Common Childhood Disease Research Articles

Electrical stimulation methods for scoliosis in children: a literature review

Introduction. Scoliosis is one of the most common orthopedic diseases of childhood and adolescence, leading to disability and reducing the child’s quality of life. The prevalence of scoliosis in the structure of pediatric orthopedic pathology reaches 30 %. In 50 % of cases, the disease is characterized by a severe progressive course, especially during puberty. Aim. Studying the effectiveness of electrical stimulation methods for scoliosis in children to develop recommendations for their practical use based on the analysis of systematic reviews and randomized controlled trials. Materials and methods. The search was carried out using the database of evidence-based physiotherapy PubMed, Cyberleninka and eLIBRARY using the keywords: «electrical stimulation», «pulse currents», «scoliosis», «children» for the period from 2008–2024.Exclusion criteria: articles published on this topic before 2008. Main content. The main methods of physiotherapy used in the treatment of scoliosis in children are electrotherapy methods, among which electrical stimulation plays a leading role. The advantage of electrical stimulation for scoliosis in children is to provide training in the strength and tone of the back muscles on the side of the deformity. Electrical stimulation is indicated for scoliosis of I and II degrees. The greatest effect in the correction of scoliotic spinal deformity in children is observed with the combined use of electrical stimulation and exercise therapy. This review provides data on the relevance of medical rehabilitation of scoliosis in children, the mechanism of action of electrical stimulation, data on the effectiveness of using electrical stimulation methods for scoliosis in children: sinusoidal modulated currents, diadynamic therapy, transcutaneous electrical neurostimulation, interference therapy, fluctuarization and functional programmable electrical stimulation. Conclusion. Currently, a wide range of electrical stimulation technologies has been developed for the medical rehabilitation of children with scoliosis, among which sinusoidally modulated currents and diadynamic currents are most often used. Transcutaneous electrical neurostimulation, having a predominantly antinociceptive effect, also has an effect on muscle contractions. Functional programmable electrical stimulation of muscles is a promising technology for medical rehabilitation of children with scoliosis, requiring further study and scientific justification.

Community Pharmacists’ Knowledge in Managing Minor Ailments: A Focus on Childhood Gastroenteritis in Saudi Arabia Using a Simulated Patient Approach

Background: Community pharmacists are frequently approached by patients seeking health advice for minor ailments, particularly for common childhood diseases like diarrhea. Globally, approximately two million children under five years of age die each year due to diarrhea, which remains a significant health concern, especially in developing countries. Objectives: The purpose of this study was to assess the skills of community pharmacists in addressing and prescribing for simple viral diarrhea in children. Methods: A hundred community pharmacies were visited by simulated clients following a standard scenario of inquiring about simple childhood diarrhea. Subsequently, they filled out a standardized form after each visit to assess the skills of the community pharmacists. Results: It was found that 98% of the pharmacists were males. Approximately 80% of them inquired about the child’s age, while only 29% asked about the presence of fever. Around 2–6% of them only asked about the stool nature, child’s feeding behavior, and family symptoms. Around 10% of them suggested a potential bacterial origin, and 24% recommended the use of antibiotics. Only 43% of the community pharmacists suggested the use of oral rehydration solution, while 15–56% recommended using antidiarrheals, anti-emetics, and spasmolytics. The mean knowledge score of the pharmacists was 9.06 out of 17. Conclusions: The results indicated a relatively low level of knowledge about managing simple viral childhood diarrhea, which may reflect a similar level of knowledge about dealing with minor ailments in general.

The potential of pharmacotranscriptomic markers for predicting mycophenolic acid efficacy in children with steroid-dependent nephrotic syndrome

Nephrotic syndrome is one of the most common glomerular diseases in childhood. It is known that about half of patients with nephrotic syndrome develop dependence on steroid therapy, which requires the inclusion of a treatment regimen of selective immunosuppressive therapy. Mycophenolic acid (MPA) has been identified as a promising drug for steroid-resistant nephrotic syndrome, and it forms the basis of immunosuppressive therapy for this condition. The present study evaluates the importance of determining the expression of genes responsible for the metabolism of mycophenolic acid in patients with steroid-dependent nephrotic syndrome to maintain stable clinical and laboratory remission of the disease. The article demonstrates the significance and role of MDR1, UGT1A7, UGT1A9 and UGT2B7 gene expression as potential markers of increased risk of relapses and opens up prospects for the use of a transcriptomic approach to identify patients who require careful selection of pharmacotherapy. Although the results obtained are promising, changes in the expression of metabolic enzymes are only one of several factors that contribute to the effectiveness of treatment. Based on these data, it may be possible in the future to develop personalized monitoring strategies that can help tailor treatment to individual patients and increase its effectiveness.

