Pairs Of Children Research Articles

Effect of swimming initiation period and continuation frequency on motor competence development in children aged up to 3 years: the Japan environment and children’s study

BackgroundAlthough involvement of toddlers in swimming activities has increased recently, information regarding the impact of swimming during toddlerhood on subsequent child motor competence development is scarce. This study aimed to determine how swimming experience, particularly the timing of initiation and the continuity of swimming activities up to the age of 3 years, affects motor competence development.MethodsThis prospective cohort study included data on children aged 1.5 and 3 years (100,286 mother–child pairs) from the Japan Environment and Children’s Study. The outcomes measured were gross and fine motor function, using the Japanese version of the Ages and Stages Questionnaire (Third edition). We assessed how these functions correlated with the continuous pattern of swimming pool use frequency from age 1 up to 3 years.ResultsThe group that used a swimming pool once a month or more from age 1–1.5 years but stopped from age 2–3 years showed consistently significant negative associations with gross motor development delay (minimum adjusted odds ratio [aOR]: 0.66, 95% confidence interval [CI]: 0.60–0.73) and fine motor development delay (minimum aOR: 0.66, 95% CI: 0.58–0.76). The group that continued swimming once a month or more from age 1–3 years showed consistently significant negative associations with gross motor development delay (minimum aOR: 0.64, 95% CI: 0.54–0.75) and fine motor development delay (minimum aOR: 0.42, 95% CI: 0.31–0.55).ConclusionsThese results suggest that swimming experience starting around age 1 year is positively associated with gross and fine motor function development. The beneficial impact on gross motor function persisted from age 1–3 years. In contrast, the effects on fine motor function were not evident until age ≥ 2.5 years after starting swimming at approximately age 1 year. These findings underscore the potential benefits of early swimming experiences in enhancing overall motor skills development during early childhood.

Effects of Digital Picture Books on Young Children Undergoing Cardiac Catheterisation and Their Family Caregivers: A Randomised Controlled Trial.

To assess the impact of digital picture books on preoperative anxiety, pain and sleep quality in young children undergoing cardiac catheterisation and the anxiety of their family caregivers. A randomised, single-blinded, two-arm, parallel-group controlled trial. Participants are young children aged 2-7 years with congenital heart disease scheduled for cardiac catheterisation and their family caregivers. They were enrolled at Fujian Medical University Union Hospital between September 2022 and July 2023. They were randomised to either a control group receiving usual care or an intervention group receiving digital picture book sessions. Anxiety and pain levels were assessed using standardised scales, and sleep quality was measured using actigraphy. The study included 64 pairs of young children and family caregivers. Digital picture books significantly reduced preoperative anxiety and bandage removal pain in children and anxiety in family caregivers. However, there was no statistical difference in sleep quality between the intervention group and the control group. Digital picture books prove to be an effective intervention for reducing anxiety and pain in paediatric cardiac catheterisation patients and anxiety of their family caregivers. The intervention did not affect sleep quality, suggesting the need for additional strategies to address this aspect of the hospital experience. This study demonstrated the effectiveness of digitally illustrated books in reducing preoperative anxiety and pain in young children and anxiety in family caregivers. Digital picture books offer a creative and engaging way to help children and their families cope with the stress and anxiety associated with medical procedures. Further research in this area may lead to the development of more innovative and effective interventions for paediatric patients and their family caregivers. The study's impact lies in its innovative approach to addressing the psychological and emotional challenges faced by young children and their family caregivers during the stressful experience of cardiac catheterisation. By demonstrating the efficacy of digital picture books in significantly reducing preoperative anxiety and postoperative pain, the research presents a non-pharmacological, accessible and engaging intervention that can be seamlessly integrated into existing healthcare practices. The findings have the potential to transform paediatric care by offering a safe, developmentally appropriate and cost-effective method to support the emotional well-being of children and their families, thereby enhancing the overall patient experience and clinical outcomes. Moreover, the study's emphasis on family caregiver involvement underscores the importance of a holistic approach to care that considers the needs of both the patient and their support system. Children and their family caregivers were invited to provide valuable input which has been critical to the development of the intervention. The participant information sheet and consent form, as well as the consent/recruitment process, were reviewed by a consumer advisor advocate from the pilot study. CONSORT. Chinese clinical trial registry: ChiCTR2200063973. Registered on 22 September 2022, https://www.chictr.org.cn/showproj.html?proj=132833.

