Risk Assessment For Children Research Articles

Health Risk Assessment in Children Occupationally and Para-Occupationally Exposed to Benzene Using a Reverse-Translation PBPK Model

Health Risk Assessment in Children Occupationally and Para-Occupationally Exposed to Benzene Using a Reverse-Translation PBPK Model

Domestic Violence Victimization Risk Assessment in Children and Adolescents: A Systematic Review

Background: Risk assessment is the process of collecting information towards the goal of protecting the physical and psychological integrity of the victim, taking into account factors associated with violence to assess the severity of violence, protect victims, and prevent recidivism. This type of risk assessment is commonly used in situations of domestic violence and needs to be adjusted for the contexts of child and adolescent victimization. Objective: Resources and standardized criteria to guide a child-centered domestic violence victimization risk assessment are lacking. This systematic review aimed to evaluate the instruments, risk factors and outcomes identified in the literature for situations of domestic violence involving children. Methods: Following the PRISMA protocol, 313 articles from the EBSCO, Web of Science and PubMed databases were screened and 13 were identified for analysis. Results: An analysis of the characteristics of some instruments created to assess the impact of domestic violence involving children shows that caregivers’ risk factors are strong predictors of child abuse, highlighting the interrelationship with other factors, as well as warning about the cumulative risk, including child homicide. Conclusions: The literature confirms the importance of family system factors regarding the risk of the mistreatment of children in situations of domestic violence. Risk assessment must cater to the needs and specificities of individual children.

Aflatoxin M1 Exposure and Health Risk Assessment in Children and Adults due to Pasteurized Milk Consumption in Addis Ababa, Ethiopia

Milk and dairy products stand as essential sources of nutrition across all age groups. However, the presence of Aflatoxin M1, particularly common and risky for young children, necessitates careful assessment of milk. This study, conducted in Addis Ababa, Ethiopia, aimed to evaluate the prevalence of Aflatoxin M1 using High-Performance Liquid Chromatography in pasteurized milk and assess associated health risks using deterministic techniques. The prevalence of Aflatoxin M1 in pasteurized milk was 56.6%, with Aflatoxin M1 levels ranging from 0 to 6.27 μg/L and a mean value of 1.237 μg/L. The risk assessment revealed substantial Aflatoxin M1 exposure risk from pasteurized milk consumption, as reflected by margin of exposure values <10,000, specifically 25.9, 109.6, and 380 for children aged 2–5, 6–9, and adults, respectively. The hazard index values for pasteurized milk consumers were 110, 26, and 7.5 for children aged 2–5, 6–9, and adults, respectively. Furthermore, cancer risk calculations yielded values of 0.18, 0.04, and 0.01 per 100,000 population for children aged 2–5, 6–9, and adults, respectively, with an average potency of 0.007978 cases per 100,000/yr ng Aflatoxin M1/kg bw/day. Notably, children aged 2–5 and 6–7 face elevated risks, whereas adults face relatively lower risks.

Children's risk assessment in street crossing using virtual reality

Introduction: Crossing streets represents a risky task for children where they have to assess both the probability and harm severity of being hit by a vehicle. To cross streets safely, children must perceive and interpret the traffic environment and scale their movements to the flow of traffic. Their ability to gather information about the surrounding environment through visual search strategies is essential in this process. This study aimed to explore children's street crossing behaviors and to identify successful risk-assessment strategies. Method: Virtual reality (VR) with built-in eye tracking was used for this investigation; 55 children between 7 and 10 years old completed six street crossing tasks with varying complexity and difficulty. Results: Varying competencies in street crossing were demonstrated among the children. Those who crossed safely looked to the left and right more often to check for traffic and spent more time assessing the traffic environment by following oncoming vehicles with their gaze before crossing than those who crossed dangerously. No apparent differences between children who crossed safely and those who crossed dangerously were found while crossing. Conclusions: The findings suggest that dangerous street crossings were, on different levels, related to assessment time before crossing, visual search strategies during assessment time, and the tasks harm severity and probability risk. Practical Applications: Future research could suggestively include indicators such as assessment time and visual search strategies, and tasks could discern harm severity and probability risk. These indicators might also be considered for training programs aiming to enhance children's pedestrian safety.

Virtual Risk Management-Exploring Effects of Childhood Risk Experiences through Innovative Methods (ViRMa) for Primary School Children in Norway: Study Protocol for the ViRMa Project.

