Older Child Age Research Articles

Social network factors and cardiovascular health among baltimore public housing residents.

Social networks – or the web of relationships between individuals – may influence cardiovascular disease risk, particularly in low-income urban communities that suffer from a high prevalence of cardiovascular disease. Our objective was to describe the social networks of public housing residents – a low-income urban population – in Baltimore, MD and the association between these networks and blood pressure. We used cross-sectional survey data of randomly selected heads of household in two public housing complexes in Baltimore, MD (8/2014–8/2015). Respondents answered questions about 10 social network members, including attributes of their relationship and the frequency of interaction between members. We calculated measures of network composition (e.g., proportion of network members who were family members) and network structure (e.g., density), which we then dichotomized as “high” (upper quartile) and “low” (less than upper quartile). We used linear regression to test the association between network measures and mean systolic and diastolic blood pressure. The sample included 259 respondents (response rate: 46.6%). Mean age was 44.4 years, 85.7% were women, 95.4% Black, and 56.0% had a history of hypertension. A high proportion of older children (age 8–17 years) in the network (>30%) was associated with a 4.0% (95%CI [0.07, 8.07], p = 0.047) higher mean systolic blood pressure (~4.9 mmHg greater). Other network attributes had no association with blood pressure. Social network attributes, such as having a high proportion of older children in one’s network, may have particular relevance to blood pressure among low-income public housing residents, reinforcing the potential importance of social relationships to cardiovascular health.

Associations between Comparison on Social Media and Depressive Symptoms: A Study of Young Parents

We aimed to assess associations between parental social media comparison (PSMC)—the degree to which individuals compare their parenting with others on social media (SM)—and depressive symptoms. In March 2018 we conducted a survey of 528 parents ages 18-30 with children under the age of 18. Participants were asked about SM use, PSMC, and depressive symptoms. PSMC was measured with 7 Likert-type items that asked participants the extent to which they agreed or disagreed with statements such as “Based on their posts, other parents on social media appear to provide a better social life for their children than I do.” Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9). Multivariable ordered logistic regression models were used to assess the association between PSMC and depressive symptoms while controlling for SM use, parent adverse childhood experiences, parent age, gender, race/ethnicity, relationship status, employment status and household income, age of oldest child, and number of children. The PSMC was internally consistent (α = 0.94). In multivariable models, after adjusting for all covariates, there was 51% greater odds of elevated depressive symptoms (AOR = 1.51, 95% CI [1.33, 1.71]) for every one-point increase on the PSMC scale. In conclusion, the PSMC is independently associated with elevated depressive symptoms among parents. Future research should assess directionality of these associations and further explore parents’ experiences of comparison with others on SM.

Complementary feeding practices and associated factors among Mongolian children 6-23months of age.

Little is known about factors influencing children's dietary intake in Mongolia, a country undergoing rapid nutrition transition. Using nationally representative data from the 2017 Mongolia National Nutrition Survey, we assessed the nutritional status of children aged <2 years and examined household, maternal, and child factors associated with feeding practices among children aged 6–23 months (n = 938). Multivariable logistic regression models were used to identify predictors of minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). The prevalence of child stunting (length/height‐for‐age Z‐score < −2 SD) was 6.3%, and the prevalence of overweight (weight‐for‐height Z‐score > +2 SD) was 16.8%. The prevalence of anaemia and iron deficiency was 39.0% and 32.2%, respectively, and 73.5% and 85.5% of children had inadequate vitamin A and vitamin D status, respectively. Of children aged 6‐23 months, 92.1% (n = 864) had MMF, 49.6% (n = 465) had MDD, and 43.8% (n = 411) achieved MAD. Increased household wealth was positively associated with all three indicators, whereas severe food insecurity was not associated with MMF, MDD, or MAD. Older child age (odds ratio, 95% CI: 1.09 [1.06, 1.12]; p < .001) and maternal dietary diversity (odds ratio, 95% CI: 2.36 [1.67, 3.34]; p < .001) were positively associated with child MDD. Nutrition‐specific and nutrition‐sensitive efforts are needed to improve the dietary quality of infants and young children in Mongolia and reduce the high burdens of child micronutrient deficiency and overweight in the country.

