Half Of Children Research Articles

Natural history of cow's milk allergy in children aged 6-12 years.

Approximately 50%-90% of children with immediate-type cow's milk allergy (CMA) acquire tolerance by pre-school age. We aimed to investigate the acquisition rate of CMA tolerance in children aged 6-12 years. We included children with CMA who persisted until the age of 6. Tolerance was defined as passing an oral food challenge with 200 mL of unheated cow's milk (CM) or consuming 200 mL of CM without symptoms, whereas persistent CMA was defined as fulfilling neither of these criteria by 12 years old. Children receiving oral immunotherapy (OIT) were excluded from the primary analysis. Risk factors associated with persistent CMA were assessed using Cox regression analysis. Of 80 included children, 30 (38%) had previous CM anaphylaxis, and 40 (50%) had eliminated CM completely from their diet. The median CM-specific immunoglobulin E (sIgE) level at 6 years old was 12.0 kUA /L. Tolerance was acquired by 25 (31%) and 46 (58%) children by the age of 9 and 12 years, respectively. At baseline, persistent CMA was associated with higher CM-sIgE levels (hazard ratio 2.29, 95% confidence interval 1.41-3.73, optimal cutoff level 12.7 kUA /L), previous CM anaphylaxis (2.07, 1.06-4.02), and complete CM elimination (3.12, 1.46-6.67). No children with CMA who had all three risk factors (n = 14) acquired tolerance. Except for OIT patients, more than half of children with CMA at 6 years old acquired tolerance by 12 years old. Children with CMA who have the risk factors are less likely to acquire tolerance.

Utilization of Early Intervention Among Children with Sickle Cell Disease

Background: The most prevalent monogenic disorder among children is sickle cell disease (SCD). SCD is the most common cause of pediatric stroke and is primarily inherited by people that identify as Black or of African descent. 1,2 Children with SCD have an elevated risk for delayed development and poor academic outcomes. 2 Our previous findings identified that 50% of children with SCD have a developmental delay, however, <5% were receiving therapy services. 3-5 Home-based programs have ameliorated cognitive and language delays in children with SCD. 6 In the United States, home-based therapy services (e.g., occupational, physical, and speech therapy) are provided through a federally mandated program called Early Intervention for free or reduced cost for children with developmental delay <3 years of age. 7 Unfortunately, this program is underutilized, especially in underserved and minoritized communities, with as few as 2% of eligible children receiving services. 8,9 Hematologists, who are tasked with providing ongoing medical care for young children with SCD, often lack the resources/tools needed to incorporate developmental screening into standard care. Thus, early indicators of developmental delay remain undetected and untreated, costing children and families precious time to intervene early. 6,10,11 This study aimed to assess the use of early intervention and determinants affecting participation in developmental screening and intervention among caregivers of children 0-4 years of age with SCD. Methods: We recruited caregivers with children under 4 years of age with SCD from clinics in St. Louis, Missouri and Memphis, Tennessee. Semi-structured interviews based on the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework were used to describe determinants for referral success and describe the mechanisms (barriers and facilitators) that influence early intervention program utilization. 12 Interviews included open-ended to address topics related to reach, perceived effectiveness, and likelihood of adoption of early intervention if recommended. Additional questions assessed caregiver knowledge of developmental delays in SCD and utilization of screening and intervention. Results: Among 127 caregivers identified as eligible, 47 consented and 20 completed an interview between September 2022 and February 2023. Similar to prior studies, over half of caregivers reported living in a low-income household, over half of children had hemoglobin SS and all participants identified as Black or African American. Interviews lasted between 15-75 minutes (mean = 34). Three themes emerged from the data including 1) Caregivers have not been informed about elevated risk for developmental delay, 2) Caregivers prioritize connecting with their provider and 3) Caregivers had not been adequately informed about early intervention services (Table 1). Conclusions: This study highlights the low utilization of early intervention services for young children with SCD. Caregivers expressed frustration with the lack of awareness regarding the elevated risk for developmental delays and prioritize that information coming from their specialty providers (e.g., sickle cell clinic). Additionally, inadequate information about available services contributes to underutilization. As healthcare providers, we are tasked with increasing awareness about the associated risks of SCD, integrating developmental screening into standard care, and providing caregivers with information that could improve developmental outcomes for children with SCD.

