Child Health Research Articles

Physicochemical characterization and determination of trace metals in different edible fats and oils in Bangladesh: Nexus to human health

The study assessed the quality of four different edible fats and oils using standard analytical techniques. The presence of potentially toxic elements was determined using atomic absorption spectrometry. This study reveals that edible oils function admirably in terms of physical traits such as moisture content, boiling point, melting point, density, and specific gravity. Some edible fats and oils exceeded the standard limit of moisture, acid value, and peroxide value and these values were found in the range of 0.120–0.760 %, 0.220–2.45 mg KOH/g, and 1.23–21.7 meq/kg respectively. The iodine value for fats showed satisfactory results but for oils observed lower than the standard value varied from 68.2 to 104 g/100 g. The results of saponification value for most of the oils and fats were found satisfactory but others were lower than recommended limits and detected results were in the range of 167–224 mg KOH/g. Trace metals viz. Fe, Mn, Ni, Pb, Cd, Cu, and Co were measured in all samples and the concentration ranged from 0.070 to 47.0, 0.120–2.44, 0.540–27.1, 0.030–1.87, 0.010–4.63 and 0.060–8.39 ppm for iron, manganese, nickel, lead, copper, and cobalt respectively. The study found high levels of Fe, Mn, Ni, Cu, and Co in edible fats and oils in Bangladesh. No Cd was found, and Pb was not present in over half of the samples, which included the majority of mustard oils. The levels of Fe and Ni were higher than advised, but there was no discernible toxicological danger from Cd or Pb. The results of the health risk assessment indicated that there was no risk to children's health and possible hazards to adults' health.

Spatial Variability in Relationships between Early Childhood Lead Exposure and Standardized Test Scores in Fourth Grade North Carolina Public School Students (2013-2016).

Exposure to lead during childhood is detrimental to children's health. The extent to which the association between lead exposure and elementary school academic outcomes varies across geography is not known. Estimate associations between blood lead levels (BLLs) and fourth grade standardized test scores in reading and mathematics in North Carolina using models that allow associations between BLL and test scores to vary spatially across communities. We link geocoded, individual-level, standardized test score data for North Carolina public school students in fourth grade (2013-2016) with detailed birth records and blood lead testing data retrieved from the North Carolina childhood blood lead state registry on samples typically collected at 1-6 y of age. BLLs were categorized as: (reference), , and . We then fit spatially varying coefficient models that incorporate information sharing (smoothness), across neighboring communities via a Gaussian Markov random field to provide a global estimate of the association between BLL and test scores, as well as census tract-specific estimates (i.e., spatial coefficients). Models adjusted for maternal- and child-level covariates and were fit separately for reading and math. The average BLL across the 91,706 individuals in the analysis dataset was . Individuals were distributed across 2,002 (out of 2,195) census tracts in North Carolina. In models adjusting for child sex, birth weight percentile for gestational age, and Medicaid participation as well as maternal race/ethnicity, educational attainment, marital status, and tobacco use, BLLs of , and were associated with overall lower reading test scores of [95% confidence interval (CI): , ], (, ), and (, ), respectively. For BLLs of , , and , spatial coefficients-that is, tract-specific adjustments in reading test score relative to the "global" coefficient-ranged from to 2.52, to 3.90, to 7.85, and to 4.33, respectively. Results for mathematics were similar to those for reading. The association between lead exposure and reading and mathematics test scores exhibits considerable heterogeneity across North Carolina communities. These results emphasize the need for prevention and mitigation efforts with respect to lead exposures everywhere, with special attention to locations where the cognitive impact is elevated. https://doi.org/10.1289/EHP13898.

