulting online through out, thereby reducing the risk of venturing to a clinic in COVID situation. Except for one visit to the Ophthalmologist which was inevitable. Ocular Manifestations – Ocular manifestations affect about 50% of patients with HZO and can be isolated. This proportion reaches 80% in case of appearance of the Hutchinson Sign. The latter reflects the involvement of the nasociliary branch and is characterized by eruption on the side and on the tip of the nose [3]. Eye examination showed that there was congestion generalized in Conjunctiva. Corneal sensation was reduced, Iris anterior chamber, Pupil, lens, Fundus and extra ocular movements were normal. Immediate treatment was instituted after counselling about the treatment. The patient was advised Valacyclovir 1000 mg, 3 times a day for 7 days along with adequate fluid intake. For relief of pain, patient was given Pregabalin, Tremedol 25 mg and Gabapentin 6%W/W+Lidocaine 5%W/W smooth locally. Eye treatment As per Ophthalmologists advice, Polyethylene glycol 400 0.4% + Propylene glycol 0.3% five times a day and Acyclovir eye ointment a day was prescribed to the patient. All the pictures were taken by the patient and shared with the doctor, during the course of the treatment helping in regular monitoring have been presented (1a – 1f). In this case, Telemedicine gave the scope of reducing waiting time, providing correct diagnosis, enabling faster delivery of care, enabling tele based access to monitor the patient’s condition, counselling, management, monitoring with good end result. Key Takeaways • The importance of (Hutchinson’s sign) involvement of the tip of nose is emphasized. • Counselling the patient with regard to the possibility of worsening of the visible symptoms while under appropriate and adequate treatment, should be given with the help of a graphic representation (Fig. 2). • Prompt referral to Ophthalmologist is necessary. • The consultant and the patient should be conscious of associated potential Vision threatening complications and the need for prompt treatment to protect from visual complications.

Beliefs about Origins and Eternal Life: How Easy Is Formal Religious Theory Development?

ABSTRACT Two studies investigated children’s and their parents’ reasoning about their mental and bodily states during the time prior to biological conception–“preexistence.” Prior research has suggested that, in the absence of a religious script, children display untutored intuitions that they existed as largely disembodied emotional beings during preexistence. This research explored whether children who are being taught a formal theological doctrine about preexistence initially display similar default intuitive tendencies and whether these facilitate acquisition of the specific formal religious doctrine that they are learning. Adult (N = 38) and 7-to 12-year-old (N = 59) members of the Church of Jesus Christ of Latter-day Saints judged whether their mental and bodily capacities functioned during preexistence. Results showed that by 11-to 12-years of age, children’s responses increasingly aligned with their parents’ doctrinally-accurate beliefs that they had a full range of mental states (i.e., epistemic, emotions, desires) and certain bodily capacities (i.e., perceptual, external body parts) during preexistence. However, at all ages, children deviated from their parents’ theologically-correct views, with children showing greatest consistency in privileging emotions as the continuous core of personhood. Findings converge with afterlife research to support conclusions that, across cultures, children are “intuitive eternalists” about psychological states. However, their intuitive tendencies also act as constraints on formal religious theory-building by primarily expediting the acquisition of those aspects of religious doctrine that are intuition-consistent not the doctrine as a whole. The process of becoming theologically correct therefore takes time and effort suggesting parallels to the process of acquiring formal scientific accuracy.

Short sleep duration and physical and psychological health outcomes among adult survivors of childhood cancer.

To examine associations between phenotypes of short sleep duration and clinically assessed health conditions in long-term survivors of childhood cancer. Survivorsrecruited from the St. Jude Lifetime Cohort(n=911;52% female;mean age34 years; 26 years postdiagnosis)completedbehavioral health surveysand underwent comprehensive physical examinations. Sleep was assessed with the Pittsburgh Sleep Quality Index. Short sleep was defined as ≤6h per night with phenotypes of short sleep including poor sleep efficiency (<85%), prolonged sleep onset latency (SOL; ≥30 min), and wake after sleep onset (≥3 times per week). Covariates includedchildhood cancertreatment exposures,demographics,body mass index, andphysicalinactivity.Separatemodified Poisson regression modelswere computed foreach healthcategoryto estimaterelative risks (RR)and 95% confidence intervals (CI).Multinomial logistic regression models examined associations between sleep and an aggregated burden of chronic health conditions. Short sleep duration was reported among 44% (95% CI 41%-47%) of survivors. In multivariable models, short sleep duration alone was associated with pulmonary (RR=1.35, 95% CI 1.08-1.69), endocrine (RR=1.22, 95% CI 1.06-1.39) and gastrointestinal/hepatic conditions (RR=1.46, 95% CI 1.18-1.79), and anxiety (RR 3.24, 95% CI 1.64-6.41) and depression (RR=2.33, 95% CI 1.27-4.27). Short sleep with prolonged SOL was associated with a high/severe burden of health conditions (OR=2.35, 95% CI 1.12-4.94). Short sleep duration was associated with multiple clinically ascertained adverse health conditions. Although the temporality of these associations cannot be determined in this cross-sectional study, sleep is modifiable and improving sleep may improve long-term health in survivors.

