Children's Center Research Articles

Assessment of dust endotoxins, airborne bacteria, and PM2.5 at old-age nursing homes and children's daycare centers in the Seoul metropolitan area, South Korea

Indoor air pollutants are associated with adverse health effects in people, particularly children and older adults—the most vulnerable groups health-wise who also happen to spend much of their time in indoor environments. To contribute to knowledge on how these groups can be protected, this study sought to determine the relationships between indoor pollutants (dust endotoxins, airborne bacteria (AB), and particulate matter (PM2.5)) and environmental factors (temperature, relative humidity (RH), use of air conditioners (AC), use of windows, and season). For each pollutant, 360 samples were collected from 31 old-age nursing homes and 31 daycare centers in South Korea. The Mann–Whitney U test, Kruskal–Wallis rank sum, Spearman's rank analysis, and multivariate regression were used to determine whether there were significant differences between indoor pollutants and environmental factors. Dust endotoxin values ranged between < LOD and 632 EU/mL and between 306 and 632 CFU/m3 for AB, and ranged from 3.9 to 32.5 µg/m3 for PM2.5. Dust endotoxin levels showed a significant relationship with RH and season in the multiple regression analysis. Periodic AC filter cleaning and exchange, as well as proper RH management in these facilities may help reduce indoor biological pollutants. The findings of this study are informative for addressing the respiratory health issues of older people and children in indoor facilities.

Nurse leaders’ recommendations for implementing LGBTQ+ inclusive practices in health systems: A qualitative descriptive study

BackgroundDiscrimination against lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) individuals in healthcare settings remains a priority issue. Nurse leaders, who oversee the largest healthcare workforce, are critical in implementing inclusive practices to address LGBTQ+ discrimination, yet implementing LGBTQ+ inclusive practices and effective strategies is inconsistent. This qualitative descriptive study explored nurse leaders’ perceptions of LGBTQ+ inclusive practices across the United States to inform recommended strategies within health systems. MethodsTwenty-one nurse leaders (e.g., chief nurse executives) from diverse healthcare settings (e.g., children's hospitals and public health centers) in 12 states across the United States participated in semi-structured interviews from October to December 2023. Interview transcripts were analyzed using content analysis to (1) describe nurse leaders’ definitions of LGBTQ+ inclusive practices and (2) identify effective strategies for their implementation. ResultsNurse leaders defined LGBTQ+ inclusive practices to include delivering culturally responsive and competent care, fostering safe and affirming environments, integrating inclusivity into daily interactions and organizational culture, and supporting the needs of both LGBTQ+ staff and patients. Key implementation strategies included fostering a flexible organizational culture through open communication; a diverse workforce; and inclusive mission statements, policies, and strategic plans. Supportive infrastructure involved effective LGBTQ+ training and adapting electronic health record systems to include information on sexual orientation and gender identity. Active and interdisciplinary engagement from staff and leadership, as well as systematic data collection on patient and staff experiences, were essential for driving inclusivity. The advocacy highlighted included legislative support, discourse within the nursing profession, and the incorporation of LGBTQ+ inclusion into healthcare regulations and accreditation standards. Additionally, multisectoral partnerships with LGBTQ+ health experts and external organizations, along with multilevel evaluations, were recommended to develop tailored interventions and promote LGBTQ+ inclusive practices. ConclusionImplementing LGBTQ+ inclusive practices in healthcare is a multifaceted effort influenced by strategies at various levels. Promoting a supportive organizational culture, establishing comprehensive support structures, encouraging active engagement, and fostering community partnerships can address the needs of LGBTQ+ individuals more effectively. Future implementation efforts should tailor strategies to accommodate variability across healthcare settings and regions, ensuring that practices are both adaptable and sustainable.

