Children Age Range Research Articles

Myeloproliferative neoplasm harboring both monosomy 7 and an ALK/ROS1 fusion gene: Proposal for a new disease entity

AbstractIntroductionWe present a case of a 9‐year‐old girl diagnosed with a myeloproliferative neoplasm (MPN) harboring both monosomy 7 and an ALK/ROS1 fusion gene.Case presentationThe neoplasm was resistant to conventional AML chemotherapy and required hematopoietic cell transplantation (HCT) to achieve remission.DiscussionMPNs with monosomy 7 and ALK/ROS1 fusions occur in a wide age range of children and adults, and require HCT for long‐term remission. Furthermore, these cases can be responsive to ALK inhibitors.ConclusionThis report underscores the potential need to reclassify such MPNs as a distinct entity, which has unique therapeutic implications.

Bromelain Supplementation in the Management of Otitis Media with Effusion in Children

Background/Objectives: The respiratory system is prone to infectious diseases, especially in children below five years of age. Upper respiratory tract infections in children are often associated with Eustachian tube dysfunction and complicated by otitis media with effusion (OME), an inflammatory process within the middle ear, which can lead to hearing loss. Treatment for these infections involves a combination of medication and symptom relief, depending on the severity and cause of the infection. In recent years, natural therapeutic drugs derived from herbal medicines have been gaining popularity in treating various pathologies. Bromelain, one of the most studied natural compounds, has been investigated extensively due to its numerous pharmacological properties, offering a potential new avenue for treatment. Based on these promising findings, our study was designed to examine the efficacy of supplementation with bromelain in countering symptoms associated with OME. Methods: This study was conducted on data acquired from medical records from the Section of Audiology of the University of Palermo, focusing on the period of January 2022 to June 2023 and selecting 224 children (age range 1–8 years), namely 174 males and 50 females, who were evaluated for presumed OME at the audiology pediatric ambulatory. All patients selected before initiating pharmacological treatment underwent thorough screening regarding the functionality of the tympanic cavities, otoacoustic emissions, the auditory threshold, and the ear canal’s integrity. Results: The preliminary findings of this study are significant, demonstrating that supplementation with bromelain led to notable improvements in the symptoms accompanying OME after 15 days and 60 days of therapy. Notably, patients who received the bromelain supplement reported reduced mucus secretions and improved auditory function. Conclusions: These results underscore the potential of naturally occurring compounds as adjuvants to standard therapeutic strategies in treating OME.

Parental Representations and Emotional Availability: The Case of Children with Autism and Severe Behavior Problems.

Studies suggest that parents' emotional availability (EA) is associated with children's wellbeing, including in the case of children with autism. Our study extended prior research by examining the role of parents' representations in fostering parental EA and by focusing on fathers and on children with autism and severe behavior problems. We expected that parents' positive representations would be associated with higher EA and compared mothers' and fathers' representations and EA. Participants were 79 mothers and 69 fathers (child age range = 61-173months, 21.95% girls). Representation assessments included the Reaction to Diagnosis Questionnaire, tapping resolution with respect to the child's diagnosis, and the coherence and positive comments in parents' Five Minute Speech Samples about the child. Parents' EA was coded from parent-child play interactions. Controlling for children's autism symptoms and adaptive functioning, mothers' resolution with respect to the child's diagnosis and positive comments (but not coherence) were associated with their EA, and fathers' coherence (but not positive comments and resolution) was associated with their EA. Mothers expressed more positive comments than fathers, and the resolution and EA scores of mothers and fathers were significantly correlated. Our results highlight the importance of considering both parents' representations and EA when studying and working with families of children with autism and severe behavior problems.