The costs and benefits of scaling up interventions to prevent poor birth outcomes in low-income and middle-income countries: a modelling study

We estimated the benefits and costs of a set of preventive interventions that could be delivered during antenatal care to prevent poor birth outcomes, including small-for-gestational-age and preterm births. We built on the assumptions and analyses underlying the Lancet Series on small vulnerable newborns (SVNs) and extended that work by incorporating more recent data, focusing only on the subset of preventive interventions, and examining a broader range of effects. A primary aim of the study was to provide a framework that decision makers could use to design programmes for women and children. The analyses used the Lives Saved Tool (LiST) to estimate the effects and costs of scaling up the 11 preventive interventions identified in the SVN Series to improve birth outcomes. We used LiST estimates of effects and costs to estimate benefit-cost ratios (BCRs) for two intervention packages (one with interventions proven to improve birth outcomes and one with proven interventions plus interventions with potential to improve birth outcomes) and for the individual interventions in these packages for 80 low-income and middle-income countries (LMICs). Both packages of interventions had BCRs more than 1, with a proven package BCR of 7·3 (IQR 5·3-9·1) and a proven plus potential package BCR of 5·8 (4·4-6·9). We found that in all cases the individual interventions had BCRs more than 1, there was a wide range of BCR values for the different interventions, and the BCR varied depending on package and country. The analyses presented in this Article provide evidence that there are preventive interventions that, if scaled up in LMICs, could have a large effect on child health and provide benefits that greatly exceed the costs. Global Affairs Canada.

Adherence of inactivated polio vaccine immunization for children in Central Java Province

Indonesia is a country with high-risk polio transmission. Administering inactivated polio vaccination (IPV) after drops-polio or oral polio vaccination (OPV) was a strategy stopping polio transmission because its ability to ward off poliovirus which was very dangerous. The IPV coverage was very low and have never reached the target since it was launched in 2016. The study purpose was analyzing determinants factors of IPV adherence. A cross-sectional survey conducted in 31 districts in Central Java Province. Sample was 685 children aged 11-23 months and selected using purposive and accidental sampling method. Collecting data by interview using structured questionnaire and observation with maternal and child health (MCH) Handbook to identify immunization status. The collected data was analyzed univariate, bivariate, and multivariate. As many as 74.3% of children received IPV. Partially, variables of delivery history, immunization status, knowledge, attitudes, sources of information, and service satisfaction were related to IPV adherence. Simultaneously, immunization status, attitudes, and sources of information influenced IPV adherence with an overall effect 35.2%. Immunization status as the dominant influencing factor. Efforts were needed reducing resistance to IPV through psychological approach that was motivating and personal, also using of social media as a medium for positive information and communication, in addition to improve immunization service system.

District-level monitoring of universal health coverage, India.

To develop a framework and index for measuring universal health coverage (UHC) at the district level in India and to assess progress towards UHC in the districts. We adapted the framework of the World Health Organization and World Bank to develop a district-level UHC index (UHC d ). We used routinely collected health survey and programme data in India to calculate UHC d for 687 districts from geometric means of 24 tracer indicators in five tracer domains: reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; service capacity and access; and financial risk protection. UHC d is on a scale of 0% to 100%, with higher scores indicating better performance. We also assessed the degree of inequality within districts using a subset of 14 tracer indicators. The disadvantaged subgroups were based on four inequality dimensions: wealth quintile, urban-rural location, religion and social group. The median UHC d was 43.9% (range: 26.4 to 69.4). Substantial geographical differences existed, with districts in southern states having higher UHC d than elsewhere in India. Service coverage indicator levels were greater than 60%, except for noncommunicable diseases and for service capacity and access. Health insurance coverage was limited, with about 10% of the population facing catastrophic and impoverishing health expenditure. Substantial wealth-based disparities in UHC were seen within districts. Our study shows that UHC can be measured at the local level and can help national and subnational government develop prioritization frameworks by identifying health-care delivery and geographic hotspots where limited progress towards UHC is being made.

