At-risk Children Research Articles

Newborn Brain Function and Early Emerging Callous-Unemotional Traits

Children with high callous-unemotional traits are more likely to develop severe and persistent conduct problems; however, the newborn neurobiology underlying early callous-unemotional traits remains unknown. Understanding the neural mechanisms that precede the development of callous-unemotional traits could help identify at-risk children and encourage development of novel treatments. To determine whether newborn brain function is associated with early-emerging empathy, prosociality, and callous-unemotional traits. In this prospective, longitudinal cohort study, pregnant women were recruited from obstetric clinics in St Louis, Missouri, from September 1, 2017, to February 28, 2020, with longitudinal data collected until March 20, 2023. Mothers were recruited during pregnancy. Newborns underwent brain magnetic resonance imaging shortly after birth. Mothers completed longitudinal follow-up when the children were aged 1, 2, and 3 years. The sample was enriched for exposure to socioeconomic disadvantage. Functional connectivity between hypothesized brain regions was assessed using newborn-specific networks and voxel-based connectivity analyses. Children's callous-unemotional traits were measured using the Inventory of Callous-Unemotional Traits. Empathy and prosociality were assessed using the Infant and Toddler Socio-Emotional Assessment. A total of 283 children (mean [SD] gestational age, 38 [2] weeks; 159 male [56.2%]; 2 Asian [0.7%], 171 Black [60%], 7 Hispanic or Latino [2.5%], 106 White [38%], 4 other racial or ethnic group [1.4%]) were included in the analysis. Stronger newborn functional connectivity between the cingulo-opercular network (CO) and medial prefrontal cortex (mPFC) was associated with higher callous-unemotional traits at age 3 years (β = 0.31; 95% CI, 0.17-0.41; P < .001). Results persisted when accounting for parental callous-unemotional traits and child externalizing symptoms. Stronger newborn CO-mPFC connectivity was also associated with lower empathy and lower prosociality at ages 1, 2, and 3 years using multilevel models (β = -0.12; 95% CI, -0.21 to -0.04; P = .004 and β = -0.20; 95% CI, -0.30 to -0.10; P < .001, respectively). Newborn functional connectivity was associated with early-emerging empathy, prosociality, and callous-unemotional traits, even when accounting for parental callous-unemotional traits and child externalizing symptoms. Understanding the neurobiological underpinnings of empathy, prosociality, and callous-unemotional traits at the earliest developmental point may help early risk stratification and novel intervention development.

Cortical Structure in Pre-Readers at Cognitive Risk for Dyslexia: Baseline Differences and Response to Intervention.

Early childhood is a critical period for structural brain development as well as an important window for the identification and remediation of reading difficulties. Recent research supports the implementation of interventions in at-risk populations as early as kindergarten or first grade, yet the neurocognitive mechanisms following such interventions remain understudied. To address this, we investigated cortical structure by means of anatomical MRI before and after a 12-week tablet-based intervention in: (1) at-risk children receiving phonics-based training (n = 29; n = 16 complete pre-post datasets), (2) at-risk children engaging with AC training (n = 24; n = 15 complete pre-post datasets) and (3) typically developing children (n = 25; n = 14 complete pre-post datasets) receiving no intervention. At baseline, we found higher surface area of the right supramarginal gyrus in at-risk children compared to typically developing peers, extending previous evidence that early anatomical differences exist in children who may later develop dyslexia. Our longitudinal analysis revealed significant post-intervention thickening of the left supramarginal gyrus, present exclusively in the intervention group but not the active control or typical control groups. Altogether, this study contributes new knowledge to our understanding of the brain morphology associated with cognitive risk for dyslexia and response to early intervention, which in turn raises new questions on how early anatomy and plasticity may shape the trajectories of long-term literacy development.

Trends in Severe Obesity Among Children Aged 2 to 4 Years in WIC: 2010 to 2020.

