Older Child Age Research Articles

Global Prevalence of Sexual Violence Against Children: A Systematic Review and Meta-Analysis.

Sexual violence against children is a global concern, yet worldwide figures of its prevalence are scant. To estimate the global prevalence of sexual violence against children using national-level population-based studies. We searched the PubMed, Embase, CINAHL, Web of Science, PsycINFO, ERIC, and APA PsycArticles databases from their respective inceptions to March 2022. Searches were updated through April 2024. Reports were included if (1) they were national-level population-based studies, (2) they reported lifetime or past-year prevalence data on any form of sexual violence against children (mean age ≤19 years), and (3) the data were based on children's self-reports of sexual violence perpetrated by anyone. Data extraction included study and participant characteristics, prevalence rates, and types of sexual violence. Outcomes were pooled using a random-effects model. Exploratory subgroup analyses were performed with categorical moderators. Primary outcomes included lifetime and past-year prevalence of forced sexual intercourse, contact sexual violence, and sexual harassment. We identified 165 studies that included 958 182 children from 80 countries, with the majority of data focusing on girls (58.2%). The sample sizes of the studies ranged from 330 to 132 948; the mean age ranged from 10.5 to 19.4 years. Lifetime sexual harassment was the most prevalent outcome, with a pooled rate of 11.4% (95% CI, 8.5%-15.1%), followed by any contact sexual violence, with a rate of 8.7% (95% CI, 4.7%-15.5%). Furthermore, 6.1% (95% CI, 5.1%-7.3%) of children reported experiencing completed forced sexual intercourse in their lifetime, and 1.3% (95% CI, 1.0%-1.7%) reported experiencing it in the preceding year. Rates of lifetime completed forced sexual intercourse were higher among girls (6.8% [95% CI, 6.1%-7.6%]) compared with boys (3.3% [95% CI, 2.5%-4.3%]), similar to past-year violence (2.3% [95% CI 1.9%-2.7%] for girls and 0.6% [95% CI 0.4%-0.9%] for boys). We found considerable variation across regions and countries in the reported prevalence of sexual violence. Older age of children, lower national income levels, and the use of school-based surveys were associated with higher rates of sexual violence reporting in some exploratory analyses. The findings of this systematic review and meta-analysis highlight the burden of sexual violence against children worldwide based on current available evidence. There is a pressing need to enhance data collection efforts globally, especially in underresearched regions and for boys. PROSPERO CRD42022327090.

Mental Health Impacts of the COVID-19 Pandemic on Australian Children and Adolescents with a Medical Condition: Longitudinal Findings

In Melbourne, Australia, strict ‘lockdowns’ were implemented in 2020 to suppress COVID-19, significantly disrupting daily life. Young people (<18 years) with medical conditions have an elevated risk of mental health problems and may have been disproportionately affected by the distress associated with the COVID-19 restrictions. To investigate this, we conducted a single-site, longitudinal cohort study involving the parents of 135 children and adolescents with medical conditions. Using an adapted version of the CoRonavIruS Health Impact Survey (CRISIS), parents rated their child’s mental health, activities and healthcare experiences pre-COVID-19 (retrospectively), during lockdown and 6 months post-lockdown. General linear mixed models revealed that mental health symptoms, including anxiety, fatigue, distractibility, sadness, irritability, loneliness and worry, were higher during lockdown compared to pre-COVID-19. Notably, anxiety, sadness and loneliness remained elevated 6 months post-lockdown. Covariates such as older child age, increased parent stress and child screen time contributed to greater mental health difficulties. While most mental health symptoms resolved post-lockdown, the persistence of anxiety, sadness and loneliness highlights the need for ongoing clinical monitoring for young people with medical conditions during periods of community stress and restrictions.

Sensitivity and Specificity of a Signaling Question for Surveillance of Cognitive Functioning in Pediatric Sickle Cell Disease.