Physiotherapy: At what cost? Parents experience of performing chest physiotherapy for infants with cystic fibrosis.

Physiotherapy is one of the most burdensome aspects of cystic fibrosis (CF) care. Healthcare requirements for older children with CF are reported to impact parental quality of life and physiotherapy adherence. How parents of infants experience performing chest physiotherapy as a part of CF care is unknown. This study aimed to explore the experience of performing chest physiotherapy for parents of infants with CF. In this study, 13 parents of infants (aged 1-2years) with CF participated in one in-depth semi-structured interview and completed a daily diary for five days. Principles of hermeneutic phenomenology guided interpretation of interview transcripts, diary entries, and field notes. For these parents, being responsible for performing chest physiotherapy was an ever-present experience of pressure, doubt, and guilt. Managing chest physiotherapy resulted in sacrifices that were perceived by parents as an expected and necessary part of meeting the healthcare needs of their child. Despite perceived sacrifices, performing chest physiotherapy was also experienced by parents as an opportunity to positively impact the health of their child. Awareness of parental perceptions and experiences of chest physiotherapy in CF may enhance the personalization of physiotherapy and minimize burden.

Weekly versus fortnightly Allied Health early intervention for children with diagnosed/suspected developmental delay

Aim and background: Reviewing service provision is prudent for early childhood development teams to ensure efficient and high quality service delivery. The context of this study is an outpatient, clinic-based, Allied Health Early Intervention service, for children, aged 1-4years with diagnosed/suspected developmental delay and their families, which is currently provided fortnightly over 10-weeks. This study aimed to compare the impact on carer and clinician preferences, client outcomes and efficiencies such as attendance rates, of weekly versus fortnightly clinics. Methods: A prospective multi-informant, group comparison design was conducted comparing fortnightly interventions over 10-weeks and weekly interventions over 5-weeks. Intervention outcome data (Canadian Occupational Performance Measure), attendance rates and questionnaire data completed by clinicians and carers, were compared between the two frequency periods. Results: No statistically significant difference was found between both models for overall attendance rates or outcome measures (n=25 fortnightly, n=29 weekly). Carers’ (n=97) and clinicians’ (n=36) perceptions showed a variety of preferences. Carers suggested weekly was preferable for children who function well with routine, have shorter term goals and homework and for rapport building. Concerns for vulnerable families regarding a shorter contact period of 5-weeks with the weekly service, compared to 10-weeks (for fortnightly service), were identified by clinicians. Consistent feedback from carers was weekly over 10-weeks as the best option. Clinician themes included perception of increased workload with weekly and additional time needed to observe change for some children. Carers for both models articulated practical attendance barriers.&#x0D; Conclusions: A flexible model of service frequency is recommended, to suit the needs of children and carers, aligning with clinicians’ clinical reasoning. Decision making considerations should include condition, type of therapy (need for intensity/longer period/routine/relationship building), family practicalities, family vulnerability and benefits of service contact time.

Longitudinal Trajectories and Reference Percentiles for Participation in Family and Recreational Activities of Children with Cerebral Palsy

Aim To create longitudinal trajectories and reference percentiles for frequency of participation in family and recreational activities for children with cerebral palsy (CP) by Gross Motor Function Classification System (GMFCS) level. Methods 708 children with CP 18-months to 12-years of age and their families participated in two to five assessments using the GMFCS and Child Engagement in Daily Life Measure. Data were analyzed using mixed-effects models and quantile regression. Results Longitudinal trajectories depict the relatively stable level of frequency of participation with considerable individual variability. Average change in the frequency of participation scores of children from 2-12 years of age by GMFCS level varied from 3.7 (GMFCS level I) to – 9.0 points (GMFCS level V). A system to interpret the magnitude of change in percentiles over time is presented. Conclusions Longitudinal trajectories and reference percentiles can inform therapists and families for collaboratively designing services and monitoring performance to support children’s participation in family and recreational activities.