Clinical and MRI Evaluation of Children with Leukodystrophies

Introduction: Leukodystrophies are a diverse group of rare, inherited neurodegenerative disorders affecting the brain’s white matter, leading to progressive neurological impairment. Magnetic Resonance Imaging (MRI) plays a crucial role in diagnosing these conditions, offering detailed insight into white matter abnormalities and aiding in distinguishing various leukodystrophies. Objective: This study aims to evaluate children with leukodystrophies using MRI, establish accurate diagnoses, assess the severity and extent of white matter lesions, and demonstrate the different patterns of abnormal myelination. Methods: This prospective observational study was conducted in the Department of Radiodiagnosis and Imaging at Sher-I-Kashmir Institute of Medical Sciences, Srinagar, from June 2022 to June 2024. All children suspected of having white matter disorders based on clinical features and biochemical tests were included. MRI was performed to identify patterns of white matter involvement, and findings were correlated with clinical data. Results: A total of 29 children (age range: 2 months to 18 years) were evaluated. MRI findings revealed that demyelinating leukodystrophies were the most common, with symmetrical white matter involvement. Hypomyelinating disorders showed diffuse white matter changes with sparing of the U-fibers. Specific patterns, such as tigroid appearance in metachromatic leukodystrophy and posterior fossa involvement in Alexander disease, were identified. MRI was instrumental in narrowing down differential diagnoses and identifying characteristic patterns for various leukodystrophies. Conclusion: MRI is an invaluable tool in the diagnosis and management of leukodystrophies in children. It allows for early identification of disease patterns, which is critical for appropriate clinical management and potential therapeutic interventions. Further research is needed to explore the genetic basis of these disorders in the Kashmiri population.

Artificial intelligence for children: UNICEF's policy guidance and beyond

AbstractThis policy review introduces the Policy Guidance on Artificial Intelligence (AI) for Children, produced by the United Nations Children's Fund (UNICEF). This Policy Guidance is the first international‐level output to boost the development of child‐centred AI and relevant policies. A main contribution of this Policy Guidance is that it outlines the foundations, requirements and specific recommendations for developing child‐centred AI and surrounding policies. The shortcomings of this Policy Guidance are also introduced, especially the insufficient gender responsiveness and age sensitivity, plus relatively low representation of the developing world. Possible suggestions for future updates of the Policy Guidance and improving policies on child‐centred AI are provided in this review, such as the inclusion of a broader age range of children during the consultation process. The coexistence of contributions and limitations of this Policy Guidance reflects the situation of development of child‐centred AI and relevant policies, which is currently immature but promising.

Child Abuse Incidences Per Child Year Predicted from the Available Average Incidence Combined with Foreign Incidences Per Child Year: Towards a New Policy

Child abuse is a worldwide recognized serious problem. Reliable child abuse incidences, preferably per child year, are fundamental for a sound detection and prevention program. Unfortunately, in most countries where child abuse data is available, incidences are not determined per child year but as an average over the child age range. In this paper we suggest a possible "next-best" solution for deriving child abuse incidences per child year when only an average value is available in an area or country. As method, we combined the country's measured average incidence with available (foreign) incidences per child year. The country's next-best incidences per child year will be estimated from its average, multiplied by the foreign incidences per child year divided by the foreign average. As results, we calculated the next-best Dutch age-dependent incidences by combining the Dutch average value with US and Ontario age-related incidences. We found comparable results for infants above 1 year and marked differences for children <1 year, likely due to cultural differences between the US and Ontario. In conclusion, next-best age-related child abuse incidences are obtainable in large areas or countries by choosing a smaller but representative region, the latter estimated from Ontario-data as ≥210,000 inhabitants, and establishing as perfectly as possible the optimal infra structure. A future perspective towards a new policy could be to initiate and stimulate this approach in the various European Union and United Nations Convention on the Rights of the Child member states.

Adapting the Lidcombe Program for 6–12-year-olds: insights from a video telehealth trial

ABSTRACT Purpose: Childhood stuttering is common and can have debilitating, long-term psychosocial implications if prompt and effective treatment is not provided. The Lidcombe Program has robust clinical evidence for treating stuttering in early childhood. The results of a recent Phase II trial with a cohort of 6–12-year-old children showed that this treatment may benefit a much broader age range of children than initially thought. Benefits included improved communication attitudes, and reduced impact of stuttering and social anxiety symptoms. This study describes how clinicians can use the Lidcombe Program flexibly to cater to the varied needs of older children. Method: The Johnson et al. (2024) trial of the Lidcombe Program included clinical mentoring meetings every 2 weeks between the treating clinician and a member of the Lidcombe Program Trainers Consortium. Practical recommendations and clinical resources were developed to help clinicians adapt aspects of the available Lidcombe Program Treatment Guide (Onslow et al., 2021) for 6–12-year-old children. Results: Five key themes emerged from the clinical mentoring meetings to support clinicians. These included (a) active generalization of stutter-free speech to everyday conversations, (b) strategies for engaging the child in treatment, (c) examples of non-verbal contingencies, (d) optimizing treatment dosage for busy families, and (e) versatile clinical resources for different settings and child ages. Conclusions: This report provides resources for speech-language pathologists who manage school-age children who stutter. The recommendations and resources described in this report are designed to assist clinicians with adapting the Lidcombe Program for a wider age range of children.