Extracutaneous Lesions in Patients with Focal Scleroderma of Craniofacial Localization: a Retrospective Cross-Sectional Study

Background. Focal scleroderma is rare, acquired disease characterized by inflammation, sclerosis, skin and underlying tissues atrophy, with no lesions to internal organs. However, craniofacial localized scleroderma (CLS) can lead to neurological, ophthalmic, and maxillofacial changes. Extracutaneous lesions at limited scleroderma remain poorly studied despite its high prevalence. Objective. The aim of the study is to characterize brain anomalies revealed at neuroimaging and to analyze their incidence in pediatric patients with focal scleroderma, as well as to describe comorbid neurological and ophthalmic disorders. Methods. Descriptive retrospective cross-sectional study included 33 pediatric patients who underwent hospital treatment at dermatology and allergology department of National Medical Research Center of Children’s Health with diagnosis of focal scleroderma from 2016 to 2024. All patients were examined by neurologist and ophthalmologist during hospitalization, as well as magnetic resonance imaging (MRI) was performed. The incidence of neurological, ophthalmic, and radiological signs was evaluated in the studied patients as well as their correlations within the data analysis. Results. 33 pediatric patients from 3 to 17 years old were studied. The number of boys and girls was not significantly different (p=0.46). MRI neuroimaging changes were revealed in 17 of 33 patients (51.5%). 12 patients (36.4%) had isolated disorders, 5 (15.1%) — multiple (two or more types) according to MRI data. Neurological disorders were reported in 8 out of 33 patients (24%). Ophthalmic disorders — in 10 out of 33 (30.3%). The study has revealed correlation indicating that the presence of epilepsy in CLS is associated with changes in the brain structure according to MRI (hyperintensive signal at T2-weighted image and FLAIR) (p=0,022). Also, such changes as hypointense signal during T2-VI are correlated with tension headache (p=0.03). No correlation between ophthalmic changes and neuroimaging changes was revealed. Conclusion. Significant number of pediatric patients with CLS have wide range of ophthalmic and neurological manifestations, including neuroimaging abnormalities. Precise and timely diagnosis of these symptoms is crucial for determining treatment intervention.

Promoting Equity: Child &amp; Adolescent Health Service

Abstract The health and well-being of children and adolescents face significant challenges, particularly in times of social instability. In response to these challenges, the Norwegian government allocated funding in 2021 to establish a national center for Child and Adolescent Health Promotion Services. Situated within the Norwegian Institute of Public Health, this center focuses on enhancing expertise, professional development, and research within municipal maternity and child health clinics, school health services, and youth health clinics. This presentation delves into the crucial role of Universal Health Promoting Services (UHPS) in mitigating the adverse effects of social inequality on child and adolescent health. By leveraging evidence-based practices and identifying knowledge gaps in health promotion and disease prevention in primary care settings, UHPS serve as catalysts for reducing health disparities and enhancing outcomes among expecting parents, children, and adolescents. Moreover, UHPS plays a vital role in addressing the underlying determinants of health inequality, including social network, lifestyle factors, promotion of health literacy and ensuring accessible health care services for all. UHPS empowers individuals and communities to actively participate in health promotion efforts, fostering a culture of health equity and resilience. Through targeted health education programs, early intervention strategies, and community empowerment initiatives the UHPS work both at a systems and individual level to address social inequality in health. This presentation contextualizes UHPS within a broader picture aimed at promoting child and adolescent health while addressing social inequality in health. By highlighting effective approaches and areas requiring further research, it aims to contribute to the ongoing discourse on optimizing health outcomes for young populations.

Study of the Evolution of a Cohort Of Low-Birth-Weight Newborns at Neonatal Discharge: A Perspective on Health and Sustainable Development Goals

Aims: This study aims to analyze the evolution of a cohort of low-birth-weight newborns at neonatal discharge, identifying key health outcomes and socio-economic factors. The goal is to inform strategies aligned with Sustainable Development Goal 3 (SDG 3), focusing on improving neonatal health, reducing child mortality, and promoting equitable access to healthcare. Method: A 12-month prospective cohort study was conducted from June 2020 to July 2021 at the neonatal and nutrition referral center of the Rabat children's hospital. The study included all newborns admitted with a birth weight under 2500g, regardless of the cause of hospitalization. Results: Among 200 low-birth-weight newborns, 42.5% showed extra-uterine growth retardation at discharge. Of these, 50.6% were full-term newborns and 36% were premature infants. Full-term newborns regained birth weight in an average of 5.96±4.07 days, with a median of 4 days. For premature infants, weight recovery averaged 11±8.09 days, with a median of 8 days. Conclusions: The study assessed the progress of low-birth-weight full-term and premature babies at discharge. Tailored nutritional management is crucial, requiring an adaptable strategy from the start and continued adjustments based on clinical progress. Of the cohort, 36.03% were hypotrophic premature infants, and 50.6% were full-term low-birth-weight babies. Enhancing neonatal care quality remains a key challenge, emphasizing the need for collaboration among healthcare professionals to ensure growth monitoring and meet the specific needs of this vulnerable group.