Prenatal and early life exposure to fine particulate matter and telomere length in early childhood

BackgroundTelomere length is a biomarker of molecular aging that may be impacted by air pollution exposure starting in utero. We aimed to examine the association between prenatal and early life exposure to fine particulate matter (PM2.5) and leukocyte telomere length (LTL) in children and explore sex differences. MethodsAnalyses included 384 mother–child pairs enrolled in the Programming Research in Obesity, Growth, and Environmental Stressors (PROGRESS) birth cohort in Mexico City. Exposure to PM2.5 was estimated at the residential level using a satellite based spatio-temporally resolved prediction model. Average relative LTL was measured in DNA isolated from blood collected at age 4–6 years using quantitative real-time polymerase chain reaction. Linear regression models were used to examine the association between average PM2.5 across pregnancy, individual trimesters, first postnatal year, and LTL. Models were adjusted for maternal age and education at enrollment, prenatal environmental tobacco smoke exposure, child sex, age, and body mass index z-score at LTL measurement. Effect modification by sex was investigated with interaction terms and stratification. ResultsIn trimester specific models, we found an association between 2nd trimester PM2.5 and elongated LTL (β: 4.34, 95%CI [0.42, 8.42], per 5 μg/m3 increase). There was suggestive effect modification by sex on average 2nd trimester PM2.5 with stronger associations seen in females compared to males (β: 7.12, [95%CI: 0.98, 13.6] and β: 1.43 [95%CI: −3.46, 6.57]) per 5 μg/m3 increase respectively. ConclusionSecond trimester PM2.5 levels were associated with changes in LTL in early childhood. Understanding temporal and sex differences in PM2.5 exposure may provide insights into telomere dynamics over early life.

Mobile phone call reminders to improve oral rehydration salt and zinc adherence for acute diarrhea in children: a single-center, randomized controlled trial

BackgroundLow-osmolarity oral rehydration salt (ORS) and zinc therapy effectively manage diarrhea in children under five years of age, offering both short- and long-term benefits. Despite this, caregivers’ adherence to ORS and zinc is often unsatisfactory due to factors such as forgetfulness, resolution of symptoms, and underestimation of the disease’s severity. This study assessed the effect of mobile call reminders on ORS and zinc tablet adherence among children with acute diarrhea in a secondary-level health facility in Kwara State, Nigeria.MethodsUsing an open-label, randomized controlled trial design, this study compared caregiver-child pairs with acute diarrhea aged 6–59 months who received standard instructions (SI) alone (control group) and an intervention group (IG) who received SI plus phone call reminders on days three and seven of zinc sulfate therapy. All participants used a pictorial diary to track loose/watery stools and ORS and zinc tablet treatments for ten days. The primary outcome measures were independent and combined adherence to ORS and zinc therapy. The secondary outcomes were independent and combined adherence scores, defined as the percentage of times the ORS was given post-diarrhea and the percentage of prescribed zinc tablets administered out of ten.ResultsA total of 364/400 mother–child pairs completed the study. The percentage of mothers with full adherence in the intervention group was 82.5% for ORS, 72.1% for zinc, and 58.5% for combined use, compared to 78.8%, 60.8%, and 43.6%, respectively, in the control group. The odds of full adherence to ORS and zinc were 1.6 and 1.7 times higher among intervention mothers [ORS: OR = 1.561, 95% CI = 0.939–2.598, P = 0.085; zinc: OR = 1.671, 95% CI = 1.076–2.593, P = 0.022], and 1.8 times higher for combined use according to WHO guidelines [OR = 1.818, 95% CI = 1.200–2.754, P = 0.005]. The mean adherence scores for the intervention group were higher than those for the control group by 4.1% (95% CI = 0.60–7.60) for ORS, 7.3% (95% CI = 3.74–10.86) for zinc, and 5.7% (95% CI = 3.23–8.17) for the combined treatment.ConclusionPhone reminders can effectively improve consistency of home treatment administered by caregivers for children under five years old.Trial RegistrationThe study was registered retrospectively (17/3/2023) with the Pan African Clinical Trial Registry (PACTR202301560735856).

