Prevalence Of Children Research Articles

Phenotypic Evidence from a Female Adult Pelvic Pain Clinic

Chronic pelvic pain (CPP) in women has complex etiology, multiple pain generators, and significant psychosocial sequalae. Deep phenotyping based on symptoms from multiple organ systems provides an optimal approach to patient-centered evaluation. This study sought to (1) identify distinct CPP profiles based on pain symptoms, cognition, and diagnoses, and (2) evaluate the clinical validity of the identified profiles by examining psychosocial histories and health care utilization. Two-hundred women seeking care for CPP in a tertiary outpatient pain clinic between 2017-2020 were included. Baseline data regarding pain intensity, interference, catastrophizing, acceptance, pain and psychiatric diagnoses were subject to a partition around medoids clustering algorithm to identify potential patient profiles. The number of profiles were determined by maximizing the average silhouette width followed by bootstrapped internal validation. Profiles were compared across demographic characteristics, social history, and subsequent treatment utilization. Two profiles with equal proportion were identified. Profile 1 was vulvodynia and myofascial pelvic pain-dominant characterized by lower pain burden and better psychological functioning. Profile 2 was visceral pain-dominant (e.g., irritable bowel syndrome, endometriosis) featuring higher pain intensity, interference and catastrophizing, lower pain acceptance, and much higher degree of psychiatric comorbidity. Patients in Profile 2 had longer pain duration, higher BMI, disability and substance use, and 2-4 times higher prevalence of childhood and adulthood abuse history (Ps<0.001). They were more likely to receive behavioral therapy (46% vs 27%, P = 0.005) and hormonal treatments (34% vs 21%, P = 0.04), and were prescribed more classes of medications for pain management (P = 0.045). Using a symptom and diagnosis-based phenotyping approach, women with CPP could be separated into two groups distinguished by pain clusters, pain cognition, and psychosocial comorbidities. The identified profiles were reflective of social history and health care utilization, and may inform future etiologic, mechanistic, and interventional research. Chronic pelvic pain (CPP) in women has complex etiology, multiple pain generators, and significant psychosocial sequalae. Deep phenotyping based on symptoms from multiple organ systems provides an optimal approach to patient-centered evaluation. This study sought to (1) identify distinct CPP profiles based on pain symptoms, cognition, and diagnoses, and (2) evaluate the clinical validity of the identified profiles by examining psychosocial histories and health care utilization. Two-hundred women seeking care for CPP in a tertiary outpatient pain clinic between 2017-2020 were included. Baseline data regarding pain intensity, interference, catastrophizing, acceptance, pain and psychiatric diagnoses were subject to a partition around medoids clustering algorithm to identify potential patient profiles. The number of profiles were determined by maximizing the average silhouette width followed by bootstrapped internal validation. Profiles were compared across demographic characteristics, social history, and subsequent treatment utilization. Two profiles with equal proportion were identified. Profile 1 was vulvodynia and myofascial pelvic pain-dominant characterized by lower pain burden and better psychological functioning. Profile 2 was visceral pain-dominant (e.g., irritable bowel syndrome, endometriosis) featuring higher pain intensity, interference and catastrophizing, lower pain acceptance, and much higher degree of psychiatric comorbidity. Patients in Profile 2 had longer pain duration, higher BMI, disability and substance use, and 2-4 times higher prevalence of childhood and adulthood abuse history (Ps<0.001). They were more likely to receive behavioral therapy (46% vs 27%, P = 0.005) and hormonal treatments (34% vs 21%, P = 0.04), and were prescribed more classes of medications for pain management (P = 0.045). Using a symptom and diagnosis-based phenotyping approach, women with CPP could be separated into two groups distinguished by pain clusters, pain cognition, and psychosocial comorbidities. The identified profiles were reflective of social history and health care utilization, and may inform future etiologic, mechanistic, and interventional research.

Rural and urban disparities in anemia among Peruvian children aged 6-59 months: a multivariate decomposition and spatial analysis.