A state-wide analysis of characteristics and predictors of dual system involvement among child victims of human trafficking

BackgroundThe child welfare system is pivotal in identifying and responding to child (younger than age 18) human trafficking victims. Children who have experienced human trafficking—or are at risk of victimization—are increasingly recognized as also being served in the juvenile justice system. Yet little is known about human trafficking victimization among children in the juvenile justice population or among children with child welfare and juvenile justice involvement. ObjectiveBuilding on previous research with child welfare–and juvenile justice–involved children, we investigated characteristics and system experiences among children who have experienced a human trafficking abuse allegation in Florida. Participants and settingThe overall study population included all children born on or after January 1, 1993, who had at least one DCF-documented maltreatment allegation before March 1, 2020. This study examined a total of 12,167 allegations in the first set of analyses and the first human trafficking allegation for each child (N = 9300) in the second set of analyses. MethodsAnalyses are based on linked administrative data for a cohort of children involved with Florida's Departments of Juvenile Justice (DJJ) and/or Children and Families (DCF). We used descriptive and multivariate logistic regression analyses to document the characteristics of single and dual system–involved children and examine predictors of child welfare, juvenile justice, and dual system involvement. Results(1) Nearly half of children with a human trafficking abuse allegation are involved in DCF at the time of the allegation, (2) females who experienced trafficking are more likely to be involved in DCF (with or without DJJ involvement) than involved in no system, (3) Black children with an alleged trafficking incident were more likely than White children to be involved in both systems compared with DCF only, and (4) children who experienced labor trafficking abuse allegations were less likely than those who experienced sex trafficking to be involved with either system. ConclusionsThis study depicts child victims of sex and labor trafficking who are involved with one or both systems in one state.

The effect of competition on children's merit-based resource allocation: The difference between interpersonal and intergroup competition.

Competition usually exists in groups in everyday interactions, but how children allocate according to competition outcomes (e.g., merit-based allocation) after intergroup competition and the difference in children's allocations of rewards between interpersonal and intergroup competition remain unclear. Children aged 3-8 years were asked to complete interpersonal or intergroup competitive games and were further asked to allocate rewards between themselves and their partners (Study 1) or between their group and the other group (Studies 2 and 3) and to reason about their decisions. We found that after interpersonal competition, children tended to conduct merit-based allocations when they won but were more inclined to conduct equal allocations when they lost; after intergroup competition, children were more inclined to make equal allocations regardless of whether they won or lost, only less than half of children followed meritorious principles. However, children conducted more merit-based allocations with age after both interpersonal and intergroup competitions. In addition, children showed less bias towards their own side after intergroup competition than after interpersonal competition. Finally, they demonstrated an earlier proclivity towards being influenced by winning outcomes than by losing outcomes after interpersonal competition, whereas a converse tendency was found after intergroup competition.

Characteristics of digital devices and their use by school children in modern conditions

Introduction. The widespread and uncontrolled use of information and communication technologies by children has determined the purpose of the present research as to identify the varieties, purpose, frequency, intensity, screen timing, and usage duration of modern digital devices and the Internet by schoolchildren and their impact on the psycho-emotional state.
 Materials and methods. A questionnaire survey was conducted on nine hundred schoolchildren between 11 and 17 years of age from general education schools.
 Results. Irrespective of age and gender, each of the surveyed schoolchildren had several types of digital devices. All schoolchildren had regular Internet access and, in almost 87% of cases, were connected via smartphone or cell phone. In addition, 75% of schoolchildren use modern digital devices to prepare for classwork/homework, and 84% use them for various games and entertainment. Almost 10% of schoolchildren use digital devices and spend four or more hours a day on social media. More than half of children use electronic devices and the Internet during the day, evening, and night. In 17% of cases, children experienced negative feelings when using digital devices and social networks.
 Limitations. One standard method of assessing children’s education and recreation mode is to conduct a survey questionnaire. Still, in our opinion, a comprehensive assessment of digital devices and Internet usage mode would be more evident with timed observations over a 7–10-day period. Moreover, in our work, we encountered the problem of limited access to schools (due to the choice of schools for study by the Ministry of Public Education of the Republic of Uzbekistan) and schoolchildren (due to classes chosen for investigation by the school administration).
 Conclusion. The results obtained were the basis for the development of methodological recommendations on the regime and regulatory standards for the use 
 of digital devices and the Internet, as well as for the revised Sanitary norms, rules, and hygienic normative “Hygienic requirements for the use of information and communication technologies in general education school of the Republic of Uzbekistan” compliance with which will level the deficiencies in the daily routine of schoolchildren.