Oral Health of Children and Adolescents with Diabetes Mellitus.

Aim: To examine the oral health of children and adolescents with and without diabetes mellitus. Background: Diabetes mellitus is the most common metabolic disease in childhood and demonstrates an increasing incidence. Many children live with gingivitis as a precursor to periodontitis. If left untreated, it can cause the development of periodontitis. The links between periodontitis and diabetes mellitus are known but have been little studied in the age group of children and adolescents. Materials and Methods: Clinical examination and collection of sulcus fluid from participants aged 5 to 21 years was performed. The following data were collected: demographic variables, caries prevalence, DMF-T, VPI, PUFA, salivary flow rate, HbA1c, PSI, and the concentration of IL-1β, IL-6, MMP-8, and TNF-α. Results: Patients with diabetes mellitus showed a significantly lower salivary flow rate with higher concentrations of MMP-8 and IL-1β. The data indicate that at this age, regular visits to the dentist are of great importance for the promotion of oral health in children and adolescents regardless of diabetes and that patients with diabetes mellitus in particular benefit from prevention, as they belong to the periodontitis risk group. Conclusions: Patients with low salivary flow rates and increased inflammatory mediators are high-risk patients for whom dental preventive measures play a major role.

ATTITUDES AND AWARENESS OF THE POPULATION OF CENTRAL AND WESTERN REGIONS OF UKRAINE TOWARDS VACCINATION

In the modern world, vaccination is the most eff ective and evidence- based method of preventing the onset and severity of infectious diseases. Today, the WHO has identifi ed vaccine hesitancy as a global public health threat [25]. The social and cultural background of people infl uences their perception of vaccines, which prompted us to investigate this problem. Aim. To study the infl uence of sociodemographic factors on vaccination attitudes of children and adults in the central and western regions of Ukraine.Materials and methods. A cross- sectional study was conducted, which included a survey of the population of diff erent social status. The study was conducted in accordance with the tenets of the Declaration of Helsinki. The study protocol was approved by the bioethics committee. We also analyzed literature data from PubMed, Medscape and CSC. The work was performed within the framework of the research project 0122U000039 «Improvement of methods of diagnosis, treatment and rehabilitation of the most common diseases of childhood». No confl icts of interest exist.Research results and discussion. 1000 respondents were interviewed by questionnaire from Kyiv, Cherkasy, Kirovograd, Khmelnytsky, Zhytomyr, Chernivtsi, Ternopil, Rivne, Volyn, Ivano- Frankivsk, Lviv regions. The data obtained indicate that barriers to vaccination are caused by low awareness of vaccination, excessive negative infl uence of opinion leaders, prevalence of myths and falsifi cations about vaccination, lack of health care resources and low supply of recommended vaccines, and forced migration. Low awareness and low vaccination coverage are also associated with low awareness among health workers who do not work directly with vaccines, falsifi cation of vaccination data, and the presence of anti-vaccine health workers. The negative attitude of parents towards vaccination is also very important, as it aff ects their children.Conclusions.1. Fear of side eff ects, long-term complications, and doubts about the quality of vaccines have been identifi ed as factors in vaccine refusal.2. The most common groups of vaccine refusers are the elderly (53.3 %) and men (16.8 %).3. The high cost of vaccines that are not included in the list of mandatory vaccines is one of the reasons for the decrease in vaccination rates.4. Improved communication between the doctor and the patient is one of the factors increasing the vaccination rate among the population.5. Information about the availability of vaccines and places of vaccination, peculiarities of the post-vaccination period and information about the possible consequences of ignoring vaccination should be provided in the media (television, radio), especially among the elderly.

Chronic Non-bacterial Osteomyelitis (CNO) In Childhood: A Review.

Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory bone disorder mostly affecting children and adolescents. Although it is considered a rare disease, CNO is likely to be the single most common autoinflammatory bone disease in childhood, underdiagnosed and underreported due to a lack of awareness of the condition in both medics and patients and the absence of validated diagnostic criteria. The exact underlying pathogenesis of CNO remains unknown, making targeted treatment difficult. This issue is exacerbated by the lack of any randomised control trials, meaning that treatment strategies are based solely on retrospective reviews and case series. This review summarises the current concepts in pathophysiology, the clinical features that help differentiate important differential diagnoses, and an approach to investigating and managing children with CNO. Ultimately, the timely and thorough investigation of children and young people with CNO is vitally important to exclude important mimics and initiate appropriate management that can prevent the complications of persistent inflammatory bone disease.

Association between IL-1 single nucleotide polymorphisms and susceptibility to juvenile idiopathic arthritis: a systematic review and meta-analysis.

Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases of childhood and presents with various clinical phenotypes. A multifactorial and complex interaction of genetic and environmental factors are responsible for JIA, of which the proinflammatory cytokine genes are of particular research interest. This meta-analysis investigates the association between IL-1A and IL-1B gene polymorphisms and susceptibility to JIA. A total of eight studies, involving 1633 patients and 2309 controls were included, and a meta-analysis was performed on the association between IL1A -889 C/T, IL1B -511 C/T, and IL1B +3954 C/T, and susceptibility to JIA. There was no significant association between the presence of IL1A -889 C/T, IL1B -511 C/T, and IL1B +3954 C/T polymorphisms and JIA, under any genetic model or in any ethnicity subgroups. Results of this study suggest that these three IL-1 variants do not increase the susceptibility to JIA. However, the limited number of studies and the considerable level of heterogeneity must be taken into account before interpretation.

HLA-DRB1*01 predicts treatment outcome in juvenile idiopathic arthritis: A retrospective-prospective cohort study.

Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory autoimmune disease in childhood, significantly contributing to both short- and long-term disability. While certain human leukocyte antigen (HLA) class II alleles are known to be associated with specific subgroups of JIA, emerging evidence suggests a strong correlation between these alleles and treatment response. This study involved 143 JIA patients diagnosed according to International League of Associations for Rheumatology criteria. Each patient underwent HLA class II typing, including HLA-B27, as well as tests for rheumatoid factor (RF) and antinuclear antibodies (ANA). Comprehensive rheumatological assessments were conducted at diagnosis, with follow-ups at three and six months post-onset. After six months of methotrexate (MTX) treatment, patients were categorized as responders or non-responders. Responders achieved clinically inactive disease based on the American College of Rheumatology Provisional Criteria for Defining Clinical Inactive Disease and Clinical Remission. Non-responders, who did not reach clinically inactive disease after six months of treatment, required the addition of another non-biological disease-modifying antirheumatic drug (DMARD) or a biological DMARD. Our analysis revealed that the HLA-DRB1*01 allele is a significant prognostic marker for therapeutic response, predicting therapeutic resistance (P=0.01). The most prevalent HLA-DRB1 alleles in the treatment-resistant group were HLA-DRB1*08:11 (11.3%), HLA-DRB1*01:01 (8.5%), HLA-DRB1*01:13, HLA-DRB1*04:11 (7%), HLA-DRB1*08:13, and HLA-DRB1*08:15 (4.2%). These findings highlight the critical role of HLA class II alleles in pediatric rheumatology, particularly in relation to treatment response and disease prognosis. In the era of personalized medicine, understanding the genetic contributions to treatment response and outcomes in JIA patients is essential. A key limitation of this study was the lack of comparison of treatment responses across different JIA subtypes. Future studies should prioritize evaluating MTX efficacy within specific JIA subgroups to enable a more tailored understanding of its effectiveness.