Population pharmacokinetic modeling of ceftriaxone in cerebrospinal fluid in children: should we be using once- or twice-daily dosing for meningitis?

Guidelines for bacterial meningitis in children recommend intravenous ceftriaxone 50 mg/kg (max 2 g) twice daily (BD) or 100 mg/kg (max 4 g) once daily (OD), leaving the decision regarding the dose frequency to the prescriber. We investigated the cerebrospinal fluid (CSF) penetration of ceftriaxone to evaluate whether one dosing regimen is superior. Unbound ceftriaxone concentrations were measured in serum and CSF samples from children aged 0-18 years treated with ceftriaxone if there was a sample remaining after clinical tests were performed. A serum-CSF population pharmacokinetic model was developed using non-linear mixed-effects modeling. The once- and twice-daily dosing regimens were simulated, and the probability of target attainment (PTA) was determined for maintaining a CSF concentration above a minimum inhibitory concentration (MIC) of 1 mg/L for common meningitis pathogens and 4 mg/L for Staphylococcus aureus for 100% of the dosing interval. Sixteen serum and 87 CSF samples were collected from 98 children (age range 0.1-18.5 years). The final two-compartment serum-CSF model included a renal maturation function with weight scaling on clearance and volume of distribution. The estimated serum:CSF uptake was 20.1%. For MIC 1 mg/L, the 24 h PTA was higher for OD (88%) compared with BD (53%) dosing, although both achieved a 100% PTA at steady state. For S. aureus (MIC 4 mg/L), neither dosing regimen was sufficient. Our findings support the use of a 100 mg/kg once daily regimen for empirical treatment of bacterial meningitis due to earlier achievement of the pharmacodynamic target. Neither dosing regimen was adequate for S. aureus meningitis.

Empatica E4 Assessment of Child Physiological Measures of Listening Effort During Remote and In-Person Communication.

Telepractice is a growing service model that delivers aural rehabilitation to deaf and hard-of hearing children via telecommunications technology. Despite known benefits of telepractice, this delivery approach may increase patients' listening effort (LE) characterized as an allocation of cognitive resources toward an auditory task. The study tested techniques for collecting physiological measures of LE in normal-hearing (NH) children during remote (referred to as tele-) and in-person communication using the wearable Empatica E4 wristband. Participants were 10 children (age range: 9-12 years old) who came to two tele- and two in-person weekly sessions, order counterbalanced. During each session, the children heard a short passage read by the clinical provider, completed an auditory passage comprehension task, and self-rated their effort as a part of the larger study. Measures of electrodermal activity and blood volume pulse amplitude were collected from the child E4 wristband. No differences in child subjective, physiological measures of LE or passage comprehension scores were found between in-person sessions and telesessions. However, an effect of treatment duration on subjective and physiological measures of LE was identified. Children self-reported a significant increase in LE over time. However, their physiological measures demonstrated a trend indicating a decrease in LE. A significant association between subjective measures and the passage comprehension task was found suggesting that those children who reported more effort demonstrated a higher proportion of correct responses. The study demonstrated the feasibility of collection of physiological measures of LE in NH children during remote and in-person communication using the E4 wristband. The results suggest that measures of LE are multidimensional and may reflect different sources of, or cognitive responses to, increased listening demand. https://doi.org/10.23641/asha.27122064.