Managing Youth Trauma Effectively: Evaluating the virtual delivery of a brief psychoeducational group for caregivers of trauma-exposed young children

Although nearly half of children who experience trauma are younger than age six, few parenting programs target parenting practices for caregivers of young children who have experienced trauma or adversity. The current study preliminarily evaluates the virtual delivery of a brief psychoeducational group—Managing Youth Trauma Effectively (MYTE)—which was developed to meet this need, regardless of whether children show trauma-related symptoms. During the Covid-19 pandemic, both the train-the-facilitator training and caregiver group sessions were delivered virtually. This study examines perceptions of virtual training, virtual group delivery, parenting changes, and parent perceptions of child changes. The data, collected in the United States, included two tiers: facilitators who were trained to deliver the curriculum (n = 21), and caregivers who participated in the group (n = 61). Caregivers were majority female (70%) and non-Hispanic White (79%). Caregivers completed an anonymous online survey using a retrospective pre-post design. Both facilitators and caregivers perceived the virtual format to be useful, appropriate, and high quality. After participating in MYTE, caregivers perceived changes in specific parenting practices and changes in their child, including improved compliance, increased soothing, and an enhanced relationship. Results provide promising preliminary support for the virtual delivery of a brief psychoeducational group to support caregivers of children ages birth through five who have experienced trauma or adversity.

Navigating Parental Duties in a TikTok World, the UK and Nigeria Regulations and the Online Safety Bill

According to Ofcom, half of children used TikTok in 2021 and it is the third most used platform behind YouTube and WhatsApp. TikTok is a social media app with one billion monthly active users (Cervi et al., 2022; Dellatto, 2021). installed on devices, 3.5 billion times, available in 154 countries and accessible in thirty-nine languages. TikTok is offered to children of 13 years old (Independent Digital News and Media, 2022; Hoegh, 2022). TikTok was founded in 2018 with a mission to inspire creativity and bring joy (TikTok, 2023). However, its screentime consumption for children has experienced revolutionary change. One in five UK internet users are children according to the UK department for science Innovation and Technology, (2021) most of whom are on TikTok. Children are exposed to over one billion videos on TikTok every day This paper seeks to comparatively investigate the cultural differences, approaches, and challenges to parenting, responsible social media use by children in the United Kingdom and Nigeria (Attrill et al., 2016). To ascertain, whether the existing legal framework is sufficient in enforcing safeguarding measures required of TikTok and other social media platforms.

Follow-up after PICU discharge for patients with acquired brain injury: the role of an abbreviated neuropsychological evaluation and a return-to-school program.

To present the results of an abbreviated testing protocol used to screen for neurocognitive and psychological sequelae of critical illness among pediatric intensive care unit (PICU) survivors with acquired brain injury in our post-discharge follow-up programs, and describe our process for facilitating this population's return to academic life. Retrospective cohort study. Neurocritical care follow-up programs at two U.S. academic, tertiary medical/surgical PICUs. Children age > 4 years enrolled in the neurocritical care follow-up programs (n=289) at these institutions who underwent neurocognitive and psychological testing between 2017-2021. None. One month after discharge from the hospital, nearly half of the children and/or their parents (48%) in our neurocritical care follow-up programs identified some type of emotional or behavioral concern compared to their premorbid state, and 15% reported some type of cognitive concern. On evaluation, 35% of the children were given a new neurocognitive diagnosis. Neurocognitive domains regulated by the executive functioning system were the most commonly affected, including attention (54%), memory (31%) and processing speed (27%). One-quarter of the children were given a new psychological diagnosis, most commonly post-traumatic stress disorder (PTSD) or stress-related symptoms (12%). Over 80% of patients in the programs were given new recommendations for school, for both new academic services and new classroom accommodations. Over half of children (57%) were referred for comprehensive follow-up neuropsychological evaluation. Abbreviated neurocognitive and psychological evaluation successfully identifies the same deficits commonly found among PICU survivors who undergo longer, more complete testing protocols. When combined with services aimed at successfully re-integrating PICU survivors back to school, this focused evaluation can provide an effective and efficient means of screening for cognitive and emotional deficits among PICU survivors, and establish a rationale for early academic support upon the child's return to school.