Websites Designed for Students with Special Needs

According to Friedman & Bryen, (2007), a person with a disability is one with a long-term physical, intellectual, mental or sensory impairment, which interferes with their social equality in relation to others. Disability, thus, varies widely across countries. Borg, Berman-Bieler, & Khasnabis (2015), indicated that by 2004, about 93 million children aged 14-years and below, suffered from moderate to severe disabilities. Examples of common disabilities include hearing loss, down syndrome, cerebral palsy, brain injury, intellectual and learning disability, congenital anomalies, muscular dystrophy, blindness, spinal code injuries, visual loss and speech impairments (Borg, Berman-Bieler, & Khasnabis, 2015) Assistive technology has become a common term in discussions regarding children with disabilities. This term includes technology, which assists disabled persons to carry out their activities or to facilitate their activities. They include technologies used to facilitate mobility, vision, hearing, communication and cognition. This paper will explore how web designs can be used to assist in the learning process. One such common disability is that of dyslexia, which is a medical condition that makes it difficult for students to read and learn and which lends itself well to assistive technologies (HKSAR, 2008). It is estimated that one in every 10 people have dyslexia (HKSAR, 2008). The condition exists across a range of cultures, abilities and conditions and is usually gene related and thus, runs in the family. While it cannot be cured, there are practical approaches that can help overcome the barriers presented by the condition. Dyslexia can be termed as a learning difference meaning that the brain approaches tasks differently to other people and affects the way people communicate (HKSAR, 2008). Since dyslexia does not affect the individual’s intelligence, it can be managed by using a different communication model in the learning process (Friedman & Bryen, 2007). Assistive technology such as the use of specialized websites can, therefore, be used to assist children with dyslexia. Keywords: Dyslexia, Cognitive Disability, Technology, Accessibility, and Autism. DOI : 10.7176/JEP/10-30-14 Publication date :October 31 st 2019

Tooth transposition prevalence and type among sub-Saharan Africans.

Although rare, tooth transposition-an exchange in location of two teeth-is a frequent topic of study. Clinical and, to a much lesser extent, dental anthropological research have focused predominantly on prevalence (0.03%-0.74% in several world populations) and case studies, albeit on a restricted spatiotemporal scale. Many regions have received little attention, including sub-Saharan Africa, while premodern data are few. Here, the aim is to supplement both fields of dental research by reviewing previous publications, and newly reporting transposition rates, types, and co-occurring abnormalities in time-successive samples across the subcontinent. Dental data in 51 sub-Saharan samples (>2500 individuals) dating >10 000 BC to 20th century were recorded. Of these, 36 are of modern and 15 premodern age, comprising males and females ≥12-years of age. Transposition presence, quadrant, and type were tabulated, cases described, and prevalence presented. In the latter case, Poisson 95% confidence intervals were calculated to better discern true population rates at various geographic levels. Overall, six of 1886 modern individuals (0.32%) and one of premodern age evidence Mx.C.P1, an exchange of the maxillary canine and first premolar. Various associated dental abnormalities are also evident, including retained deciduous teeth, reduced permanent crowns, and agenesis. This study provides additional insight into the geographic distribution, features, and time depth of transposition, along with hints supporting a genetic etiology and, potentially, some indications of diachronic change from an initial Mx.C.P1 to several types more recently based on premodern evidence. It is of clinical concern today, but is not just a modern anomaly.

Association between Maltreatment, Positive Parent–Child Interaction, and Psychosocial Well-Being in Young Children

To explore the prevalence of maltreatment and the combined effect of maltreatment and frequency of positive parent-child interaction on psychosocial well-being in young children in China. A retrospective study was conducted in 2016 in a representative sample of 20 324 children aged 3-4years who were newly enrolled in kindergartens in Shanghai, China. All data were collected through online platforms. Parents reported the maltreatment history of their children and completed the Strengths and Difficulties Questionnaire and the Chinese Parent-Child Interaction Scale. The prevalence of parent-reported child maltreatment in Shanghai was 2.70% (95% CI, 2.38-3.05). A history of maltreatment increased the risk of total difficulties (aOR, 2.36; 95% CI, 1.39-4.03) and prosocial problems (aOR, 2.31; 95% CI, 1.37-3.91). A high frequency of positive parent-child interaction had a moderating effect on the correlation between maltreatment and prosocial problems. Maltreated children had an increased risk of developing psychosocial problems, particularly those with a low frequency of positive parent-child interactions. A higher frequency of positive parent-child interactions may be associated with fewer adverse outcomes in maltreated children.