Anemia is a global public health issue that affects mainly children aged less than 5 years. In Peru, despite the reduction in the prevalence of anemia between 2010 and 2018, anemia remains a major concern, especially in high-risk zones such as rural areas. Several sociodemographic factors have been associated with anemia in children; however, components contributing to the urban-rural gap have not been previously assessed. The purpose of this study was to evaluate the determinants of the difference in anemia prevalence between urban and rural areas, and its spatial distribution in Peruvian children aged 6-59 months. A secondary data analysis was conducted using the 2019 Peruvian Demographic Health Survey. The study population included 18 846 children aged 6-59 months. A multivariate decomposition analysis for non-linear response model was performed to identify the factors contributing to the gap in the prevalence of anemia across urban and rural areas. Global Moran&acute;s I autocorrelation, Ordinary Kriging interpolation and Bernoulli-based purely spatial scan statistics were employed to assess the spatial pattern of anemia. Nationwide, the prevalence of anemia in Peru was 29.47% (95%CI 28.63-30.33). In rural areas, it was 38.25%, and in urban areas 26.39%. The decomposition analysis revealed that 88.61% of the difference in the prevalence of anemia between urban and rural areas was attributed to the difference in the respondents' characteristics. Wealth index, mother&acute;s education, mother&acute;s employment status, number of living children and mother&acute;s age were key determinants contributing to the rural-urban gap. Spatial heterogeneity of anemia prevalence in childhood was observed at both inter- and intradepartmental level. The SaTScan spatial analysis identified six significant cluster areas with high prevalence of anemia in childhood. A considerable gap of anemia prevalence between urban and rural areas was found. Targeted interventions are necessary to reduce geographic disparities.

Prevalence of Children With Medical Complexity and Associations With Health Care Utilization and In-Hospital Mortality

Children with medical complexity (CMC) have substantial health care needs and frequently experience poor health care quality. Understanding the population prevalence and associated health care needs can inform clinical and public health initiatives. To estimate the prevalence of CMC using open-source pediatric algorithms, evaluate performance of these algorithms in predicting health care utilization and in-hospital mortality, and identify associations between medical complexity as defined by these algorithms and clinical outcomes. This retrospective cohort study used all-payer claims data from Colorado, Massachusetts, and New Hampshire from 2012 through 2017. Children and adolescents younger than 18 years residing in these states were included if they had 12 months or longer of enrollment in a participating health care plan. Analyses were conducted from March 12, 2021, to January 7, 2022. The pediatric Complex Chronic Condition Classification System, Pediatric Medical Complexity Algorithm, and Children With Disabilities Algorithm were applied to 3 years of data to identify children with complex and disabling conditions, first in their original form and then using more conservative criteria that required multiple health care claims or involvement of 3 or more body systems. Primary outcomes, examined over 2 years, included in-hospital mortality and a composite measure of health care services, including specialized therapies, specialized medical equipment, and inpatient care. Outcomes were modeled using logistic regression. Model performance was evaluated using C statistics, sensitivity, and specificity. Of 1 936 957 children, 48.4% were female, 87.8% resided in urban core areas, and 45.1% had government-sponsored insurance as their only primary payer. Depending on the algorithm and coding criteria applied, 0.67% to 11.44% were identified as CMC. All 3 algorithms had adequate discriminative ability, sensitivity, and specificity to predict in-hospital mortality and composite health care services (C statistic = 0.76 [95% CI, 0.73-0.80] to 0.81 [95% CI, 0.78-0.84] for mortality and 0.77 [95% CI, 0.76-0.77] to 0.80 [95% CI, 0.79-0.80] for composite health care services). Across algorithms, CMC had significantly greater odds of mortality (adjusted odds ratio [aOR], 9.97; 95% CI, 7.70-12.89; to aOR, 69.35; 95% CI, 52.52-91.57) and composite health care services (aOR, 4.59; 95% CI, 4.44-4.73; to aOR, 18.87; 95% CI, 17.87-19.93) than children not identified as CMC. In this study, open-source algorithms identified different cohorts of CMC in terms of prevalence and magnitude of risk, but all predicted increased health care utilization and in-hospital mortality. These results can inform research, programs, and policies for CMC.

Simulations to Assess the Performance of Multifactor Risk Scores for Predicting Myopia Prevalence in Children and Adolescents in China.