To examine the prevalence and trends in severe obesity among 16.6 million children aged 2 to 4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) from 2010 to 2020. Severe obesity was defined as a sex-specific BMI for age ≥120% of the 95th percentile on the Centers for Disease Control and Prevention growth charts or BMI ≥35 kg/m2. Joinpoint regression was used to identify when changes occurred in the overall trend. Logistic regression was used to compute the adjusted prevalence differences between years controlling for sex, age, and race and ethnicity. The prevalence of severe obesity significantly decreased from 2.1% in 2010 to 1.8% in 2016 and then increased to 2.0% in 2020. From 2010 to 2016, the prevalence decreased significantly among all sociodemographic subgroups except for American Indian/Alaska Native (AI/AN) children. The largest decreases were among 4-year-olds, Asian/Pacific Islander and Hispanic children, and children from higher-income households. However, from 2016 to 2020, the prevalence increased significantly overall and among sociodemographic subgroups, except for AI/AN and non-Hispanic white children. The largest increases occurred in 4-year-olds and Hispanic children. Among 56 WIC agencies, the prevalence significantly declined in 17 agencies, and 1 agency (Mississippi) showed a significant increase from 2010 to 2016. In contrast, 21 agencies had significant increases, and only Alaska had a significant decrease from 2016 to 2020. Although severe obesity prevalence in toddlers declined from 2010 to 2016, recent trends are upward. Early identification and access to evidence-based family healthy weight programs for at-risk children can support families and child health.

A systematic literature review of math interventions across educational settings from early childhood education to high school

Early math skills lay the foundation for children’s long-term academic success. An increasing number of randomized controlled math interventions have been carried out across educational settings. The aim of the present systematic review was to identify the distribution of the randomized controlled math interventions conducted between 2001 and 2021 in educational settings across Early Childhood Education (ECE) up to high school among various sample types, and to describe their central features at each educational setting separately. Based on the knowledge gaps exposed through the systematic review, we aimed to discuss where and how future math interventions are still needed in order to optimize all children’s math skill development across educational settings and sample types from early on. A total of n = 75 math interventions meeting the inclusion criteria using the PRISMA-guidelines were identified, of which the majority of them were executed in the elementary school, mostly targeting at-risk children. It is proposed that there is still a large potential of promoting children’s math skills from early on in the ECE settings, utilizing both teachers and parents, among at-risk and non-at-risk samples.

Incidence, associated factors, and outcomes of delirium in critically ill children in china: a prospective cohort study

BackgroundDelirium occurs frequently in critically ill children and has been reported in many countries, but delirium is not well-characterized in China. The aim of this study was to represent the incidence of delirium in critically ill children in China, its associated factors, and the influence of delirium on in-hospital outcomes.MethodsThis observational prospective cohort study was set up in a large academic medical center with a 57-bed PICU in southwestern China. Critically ill children who required PICU stays over 24 h and were admitted between November 2019 and February 2022 were included in this study. The Cornell Assessment of Pediatric Delirium was used twice daily for delirium evaluation by bedside nurses, and twenty-four clinical features were collected from medical and nursing records during hospitalization.ResultsThe incidence of delirium was 26.0% (n = 410/1576). Multivariate analysis revealed that seven independent risk factors including days of mechanical ventilation and physical restraints, admission diagnosis (neurologic disorder), sleep deprivation, use of benzodiazepines and dexmedetomidine, liver failure/liver dysfunction associated with delirium in critically ill children. One potentially protective factor was the watching television /listening to music/playing with toys. Children with delirium had longer lengths of stay in the PICU (median 11 vs. 10 days, p < 0.001) and hospital (median 18 vs. 15 days, p < 0.001) compared to those without delirium. Additionally, the in-hospital mortality rates were 4.63% and 0.77% in patients with and without delirium (p < 0.05).ConclusionsDelirium is common in critically ill children in China and related to poor outcomes. Interventional studies are warranted to determine the best practices to reduce delirium exposure in at-risk children.

Zonulin as a Biomarker for the Development of Celiac Disease.