Ketogenic Diet Affects Sleep Architecture in C57BL/6J Wild Type and Fragile X Mice.

Nearly half of children with fragile X syndrome experience sleep problems including trouble falling asleep and frequent nighttime awakenings. The goals here were to assess sleep-wake cycles in mice in response to Fmr1 genotype and a dietary intervention that reduces hyperactivity. Electroencephalography (EEG) results were compared with published rest-activity patterns to determine if actigraphy is a viable surrogate for sleep EEG. Specifically, sleep-wake patterns in adult wild type and Fmr1KO littermate mice were recorded after EEG electrode implantation and the recordings manually scored for vigilance states. The data indicated that Fmr1KO mice exhibited sleep-wake patterns similar to wild type littermates when maintained on a control purified ingredient diet. Treatment with a high-fat, low-carbohydrate ketogenic diet increased the percentage of non-rapid eye movement (NREM) sleep in both wild type and Fmr1KO mice during the dark cycle, which corresponded to decreased activity levels. Treatment with a ketogenic diet flattened diurnal sleep periodicity in both wild type and Fmr1KO mice. Differences in several sleep microstructure outcomes (number and length of sleep and wake bouts) supported the altered sleep states in response to a ketogenic diet and were correlated with altered rest-activity cycles. While actigraphy may be a less expensive, reduced labor surrogate for sleep EEG during the dark cycle, daytime resting in mice did not correlate with EEG sleep states.

Dampak Sosial Media Bagi Kehidupan Anak Masa Kini

The impact of gadgets in the era of globalization has positive and negative impacts. Ease of finding information, knowledge, being able to obtain or communicate with each other remotely is one of the positive paths. The existence of children's behavior that lacks socialization, does not understand politeness as result of never socializing is negative impact that many complain about social development in children. The method used in carrying out health education activities is by holding offline counseling at SD Al ALKHAIRAAT 2 PALU, Central Sulawesi. The counseling is carried out using the presentation and answer method. Analysis of article data used was obtained from internet using official website which discussed the topic of Impact of Social Media on the Lives of Today's Children, then analysis method was carried out by selecting articles according to the inclusion criteria and analyzing the content and findings in the articles obtained in study. Based on the results of statistical tests that have been carried out, it shows an increase in children's knowledge before and after being given counseling about the impact of social media on children offline. It can be interpreted that the children of SD AL KHAIRAAT 2 PALU Central Sulawesi already have good knowledge about the Impact of Social Media on the Lives of Today's Children and expected to be able to apply and disseminate the information obtained to friends and family at home. More than half of children have low knowledge about impact of social media. Basically, social media users are not limited by age and time. Everyone, both children, teenagers and adults can have their own social media accounts, especially children.

Influenza Vaccinations Among Privately and Publicly Insured Children With Asthma.

Annual influenza vaccination rates for children remain well below the Healthy People 2030 target of 70%. We aimed to compare influenza vaccination rates for children with asthma by insurance type and to identify associated factors. This cross-sectional study examined influenza vaccination rates for children with asthma by insurance type, age, year, and disease status using the Massachusetts All Payer Claims Database (2014-2018). We used multivariable logistic regression to estimate the probability of vaccination accounting for child and insurance characteristics. The sample included 317,596 child-year observations for children with asthma in 2015-18. Fewer than half of children with asthma received influenza vaccinations; 51.3% among privately insured and 45.1% among Medicaid insured. Risk modeling reduced, but did not eliminate, this gap; privately insured children were 3.7 percentage points (pp) more likely to receive an influenza vaccination than Medicaid-insured children (95% confidence interval [CI]: 2.9-4.5pp). Risk modeling also found persistent asthma was associated with more vaccinations (6.7pp higher; 95% CI: 6.2-7.2pp), as was younger age. The regression-adjusted probability of influenza vaccination in a non-office setting was 3.2pp higher in 2018 than 2015 (95% CI: 2.2-4.2pp), and significantly lower for children with Medicaid. Despite clear recommendations for annual influenza vaccinations for children with asthma, low rates persist, particularly for children with Medicaid. Offering vaccines in non-office settings such as retail pharmacies may reduce barriers, but we did not observe increased vaccination rates in the first years after this policy change.