Determinants of Therapy Access for US School‐Aged Children with Developmental Disabilities

Developmental disabilities (DDs) affect the health of many children nationwide. Access to therapy services (e.g., speech and language therapy, occupational therapy) for children with DDs can help to optimize their health across the lifespan. Policy initiatives such as state Medicaid Home and Community Based Services (HCBS) waivers intended to improve therapy access for school‐aged children with DDs may benefit from increased knowledge of therapy access state variation and determinants. This study aimed to (1) determine whether significant state variation in therapy access exists and (2) examine associations of child, parent or family, neighborhood, healthcare, and state determinants with therapy access among US school‐aged children with DDs.This was a secondary analysis of individual level data from the 2016 and 2017 National Survey of Children’s Health and state level data from the 2016 American Community Survey, 2016 Health Resources and Services Administration, 2015‐16 Office of Special Education Programs, and 2016 Centers for Medicare and Medicaid Services. The dependent variable was if the child was currently accessing therapy services to meet his/her developmental needs. Independent variables examined included characteristics of the child (e.g., age), parent or family (e.g., income), neighborhood (e.g., neighborhood amenities), healthcare (e.g., medical home), and state factors (e.g., number of state HCBS waivers targeting children with DDs). We fit weighted multilevel regression models to examine therapy access variation and determinants across states.The sample included 9,984 US children ages 6‐17 years with ADHD, learning disability, developmental delay, speech and language disorder, ASD, blindness, deafness, intellectual disability, epilepsy, cerebral palsy, Tourette syndrome, and/or down syndrome. The sample represented 19% of the US child population ages 6‐17 years.Overall, 34.6% of school‐aged children with DDs were accessing therapy services. Statistically significant variation in therapy access for children with DDs was found across states (σ2 = .11, SE = .04, Range: Iowa = 21.7%, D.C. = 51.1%). Older child age and private insurance were each associated with significantly lower adjusted odds of therapy access. Functional limitations, individualized education program, frustration accessing services, and care coordination need were each associated with significantly higher adjusted odds of therapy access. Bivariate analysis results showed lower number of medically underserved areas, higher percent of children with IDEA Part B services, and higher number of HCBS waivers per state were each associated with higher odds of therapy access; however, these associations did not remain statistically significant in multivariable analysis results. Multivariable analysis results for children with DDs in waiver states demonstrated higher estimated annual costs per child to be associated with lower adjusted odds of therapy access (aOR = 0.85; 95% CI: 0.81‐0.90). Sensitivity analysis results also showed that among children with DDs and functional limitations, ≥2 state HCBS waivers were associated with increased adjusted odds of therapy access.Therapy access for school‐aged children with DDs varies widely across states, reflecting geographic disparities in care. Results further highlight pronounced disparities in therapy access by age, insurance, and service needs among school‐aged children with DDs.To advance equitable access to therapy services for school‐aged children with DDs, targeted policy and practice initiatives remain needed.Agency for Healthcare Research and Quality.

Glycemic Variability: An Independent Predictor of Mortality and the Impact of Age in Pediatric Intensive Care Unit.

Objective: To compare the ability of different indices of glycemic variability (GV) in the prognostic evaluation of critically ill children and investigate whether heterogeneity of glucose control exists within this population group.Methods: We conducted a retrospective study of the GV data collected from patients admitted to the pediatric intensive care unit, Children's Hospital of Chongqing Medical University between January 2016 and December 2016. We calculated the mean glucose level (MGL) and four indices of GV, namely, standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), and glycemic lability index (GLI). The 28-day mortality was considered as the primary endpoint.Results: Survivors and non-survivors showed significant differences in terms of the SD, CV, MAGE, and GLI (P < 0.05, for all). However, GLI was superior to the other indices and showed an independent association with ICU mortality (odds ratio [OR], 1.082; 95% confidence interval [CI], 1.031–1.135; P < 0.01). Sub-group analysis disaggregated by quartiles of MGL and GV revealed that younger subjects (age ≤ 36 months) had significantly higher mortality in the lowest quartile of the MGL and in the highest quartile of GV; the older children (age > 36 months) experienced significantly higher mortality in the highest quartiles of MGL and GV.Conclusion: GV is closely associated with mortality, and among all glucose parameters evaluated, GLI was found to be the strongest predictor of outcomes. This paper is the first report of age being a potentially important modifier of the association between GV, MGL, and mortality in critically ill children.