Increased intestinal permeability seems to be a key factor in the pathogenesis of autoimmune diseases, including celiac disease (CeD). However, it is unknown whether increased permeability precedes CeD onset. This study's objective was to determine whether intestinal permeability is altered before celiac disease autoimmunity (CDA) in at-risk children. We also examined whether environmental factors impacted zonulin, a widely used marker of gut permeability. We evaluated 102 children in the CDGEMM study from 2014-2022. We included 51 CDA cases and matched controls, who were enrolled for 12 months or more and consumed gluten. We measured serum zonulin from age 12 months to time of CDA onset, and the corresponding time point in controls, and examined clinical factors of interest. We ran a mixed-effects longitudinal model with dependent variable zonulin. Children who developed CDA had a significant increase in zonulin in the 18.3 months (range 6-78) preceding CDA compared to those without CDA (slope differential = β = 0.1277, 95% CI: 0.001, 0.255). Among metadata considered, zonulin trajectory was only influenced by increasing number of antibiotic courses, which increased the slope of trajectory of zonulin over time in CDA subjects (P = .04). Zonulin levels significantly rise in the months that precede CDA diagnosis. Exposure to a greater number of antibiotic courses was associated with an increase in zonulin levels in CDA subjects. This suggests zonulin may be used as a biomarker for preclinical CeD screening in at-risk children, and multiple antibiotic courses may increase their risk of CDA by increasing zonulin levels.

International Humanitarian Award: Garth Neufeld.

This award recognizes extraordinary humanitarian service and activism by a psychologist or a team of psychologists, including professional and/or volunteer work conducted primarily in the field with underserved populations. "As president of Shared Space for All (SSFA), a nonprofit organization that educates and mentors impoverished youth in a village in the province of Isaan, Thailand, Mr. Garth Neufeld has successfully and strategically led the organization. SSFA promotes safer futures for youth in a context where poverty limits education and promotes migration to cities where a lack of skills translates into vulnerability to recruitment into sex work and trafficking. Over 200 at-risk school-aged children have received a range of services through SSFA, including supervised care before and after school, social services such as transportation, and full scholarships for higher education. The organization is exemplary in partnering with the local community and privileging the wisdom of those it serves. Mr. Neufeld has assembled a board of Thai and American members, mobilizing local commitment and engagement, harnessing the power of volunteers both local and overseas, underscoring contextually and culturally appropriate approaches, and balancing when to lead from the front or from behind. Mr. Neufeld is a tenured professor of psychology at Cascadia College, managing an active academic career and commitment to SSFA. He is a leader in Division 2, where he is highly regarded by his colleagues and has received multiple awards for teaching. Mr. Neufeld's vision through SSFA has been described as transformative, creating change by investing in the next generation to build human capital. Mr. Neufeld stands as a shining example of how psychologists can bring their skills and passion to organize and mobilize partnerships that can make a lasting difference in a vulnerable community. For these reasons, American Psychological Association's (APA's) Committee for Global Psychology is honored to present this award to Garth Neufeld." (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An exploration of the needs for expert consulting support and the changes of the early childhood teachers for children at risk of disabilities

Objectives The purpose of this study was to explore the needs of the early childhood teachers for expert consulting support for children at risk of disabilities, and what changes there are in early childhood teachers after participating in consulting. Methods The study participants are two early childhood teachers who are living with at-risk children age 3 and 4. And this researcher, a professor in the dept. of early childhood education who is very interested in and has extensive experience in children at risk of disabilities, directly observed children at risk of disabilities and then conducted interviews and consulted the early childhood teachers. In addition, data were analyzed based on interviews and consulting data for early childhood teachers and the researcher's field record notes. And the research results were derived. Results According to the results of the study, Firstly, early childhood teachers' needs for expert consulting support for children at risk of disabilities includes : 1) direct visits to early childhood education field by the experts, 2) expectations of the observation of children at-risk and advice between teachers and children and between children and children, 3) a request to establish a system in the early childhood education field applying interviews and micro-teaching, and 4) a request for the role of experts as mediators between parents and teachers. Secondly, changes in early childhood teachers after expert consulting support for children at risk of disabilities : 1) improving teachers’ capacity for children at risk of disabilities, 2) strengthening a sense of duty and responsibility as an early childhood teacher, and 3) increasing satisfaction and confidence through expert consulting. Conclusions The researcher is looking forward for this study to be served as a basic and practical data for early detection of children at risk of disabilities and becomes an educational support for them, furthermore support early childhood teachers in charge of children at risk of disabilities.