Local allergic rhinitis in children: Clinical characteristics and role of basophil activation test as a diagnostic tool.

Local allergic rhinitis (LAR) is a condition involving a localized nasal allergic response in absence of systemic atopy. Most studies on LAR have been performed in adults. We aimed to describe clinical characteristics of LAR pediatric patients, its clinical evolution over a 7-year follow-up period and to study the role of basophil activation test (BAT), for its diagnosis. Forty-four children with non-allergic rhinitis (NAR) were included (24 males, 20 females, aged under 15 years). Nasal allergen provocation test (NAPT) and BAT were performed with Dermatophagoides pteronyssinus and Phleum pratense. Seven patients (16%) were diagnosed of LAR. Six reacted to D pteronyssinus and one to P pratense. All LAR and 86% of NAR patients presented perennial symptoms. Fifty-seven percent of NAR and LAR patients referred persistent symptoms. Around half of NAR and LAR patients reported mild-moderate clinical manifestations. Three LAR patients associated conjunctival symptoms, proportionally more than NAR patients (19%, 7 out of 37). NAR patients presented bronchial asthma (n=10) more frequently than LAR children (n=1). More than half of LAR and NAR patients presented family history of atopy. BAT was negative in all LAR patients. On follow-up, 3 LAR patients and 10 of the 25 NAR patients who agreed to be retested, presented systemic sensitization. Dust mites were the most frequent allergen involved. LAR should be ruled out in children with NAR. Almost half of children with LAR develop systemic sensitization over time. BAT shows low sensitivity for the diagnosis of LAR in children.

Asymmetric involvement of hands: Psychometric properties of the Turkish version of the Bimanual Fine Motor Function 2.0 classification in children with cerebral palsy

BackgroundManual functions affect more than a half of children with Cerebral palsy (CP). Asymmetric involvement of hands may also affect unilateral and bilateral activities of daily life. The Bimanual Fine Motor Function version 2.0 (BFMF-2.0) is a unique functional classification that categorizes the capacity of each hand (what the child can do) during bimanual functions. PurposeThe aim of this study was to investigate the validity and reliability of the Turkish version of the BFMF-2.0 in children with CP. Study DesignClinical measurement and cross-sectional study. MethodsThe study included 91 children with CP (56 girls, mean age; 7.41 ± 4.23 years [4–18 years]) and their parents. The Manual Ability Classification System (MACS), the Quality of Upper Extremity Skills Test (QUEST), and the Box and Block Test (BBT) were used for construct and concurrent validity. Experienced/inexperienced therapists and parents classified fine motor capacities of the children via live or video-based observation to assess inter-rater reliability. Three weeks later, the children were reclassified for intra-rater reliability. ResultsThe Turkish version of the BFMF-2.0 classification was strongly correlated with the MACS (rho = −0.88, p < 0.001), the QUEST (rho = 0.80, p < 0.001), and the BBT (rho = −0.77, p < 0.001). The inter-rater reliability scores were weak to excellent between the parents and the therapists (via live observation, κw = 0.57) and also between experienced/inexperienced therapists (via live or video-based observation, κw = 0.66–0.79). Intra-rater reliability scores were good to excellent (Intraclass Correlation Coefficient [ICC] = 0.87–0.95). ConclusionsThe Turkish version of the BFMF-2.0 classification is valid and reliable and could be applied by experienced and inexperienced therapists via live or video-based observation and by parents via live observation.