The metalinguistic and metarepresentational attitude of early bilingual children: A study on definitional skills

Aims and objectives: Definitional skill is the ability to define words using canonical formats. This skill requires lexical, morpho-syntactic, and pragmatic abilities, as well as metalinguistic attitude. Bilingualism has a crucial role in cognitive development, especially in promoting metareflective competencies. The relationship between bilingualism and definitional skills is a very under investigated topic. The aim of this study is to explore in the same sample of bilingual children how they define words in both languages. Methodology: Thirty early bilingual minority language children (age range 7–16 years) were administered a definition task (Co.De.Scale). They were asked to define words both in their native language, Romanian (L1), and their second language, Italian (L2). Data and analysis: Data were analyzed via mixed-method effects. Furthermore, we were also interested in studying if there were any differences in the answer proportions per definitional level (from 0 to 6) between Italian and Romanian. Findings: The results showed the production of better definitions in L2 compared with L1. The finding is readable in the light of the different settings where the two languages are used: home/family for L1 versus at school/non-family contexts for L2. Originality: This is the first study to show the role of both educational school settings and language dominance in promoting development of formal definitional skills. More specifically, it is worth stressing the relevance to study this topic in minority language bilingual children. Implications: Given the lower performance of minority language bilingual children in defining in their native language L1, a crucial educational objective could be enhancing the definitional skills in L1, designing ad hoc interventions that boost formal instruction. In turn, this would favor more inclusion and the exploitation of the minority language children, as well as more intercultural integration, thus enhancing language minority cultures.

First-Drug Efficacy and Drug-Resistant Epilepsy Rates in Children With New-Onset Epilepsies: A Multicenter Large Cohort Study.

Objective: This study aimed to assess the first-drug efficacy rate in newly diagnosed children with epilepsies treated with antiseizure medications. Methods: This retrospective study was conducted on 1003 children (age range: 3-10 years, and the mean duration of follow-up: 22 ± 13 months) with newly diagnosed epilepsy. The following parameters were evaluated: first-drug efficacy rate, first-drug-failure rate, and drug resistance rate in the cohort. Results: The first-drug-failure rate was defined in 335/1003 (33%) of the patients, no seizure control in 315 (31%), and drug withdrawal in 20 (2%). There was no significant difference between the group with focal-onset seizures and the group with generalized onset seizures. The first-drug efficacy rate was 67% in children with focal-onset seizures and 66% in children with generalized-onset seizures. Adjunctive antiseizure medication therapy was initiated in 335 patients-dual therapy with 180 patients (18%) and polytherapy with 155 (15%). Drug-resistant epilepsy was defined as 15% in the follow-up period. Etiology-specific diagnoses of the cohort were structural (n = 165, 17%), genetic (n = 25, 3%), metabolic (n = 15%), immune-infectious (n = 17 (2%), and unknown (n = 781, 77%). With a comparison of the 2 most common etiology subgroups (structural versus unknown), a first-drug efficacy rate of 53% and a higher prevalence of drug-resistant epilepsy at 30% were observed in children with structural etiology. First-drug efficacy was statistically lower in children without well-defined epilepsy syndromes (65%) compared with the rate of those with well-defined epilepsy syndrome (79%). Conclusion: This study revealed a first-drug failure rate (33%) in the presented cohort with a drug-resistance epilepsy rate (15%).

Which Factors Predict L2 Receptive Vocabulary and Expressive Syntax in Bilingual Children from Low-SES Families?

The objective of the current study was two-fold. First, it aimed to estimate receptive vocabulary and expressive syntax skills in L2 Italian among early sequential/simultaneous bilingual children of migrant single-mother families with very low socioeconomic status (SES). This objective was achieved by matching the participants' performance with normative data. Secondly, this study aimed to identify which individual and language exposure factors contributed to learning L2 vocabulary and syntax. Twenty-four early sequential/simultaneous bilingual children (age range = 5.10-12.4 years) and their mothers were enrolled. Mothers answered questions about linguistic biography and demographic information. Children completed Lexical Comprehension, Sentence Repetition, and Non-Word Repetition tasks from the Language Assessment Battery for 4-12-year-olds to, respectively, assess receptive vocabulary, expressive syntax, and phonological processing. Moreover, non-verbal intellectual functioning was evaluated by the Raven's Test. Compared to normative data, 20 children showed lower receptive vocabulary abilities (<-1.5 SD), 24 lower expressive syntax skills (-2DS), and 7 children lower phonological processing (<-1.5 DS). Moreover, L2 phonological processing and the length of L2 exposure in an educational context positively predicted L2 receptive vocabulary as well as L2 expressive syntax skills. To date, performance in L2 among early sequential/simultaneous bilingual children from migrant households and very low SES remains underexplored. Future efforts need to be directed towards the understanding of factors that impact oral competence in L2, considering that these children will also be exposed to written L2 in the school context.