Intravenous cannula placement in children for induction of general anesthesia: Prospective audit and identification of success factors.

Approaches to pediatric induction of anesthesia vary widely. While oral sedative premedication and inhalational induction are common, total intravenous anesthesia is becoming increasingly popular. Total intravenous anesthesia without anxiolytic premedication, which is the most commonly used technique in our hospital, requires intravenous (IV) cannula placement in an awake child. To quantify the success rate of IV cannula placement in 1 or 2 attempts and to identify success factors and barriers. With ethical approval and written informed consent from participating anesthesiologists, a prospective audit of IV cannulation was undertaken over a 1-month period. The attending anesthesiologist captured basic demographics, IV insertion characteristics, setting, distraction techniques, the behavior of the child, number of attempts, and success/failure. A logistic regression model for successful IV cannulation was created. Anesthesiologists and procedural suite nurses participated in semi-structured interviews to identify success factors, barriers, and teaching approaches. Data from 984 cases were analyzed. IV induction was planned in 562 cases, and IV cannulation was successful in 90% of these patients. Anxiolytic premedication was given in 6% of cases. Observations indicated that 64% of children were pain- and reaction-free, and 90% experienced minimal or no reaction. Predictors for success included older child's age and child behavior at first encounter. Qualitative interview data from 13 participants suggested success factors included effective distraction, preparing the family for IV induction, parental presence, support of the operating room team, effective use of local analgesic cream, adapting the approach to the individual child, and the anesthesiologist's efficiency. Barriers included needle phobia, uncooperative child, anxious parents, ineffective use of analgesic cream, and unfavorable anatomy. Distraction techniques varied by age and developmental stage of the child. Cannulation for planned IV induction is feasible for most children, enabling increased use of total intravenous anesthesia as an institutional anesthetic strategy.

Age Structural Transitions and Copayment Policy Effectiveness: Evidence from Taiwan's National Health Insurance System.

Background: Population ageing is a worldwide phenomenon that could influence health policy effectiveness. This research explores the impact of age structural transitions on copayment policy responses under Taiwan’s National Health Insurance (NHI) system. Methods: The time-varying parameter vector autoregressive model was applied to create two measures of the copayment policy effectiveness, and multiple linear regression models were used to verify the nonlinear effect of age structural transitions on copayment policy responses. Results: Our results show that copayment policy effectiveness (in terms of the negative response of medical center outpatient visits to upward adjustments in copayment) is positively correlated with the proportions of the population in two older age groups (aged 55–64 and ≥ 65) and children (age < 15), but negatively correlated with the proportion of the population that makes up most of the workforce (aged 15‒54). These tendencies of age distribution, which influence the responses of medical center outpatient visits to copayment policy changes, predict that copayment policy may have a greater influence on medical center outpatient utilization in an ageing society. Conclusions: Policymakers should be concerned about the adverse effects of copayment adjustments on the elderly, such as an increasing financial burden and the effect of pricing some elderly patients out of Taiwan’s NHI system.

