Burden Of Children Research Articles

Residential Area Characteristics Are Associated With Asthma Burden in Children.

Wheezing illnesses, especially those triggered by rhinovirus infection, cause a major disease burden, and they often precede asthma. Environmental exposures are known to affect recurrence of wheezing. We investigated the relations of population density, greenness (forested areas), and socioeconomic factors of the living surroundings to the burden of asthma in children with prior bronchiolitis. Three hundred and ninety-four children, aged 0-24 months, with doctor-diagnosed bronchiolitis were enrolled in the MARC-30 Finland study. We assessed the children's early-life exposures to greenness and socioeconomic factors using time-series of Corine Land Cover data and Statistics Finland's grid data. We compared the living surroundings data to the prescription drug purchases and special asthma reimbursement benefits until the age 8 years; asthma data were from the Social Insurance Institution of Finland. Children living in sparsely populated areas had lighter asthma disease burden than children living in densely populated ones, with burden measured in median bronchodilator (50DDD [defined daily dose] vs. 104DDD, p = 0.02) and inhaled corticosteroid (0DDD vs. 123DDD, p = 0.04) purchases. In the subgroup of children with rhinovirus-induced bronchiolitis, children living in more forested areas developed asthma 10 months later than those with less forested areas (p = 0.04). Neighborhood socioeconomic characteristics were not associated with differences in asthma burden. Sparsely populated areas and forested environments seem to have a beneficial association with children's respiratory health. These findings warrant further studies on the protective health effects of greenness and the type of biodiversity around homes.

The Impact of Prenatal Environmental Tobacco Smoking (ETS) and Exposure on Chinese Children: A Systematic Review.

Background: There is considerable evidence to support the association between exposure to environmental tobacco smoke (ETS) and children's burden of disease. However, the literature on the health outcomes of prenatal ETS exposure among Chinese children has not yet been comprehensively reviewed. Objective: This systematic review examines the currently available evidence and identifies gaps for further research on the health consequences of prenatal ETS exposure on Chinese children. Methods: Following the JBI systematic-scoping review methodological framework, we conducted a computer-aided search of three electronic databases-PubMed, EBSCOhost, and ProQuest to include studies from January 2011 to May 2023 that addressed the health outcomes of Chinese children whose mothers were exposed to ETS at any stage of pregnancy. Furthermore, a methodological quality assessment of the selected articles was conducted using JBI critical appraisal checklists. Results: A total of 30 articles were reviewed, including eleven high-quality studies and nineteen moderate-quality studies. Five main themes, including hypertension, fetal and children's development, behavioural disorders, respiratory outcomes, and "other health outcomes", were encompassed. The majority of the studies showed a positive link between prenatal ETS exposure and an increased risk of preterm birth, and moderate risk of fetal growth restriction. A few studies explored other potential adverse outcomes of ETS, including hypertension, respiratory morbidity, lung function, and asthma in children. Conclusions: The currently available evidence on prenatal ETS exposure in Chinese children has unveiled a wide range of health outcomes, including preterm birth, fetal development, behavioural disorders, and much more. However, Chinese studies in this area are still lacking and a gap still exists in relation to the strength of association between prenatal ETS exposure and some health risks. Efficient anti-smoking policies and smoking cessation programs should be developed to promote maternal and child health. Further research is also needed to provide better evidence in this field.

Public health priorities for Sino-Africa cooperation in Eastern Africa in context of flooding and malaria burden in Children: a tridecadal retrospective analysis