Examining accelerometer validity for estimating physical activity in pre-schoolers during free-living activity.

The present study examined the efficacy of accelerometers for the assessment of free play physical activity (PA) in pre-school-aged children with consideration of epoch length and wear location. Following ethics approval, parental informed consent, and child assent, 66 pre-schoolers aged 3-4years (30 females and 36 males) wore an accelerometer (ActiGraph GT3X; sampling at 100Hz) on their non-dominant wrist and their right hip during 1hour of free play. Concurrently, direct observation, using the OSRAC-P, was used to determine sedentary behavior (SB), light (LPA), or moderate-to-vigorous (MVPA) intensity PA. For the ActiGraph, vertical axis counts and summed vector magnitude (VM) for hip, and VM for wrist, were downloaded using 5-, 10-, 15-, and 30-second epoch lengths. Accelerometer counts were averaged over each 30seconds to match the observation periods. Receiver operating curve analysis was used to evaluate the ability of the ActiGraph to predict SB, LPA, and MVPA. SB and MVPA obtained from wrist- and hip-worn accelerometers demonstrated fair agreement with direct observation (AUC=>0.7). LPA determined by accelerometer had poor agreement with observed LPA, for both the hip and wrist placement (AUC=0.53-0.56), with weak levels of specificity (0.34-0.43), although sensitivity was fair (0.74-0.84). This study is the first to examine accelerometer validity, considering wear location and epoch in pre-schoolers during free play, and suggests that the ActiGraph is a fair measure for SB and MVPA in pre-school children. Neither placement performed predominantly better irrespective of epochs or used count data (vertical axis, VM).

Outbreaks of Salmonella enterica infections linked to animal contact: Demographic and outbreak characteristics and comparison to foodborne outbreaks-United States, 2009-2014.

In the United States, multistate Salmonella outbreaks are most commonly linked to a food source; however, contact with live animals can also result in outbreaks of human illness. To characterize Salmonella outbreaks linked to animal contact and examine differences compared to foodborne outbreaks, we analysed data reported to the Centers for Disease Control and Prevention through the National Outbreak Reporting System (NORS) from 2009 to 2014 with a primary mode of transmission listed as "animal contact" or "food." Four hundred and eighty-four outbreaks with animal contact or foodborne transmission were reported through NORS; of these outbreaks, 99 (20.5%) resulted from Salmonella transmission through animal contact and 385 (79.5%) resulted from foodborne transmission, which resulted in 3,604 (19.8%) and 13,568 (80.2%) illnesses, respectively. A higher proportion of illnesses among children aged <1year and children aged 1-4years were linked to animal contact outbreaks compared to foodborne outbreaks (15.2% vs. 1.4%, p<0.01 and 24.5% vs. 5.6%, p<0.01, respectively). Illnesses resulting in hospitalizations (OR: 1.81, 95% CI: 1.62, 2.02) were more likely to be associated with animal contact compared to food. Animal contact outbreaks reported to NORS were more likely to be multistate compared to foodborne outbreaks (OR: 5.43, 95% CI: 3.37, 8.76) and had a longer median duration (99.0days vs. 9.0days, p<0.01). Characterizing the differences between outbreaks of illness linked to animal contact and outbreaks linked to food provides useful information to investigators to improve public health response.

The growth trend of planted trees (Pinus sylvestris L.) in the early stage of plantation establishment