Sickle cell disease (SCD) confers neurological risks that contribute to cognitive and academic difficulties. Clinical guidelines state that cognition should be monitored using signaling questions. However, evidence is lacking regarding the extent to which signaling questions accurately identify children with cognitive issues. Caregivers of youth with SCD between ages 7 and 16years (n = 89) responded to a signaling question about their child's academic performance: "How would you rate your child's academic performance relative to their peers?" Response choices included below grade level, on grade level, or above grade level. Youth with SCD completed the Wechsler Intelligence Scale of Intelligence, Fifth Edition to assess cognitive functioning. Most children were described by caregivers as being on grade level (67%), followed by below grade level (21%), and above grade level (11%). Cognitive testing revealed that 36% of participants had a low IQ (≤85; i.e., ≥1 SD below the mean), 60% had an IQ within normal limits (86-114; i.e., <1 SD below or above the mean), and 4% had a high IQ (≥115; i.e., ≥1 SD above the mean). Academic performance grouping was significantly associated with differences across cognitive domains (all p<0.001). Cognitive functioning varied by academic grouping for younger (ages 7-11; all p≤0.002) but not older children (ages 12-16; all p≥0.05). The signaling question's sensitivity for identifying those with cognitive difficulties was low (42%-54%); specificity, negative predictive value, and positive predictive value estimates were acceptable (87%-93%, 74%-84%, and 53%-79%, respectively). Asking caregivers of children with SCD to report on academic performance is a simple method of monitoring cognition. Children rated as below grade level should be referred for cognitive screening or evaluation. However, this question will likely result in a high rate of false negatives, and additional questions may be necessary to determine when to refer patients without obvious academic concerns.

Associations of early life per- and polyfluoroalkyl substances (PFAS) exposure with body mass index and risk of overweight or obesity at age 2-18 years: Mixture analysis in the prospective Boston Birth Cohort.

Per- and polyfluoroalkyl substances (PFAS) are a class of widespread persistent chemicals, which may have obesogenic effects during the fetal period. This study investigated the long-term association of maternal plasma PFAS concentrations at delivery and their mixture with child body mass index (BMI) and the risk of Overweight or Obesity (OWO) at the age of 2-18years. The study included 1189 mother-child dyads from the prospective Boston Birth Cohort. Eight PFAS were measured in maternal plasma samples collected 24-72h after delivery. Outcomes were BMI Z-score and OWO status of children at 2-18years. The exposure-outcome associations were evaluated with linear and modified Poisson mixed-effects regression for individual PFAS and Bayesian kernel machine regression and quantile-based g-computation models for PFAS mixture. We explored the effect modification by maternal pre-pregnancy OWO, child age, sex, and race. Maternal plasma samples had PFAS detection frequencies from 87% to 100% and geometric means ranging from 0.11 to 3.67ng/mL. PFHpS and PFHxS were associated with higher child BMI Z-score. Such associations were stronger in children aged 6-12years and 13-18years than in 2-5years. Stratified by maternal pre-pregnancy OWO, significant associations of the PFAS mixture with child BMI Z-score were only found in children of non-OWO mothers. In children aged 13-18years, children with both high maternal plasma PFDeA, PFNA, and PFOA concentrations and maternal OWO had the highest risks of OWO compared to children with either only. Such synergistic effects were not found in younger children. Early life exposure to individual PFAS and their mixture were associated with a higher risk of childhood OWO, with stronger associations observed in older child age groups and in children of non-OWO mothers. Synergistic effects of PFAS exposures and maternal pre-pregnancy OWO became evident in adolescence.

Whom to turn to? The association between childhood living arrangement and the parent-child relationship

Objective: First, the study examines if children’s perception of their parent-child relationship is associated with parental separation and second, it investigates if children’s perception of their relationship with parents is associated with their living arrangements post-separation. Background: Previous findings indicate that children living in shared residence generally fare better across several life domains compared to children living in sole parental households. There is, however, limited knowledge of how children perceive their relationships with both their separated parents during childhood. Method: The data includes two cross-sectional waves (2000 and 2010) of the child survey (Child-LNU) that accompanies the Swedish Level-of-Living Survey (LNU). The analytical sample consisted of 2,064 children (10-18 years), and the subsample of separated families comprised 455 children. Results: Children in separated families were less likely to turn to both parents when worried (emotional support) compared to children living with two custodial parents in the same household. Additionally, they were less likely to report that they get along very well with both parents. Children in shared residence arrangements did not differ significantly from children in households with two custodial parents, with the exception of older children (age 14-18), who also reported less often that they get on very well with both parents. In contrast, children in sole parental residence fared worse regarding both emotional support from, and relationship quality with, both parents. Conclusion: Shared residence enables children to maintain a relationship with both parents after separation, regarding both emotional support and relationship quality. This result is on par with the parental relationships of children in households with two custodial parents. Importantly, this study does not claim to provide causal interpretation due to the use of cross-sectional data.