BackgroundMalaria remains a major public health burden to children under five, especially in Eastern Africa (E.A), —a region that is also witnessing the increasing occurrence of floods and extreme climate change. The present study, therefore, explored the trends in floods, as well as the association of their occurrence and duration with the malaria incidence in children < 5 years in five E.A partner countries of Forum for China-Africa Cooperation (FOCAC), including Ethiopia, Kenya, Somalia, Sudan, and Tanzania between 1990 and 2019.MethodsA retrospective analysis of data retrieved from two global sources was performed: the Emergency Events Database (EM-DAT) and the Global Burden of Diseases Study (GBD) between 1990 and 2019. Using SPSS 20.0, a correlation was determined based on ρ= -1 to + 1, as well as the statistical significance of P = < 0.05. Time plots of trends in flooding and malaria incidence were generated in 3 different decades using R version 4.0.ResultsBetween 1990 and 2019, the occurrence and duration of floods among the five E.A partner countries of FOCAC increased and showed an upward trend. On the contrary, however, this had an inverse and negative, as well as a weak correlation on the malaria incidence in children under five years. Only Kenya, among the five countries, showed a perfect negative correction of malaria incidence in children under five with flood occurrence (ρ = -0.586**, P-value = 0.001) and duration (ρ = -0.657**, P-value = < 0.0001).ConclusionsThis study highlights the need for further research to comprehensively explore how different climate extreme events, which oftentimes complement floods, might be influencing the risk of malaria in children under five in five E.A malaria-endemic partner countries of FOCAC. Similarly, it ought to consider investigating the influence of other attributes apart from flood occurrence and duration, which also compound floods like displacement, malnutrition, and water, sanitation and hygiene on the risk and distribution of malaria and other climate-sensitive diseases.

RWD153 Investigating Trends of Behavioral Healthcare Resource Utilization Burden in Children and Adolescents with Suicidal Symptoms in the United States: An Analysis of Electronic Health Record Data

The increasing rates of mental health disorders and suicide among children and adolescents have highlighted the importance of understanding the burden of healthcare resource utilization for this population. This study aims to investigate trends in the utilization of behavioral health services by minors with suicidal or self-harm symptoms in the United States.

X-linked genodermatoses from diagnosis to tailored therapy.

Genodermatoses are rare heterogeneous genetic skin diseases with multiorgan involvement. They severely impair an individual's well-being and can also lead to early death. During the progress of this review, we have implemented a targeted research approach, diligently choosing the most relevant and exemplary articles within the subject matter. Our method entailed a systematic exploration of the scientific literature to ensure a compre-hensive and accurate compilation of the available sources. Among genodermatoses, X-linked ones are of particular importance and should always be considered when pediatric males are affected. Regardless of other syndromic forms without prevalence of skin symptoms, X-linked genodermatoses can be classified in three main groups: keratinization defects, pigmentation defects, and inflammatory skin diseases. Typical examples are dyskeratosis congenita, keratosis follicularis spinulosa decalvans, hypohidrotic ectodermal dysplasia, chondrodysplasia punctata, hypohidrotic ectodermal dysplasia, incontinentia pigmenti, chronic granulomatous disease, CHILD syndrome and ichthyosis. In this field, genetic diagnosis of the specific disease is important, also considering that numerous clinical trials of orphan drugs and genetic therapies are being proposed for these rare genetic diseases. Thus, this chapter starts from clinical to molecular testing and ends with a review of all clinical trials on orphan drugs and gene therapy for genodermatoses.

Disease Burden in Children With Spinal Muscular Atrophy: Results From a Large Cross-Sectional Study.

Background:To facilitate advances in spinal muscular atrophy therapeutic research, it is important to determine the impact and prevalence of symptoms experienced by children with spinal muscular atrophy. Methods: We conducted qualitative interviews with caregivers of children with spinal muscular atrophy. From these interviews, we generated a survey inquiring about 260 symptoms of importance grouped into 17 symptomatic themes. Results: Sixteen caregivers of children with spinal muscular atrophy aged from 4 months to 12 years participated in initial interviews, and 77 caregivers completed the survey. Higher symptom prevalence was associated with spinal muscular atrophy type, SMN2 copy number, and functional status. Hip, thigh, or knee weakness had the greatest reported impact on the lives of children with spinal muscular atrophy. Conclusions: This research provides one of the largest data sets regarding disease burden in children with spinal muscular atrophy. The most prevalent symptoms are not identical to those with the greatest impact. This unique insight into the most impactful symptoms will help focus therapeutic development in spinal muscular atrophy.