Background: Myopia is the most common visual impairment among Chinese children and adolescents. The purpose of this study is to explore key interventions for myopia prevalence, especially for early-onset myopia and high myopia. Methods: Univariate and multivariate analyses were conducted to evaluate potential associations between risk factor exposure and myopia. LASSO was performed to prioritize the risk features, and the selected leading factors were used to establish the assembled simulation model. Finally, two forecasting models were constructed to predict the risk of myopia and high myopia. Results: Children and adolescents with persistently incorrect posture had a high risk of myopia (OR 7.205, 95% CI 5.999–8.652), which was 2.8 times higher than that in students who always maintained correct posture. In the cohort with high myopia, sleep time of less than 7 h per day (OR 9.789, 95% CI 6.865–13.958), incorrect sitting posture (OR 8.975, 95% CI 5.339–15.086), and siblings with spherical equivalent <−6.00 D (OR 8.439, 95% CI 5.420–13.142) were the top three risk factors. The AUCs of integrated simulation models for myopia and high myopia were 0.8716 and 0.8191, respectively. Conclusion: The findings illustrate that keeping incorrect posture is the leading risk factor for myopia onset, while the onset age of myopia is the primary factor affecting high myopia progression. The age between 8 and 12 years is the crucial stage for clinical intervention, especially for children with parental myopia.

Hearing Instability in Children with Congenital Cytomegalovirus: Evidence and Neural Consequences.

Sensorineural hearing loss (SNHL) is a common sequela of congenital cytomegalovirus (cCMV), potentially exacerbating neurocognitive delay. The objectives of this study were to assess: (1) age at which SNHL in children with cCMV; (2) stimulability of the auditory system in children with cCMV following cochlear implantation (CI); and (3) whether features of magnetic resonance imaging (MRI) potentially are predictive of hearing outcomes. In this retrospective study of a prospectively acquired cohort, 123 children with cCMV who were referred for hearing loss at a single tertiary referral hospital over 20 years were compared with an unmatched comparative group of 90 children with GJB2-related deafness. Outcome measures were results of newborn hearing screening (NHS), behavioral audiograms, and, in a subgroup of cochlear implant (CI) users, responses from the auditory nerve and brainstem evoked by CI at initial activation, as well as lesional volume of FLAIR-hyperintense signal alterations on MRI. All but 3 of 123 children with cCMV had confirmed and persistent SNHL. At birth, 113 children with cCMV underwent NHS, 31 (27%) passed in both ears and 23 (20%) passed in one ear (no NHS data in 10 children). At the first audiologic assessment, 32 of 123 (26%) had normal hearing bilaterally; 35 of 123 (28%) had unilateral SNHL; and 57 of 123 (46%) had bilateral SNHL. More than half (67 of 123, 54%) experienced hearing deterioration in at least one ear. Survival analyses suggested that 60% of children who developed SNHL did so by 2.5 years and 80% by 5 years. In the children who passed NHS in one or both ears, 50% developed hearing loss by 3.5 years in the ear, which passed unilaterally (n=23 ears), and 50% by 5 years in bilateral passes (n=62 ears). Hearing loss was significant enough in all but one child with isolated high-frequency loss for rehabilitation to be indicated. Hearing thresholds in individual ears were in the CI range in 83% (102 of 123), although duration of deafness was sufficient to preclude implantation at our center in 13 children with unilateral SNHL. Hearing aids were indicated in 16% (20 of 123). Responses from the auditory nerve and brainstem to initial CI stimulation were similar in children with cCMV-related SNHL compared with GJB2-related SNHL. Characteristic white matter changes on MRI were seen in all children with cCMV-related SNHL (n=91), but the lesion volume in each cortical hemisphere did not predict degree of SNHL. cCMV-related SNHL is often not detected by NHS but occurs with high prevalence in early childhood. Electrophysiological measures suggest equivalent stimulability of the auditory nerve and brainstem with CI in children with cCMV and GJB2-related SNHL. Hyperintense white matter lesions on FLAIR MRI are consistently present in children with cCMV-related SNHL but cannot be used to predict its time course or degree. Combined, the data show early and rapid deterioration of hearing in children with cCMV-related SNHL with potential for good CI outcomes if SNHL is identified and managed without delay. Findings support universal newborn screening for cCMV followed by careful audiological monitoring. 3 Laryngoscope, 132:S1-S24, 2022.