Use of Child Restraint Systems in Thailand and Factors associated with it: A Cross-Sectional Study

Objective: To determine the use of child restraint systems among caregivers of children in Thailand and to identify factors associated with it. Materials and Methods: Caregivers of children under 12 years old who utilized medical services at Lampang Hospital between March 2023 and March 2024 were asked to participate in this cross-sectional study. Data on characteristics of child and caregiver, driving behavior, and knowledge about child restraint systems were collected via a questionnaire. Multivariable regression was applied to analyze associated factors. Results: Of the 322 eligible caregivers, 279 (86.6%) participated, of which 127(44.5%) used a child restraint system. A higher caregiver education level (odds ratio [OR] 2.28, 95% CI 1.18; 4.39), and driving 3–7 days per week (OR 3.92, 95% CI 1.82; 8.40) were associated with more frequent restraint use. A higher age of the child (OR 0.97, 95% CI 0.96; 0.98) was associated with less frequent restraint use. Conclusion: Fewer than half of the caregivers utilized child restraint systems. Higher caregiver education levels and more frequent driving were associated with more frequent use, while older child age was associated with less frequent use of child restraint systems. Targeted interventions are needed to improve the use of child restraint systems.

Development and Validation of an Assessment-Driven Behavioral Intervention for Primary Complex Motor Stereotypies in Young Children.

Complex motor stereotypies are rhythmic, repetitive, fixed, and non-goal directed movements (e.g., bilateral flapping/waving movements of the hands/arms). Movements typically begin in early childhood and can occur in otherwise normally developing ("primary") or autistic ("secondary") children. Stereotypies persist, occur multiple times a day, have prolonged durations, can be socially stigmatizing, and may lead to bullying and isolation. Prior behavioral treatment studies have focused on older children (ages 6-12) and report modest reductions in stereotypy (i.e., between 14% and 33%). The current study involves the functional assessment and treatment of five children with Primary Complex Motor Stereotypy using a modified awareness training procedure, differential reinforcement of other behavior, and schedule thinning in a nonconcurrent multiple baseline design. Results suggest a 99% reduction of motor stereotypy from baseline across all participants.

A Demographic Description of Children and Adolescents With Concomitant Autism and Anxiety Along With a Comparison of Receipt of Psychological Services.

(1) Evaluate differences in demographic distributions between those with autism alone and those with autism concomitant with anxiety and (2) assess demographic factors associated with receipt of psychological therapy in patients with autism. Using deidentified health care claims data, we extracted all encounters among children with the International Classification of Diseases-10-CM for Autism Spectrum Disorder (F84) and flagged those with concomitant anxiety (F41.9). Extracted data included age, sex, race, ethnicity, insurance status, and Rural-Urban Continuum Codes. Current procedural terminology codes for psychological services were extracted. Data were analyzed using Mann-Whitney U tests, χ2 tests of association, and logistic regression. Demographic differences between children/adolescents with autism alone versus autism concomitant with anxiety were noted for age, sex, and race/ethnicity, with a greater prevalence of autism/anxiety identified in older-aged children and children identifying as female and non-Hispanic White residing in an urban area. While 21% of those included in this study had received psychotherapy, the percentages within the autism only and autism/anxiety groups were 12% and 50%, respectively (p < 0.001). Children/adolescents who were older age quartile, resided in an urban residence, and with a concomitant diagnosis of anxiety were more likely to receive psychological services, while non-Hispanic Other were less likely to, compared with the reference of non-Hispanic White. We identified demographic disparities in the diagnosis of autism versus autism with concomitant anxiety, including age, sex, race/ethnicity, and residence location. Age quartile, urban location, and concomitant anxiety were associated with increased likelihood of receipt of psychological services.