Specific and shared cognitive predictors of drawing and block building in typically developing children.

Spatial construction is a complex ability involving attention, global/local visual processing, mental representation, visuo-motor coordination and, to varying extent, working memory and executive functions, and verbal abilities. In developmental neuropsychology, little attention has been paid to comprehend whether and to what extent the above cognitive processes are involved in two main spatial construction tasks, that is drawing and block building. We used path analysis to test shared and specific effects of verbal and spatial working memory, spatial attention, inhibition, verbal abilities (vocabulary and naming), figure disembedding, mental rotation, and visual-motor coordination, as well as of demographics (sex, age and socio-economic status), on two classical drawing (Rey-Osterrieth Complex Figure; ROCF) and block building (Block design; BD) tasks in a sample of 195 typically developing children (age range: 7-11 years). Figure disembedding and visuo-motor coordination were the only shared predictors of both spatial construction tasks. Moreover, ROCF score was directly related with spatial attention and inhibition, while BD score was directly related with sex, vocabulary, mental rotation and backward spatial working memory. These findings distinguish between abilities involved in spatial construction regardless of the type of task and those specifically related to ROCF or Block Design, thus providing clues relevant to neuropsychological assessment and intervention in children with spatial construction disorders.

Religious Coping as Mediator of Sense of Competence and Post-traumatic Growth in Mothers of Children With Cerebral Palsy.

The present study aimed to determine whether religious coping mediates the relationship between parenting sense of competence (PSOC) and post-traumatic growth (PTG). Cross-sectional research design was used. A sample of 74 mothers (age range; 20-45 years) of CP children (age range; 2-9 years) was collected through purposive sampling from different physiotherapy centres and special education schools of Lahore. PSOC scale, brief RCOPE and PTG inventory were used. Positive religious coping partially mediated (β = 0.190, 95% CI [0.026, 0.374], p < 0.05) between PSOC and PTG. Partial mediation exists between PSOC and appreciation of life through pathway of positive religious coping (β = 0.040, 95% CI [0.007, 0.075], p < 05). Full mediation exists between PSOC and personal strength through pathway of positive religious coping (β = 0.041, 95% CI [0.001, 0.081], p < 0.05) and through negative religious coping (β = 0.034, 95% CI [0.002, 0.066], p < 0.05). Positive religious coping fully mediated (β = 0.029, 95% CI [0.007, 0.058], p < 0.05) between PSOC and spiritual change. Moreover, indirect effect of PSOC on relating to others and new possibilities through positive and negative religious coping was non-significant, indicating no mediation. Positive religious coping affected the association between PSOC and PTG, that is, mothers of CP children having high parenting competence are more likely to use positive religious coping strategies that results in more PTG.

Clinical and Hemodynamic Outcomes with Enalapril Orodispersible Minitablets in Young Children with Heart Failure Due to Congenital Heart Disease.

Background: The angiotensin-converting enzyme inhibitor (ACEI) enalapril is often administered to infants and young children with heart failure (HF) in various dosing regimens and formulations not adapted for their age. Methods: This prospective, two-center, open-label 8-week study evaluated an age-appropriate formulation of orodispersible minitablets (ODMTs) of enalapril (0.25 mg and 1 mg) in children aged 0 to 6 years with HF due to congenital heart disease. An age/weight-based dosing schedule was followed. Measures of echocardiographic parameters, blood pressure, heart rate, modified Ross score, and biochemistry were obtained over the 8-week period. The following two groups were assessed: ACEI-naïve and ACEI-pretreated patients. Results: In total, 53 children (age range of 0.05 to 4.8 years) were enrolled and 29 were ACEI-naïve. The average enalapril dose was 0.098 mg/kg (0.06-0.17 mg/kg) in the naïve group and 0.15 mg/kg (0.07-0.3 mg/kg) in pretreated patients. After 8 weeks, the modified Ross score and left ventricular diastolic dimension (LVD) z-score showed a significant decrease in both groups (p < 0.005). During 8 weeks follow-up, there were no difference in the z-scores for the systolic blood pressure (p = 0.071) or heart rate (p = 0.146). Conclusions: Pediatric patients treated with ODMTs of enalapril for 8 weeks had favorable improvements in LVD and HF symptoms.