An Analysis of the Time Required for the Diagnosis of ASD and the Factors Influencing Its Duration in a Sample of the Pediatric Population from Poland.

Background/Objectives: Early diagnosis of autism spectrum disorder (ASD) is a very important factor for improving the quality of life of people on the spectrum, but it still remains a major problem in Europe, especially concerning girls. In this study, we tried to answer the question of what factors affect the age of diagnosis in Poland. Additionally, we tried to establish the time between the first visit to the mental health center (MHC) and the diagnosis in this population, and what factors affect its length. Methods: 77 children were randomly recruited among the patients who came to local MHC at the Child and Family Health Centre in Sosnowiec. All participants were tested using the ADOS-2 protocol. In addition, the study used the TAS-20 test and BDI. Results: The mean age of the first enrollment in the MHC was 9.09 years for girls and 6.42 for the boys. The time needed to obtain a diagnosis from the first visit was consecutively 2.90 years and 4.29 years, but the difference was not statistically significant (p > 0.05). Obtaining a different psychiatric diagnosis did not affect the average time to diagnosis and the age of diagnosis. Conclusions: The results of the study indicate that the diagnosis of ASD is still a significant problem both in Poland and in the world. Obtaining an accurate diagnosis requires significant time, and it frequently involves consulting multiple specialists. The diagnostic process should be flexible, and the specialist should always take into account the axial symptoms but remain aware that the "overdiagnosis" of ASD can also have harmful consequences for the child.

Major air pollution and climate policies in NYC and trends in NYC air quality 1998-2021.

Air pollution poses serious health risks to humans, with particular harm to children. To address the gap in understanding the efficacy of policies to reduce exposure to air pollution, we sought to assess the temporal relationship between the enactment of major air pollution and climate policies in NYC and trends in air quality during the period 1998-2021. We used previously available data from citywide monitoring and new data from the Columbia Center for Children's Environmental Health (CCCEH) longitudinal cohort studies of mothers and children living in communities in Northern Manhattan and the South Bronx. We utilized publicly available citywide air monitoring data for particulate matter (PM2.5) and nitrogen dioxide (NO2) from 2009 to 2021 from the New York City Community Air Survey (NYCCAS) database and CCCEH cohort data on residential exposure to PM2.5 and NO2 and personal exposure to polycyclic aromatic hydrocarbons (PAH) during pregnancies occurring from 1998-2016 and 1998-2021, respectively. We compared annual and overall reductions in PM2.5 and NO2 citywide and reductions in PAH concentrations in the cohort studies. As previously reported, annual average concentrations of pollutants in NYC dropped significantly over time. Between 1998 and 2021, PM2.5 and NO2 concentrations were reduced citywide by 37 and 31%, respectively. In our CCCEH cohorts, between 1998 and 2016, the annual average PM2.5 and NO2 concentrations also decreased significantly by 51 and 48%, respectively. Between 1998 and 2020, PAH concentrations decreased significantly by 66%. While it is not possible to link improved air quality to a single policy, our analysis provides evidence of a cumulative beneficial effect of clean air and climate policies enacted between 1998 and 2021 both city-wide and in our cohorts residing in communities that have been disproportionately affected by air pollution. There are important implications for health benefits, particularly for children, who are known to be especially vulnerable to these exposures. The results support further environmental and social policy changes to prevent the serious health impacts of air pollution from fossil fuel emissions.

유치원 방과후 과정 운영 질 제고를 위한 사례연구

Objectives This study aimed to enhance the quality of after-school programs in kindergartens by visiting kindergartens with exemplary after-school operations and examining their management practices. Methods Through the cooperation of officials from regional education offices, kindergartens with notable after-school program operations were recommended, and eight kindergartens across the country were visited. Data related to the operational cases of each kindergarten were collected, and interviews were conducted with principals and teachers. The study examined how after-school programs are conducted through various procedures, processes, and interactions within different kindergarten contexts. Results The results indicated that high-quality after-school programs in kindergartens were managed through various methods, including the operation of professional learning communities, adherence to play-centered after-school programs true to their essence, the appointment of dedicated after-school teachers, community-linked after-school programs, and the establishment of care systems for children. Care systems for children were often established in rural kindergartens and operated in forms such as all-day care, Saturday care, intensive care during farming seasons, and care linked to local children's centers. Conclusions This study suggests the need for a change in perception about after-school programs among principals and curriculum teachers, recognition and training support for after-school teachers and connection with local communities.