Violence, Fear, and Infant Mortality: How violent conflict reduces healthcare demand and harms child well-being

What are the health effects of violent conflict? It is well known that wars kill civilians away from the battlefield and long after the fighting has stopped. Yet why this happens remains only partially understood. While we have good evidence that factors such as the destruction of infrastructure, political neglect, and the out-migration of health workers—what may be called supply-side factors—negatively affect health outcomes, we know much less about how violence shapes the attitudes and behavior towards healthcare use among civilians exposed to violent conflict—what may be called demand-side factors. Here, I propose a theory that exposure to violence suppresses civilian demand for healthcare through two mediating channels—mistrust of government institutions and fear of future violence—with adverse consequences for health outcomes, particularly child health. To test this theory empirically, I combine information from over 80,000 interviews conducted in 22 conflict-affected countries in Africa with individual- and context-level measures of exposure to violent conflict. Exposure to violence is associated with significantly lower levels of political trust and increased fear of future violence, which in turn predict lower healthcare utilization, lower immunization rates, and higher infant and child mortality. To fully address the health consequences of armed conflict, it is essential that we better understand the attitudinal and behavioral correlates of exposure to violence.

Recent trends and disparities in 24-hour movement behaviors among US youth with mental, behavioral and neurodevelopmental conditions

BackgroundMeeting 24-h movement behaviors (24-HMB: physical activity [PA], screen time [ST], and sleep [SL]) recommendations may be associated with positive health outcomes among youth with specific mental, behavioral, and neurodevelopmental (MBD) conditions. However, temporal trends and disparities in meeting 24-HMB guidelines in these higher-risk groups have not been investigated, hampering the development of evidence-based clinical and public health interventions. MethodsSerial, cross-sectional analyses of nationally National Survey of Children's Health (NSCH) data (including U.S. youth aged 6–17 years with MBD conditions) were conducted. The time-trends survey data was conducted between 2016 and 2021.The prevalence of 24-HMB adherence estimates were reported for the overall sample and for various sociodemographic subgroups. The subgroups analyzed included: age group (children[aged 6 to 13 years], adolescents[aged 14 to 17 years]), sex, socioeconomic status, and ethnicity. ResultsData on 52,634 individuals (mean age, 12.0 years [SD,3.5]; 28,829 [58.0 %] boys) were analyzed. From 2016 to 2021 the estimated trend in meeting PA + ST + SL guidelines declined (−0.8 % [95%CI, −1.0 % to −0.5 %], P for trend <0.001), whereas meeting none of 24-HMB guidelines increased (2.2 % [1.8 % to 2.6 %], P for trend <0.001). White participants, children, and boys reported higher estimated prevalence of meeting full integrated (PA + ST + SL) guidelines. DiscussionThe temporal trends observed in this study highlight the importance of consistently monitoring movement behavior among MBD youth and identifying variations by sociodemographic groups in meeting 24-HMB guidelines for health promotion within these vulnerable groups.

Development and validation of a predictive model for tumor lysis syndrome in childhood acute lymphoblastic leukemia

BackgroundTumor lysis syndrome (TLS) frequently manifests shortly after induction chemotherapy for acute lymphoblastic leukemia (ALL), with the potential for swift progression. This study endeavored to develop a nomogram to predict the risk of TLS, utilizing clinical indicators present at the time of ALL diagnosis. MethodsWe retrospectively gathered data from 2,243 patients with ALL, spanning December 2008 to December 2021, utilizing the clinical research big data platform of the National Center for Clinical Research on Children's Health and Diseases. The Least Absolute Shrinkage and Selection Operator (LASSO) method was employed to filter variables and identify predictors, followed by the application of multivariate logistic regression to construct the nomogram. ResultsThe LASSO regression identified six critical variables among ALL patients, upon which a nomogram was subsequently constructed. Multifactorial logistic regression revealed that an elevated white blood cell count (WBC), serum phosphorus <2.1mmol/L, potassium <3.5mmol/L, aspartate transaminase (AST) ≥50U/L, uric acid (UA) ≥476μmol/L, and the presence of acute kidney injury (AKI) at the time of initial diagnosis were significant risk factors for the development of TLS in ALL patients (P<0.05). The predictive model achieved an area under the receiver operating characteristic curve (AUC) of 0.824 [95% CI (0.783, 0.865)], with an internal validation AUC of 0.859 [95% CI (0.806, 0.912)]. The Hosmer-Lemeshow goodness-of-fit test confirmed the model’s robustness (P=0.687 for the training cohort; P=0.888 for the validation cohort). Decision curve analysis (DCA) indicated that the predictive model provided substantial clinical benefit across threshold probabilities ranging from 10% to 70%. ConclusionsA nomogram incorporating six predictive variables holds significant potential for accurately forecasting TLS in pediatric patients with ALL.

