Children Mean Age Research Articles

Validation of the Italian, European, North German, Malaysian, and South African black formulas on Cameriere method using panoramic radiographs in Kenyan children

This study aimed to validate the accuracy of five different formulas based on the Cameriere method for age estimation in Kenyan children. We analyzed panoramic radiographs of 350 Kenyan children (184 males and 166 females) aged between 6 and 13years. The dental development of each child was estimated by the analysis of the first seven left permanent teeth in the left mandible. Dental age was calculated by the Italian, European, North German, Malaysian, and South African black formulas previously published in peer-review journals. The children's mean chronological age (CA) was 9.34 ± 2.02years and 9.26 ± 2.01years for males and females. In males, the South-African formula overestimated CA least, by 0.12years, followed by the Italian formula by 0.22years, the European formula by 0.37years, the Malaysian formula by 0.48years, and the North-German formula overestimated the most, by 0.57years. In females, the South-African formula underestimated CA by - 0.12years. The Italian overestimated by 0.12years, followed by the North-German formula by 0.29years, the European formula by 0.31years, and the Malaysian formula by 0.40years. The Italian formula provided the best accuracy in the absolute difference within ± 1year, by 75.72% and 75%, following the North-German formula by 66.47% and 70.27% for males and females, respectively. Therefore, the findings suggest that the Italian formula best estimates dental age in Kenyan children.

Cultural influences on infant and toddler feeding among low-income Latinx mothers.

Latinx infants and toddlers experience higher obesity rates than their black or white counterparts, increasing chronic disease risk later in life. Infant and toddler feeding (ITF) interventions are shown to improve dietary behaviours, but few studies target Latinx populations. Culturally tailoring such interventions is imperative, but cultural influences on Latinx ITF practices remain unclear. The purpose of this study was to characterize how culture influences ITF practices among Latinx mothers of low income. A brief survey and semistructured interview informed by the theory of planned behaviour (TPB) were conducted on Zoom with New York City‐based Latinx mothers of children 4 to 24 months old. A directed content analysis approach was used to identify themes using TPB theoretical codes and inductive codes. Transcripts were coded independently by two researchers using NVivo 12. Survey data were analyzed using descriptive statistics in Excel. Participants (n = 19) were of Dominican, Mexican and Central and South American origin, had low acculturation scores and mean child age was 16.7 months (range: 5–24 months old). The central theme identified was that participants balanced cultural information with evidence‐based health information to determine which ITF practices were most beneficial to infant/toddler health. This resulted in the adoption of evidence‐based ITF recommendations, adoption of cultural practices that aligned with evidence‐based recommendations and dismissal or postponement of cultural ITF practices that contradicted evidence‐based recommendations. The present results can be applied to culturally relevant ITF education as follows: emphasizing the benefits of desirable ITF practices on children's health and promoting healthy cultural ITF practices.

#66 Clinical characteristics and outcomes of children with single or co-detected rhinovirus-associated acute respiratory infection in Middle Tennessee

Abstract Background Rhinovirus (RV) is one of the most common viral etiologies of acute respiratory infection (ARI)—the leading infectious cause of mortality in young children. Multiple respiratory viruses may be detected with RV in children with ARI, but the clinical significance of viral co-detection is unclear. We aimed to compare the clinical characteristics and outcomes of children with ARI associated with RV-only detection or RV co-detection. Method We conducted a prospective viral surveillance study (11/2015–7/2016) in Nashville, Tennessee. Children <18 years old who presented to the emergency department (ED) or were hospitalized with fever and/or respiratory symptoms of <14 days duration were eligible if they resided in one of nine selected counties in Middle Tennessee. Demographics and clinical characteristics were collected by parental interviews and medical chart abstractions. Nasal and/or throat specimens were collected and tested for RV, RSV, metapneumovirus, adenovirus, parainfluenza 1–4, and influenza A–C using real-time reverse transcriptase polymerase chain reaction assays. We compared clinical characteristics and outcomes of children with RV-only detection or RV co-detection using Pearson's χ2 test for categorical variables and linear regression with robust standard errors for continuous variables. Results Of 1,250 children who were enrolled, 904 (72.3%) were positive for at least one virus. RV was detected in 406 virus-positive children (44.9%), of whom 117 (28.8%) had RV co-detection. The most common RV co-detection pair was RV/RSV (n=36). The mean age of children with RV co-detection was lower than those with RV-only detection (2.6 ± 2.7 years vs. 4.3 ± 4.4 years; p<0.001). The signs and symptoms of children with RV-only detection and those with RV co-detection are compared in Table 1. A total of 283 children with RV were discharged from the ED (69.7%), of whom 89 (31.4%) had RV co-detection. Children with RV co-detection who were discharged from the ED were less likely to have a diagnosis of asthma/reactive airway disease (RAD) than those with RV-only detection (10.1% vs. 21.6%; p=0.019) but more likely to be diagnosed with bronchiolitis (18.0% vs. 1.5%; p<0.001). Of the 123 hospitalized children with RV, 28 (22.8%) had RV co-detection. Hospitalized children with RV co-detection were less likely to have an admission diagnosis of asthma/RAD than those with RV-only detection (7.1% vs. 43.2%; p<0.001) but more likely to be diagnosed with bronchiolitis (32.1% vs. 14.7%; p=0.038) and pneumonia (32.1% vs. 8.4%; p<0.001). We did not identify differences in hospitalization, intensive care unit admission, supplemental oxygen use, or length of stay between children with RV-only detection and RV co-detection. Conclusion We did not find evidence that RV co-detection was associated with worse outcomes in children with ARI. However, the clinical presentation of children with RV co-detection differs from that of children with RV-only detection. These distinctions warrant consideration in the diagnostic evaluation and management of RV-positive children. Further studies are needed to describe the distinct clinical presentations of RV/non-RV pairs and RV species.