Assessing an App-Based Child Restraint System Use Intervention in China: An RCT

While child restraint systems are effective in protecting children from crash-related injuries and deaths, their use in China is extremely low. This study assessed the effectiveness of child restraint system education with and without behavioral skills training on improved use and explored participants' views regarding content and delivery of an onsite intervention and online (WeChat) boosters. A randomized trial was conducted in 6 kindergartens from May 2017 to January 2018 in Shantou and Chaozhou, China. Selected kindergartens were randomly assigned to 3 groups: (1) control, (2) child restraint system education‒only, and (3) child restraint system education plus behavioral skills training. Analysis was conducted in May 2018. Participants were parents from the selected kindergartens. Both intervention groups received child restraint system education that included one-time onsite education and biweekly online boosters for 3 months using an app to deliver education messages. Survey questions included parent knowledge, attitude and behaviors of child restraint system use, and opinions related to the content and delivery of the onsite intervention and online boosters. Child restraint system use in both intervention groups was higher than that of the control group post-intervention (27.3% and 31.7%, respectively). Compared with the control group, the intervention groups had a higher percentage of correct answers to all 9 items, except Item 7 measuring the parents' knowledge, attitude, and behaviors of child passenger safety after the intervention. Lower parent's level of education (OR=7.00, 95% CI=2.62, 18.70) and older child age (4 years: OR=3.92, 95% CI=1.08, 5.28; 5 years: OR=2.08, 95% CI=1.52, 5.31) were associated with lower rates of child restraint system use. Most parents (92.3%) preferred the online over the onsite intervention component. An education intervention was effective in improving parents' knowledge, attitude, and practice of child restraint system use. A social media intervention booster (WeChat) may provide a new channel to help promote child passenger safety in China.

Clinical characterization of status epilepticus in childhood: a retrospective study in 124 patients

PurposeThe aim of this study is to describe demographic data, semiology and etiology in a pediatric population with status epilepticus (SE) and refractory SE (RSE). MethodWe retrospectively reviewed patients with the following inclusion criteria: i) age between two months and eighteen years; ii) SE diagnosis; iii) admission from January 2001 to December 2016; iv) available clinical data. ResultsWe enrolled 124 patients. Mean and median age was 4.6 ± 4.2 years and 3.3 [1.2-7.5] years respectively.SE had a “de novo” onset in 66.9%. Focal convulsive-SE was the most common semiology (50.8%) whilst generalised (32.3%) and nonconvulsive-SE (NCSE) (16.9%) were less represented. Some etiologies showed a different age distribution: febrile in youngest age (p = 0.002, phi 0.3) and idiopathic-cryptogenic in older children (p = 0.016, phi 0.2).A statistical significance correlation was detected between semiology and etiology (p < 0.001, Cramer’s V 0.4), chemotherapy and NCSE (n = 6/21 vs 3/103, p < 0.001) as well as PRES and NCSE (n = 7/21 vs 5/103, p < 0.001).Only 17.7% had a RSE. No correlation was found in demographic and clinical data, but NCSE, acute and idiopathic-cryptogenic etiologies were more frequently associated to RSE. Encephalitis was the most common diagnosis in acute etiologies whereas unknown epilepsy in idiopathic-cryptogenic group. ConclusionMost of our findings were previously described however we found a significant role of non-antiepileptic treatments (chemotherapy-dialysis) and comorbidity (PRES) determining acute etiology and NCSE. Acute (mostly encephalitis), idiopathic-cryptogenic (mainly unknown-epilepsy) and NCSE were frequently detected in RSE. In the above mentioned conditions a high level of suspicion was recommended.

The impact of unplanned school closure on children's social contact: rapid evidence review.

BackgroundEmergency school closures are often used as public health interventions during infectious disease outbreaks to minimise the spread of infection. However, if children continue mixing with others outside the home during closures, the effect of these measures may be limited.AimThis review aimed to summarise existing literature on children’s activities and contacts made outside the home during unplanned school closures.MethodsIn February 2020, we searched four databases, MEDLINE, PsycInfo, Embase and Web of Science, from inception to 5 February 2020 for papers published in English or Italian in peer-reviewed journals reporting on primary research exploring children’s social activities during unplanned school closures. Main findings were extracted.ResultsA total of 3,343 citations were screened and 19 included in the review. Activities and social contacts appeared to decrease during closures, but contact remained common. All studies reported children leaving the home or being cared for by non-household members. There was some evidence that older child age (two studies) and parental disagreement (two studies) with closure were predictive of children leaving the home, and mixed evidence regarding the relationship between infection status and such. Parental agreement with closure was generally high, but some disagreed because of perceived low risk of infection and issues regarding childcare and financial impact.ConclusionEvidence suggests that many children continue to leave home and mix with others during school closures despite public health recommendations to avoid social contact. This review of behaviour during unplanned school closures could be used to improve infectious disease modelling.