Sensorineural hearing loss among children at risk: A 16-year audiological records review in a tertiary referral center

ObjectivesHearing loss (HL) constitutes an increasing worldwide health problem. Neonatal hearing screening improved early detection and management to alleviate HL detriments on the person and society. Still, HL in childhood, beyond infancy, is under-investigated, especially in developing countries. This study aimed to explore the prevalence of HL in childhood amongst Jordanian children with HL risk factors and investigate the associated risk factors. MethodsRetrospective cross-sectional review of audiological records in a tertiary public and teaching hospital. The data of 1307 children aged 0–15 years who underwent audiological assessment from 2000 to 2016 were included. A review of diagnostic audiological and medical records was conducted to investigate the prevalence of sensorineural HL in high-risk (HR) children and the most contributing risk factors. ResultsDescriptive statistical analysis showed that the prevalence of sensorineural HL was 29.2% in the study sample. The HL was bilateral in 95% and mild to moderate HL in 73%. The mean age at the diagnosis was around 4.5 years. The most common risk factors were parental concern about their child's hearing, ototoxic drug use, and developmental and speech delay. The Chi-squared test showed that parental concern and ototoxic drug use were associated with an increased probability of having HL. ConclusionThe prevalence of HL amongst at-risk children in Jordan is relatively high, and the diagnosis is delayed. The results highlight the importance of implementing a hearing screening program in at-risk children. This needs to start from birth and include a serial follow-up to detect cases of delayed-onset HL.

The Role of Relationships in Resilience: Teachers Who Were At-Risk Youth Supporting At-Risk Students

Despite extensive research on resilience, little information exists on the resilience of teachers who faced adversity in childhood and the meanings they attribute to their current work with at-risk students. Thus, this study aimed to address this knowledge gap by examining the narratives of teachers who were at-risk children. Based on 30 semi-structured life-narrative interviews, the findings revealed the significant meaning that the participants ascribed to positive relationships. Whether such relationships were present or absent in their childhood, these relationships were instrumental in their choice to pursue a career in education. In supporting their students’ resilience and becoming the teachers they wanted as children, they found meaning in their past experiences of risk and coping. The study’s discussion applies the social mirroring theory to analyze how the participants resisted the negative image presented to them by others in their childhood and how a belief of hopeful prospects fortified them and led them to take on transformative justice as their life mission. Supporting at-risk children functioned as a form of healing for the participants, fostering both their students’ and their own resilience. The study findings highlight the importance of accounting for teachers’ childhood experiences as formative narratives that mold their educational work.

Tobacco and alcohol use among adolescents in Northern India.

Alcohol and cigarette usage are major public health issues that particularly affect young people worldwide. Because most users begin using these drugs well before the age of 18, there are significant psychosocial and health consequences. This study seeks to identify the incidence of underage drinking and smoking in northern India and the multiple risk factors associated with this exposure. A cross-sectional study was conducted on adolescents (13-18 years) from Northern India, to assess their knowledge, attitude, and practice of usage of alcohol and tobacco. The study was conducted using a semi-structured questionnaire for interview purposes and analyzed via Epi Info version 7. The mean age of the participants was 16.15 (1.34) years, of which 65.74% are males and 34.26% are females. 18.25% of students stay in a hostel. Of 108 participants, about 24.07% of students have tried their first cigarette before 18 years of age. 28.70% of students have people in their homes, and 41.67% have friends who use tobacco. Among the 108 respondents, 26.85% of students have tried or used alcohol before 18 years of age. It is crucial to create preventive techniques to lessen tobacco use in light of the significant negative health effects that come along with tobacco addiction. Spreading awareness among at-risk children and adolescents by limiting advertising and promotional efforts, early user detection and treatment are all examples of preventive techniques.