This study examined the growth of planted Scots Pine trees of different ages growing in the Tujyin Nars National park, located in Selenge aimag in the north of Mongolia. A total of seven, 50 x 20 m (0.1 ha) sized sample plots were established using a completely randomized sampling design. The tree growth monitoring was carried out between 2003 and 2017, by an annual repeated measurement at the end of each growing season. The total height, annual height increment and diameter at breast height were measured at sample plots and tree samples were taken for laboratory analysis. For statistical analysis, a One-way analysis of variance (One-way ANOVA) and F-test were applied. Our findings showed that the annual height (F=15.21, P&lt;0.0001) and radial increments (F=15.76, P&lt;0.0001) varied among plantations commensurate to their age. In our study, the highest height (46.5±6.1 cm) and radial (4.1±0.8 mm) increment were occurred in 12 and 10 years old plantations. Therefore, a strong positive correlation (r=0.99) between tree increment and plantation age was observed in plantations below 12 years of age. After this age, increment values were relatively stable, which tended to gradually decrease with plantation age. Our findings confirm that initial planting design leads to overcrowding with plantation age; therefore, implementation of a thinning practice is necessary after a plantation reaches 12 years of age. The ever-decreasing trend of both radial and height increments in plantations beyond 12-years of age supports the importance of thinning as a practice to reduce competition and to support the growth of remaining trees in older plantations.

Lead exposure from households and school settings: influence of diet on blood lead levels.

Lead is known as a potent toxicant to human health, particularly for children while their central nervous system is developing. The aim of this study was to investigate the associations between blood lead levels (BLLs) and lead exposure in the children's diet, home, and school environments. A cross-sectional study was conducted with 153 children aged 1-4years, in four day care centers (DCCs), where a high prevalence of lead exposure was previously found. Lead determination by graphite furnace atomic absorption spectrometry (GF-AAS) was performed for venous blood, drinking water collected in the DCCs, and the 24-h diet (n = 64). Environmental screenings were conducted to evaluate lead concentrations in the tableware, buildings, and playground items in all DCCs and children's homes (n = 18) by using a field-portable X-ray fluorescence analyzer (FP-XRF). The BLL mean was 2.71μgdL-1. Means for 24-h lead concentrations in the diet were 1.61 and 2.24μgkg-1 of body weight (BW) in two DCCs. Lead concentrations in the water supply were lower than 2μgL-1. More than 11% of the DCCs' environmental analyses presented lead concentrations higher than or equal to 1mgcm-2, as defined by the USEPA. The diet was not found to be a risk factor for lead exposure, but households and DCC settings raised concern. Children's exposure to lead in DCC environments, where they spend the most part of their weekdays, appeared to be relevant. Graphical abstract ᅟ.

Early childhood caries, salivary and microbiological aspects among 3- to 4-year-old children in Cali, Colombia.

To investigate the presence of early childhood caries (ECC) in relation to plaque index, colony-forming units of Streptococcus mutans (S. mutans) and Lactobacillus spp., pH and salivary buffer capacity in day-care pre-schooler's aged 3-4years old in Cali, Colombia, 2016. Caries prevalence was determined in 124 children using the International Caries Detection and Assessment System and plaque index. In addition, a non-stimulated saliva sample was obtained to determine its pH, and buffer capacity. 55.65% of the children had ECC. The mean decayed-missing-filled teeth index was 2.94 ± 4.26. The absence or presence of ECC, compared to the median plaque index showed statistically significant differences (p < 0.05). There was not an association between ECC and S. mutans, Lactobacillus spp. colonies, pH and buffer capacity of saliva. This study reported association between ECC and the increasing amount of bacterial plaque. Other important biological risk factors were not associated with ECC. Regular tooth cleaning can be the most important public health measure to control ECC in day-care children.

Different visual development: norms for visual acuity in children with Down’s syndrome

BackgroundVisual acuity is known to be poorer in children with Down’s syndrome than in age‐matched controls. However, to date, clinicians do not have access to norms for children with Down’s syndrome that allow differential discrimination of healthy from anomalous visual development in this population.MethodsThe Down’s Syndrome Vision Research Unit at Cardiff University has been monitoring visual development in a large cohort of children since 1992. Cross‐sectional data on binocular visual acuity were retrospectively analysed for 159 children up to 12-years of age in order to establish binocular acuity norms. Longitudinal binocular acuity data were available for nine children who were seen regularly over the 12-years age‐range. Monocular acuity was successfully recorded less often in the cohort, but analysis of scores for 69 children allowed assessment of inter‐ocular acuity differences and binocular summation.ResultsIn comparison with published norms for the various acuity tests used, binocular acuity was consistently poorer in children with Down’s syndrome from the age of three-years and stabilised at around 0.25 logMAR from the age of four-years. Inter‐ocular acuity difference and binocular summation were both 0.06 logMAR, which is similar to the reported values in children without Down’s syndrome.ConclusionsThe study provides eye‐care practitioners with the expected values for binocular acuity in children with Down’s syndrome and demonstrates the visual disadvantage that children with Down’s syndrome have when compared with their typically developing peers. The results emphasise the responsibility that practitioners have to notify parents and educators of the relatively poor vision of children with Down’s syndrome, and the need for classroom modifications.