Mortality in Cases of Acute Alcohol Intoxication in Children: A 10-Year Retrospective Study of the Moscow Region, Russia.

Russia suffers from high alcohol-related mortality. Most forensic autopsies in Russia include blood alcohol tests, but a systematic analysis of these data has never been conducted for children's deaths. We performed an analysis of juvenile mortality using autopsy reports from the Moscow Region Bureau of Forensic Medical Examination from January 1, 2009, to December 31, 2018. Despite a decrease in incidence ( Rs = -0.661), the number of cases of alcohol intoxication in minors was still high. The mean age of children in our study was 14.77 years (95% confidence interval [CI], 14.31-15.23). Death was predominantly among boys (72%) and those with higher blood alcohol concentrations (mean difference [MD], 0.295; 95% CI MD , 0.012-0.58). The number of cases of unnatural death increased with age ( Rs = 0.746, P = 0.001). Accidents were the most predominant cause of death, followed by suicide, homicide, and natural causes. Fatal alcohol intoxication was observed at an average blood alcohol concentration of 3.58 g/L (95% CI, 1.46-5.7), without any specific signs on autopsy. Even a strong smell of alcohol is an unreliable sign in the clinic. A systematic study of alcohol in forensic autopsy shows that the number of children who die with alcohol intoxication is high. Teenagers are the predominant age group experiencing alcohol intoxication. In our opinion, an alcohol blood test should be performed in all suspicious cases, especially in teenagers.

Interventions for treating supracondylar elbow fractures in children.

Interventions for treating supracondylar elbow fractures in children.

Long-term neurodevelopmental outcome in children after antenatal intravenous immune globulin treatment in fetal and neonatal alloimmune thrombocytopenia

Children with fetal and neonatal alloimmune thrombocytopenia face increased risk of intracranial hemorrhage potentially leading to developmental impairment. To prevent intracranial hemorrhage, pregnant women with alloantibodies against fetal platelets are often treated with intravenous immunoglobulin. Intravenous immunoglobulin seems effective in vastly reducing the risk of fetal or neonatal bleeding complications. However, information on long-term neurodevelopment of these children is lacking. This study aimed to evaluate long-term neurodevelopmental outcome in children with fetal and neonatal alloimmune thrombocytopenia who were treated with intravenous immunoglobulin antenatally. An observational cohort study was performed, including children of mothers treated with intravenous immunoglobulin during pregnancy because a previous child was diagnosed with fetal and neonatal alloimmune thrombocytopenia. Children were invited for a follow-up assessment including standardized cognitive and neurologic tests. The parents were asked to complete a behavioral questionnaire and school performance reports. The primary outcome was severe neurodevelopmental impairment, defined as severe cognitive impairment (intelligence quotient <70), cerebral palsy with Gross Motor Function Classification System Level ≥3, bilateral blindness, and/or bilateral deafness (requiring amplification). The secondary outcome was mild to moderate neurodevelopmental impairment, defined as either mild to moderate cognitive impairment (intelligence quotient <85), cerebral palsy with Gross Motor Function Classification System Level ≤2, minor neurologic dysfunction, vision loss, and/or hearing loss. Between 2003 and 2017, 51 children were live-born after antenatal intravenous immunoglobulin treatment. One family moved abroad and was therefore not eligible for inclusion. In total, 82% (41/50) of the eligible cases were included for neurodevelopmental assessment at a median age of 9 years and 8 months. Severe neurodevelopmental impairment was not detected. The incidence of mild to moderate neurodevelopmental impairment was 14% (6/41; 95% confidence interval, 6%-29%). The children's mean cognitive score, behavioral scores, and academic achievement were not different from those observed in the Dutch norm groups. Neuroimaging was performed in 90% (37/41) of cases. Severe intracranial hemorrhage was diagnosed in 2 cases (5%), one antenatally before the start of intravenous immunoglobulin and the other case 1 day after birth. Both cases had a normal neurodevelopmental outcome. The risk of neurodevelopmental impairment in children whose mothers were treated for fetal and neonatal alloimmune thrombocytopenia with antenatal intravenous immunoglobulin is comparable to that reported in the general population.