COVID-19 Vaccine Hesitancy in Caregivers of Hospitalized Children From 2020 Through 2023.

Data on US caregiver perceptions on coronavirus disease 2019 (COVID-19) and COVID-19 vaccination are limited. We identified trends in and associations with COVID-19 vaccine hesitancy in caregivers of hospitalized children. Cross-sectional surveys on pediatric COVID-19 disease and vaccine attitudes, behaviors, and beliefs were administered across study years (December 8, 2020-April 5, 2021, November 30, 2021-March 15, 2022, and October 26, 2022-March 15, 2023). English and Spanish-speaking caregivers of hospitalized children ages 6 months to 11 years were included. General vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines survey. Of 1268 caregivers from diverse backgrounds, one-third vaccinated or intended to vaccinate their child. Half endorsed fear of their child receiving the COVID-19 vaccine and were concerned the vaccine was new. Over time, more believed "the COVID-19 vaccine does not work" and fewer agreed "children who are otherwise healthy can die from COVID-19." Study season (2022-2023), older child age, higher income, child receipt of influenza vaccine, caregiver receipt of COVID-19 vaccine, and not being worried about vaccine novelty were positively associated with child vaccination. Intent to vaccinate was negatively associated with study season (2022-2023), Parent Attitudes about Childhood Vaccines score ≥50, lack of child influenza and caregiver COVID-19 vaccination, lack of fear of their child "getting COVID-19" and being "worried that the COVID-19 vaccine is new." The majority who intended to vaccinate were willing to immunize before discharge. Vaccine novelty and perceived lack of need were associated with refusal. Caregiver COVID-19 and child influenza vaccine acceptance were positively associated with COVID-19 vaccine acceptance. The inpatient setting offers the opportunity to improve vaccine uptake.

Maternal child maltreatment and trajectories of offspring behavioural and emotional difficulties from age 4 to 7 years - results from a prospective birth cohort study.

Maternal experience of child maltreatment (CM) has been associated with maternal and child mental health. However, evidence about the course of child mental health and maternal CM is scarce. Therefore, this study aims to compare trajectories of mental health in children according to maternal CM exposure and maternal mental health. We included 327 mothers and their singleton child from the Ulm SPATZ Health Study, a prospective birth cohort study. Child mental health was determined by the Strength and Difficulties Questionnaire (SDQ) at the age of 4, 5, 6, and 7 years and maternal CM by the Childhood Trauma Questionnaire (CTQ). Results display that maternal CM is associated with more behavioural and emotional difficulties in children, a trend that tends to increase with older child age. The sum of maternal mental health problems across this time course mediates this association. Male child sex is associated with more mental health problems in the child and the mother. These results provide an important first insight into the relevance of maternal CM on the trajectories of mental health in the offspring and highlight the importance of chronicity and severity of maternal mental health. Further prospective research in cohorts with longer follow-ups up into adolescence and adulthood is needed.

Child Age at Time of First Maternal Concern and Time to Services Among Children with Autism Spectrum Disorder.

Early treatment of autism spectrum disorder (ASD) can improve developmental outcomes. Children with ASD from minority families often receive services later. We explored factors related to child's age at time of mother's first concerns about child's development and subsequent time to service initiation among children with ASD. Analysis included 759 preschool-age children classified with ASD based on comprehensive evaluations. Factors associated with retrospectively reported child age at time of first maternal concern and subsequent time to service initiation were investigated using multiple linear regression and Cox proportional hazards. Earlier maternal concern was associated with multiparity, ≥1 child chronic condition, externalizing behaviors, and younger gestational age, but not race/ethnicity. Time to service initiation was longer for children of non-Latino Black or other than Black or White race and higher developmental level and shorter for children with ≥1 chronic condition and older child age at first maternal concern. Parity, gestational age, and child health and behavior were associated with child age at first maternal concern. Knowledge of child development in multiparous mothers may allow them to recognize potential concerns earlier, suggesting that first time parents may benefit from enhanced education about normal development. Race/ethnicity was not associated with child's age when mothers recognized potential developmental problems; hence, it is unlikely that awareness of ASD symptoms causes racial/ethnic disparities in initiation of services. Delays in time to service initiation among children from racial/ethnic minority groups highlight the need to improve their access to services as soon as developmental concerns are recognized.