Maxillary Protraction with Miniscrew Assisted Rapid Palatal Expander in Children with Skeletal Class III Malocclusions

Protraction headgear therapy with a rapid palatal expansion appliance used as an intraoral anchorage is common in children with Class III malocclusion and maxillary deficiency. However, it can show anchorage loss or failure of protraction in older age children. Therefore, some clinicians proposed the use of skeletal anchorage such as miniplates in the infrazygomatic crest area or miniscrews in the palate. These case reports describe maxillary protraction therapy in children with the miniscrews assisted rapid palatal expander (MARPE). At first, MARPE has been developed for the maxillary expansion in adults, but it could also serve as a good skeletal anchorage for protraction therapy in children.

High cost child welfare cases: Child characteristics and child welfare services

The IV-E Waivers and Family First Prevention Services Act prioritize prevention services, including services that reduce out-of-home placements. Placement in out-of-home care is associated with a variety of adverse outcomes as well as high costs to society. Studies that focus on utilization of health services suggest that these costs are not evenly distributed among recipients, and that high utilizers make up a small percentage of individuals who utilize a disproportionate share of resources. The purpose of the paper is to examine child characteristics and child welfare services associated with high welfare costs, defined as the top decile of child welfare costs. Results indicate that older age of child, child sexual abuse and/or neglect, and inability of parent to provide care are associated with high child welfare costs. Parental substance abuse or domestic violence in the household are less common among children with high costs. High cost children are more likely to have serious behavioral problems perhaps reflecting the severity of these problems. Residential treatment and group home placements and services were also associated with having high costs.

Foreign background and older age of children were associated with infection in Swedish tuberculosis contacts.

We present our results using interferon-gamma release assays in any child <18years or tuberculin skin tests in Bacille Calmette-Guérin unvaccinated children for tuberculosis contact investigation in Stockholm, Sweden. During 2000-2019, we investigated 892 children with a median age of seven years. We explored associations between TB infection and characteristics such as closeness to contact, age, sex, BCG status and foreign origin. The overall rates were for TB infection 10.2% (n=91) and for TB disease 1.1% (n=10). In addition to infectiousness of index case and closeness of contact, foreign background, male sex and increasing age were independently associated with infection. In foreign-born children, the rates of tuberculosis infection and disease were 18.7% and 3.9%, respectively. In 18/46 (39%) infected foreign-born children, a baseline negative tuberculosis test supported a diagnosis of recent infection. Foreign background, older age and male sex were associated with infection. In a significant proportion of infected children, a previous negative test made recent infection likely.

Association of Parental and Contextual Stressors With Child Screen Exposure and Child Screen Exposure Combined With Feeding