Cohort profile: the Swiss Mother and Child HIV Cohort Study (MoCHiV)

PurposeProspective, multicentric observational cohort study in Switzerland investigating measures to prevent mother-to-child transmission in pregnant women with HIV (WWH) and assessing health and development of their exposed children as well...

Cognitive outcomes after fetal exposure to carbamazepine, lamotrigine, valproate or levetiracetam monotherapy: Data from the EURAP neurocognitive extension protocol

PurposePrenatal exposure to antiseizure medications (ASMs) has been associated with an increased risk of major malformations and neurodevelopmental disorders, with the latter being mainly associated with valproate (VPA). Our aim was to compare neurocognitive outcome at age 6–7 years in children exposed prenatally to lamotrigine (LTG), carbamazepine (CBZ), valproate (VPA) or levetiracetam (LEV) monotherapy. MethodsEligible mother–child pairs were identified from the observational prospective multinational EURAP cohort study. Assessor-blinded testing was conducted at age 6–7 years using WISC-III and NEPSY-II. Verbal IQ (VIQ), performance IQ (PIQ), full scale IQ (FSIQ) and performance in neuropsychological tasks were compared across ASM groups by ANOVA. Scores were adjusted for maternal IQ, paternal education, maternal epilepsy type and child sex. ResultsOf 169 children enrolled in the study, 162 (LTG n = 80, CBZ n = 37, VPA n = 27, LEV n = 18) had sufficient data from WISC-III, NEPSY-II or both, and were included in the analyses. Observed (unadjusted) PIQ and FSIQ did not differ across exposure groups, but a difference was identified for VIQ (P<0.05), with children exposed to VPA having lower scores than children exposed to LEV (P<0.05) and children from all groups combined (P<0.01). Adjusted VIQ, PIQ and FSIQ scores did not differ significantly across groups, but VPA-exposed children had borderline significantly lower adjusted VIQ scores than children from all groups combined (P=0.051). VPA-exposed children had lower scores in comprehension of instructions before and after adjustment for confounding variables than children exposed to LTG (P<0.001), LEV (P<0.01) or children from all groups combined (p < 0.001). The VPA-exposed group also had lower scores in immediate and delayed memory for faces compared to children exposed to CBZ (P<0.05 and P<0.001, respectively) and LTG (P<0.05 and P<0.02, respectively), and children from all groups combined (P<0.02 and P<0.001, respectively). LEV-exposed children had lower scores in delayed memory for names than children exposed to LTG (P<0.001), CBZ (P<0.001), VPA (P<0.05) and children from all groups combined (P<0.001). ConclusionsConsistent with previous reports, our results provide evidence for an adverse effect of prenatal exposure to valproate on verbal development. Our finding of relatively weaker performance of VPA-exposed children compared to other ASM exposures in both comprehension of instructions and face memory also suggest that children of mothers treated with VPA are at increased risk for compromised memory functions or altered processing of socially relevant information.

Parent and child opinion on the use of standing desks in the classroom

ObjectiveStanding desks present a novel approach to reduce sedentary time in the classroom and address cardiovascular risk factors at an early age. In the context of designing a standing desk study, parents and children were surveyed regarding their perceptions and current use of standing desks and other flexible seating. MethodsSurvey administered from January 31st to February 26th, 2024 to a convenience cohort of 50 parent–child pairs presenting for well or acute care at a pediatrics clinic affiliated with an academic institution (Hershey, Pennsylvania, United States). Logistic regression examined parent support of and child willingness to use a standing desk in the classroom. ResultsParents were primarily non-Hispanic, white females above 40 years of age. Child participants mean age and grade level were 10.5 years and 5th grade respectively. Among parents, 85 % (39/46) were supportive of their child’s use of a standing desk in the classroom, with 4 declining to answer. For children, almost half, 48 % (24/50), were willing to use a standing desk. Acceptability decreased for child body mass index (BMI) ≥85th percentile versus BMI <85th percentile (parent acceptability OR = 0.07 [95 % CI: 0.01–0.63; p = 0.018]; child acceptability: OR = 0.13 [95 % CI 0.03–0.51, p = 0.003]). ConclusionsMost parents and children are amenable to use of a standing desk in the classroom. Additional information for children with elevated BMI and their parents may be required to address reservations about standing. This study was limited by its small sample size, which may not generalize to other populations.