Electronic media use and food intake in Thai toddlers

ObjectivesViewing electronic media at mealtime is a common coping strategy for feeding difficulties, but its impact on food consumption is not known. We studied the prevalence of electronic media use at mealtime, its association with food intake, and associated factors. Methods138 healthy 18- to 30-month-old children were classified according to the presence of feeding difficulties using the Thai language version of the Montreal Children's Hospital Feeding Scale. Electronic media use and 3-day food intake history were collected. Each child's mean energy intake and time spent eating were compared between meals consumed with and without electronic media. Results58% of children watched electronic media while eating. Children with feeding difficulties ingested significantly more energy per meal when they watched media (184.0 ± 104.0 vs 152.7 ± 67.0, p = 0.04). Children without feeding difficulties spent significantly more minutes per meal when watching media (29.9 ± 10.1 vs 26.2 ± 7.6, p = 0.001). Longer total daily screen time (p < 0.001) and presence of feeding difficulties (p = 0.006) were associated with regular media use. Children who regularly used media at mealtime were significantly more likely to have a BMI-for-age z score classification as obese (16.7% VS 0.9%, p < 0.001). ConclusionMedia use during feeding is associated with greater energy intake and longer meal duration. Thai children who regularly use media at mealtime were significantly more likely to be obese. Children with longer total daily screen time, and those with feeding difficulties are more likely to regularly use media at mealtime.

The Serum Level of Proinflammatory TNF-alpha Cytokine in Cyanotic and Acyanotic Congenital Heart Diseases in Mosul City

Background:Tumor necrosis factor – alpha (TNF-α) has been proposed to play an important role in the etiopathology of congenital heart diseases (CHD) worldwide. However, no previous study about the role of TNF-α in the pathogenesis of CHDs in Mosul city / Iraq has been reported . Objectives:1) To evaluate the serum levels of TNF-α cytokine in cyanotic and a cyanotic congenital heart diseases (CHDs and to compare the results with control healthy children in Mosul city 2) To find any association between the level of this pro-inflammatory marker and other demographic parameters such as age and gender 3) To test the diagnostic validity of this cytokine for the diagnosis of CHD at different cut-off values. Patients, materials and methods:A case-control study was conducted in the Department of Microbiology / College of Medicine / University of Mosul over two years and 3 months from April 2019 to July 2021. Twenty nine (29) child with a cyanotic congenital heart diseases and seventeen (17) child with cyanotic heart diseases were included. Another Thirty one (31) healthy child were also included as a controls. . All patients were collected from Al-Khansa teaching hospital in Mosul city. The serum TNF-α concentration was measured in all participants by using ELISA. Results: Mean age of children with acyanotic heart diseases (2.7 ± 2.9 years) did not significantly differ from that of cyanotics (2.1 ± 1.9) or healthy controls (3.1 ± 1.7) , (P>0.05). The average TNF-α level in acyanotic heart diseases was 321.18 ± 325.71 ng/l compared to 120.63 ± 84.33 ng/l in cyanotics and 119.01 ± 139.71 in healthy controls. TNF- α was significantly elevated in acyanotic heart diseases in comparison to healthy children (P = 0.003). No significant difference was noted between acyaotics and cyanotic heart diseases in regards to TNF- α concentrations (P = 0.07). No age or gender effects were noted on TNF-α concentration in both acyanotic and cyanotic heart diseases (P>0.05). At the best cut-off value of 124 ng/l TNF-α had a specificity of 90.32% , sensitivity of 48.28% and accuracy rate of 39% as indicated by AUC-ROC curve . Conclusion: The current study showed higher TNF- α in acyanotic (but not in cyanotic) heart diseases compared to healthy controls. TNF-α had poor diagnostic utility to discriminate between CHD and healthy individuals and therefore not recommended as valuable biological marker for the diagnosis of CHD.