Post-COVID syndrome in children and adolescents of a large industrial city

Background. About 30 to 80% of children who have had a new coronavirus infection, suffer from post-COVID syndrome, the manifestations of which are diverse and persist for 12 weeks or more. Post-COVID syndrome remains an urgent problem in pediatrics, the clinical variants of which are diverse. There is no statistically significant relationship between the severity of coronavirus infection and the development of post-COVID syndrome. According to current data, the risk group for post-COVID syndrome includes children under 1 year of age, children with comorbid pathology.&#x0D; Aim. To evaluate the frequency of development, clinical variants and course of post-COVID syndrome in children and teenager of a large industrial city in order to optimize recommendations for their rehabilitation after a new coronavirus infection.&#x0D; Materials and methods. The were analyzed developmental histories of 6252 children and adolescents in Kemerovo (form 112/y) who had a new coronavirus infection.&#x0D; Results. Data on post-COVID syndrome were recorded in the developmental histories of 3066 (49.04%) children and adolescents, analyzed by medical documents. At the age of 13–15 years, the incidence of post-COVID syndrome is 55%, which is statistically significantly higher than in other age groups (p=0.005–0.0001). The following clinical variants of post-COVID syndrome were identified: asthenic, respiratory, cardiac, recurrent ears, nose, and throat, functional gastrointestinal disorders and mixed, the frequency of which varies depending on age and gender. Children with comorbid pathology (iron deficiency anemia and grade I–II pharyngeal tonsil hypertrophy) are statistically significantly more likely to suffer from post-COVID syndrome (p=0.000000001; 0.00000009; 0.00000009) than children without a history of comorbid pathology.&#x0D; Conclusion. Post-COVID syndrome occurs in half of children and adolescents who have had a new coronavirus infection. The frequency of post-COVID syndrome variants in children and adolescents differs. The presence comorbid pathology (iron deficiency anemia, pharyngeal tonsil hyperplasia of the 2 degree) increases the risk of developing post-COVID syndrome. It is necessary to examine patients in a timely manner for the purpose of differential diagnosis and drawing up an individual rehabilitation plan. Special attention should be paid to children with comorbid pathology.

Stunting among Children Aged 6 to 59 Months Visiting the Outpatient Department of Pediatrics in a Tertiary Care Centre.

Stunting refers to low height for age, resulting from chronic undernutrition, often linked to poor socio-economic conditions, maternal health, infant care, and nutrition. It hinders children's physical and cognitive development. In Nepal, over half of children under five suffer from malnutrition. Despite efforts, stunting remains high but has decreased from 57% in 1996 to 25% in 2022. The aim of the study was to find out the prevalence of stunting among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre. A descriptive cross-sectional study was conducted among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre after obtaining ethical approval from the Institutional Review Committee from 27 April 2023 to 15 July 2023. Anthropometric measurements were taken. World health organization standard growth charts for Z score was used appropriately for the completed age in months and gender of the child. A pre-designed questionnaire was used for face-to-face interviews. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 320 children, 46 (14.38%) (10.54-18.22, 95% Confidence Interval) children had stunting. Among those 46 children with stunting, 20 (43.47%) had severe stunting. The prevalence of stunting among children aged 6 to 59 months was found to be lower than other studies done in similar settings. children; prevalence; stunting; undernutrition.

Yield of diagnostic testing in evaluating etiology and end organ effects of pediatric hypertension.

Current recommendations regarding the utility of diagnostic investigations for pediatric hypertension are based on limited evidence, leading to wide practice variation. The objective of this study was to characterize the cohort of children that may benefit from secondary hypertension workup, and determine the diagnostic yield of investigations. This was a single-center, retrospective cohort study of 169 children aged 1-18years referred between 2000 and 2015, to a tertiary pediatric nephrology center in Canada, for evaluation of hypertension. The number of investigations completed, abnormal findings, and diagnostic findings that helped establish hypertension etiology was determined. 56 children were diagnosed with primary and 72 children with secondary hypertension in the outpatient setting. Secondary hypertension was predominant at all ages except for obese adolescents ≥ 12years. Half of children with traditional risk factors for primary hypertension, including obesity, were diagnosed with secondary hypertension. Kidney ultrasound had the highest yield of diagnostic results (19.8%), with no difference in yield between age groups (P = 0.19). Lipid profile had a high yield of abnormal results (25.4%) as part of cardiovascular risk assessment but was only abnormal in overweight/obese children. Echocardiogram had a high yield for identification of target-organ effects in hypertensive children (33.3%). A simplified secondary hypertension workup should be considered for all hypertensive children and adolescents. High yield investigations include a kidney ultrasound, lipid profile for overweight/obese children, and echocardiograms for assessment of target-organ damage. Further testing could be considered based on results of initial investigations for the most cost-effective management. A higher resolution version of the Graphical abstract is available as Supplementary information.