Optimizing discharge readiness to reduce health disparities for at-risk children with cancer in the Bronx.

407 Background: Transitions in care between hospital and home are overwhelming for patients and families, and often result in medical errors. Children with cancer are at an increased risk of adverse outcomes due to their immunocompromised state. Despite a robust therapeutic armamentarium, unfavorable outcomes secondary to disease- and treatment-related complications remain a challenge, and children with cancer are particularly vulnerable to these outcomes during transitions of care. At our institution, the pediatric oncology team noted that caregivers of patients with new pediatric cancer diagnoses often admitted to confusion regarding infection precautions, central venous catheter care, and medications when returning for follow up appointments. This experience is supported by data showing that caregivers of patients with leukemia feel subjectively unprepared to take care of patients after hospital discharge. The increasing prioritization of outpatient management in healthcare has shifted responsibility for identifying and managing emergencies and complications to caregivers. Methods: We initiated a comprehensive cancer-specific program through the use of quality improvement measures and four plan-do-study-act (PDSA) cycles to ensure consistency of healthcare provider-delivered education and improve caregiver knowledge of homecare instructions in a high-risk patient population. Results: Based on our recent publication, overall retention of key discharge information was greater in the intervention cohort compared to the non-intervention cohort (median total scores: 89 and 63, respectively; p=0.001). Improvements in the proportions of correct responses post-intervention were also observed across all subject matters: from 0.57 to 0.88 for fever guidelines (p=0.059), from 0.71 to 0.78 for signs of sepsis (p=0.65), from 0.57 to 1.00 for accurate choice of on-call number (p=0.004), and from 0.71 to 0.94 for antiemetic management (p=0.14). Conclusions: Our study demonstrated that standardized processes with a multi-disciplinary team and task allocation significantly improves ability of caregivers to retain important information after a new cancer diagnosis, with specific improvement in retention of fever guidelines and on-call contact instructions. During our intervention, it became clear that as team members change (residents changing cycle, oncologist going off service, nurses switching), having one point person is absolutely critical in ensuring discharge education continues. We anticipate that a dedicated patient navigator focused on consistent psychosocial screening and health literacy comprehension of key discharge details would lead to a marked improvement in cancer care delivery for children with cancer in the Bronx; specifically, discharge readiness, medication adherence, family satisfaction, and patient safety for children with cancer in the Bronx.

Utility of the material community deprivation index as a metric to identify at-risk children for severe traumatic brain injury

OBJECTIVE Pediatric traumatic brain injury (TBI) is a significant cause of morbidity and mortality with lasting effects including neurological deficits and psychological comorbidities. Recent studies have shown that social determinants of health are key factors that impact clinical outcomes in other pediatric traumatic injuries, suggesting that these health disparities may have a significant impact on patients sustaining TBI as well. The purpose of this study was to retrospectively review a cohort of pediatric patients diagnosed with TBI and elucidate the relationships among socioeconomic deprivation, patient-specific demographics, and morbidity and mortality. METHODS The authors conducted a retrospective cross-sectional analysis of pediatric patients (≤ 18 years of age) treated for TBI at a level I pediatric trauma center between 2016 and 2020. Patients with concussion-related injuries without intracranial findings and those with nonaccidental trauma were excluded from the study. In addition to evaluating basic patient demographics, the authors geocoded patient addresses to allow identification of the patient’s home census tract using the material community deprivation index (MCDI). The MCDI is a unique composite index score created by the combination of six census variables and ranges from 0 to 1 in severity. RESULTS Of the 513 patients included in this study, 71 (13.8%) were diagnosed with severe TBI, 28 (5.5%) with moderate TBI, and 414 (80.7%) with mild TBI. Patients in quartile 4 (MCDI ≥ 0.45) were at a significantly higher risk of having a severe TBI than patients in quartile 1 (OR 2.29, 95% CI 1.1–4.71; p = 0.02). Black patients were more likely to have a firearm-related TBI (OR 3.74, 95% CI 2.01–8.7; p = 0.018) than non-Black patients. Patients who lived in a neighborhood with a lower MCDI were significantly more likely to be discharged home than those who lived in an area with a higher MCDI (OR 2.78, 95% CI 7.90–32.93; p &lt; 0.001). CONCLUSIONS This study demonstrated that inequities continue to exist within the pediatric TBI population and that the MCDI is a valuable tool to identify at-risk subpopulations. More specifically, patients who lived in a neighborhood with a higher MCDI were at higher risk of sustaining a severe TBI. By partnering with communities, families, and policymakers, healthcare providers could serve as advocates for these patients and work to minimize the social disparities that continue to exist.