Clinician actions in response to Adverse Childhood Experience (ACE) screening

Background and ObjectiveAdverse Childhood Experiences(ACEs) have a powerful influence on mental health, physical health, and life expectancy. Screening for ACEs and the clinician response to ACEs are critical to addressing the health and well-being of children, however, little is known about the actions clinicians take in response to ACE screening. Therefore, we aimed to examine clinician responses to ACE screening at five California pediatric clinics in a large public health care system. MethodsPatient demographics, indicators of social and behavioral determinants of health (e.g., housing insecurity), the number of ACEs endorsed on the screening instrument, and the actions clinicians took in response to each ACE screen were collected. Data was collected from May to October 2021. These data were used to examine the association between number of ACEs reported and clinician response, controlling for patient demographics and their social and behavioral determinants of health using multiple logistic regression. ResultsFive participating pediatric clinics conducted 2,652 ACE screens in six-months. Clinicians documented an action twice as often when ACEs were present after controlling for patient demographics and their social and behavioral determinants of health (odds ratio(OR) = 2.2, 95 % confidence interval(CI): 1.5–3.3, p-value < 0.0001). Clinicians were three times more likely to record referrals to mental health clinicians, social workers, and community organizations relative to anticipatory guidance when the number of ACEs increased from one to three to four or more (OR=3.2, 95 %CI: 1.6–6.5, p < 0.0001). ConclusionFindings provide early information that ACE screening results are associated with patient care.

Depression Part 1: Evaluation.

By young adulthood, 1 in 5 teens will experience an episode of major depression. The second leading cause of death among youths aged 15 to 24 years is suicide, most of which will have been caused by untreated or undiagnosed depression. Depression is a highly heritable condition: depressed children often have depressed parents. Support to caregivers is important because depressed parents can have negative effects on children's development and future mental health. Groups more vulnerable to mental health disorders such as depression include Black, Indigenous, and persons of color and lesbian, gay, bisexual, transgender, or queer/questioning, who in recent years have the highest rate of suicide attempts (Black teens, sexual minority youth), the highest increases in suicide rates (Black children and youths), and the highest suicide rates (American Indian/Alaskan native). They frequently experience more adverse childhood events, which increases the risk of depression and suicide attempts. Pediatricians are most likely to care for these vulnerable youths, who often are less engaged in specialty mental health care for a variety of reasons, including stigma and barriers to access. By offering behavioral and mental health care to vulnerable populations in primary care, mental health equity may be achieved. Screening for depression and assessment for suicide are within the scope of pediatric practice and among the competencies recommended by the American Academy of Pediatrics and The American Board of Pediatrics.

Child protection and developmental trajectories of children who entered care as infants

AbstractInfants have the highest rate of admission into out‐of‐home care in Australia, with rising rates of entry to care occurring around the world. Our previous research identified children who entered care as infants as having high levels of developmental vulnerability. The objective of this study was to determine the child protection and developmental trajectories of children who entered care as infants and whether meeting developmental needs through service provision improves trajectories and outcomes for these children. This is a prospective cohort study using three waves (2011–2016) of survey data from the New South Wales Pathways of Care Longitudinal Study which includes standardised assessments (Age and Stages Questionnaire, Brief Infant Toddler Social Emotional Assessment and the Child Behaviour Checklist), as well as linked administrative child protection and health data. Our findings suggest that children who entered care as infants predominantly remained in the care system and had a high level of developmental vulnerability as infants. A large group had positive physical and cognitive developmental trajectories with service provision increasing over time; however, early service provision is needed. Another group was identified as having early social–emotional concerns and displaying worsening social–emotional trajectories. Intervention for this group is an important priority to reduce risk of ongoing poor mental health outcomes.