Coverage and determinants of COVID-19 child vaccination in Munich, Germany in October 2022-January 2023: Results of the COVIP-Virenwächter study.

COVID-19 vaccination reduces the risk of severe disease, in children as well as adults. We studied COVID-19 vaccination coverage among children, parental COVID-19 vaccination intent for their children and determinants of vaccination among children to inform communication strategies. We invited parents of children aged 6 months-11 years in Munich, Germany, to an anonymous online survey between 13.10.2022 and 15.01.2023. Parents reported COVID-19 vaccination status and, for unvaccinated children, vaccination intent per child. We determined vaccination coverage (≥ 1 dose) and parental intent, and subsequently used logistic regression to identify determinants of vaccination, including the 5C psychological antecedents of vaccination (confidence, complacency, constraints, calculation, collective responsibility). In total, 339 parents reported on 591 children. Vaccination coverage was 7% (6/86) amongst 6-months-4-year-olds and 59% (295/498) amongst 5-11-year-olds. For unvaccinated 6-months-4-year-olds, 31% of parents reported high, 13% medium, 56% low vaccination intent; for 5-11-year-olds 8% reported high, 20% medium, 71% low intent. Positive determinants of vaccination were older child age, child belonging to a clinically vulnerable group, as well as parental COVID-19 vaccination, higher education level, country of birth Germany, and high level of trust in official guidelines; a negative determinant was previous vaccination refusal. For 5-11-year-olds, additional positive determinants were higher confidence and lower complacency. Conclusion: While a substantial proportion of 5-11-year-olds were vaccinated against COVID-19, coverage was low among 6-months-4-year-olds. Parental vaccination intent for unvaccinated children was low. Vaccination communication should take into account parental socio-demographic characteristics and specifically address individual risks and benefits of child vaccination. What is Known: • COVID-19 vaccination lowers severe disease risk in all ages. • Germany recommends vaccination for 5-11-years-olds since December 2021 and for 6 months-4 year-olds since November 2022. What is New: • In Munich, vaccine uptake was high in 5-11-year-olds but parental intent for not yet vaccinated children was low; the opposite was the case for 6-months-4-year-olds;vaccination determinants were eligibility, parental education, birth country and general vaccination hesitancy; psychological antecedents were confidence and complacency. • Tailored interventions should address guidelines, health literacy, cultural sensitivity, and boost confidence in vaccines and institutions while raising awareness of COVID-19 risks for children.

Molecular Epidemiology of Group A Streptococcus Isolated from Children in Beijing during 2011 to 2019

Abstract Objective This study aimed to examine the characteristics of Group A Streptococcus (GAS) infection and identify the emm genotypes and the superantigen gene of GAS strains isolated from children from 2011 to 2019 in Tongzhou District, Beijing. Methods Pharyngeal swab samples from children with scarlet fever or pharyngeal infection were collected and tested for GAS. In GAS isolates, emm genotypes and superantigen genes were identified. Logistic regression models were used to explore the correlations between demographic characteristics, clinical manifestations, and GAS infection. Results In total, 172/1,214 (14.2%) GAS were isolated. The GAS infection rate in children with scarlet fever was 47.5%, higher than 8.5% in children with pharyngeal infection (p &lt; 0.001). The risk of GAS infection was associated with oral mucosal congestion in children with scarlet fever, and older age, tonsillitis, and rash in children with pharyngeal infection. Seven emm genotypes were detected in 164 GAS isolated strains, of which emm12 and emm1 accounted for 47.0 and 46.3%, respectively. Among 112 GAS isolates, the top 5 detection rates of superantigen genes were speF 100.0%, speG 100.0%, speB 98.2%, speC 94.6%, and smeZ 82.1%. Higher proportions of speA, speJ, and speK were detected in emm1 isolates, while speH and speI were more common in emm12 isolates (p &lt; 0.001). Conclusion The changing predominant type expanded the knowledge of the circulating emm types, which should be considered in future vaccine development.