Genetics in the ADHD Clinic: How Can Genetic Testing Support the Current Clinical Practice?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with a childhood prevalence of 5%. In about two-thirds of the cases, ADHD symptoms persist into adulthood and often cause significant functional impairment. Based on the results of family and twin studies, the estimated heritability of ADHD approximates 80%, suggests a significant genetic component in the etiological background of the disorder; however, the potential genetic effects on disease risk, symptom severity, and persistence are unclear. This article provides a brief review of the genome-wide and candidate gene association studies with a focus on the clinical aspects, summarizing findings of ADHD disease risk, ADHD core symptoms as dimensional traits, and other traits frequently associated with ADHD, which may contribute to the susceptibility to other comorbid psychiatric disorders. Furthermore, neuropsychological impairment and measures from neuroimaging and electrophysiological paradigms, emerging as potential biomarkers, also provide a prominent target for molecular genetic studies, since they lie in the pathway from genes to behavior; therefore, they can contribute to the understanding of the underlying neurobiological mechanisms and the interindividual heterogeneity of clinical symptoms. Beyond the aforementioned aspects, throughout the review, we also give a brief summary of the genetic results, including polygenic risk scores that can potentially predict individual response to different treatment options and may offer a possibility for personalized treatment for the therapy of ADHD in the future.

Malaria hospitalisation in East Africa: age, phenotype and transmission intensity

BackgroundUnderstanding the age patterns of disease is necessary to target interventions to maximise cost-effective impact. New malaria chemoprevention and vaccine initiatives target young children attending routine immunisation services. Here we explore the relationships between age and severity of malaria hospitalisation versus malaria transmission intensity.MethodsClinical data from 21 surveillance hospitals in East Africa were reviewed. Malaria admissions aged 1 month to 14 years from discrete administrative areas since 2006 were identified. Each site-time period was matched to a model estimated community-based age-corrected parasite prevalence to provide predictions of prevalence in childhood (PfPR2–10). Admission with all-cause malaria, severe malaria anaemia (SMA), respiratory distress (RD) and cerebral malaria (CM) were analysed as means and predicted probabilities from Bayesian generalised mixed models.Results52,684 malaria admissions aged 1 month to 14 years were described at 21 hospitals from 49 site-time locations where PfPR2–10 varied from < 1 to 48.7%. Twelve site-time periods were described as low transmission (PfPR2–10 < 5%), five low-moderate transmission (PfPR2–10 5–9%), 20 moderate transmission (PfPR2–10 10–29%) and 12 high transmission (PfPR2–10 ≥ 30%). The majority of malaria admissions were below 5 years of age (69–85%) and rare among children aged 10–14 years (0.7–5.4%) across all transmission settings. The mean age of all-cause malaria hospitalisation was 49.5 months (95% CI 45.1, 55.4) under low transmission compared with 34.1 months (95% CI 30.4, 38.3) at high transmission, with similar trends for each severe malaria phenotype. CM presented among older children at a mean of 48.7 months compared with 39.0 months and 33.7 months for SMA and RD, respectively. In moderate and high transmission settings, 34% and 42% of the children were aged between 2 and 23 months and so within the age range targeted by chemoprevention or vaccines.ConclusionsTargeting chemoprevention or vaccination programmes to areas where community-based parasite prevalence is ≥10% is likely to match the age ranges covered by interventions (e.g. intermittent presumptive treatment in infancy to children aged 2–23 months and current vaccine age eligibility and duration of efficacy) and the age ranges of highest disease burden.

Children's Resilience to Ongoing Border Attacks: The Role of Father, Mother, and Child Resources.

To understand children's resilience to ongoing violent border attacks (low PTSD symptoms and internalizing/externalizing behavior problems, and high sense of coherence-SOC), this study examined a multidimensional model of protective resources. This model comprised factors at the family level (fathers'/mothers' coping strategies and SOC) and at the individual level (children's coping strategies and attachments with father/mother). Participants were 251 Israeli father-mother-child triads living near the border with Gaza (children ages 9-12years). Preliminary analyses indicated children's prevalence of clinical PTSD was 6%. SEM analyses revealed the theoretical model's high fit with empirical data, χ2(1) = .00, p = .99, CFI = 1, TLI = 1, SRMR = .00, RMSEA = .00 [90% CI (.00, .00)]. More significant paths emerged between fathers' coping resources and children's resilience measures than for mothers' coping resources. Results also pinpointed the significant role of children's parental attachments and coping strategies. Discussion focused on the unique value of father, mother, and child risk/protective factors for explaining well-adjusted functioning among children living in conflict areas.