The MuCAYAplus study- Influence of physical activity and metabolic parameters on structure and function of the cardiovascular system in young athletes

Exercise has a significant impact on the cardiovascular health of children and adolescents, with alterations in cardiovascular structure and function evident even at an early age. Engagement in regular moderate physical activity (PA) is associated with long-term cardiovascular health benefits and reduced risk of cardiovascular disease and mortality later in life. However, competitive sports often involve training intensities beyond recommended levels for young athletes, potentially leading to adverse cardiovascular outcomes. This emphasizes the importance of early monitoring of the cardiovascular status to prevent detrimental adaptations to intense physical exercise. The MuCAYAplus study (NCT06259617) aims to investigate the yet unclear adaptations to intense exercise in young athletes, focusing on various factors, including cardiovascular health, physical activity, cardiopulmonary performance, body composition, eating habits and biochemical markers.In this longitudinal prospective study, a sample of 250 young competitive athletes (age 10-17) will undergo yearly examinations at the Institute of Preventive Pediatrics at the Technical University of Munich (TUM) over the span of three years. The testing protocol includes anthropometric measurements, basic medical examinations, electrocardiography together with blood pressure and pulse wave analysis, echocardiography, sonography of the carotid artery, blood sampling for laboratory analysis, cardiopulmonary exercise testing on a bicycle ergometer and completion of questionnaires regarding physical activity (MoMo-PAQ) and nutrition.It is not yet fully understood how exercise influences cardiac and vascular remodeling during long-term exercise and how different biochemical and metabolic parameters, body composition and nutrition impact such adaptations. The MuCAYAplus study seeks to address these gaps in knowledge and provide comprehensive evidence on the longitudinal effects of exercise on the cardiovascular system of young athletes.

Screen media use and mental health of children and adolescents

Screen media use and mental health of children and adolescents

Integrating Emotional Health Assessments into Pediatric Care: Initial Learnings from an MOC Part 4 Activity

Introduction: Living with a chronic condition often impacts the emotional health of children. Pediatricians frequently feel unprepared to address these concerns. The American Board of Pediatrics Roadmap Project aims to support these clinicians. We describe the results from the initial cohort of pediatricians who completed the American Board of Pediatrics Maintenance of Certification (MOC) Roadmap Part 4 activity. Methods: The Roadmap MOC activity uses a standardized improvement template with accompanying resources to guide participants. Physicians self-assess their ability to provide emotional health support by completing a Roadmap Readiness Checklist and creating a personal project relevant to their practice. They collect data at three time points: baseline, midpoint, and completion for two measures (the Readiness Checklist and a participant-selected measure). Physicians also reflect on their experience. Results: Of the initial cohort of 29 physicians, 22 submitted three sequential checklist assessments. Scores increased for “developing a family resource list” (by 90%), “confidence to address emotional health” (79%), “having a family crisis plan” (78%), and “staff awareness” (34%). Twenty-four physicians who measured whether clinical encounters addressed emotional health documented an increase from 21% to 77%. Physician feedback was positive, for example, “This project has had a profound impact on our care of children.” Conclusions: This initial cohort of participants improved on the Readiness Checklist and emotional health assessment. Both generalist and subspecialty pediatricians found the activity useful and relevant, suggesting that this MOC Part 4 activity is a feasible resource for supporting physicians in addressing emotional health.

Gender Difference of the Association Between Sleep Duration and Myopia Among Children and Adolescents.