Older age, CNS leukaemic involvement and induction tumour lysis increases the risk of methotrexate (MTX)-induced neurotoxicity in childhood acute lymphoblastic leukaemia/lymphoma: Experience from a tertiary care centre in South India.

Methotrexate (MTX), although an indispensable part of contemporary treatment protocols for childhood acute lymphoblastic leukaemia (ALL)/lymphomas (LBL) in improving outcomes, can lead to serious neurotoxicity with long-term consequences. The aetiopathogenesis, predisposing factors and treatment for MTX-induced neurotoxicity are not yet well defined. The aim of our study was to detect the incidence, risk factors and to assess the overall outcomes of MTX-induced neurotoxicity among large cohort of paediatric ALL/LBL patients treated on a uniform protocol. We conducted retrospective audit of medical records of 622 consecutive children (≤14 years) diagnosed with ALL and LBL between January 2018 and December 2022 and treated on modified BFM-95 protocol at the Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram. Risk factors predisposing to MTX-induced neurotoxicity were identified using binary logistic regression analysis. Forty-three children were diagnosed with MTX-induced neurotoxicity with an incidence rate of 6.9%. More than two-thirds of them had high-grade MTX-induced neurotoxicity CTCAE v5.0 with a median age of 9 years (range: 9 months to 14 years). Almost half of them developed MTX neurotoxicity during Protocol M followed by Phase-Ib consolidation (15%). Majority of these patients (84%, 36/43) were challenged again with MTX, with 11% (4/36) developing recurrence. Fifteen per cent had persistent neurological deficits at last follow-up. Univariate analysis found older age (age > 5 years) (p < 0.001), T-cell phenotype (p = 0.040), tumour lysis syndrome during induction (p < 0.001), baseline renal problems prior to MTX exposure (p < 0.001) and CNS leukaemic involvement (p < 0.003) to be significantly associated with MTX neurotoxicity. On multivariate analysis, older age (>5 years), tumour lysis during induction and CNS leukaemia retained statistical significance (p < 0.05). Methotrexate-induced neurotoxicity during paediatric acute lymphoblastic leukaemia/lymphoma therapy is a transient phenomenon in majority and re-challenge with MTX is generally safe. Older age children who develop tumour lysis during induction and CNS leukaemic involvement are at increased risk for MTX-induced neurotoxicity during ALL/LBL treatment.

Home participation and personal and environmental factors in children and adolescents with Down syndrome.

To describe current home participation (frequency, involvement) and caregiver's desire for change in home participation of children and adolescents with Down syndrome, as well as home environmental factors, and to explore the associations of personal and environmental factors with current participation and caregiver's desire for change. Eighty-two caregivers (mean age = 45 years 10 months) of children and adolescents with Down syndrome (mean age = 10 years 7 months) were surveyed about the child's home participation and environmental factors using the Participation and Environment Measure-Children and Youth. Furthermore, children's personal and environmental factors were collected. Results are reported using descriptive analysis and correlations (Spearman's rank correlation coefficients and Mann-Whitney U test) to describe the relationship between current participation and caregiver's desire for change, with personal and environmental factors as ordinal and nominal variables respectively (p < 0.05). Children's participation was highest with regard to personal care management and lowest with regard to school-related activities. Most caregivers desired change in homework and household chores. Greater frequency was associated with male sex, caregiver less rigorous social distancing due to the COVID-19 pandemic, and children receiving therapies. Greater involvement was associated with younger age in children and higher environmental support. Older age in children was associated with caregiver's greater desire for change. Personal and environmental factors correlated with participation in specific ways. Creative strategies to promote participation that consider caregiver's wishes should be undertaken.