Association of phenol exposure during pregnancy and asthma development in children: The Japan Environment and Children's study

BackgroundAlkylphenols can originate from numerous products containing alkylphenol ethoxylates, including cleaning products, household items, and cosmetics. Some phenols, such as nonylphenol, are known to be endocrine disruptors, and exposure to them is thought to have contributed to the recent increase in allergic diseases such as asthma. However, the impacts of prenatal phenol exposure on asthma development in children are still unclear. MethodsWe analyzed the association between maternal urinary phenol concentrations during early pregnancy and the development of asthma in children at the age of 4, using data from the Japan Environment and Children's Study (JECS), a large-scale nationwide birth cohort study. ResultsWe recruited 3,513 pairs of mothers and children participating in the Sub-Cohort Study of JECS. We measured 24 phenols, including nitrophenol, parabens, bisphenol, octylphenol, and nonylphenol, in urine samples taken during the first trimester of pregnancy. The urinary levels of these phenols differed markedly, and some showed a broad spectrum of distribution. Methylparaben was detected at high levels in almost every participant (267.7 ng/ml, standard deviation 433.78). Logistic regression analysis revealed that the odds ratio of asthma onset for high exposure to butylparaben was 1.54 (95% confidence interval: 1.11–2.15). Additionally, logistic regression analysis by gender revealed an asthma development odds ratio of 2.09 (95% confidence interval: 1.20–3.65) for males and 0.65 (95% confidence interval: 0.25–1.70) for females born to mothers in whom 4-nonylphenol was detected, suggesting a gender difference. ConclusionOur current analysis using large cohort data suggests that high exposure to butylparaben and low exposure to 4-nonylphenol during pregnancy are risk factors for asthma development in children. These findings establish a valuable foundation for formulating recommendations about prenatal phenol exposure.

Perinatal outcomes after a prenatal diagnosis of a fetal copy number variant: a retrospective population-based cohort study

BackgroundThere are no established guidelines for the follow up of infants born after a prenatal diagnosis of a genomic copy number variant (CNV), despite their increased risk of developmental issues. The aims of this study were (i) to determine the perinatal outcomes of fetuses diagnosed with and without a CNV, and (ii) to establish a population-based paediatric cohort for long term developmental follow up.MethodsAn Australian state-wide research database was screened for pregnant individuals who had a prenatal chromosomal microarray (CMA) between 2013–2019 inclusive. Following linkage to laboratory records and clinical referrer details, hospital records were manually reviewed for study eligibility. Eligible participants were mother–child pairs where the pregnancy resulted in a livebirth, the mother was able to provide informed consent in English (did not require a translator) and the mother was the primary caregiver for the child at hospital discharge after birth. Research invitations were sent by registered post at an average of six years after the prenatal diagnostic test. Statistical analysis was performed in Stata17.ResultsOf 1832 prenatal records examined, 1364 (74.5%) mother–child pairs were eligible for recruitment into the follow up cohort. Of the 468 ineligible, 282 (60.3%) had ‘no live pregnancy outcome’ (209 terminations of pregnancy (TOP) and 73 miscarriages, stillbirths, and infant deaths), 157 (33.5%) required a translator, and 29 (6.2%) were excluded for other reasons. TOP rates varied by the type of fetal CNV detected: 49.3% (109/221) for pathogenic CNVs, 18.2% (58/319) for variants of uncertain significance and 3.3% (42/1292) where no clinically significant CNV was reported on CMA. Almost 77% of invitation letters were successfully delivered (1047/1364), and the subsequent participation rate in the follow up cohort was 19.2% (201/1047).ConclusionsThis study provides Australia’s first population-based data on perinatal outcomes following prenatal diagnostic testing with CMA. The relatively high rates of pregnancy loss for those with a prenatal diagnosis of a CNV presented a challenge for establishing a paediatric cohort to examine long term outcomes. Recruiting a mother–child cohort via prenatal ascertainment is a complex and resource-intensive process, but an important step in understanding the impact of a CNV diagnosis in pregnancy and beyond.Trial registrationACTRN12620000446965p; Registered on April 6, 2020.