Parents may use screen exposure or screen exposure combined with feeding for infants and toddlers to alleviate their own stress. To evaluate the association of individual and contextual stressors with child screen exposure (CSE) and CSE combined with feeding (CSE+F) in children aged 7 to 18 months as measured by parent-reported use and variation in quantity of CSE and CSE+F. This cross-sectional, population-based study drew parent-child participants from TARGet Kids, a network of primary health care research settings throughout Toronto, Ontario, Canada, between November 1, 2011, and July 31, 2018. The included children were aged 7 to 18 months. Exclusion criteria were health conditions affecting growth, acute conditions, chronic conditions, severe developmental delay, and families who were unable to communicate in the English language. Data were analyzed from April 1, 2019, to July 31, 2019. Parenting stress, child age, child negative affectivity, family living arrangements, and family income were assessed with parent-completed questionnaires. The primary outcome was CSE and the variation in CSE, which represented the amount of background and engaged use of screens (television, videos or DVDs, video games, computers, and mobile devices) in a typical week. The secondary outcome was CSE+F, which represented the frequency of breakfast, lunch, dinner, and snack consumption during screen exposure in a typical week. Both CSE and CSE+F were assessed with the parent-completed Nutrition and Health Questionnaire; Infant Behavior Questionnaire, Revised Very Short; and Parenting Stress Index, Short Form. The final sample size was 1085 children for the analysis of CSE and 1083 children for the analysis of CSE+F. Among 914 respondents, the children's mean (SD) age was 11.6 (2.3) months, and 478 (52.3%) were male. Among 910 respondents, 839 (92.2%) were mothers, with a mean (SD) age among 873 respondents of 34.4 (4.2) years. In a typical week, 581 of 779 children (74.6%) were reported to have any CSE, and 321 of 874 children (36.7%) had some CSE+F. Higher parenting stress levels (odds ratio [OR], 1.01; 95% CI, 1.00-1.02; P = .04) and older child age (OR, 1.43; 95% CI, 1.01-2.03; P = .04) were associated with CSE. Higher parenting stress levels (incidence rate [IR], 1.00; 95% CI, 1.00-1.01; P = .002) and lower household income (IR, 1.26; 95% CI, 1.10-1.45; P = .01) were associated with increased CSE. Older child age (OR, 1.79; 95% CI, 1.35-2.38; P < .001) and lower household income (OR, 2.54; 95% CI, 1.72-3.74; P < .001) were associated with CSE+F. Lower household income (IR, 1.21; 95% CI, 1.03-1.42; P = .02) was associated with increased CSE+F. This study found that parenting stress, income, and child age were associated with CSE, and child age and household income were associated with CSE+F. Given these findings, interventions to improve parental coping mechanisms may decrease child screen exposure.

Pollen Food Allergy Syndrome in Black and White Children with Food Allergies in the FORWARD Study

Pollen Food Allergy Syndrome (PFAS) and allergic rhinitis (AR) have not been well documented in the pediatric population with reference to race. The aim was to determine the prevalence of PFAS and AR by race in children with food allergies. FORWARD is a prospective, multi-center, cohort study, recruiting black and white children 0-12 years of age with allergist-diagnosed IgE-mediated food allergies. Guardians of enrolled participants completed an intake survey, which assesses food allergy in association with PFAS and AR. Of 492 children [170 (34.6%) black] with complete surveys, 9.2% reported PFAS (11.5% of blacks, 8.0% of whites). There was no observed association between race and PFAS (p>0.05). However, there was a significant association between age and PFAS (p<0.01) in whites, with children >5 years old more likely to have PFAS than those <5 years. There was no significant association between age and PFAS in black children. Black children allergic to tree nut, shellfish, soy, and sesame were more likely to have PFAS (p<0.05). White children allergic to fin fish and sesame were more likely to have PFAS (p<0.05). White children with PFAS were more likely to have AR (p<0.001). In this cohort, 9.2% of children with food allergy also have PFAS, but there was no association by race. PFAS was associated with older age in white children. Interestingly, specific food allergens associated with PFAS differed by race.

Protective role of breastfeeding status, chronic health problems, and temperament of children in maltreatment by mothers.

In order to reduce parental violence against children, it is necessary to establish risk factors associated with maltreatment of children in different societies. This study aims to evaluate the impact of mother-child characteristics on self-reported mother's maltreatment (physical or emotional abuse) against pre-school children. The general characteristics of mother-infant pairs and maternal knowledge and attitudes about violence were taken using a questionnaire at routine child health supervision. Overall, 244 mother-infant pairs were enrolled and mothers described their child as easy-going (27.0%), normal (61.1%), and naughty (11.9%). Of all mothers, 32.8% had been exposed to violence in their childhood. According to maternal self-reports, 82.4% of the mothers abused their children emotionally and 24.6% physically. Multiple logistic regression analysis revealed that older child age, naughty or normal defined child, maternal exposure to violence during her childhood period were identified as predictors. Older child age, breastfeeding for less than 6 months, and naughty-defined child were associated with elevated odds ratio of physical abuse; however, those with a chronic disease were less likely to be abused. Pediatricians should be aware of the fact that older preschool children, being breastfed for less than 6 months, and naughty children could be at risk for victimization.