Analyzing early childhood allergy prevention motivation of mothers of infants and its predictors using latent class analysis and structural equation modelling

BackgroundAllergic diseases are among the most common chronic diseases in childhood. Early childhood allergy prevention (ECAP) behaviors of those caring for the infant during pregnancy and the first months of life may influence the risk of allergy development over the life course. Motivation and intention to use appropriate primary ECAP measures are thus of critical importance.AimsTo characterize parental ECAP motivation, (a) valid indicators will be developed and (b) typical parental characteristics will be identified. (c) According to socio-cognitive models, the predictive value of parental risk perception, control belief and self-efficacy for parental ECAP motivation shall be determined.MethodA sample of N = 343 (expectant) mothers of infants completed a questionnaire on self-reported ECAP motivation, risk perception, control belief, and self-efficacy. The cross-sectional data were analyzed using latent class analysis and structural equation modelling including nominal regression models.ResultsFour typical maternal response profiles (motivated to a customary degree, 70%; motivated to use primary preventive measures, 17.8%; reluctant towards new prevention measures, 6.4%; highly motivated to apply preventive measures in case of an existing allergy, 5.8%) could be identified for the items on ECAP motivation. After splitting the model variables “risk perception” (allergy vs. allergy-associated general health problems) and “self-efficacy” (trust vs. insecurity) a satisfactory model-fit was achieved (CFI = .939; RMSEA = .064). Particularly, increased “risk perception-allergy” (OR = 1.655) and “self-efficacy-insecurity” (OR = 2.013) as well as lower “risk perception-general health” (OR = 0.555) and “control belief” (OR = 0.217), respectively, are associated with higher ECAP motivation.ConclusionThe use of ECAP-measures by parents to protect their newborns from allergies is important, but there are deficiencies in their implementation. Based on a social cognitive model approach, predictive characteristics could be identified, which are associated with increased motivation to implement ECAP-measures. For public health our findings provide a promising basis for conception of behavioral and environmental ECAP prevention measures and their motivated implementation by parents.

Rheum for Improvement? Delayed Diagnosis of Juvenile Idiopathic Arthritis: A Narrative Review.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood and a disease for which we have safe and effective therapies. Early diagnosis of JIA enables timely initiation of therapy and improves long-term disease outcomes. However, many patients with JIA experience prolonged diagnostic delays and have a turbulent course to diagnosis. In this narrative review, we explore the importance of early diagnosis in JIA, what is known about time to diagnosis and diagnostic trajectory, and factors that contribute to delayed diagnosis. We also discuss next steps to improve time to diagnosis for these vulnerable patients.

New Perspective of Multi-dimensional Approach for the Management of Attention-deficit Hyperactivity Disorder: A Review

One of the most common mental diseases in childhood, attention-deficit/hyperactivity disorder (ADHD) often lasts into adulthood for many individuals. The neurodevelopmental condition known as ADHD impacts three areas of the brain: hyperactivity, impulsivity, and attention. The visual field is where attention is most affected by ADHD. Non-strabismic binocular vision disorder (NSBVD), which impairs eye coordination and makes it challenging to focus, has been linked to ADHD. Through a critical cognitive process called visual attention, humans are able to take in and organize information from their visual environment. This greatly affects how one observes, processes, and understands visual information in day-to-day living. Vision therapy is a non-invasive therapeutic approach that aims to improve visual talents and address visual attention deficits. This study aims to provide an overview of the research on the many approaches to treating ADHD, the relationship between NSBVD and ADHD, and whether vision therapy is a viable treatment option for ADHD. After a comprehensive search of many online resources, relevant studies were found. The review's findings provide insight into the range of ADHD patients' treatment choices. In order to improve treatment outcomes, non-pharmacological treatments can be employed either alone or in conjunction with medicine. Medicine by itself is insufficient and has several severe side effects when used continuously. The efficacy of vision therapy in improving visual attention and making recommendations for potential directions for further research in this field. Multiple studies are needed to identify the most effective treatment modalities for achieving positive outcomes for ADHD patients.

Asthma as a child: continuous attentiveness to breathing to participate in everyday activities - need for support.

Asthma is one of the most common chronic diseases in childhood. This study explores the experiences of participating in everyday activities among children with asthma. The study employed a qualitative design and was grounded in a hermeneutic-phenomenological approach. The data were collected through in-depth interviews with four children aged 9-12 diagnosed with asthma. One theme was 'heavy breathing stopping the body in motion', and subthemes were as follows: 'experiencing intrusive wheezing', 'calming one's breath to participate' and 'being sick and refraining from participating'. Another theme was 'help in everyday life and support to participate', and subthemes were as follows: 'taking the necessary asthma medicine', 'being understood and met as sick' and 'adapting one's leisure activities'. To participate in everyday activities, children with asthma require insight into and an understanding of the importance of taking asthma medicine as recommended. They also need help in everyday life and support to participate in everyday activities. Children taking care of their own illnesses and listening to their bodies provide them with the greatest degree of participation in activities in their everyday lives. These findings represent an important contribution to the understanding of nursing care for children with asthma.