Socioeconomic adversity, maternal nutrition, and the prenatal programming of offspring cognition and language at two years of age through maternal inflammation

Increasing rates of child neurodevelopmental vulnerability are a significant public health challenge. The adverse effect of socioeconomic adversity on offspring cognition may be mediated through elevated prenatal maternal systemic inflammation, but the role of modifiable antecedents such as maternal nutrition has not yet been clarified. This study aimed to examine (1) whether prenatal factors, with an emphasis on maternal nutrition, were associated with prenatal maternal systemic inflammation at 28 weeks’ gestation, including the metabolomic marker glycoprotein acetyls (GlycA); (2) the extent to which the association between prenatal maternal nutrition and child cognition and language at age two years was mediated by elevated maternal inflammation in pregnancy; (3) the extent to which the associations between prenatal socioeconomic adversity and child neurodevelopment were mediated through prenatal maternal nutrition and GlycA levels. We used a prospective population-derived pre-birth longitudinal cohort study, the Barwon Infant Study (Barwon region of Victoria, Australia), where 1074 mother–child pairs were recruited by 28 weeks’ gestation using an unselected sampling frame. Exposures included prenatal factors such as maternal diet measured by a validated food frequency questionnaire at 28 weeks’ gestation and dietary patterns determined by principal component analysis. The main outcome measures were maternal inflammatory biomarkers (GlycA and hsCRP levels) at 28 weeks’ gestation, and offspring Bayley-III cognition and language scores at age two years. Results showed that the ‘modern wholefoods’ and ‘processed’ maternal dietary patterns were independently associated with reduced and elevated maternal inflammation respectively (GlycA or hsCRP p < 0.001), and also with higher and reduced offspring Bayley-III scores respectively (cognition p ≤ 0.004, language p ≤ 0.009). Associations between dietary patterns and offspring cognition and language were partially mediated by higher maternal GlycA (indirect effect: cognition p ≤ 0.036, language p ≤ 0.05), but were less evident for hsCRP. The maternal dietary patterns mediated 22 % of the association between socioeconomic adversity (lower maternal education and/or lower household income vs otherwise) and poorer offspring cognition (indirect effect p = 0.001). Variation in prenatal GlycA levels that were independent of these dietary measures appeared less important. In conclusion, modifiable prenatal maternal dietary patterns were associated with adverse child neurocognitive outcomes through their effect on maternal inflammation (GlycA). Maternal diet may partially explain the association between socioeconomic adversity and child neurocognitive vulnerability. Maternal diet-by-inflammation pathways are an attractive target for future intervention studies.

Birth outcomes and survival by sex among newborns and children under 2 in the Birhan Cohort: a prospective cohort study in the Amhara Region of Ethiopia

IntroductionDespite the progress in reducing child mortality, the rate remains high, particularly in sub-Saharan African countries. Limited data exist on child survival and other birth outcomes by sex. This study...

Prenatal mercury exposure and the secondary sex ratio: The Japan Environment and Children's Study

Prior research into the association between prenatal mercury (Hg) exposure and the secondary sex ratio has yielded inconclusive and conflicting results. Notably, no study has used cord blood Hg measurement in this context. Also, the differences in Hg species and the potential modifying role of selenium (Se) on this association remain unexplored. Using data from the Japan Environment and Children's Study, we analyzed mother–child pairs with available data for concentrations of total mercury (THg) and Se in maternal blood during late pregnancy, and THg, inorganic mercury (IHg), methylmercury (MeHg), and Se in cord blood. Logistic regression models were employed to examine the association between Hg and Se biomarkers and the secondary sex ratio. Out of the total sample of 3698 children, 1877 (50.8 %) were male, corresponding to an overall secondary sex ratio of 1.03. After adjusting for maternal age and parity, no significant associations were observed between THg concentrations of maternal blood and the secondary sex ratio. Nevertheless, we identified that two-fold increases in THg, IHg, and MeHg concentrations in cord blood were positively associated with increased odds of having a male child, yielding adjusted odds ratios of 1.13 (95 %CI: 1.04, 1.22), 1.12 (1.03, 1.21), and 1.12 (1.03, 1.22), respectively. When stratified by the median Se concentrations, no apparent differences were detected in the associations between Hg concentrations and the secondary sex ratio. In summary, elevated Hg concentrations in cord blood, but not maternal blood, were associated with an increased probability of male births.