A Silent Crisis: The Impact of Public Health Expenditure on Malnutrition Prevalence in Children Aged Below Five in the Philippines

This study mainly aims to determine whether public health expenditures have been effective in reducing malnutrition among children aged below five in the Philippines. The researchers construct a Grossman (1972) model-based health production function, which treats economic, social, and environmental factors as determinants of nutritional status. OLS estimates show that an increase in food security rates, a decrease in poverty incidence rates, and an increase in the level of urbanization significantly reduce stunting rates. However, no statistically significant relationship exists between the aforementioned independent variables and underweight and wasting rates (aside from the level of urbanization and wasting). In all regression models, the coefficient estimate for public health expenditure is valued near zero and is statistically insignificant, implying that government spending on health has been insubstantial and ineffective in reducing malnutrition prevalence.

Clinical Profile and Molecular Genetic Analysis of Prader - Willi Syndrome: A Single Center Experience.

Aim:The prevalence of childhood and adolescent obesity is increasing worldwide as well as in India. Prader–-Willi syndrome (PWS) is one of the most common causes of syndromic obesity with varied clinical manifestations across different lifespan. Herewith, we describe clinical and molecular characteristics of eight PWS who were diagnosed in an obesity clinic of tertiary care hospital.Materials and Methods:Clinically suspected cases of PWS were screened between January 2014 and January 2022. Detailed history and clinical examination were done to look for typical features of PWS like characteristic facial appearance, short stature, obesity, hyperphagia, delayed puberty or hypogonadism, diabetes mellitus, developmental delay, cognitive dysfunction, learning disabilities or abnormal behavior. All were evaluated, with 75 g oral glucose tolerance tests (GTT), HbA1c, Free T4, TSH, LH, FSH, testosterone, and growth hormone level. Intelligent quotient (IQ) of each patient was assessed by a psychiatrist using Binet–Kamat test. Molecular confirmation of clinically suspected PWS was done by either Methylation-specific polymerase chain reaction (MS-PCR) or Fluorescence in situ Hybridization (FISH) methods.Results:Based on clinical and molecular characteristics, eight were diagnosed as PWS. Except one, all were male with characteristic facies, mean age of study cohort was 12 years and mean BMI of 44.58. Obesity, short stature, hyperphagia, hypotonia, and mild to moderate mental retardation were noted in entire (100%) PWS study population. All male PWS patients had cryptorchidism, which was bilateral in six patients and unilateral (right undescended testes) in one. Apart from obesity, short stature, other endocrine associations noted were diabetes mellitus in 50% and subclinical hypothyroidism in 37% of PWS. Molecular characteristics of PWS were confirmed by Methylation-specific PCR in seven and by FISH method in one.Conclusion:Prader–Willi syndrome should be kept in mind in case of childhood or adolescent obesity with short stature, hypotonia, cryptorchidism, and developmental delay or cognitive dysfunction. Judicious use of molecular diagnostic testing should be made in all clinically suspected cases. Early diagnosis and appropriate management of this complex disorder by a multidisciplinary team will improve the quality of life and treatment outcome.

Burden of Early Life Obesity and Its Relationship with Protein Intake in Infancy: The Middle East Expert Consensus.

Adequate nutrition in early life is proposed to shape a child’s future health by launching the growth trajectory in the proper direction, which helps to avoid negative metabolic programming effects. Protein intake during infancy and early childhood is of great importance, as it plays a key role in infant metabolic programming and the future risk of obesity. Breastfeeding provides the best nutrition in early life, with many benefits tailored for the baby, including the appropriate quantity and quality of proteins. Considering the high prevalence of childhood, and subsequent adult, obesity in the region, a virtual Middle East expert consensus meeting was held to discuss an effective approach for managing childhood obesity. Leading pediatric experts from Bahrain, Egypt, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates participated in the meeting. The experts discussed, debated, and agreed on certain directions, including the importance of educating parents, endorsing breastfeeding, and ensuring optimum quantity and quality intake of proteins in early life. This expert consensus may serve as the starting point for healthcare professionals in the region who are interested in shaping a healthy future for the generations to come.

Effect of a Nationwide Universal HBV Vaccination Program and Catch-up Vaccination Campaign on HBV Prevalence in Children

Effect of a Nationwide Universal HBV Vaccination Program and Catch-up Vaccination Campaign on HBV Prevalence in Children

Treating autism spectrum disorder by intervening with gut microbiota.