A comparison of caregiver-reported snoring and objective snoring in children from urban neighborhoods

ObjectiveSleep Disordered Breathing (SDB) is both prevalent and under-recognized in pediatric minority populations. Recognition of SDB is often triggered by symptoms of caregiver-reported snoring. However, the validity and utility of caregiver reports likely vary across populations. Our objective is to assess the association between caregiver-reported snoring and objectively recorded snoring in a low-income urban community and explore factors associated with agreement between objective and subjective snoring. Methods169 6 to 12 year old participants underwent at-home sleep studies with a WatchPAT device as part of the Environmental Assessment of Sleep in Youth (EASY) cohort study. Differences in subjective snoring, objective snoring, and concordance between subjective and objective snoring based on socioeconomic and clinical characteristics were assessed. ResultsThe sample had a high proportion of non-white (78.9 %) and low income (39.6 %) children. Caregivers reported snoring for 20.7 % of the children and snoring was measured objectively for 21.9 %. Of those with objective snoring, only 29.7 % were identified as snorers by caregiver report (sensitivity: 0.30; specificity: 0.82). Primary Spanish language and co-sleeping were associated with increased caregiver reported snoring, and allergy was associated with increased objective snoring. Older child age and normal range BMI percentile were associated with higher concordance between caregiver and objective snoring. ConclusionsAmong a community-based, predominantly minority sample, caregiver-reported snoring resulted in under-estimation of prevalence of objectively assessed snoring. Reliance on caregiver report may poorly identify children with snoring or SDB in clinical practice.

Cholera toxin and O-specific polysaccharide immune responses after oral cholera vaccination with Dukoral in different age groups of Bangladeshi participants.

Vaccination is important to prevent cholera. There are limited data comparing anti-O-specific polysaccharide (OSP) and anti-cholera toxin-specific immune responses following oral whole-cell with cholera toxin B-subunit (WC-rBS) vaccine (Dukoral, Valneva) administration in different age groups. An understanding of the differences is relevant because young children are less well protected by oral cholera vaccines than older children and adults. We compared responses in 50 adults and 49 children (ages 2 to <18) who were administered two doses of WC-rBS at a standard 14-day interval. All age groups had significant IgA and IgG plasma-blast responses to the OSP and cholera toxin B-subunit (CtxB) antigens that peaked 7 days after vaccination. However, in adults and older children (ages 5 to <18), antibody responses directed at the OSP antigen were largely IgA and IgG, with a minimal IgM response, while younger children (ages 2 to <5) mounted significant increases in IgM with minimal increases in IgA and IgG antibody responses 30 days after vaccination. In adults, anti-OSP and CtxB memory B-cell responses were detected after completion of the vaccination series, while children only mounted CtxB-specific IgG memory B-cell responses and no OSP-memory B-cell responses. In summary, children and adults living in a cholera endemic area mounted different responses to the WC-rBS vaccine, which may be a result of more prior exposure to Vibrio cholerae in older participants. The absence of class-switched antibody responses and memory B-cell responses to OSP may explain why protection wanes more rapidly after vaccination in young children compared to older vaccinees.IMPORTANCEVaccination is an important strategy to prevent cholera. Though immune responses targeting the OSP of V. cholerae are believed to mediate protection against cholera, there are limited data on anti-OSP responses after vaccination in different age groups, which is important as young children are not well protected by current oral cholera vaccines. In this study, we found that adults mounted memory B-cell responses to OSP, which were not seen in children. Adults and older children mounted class-switched (IgG and IgA) serum antibody responses to OSP, which were not seen in young children who had only IgM responses to OSP. The lack of class-switched antibody responses and memory B-cell responses to OSP in younger participants may be due to lack of prior exposure to V. cholerae and could explain why protection wanes more rapidly after vaccination in young children.

Mapping the duration and severity of preschool-aged children's depressive moods and behaviors.