Integrating Multi-Omics with environmental data for precision health: A novel analytic framework and case study on prenatal mercury induced childhood fatty liver disease

BackgroundPrecision Health aims to revolutionize disease prevention by leveraging information across multiple omic datasets (multi-omics). However, existing methods generally do not consider personalized environmental risk factors (e.g., environmental pollutants). ObjectiveTo develop and apply a precision health framework which combines multiomic integration (including early, intermediate, and late integration, representing sequential stages at which omics layers are combined for modeling) with mediation approaches (including high-dimensional mediation to identify biomarkers, mediation with latent factors to identify pathways, and integrated/quasi-mediation to identify high-risk subpopulations) to identify novel biomarkers of prenatal mercury induced metabolic dysfunction-associated fatty liver disease (MAFLD), elucidate molecular pathways linking prenatal mercury with MAFLD in children, and identify high-risk children based on integrated exposure and multiomics data. MethodsThis prospective cohort study used data from 420 mother–child pairs from the Human Early Life Exposome (HELIX) project. Mercury concentrations were determined in maternal or cord blood from pregnancy. Cytokeratin 18 (CK-18; a MAFLD biomarker) and five omics layers (DNA Methylation, gene transcription, microRNA, proteins, and metabolites) were measured in blood in childhood (age 6–10 years). ResultsEach standard deviation increase in prenatal mercury was associated with a 0.11 [95% confidence interval: 0.02–0.21] standard deviation increase in CK-18. High dimensional mediation analysis identified 10 biomarkers linking prenatal mercury and CK-18, including six CpG sites and four transcripts. Mediation with latent factors identified molecular pathways linking mercury and MAFLD, including altered cytokine signaling and hepatic stellate cell activation. Integrated/quasi-mediation identified high risk subgroups of children based on unique combinations of exposure levels, omics profiles (driven by epigenetic markers), and MAFLD. ConclusionsPrenatal mercury exposure is associated with elevated liver enzymes in childhood, likely through alterations in DNA methylation and gene expression. Our analytic framework can be applied across many different fields and serve as a resource to help guide future precision health investigations.

Impact of environmental exposures on exhaled breath and lung function: NELA Birth Cohort

Exposure to environmental exposures (i.e.air pollution and second-hand tobacco smoke) have been associated with impaired lung function. However, the impact of environmental factors on lung health is usually evaluated separately and not with an exposomic framework. In this regard, breath analysis could be a non-invasive tool for biomonitoring of global human environmental exposure.Data come from 337 mother–child pairs from the NELA birth cohort. Levels of BTEX (benzene, toluene, ethylbenzene and xylenes) in exhaled breath from mothers and children at 3 months after birth were estimated using gas chromatography-mass spectrometry. Short-term residential exposures (breath sampling day and 15 days before breath sampling) to nitrogen dioxide (NO2), particulate matter (PM2.5), and ozone (O3) were determined by chemical dispersion/transport modelling. Forced vital capacity (FVC), forced expiratory volume at 0.5 s (FEV0.5) and forced expiratory flow at 75% of FVC (FEF75) and at 25%–75% of FVC (FEF25-75) were measured in infants according to the raised-volume rapid thoracoabdominal compression technique.The results showed significant associations between short-term exposure to external agents and levels of benzene and toluene in exhaled breath. It was observed that exhaled levels of benzene and toluene were influenced by smoking status and outdoor air pollution in mothers, and by air pollution in infants (3 months of age). No significant relationship was observed between exposure to maternal tobacco smoking and/or short-term air pollution and lung function in healthy infants. However, there was a significant relationship between FEV0.5and exhaled toluene in children.These findings indicated a significant relationship between environmental exposures and exhaled levels of benzene and toluene, suggesting that breath analysis could be a helpful exposure biomonitoring tool.

The phenotypes of double burden of malnutrition in pairs of mothers and their children aged 0–59 months at a rural district in west region, Cameroon: A cross-sectional study