Autism spectrum disorder (ASD) comprises a group of neurodevelopmental disorders with a high prevalence in childhood. The gut microbiota can affect human cognition and moods and has a strong correlation with ASD. Microbiota transplantation, including faecal microbiota transplantation (FMT), probiotics, breastfeeding, formula feeding, gluten-free and casein-free (GFCF) diet and ketogenic diet therapy, may provide satisfying effects for ASD and its related various symptoms. For instance, FMT can improve the core symptoms of ASD and gastrointestinal symptoms. Probiotics, breastfeeding and formula feeding, and GFCF diet can improve gastrointestinal symptoms. The core symptom score still needs to be confirmed by large-scale clinical randomized controlled studies. It is recommended to use a ketogenic diet to treat patients with epilepsy in ASD. At present, the unresolved problems include which of gut the microbiota are beneficial, which of the microorganisms are harmful, how to safely and effectively implant beneficial bacteria into the human body, and how to extract and eliminate harmful microorganisms before transplantation. In future studies, large sample and randomized controlled clinical studies are needed to confirm the mechanism of intestinal microorganisms in the treatment of ASD and the method of microbial transplantation.

U.S. national, regional, and state-specific socioeconomic factors correlate with child and adolescent ADHD diagnoses pre-COVID-19 pandemic

Attention-deficit/hyperactivity disorder (ADHD), the most diagnosed emerging neurodevelopmental disorder in children, is a growing health crisis in the United States. Due to the potential increase in ADHD severity during and post the COVID-19 pandemic, we analyzed recent national and two state-specific ADHD data distribution among U.S. children and adolescents by investigating a broad range of socioeconomic status (SES) factors. Child and adolescent ADHD diagnosis and treatment data were parent-reported via National Survey of Children’s Health (NSCH). The nationwide childhood prevalence of ADHD is 8.7%, and 62.1% of diagnosed children are taking medication. Louisiana (15.7%) has the highest percentage of children diagnosed with ADHD and California (5.6%) has the lowest, followed by Nevada (5.9%). Multiple correspondence analysis (MCA, n = 51,939) examining 30 factors highlights four areas of interest at the national and state level: race/ethnicity, financial status, family structure, and neighborhood characteristics. Positive correlations between ADHD diagnosis and unsafe school, unsafe neighborhood, and economic hardship are evident nationally and statewide, while the association between a lack of ADHD diagnosis and higher urban neighborhood amenities are evident nationally, but not in two opposing outlier states—Louisiana or Nevada. National and state-specific hierarchical analyses demonstrate significant correlations between the various SES factors and ADHD outcomes. Since the national analysis does not account for the demographic heterogeneity within regions or individual states, the U.S. should rely on comprehensive, county-specific, near real-time data reporting to effectively model and mitigate the ADHD epidemic and similar national health crises.

Community Perceptions in New York City: Sugar-Sweetened Beverage Policies and Programs in the First 1000 Days

ObjectivesTo examine perceptions of Sugar-sweetened beverage (SSB) policies and programs focused on the first 1000 days—gestation through age 2 years—among community stakeholders in Washington Heights and the South Bronx, two neighborhoods in New York City with disproportionately high prevalence of childhood obesity.MethodsA multilevel framework informed interview guide development. Using purposeful sampling, we recruited study participants who were (1) able to speak English or Spanish and (2) resided or employed in Washington Heights or the South Bronx. Participants included community leaders (local government officials, community board members, and employees from community- and faith-based organizations) as well as community members. Trained research staff conducted semi-structured in-depth interviews. Using immersion/crystallization and template style coding, the study team performed thematic analysis until no new relevant themes emerged.ResultsAmong the 19 female study participants, perceived facilitators to SSB policy and program implementation included sustained partnerships with broad coalitions; continual education and clear messaging; and increased accessibility to healthier beverages. Perceived barriers included systems-level challenges accessing programs that support healthy beverage options, and individual-level lack of access to affordable healthy beverages. Acceptable potential intervention strategies included messaging that emphasizes health in pregnancy and infancy; policies that require healthy beverages as the default option in restaurants; and policies that remove SSBs from childcare settings. Some strongly favored SSB excise taxes while others opposed them, but all participants supported reinvestment of SSB tax revenue into health resources among marginalized communities.ConclusionsA multi-pronged approach that incorporates engagement, access, equitable reinvestment of revenue, and continual clear messaging may facilitate implementation of policies and programs to reduce SSB consumption in the first 1000 days.

Allergic rhinits: impact on quality of life of adolescents.