The Effects of a Multisector, Multilevel Intervention on Child Dietary Intake: California Childhood Obesity Research Demonstration Study.

Consuming too few fruits and vegetables and excess fat can increase the risk of childhood obesity. Interventions which target mediators such as caregivers' dietary intake, parenting strategies, and the family meal context can improve children's diets. A quasi-experimental, pre-post intervention with four conditions (healthcare (HC-only), public health (PH-only), HC + PH, and control) was implemented to assess the effects of the interventions and the effects of the mediators. HC (implemented with the Obesity Care Model) and PH interventions entailed capacity building; policy, system, and environment changes; and a small-scale media campaign to promote healthy eating. Linear mixed models were used to assess intervention effects and the mediation analysis was performed. Predominantly Hispanic/Latino children and caregivers from rural communities in Imperial County, California, were measured at baseline (N = 1186 children/848 caregivers) and 12 months post-baseline (N = 985/706, respectively). Children who were overweight/obese in the HC-only condition (M = 1.32) consumed more cups of fruits at the 12-month follow-up than those in the control condition (M = 1.09; p = 0.04). No significant mediation was observed. Children in the PH-only condition consumed a significantly higher percentage of energy from fat (M = 36.01) at the follow-up than those in the control condition (M = 34.94, p < 0.01). An obesity intervention delivered through healthcare settings slightly improved fruit intake among at-risk children, but the mechanisms of effect remain unclear.

Quality of childcare and delayed child development in left-behind children in China.

Inequalities in job opportunities and income prompts many Chinese parents to leave rural regions to work in urban regions. Their children are left behind in rural regions, subjected to worse quality of childcare that jeopardizes their development. This study aimed to examine the association between quality of childcare and delayed child development in under-three years children left behind in China. Cross-sectional national survey was conducted in children left behind in rural China in 2017. Exploratory and confirmatory factor analysis was used to develop a quality of childcare index. Mutlilevel analyses determined factors associated with quality of childcare and child development on a province and individual level. The largest population of at-risk children left behind were found in higher-GDP provinces. Children left behind had the lowest mean quality of childcare score. Multilevel analysis found that province level accounted for a great proportion of variance observed. While migration to urban regions for work may improve household income, a trade-off in worse quality of childcare and developmental delays exists. With improving household income often being the greatest contributing factor for parental migration, policies to reduce inequalities in job opportunities and wealth between rural and urban regions are required. Previous studies identified higher prevalence of developmental delays in children left behind in China. However, quality of childcare has not been examined. Based on WHO's Nurturing Care Framework, we developed a quality of childcare index to assess its association with child development in children left behind. Greatest proportion of children left behind at-risk of developmental delays resided in higher-GDP states, indicating a trade-off in worse quality of childcare and developmental delays. Since improving household income is the main factor for parental migration, policies to close inequalities in job opportunities and wealth between rural and urban regions are required.