Uptake of gynecological consultation following domestic or sexual violence: A case-control study in the context of induced abortion

ObjectiveThe aim of this study was to determine the prevalence of domestic and sexual violence and to characterize the association between exposure to domestic and sexual violence and low uptake of gynecological care, in the context of induced abortion.Study design.We conducted a case-control study among women seeking abortion care, in mother and child centers and sexual health centers in the Paris, France area (April 2022-March 2023). ResultsA total of 103 women were included in the study during induced abortion care. Physical, psychological or sexual domestic violence was reported by 48.5 % and sexual violence, whoever the perpetrator, was reported by 23.3 %. In the bivariate analysis, a history of physical, psychological or sexual domestic violence was not associated with the absence of a gynecological consultation in the past two years, compared with no history of intimate partner violence (p = 0.09). After adjustment for regular pelvic pain, dysmenorrhea, vulvodynia and dyspareunia, there was no association between a history of sexual violence and the absence of a gynecological consultation in the past two years (OR 1.05; CI95% 0.27–4.13, p = 0.93). ConclusionViolence was a common finding among women seeking abortion care. We did not find any association between a history of sexual violence and the absence of a gynecological consultation in the past two years. We suggest investigating multiple or frequent use of gynecological care following violence. The combination of ethical, moral, and psychological constraints associated with violence screening and abortion care is a challenge to patient recruitment in future studies.

Obstetric psychoprophylaxis and duration of the active phase dilation period: A relational study

Objective: To identify the correlation between obstetric psychoprophylaxis and the duration of the active phase dilation period in pregnant women at the Centro Materno Infantil Daniel Alcides Carrión, Lima – 2019. Materials and methods: Non-experimental cross-sectional study. a documentary review was carried out and was complemented with the application of two data collection forms as an instrument, considering as variables the clinical history, age, number of pregnancies, number of prenatal care, gestational age at the first obstetric psychoprophylaxis session and the number of psychoprophylaxis sessions recorded. Results: The study included 165 medical records of pregnant women whose deliveries were attended at the daniel alcides carrión maternal and child center in lima during 2019, from which it was found that 69.09 % of the pregnant women ranged from 18 to 29 years of age; 77. 58 % of them were multiparous, 69 % showed more than 3 prenatal care, 91 % started their first obstetric psychoprophylaxis session between 28 to 37 weeks, 55.76 % had 4 to 6 obstetric psychoprophylaxis sessions and 68 % had a duration of up to 6 hours in the dilation period – active phase. Conclusions: Obstetric psychoprophylaxis has shown a significant level of incidence with respect to the duration of the active phase dilation period, demonstrating the benefit obtained by the pregnant woman during labor.

Analysis of Genetic Characteristics of Patients with Thalassemia in the Chengdu Region, Sichuan Province

To analyze the gene mutation types and composition characteristics of patients with thalassemia in Chengdu Region, Sichuan Province. 6 649 suspected thalassemia patients with positive screening results who visited Chengdu Women's and Children's Center Hospital from January 2017 to December 2020 were selected as the study subjects. Among them, there were 2 273 males and 4 376 females. The frequency and distribution of α and β genotypes of thalassemia in this cohort was analyzed by Luminex liquid-phase microarray method. Among the 6 649 samples, 3 787 were genetically diagnosed as thalassemia, with a total positive rate of 56.96%; in which, 2 063 (31.03%) cases were β-thalassemia, 1 629 (24.50%) cases were α-thalassemia, and 95 (1.43%) cases were α combined with β thalassemia. The types of β-thalassemia gene mutation were mainly CD17/N (36.45%, 752/2 063), CD41-42/N (25.30%, 522/2 063), and IVS-II-654/N (24.72%, 510/2 063); and 2 037 cases of simple heterozygous mutations were identified, accounting for 98.74% of β-thalassemia patients. The types of α-thalassemia gene mutation were mainly -- SEA/αα (79.01%, 1 287/1 629), -α3.7/αα (10.62%, 173/1 629), -α3.7/-- SEA (2.95%, 48/1 629), and -α4.2/αα (2.15%, 35/1 629). The α combined with β thalassemia was dominated by -α3.7/αα; CD17/N and -α3.7/αα; IVS-II-654/N, both accounting for 14.74% (14/95) of patients with α combined with β thalassemia. In Chengdu region, Sichuan province, β thalassemia is more common than α thalassemia, the main type of β thalassemia mutation is CD17/N, and the main type of α thalassemia mutation is -- SEA/αα, with regional characteristics.