Role of chemerin in the metabolic regulation of type 1 diabetes in children

Introduction and objective: Type 1 diabetes is one of the most common chronic diseases of childhood, leading to the development of chronic micro- and macrovascular complications. Recently, many researchers have been focusing their efforts on identifying new markers for the progression of this disease. It is known that adipokines play a significant role in the regulation of lipid and carbohydrate metabolism. The aim of this study was to evaluate the level of serum chemerin in children with type 1 diabetes and assess their correlation with body mass index, glycated haemoglobin, and lipid profile. Materials and methods: The study group included 40 children with newly diagnosed, 40 with long-term diabetes, and 14 children without diabetes as a control group. Chemerin levels were measured using a sandwich enzyme-linked immunosorbent assay. Results: We did not find any statistically differences in chemerin levels in the studied groups of children. In the group of patients with long-term, metabolically well-controlled diabetes, chemerin levels were higher in girls than in boys (p = 0.028). Moreover, no difference in chemerin levels was observed between the studied groups of children depending on the body mass index percentiles. A negative correlation was found between chemerin level and age in children with newly diagnosed diabetes and metabolically well-controlled diabetes. Conclusions: Our study provides new insights into the status of chemerin among paediatric patients with varying degrees of type 1 diabetes control. However, further research is needed involving larger groups of patients with differing degrees of sexual maturation and with the presence of microvascular complications.

Significance of Juvenile Idiopathic Arthritis in Pediatric-Phthisiatric Practice (Review)

Juvenile idiopathic arthritis (JIA) is a heterogeneous group that includes all forms of childhood chronic arthritis (joint inflammation lasting more than 6 weeks) of unknown cause in children under 16 years of age. JIA is the most common rheumatic disease in childhood (with an annual incidence from 1.6 to 23.0 new cases per 100,000 adolescents) and is characterized by an often hidden onset and a chronic relapsing course after diagnosis. Tuberculosis plays a special role among opportunistic infectious diseases in JIA, because rheumatic diseases are associated with an increase in the overall risk of developing tuberculosis. Children's phthisiologists often deal with the differential diagnosis difficulty of tubercular lesions of the joints with JIA, and first of all, with oligoarthritis. Clinical symptoms in JIA can be very diverse, and some characteristics of arthritis, not necessarily significant in JIA diagnosis, may have multiple etiologies that need to be carefully differentiated. It was detected during review that JIA is of urgent importance in children’s phthisiatric practice due to various reasons: oligoarthritis in JIA has similar clinical manifestations as in tuberculosis arthritis, which significantly complicates differential diagnosis and delays timely treatment of a correctly diagnosed disease; there is a high frequency of diagnosis of latent tuberculosis infection (LTBI) in JIA, which requires the appointment of preventive treatment to reduce the risk of LTBI progression to an active form of tuberculosis; patients with JIA receiving tumor necrosis factor blockers and/or methotrexate have a higher risk of tuberculosis activation, which is a serious problem in the treatment plan, and require constant monitoring for the possible development of tuberculosis. Therefore, in all pediatric patients with JIA, mandatory diagnostic screening (combination of tuberculin skin test methods with QuantiFERON®-TB Gold In-Tube, taking into account the high frequency of false-negative result of the tuberculin skin test due to immunosuppression caused by JIA) for timely detection of LTBI, and with a positive result of preventive antimycobacterial treatment, which will prevent the development of an active form of tuberculosis.Therefore, all pediatric patients with JIA should undergo mandatory diagnostic screening (combination of tuberculin skin test methods with QuantiFERON®-TB Gold In-Tube, considering the high frequency of false-negative result of tuberculin skin test due to immunosuppression caused by JIA) for timely detection of LTBI. When there is a positive result of the screening tests, it is necessary to carry out prophylactic antimycobacterial treatment, which will prevent the development of an active form of tuberculosis.