Prevention Is Better than Cure: Impact of Allergen Immunotherapy on the Progression of Airway Disease

Allergen immunotherapy is highly effective for seasonal pollinosis. Three years of treatment results in long-term efficacy. This disease modification is accompanied by downregulation of allergen-specific Th2 responses and the induction of persistent specific IgG- and IgA-associated IgE-blocking activity. In children with seasonal rhinitis, both subcutaneous and sublingual pollen immunotherapy have been shown to reduce the development of asthma symptoms and asthma medication requirements. House dust mite tabletallergen immunotherapy has been shown to be effective for perennial mite-driven rhinitis in adults and children and may suppress asthma exacerbations, whereas its long-term efficacy has yet to be explored. The success of primary prevention of peanut allergy in childhood by introduction of peanut into the diet during infancy provides a strong rationale to explore whether primary prevention of inhalant allergies and asthma may also be possible. House dust mite allergy is a major risk factor for developing asthma. Preliminary data in at-risk children suggest that sublingual house dust mite immunotherapy initiated during infancy could reduce the onset of multiple allergen sensitizations and prevent the development of asthma at age 6 years. This possibility should now be explored in an adequately powered, prospectively randomized controlled trial.

A longitudinal study of school adjustment among children attending Reggio-inspired preschools

The goal of this study was to track the progress of Italian children at risk for school failure enrolled in preschools based on the Reggio-Emilia approach. Risk factors considered included family socioeconomic status (SES), child receptive language, and child gender. Participants were 211 children (Mage = 60.8 months, 116 girls) in Reggio-inspired preschools in Genoa, Italy. The sample was followed over six time points starting from the last year of preschool (ages 5–6 years) through the end of the second year of elementary school. We examined trajectories of school liking, teacher–child relationships, and teacher-rated language/mathematics. Trajectories of at-risk children were predominantly indistinguishable from those of the full sample. Children at risk because of lower SES and poorer receptive language (but not gender) were rated by teachers as more dependent than children not identified as at risk. Contrary to expectations, children of mothers from low-SES backgrounds liked school more than the rest of the sample.

Determinants of vascular structure and function in at-risk children born to mothers managed for pre-eclampsia (FINNCARE study).

Pre-eclampsia (PE) is related to elevated blood pressure (BP) in children. The study aims to investigate if elevated BP is reflected in child arterial health and how anthropometrics, body composition, and gestational and perinatal factors influenced this. In this prospective cohort study, we assessed the arteries of 182 children exposed (46 had an early onset, with a diagnosis before 34 gestational weeks, and 136 had a late onset) and 85 children unexposed (non-PE) to PE at 8-12 years from delivery using ultra-high-frequency ultrasound in addition to ambulatory and central BPs, body composition and anthropometrics, and tonometry-derived pulse wave velocity (PWV). No differences were found in intima-media thickness (IMT), adventitia thickness (AT), lumen diameter (LD), local carotid artery stiffness, distensibility, or wall stress between PE-exposed and non-PE-exposed children. All children's brachial, radial, and femoral artery IMTs were associated with 24-h systolic BP (SBP) and pulse pressure, carotid-femoral PWV, and anthropometric measures. The 24-h SBP and anthropometrics, notably lean body mass, were independent predictors of peripheral artery IMTs (brachial R2 = 0.217, radial R2 = 0.208, femoral R2 = 0.214; p < 0.001). Head circumference predicted carotid artery IMT and LD (β = 0.163, p = 0.009; β = 0.417, p < 0.001, respectively), but carotid artery IMT was not associated with BP. No independent associations were found for peripheral artery ATs. Local carotid artery stiffness, distensibility, and wall stress were independently associated with adiposity. No significant associations were found between gestational or perinatal factors and child vascular health parameters. The peripheral artery IMT of PE-exposed children is identical to that of non-PE-exposed children, but associated with BP. Adiposity is related to local carotid artery stiffness. These adverse associations in arterial health may reflect the early progression of cardiovascular disease in PE-exposed children.