With girls typically exhibiting higher rates of myopia than boys, however, the mechanisms behind this gender difference remain unclear. This study aims to investigate the gender disparities in the relationship between myopia, sleep duration, physical activity, and BMI. A total of 3138 primary and secondary school students were included. Mplus 8.3 was used to perform the multiple mediation analysis. Sleep duration was indicated to directly affect myopia (β=0.273, 95% CI=0.184-0.356) and through physical activity, BMI, physical activity and BMI three significantly mediation pathways, respectively. In terms of gender, the mediating direct effect of sleep duration on myopia of boys was 66.96%, which is much higher than that of girls' 50.91%. And the mediating indirect effect of sleep duration on myopia through physical activity and BMI are 32.65% and 12.10% respectively among girls, both of which are significantly higher than that of boys. The study found that there are significant differences in the impact of sleep duration on myopia in children and adolescents of different genders. In this regard, while paying attention to the sleep duration of children and adolescents, special attention should also be paid to the indirect impact of girls' physical activity and BMI on myopia, and targeted measures should be formulated according to children of different genders to effectively protect the eye health of children and adolescents.

Behaviour change intervention (education and text) to prevent dental caries in secondary school pupils: BRIGHT RCT, process and economic evaluation.

The presence of dental caries impacts on children's daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae. To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils. A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations. Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school. Pupils aged 11-13 years at recruitment, who have their own mobile telephone. Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils' mobile phones about toothbrushing, compared with routine education. Primary outcome: presence of at least one treated or untreated carious lesion using DICDAS4-6MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of DICDAS4-6MFT; presence and number of DICDAS1-6MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children). Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05). The intervention had higher incremental mean costs (£1.02, 95% confidence interval -1.29 to 3.23) and lower incremental mean quality-adjusted life-years (-0.003, 95% confidence interval -0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging. The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution. Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility. This trial is registered as ISRCTN12139369. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/166/08) and is published in full in Health Technology Assessment; Vol. 28, No. 52. See the NIHR Funding and Awards website for further award information.

Machine-Learning Diagnostic Models for Ovarian Tumors

PurposeTo create a diagnostic framework for clinical behavior and pathological tissue prognosis in ovarian cancer by using machine-learning (ML) methods based on multiple biomarkers. Experimental DesignOverall, 713 patients with ovarian tumors at Sun Yat Sen Memorial Hospital were randomized into training and test cohorts. Four supervised ML classifiers, namely Support Vector Machine, Random Forest, k-nearest neighbor, and logistic regression were used to derive diagnostic and prognostic information from 10 parameters commonly available from pretreatment peripheral blood tests and age. The best prediction model was selected and validated by comparing the accuracy and the area under the ROC curve of each prediction model and by applying the external data of Guangdong Maternal and Child Health Center. ResultsML techniques were superior to conventional regression-based analyses in predicting multiple clinical parameters pertaining to ovarian tumor. Ensemble methods combining weak decision trees and RF showed the best reference in diagnosis, especially for malignant ovarian cancer. The values for the highest accuracy and area under the ROC curve for malignant ovarian cancer from benign or borderline ovarian tumors with RF were 99.82% and 0.86 (micro-average ROC curve), respectively. The greatest accuracy and AUC for the diagnosis of pathological tissue with logistic regression curve were 78.0% and 0.95 (micro-average ROC curve), respectively. In external validation, the random forest prediction model had an accuracy of 0.789 for applying data from external centers to verify tumor benignity and malignancy, and the logistic regression model had an accuracy of 0.719 for predicting the nature of the tumor ConclusionsAn ovarian tumor can be diagnosed and characterized before initial treatment via ML systems to provide critical diagnostic and prognostic information. The use of predictive algorithms can facilitate customized treatment options with patient preprocessing stratification.