Motivation to the Past, Present, and Future: Time Orientation and Disorientation before Therapy

ObjectivesThe aim of this research was to confirm the structure of time orientation and affects associated with the past, present, and future and self‐esteem of those beginning therapy and a comparison group.MethodResponses from clinical respondents (n = 217; mean age 33-years) and non‐clinical respondent (n = 196; mean age 34-years) were used to analyse the structure of the measures. A matched group method was used to investigate group differences based on clinical status and gender of the respondent.ResultsThe measures of time orientation and measures of affects associated with the past, present, and future were well structured and provide evidence of a balanced view in which an orientation to each time dimension is important. Results showed that the therapeutic group was less future, present, and past oriented. Further, the therapeutic group was consistently and significantly higher on negative affect and lower on positive affect and self‐esteem than the comparison group. The findings are discussed in reference to therapeutic and theoretical implications.ConclusionsThe concept of time orientation and the associated affects is of substantial interest to therapeutic interventions and the findings provide some evidence of the utility of attending to the strength of orientation to the three time dimensions and the dependency between them over their apparent separateness. The measures have utility in providing insights that inform the focus of therapy.

Outdoor environment, ozone, radionuclide-associated aerosols and incidences of infantile eczema in Minsk, Belarus.

The early occurrence of atopic dermatitis in infants may be influenced by urban air pollution. The aim of this study was to determine the relationship between incidences of infantile eczema in children under 2years of age and urban outdoor environmental factors. A 11-year population-based study was conducted in retrospective design. The age/gender-adjusted incidence rates of infantile eczema were determined using the data of outpatient visits. We analysed 1965 cases with atopic dermatitis including infantile eczema in relation to the annual means of outdoor monitoring data from 2005 through 2015 in Minsk. Logistic regression and principal component analysis were performed to determine association between the annual means of air pollutants, meteorological variables and incidences of infantile eczema. Higher mean annual carbon monoxide, ammonia, formaldehyde, lead, particulate matter and ground-level ozone were associated with high incidence rates of infantile eczema both in boys and girls. Higher nitrogen dioxide was associated with high incidence rates of infantile eczema in girls 1-2years of age and boys 0-2years of age. There were identified by principal component analysis five combinations of pollutants and meteorological factors. High incidence rates of infantile eczema were associated with the combinations contained higher levels of air pollutants and ultraviolet index, or lower β-activity of the radionuclide-associated aerosols. The higher phenol and formaldehyde levels the higher incidence rates of infantile eczema were observed among boys 0-1years of age and girls 1-2years of age. The higher total column ozone with lower lead level was associated with low incidence rates of infantile eczema among boys and girls 1-2years of age. Urban outdoor air pollutants and their combination with meteorological conditions may impact onset of infantile eczema in both genders.

Are we doing better? Barium enema reduction of intussusception.

Introduction Intussuception remains one of the most common surgical abdominal emergencies in the paediatric population. The aim of this study was first to re-evaluate our non-operative reduction rate of intussusception using multiple interval barium enemas and second to investigate or discuss an audit cycle, providing evidence and validating the modification of clinical practice. Materials and methods This five-year retrospective study performed at one of two institutions at which a paediatric surgical service is offered. Individuals included were all patients under 12-years of age who were diagnosed with intussusception. Factors considered to be influential in the reduction of the intussusception were collected. End points were defined as successful barium enema reduction or surgical intervention. Results were compared with similar research published in 2010. Results Overall prevalence was found to be 12 cases/year, with a sample size of 60 patients, the mean age at presentation of 13.6 months. Barium enema reduction was attempted in 56/60 patients, while 4/60 patients had operative management as a first intervention. Overall reduction rate was 66% (37/56), 78% occurring on first attempt and 22% on the second attempt. There was no evidence of intussusception in 3/19 patients who had operative management as a second intervention. Delayed interval barium enema reduction demonstrated an improved reduction rate of 66% compared with single-use barium enema reduction of 41% (chi square 0.02). Conclusion A significant benefit was achieved by performing delayed interval enema reduction, which contributed to a 61% increased reduction rate, the actual reduction rate approaches 71%. The audit cycle remains of paramount importance to ensure optimum patient care.