Current Trends in Clinico-Bacteriological Profile and Antimicrobial Susceptibility Pattern in Active Chronic Suppurative Otitis Media (Safe and Unsafe) at a Tertiary Care Center in Uttarakhand: An Observational Study.

Otitis media is defined as inflammation of the middle ear due to any cause that may also involve any contiguous pneumatized portion of the temporal bone. It is also one of the most common diseases of childhood after viral upper respiratory tract infection. As a result of the widespread availability of over-the-counter topical antibiotics and the irrational use of these agents, there is a development of multidrug-resistant bacteria. The aim of this study was to assess the current bacteriological profile and antimicrobial susceptibility pattern in clinically diagnosed cases of active chronic otitis media (COM) at a tertiary care center in Uttarakhand. The proposed observational cross-sectional study was conducted in the Department of Otolaryngology and Head and Neck Surgery and Department of Microbiology of Government Doon Medical College Hospital, Dehradun, over a period of 18 months from August 2022 to January 2024. One hundred and thirty-seven cases of active COM fulfilling the inclusion criteria were recruited in the study. Under strict aseptic conditions, pus samples were collected from the middle ear using two sterile cotton swabs under microscopic examination and sent to the microbiology lab for pathogen identification and isolation. The isolated organisms were subjected to antibiotic susceptibility testing using VITEK-2 as per the latest Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: In the present study, the most common age group affected by COM was between 18 and 30 years with female predominance. Pseudomonas aeruginosa (33.6%) was the predominantly isolated organism followed by Staphylococcus aureus (17.8%). Considering the antibiotic susceptibility, Pseudomonas aeruginosa was susceptible to piperacillin/tazobactam and meropenem while least sensitive to levofloxacin and ciprofloxacin. Staphylococcus aureus was susceptible to linezolid, daptomycin, and vancomycin. The maximum resistance of Staphylococcus aureus was observed to ciprofloxacin and levofloxacin. The study of changing clinico-bacteriological profile and antibiotic susceptibility pattern in cases of COM due to variations in the geography and environment of the study population can help to guide appropriate antibiotic treatment and thus prevent the development of multidrug-resistant bacteria.

Relationship between serum zinc levels and the burden of treatment in children with pneumonia

Background: Pneumonia is a common childhood disease often requiring hospitalization, with the potential for rapid progression and complications, particularly in children under five years old. Zinc plays a crucial role in various organ systems, especially the respiratory system. However, data on zinc levels and pneumonia in Vietnamese children remain limited. This study aimed to investigate the relationship between serum zinc levels and the treatment burden in children with pneumonia. Methods: A prospective observational study was conducted involving 200 children aged 2 to 59 months who were diagnosed with pneumonia and hospitalized at Can Tho Children's Hospital, Vietnam. Serum zinc levels were measured, and treatment characteristics were monitored, including the need for respiratory support, antibiotic escalation, and treatment duration. Data were analyzed using descriptive statistics, independent t-tests, simple linear regression and multivariable linear regression to determine associations between serum zinc levels and treatment outcomes. Results: Children who were not exclusively breastfed for the first six months had significantly lower serum zinc levels compared to those who were exclusively breastfed (p<0.001). Lower serum zinc levels were significantly associated with the need for respiratory support (p=0.001), antibiotic escalation (p=0.002), prolonged antibiotic use (p=0.01), and longer treatment duration (p=0.011). Multivariate linear regression revealed that each unit decrease in serum zinc levels increased treatment duration by 0.218 days (p=0.015). Conclusion: Low serum zinc levels are associated with increased treatment burden in children under five years old with pneumonia.

Qualitative study with mothers of children with atopic dermatitis: emotional and social impacts.