O011 Effect of Continuous Positive Airway Pressure on Quality of Life and Treatment Burden in Children with Obstructive Sleep Apnoea

Abstract Introduction Increasing numbers of children with obstructive sleep apnoea (OSA) require treatment with continuous positive airway pressure (CPAP). We aimed to assess the impact on quality of life (QOL) and treatment burden for caregivers of children requiring CPAP. Methods Prospective study of children commencing outpatient CPAP in a tertiary sleep unit 2020-2022. Questionnaires regarding sleep-related symptoms (PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment), QOL (OSA-18, QI-Disability), caregiver burden (Caregiver Strain Questionnaire) and overall health impact (Glasgow Children’s Benefit Inventory) were completed by caregivers at commencement of CPAP and 6 weeks later. Progress Complete data available to date in 24 children (6F; median age 12.5y, range 6-18y; median OAHI 9.2/hr; median BMI 30.7). OSA-related QOL significantly improved at follow-up (OSA-18 total and domain scores all p&amp;lt;0.001). There were significant improvements in child general QOL (p&amp;lt;0.0001), sleep disturbance (p&amp;lt;0.01) and sleep-related impairment (p&amp;lt;0.001). Caregivers rated CPAP as beneficial to their child’s general condition (mean 30, where maximum harm -100, maximum benefit +100). Caregiver strain reduced at follow-up (p&amp;lt;0.001) and benefit outweighed inconvenience (p&amp;lt;0.0001). 3 caregivers scored inconvenience higher than benefit; 1 scored them equally. 1 caregiver rated CPAP harmful and 3 caregivers reported no effect on their child’s general health. Outcome CPAP results in significant improvements in QOL and sleep-related symptoms in children with OSA, and reductions in caregiver strain. Perceived benefits generally outweighed the burden of treatment, but not for all families. Further analysis will investigate how the balance of benefit to burden relates to adherence and the effect of co-morbidities.

Analysis of INSPPIRE-2 Cohort: Risk Factors and Disease Burden in Children With Acute Recurrent or Chronic Pancreatitis.

The objective of this study is to investigate risk factors and disease burden in pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). Data were obtained from INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2), the largest multi-center prospective cohort study in pediatric patients with ARP or CP. Of 689 children, 365 had ARP (53%), 324 had CP (47%). CP was more commonly associated with female sex, younger age at first acute pancreatitis (AP) attack, Asian race, family history of CP, lower BMI%, genetic and obstructive factors, PRSS1 mutations and pancreas divisum. CFTR mutations, toxic-metabolic factors, medication use, hypertriglyceridemia, Crohn disease were more common in children with ARP. Constant or frequent abdominal pain, emergency room (ER) visits, hospitalizations, medical, endoscopic or surgical therapies were significantly more common in CP, episodic pain in ARP. A total of 33.1% of children with CP had exocrine pancreatic insufficiency (EPI), 8.7% had diabetes mellitus. Compared to boys, girls were more likely to report pain impacting socialization and school, medical therapies, cholecystectomy, but no increased opioid use. There was no difference in race, ethnicity, age at first AP episode, age at CP diagnosis, duration of disease, risk factors, prevalence of EPI or diabetes between boys and girls. Multivariate analysis revealed that family history of CP, constant pain, obstructive risk factors were predictors of CP. Children with family history of CP, constant pain, or obstructive risk factors should raise suspicion for CP.

Asthma Comorbidities: Frequency, Risk Factors, and Associated Burden in Children and Adolescents.