Agricultural burning in Imperial Valley, California and respiratory symptoms in children: A cross-sectional, repeated measures analysis

Burning of agricultural fields is an understudied source of air pollution in rural communities in the United States. Smoke from agricultural burning contains air toxics that adversely impact respiratory health. Imperial County in southeastern California is a highly productive agricultural valley that heavily employs agricultural burning to clear post-harvest crop remnants. We related individual-level exposure to agricultural burns to parent-reported respiratory symptoms in children.We leveraged the Children's Assessing Imperial Valley Respiratory Health and the Environment (AIRE) cohort of 735 predominantly Hispanic low-income elementary school students in Imperial County. Parents reported children's respiratory health symptoms and family demographic characteristics in questionnaires collected at enrollment and in annual follow-up assessments from 2017 to 2019. Permitted agricultural burns in Imperial County from 2016 to 2019 were spatially linked to children's geocoded residential addresses. We used generalized estimating equations to evaluate prevalence differences (PDs) in respiratory symptoms with increasing exposure to agricultural burning within 3 km in the 12 months prior to each assessment.Nearly half of children (346, 49 %) lived within 3 km of at least one agricultural burn in the year prior to study enrollment. In adjusted models, each additional day of agricultural burning in the prior year was associated with a one percentage point higher prevalence of wheezing (PD 1.1 %; 95 % CI 0.2 %, 2.0 %) and higher bronchitic symptoms (PD 1.0 %; 95 % CI -0.2 %, 2.1 %). Children exposed to four or more days of burning had an absolute increased prevalence of wheezing and bronchitic symptoms of 5.9 % (95 % CI -0.3 %, 12 %) and 5.6 % (95 % CI -1.8 %, 13 %), respectively, compared to no burn exposure. Associations with wheezing were stronger among children with asthma (PD 14 %; 95 % CI -1.4 %, 29 %).To our knowledge, this is the first U.S. study of agricultural burning and children's respiratory health. This work suggests that reducing agricultural burning could improve children's respiratory health.

Child Nutrition Outcomes and Maternal Nutrition-Related Knowledge in Rural Localities of Mbombela, South Africa.

Poor nutrition outcomes among children have become one of the major public health concerns in South Africa, attributed to poor feeding practices and maternal nutrition-related knowledge with conflicting data. In view of this, a cross-sectional study was conducted to determine the association of nutrition outcomes of children aged under two years with feeding practices and maternal nutrition-related knowledge in Mbombela, South Africa. Mothers' nutrition-related knowledge was estimated using an adapted structured questionnaire on colostrum, continued breastfeeding, diarrhea prevention and treatment using oral rehydration solution, immunization, and family planning, and scored as excellent (80-100), good (60-79), average (40-59), and fair (0-39). This was along with questions on socio-demographic factors and obstetric history, as well as anthropometric measurements. Child nutrition outcomes were estimated by WHO classification using z-scores for stunting (length-for-age (LAZ)), underweight (weight-for-age (WAZ)), and thinness (body mass index-for-age (BAZ)). Using STATA 17, 400 pairs of children (8 ± 6 months) and their mothers (29 ± 6 years) participated in the study and were living in a poor socio-economic status environment. Half of children were stunted (50%) and over half (54%) were obese, while mothers were underweight (39%) and overweight (34%). In addition to one third of mothers reporting obstetric complications, two thirds, initiated breastfeeding within one hour of delivery, 30% exclusively breastfed, 48% introduced early complementary feeding, and 70% practiced mixed feeding. Twenty-eight percent (28%) of mothers had fair nutrition-related knowledge, while 66% had average knowledge, 6% good knowledge, and none of the mothers had excellent knowledge. A chi-square test showed that mothers' nutrition-related knowledge was significantly associated with child stunting. The final hierarchical logistic regression showed significant associations of stunting with mothers' nutrition-related knowledge (average: AOR = 1.92, 95%CI: 1.12-3.29), child's age (6-11 months: AOR = 2.63, 95%CI: 1.53-4.53 and 12-23 months: AOR = 3.19, 95%CI: 1.41-7.25), and education (completing Grade 12: AOR = 0.36, 95%CI: 0.15-0.86). Contextual and intensified interventions on continued education for mothers to gain accurate information on nutrition-related knowledge and feeding practices could ultimately enhance child nutrition outcomes in poorer settings. Efforts should therefore be made to ensure that nutrition knowledge is appropriately provided based on the phases of child growth from 0 to 2 years, even beyond infancy into school age.