Pilot Study of Maternal Autoantibody-Related Autism.

The objective of this study was to investigate the presence of maternal autoantibody-related autism spectrum disorder (MAR-ASD) in 2 geographically distinct DBPNet clinical sites (Pennsylvania and Arkansas). MAR-ASD is a biologically defined subtype of ASD that is defined by the presence of autoantibodies specific to proteins in the fetal brain and present in approximately 20% of a Northern California sample but has not been studied in other states. Sixty-eight mothers of children with ASD were recruited from 2 DBPNet clinics and provided blood samples. Mothers also completed behavioral questionnaires about their children, and data from the child's clinical diagnostic assessment were abstracted. The mean age of mothers was 38.5 ± 6.1 years, and the mean age of children was 8.3 ± 2.7 years. MAR-ASD was present in 24% of the sample and similar across sites. Children of +MAR mothers had more severe autism symptoms as measured by Autism Diagnostic Observation Schedule comparison scores (W = 3604; p < 0.001) and the Social Communication Questionnaire (W = 4556; p < 0.001). There were no differences in IQ, adaptive function, or aberrant behavior. MAR-ASD is a subtype of autism that is present in similar frequencies across 3 states and related to autism severity.

Low Fruit, Vegetables, and Carotenoids Intake Driving Low Healthy Eating Index in Young Children With Food Insecurity

ObjectivesThis pediatric primary care setting implementation program provides supplemental food delivery and intensive family support to decrease food insecurity and improve child nutrition and health. The objective of this preliminary sub-analysis is to use a variety of metrics to describe nutritional profiles of young children and their caregivers. Methods38 families with children ages 0–5 years who are patients in a Washington, DC pediatric primary care clinic and had food insecurity were consented and enrolled in a 12-month program. We utilized Automated Self-Administered 24-hour (ASA24) dietary recalls for adults and children. ASA data were used to score the Healthy Eating Index (HEI, rated to 100) and sub-scores for daily intakes including Total Fruits (TF), Total Vegetables (TV), and Total Carotenoids (TC). The Veggie Meter (VM) portable reflection spectrometer was used to measure skin carotenoids. Statistical analysis included means/medians, distributions, and point-biserial correlations. ResultsTo date, 26 parent-child dyads completed full baseline assessments; 96% of families were African American, and 100% were Medicaid eligible. Mean child age at enrollment was 3.2 years; 24% of children were overweight. Mean TF and TV (cups/day) were, respectively, 1.08 and 0.61 in children and 0.52 and 0.95 in adults. Mean children’s HEI was 52 (U.S. avg. 60.1) and parents’ HEI was 48 (U.S. avg. 58.3). Low intakes of fruits/vegetables, dairy, and healthy protein contributed more to low HEI scores than overconsumption of less healthy foods. Mean TC intakes (mg/day) were 4.09 in children and 6.04 in adults. VM scores were similarly low: 236 for children and 247 for adults. VM weakly correlated with TV and carotenoids, but not TF. In adults, TV was moderately correlated with TC but was negatively correlated with VM. ConclusionsYoung children and families experiencing food insecurity have poor nutritional quality characterized more by low intake of healthful foods rather than excessive processed, fatty, and high carbohydrate foods, supporting public health interventions that provide supplemental fruits, vegetables and nutritional education to families experiencing food insecurity. Funding SourcesA. James and Alice B. Clark Foundation, Share Our Strength’s No Kid Hungry, Power of 10, J. Willard and Alice S. Marriott Foundation.