Identifying asthma comorbidities in children is fundamental for improving disease management. We aimed to investigate the frequency of allergy-related comorbidities in children and adolescents with asthma, and to identify associated risk factors and disease burden. Between September 2015 and December 2018, 508 asthmatic patients (5–17 years) were consecutively enrolled. Parents answered a standardized questionnaire on the history of disease and risk factors. Comorbidities were classified based on the involvement of respiratory and/or extra-respiratory districts: asthma only (A, 13%), asthma with respiratory comorbidities (AR, 37%), asthma with extra-respiratory comorbidities (AER, 10%), and asthma with both respiratory and extra-respiratory comorbidities (ARER, 40%). Multinomial logistic regression showed that membership in the AR group was significantly associated with a maternal history of asthma (OR = 3.08, 95% CI: 1.23–7.72), breastfeeding ≥ three months (OR = 1.92, 1.06–3.46), early mold exposure (OR = 2.39, 1.12–5.11), and current environmental tobacco smoke exposure (OR = 2.06, 1.11–3.83). Membership in the AER group was significantly associated with the female gender (OR = 3.43, 1.54–7.68), breastfeeding ≥ three months (OR = 2.77, 1.23–6.22). ARER was significantly associated with all the aforementioned exposures. Patients with AR reported exacerbations in the last 12 months more frequently (p = 0.009). Several personal and environmental risk factors are associated with comorbidities in asthmatic children and adolescents, possibly worsening the disease burden.

Hydroxyurea Reduces the Transfusion Burden in Children with Sickle Cell Anemia: The Reach Experience

▪Introduction: Many children with sickle cell anemia (SCA) require blood transfusions, which carry risks and utilize a scarce resource globally, particularly in Africa. Realizing Effectiveness Across Continents with Hydroxyurea (REACH, NCT01966731) has documented the safety, feasibility, and benefits of hydroxyurea for children with SCA living in sub-Saharan Africa. In REACH, hydroxyurea escalated to maximum tolerated dose (MTD) significantly decreased vaso-occlusive events, malaria, and death; transfusions were decreased by ~70% over 30 months of treatment when compared to the 2-month screening period. Characterizing how hydroxyurea reduces transfusion needs in REACH could contribute to improved clinical understanding and lead to better outcomes, a decreased transfusion burden, and preservation of the blood supply in these limited-resource settings.Methods: Transfusions were recorded prospectively in the REACH REDCap electronic database. Using time-varying predictors and landmark analysis, transfusions during screening and treatment were analyzed by clinical site, calendar month, age, gender, splenomegaly, hydroxyurea dose, MTD status, baseline and latest laboratory values (Hemoglobin, MCV, HbF, absolute neutrophil count, and platelets, all measured at least 30 days prior to the transfusion), alpha thalassemia trait, and G6PD deficiency. Incidence rate ratios (IRR) were calculated for treatment periods compared to screening. Univariate relationships were assessed using the Anderson-Gill model, plus multiple regression to estimate Hazard Ratios (HR) with 95% confidence intervals (CI's).Results: A total of 635 children with SCA enrolled in REACH, and 606 started hydroxyurea treatment. During screening, 48 transfusions were given to 43 children, and during the treatment phase 405 transfusions were administered to 214 children over an average treatment time of 5.2 ± 1.3 years. The transfusion rate was 43.3 per 100 patient-years during screening, which decreased to 22.0 per 100 patient-years during the initial fixed dose treatment period (IRR = 0.50; 95%CI = 0.35-0.74, p<0.001 compared to screening) and then decreased further to 12.1 per 100 patient-years during the dose escalation period (IRR = 0.28; 95%CI = 0.21-0.39, p<0.001 compared to screening; IRR = 0.54; 95%CI = 0.43-0.73, p<0.001 compared to fixed-dose). For every 100 children treated for a year with hydroxyurea during dose escalation, there were 31.4 fewer transfusions compared to the untreated screening period. Comparison of the indications for transfusion between the screening and treatment periods revealed transfusions administered for anemia decreased from a rate of 26.1 to 5.1 per 100 patient-years (p<0.001), while transfusions for malaria trended toward a decrease from 7.2 to 3.8 per 100 patient-years (p=0.08). Lower transfusion rates on hydroxyurea were associated with higher hemoglobin concentration (HR = 0.72 per 1g/dL increase; 95%CI = 0.65-0.78, p <0.0001) and higher HbF levels (HR = 0.80 per 10% increase, 95%CI = 0.69-0.92, p=0.0071). Those with palpable splenomegaly had higher transfusion rates (HR = 1.58, 95%CI = 1.22-2.03, p=0.0094). Age, gender, alpha thalassemia trait, G6PD deficiency, and neutrophil count were not associated with differences in transfusion rates.Conclusion: Hydroxyurea significantly reduces blood transfusion administration in children with SCA in sub-Saharan Africa, especially when escalated to MTD. Transfusions for the sole indication of anemia decreased significantly on hydroxyurea treatment, likely due to higher treatment-associated hemoglobin levels and decreased hemolysis, and transfusions for malaria also trended toward a decrease. Splenomegaly remains a risk factor for transfusions despite hydroxyurea treatment. Overall, increased access to and implementation of hydroxyurea treatment for children with SCA across sub-Saharan Africa may not only improve individual patient outcomes through reduction in anemia, transfusion burden, and transfusion-associated complications including infections, but may also to help preserve the scarce blood supply for the benefit of the larger population. DisclosuresAygun: Global Blood Therapeutics: Consultancy; Patient Centered Outcomes Research Institute: Research Funding; National Heart, Lung, Blood Institute: Research Funding; National Institute of Nursing Research: Research Funding; bluebird bio, Inc.: Membership on an entity's Board of Directors or advisory committees, Research Funding. Stuber: ASH Research Collaborative: Consultancy. Ware: Bristol Myers Squibb: Research Funding; Addmedica: Research Funding; Hemex Health: Research Funding; Nova Laboratories: Research Funding; Novartis: Other: DSMB Chair; Editas: Other: DSMB Chair.