Thiopurines Maintenance Therapy in Children With Ulcerative Colitis: A Multicenter Retrospective Study.

Thiopurines are an established treatment for pediatric ulcerative colitis (UC). However, data regarding safety and efficacy are lacking. We aimed to determine short and long-term outcome following thiopurines use in children with UC. We conducted a retrospective review of children (2-18 years) with UC treated with thiopurines between January 2008 and January 2019 at 7 medical centers in Israel. The primary outcome was corticosteroid (CS)-free clinical remission at week 52 following thiopurines initiation without the need for rescue therapy (infliximab, calcineurin inhibitors, or colectomy). A total of 133 children were included [median age at diagnosis of 12.4 (interquartile range 11.0-15.8) years, 30 (23%) left-sided colitis, 113 (85%) with moderate or severe disease at diagnosis]. At diagnosis 58 patients (44%) were treated with 5-aminosalicylates and 72 (54%) with CS. Sixty patients (45%) received thiopurines as 1st line maintenance therapy. Seventy-four patients (56%) had CS-free clinical remission at week 52 without rescue therapy. Predictors of clinical remission were not identified. In a sub-analysis among patients with steroid-responsive moderate to severe UC, 59 (55%) patients achieved this outcome. The likelihood of remaining free of rescue therapy among thiopurines-treated patients was 83%, 62%, 45%, and 37% at 1, 2, 3, and 4 years, respectively. More than half of children with UC starting thiopurines without previous or concomitant biologic therapy have CS-free clinical remission at 52 weeks later without the need for rescue therapy. Thiopurines are effective in pediatric UC and could be considered prior to biologics.

Co-design of an Augmented Reality Asthma Inhaler Educational Intervention for Children: Development and Usability Study.

Smartphone and tablet apps that deliver health care education have been identified as effective in improving patient knowledge and treatment adherence in asthma populations. Despite asthma being the most common chronic disease in pediatrics, there are few apps that are targeted specifically for children. Only half of children with asthma have acceptable control of their symptoms, and 40%-98% do not use their inhalers correctly. With children being increasingly connected to technology, there is an opportunity to improve asthma inhaler technique education by delivery via smartphone or tablet apps. Augmented reality (AR) technology was used in this study to capitalize on growing technological innovations. Digital health interventions that use a co-design process for development have the highest likelihood of successful uptake and effectiveness on their intended outcomes. Perceived usability also has been shown to improve the effectiveness of education as well as the acceptance of the intervention. The aims of this study were to describe the co-design process, development, and design outcomes of a smartphone or tablet app that incorporates AR technology to deliver asthma inhaler technique education to children with asthma. This study also aimed to provide a usability evaluation, using the System Usability Scale to inform our work and future research, and recommendations for others performing similar work. The development of the AR asthma inhaler technique education app was based on an iterative co-design process with likely end users (children with asthma, their caregivers, and health care professionals). This involved multiple stages: recruitment of end users for qualitative interviews and usability testing with a previously designed educational intervention, which used an AR-embedded smartphone or tablet app; ideation of content for a specific asthma inhaler technique education intervention with end users; development of the specific asthma inhaler intervention; and 2 further rounds of interviews and usability testing with the redesign of the initial prototype. We included 16 participants aged 9-45 years. Using the co-design process, the AR asthma inhaler technique education app was designed, incorporating the preferences of end users. After iteration 1, animation was included based on the feedback provided. Iteration 2 feedback resulted in increased AR experiences and the removal of the requirement of a paper-based resource to trigger AR in the third iteration. Throughout all rounds, the ease of use of the app and the novel nature of the intervention were frequently described. The usability of the intervention overall was perceived to be excellent, and the mean System Usability Scale score of the intervention was found to be highest in the final round of evaluation (90.14). The results from this co-design process and usability evaluation will be used to develop a final AR asthma inhaler technique educational intervention, which will be evaluated in the clinical setting. RR2-10.1177/16094069211042229.