Child's Understanding of Cancer when Faced with Advancing Disease: A Retrospective Chart Review

Abstract Introduction It is difficult to comprehend a child's understanding of disease-related information as they might be unwilling to talk or feel inhibited about raising their concerns. Understanding children's perception is important to facilitate better communication in palliative care. Objectives To study child's understanding of advancing disease when referred to the Pediatric Palliative Care Services. Materials and Methods A retrospective chart review of 34 case record forms from March 2019 to March 2020 was conducted after obtaining a waiver of consent and Institutional Ethics Committee approval. The inclusion criteria were children having advanced cancer referred for palliative care, incomplete records were excluded. Data were analyzed using thematic analysis. Results Twenty-three were male, and 11 were female children, the mean age was 12 years. Five major themes were identified—the child's understanding of disease diagnosis and prognosis, nature of communication between parents and the child, barriers to communication, child's means of support, and interventions used during counseling. Conclusion Communication between children suffering from advanced cancer and their parents/caregivers is a sensitive issue, and noncommunication is often due to mutual effort to shield each other from the stress of difficult conversations. Lack of communication contributes to poor coping and forces children to seek comfort in other sources leaving parents distressed. Psychological interventions like resource building and psychoeducation are effective.

Factors relating to failure rates of dental procedures in children following comprehensive dental treatments under general anesthesia: A 2-year retrospective study.

This study assessed the demographic, treatment, and patient characteristics relating to 2-year postoperative failure and success rate of 2 to 12-years-old healthy children that underwent various dental procedures during comprehensive dental treatment under general anesthesia (GA). A retrospective study was conducted after the completion of a 2-year postoperative follow-up examination. The hospital records of all the children were reviewed by an experienced examiner. In the follow-up appointment, the clinical and radiographic evaluations of the treatments, oral hygiene, and oral hygiene practices were recorded. A P value of <0.05 was set as statistically significant. Around 221 healthy children were included in the study, with a mean (SD) age of 4.92 (1.37). The most common type of failure detected 2 years postoperatively were recurrent decay (mean = 2.68, SD = 2.50), followed by stainless steel crown (SSC) open margin (mean = 0.69, SD = 1.02). Children with good oral hygiene involved the highest number of successful procedures (mean = 5.28, SD = 1.99) (P = 0.032). Children with poor oral hygiene was the factor that involved the highest number of procedure failures (mean = 8.28, SD = 3.38) (P < 0.001). The Pearson correlation coefficient showed that the younger the mean age of children during treatment under GA, the higher the rate of dental procedure failure (r = -0.202, n = 221, P < 0.01). The failure rate of dental procedures performed during treatment under GA was highest among younger children and children with poor oral hygiene at the time of treatment. SSC crown restoration was the most common type of dental procedure received, and recurrent decay and SSC open margin were the most common types of failure detected.

0207 Mothers’ Adverse Childhood Experiences and Protective Factors are Associated with Rest-activity Rhythms in their Children

Abstract Introduction Mothers’ history of adverse childhood experiences (ACEs; e.g. maltreatment, household dysfunction) are associated with poor health outcomes in their children, but mechanisms underlying this intergenerational transmission are poorly understood. Given links between circadian rhythm and the stress-response system, we test the hypothesis that maternal ACEs influence child health through disrupted rest-activity rhythm (RAR) in the mother and child. We also explore whether mothers’ benevolent childhood experiences (BCEs) are protective against disrupted RAR. Methods We conducted a cross-sectional pilot study of maternal-child dyads with preschool-age children. Mothers reported history of childhood adversity (ACEs Scale, Childhood Trauma Questionnaire) and protective factors (BCE Scale). Dyads wore wrist actigraphs for 8-10 days and mothers completed daily electronic diaries. Nonparametric measures of RAR (e.g. interdaily stability [IS], intradaily variability [IV]) were calculated. We used linear regression to examine associations between mothers’ childhood history and maternal and child RAR measures, controlling for household size and maternal employment. Results Maternal-child dyads (N=20) identified as white (75%), Black (15%), and Hispanic/Latina (10%). Mean child age was 4.2 years (40% female). Average household size was 4.5 ±.1.1 and 65% of mothers were employed. Forty-two percent of mothers reported 1-2 ACEs and 25% reported 3 or more ACEs. Maternal childhood history was not associated with mothers’ RAR. However, maternal ACEs and CTQ total score were associated with decreased child IS (ACEs: β= -0.47, SE=0.01, p=.02; CTQ total: β= -0.53, SE=.01, p=.001) and increased child IV (ACEs: β=0.29, SE=.01, p=.051; CTQ total: β=0.38, SE+.00, p=.03). CTQ subscales revealed maternal childhood physical abuse (β= -0.54, SE=.01, p&amp;lt;.0001), emotional abuse (β= -0.42, SE=.00, p=.002), and sexual abuse (β= -.73, SE=.00, p&amp;lt;.0001) were associated with decreased child IS, while maternal childhood emotional neglect was associated with increased child IV (β= 0.39, SE=.01, p=.04). Maternal BCEs were associated with decreased child IV (β= -0.44, SE=.01, p=.03). Conclusion Maternal ACE history may influence child health through effects on children’s circadian rhythm (i.e. decreased synchronization, increased fragmentation), while maternal BCEs may protect against rhythm fragmentation. Additional research is needed to support these novel preliminary findings. Support (If Any) National Institute of Nursing Research (K99NR018876) and American Nurses Foundation.