Effects of cycling training on balance and gait in children with Duchenne muscular dystrophy: A randomized controlled study

Background and aimsAlthough aerobic exercises such as cycling and swimming are increasingly being recommended in Duchenne muscular dystrophy (DMD), their effect on gait and balance parameters is unclear. This study was aimed to investigate the effect of cycling training on balance and spatio-temporal gait parameters in children with DMD. MethodsAmbulant children (age range: 6.17–11.33 years) were randomly divided into two groups: home-based exercise training applied in the control group (n = 12) while 12 weeks of supervised submaximal lower extremity cycling training in addition to home-based exercise training performed in the study group (n = 11). Gait and balance parameters were evaluated using the GAITRite electronic walkway system and the Bertec Balance Check Screener™, respectively. Assessments were applied before and after 12 weeks of training. ResultsThe mean ages of the children in the study and control groups were 8.20 (SD:1.34) and 8.86 (SD:1.30) years, consecutively (p > 0.05). Considering the baseline values, the balance and spatio-temporal gait parameters of the children were similar except for the antero-posterior postural sway on the perturbed surface with eyes open (p > 0.05). There was a significant time x group interaction effect in favor of the study group for the antero-posterior postural sway of children on the normal surface with eyes open (F (1,58) = 12.62, p = 0.002). It was found that the antero-posterior postural sway on the normal surface with eyes open was improved in the study group within group comparison (F (1,10) = 8.50, p = 0.015). ConclusionsThe study showed that both the cycling and the home-based exercise training groups may maintain gait and balance parameters during the study. Adding a cycling training to the rehabilitation program can also provide additional contribution to improve antero-posterior balance.

Atypical Sensory Processing in Neurodevelopmental Disorders: Clinical Phenotypes in Preschool-Aged Children.

Sensory processing issues are frequent in neurodevelopmental disorders (NDDs), with very variable prevalence rates ranging from 20% to 95%. This study aimed to investigate sensory processing in preschool-aged children with NDDs, to clarify the epidemiology, and to identify associated or correlated clinical and psychometric variables. A total of 141 NDD children (age range 2-5 years old) were included and enrolled in two subgroups: 72 with ASD and 69 with other NDDs. A standardized neuropsychological evaluation was assessed (Griffiths III/WPPSI-III/Leiter-R, ADOS-2) and the parents completed the CBCL ½-5, the SPM-P, and the ADI-R. Atypical sensory processing was reported in 39.7% of the total sample, more frequently in ASD (44.4%) than in other NDDs (34.8%). No statistically significant differences were found regarding gender and developmental level. A positive correlation was found between sensory processing abnormalities and behavioral problems (p < 0.01). Compared to other NDDs, ASDs more frequently have atypical sensory processing and appear to present a specific vulnerability in the processing of proprioceptive and vestibular inputs. Our results suggest that sensory processing difficulties should be considered regardless of developmental level and in children with behavioral problems.

The Effect of 12 Weeks Training Program With TheraSuit and Its Durability on Balance Control and Gait Parameters in Children With Cerebral Palsy