Adolescence is one of the most rapid phases of human development, in which biological maturity precedes psychosocial maturity. Rhinoconjunctivitis (ARC) is present in around 15 percent of 13-14-year-old children, which indicates a higher prevalence when compared with 6-7-year-old children (8.5 percent). During childhood (0-10 years) prevalence of Allergic Rhinitis (AR) is higher among males compared to females. Quite the reverse, during adolescence (11-17 years) females display higher prevalence of AR compared to males. However, when they reach adulthood (18-79 years), there is no difference in prevalence between genders. AR and ARC have significant physical and mental impacts on the QoL of adolescents and their parents. Apart from de adverse effects of first generation antihistamines, which include sedating effects, AR-ARC leads to school absences and poorer performance due to distraction, fatigue and irritability. The mobile technology facilitates an innovative investigatory approach to better and more precisely characterize allergy symptoms and their association with other allergic diseases. The success of treatment lies in the partnership between adolescents with AR and mobile technology, allowing them to have more information both on the disease and treatment. Adolescence is a special period in which AR is highly prevalent with some sex-dependent differences. There are also peculiarities on how AR affects QoL of adolescent patients.

Comprehensive approach to the tuberculosis indicators assessment of the children population in the Republic of Crimea

Introduction. Childhood tuberculosis (TB) control is relevant due to the peculiarities of its course in this age group, and the TB incidence in children is an important prognostic epidemiological indicator.Aim. Use of multivariate statistical analysis to estimate and predict childhood TB indicators in the Republic of Crimea (RC).Materials and methods. The official TB statistics in the Republic of Crimea for 2014-2018 are used. The calculated means of the indicators are checked for normality using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Pearson correlation analysis is applied to determine pair correlation relationships. Stepwise multiple regression analysis is carried out to determine group conditionality of the indicators, where coefficients, with which significant pairwise correlations are found, are selected as independent variables. Based on the results, multiple regression equations are made to predict the values of dependent variables. The data is processed using Statistica 10.0 software.Results. For childhood TB incidence, strong direct correlations are established with the incidence and prevalence of pulmonary TB among children. The paired correlation coefficient between the incidence of childhood TB and childhood lung TB and the detection of active TB patients in preventive examinations of children varied in the range of 0.63-0.72. For the prevalence of TB among children, strong direct correlations were found with the incidence of TB and pulmonary TB in children. Multiple correlation coefficients for the incidence and prevalence of childhood TB exceeded the values of paired correlation coefficients and were in the range of 0.93 to 0.98 (p&lt;0.001), indicating greater significance of group conditionality of the indicators. Determination coefficients R2 were between 0.87 and 0.96. Multiple regression models were built for the childhood TB incidence, childhood lung TB incidence, childhood TB prevalence, childhood lung TB prevalence.Conclusion. The found strong direct pairwise correlations for childhood TB incidence and prevalence and childhood pulmonary TB incidence and prevalence can serve as prognostic criteria and reflect the quality of antituberculosis interventions. High values of paired correlation coefficient between childhood TB incidence and childhood pulmonary TB and detection of patients with active TB in preventive examinations of children are a criterion of quality of both TB services and primary care, which can prevent the spread of TB and improve the epidemic situation of TB in Crimea. The calculated multiple regression models for the studied indicators can serve the needs of practical forecasting in Healthcare.

Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences?

Individuals with Duchenne muscular dystrophy (DMD) frequently develop sleep-disordered breathing. Noninvasive ventilation is often prescribed for sleep-disordered breathing treatment based on the American Academy of Sleep Medicine (AASM) criteria. In 2018, DMD disease-specific criteria for sleep-disordered breathing were established. Our study aimed to examine the clinical interpretation differences using these different criteria. We performed a multicenter, retrospective chart review of children with DMD followed at The Hospital for Sick Children, Toronto, Canada, and Rady Children's Hospital, San Diego, California, who underwent polysomnography from August 1, 2012, to February 29, 2020. Baseline characteristics and polysomnography data were summarized using descriptive statistics. Agreement for the diagnosis of sleep-disordered breathing evaluated by kappa statistics and sensitivity/specificity analysis was assessed. One hundred five male children with DMD (mean ± SD age: 12.1 ± 3.8 years; body mass index z score: 0.2 ± 2.3) were included. The proportions of children with DMD that met at least 1 AASM criterion and at least 1 DMD criterion were 45.7% and 67.6%, respectively. We found that 32.4% of children met neither AASM nor DMD criteria. Overall agreement between AASM and DMD criteria was moderate (k = 0.57). There was almost perfect agreement in sleep apnea diagnosis (k = 0.90); however, there was only slight agreement in hypoventilation diagnosis (k = 0.12) between AASM and DMD criteria. There were more children with DMD diagnosed with nocturnal hypoventilation and prescribed noninvasive ventilation using DMD criteria compared with AASM criteria. Future studies should address whether the prescription of noninvasive ventilation for children with DMD based on both criteria is associated with different clinical outcomes. Hurvitz MS, Sunkonkit K, Massicotte C, Li R, Bhattacharjee R, Amin R. Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences? J Clin Sleep Med. 2022;18(2):609-615.