BackgroundIn most of the sub-Saharan African countries, there is a lack of epidemiological data on maternal obesity and child undernutrition. The present study aims to determine the prevalence of the double burden of malnutrition (DBM) among mother–child pairs in a rural locality of Cameroon, and understand the main associated factors. MethodsA cross-sectional study was conducted in the Health Districts of the locality of Dschang in the West region of Cameroon between June 2021 to November 2021. Data were collected from 200 under-five children of both sexes using a questionnaire that was administered to consented children's mothers/guardians. Malnutrition in children was assessed by WHO growth standards. Logistic regression analyses were done to identify factors associated with different coexisting forms of malnutrition. ResultsThe prevalence of DBM phenotypes was 2.7 % for mother overweight/obese-child wasted, 7.7 % for mother overweight/obese-child underweight, and 16.5 % for mother overweight/obese-child stunted. The results from logistic regression analyses showed a great risk of the phenotype mother overweight/obese-child stunted in younger mothers (OR = 3.45; 95 % CI: 1.23–9.69), as was the case in mothers with a low socio-economic level (OR = 3.55; 95 % CI: 1.22–10.33). Additionally, low maternal education level (OR = 16.80; 95 % CI: 1.78–158.58) and limited maternal food consumption (OR = 10.43; 95 % CI: 1.10–98.35) increased the risk of presenting the phenotype of mother overweight/obese-child wasted. ConclusionThis study demonstrated the evidence of DBM among mother-child pairs in rural areas. Further studies are thus needed in other rural localities of the country to better understand the DBM and to develop innovative policies.

Prenatal exposure to PM2.5 and childhood body mass index growth trajectories from birth to 6 years old

This study aimed to determine the relationships between prenatal PM2.5 exposure and childhood growth trajectories during the first 6 years of life. A total of 47,625 pairs of mothers and children were recruited from a prospective birth cohort conducted between 2011 and 2013 in Wuhan, China, and followed for 6 years. We used the group-based trajectory models to classify the population into three trajectory groups: slow growth (n = 13,671, 28.7%), normal growth (n = 29,736, 62.4%), and rapid growth (n = 4218, 8.9%). Multinomial logistic regression models were used to determine the associations of prenatal PM2.5 exposure and childhood growth trajectories. Compared to normal growth trajectory, increased PM2.5 exposure in trimester 1, trimester 2 and the entire pregnancy showed significant associations with an increased risk of the slow growth trajectory but reduced the risk for the rapid growth trajectory, significant association of prenatal PM2.5 exposure with rapid growth trajectory was only observed in the trimester 3. Stratified analyses displayed relatively stronger associations among those mothers with maternal age over 35 years, pre-pregnancy BMI ≥ 25 kg/m2, and previous delivery experience. Prenatal exposure to PM2.5, particularly during the midpoint period of pregnancy, was more likely to have a slow growth trajectory and a lower risk of rapid growth trajectory. Maternal age, pre-pregnancy BMI, and previous delivery experience might modify these associations.

Understanding the differences in the use of graphic tool and planning during graphic execution between individuals with autism and typically developing individuals

Individuals with autism (ASD) often face difficulty in executing graphic tasks. This can be related to how one uses a graphic tool (e.g., pen) and plans ahead the graphic execution. Use of graphic tool can be captured using attributes, e.g., pen-tip pressure, number of pen lifts, etc. One’s ability to plan a graphic execution can be quantified using the total duration of pen lifts (i.e., air time). Though pen-and-paper-based Trail Making Test-Part A (TMT-A) can estimate planning of graphic execution, yet it cannot capture other attributes, e.g., pen-tip pressure, pen lift, etc. This can be possible if TMT-A is administered on a pressure-sensitive tablet as seen from existing studies with typically developing (TD) individuals. However, quantification of such attributes using TMT-A administered on a pressure-sensitive tablet remains unexplored for individuals with ASD. In addition, such objective measures can help to understand variations in the use of graphic tool and ability to plan graphic execution even outside the TMT-A task, e.g., while drawing shapes which is important to the development of children’s graphic skills. Here, we conducted a study with 12 pairs of TD children and those with ASD who executed TMT-A (in Phase-I) and shape drawing (in Phase-II) on a pressure-sensitive tablet. Results of our study show differences in the use of graphic tool and planning ahead the graphic execution between two participant groups in both the Phases. Such insights can offer clinical inputs that can be helpful in designing individualized intervention paradigms for children facing difficulties in graphic execution.