Background and Aims The prevalence of spastic cerebral palsy is increasing rapidly among children, with a prevalence of 2-4 per thousand people. This study aimed to investigate the effect of 12 weeks training program with TheraSuit and its durability on balance control and gait parameters in children with cerebral palsy. Methods This quasi-experimental study was performed on children (age range of 6-12 years) with spastic diplegia cerebral palsy referred to occupational therapy and rehabilitation clinics in Hamadan City, Iran, in 2021. Twelve children were selected by convenience sampling. Without random assignment, the patients were divided into two groups: with and without TheraSuits. Before and after the intervention, the balance score and kinematic parameters, including step length, step width, walking speed, ankle, thigh and knee range of motion, were measured in stationary and moving positions in both groups. The exercises were performed for 12 weeks, three sessions every other day for one hour. The Mann-Whitney U and Wilcoxon tests were used to evaluate the effectiveness of the intervention. All statistical analyses were performed in SPSS software, version 24 at a significance level of 5%. Results The results showed a significant improvement in balance score after the intervention in the intervention group compared to the control group (P=0.002), but the speed of walking, hip and knee range of motion significantly decreased compared to the control group (P&lt;0.05). The results showed that 10 weeks and one month later, there was a lasting effect of training in both groups (P&gt;0.05). Conclusion Our results confirmed the effectiveness of corrective exercises in the group with TheraSuit, so its use in a rehabilitation program for cerebral palsy patients is recommended, and the durability of the exercise was seen in both groups.

Study the Effects of Age, Gender, and Body Mass Index on Heart Rate

Heart disease is one of the deadliest diseases in the world in 2019; the increase in deaths has reached 2 million to 8.9 million people since 2000. Heart rate (HR) is an essential medical helpful sign for quickly evaluating health and knowing a person's fitness. Besides cardio exercises, some non-physical activities influence HR, such as age, gender, and body mass index (BMI). This study aims to analyze the RR intervals in leads I, II, III, aVR, aVL, and aVF and determine the effect of age, gender, and BMI on HR. HR measurements were carried out using a portable ECG, the KardiaMobile 6L, during 30 seconds of recording on the subject in resting conditions and normal sinus rhythm. The number of subjects in this study was 168 people in 5 age groups, namely A (4-5 years), B (6-7 years), C (10-13 years), D (19-30 years) and E ( 55-75 years). Each age group consisted of female and male subjects, but complete BMI category variations were only found in group D. Based on the results of the HR analysis based on age, it can be concluded that with age, HR will decrease. This decrease is estimated at 4.19 bpm/year in the age range of children to adolescents (4.0 to 11.5 years) and 0.16 bpm/year in the age range of adolescents to the elderly (11.5 to 75 years). Based on gender in all age groups, it can be concluded that the average HR of women is not always higher than that of men. In group D (19-30 years), BMI in resting subjects did not affect HR. RR interval values ​​in lead I (0.6997 0.056), lead II (0.6998 0.056), lead III (0.6998 0.056), aVR (0.6998 0.056), aVL (0.6995 0.057 ) and aVF (0.6998 0.056) indicate that the RR interval values ​​for each lead are identical.

Current teachers' perceptions and students' perspectives regarding activities modalities, instructional settings during primary school physical education classes in China: a cross-sectional observational study.

This study set out to understand the association between teaching practices, teacher confidence, competence, self-efficacy, and the resulting student outcomes. Data regarding teaching behaviours were collected via video recording and then evaluated using the MASTER Observation Tool. The information about demographics, self-reported teaching confidence, competence, self-efficacy, and student outcomes was collected using questionnaires. The association between teacher characteristics, and teacher and/or student outcome variables were tested using a one-way analysis of variance (ANOVA). A total of ten primary schools were involved, including 597 children (age range: 10-12 years, grade 4-6) and 16 grade 4-6 PE teachers (with 16 PE classes). Most of the Physical Education (PE) lesson time was spent in training-form activities (60.2% ± 9.1), followed by instructional time (33.1% ± 8.6%), reflection (3.4% ± 2.3%), and warm-up (2.9% ± 2.0 %). It was observed that teaching behaviours and student outcomes were significantly better in urban than rural areas. Smaller class sizes (21-30 children) were found to have more positive feedback than larger ones (41-50 children). PE teachers with more than 10 years of teaching experience reported more teaching competence and self-efficacy than teachers with less than 10 years of experience. PE teachers with class sizes of 21-30 children enjoyed significantly better scores in self-efficacy than classes with 41-50 children. They also scored more highly in confidence and competence than classes with 41-50 and 51-60 pupils. The current study confirmed that teachers dedicated a large proportion of lesson time to PE delivering training-form activities, followed by instructional time. Teaching behaviour and student outcomes were associated with location and class size, but not gender. The study contributes to our understanding of PE instruction in Chinese primary schools and offers preliminary evidence to improve future PE teaching strategies in the country.