Experience of Treating Acute Appendicitis in Tashkent

Modern diagnostics of acute appendicitis in children should include abdominal ultrasound investigation upon admission to a specialized hospital, if necessary, in an ultrasound monitoring mode during clinical dynamic observation of the child. Surgical treatment is indicated only for destructive appendicitis. The method of a surgical treatment choice is laparoscopic surgery including destructive appendicitis complicated by appendicular peritonitis. Surgeries in acute appendicitis make up 75% of all emergency surgical interventions. Annually only in the Republican Research Centre of Emergency Medicine 700 appendectomies in children are made on average. The article summarizes data obtained in the retrospective analysis of case histories of 6 256 patients with acute appendicitis and its complications who were hospitalized in the pediatric department of emergency surgery for 12 years. The following incidence of acute appendicitis in children is reported: from 1 to 3 years old - 0.6 per 1 000; from 4 to 7-1.4 - 2.6 per 1 000; 13 years of age - 8 per 1 000. The authors discuss specific features in the clinical picture of acute appendicitis in children depending on patient’s age and anatomical location of the appendix. The clinical picture in children of older age and of the first three years of life is discussed separately. Among 6 256 pediatric patients with acute appendicitis 72 (1.15%) were children younger than 3 years. The authors have substantiated a complex of diagnostic and therapeutic manipulations as well as tactic options to the treatment of this category of patients. Widespread implementation of the laparoscopic technique into surgical practice has significantly changed the tactics of treatment. The number of surgeries for simple appendicitis in children has decreased up to 3.9-7%.

Risk factors for undernutrition among children 0–59 months of age in Myanmar

AbstractPrevalence of childhood stunting in Myanmar is one of the highest in the South-East Asia countries. Cross-sectional data from the Demographic Health Survey 2015–16 were used to examine risk factors for stunting, wasting, and underweight among children aged 0–59 months. The prevalence of stunting (height-for-age z-score &lt; -2), wasting (weight-for-height z-score &lt; -2), and underweight (weight-for-age z-score &lt; -2) was 29.0%, 7.3%, and 19.2%, respectively. Accounting for cluster design and sampling weights, multivariable logistic regression was conducted with 35 household, maternal, and child characteristics. Current pregnancy and maternal height &lt; 145 cm, and child's small birth size recalled by mother, home delivery, and older child age (ref: 0–5 months) predicted both stunting and underweight. Child's large birth size was protective for all stunting, wasting, and underweight. Maternal BMI &lt; 18.5 kg/m2 was a common risk factor for wasting and underweight. Lower wealth quintiles, maternal engagement in non-agricultural occupation, and male child predicted stunting only. Younger child age and not receiving vitamin-A supplementation in the last 6-month was risk factor for wasting only. Regional variation was also seen with a higher odds of stunting in West-South Region, North-East States, and West States, compared to Central Regions. In Myanmar, socioeconomic-demographic factors, poor maternal nutritional status, and living in certain geographic location are affecting children's undernutrition. It is recommended that intervening growth faltering focusing on the 1000 days of life; ensuring optimum maternal nutrition during and before pregnancy and at adolescence; societal support for mothers in poverty or engaged in non-agriculture; and understanding region-specific undernutrition pathways.

Young children police group members at personal cost.

Humans' evolutionary success has depended in part on their willingness to punish, at personal cost, bad actors who have not harmed them directly-a behavior known as costly third-party punishment. The present studies examined the psychological processes underlying this behavior from a developmental perspective, using a novel, naturalistic method. In these studies (ages 3-6, total N = 225), participants of all ages enacted costly punishment, and rates of punishment increased with age. In addition, younger children (ages 3-4), when in a position of authority, were more likely to punish members of their own group, whereas older children (ages 5-6) showed no group- or authority-based differences. These findings demonstrate the developmental emergence of costly punishment, and show how a sense of authority can foster the kind of group-regulatory behavior that costly punishment may have evolved to serve. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Influence of leftover antibiotics on self-medication with antibiotics for children: a cross-sectional study from three Chinese provinces

ObjectivesTo investigate leftover antibiotics and their influence on self-medication with antibiotics (SMA) for Chinese children, and further explore the different influences of leftovers from two main sources: previous prescriptions and...