The Effects of Seizure Care Training on Anxiety and Parents Care Burden in Children with Seizure Referred to Ali Asghar Children's Hospital

Seizure is one of the most common chronic neurological diseases. Occurrence of a chronic disease in family member is an important event for the whole family. Seizure is often associated with social, cognitive, emotional and physical challenges. It can have negative effects on family dynamics. Reduce the quality of life for both caregivers and the patient. Methods: First, through the necessary permits, the experimental and control groups are randomly selected. In each group, 29 people were selected. The training items included 3*30-minute sessions, performed in four consecutive weeks (one session per week). Parents were adjusted to the meeting time and the sessions were taught according to their circumstances, the researcher using face-to-face training talked to parents about childhood seizure, common signs and symptoms, diagnostic methods and treatment programs, according to the stage and condition of the child's illness. These parents were given basic training in this area. Results: Using paired t-test, we found that the level of anxiety before the intervention in the experimental and control groups was not significantly different from sig = 0.11. If we notice a significant difference in the level of anxiety after the intervention in the experimental and control groups sig = 0.000 and we find that the training has been effective. At the level of pre-intervention care burden with sig = 0.211 in the experimental and control groups, we find that there is no significant difference however after the intervention the probability value reaches 0.011 and makes a significant difference at this level and indicates that training has been effective. Conclusion: The results of the present study showed that after training caregivers 'anxiety in the intervention group has been decreased compared to the control group, information support of patients' families will help them to adopt better in encountering stressful situations. In fact, educating the patient and family will increase the level of information and will reduces the anxiety of the patient and family and reduces the problems in encounter the disease. Measures such as familiarizing caregivers to the hospital and illness information, stress management and patient care as well as follow-up care through Telephones and social networks can be effective. Patients' caregivers have an important role in supporting the patient, the need for attention and give importance to them by the health care system is important because supporting them means continuing to care for the patient.

Policy Analysis Of Supporting Children With Disabilities Access To Social Security

If disabled people are considered as the weak individuals in community, the handicapped children will be more vulnerable as they are lack of the ability to take care of themsselves. The disadvantage of these people is the dependence on others in many aspects of their lives. The Government has issued amble policies in order to help paralyzed people and children, specifically policies related to social security. According to the Children Law No. 102/2016/QH13, the disabled children are ranked in the top 14 of those who are having underprivileged lives. This law is really important in reducing the handicapped children's burdens in life by providing them with caring and sharing from others. Despite this attention of the Government, the policies for disabled children are given less prioritization than those for normal children and disabled adults. In fact, the policies for disabled children are the same as those for children under 6 years old as well as the disabled adults. However, there are a number of troubles from processing to implementing the policies, negatively affecting the opportunities of accessing to social security of disabled people in general and handicapped children in particular. As a result, those disadvantaged people still have many difficulties in life need to be shared from others.