Affective symptoms in pregnancy are associated with the vaginal microbiome

BackgroundComposition of the vaginal microbiome in pregnancy is associated with adverse maternal, obstetric, and child health outcomes. Therefore, identifying sources of individual differences in the vaginal microbiome is of considerable clinical and public health interest. The current study tested the hypothesis that vaginal microbiome composition during pregnancy is associated with an individual's experience of affective symptoms and stress exposure. MethodsData were based on a prospective longitudinal study of a medically healthy community sample of 275 mother-infant pairs. Affective symptoms and stress exposure and select measures of associated biomarkers (diurnal salivary cortisol, serum measures of sex hormones) were collected at each trimester; self-report, clinical, and medical records were used to collect detailed data on socio-demographic factors and health behavior, including diet and sleep. Vaginal microbiome samples were collected in the third trimester (34–40 weeks) and characterized by 16S rRNA sequencing. Identified taxa were clustered into three community clusters (CC1–3) based on dissimilarity of vaginal microbiota composition. ResultsResults indicate that depressive symptoms during pregnancy were reliably associated with individual taxa and CC3 in the third trimester. Prediction of functional potential from 16S taxonomy revealed a differential abundance of metabolic pathways in CC1–3 and individual taxa, including biosynthetic pathways for serotonin and dopamine. We did not find robust evidence linking symptom- and stress-related biomarkers and CCs. ConclusionsOur results provide further evidence of how prenatal psychological distress during pregnancy alters the maternal-fetal microbiome ecosystem that may be important for understanding maternal and child health outcomes.

Health policies and guidelines to promote, protect and support early childhood development: A narrative review

ABSTRACT This comprehensive review examines the pivotal role of health policies and guidelines in promoting, protecting, and supporting early childhood development (ECD). Recognizing the multifaceted nature of ECD, the study explores key elements commonly found in policies that span health, education, social services, and community support. The focus is on creating an integrated approach that ensures the optimal well-being and growth of children during their formative years. The review highlights the significance of maternal and child health care, emphasizing contact toward prenatal and postnatal care for pregnant women and newborns. Nutritional policies center around supporting breastfeeding and ensuring access to nutritious food, laying the foundation for a healthy start in life. Early childhood education programs and parental education initiatives are crucial components, emphasizing cognitive, social, and emotional development from the earliest stages. The review underscores the importance of a holistic perspective, urging the integration of services across sectors to provide a comprehensive framework for ECD. Research-based policies, continuous monitoring, and evaluation mechanisms ensure evidence-driven decision-making and ongoing refinement of strategies. Additionally, the role of legislation and advocacy is highlighted in protecting the rights and well-being of children and advocating for ECD at various levels. In the end, this review highlights the importance of ECD guidelines and health policies as investments that not only help individual children but also enhance societal productivity and general well-being. By prioritizing the early years, policymakers can lay a strong foundation for future health, learning, and success.

Combating Pediatric Pneumonia: The Dynamic Duo of Cinnamon-Clove Steam and Physiotherapy

IntroductionPediatric Community-Acquired Pneumonia (CAP) is a prevailing respiratory infection that impacts children in non-medical settings, giving rise to substantial morbidity and mortality, especially in less developed areas. The current study was aimed at finding a holistic approach for improving the management and treatment of pediatric CAP. For that purpose, a comparative interventional study was conducted to investigate the effectiveness of chest physiotherapy (CPT) combining with Cinnamon varum and Syzygium aromaticum steam therapy in pediatric CAP. MethodsA total of 60 pediatric patient hospitalized with CAP were assessed. The study included both male and female participants aged between 3 -14 years. The study was conducted at Children Hospital and Institute of Child Health in Faisalabad, Pakistan. The subjects were divided into three equal groups: Group 1 received CPT, Group 2 underwent CPT accompanied with nebulization, and Group 3 received CPT along with steam therapy using Cinnamon varum and Syzygium aromaticum. Each participant received the assigned therapy twice a day for 7 consecutive days. The study was approved and registered by Ethics Review Committee, Government College University, Faisalabad, Pakistan (Reference number GCUF/ERC/214). ResultsAmong the three groups studied, those who received the combined therapy exhibited improved outcome by improving the complete blood count (CBC), spirometer index, arterial blood gases (ABGs) and smart-cop severity score for pneumonia. ConclusionsThe antimicrobial, anti-inflammatory and mucolytic properties of cinnamon and clove, along with the positive effects of CPT, resulted in reduced lung inflammation, enhanced respiratory performance, and improved vital signs.