Establishment of health related physical fitness evaluation system for school adolescents aged 12-16 in Pakistan: a cross-sectional study.

The decline in adolescent physical fitness is a significant global public health concern, and Pakistan is no exception. The country's absence of a health-related physical fitness (HRPF) evaluation system has compounded this issue. To bridge this gap, this study aims to develop a scientifically-based HRPF evaluation system for the adolescent population that meets international standards. The evaluation system identifies at-risk children and improves adolescent health outcomes, including obesity, cardiovascular and musculoskeletal disorders, chronic diseases, and psychological illnesses, through crucial physical fitness evaluation. This study specifically aims to establish an HRPF evaluation system for school adolescents aged 12-16 in Pakistan. A cross-sectional study was conducted among 2,970 school adolescents aged 12-16 years in the South Punjab, Pakistan. The study used a stratified sampling technique to select participants. The HRPF evaluation system included four components: cardiorespiratory endurance, core muscular endurance, muscular strength, and body composition. Data were collected through standardized tests and anthropometric measurements. The study's results indicated that the HRPF evaluation scoring system was feasible and valid for evaluating the HRPF of school adolescents in the South Punjab region of Pakistan. The results of the evaluation system categorized participants into five groups based on their performance: excellent (6.2%), good (24.9%), medium (50.7%), poor (17%), and very poor (1.2%). The study establishes an HRPF evaluation system for Pakistani school adolescents. This system lays the foundation for implementing effective strategies to improve their physical health. The findings offer valuable insights to policymakers, health professionals, and educators, enabling them to promote fitness and devise impactful interventions for enhancing HRPF in this population.

51 Mental Health Trajectories of Children and Caregivers who Accessed School-based Health Centres during the COVID-19 Pandemic

Abstract Background School-based health centres (SBHCs) improve health care access for students with mental health concerns, especially for disadvantaged communities who face access barriers. During the pandemic, health care access was restricted; however our SBHCs remained accessible. How SBHCs supported children’s and parents’/caregivers’ mental health during the pandemic is unclear. Objectives The primary objective of this study was to compare the trajectory of mental health symptoms in children who used SBHCs during the pandemic compared to those who did not. Design/Methods This was a prospective longitudinal cohort study of children who used SBHCs serving disadvantaged children with developmental and mental health conditions. A mental health survey which included the Strengths and Difficulties Questionnaire (SDQ) and the Generalized Anxiety Disorder-7 (GAD-7) was used at three time points during the pandemic for children registered with SBHCs. The primary analysis compared the trajectory of SDQ scores over time between children who accessed the SBHCs during the pandemic and those that did not. The secondary analysis was the same, using the GAD-7 scores for parents/caregivers. Results There were 435 children included in the study. The mean age was 10.7 years (SD=3.2). Two hundred and ninety-five children (67.8%) identified as male. One hundred and twenty-eight (29.4%) children had an annual family income of less than $30,000.00. After adjusting for age, gender, and diagnoses, children who attended SBHCs had higher SDQ scores over time relative to children who did not (0.15, 95% CI 0.03 to 0.28, p=0.02). Specifically, the total SDQ score increased by 0.14 (95% CI: 0.02, 0.27; p = 0.03) per month in those who accessed SBHCs during the pandemic, while the change in total SDQ score per month was -0.01 (95% CI: -0.06, 0.03; p = 0.55) in those who did not. Parents of children who attended SBHCs also had higher GAD-7 scores over time (0.16, 95% CI = 0.06 to 0.27, p = 0.002) compared with those whose children did not visit the SBHCs. Conclusion Mental health symptoms and anxiety symptoms worsened among children and parents/caregivers who attended a SBHC at least once during the pandemic. SBHCs may have decreased access barriers for children and parents/caregivers with socioeconomic risk factors who experienced mental health symptoms during the pandemic, when other healthcare options were limited. Longitudinal studies with longer follow up would help determine the role of SBHCs in supporting at-risk children and parents/caregivers with mental health needs during the pandemic.