Atopic Dermatitis (AD) is the most common skin disease in childhood and its control requires the support of the family members. This disease significantly interferes with the Quality of Life (QoL) of children and families, however, literature on the social and emotional impact of the disease on the caregivers is lacking. To evaluate the emotional and social impact of AD on mothers of children with the disease. This is a qualitative study of semi-structured interviews with mothers of children diagnosed with AD. The following variables were evaluated: diagnosis and start of treatment, knowledge about the disease, and impact on the mothers' lives. The material was analyzed using Lawrence Bardin's content analysis technique. The AD severity was assessed by SCORAD. A total of 23 interviews were conducted with mothers of children diagnosed with AD. In 82.6% of the cases, the mothers presented conflicts in the face of the first contacts with the disease. In 43.5% of cases, mothers were solely responsible for their children's treatment. About 56.6% defined AD as a cause of suffering and difficulty and 21.7% pointed out the AD experience as a learning experience. The AD is a chronic disease that has a psychological and social impact on the lives of mothers. In the treatment of AD, mothers must be screened and offered psychological support to improve adherence to treatment in the long term.

Physicians and the Production of Health: Returns to Health Care during the Mortality Transition

Abstract This paper investigates the returns to health care provision during the mortality transition. We construct a new panel data set covering German municipalities from 1928 to 1936. The endogeneity of health care supply is addressed by using the expulsion of Jewish physicians from statutory health insurance as exogenous variation in regional physician supply. Increases in the supply of physicians reduce infant mortality and mortality from common childhood diseases. Using a semiparametric control function approach, we find diminishing marginal returns to health care provision. The results are consistent with historical trends in infant mortality over the 20th century.

A Tele-detection and referral pAthways model for early childhood cariEs control- a protocol for a randomized factorial study: the TRACE study

BackgroundEarly childhood caries (ECC) is one of the most common childhood diseases affecting the primary teeth of children younger than 6 years of age. ECC progression can be reversed in the early stages although these lesions often go undetected. New approaches are needed to detect oral diseases at an early stage when they can be better controlled. The aim of the study is to assess the effectiveness of ECC tele-detection methods combined with referral pathways with and without user fee removal in controlling ECC.MethodsA randomized factorial trial will be used to compare two tele-dentistry detection methods for ECC (intraoral camera and smartphone camera) and two referral pathways (user fee removal versus conventional care). The study will recruit children younger than 6 years of age in marginalized communities in Alexandria, Egypt. The primary outcome is the percentage of teeth receiving indicated care, while the secondary outcomes are the oral health-related quality of life, acceptance of teledentistry by dentists, procedure time, and child cooperation. Two-way analysis of variance will be used to assess the effect of the two factors as between group variables on the outcomes after 6 and 12 months. The interaction between detection methods and referral pathways will also be assessed, and the effect of confounders will be controlled in a multivariable linear regression model.DiscussionThe findings of this study have the potential to inform clinical practice and oral healthcare policies for ECC management. Successful tele-detection and referral pathways could be integrated into oral healthcare systems, leading to improved oral health outcomes for children.Trial registrationThe trial has been registered on ClinicalTrials.gov in August 2023 (initial release) ID: NCT06019884.

Comparative Efficacy of Mometasone Nasal Spray Combined with Different Doses of Desloratadine, and Montelukast in Childhood Allergic Rhinitis: A Randomized Clinical Trial.

Allergic rhinitis is a common childhood disease. Although various drugs have been used to treat allergic rhinitis, including nasal corticosteroids, antileukotrienes, and antihistamines, there is still controversy about the optimal dose and the best combination with the highest efficacy. Higher doses of antihistamines are recommended for better control of urticaria, but there is insufficient evidence regarding the efficacy of increased doses of antihistamines in allergic rhinitis. The aim of the study was to evaluate the effectiveness of different drug combinations in the treatment of children with allergic rhinitis. Sixty-four children with persistent moderate to severe allergic rhinitis were enrolled and randomly divided into 4 groups. All children received mometasone furoate nasal spray once daily. In addition to mometasone, each group received one of the following drugs or drug combinations: daily desloratadine, twice daily desloratadine, montelukast, or a combination of desloratadine and montelukast. The severity of symptoms before and after the intervention was evaluated based on the total nasal symptoms score, including sneezing, nasal congestion, nasal itching, and rhinorrhea. Sixty patients completed the study. The reduction of nasal congestion score and total nasal symptoms score in the groups receiving desloratadine twice a day and desloratadine plus montelukast was superior to the daily desloratadine group and daily montelukast groups. According to this work, the treatment of allergic rhinitis with mometasone nasal spray with desloratadine twice a day or with the combination of desloratadine and montelukast was more effective than other treatment regimens.