Functional assessment of children and adolescents with autism spectrum disorder in Argentina: ICF-ASD multicenter study.

Introduction. Autism spectrum disorder (ASD) is characterized by difficulties in social communication and repetitive and stereotyped behaviors. In addition to the diagnostic category, the activities performed by children and adolescents and their social involvement are the main aspects to be considered according to the International Classification of Functioning, Disability, and Health (ICF) proposed by the World Health Organization to describe health status. In a previous study, we developed the first version of a pediatric tool based on the ICF called ICF-ASD for the functional assessment of children and adolescents with ASD to capture functional characteristics adapted to our cultural setting. Our subsequent objective was to apply the ICF-ASD in a multicenter format to assess children and adolescents from different regions, review, and update it, and identify barriers and facilitators. Population and methods. The ICF-ASD version 1.0 was administered to children and adolescents younger than 16 years with a confirmed diagnosis of ASD (as per DSM-5 criteria), who were receiving follow-up at 5 children's health centers across Argentina. Results. Version 2.0 of the ICF-ASD was obtained, which included 34 categories (10 under body function, 15 under activities and participation, and 9 under environmental factors). A functional profile was developed for the whole sample (n = 308). Conclusions. The updated version of the ICF-ASD helps to standardize and systematize the collection of necessary data for an adequate follow-up of children and adolescents with ASD at a national level. It also allows to identify barriers to overcome and facilitators to be generalized.

Vitamin D Supplementation Selectively Affects Peripheral Lymphocyte Subsets in Infertile Women.

This study aimed to explore the effect of vitamin D supplementation on lymphocyte subsets in infertile women. The study involved a total of 247 patients who suffered recurrent embryo implantation failure (RIF) or recurrent spontaneous abortion (RSA) between January and December 2019 in the Reproductive Medicine Center of Children's Hospital of Shanxi and Women Health Center of Shanxi. The differences in the vitamin D and lymphocyte subsets of the two diseases, the correlation between the 25-hydroxy vitamin D and lymphocyte subsets, the changes in the lymphocyte subsets after vitamin D supplementation and the impact on pregnancy outcome were analysed. The prevalence of vitamin D deficiency was 77.33% (191/247). After vitamin D supplementation, there were no significant differences in helper T cells (Th), cytotoxic T cells (Tc), Th/Tc and natural killer cells (NK) (p > 0.05), but there were significant differences in leukocyte differentiation antigens 3+ (CD3+), natural killer T cells (NKT), B lymphocytes and vitamin D (p < 0.05). Before vitamin D supplementation, the difference in the composition ratio of different vitamin D levels between the RIF and RSA groups was not statistically significant. At different vitamin D levels, there were no significant differences in CD3+, Th, Tc, Th/Tc, NK or B lymphocyte (p > 0.05), but there was a significant difference in NKT (p < 0.05). Vitamin D supplementation can reduce the level of NKT in infertile women, which may be of benefit to the pregnancy outcome of couples who experience RIF.

Pediatrics ACES and related life event screener (PEARLS): translation, transcultural adaptation, and validation to Brazilian Portuguese

ObjectiveAdverse Childhood Experiences (ACEs) have been associated with negative health outcomes. Screening for ACEs is crucial for improving health results, however, there is a shortage of standardized tools designed for children in Brazilian Portuguese. This study aimed to translate, culturally adapt, and validate the Pediatrics ACES and Related Life Event Screener (PEARLS) for use in Brazil. MethodThe study followed a methodological design for cross-cultural adaptation and psychometric evaluation. The PEARLS was translated and culturally adapted following a methodology that includes translation, synthesis, expert committee evaluation, target audience evaluation, and back-translation. After adaptation, a pilot cross-sectional study was conducted at a Multidisciplinary Health Care Clinical Center and a General Hospital-Reference Center for Child and Adolescent Care to assess the instrument's internal consistency, convergent validity, content validity and test-retest reliability. ResultsThe PEARLS-Br versions for Children, Teens, and Teen Self-Report were developed and subjected to pilot testing with 202 subjects. Participants demonstrated excellent comprehension, with Verbal Rating Scale median scores of 4 (IQR 4–5). Internal consistency was high, with Cronbach's alpha coefficients ranging from 0.78 to 0.81. Content validity, assessed by Kappa, indicated slight to almost perfect agreement across constructs. Test-retest reliability, assessed by Spearman's correlation coefficient, ranged from 0.89 to 0.94. ConclusionsPEARLS-BR (Child, teen, and teen self-report versions) were successfully translated, culturally adapted, and validated for assessing ACEs in Brazilian children and adolescents. This tool fills a crucial gap in ACE assessment in the Brazilian context, aligning with global recommendations for screening ACEs to improve overall health outcomes.