Factors Influencing Childhood and Adolescent Obesity in the Arab Gulf States: A Systematic Review

BACKGROUND: About one third of the population in the Arab Gulf States are overweight and obese. Among children and adolescents, however, the prevalence of obesity is at rates higher than those reported worldwide. &#x0D; &#x0D; OBJECTIVES: The present study aims to systematically review and evaluate factors related to and affecting childhood and adolescent overweight and obesity in the Arab Gulf States.&#x0D; &#x0D; METHODS: We conducted a comprehensive and systematic search in PubMed, Ovid MEDLINE(R), Embase and Embase Classic to identify studies reporting on the risk factors of overweight and obesity in children and adolescent in the study region. &#x0D; &#x0D; RESULTS: We examined 22 studies and identified 12 reports to be included into this systematic review. The reviewed studies were from six Arab gulf States (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain and Qatar) and examined 9,723 children. Approximately 30 different risk factors were identified from the selected studies. These were generally falling under six main risk factors including unhealthy eating habits, sedentary lifestyle, family-related factors, (particularly mother physical activities and food habits), child feeding practices during infancy, child sleeping pattern and low intake of or deficiency in micronutrients important for growth.&#x0D; &#x0D; CONCLUSION: This study further establishes several of the universal-and regional-specific risk factors that influence the increased prevalence of childhood and adolescent overweight and obesity in the Arab Gulf States. Consideration of these risk factors is critical for developing effective policies and practices that address this public health concern to curb and reverse the rise in its prevalence within the Gulf Region.

Zusammenhang zwischen Stilldauer und Early Childhood Caries

Background: Dental caries in primary dentition affects approximately 500 million children worldwide, which makes it a serious global public health issue. Considering this background and the high caries prevalence in childhood, further research is needed to understand the influence of breastfeeding on caries development.Objectives: Aim of this study was to evaluate the association between breastfeeding duration (exclusive and then subsequent partial breastfeeding) and caries in the primary dentition considering socioeconomic status (SES), age, body mass index (BMI), and oral hygiene as potential confounders.Materials and methods: This cross-sectional study was part of the LIFE Child project and it analyzed data from 597 children aged 1-5 years (50.4% male, 99.7% born in Germany). A PC-based standardized questionnaire was used to collect information on sociodemographic data and breastfeeding behavior. The body mass index (BMI) was adjusted to age from weight and height. Visible plaque index (VPI), malocclusion and caries (dmf-t [decayed, missing due to caries, and filled teeth] according to WHO [World Health Organization] diagnosis criteria) were clinically collected. The statistical analysis was calculated using chi square and t-test, and multivariable logistic regression, respectively. Results: The caries frequency in this sample was 9.9% (n=59/597), the mean dmf-t ± SD (standard deviation) was 0.27 ± 1.1. The duration of exclusive/partial breastfeeding (± SD) was 4.5 ± 4.7 and 9.3 ± 7.7 months, respectively. Children from families with a low SES were breastfed for significantly shorter periods of time (1.2 months for exclusive and 3.3 months for partial breastfeeding, p<0.05). The bivariate analyses showed caries protection when breastfed 6-12 months (odds ratio [OR]=0.5; 95% confidence interval [CI]: 0.3-0.9), but in the multivariable analyses the effect disappeared; significant influencing factors were plaque (OR=9.8, 95% CI: 5.1-18.8), low SES (OR=2.3, 95% CI: 1.0-5.3), and age (OR=2.0, 95% CI: 1.5-2.6). Conclusion: The analyzed parameters showed that poor oral hygiene and low SES are risk factors for caries in the primary dentition. Duration of exclusive/partial breastfeeding had no effect on caries development in this study.Keywords:Breastfeeding, Caries, Cross-sectional study, Socioeconomic status, Dental plaque