Statistical analysis plan for cluster randomised trial to evaluate a community-level complementary food safety and hygiene and nutrition intervention in Mali: the MaaCiwara study

BackgroundDiarrheal disease is a significant cause of morbidity and mortality in under-fives in many low- and middle-income countries. Changes in food safety, hygiene practices, and nutrition around the weaning period may reduce the risk of disease and improve infant development. The MaaCiwara study aims to evaluate the effectiveness of a community-based educational intervention designed to improve food safety and hygiene behaviours, as well as child nutrition. This update article describes the statistical analysis plan for the MaaCiwara study in detail.Methods and designThe MaaCiwara study is a parallel group, two-arm, superiority cluster randomised controlled trial with baseline measures, involving 120 clusters of rural and urban communities. These clusters are randomised to either receive the community-based behaviour change intervention or to the control group. The study participants will be mother–child pairs, with children aged between 6 and 36 months. Data collection involves a day of observation and interviews with each participating mother–child pair, conducted at baseline, 4 months, and 15 months post-intervention.The primary analysis aims to estimate the effectiveness of the intervention on changes to complementary food safety and preparation behaviours, food and water contamination, and diarrhoea. The primary outcomes will be analysed generalised linear mixed models, at individual level, accounting for clusters and rural/urban status to estimate the difference in outcomes between the intervention and control groups. Secondary outcomes include maternal autonomy, enteric infection, nutrition, child anthropometry, and development scores. In addition, structural equation analysis will be conducted to examine the causal relationships between the different outcomes.Trial registrationInternational Standard Randomised Controlled Trial Number (ISRCTN) register: ISRCTN14390796. Registered on 13 December 2021.

Risk factors for the development of congenital giant nevi in children

BACKGROUND: Congenital giant melanocytic nevi (CMN) occur approximately in 1 of 250,000–500,000 newborns. According to foreign literature, the risk of malignancy of a melanocytic nevus varies widely within 5%–42%. AIM: This study aimed to identify possible risk factors for CMN in children and determine the most common location and actual list of examination. MATERIALS AND METHODS: The study enrolled 104 mother–child pairs, where the children had CMN. The control group included 60 mother–child pairs, in which the children had no CMN. RESULTS: CMN were located on the head in 42.4% of cases, which was the most frequent localization. The most frequent localizations also included the trunk and simultaneous location of nevi on several body segments. Abnormalities in thyroid hormone levels were noted in 12.5% of the mothers. The frequency of large nevi in the grandparents of children with CMN (13.5%) was significantly higher than that in their parents (mother, 1.9%; father, 2.9%). In addition, 19.2% of the children were examined by an oncologist or are on a dispensary register with an oncologist. Moreover, 4.8% of the patients were observed by a neurologist. Magnetic resonance imaging was performed once in 19.2% of the children, who underwent genetic testing. No foci of melaniform cell accumulation in the nervous tissue were detected in any examined child. CONCLUSIONS: The most common location of CMN is the head and torso – areas of risk of damage to the central nervous system by melanoform cells. The survey results of parents of the main group identified the following as risk factors for CMN development in children: a history of miscarriage or frozen pregnancy, thyroid hormone abnormalities, CMN in grandparents, ARVI during pregnancy, particularly in the first trimester, and visiting a solarium and using long-lasting gel polishes during pregnancy.

The Relationship Between School-Age Children’s Physical Activity and Their Leisure Activity Interests: An Exploratory Study

ABSTRACT Physical activities and leisure engagement are important occupations that children partake in. However, the association between physical activities and leisure engagement preferences in children remains largely unexplored in Australian contexts. As such, this study investigated the relationship between children’s physical activities and their leisure activity engagement preferences. A study was conducted involving 27 pairs of school-aged children and their parents/caregivers. Children completed the Preferences for Activities of Children and Children’s Leisure Assessment. Parents/caregivers completed the Children’s Physical Activity Questionnaire. Spearman rho correlations and linear regression analyses with bootstrapping were completed. Children’s games and sports activity variety was significantly correlated with active school activity duration (rho = .452, p = .018). In addition, children’s preferences for instrumental indoor activities predicted sports frequency on weekdays (R2 = .446, p = .003). Similarly, self-enrichment activities variety was predictive of sports activities frequency on weekdays (R2 = .446, p = .006) and weekends (R2 = .151, p = .026). Finally, children’s sociability in instrumental indoor activities predicted active leisure activity duration on weekends (R2 = .120, p = 043). Findings suggest that children’s leisure engagement preferences are predictive of their participation in physical activities. Specific aspects of leisure participation, such as variety and sociability, can also predict children’s physical activity levels. When promoting physical activities, it is important to understand children’s leisure engagement preferences so that clinicians can develop individualized plans by incorporating children’s interests. This will inform child-centered goal setting and intervention planning. Further research in this area is recommended.