카오스, 죽음, 재탄생으로 나타난 모래놀이상담 사례

This study is a case study of sand play counseling that appeared as chaos, death, and rebirth. The subjects of this study are two elementary school children living in Jeollabuk-do. Child A is a third-grade boy at Y Elementary School in City I, and Child B is a fourth-grade girl at B Regional Children's Center in County Y. The results of the study showed that in the chaos stage of Children A and B, they displayed disorderly characters, unrelated tasks, and threatening or confusing play, and showed confusion and conflict about maternal nature. In the death stage, the conflict between uncertainty and certainty began, a strong desire for attachment was shown, and fear and anxiety about reality appeared. In the rebirth stage, a new self appeared, adaptation to daily life was shown, and the play of death and rebirth was in progress, and new thoughts were reborn through death, and they appeared in the order of integration, order, and organization. This shows that sandplay counseling is a process of adaptation that shows inner strength, communication with the world, and harmonious integration to children who have experienced emotional conflict, maladjustment, and confusion during the growing up process.

МЕКТЕП ЖАСЫНДАҒЫ БАЛАЛАРҒА КОРРЕКЦИЯЛЫҚ ЖҰМЫС ЖҮРГІЗУДЕ ОЙЫН ТЕРАПИЯСЫН ПАЙДАЛАНУ

the problem of correctional work for children of primary school age is relevant today. In this scientific article, the authors suggest that school-age children use toys and games as a means of conducting remedial classes. Play therapy is a tool that can be used when working with both children and their parents. To illustrate the research work, the article used the questionnaire method, the bibliographic method, and the observation method. In addition, caterers from real situations were presented and the games used for corrective work and their guidance were shown. The MEGA Tulga children's development center was acquired as a research base, which has been operating on the basis of play therapy in Taraz since 2016. The center accepts children aged 3 to 14 years and conducts their correctional work. The center presents more than 30 types of toys that enhance children's intellectual abilities. In the process of proper communication with children and correctional work, it is necessary to choose the right special tools. And game therapy in this case becomes universal. Despite the fact that this area of psychology has developed in foreign countries, attention is now being paid and studied in Kazakhstan. Therefore, the topic and direction of the article do not lose their relevance.

Challenges of Leadership in the Implementation of the National Children’s Policy of Ethiopia at Bahir Dar City Administration Women, Children and Social Affairs Department

The purpose of this research was to identify the major challenges of Leadership in the implementation of the national children’s policy of Ethiopia, at Bahir Dar City Administration Women, Children and Social Affairs Department. To identify the major challenges of leadership in the implementation of the policy, constructivist research paradigm, qualitative research approach and phenomenological research design were employed. Interviews and focus group discussions were the basic tools of data collection. Purposive sampling technique and thematic data analysis are employed. The challenges of leadership in the implementation of the national children’s policy in the study area are multi-faceted. But according to the findings of this study, they are grouped into four themes. These are: economic challenges, socio-cultural challenges, lack of awareness and political and legal problems. To overcome the challenges of leadership in the implementation of the policy, the following recommendations were given. These were: providing education and health facilities for children, providing school feeding for children, creating awareness about the rights of children for all stakeholders, increasing the economic level of families, building recreational centers for children, allocating enough financial and human resources for children affairs, increasing children role and participation in decision making processes affecting them, giving due attention for the rights of children by the government and providing effective justice system for children.