A multicentre Canadian survey of caregiver perspectives on COVID vaccine-related pain and stress for their family.

Caregiver hesitancy for their children to receive the COVID-19 vaccine remains due to concerns regarding safety and efficacy, but also due to fear of vaccine administration-related pain and distress. Study objectives were to determine caregivers' perceptions regarding both their personal and child's COVID-19 vaccine administration-related stress and fear and relate this to their likelihood to allow their child to receive COVID-19 vaccinations. This study was a secondary data analysis of a multicentre, cross-sectional survey of caregivers presenting to four Canadian pediatric emergency departments. Caregivers were surveyed between December 2020 and March 2021 and completed a digital survey on their own smartphones. 331 caregivers responded to the survey (mean age 39.9 years [SD 7.71]); 74.2% (245/331) were mothers. Children's mean age was 8.8 years [SD 5.4]; 49.8% (165/331) were female. 64.1% (209/326) of caregivers were willing to vaccinate their child against COVID-19, while 35.9% (117/326) were not. Greater perceived COVID-19 vaccine administration-related pain (0.88 [0.80; 0.95], p = .003) and stress (0.82 [0.76; 0.89], p = <.001) for their child as well as greater perceived personal stress with their own COVID-19 vaccine administration (0.81 [0.75; 0.88], p = <.001) were associated with caregivers being less likely to vaccinate their child. During the time period between COVID-19 pandemic waves 2 and 3, and after the vaccine had been federally approved for adults, one-third of Canadian caregivers surveyed reported being unwilling to vaccinate their child against COVID-19 in the future. Managing children's and caregivers' vaccine administration-related fear and stress may improve vaccine uptake for children.

Screening and management of bladder and bowel dysfunction in general pediatric outpatient clinic: a prospective observational study

BackgroundBladder and bowel dysfunction (BBD) is a common disorder in children that is often associated with psychosocial and behavioral problems. Data specific to BBD in Asian children are comparatively scarce. Accordingly, this study aimed to investigate the prevalence of BBD and the response to standard urotherapy among Thai children attending the general pediatric outpatient clinic of Siriraj Hospital – Thailand’s largest national tertiary referral center. MethodsChildren aged 4–12 years were recruited to complete the Dysfunctional Voiding Symptom Score (DVSS) questionnaire to screen for BBD during 2018 to 2020. Standard urotherapy, which consists of education and behavior management, was prescribed to those with a DVSS score that suggests the presence of BBD. Enrolled children and their caregivers were followed-up at 3 and 6 months. The Strengths and Difficulties Questionnaire (SDQ) was completed at baseline. DVSS scores at baseline, and at 3 months and 6 months after standard urotherapy were compared using repeated measures analysis of variance (ANOVA).ResultsA total of 1,042 children completed the DVSS during the study period, and 90 (8.6%) were deemed to have BBD. The mean age of BBD children was 6.9 ± 2.2 years, and the female to male ratio was 2.9:1. The most common symptoms were defecation frequency (80.0%), difficult defecation (80.0%), curtsying (74.4%), urgency (68.9%), infrequent voiding (43.3%), and daytime incontinence (32.2%). Forty-one BBD children completed the SDQ, and 32.5% had scores suggestive of hyperactivity problems. Among the 24 BBD patients who were followed-up after 3 and 6 months of standard urotherapy, there was a significant improvement in DVSS results (9.5 ± 3.1 at baseline vs. 6.9 ± 3.4 at 3 months vs. 4.4 ± 3.9 at 6 months; p < 0.01). Nine of 12 patients with urinary incontinence showed complete response at 6 months. The overall Bristol stool score significantly improved from 2.6 ± 0.7 at baseline to 3.2 ± 1.0 at 6 months (p = 0.03).ConclusionsBBD is a prevalent condition among Thai children that is often associated with emotional and behavioral problems. Standard urotherapy prescribed in a general pediatric outpatient clinic setting yielded favorable outcomes in Thai children with BBD.