Depressive moods and behaviors are developmentally normative, yet potentially impairing, in preschool-aged children. In addition to frequency, duration of behavior is an important parameter to consider when characterizing risk for worsening mood dysregulation. The goal of this study was to identify the duration and severity of depressive moods and behaviors and associations with impairment in a large community sample of preschool-aged children using an online parent-report daily diary. Primary caregivers (N = 900) of 3-5-year-old children reported the daily duration of each instance of seven depressive moods and behaviors for 14 days. We used item response theory analyses to examine duration item characteristics. Moods and behaviors occurred at specific durations to be considered psychometrically severe/rare; for example, instances of sadness had to last an average total of 32 min per day or more, irritability at least 38 min, tantrums at least 30 min, and tearfulness/sensitivity at least 35 min. Longer durations of mood and behavior were associated with daily impairment, as well as older child age and less parental education. To our knowledge, this is the first study to delineate specific duration ranges for depressive moods and behaviors in preschool-aged children. These data, coupled with information about the frequency of mood-related behaviors, can assist child practitioners in differentiating normative patterns from less normative mood problems to evaluate which children may be at risk. Future work should identify the duration of depressive moods and behaviors in early childhood that predict clinically significant psychopathology over time.

Posttraumatic stress and depression symptom classes in parents of trauma-exposed children: a transdiagnostic perspective using pooled individual participant data.

Background: In the aftermath of child trauma, post-traumatic stress (PTS) and depression symptoms often co-occur among trauma exposed children and their parents. Studies have used latent class analysis (LCA) to examine PTS and depression symptoms and identify homogeneous subgroups among trauma exposed children. However, little is known about subgroups or classes of PTS and depression reactions of parents of traumatised children.Objectives: (1) Determine PTS and depression symptom classes at 2-9 months post-trauma, and (2) to examine sociodemographic covariates among parents of trauma exposed children.Methods: Using harmonised individual participant data (n = 702) from eight studies (Australia, UK, US) included in the Prospective studies of Acute Child Trauma and Recovery Data Archive (PACT/R), we modelled these phenomena at the symptom level using LCA.Results: Our LCA yielded three solutions: 'high internalizing symptom' class (11%); 'low PTS-high depression' class (17%); and 'low internalizing symptom' class (72%). Parents of children in the 'low PTS-high depression' class were more likely to have children of older age and be part of an ethnic minority, compared to the 'low internalizing symptoms' class. Mothers were more likely to be in the 'high internalizing symptom' class compared to the 'low internalizing symptoms' class.Conclusions: These findings reveal a qualitative structure and relationship between depression and PTS symptoms that highlights the importance of assessing and targeting a broad range of internalising symptoms in post-trauma psychological treatment.

Determinants of severe acute malnutrition among under-five children in Ethiopia: analysis using data from the 2016 Ethiopia Demographic and Health Survey.

Malnutrition is a silent killer that is under-reported, under-addressed, and, as a result, emphasized. This study aimed to identify the determinants of severe acute malnutrition (SAM) among under-five children in Ethiopia. Cross-sectional data from the 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 6,170 under-five children were included in the current analysis. The data were cleaned and analyzed using STATA 14. An adjusted odds ratio (AOR) and their 95% confidence intervals (CIs) were calculated to determine the association between factors and outcomes. A p-value of less than 0.05 was considered significant in multivariable logistic regression. A multivariable logistic regression revealed that under-five children with the age of children in months 6-11 (AOR = 1.52, 95% CI: 1.25, 1.86), 12-23 (AOR = 1.98, 95% CI: 1.65, 2.37), and 24-59 months (AOR = 1.71, 95% CI: 1.40, 2.08), birth order between fourth and fifth (AOR = 1.24, 95% CI: 1.01, 1.54), having fever (AOR = 1.31, 95% CI: 1.09, 1.58), anemic children (AOR = 1.21, 95% CI: 1.07, 1.36), age of mothers in years 25-34 (AOR = 0.60, 95% CI: 0.51, 0.72) and 35-49 (AOR = 0.49, 95% CI: 0.39, 0.63), antenatal care (ANC) visits (AOR = 0.83, 95% CI: 0.71, 0.92), rural residence (AOR = 2.98, 95% CI: 2.54, 3.49), and solid fuels users (AOR = 2.46, 95% CI: 1.86, 3.26) were significant predictors. Older age of children, those with higher birth order, those having fever, anemic children, those living in rural areas, and solid fuel users were more likely to suffer from SAM, while older mothers and those having ANC visits had reduced SAM as significant predictors.