Features of social rehabilitation and adaptation of children with autism spectrum disorder

This article is devoted to the diagnosis of autism spectrum disorder, namely the adaptation of children with this diagnosis. The results of an empirical study of social work specialists in the institutions of ANO «RAStem together», MU «Social Rehabilitation Centre for Children and Adolescents with Disabilities» and Centre for Social Assistance to Children «MOSAIKA» in Magnitogorsk, ANO «Atmosphere» in Novosibirsk. The authors present an analysis of the results of a study on the awareness of specialists about the diagnosis. Based on the findings, the authors developed a social rehabilitation programme for children with autism spectrum disorder to ensure the social, emotional, intellectual and physical development of children with the disorder and to try to maximise their potential for learning.

Association of Maternal Short Sleep Duration With Neurodevelopmental Delay in Offspring: A Prospective Cohort Study.

To investigate how short sleep duration (SSD) during pregnancy is related to neurodevelopmental delays in offspring, we aimed to inform pregnancy sleep guidelines and promote maternal health and child development. To identify the associations between SSD during pregnancy and offspring neurodevelopmental delay and to determine whether fetal glucose metabolism plays a role in SSD and neurodevelopmental delays. This cohort study followed 7059 mother-child pairs from the Maternal & Infants Health in Hefei cohort, and collected sleep data during pregnancy via the Pittsburgh Sleep Quality Index at weeks 24 to 28 and 32 to 36. Neurodevelopmental outcomes from 6 to 36 months postpartum were assessed via the Denver Developmental Screening Test-II and the Gesell Development Diagnosis Scale. Cox proportional hazard regression was used to analyze the link between maternal SSD and neurodevelopmental delay risk. Mediation analysis was used to evaluate the role of cord blood serum C-peptide levels. Three hospitals and children's health centers in Hefei were involved. The stratified analysis revealed a significant association between mothers with SSD during midpregnancy and neurodevelopmental delay in boys (adjusted HR 2.05, 95% CI 1.29, 3.25). Cord blood marker analysis revealed a positive relationship between cord blood serum C-peptide levels and neurodevelopmental delay in offspring (RR 0.04, 95% CI 0.00, 0.08). The proportion of the association between SSD and neurodevelopmental delay mediated by cord blood C-peptide was 11.05%. Maternal SSD during pregnancy was continuously associated with an increased incidence of neurodevelopmental delay with sex differences among offspring. This association may be mediated in part by increased higher levels of cord C-peptide.

Efficacy and safety of oral cyclophosphamide versus mycophenolate mofetil in childhood nephrotic syndrome: an open-label comparative study

IntroductionThere is a scarcity of research comparing the efficacy of cyclophosphamide and mycophenolate mofetil in childhood nephrotic syndrome. The aim was to evaluate the efficacy and safety of oral cyclophosphamide (CYC) and mycophenolate mofetil (MMF) in children with steroid-sensitive nephrotic syndrome in terms of the proportion of children who have been off steroids for at least 6 months without proteinuria (responders).MethodsThis open-label retrospective-prospective comparative study was conducted in a pediatric nephrology clinic of a referral center for children between 1 and 18 years of age with FR/SD nephrotic syndrome. Group A consisted of patients who received oral cyclophosphamide (100, 25% female) at a dose of 2–2.5 mg/kg once daily for a period of 8–12 weeks. Group B consisted of patients who received oral mycophenolate mofetil (n = 61, 18% female) (dose: 800–1200 mg/m2) for at least 12 months. Responders were defined as children who were off steroids for at least 6 months along with absence of proteinuria.ResultsIn the CYC group, 50% of the patients were responders, whereas 54% of the patients in the MMF group were responders (p = 0.614). The time to first relapse with CYC was 7 months (IQR 5.25–11) compared to 7 months (IQR 3.5–12) with MMF (p = 0.092). The relapse rate in the CYC group was 1.77 relapses per patient-year compared to 1.295 relapses per patient-year in the MMF group. The difference in relapse rate was significant (-0.474; 95% CI, 0.09 to 0.86 relapses/person-year) (p value = 0.009). Multivariate analysis revealed that an age of less than 5 years at the start of treatment was a significant factor for a better response to MMF (p value = 0.039, OR = 2.988, CI -1.055-8.468).ConclusionsThe efficacy of MMF was similar to that of CYC in terms of response (6 months without steroids) in children with FR/SD nephrotic syndrome. MMF showed a favorable response in terms of the frequency of relapse and treatment failure.Registration of the study with Clinical Trials Registry of India(http://ctri.nic.in;CTRI/2021/06/034421) (Dt: 28/06/2021).