IS ADHD UNDER-DIAGNOSED IN BOSNIA AND HERZEGOVINA? COMPARISON OF CLINICALLY CONFIRMED CASES VS. PARENT-REPORTED PREVALENCE OF ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder characterized by hyperactivity, inattention, and impul- sivity. The issue of whether ADHD is a socially constructed disorder has received much attention. The goal of the present study was to examine the clinical prevalence of ADHD in Bosnia and Herzegovina (BIH). An additional goal was to investigate the prevalence of school-aged children who fulfill the criteria for the condition but do not have a clinical diagnosis. For the first research goal, the sample consisted of five University Clinical Centers in BIH that provided data on the prevalence. For the second goal, the sample consisted of 1935 parents of children aged 6 to 15 years. Parents of 1935 school-aged children from the Federation BIH completed the questionnaire regarding ADHD symptoms. Children ranged in age from 6 to 15 years. The mean age of children was 10.2 years (SD- 2.1 years). There were 1061 girls and 874 boys in the sample. Five hospitals in the Federation BIH (4 University Clinical Centers and 1 Cantonal Hos- pital) were sent a questionnaire to provide us with information on how many school-aged children were diagnosed with ADHD and their basic demographic data. In addition, the Clinical Centers were asked to provide information on what treatment they provide to children with ADHD. The results of this study indicated that clinical diagnosis of ADHD is infrequent. The number of clinically confirmed cases of ADHD in the Federation BIH was 138 or less than 0.001%. On the other hand, accord ing to survey data, there is a prevalence rate of ADHD indicated like that observed in western countries. According to the parents’ reports, there were 97 children or 5% who fulfilled the criteria for ADHD diagnosis. In relation to gender distribution of ADHD, there were more boys (88 boys) than girls (50 girls) with a clinically confirmed diagnosis of ADHD and boys were 1.76 times more likely to have a ADHD diagnosis than were girls. On the other hand there were more girls than boys who had ADHD according to parents’ reports, but this difference, according to the Chi square test, was not statistically significant (ꭓ 2 = 0.14; p = ,70). The results of this study have clearly shown that ADHD is underdiag- nozed in Bosnia and Herzegovina. There is a huge discrepancy between the clinically diagnosed children and the parent-reported symptoms of ADHD. Given the burden that ADHD has on children and their families it should be of the utmost importance to provide timely diagnosis and proper treatment. One way to improve the current situation is through a better cooperation between school staff (psychologists, teachers), parents, and medical professionals.

How mothers of a child with type 1 diabetes cope with the burden of care: a qualitative study

IntroductionCaregiver burden is a complex construct that depends heavily on the context and culture of the community in which care takes place. This study aimed to explore the lived experience of being mothers of a child with type 1 diabetes aged 6 to 18 years.Materials and methodsWe used a qualitative methodology utilizing conventional content analysis. We conducted 24 interviews with 20 mothers who had a child with type 1 diabetes aged 6 to 17 years.ResultsThe mean age of mothers and children were 36.3 and 12.3 years, respectively. The mean of years with the disease was 4.3 years. Thirteen children were girls. The essential theme was coping with the burden of care through personalized coping and active acquisition of social support. The main theme consists of four sub-themes including Crisis in the family and burden of care, Losing the family equilibrium, Personalized coping strategies, and Active acquisition of social support. Mothers used personalized strategies and every support they could get to reach their aim.ConclusionsFamilies of children with type 1 diabetes need extensive and personalized care plans.

Is modified reverse step-cut osteotomy better than Yun's reverse V osteotomy in paediatric cubitus varus deformity correction? A prospective, double-blinded, randomized controlled trial.