PND100 A Systematic Literature Review of the Humanistic Burden in Children and Adolescents with Autism Spectrum Disorder

PND100 A Systematic Literature Review of the Humanistic Burden in Children and Adolescents with Autism Spectrum Disorder

Problem Joints and Their Clinical and Humanistic Burden in Children and Adults with Moderate and Severe Hemophilia a: CHESS Paediatrics and CHESS II

Problem Joints and Their Clinical and Humanistic Burden in Children and Adults with Moderate and Severe Hemophilia a: CHESS Paediatrics and CHESS II

Behavioral Problems, Quality of Life and Caregiver Burden in Children with Idiopathic Nephrotic Syndrome: Improving Outcomes by Pragmatic Interventions in a Resource-Poor Setting.

A cross-sectional questionnaire-based study was conducted on 38 children with idiopathic nephrotic syndrome. The prevalence and pattern of behavioral abnormalities was studied. Except in the conduct domain, the prevalence of behavioral problems was comparable with controls. Severe complications of disease and adverse drug effects were significantly associated with abnormal behavior. The Quality of life (QOL) of these children and their caregivers was assessed. It appeared to be unaffected by illness. Additional findings were high maternal literacy, no disruption of schooling, regular follow-up and good adherence to treatment. Behavioral problems in childhood nephrotic syndrome can be minimized by regular follow-up and supportive interventions to reduce caregiver burden. Such children and their caregivers can do well in terms of QOL, even in a resource-poor setting, with appropriate psycho-social support.

Symptom burden of atopic dermatitis in early childhood assessed from daily monitoring of symptoms and topical steroid use

To our knowledge, diseaseburden of atopic dermatitis (AD) as number of days with symptoms and medical treatment has never been studied as measure of severity. To investigate risk factors for AD burden in the first 3years of life. The Copenhagen Prospective Studies on Asthma in Childhood2010 included 700 children. AD burden was assessed by daily diary entries with information on AD and steroid days measuring 18 possible heritable, prenatal, and postnatal environmental exposures. The children with AD had a median (interquartile range) of 136 symptom days (61-294days) and 72 steroid days (27-145days) during the first 3years of life, with the highest disease burden in the second year of life. The multivariable risk factor analysis showed that maternal AD and childhood allergic sensitization were associated with a higher number of AD days and maternal AD, filaggrin mutation, and allergic sensitization were associated with a higher number of steroid days. Participants with a personal interest in atopic diseases could be more likely to participate. Children's burden of AD, assessed quantitatively as AD and steroid days, demonstrated positive associations with maternal AD, filaggrin mutation, and early-life allergic sensitization, with the highest disease burden in the second year of life.

Peanut allergy impact on productivity and quality of life (PAPRIQUA): Caregiver-reported psychosocial impact of peanut allergy on children.

Limited research has examined the impact of peanut allergy (PA) on children using validated instruments to assess psychosocial burden and the factors influencing burden. The PAPRIQUA study aimed to assess the caregiver-reported impact of living with PA on children's health-related quality of life (HRQL), correlations between PA severity and child's sex, and associations of caregivers' sex and anxiety with the proxy report of their child's HRQL and to identify significant predictors of a child's HRQL. A cross-sectional survey of caregivers of children with mild, moderate and severe PA, based on caregiver perception, was conducted in the United Kingdom. Participants were recruited through a survey recruitment panel; a maximum quota of 20% who rated their child's PA as mild was set to ensure population diversity; however, the quota was not required as few participants considered their child's PA mild. The survey, funded by Aimmune Therapeutics, included sociodemographic and clinical questions, the EQ-5D-Y, Hospital Anxiety and Depression Scale, Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF) and Food Allergy Independent Measure (FAIM). One hundred caregivers of children with PA (aged 4-15years) completed the survey. Child's sex was not associated with proxy-reported burden. For younger children (aged 4-10years), there was no effect of PA severity; parents of older children (aged 11-15years) reported low to higher burden for their child on the EQ-5D-Y and FAQLQ-PF dependent upon PA severity. For all measures of child burden except the EQ-5D-Y, two or more reactions in the past 12months and parental anxiety significantly predicted higher levels of burden for the child (P<.05-P<.001). Experiencing a life-threatening event in the past 12months significantly predicted EQ-5D-Y proxy utility (P<.01). Caregivers report that children with PA experience high levels of psychosocial burden, particularly those with more severe PA and a reaction history. Interventions to decrease caregiver anxiety and reaction frequency may help reduce the child's burden. Self-report studies in children with PA would help confirm these findings.

Anticholinergic Burden in Children, Adults and Older Adults in Slovenia: A Nationwide Database Study

Anticholinergic burden has been widely studied in specific patient populations with specific conditions. However, the prevalence in the general population is poorly understood. This retrospective cross-sectional study was a nationwide database analysis of outpatient prescriptions of anticholinergic medications. The study was based on Slovenian health claims data of all outpatient prescriptions in 2018. Anticholinergic burden was evaluated using the Anticholinergic Cognitive Burden scale. Three age groups were analysed: children (≤18 years), adults (19–64 years) and older adults (≥65 years). Anticholinergic medications were prescribed to 29.8% of the participants; 7.6% were exposed to a clinically significant anticholinergic burden. The proportion of patients exposed to anticholinergic burden was highest in older adults (43.2%), followed by adults (25.8%) and children (20.7%). The most frequently prescribed medications with the highest anticholinergic activity were antipsychotics and medications for urinary diseases (42.8% and 40.2%, respectively). Medications with second highest activity were mostly antiepileptics (87.3%). Medications with possible anticholinergic activity included diverse therapeutic groups. Anticholinergic burden is highest in older adults but is also considerable among adults and children. Medications with anticholinergic activity belong to diverse therapeutic groups. Further research is needed on safe use of these medications in all age groups.

5-Hydroxymethylcytosine Profiles in Circulating Cell-Free DNA Associate with Disease Burden in Children with Neuroblastoma.

5-Hydroxymethylcytosine (5-hmC) is an epigenetic marker of open chromatin and active gene expression. We profiled 5-hmC with Nano-hmC-Seal technology using 10 ng of plasma-derived cell-free DNA (cfDNA) in blood samples from patients with neuroblastoma to determine its utility as a biomarker. For the Discovery cohort, 100 5-hmC profiles were generated from 34 well children and 32 patients (27 high-risk, 2 intermediate-risk, and 3 low-risk) at various time points during the course of their disease. An independent Validation cohort encompassed 5-hmC cfDNA profiles (n = 29) generated from 21 patients (20 high-risk and 1 intermediate-risk). Metastatic burden was classified as high, moderate, low, or none per Curie metaiodobenzylguanidine scores and percentage of tumor cells in bone marrow. Genes with differential 5-hmC levels between samples according to metastatic burden were identified using DESeq2. Hierarchical clustering using 5-hmC levels of 347 genes identified from the Discovery cohort defined four clusters of samples that were confirmed in the Validation cohort and corresponded to high, high-moderate, moderate, and low/no metastatic burden. Samples from patients with increased metastatic burden had increased 5-hmC deposition on genes in neuronal stem cell maintenance and epigenetic regulatory pathways. Further, 5-hmC cfDNA profiles generated with 1,242 neuronal pathway genes were associated with subsequent relapse in the cluster of patients with predominantly low or no metastatic burden (sensitivity 65%, specificity 75.6%). cfDNA 5-hmC profiles in children with neuroblastoma correlate with metastatic burden and warrants development as a biomarker of treatment response and outcome.

Pain Burden in Children and Adolescents With Cerebral Palsy

Pain Burden in Children and Adolescents With Cerebral Palsy