Various corrective osteotomy techniques have been described in the literature for correcting paediatric cubitus varus. But we are still in search of the perfect technique that gives maximum possible deformity correction and cosmetic appearance that satisfies parents with minimal complications. We compared the outcomes of two technically sound osteotomy techniques having minimal postoperative lateral condyle prominence described in the literature. Is modified reverse step-cut osteotomy (MRSO) better in terms of clinical, radiological, and cosmetic outcomes than Yun's reverse V osteotomy (RVO) in pediatric cubitus varus deformity correction? In total, 20 children with unilateral cubitus varus resulting from malunited supracondylar humerus fractures were included. Randomization was done by computer-generated random slips. A total of ten cases each were operated by MRSO and RVO techniques, respectively. Clinical, radiological, and cosmetic appearance assessments were done at the final two year follow-up and compared between the two groups. The mean age of children in the MRSO and RVO groups is 9.9years (3-16) and 8.6years (3-16), respectively. The mean pre-operative carrying angle in the deformed elbow of MRSO and RVO group was - 20.5° and - 19.5°, respectively, and the mean pos-toperative carrying angle in the corrected elbow of MRSO and RVO group was + 6.8° and + 6.5°, respectively. Regarding the lateral prominence index (LPI), a positive correlation was noted between pre-operative and post-operative periods with a value of 0.855 and 0.844 (p value: 0.001 and 0.03, respectively) in both MRSO and RVO groups, respectively. However, the change was statistically not significant when compared between the two groups (p = 0.63). There was no statistically significant difference (p > 0.05) when the clinical, radiological, and cosmetic outcomes were compared between the groups at final follow-up. The surgeon can choose either one of these techniques based on their expertise since the results of both the techniques are comparable in terms of clinical, radiological, and cosmetic outcomes.

THE DIAGNOSTIC VALUE OF ALLERGIC INFLAMMATION MARKERS IN INFANTS WITH BRONCHIOLITIS

Introduction. It is quite important to study the markers of allergic inflammation depending on the status of vitamin D in order to understand the pathogenetic links of bronchiolitis in infants.Aim of study. Analysis of the relationship between serum vitamin D levels and indicators of allergic inflammation (eosinophil cationic protein (ECP) and IgE) in infants with bronchiolitis.Materials and methods. A clinical examination of 55 infants was conducted. The main group consisted of 25 children with bronchiolitis who had a history of allergies. The comparison group consisted of 20 children with bronchiolitis without a burdensome allergy history. The control group included 10 relatively healthy children. The mean age of children in the main group was 7.2 ± 1.4 months, 6.4 ± 1.2 months in the comparison group, and 9.2 ± 1.6 months in the control group.Results of the study. It was found that the duration of hospital stay in children of the main group was 8.2 ± 1.32 days, while in children of the comparison group the duration of stay in hospital was significantly shorter (p &lt;0.05). We found a significant difference in the indicators of allergic inflammation that depended on the status of vitamin D in the examined children. Thus, in children with vitamin D deficiency and insufficiency, a marked increase in ECP (56.3 ± 12.8 ng / ml) and total IgE levels to 127.5 ± 3.12 IU / ml was found compared to the same indicators as in children of the main group with the optimal level of 25 (OH) D, and in children of the comparison group, p˂0,001. It should be noted that the rate of allergic inflammation marker ECP in children of the comparison group with deficiency and insufficiency of vitamin D in serum also had a significant difference when compared with infants of the control group, p˂0.05. Conclusions. In children with bronchiolitis, obtained history of allergies and insufficient levels of vitamin D and its insufficiency, the severity of the disease is manifested by a longer duration of clinical symptoms and hospital stay. Eosinophilic cationic protein can be considered as a marker of allergic inflammation in infants with bronchiolitis.

Quality of Life of Parents of Children With Refractory Seizures Referred to a Hospital in Ahvaz, Iran

Background and Objectives Up to 25% of children with epilepsy experience resistance to treatment and recurrence of seizures and have low quality of life (QoL) in various dimensions. Limited evidence is available on the QoL of the parents of these patients in the south of Iran. Therefore, this study aims to evaluate the QoL of parents with children having refractory epilepsy in Ahvaz, Iran Subjects and Methods Using a sequential sampling method, 157 parents of 113 children with refractory epilepsy who referred to the neurology clinic of Golestan Hospital in Ahvaz city during 2009-2016 were selected to participate in the study. The 36-item short form health survey (SF-36) was used to assess the QoL of parents. The significance level of statistical tests was set at 0.05. Results The mean age of parents was 35.2±8.5 years and the mean age of children was 7.1±2.6 years. Of 157 parents, 98 (62.4%) were mothers and the rest were fathers. The children had seizures for 3.1±1.6 years. The mean score of SF-36 was 62.6±21.4. In all domains of the SF-36, mothers had significantly lower scores than fathers (P&lt;0.000). Conclusion The QoL of parents with children having resistant epilepsy, especially their mothers, in Ahvaz is lower compared to the general population of Iranian