Research indicates that risky play benefits children's risk assessment and risk management skills and offers several positive health effects such as resilience, social skills, physical activity, well-being, and involvement. There are also indications that the lack of risky play and autonomy increases the likelihood of anxiety. Despite its well-documented importance, and the willingness of children to engage in risky play, this type of play is increasingly restricted. Assessing long-term effects of risky play has been problematic because of ethical issues with conducting studies designed to allow or encourage children to take physical risks with the potential of injury. The Virtual Risk Management project aims to examine children's development of risk management skills through risky play. To accomplish this, the project aims to use and validate newly developed and ethically appropriate data collection tools such as virtual reality, eye tracking, and motion capturing, and to provide insight into how children assess and handle risk situations and how children's past risky play experiences are associated with their risk management. We will recruit 500 children aged 7-10 years and their parents from primary schools in Norway. Children's risk management will be measured through data concerning their risk assessment, risk willingness, and risk handling when completing a number of tasks in 3 categories of virtual reality scenarios: street crossing, river crossing, and playing on playground equipment. The children will move around physically in a large space while conducting the tasks and wear 17 motion-capturing sensors that will measure their movements to analyze motor skills. We will also collect data on children's perceived motor competence and their sensation-seeking personality. To obtain data on children's risk experiences, parents will complete questionnaires on their parental style and risk tolerance, as well as information about the child's practical risk experience. Four schools have been recruited to participate in data collection. The recruitment of children and parents for this study started in December 2022, and as of April 2023, a total of 433 parents have consented for their children to participate. The Virtual Risk Management project will increase our understanding of how children's characteristics, upbringing, and previous experiences influence their learning and ability to handle challenges. Through development and use of cutting-edge technology and previously developed measures to describe aspects of the children's past experiences, this project addresses crucial topics related to children's health and development. Such knowledge may guide pedagogical questions and the development of educational, injury prevention, and other health-related interventions, and reveal essential areas for focus in future studies. It may also impact how risk is addressed in crucial societal institutions such as the family, early childhood education, and schools. DERR1-10.2196/45857.

Perioperative Risk Assessment in Children With Congenital Heart Disease Undergoing Noncardiac Procedures

To risk-stratify children with congenital heart disease undergoing noncardiac surgery or diagnostic procedures for perioperative cardiopulmonary complications using the authors' established institutional guidelines. A retrospective cohort study. The study was conducted in an academic, tertiary-care children's hospital. A total of 1,005 children, from birth to 19 years of age with a diagnosis of congenital heart disease, who underwent a noncardiac surgery or diagnostic procedure from January 2017 to December 2018, were included in the study. None. The incidence of a severe perioperative complication, defined as a perioperative cardiac arrest or death within 30 days of the procedure, was 1.6%. Age, an emergent surgery/procedure, a preoperative renal abnormality, preoperative mechanical ventilation, and a preoperative pericardial effusion were significant for severe perioperative complications, in the multivariate analysis. The area under the receiver operating characteristic curve for severe complications was 0.936. However, the area under the curve for moderate perioperative complications was 0.679, in which moderate complications were defined as (1) an escalation in anticipated postoperative disposition (from planned disposition), (2) an escalation in postoperative disposition (from preoperative location), (3) an escalation of preoperative airway support, (4) an administration of any intraoperative vasoactive medication/infusion, (5) a noncardiac surgery reoperation within 30 days of the procedure (if related to the primary procedure or change in physiology), or (6) unplanned readmission with 24 hours of the procedure. A robust model for severe perioperative complications was developed within the authors' institutional clinical guidelines, identifying 5 predictors for perioperative cardiac arrest or death. The usual markers of critical illness were not found to be predictive of a moderate perioperative complication, regardless of the level of anesthesiologist training, suggesting that many of these children with congenital heart disease undergoing noncardiac procedures can be treated by a general pediatric anesthesiologist rather than a pediatric cardiac anesthesiologist within an institution that has or can establish clinical guidelines for these children.

Caries Risk Assessment in Children with Different Rates of Vitamin D Deficiency, Using Cariogram Model

Objective: Vitamin D plays a very important role in improving oral and dental health as well as general health. The present study aims to evaluate the risk of caries development risk of children with and without vitamin D deficiency using the Cariogram model.
 Methods: This study included a total of 75 healthy children aged 6-12 years, of which 50 (35 girls and 15 boys) had different levels of vitamin D deficiency, and 25 (12 girls and 13 boys) had none. Their risk of developing new dental caries was assessed with Cariogram. SPSS v21.0 (IBM, USA) was used for analyzing the study data. In the statistical tests, a p-value less than 0.05 was considered statistically significant.
 Results: Mean chronological and dental ages of the participants were obtained as 9±2.32 and 8±2.36, respectively. The distribution of salivary flow rate, buffering capacities, and distributions of Lactobacilli and S. mutans counts between the groups were found to be similar. There was a significant difference between Group I and Group II and between Group I and Group III in regard to the Cariogram green percentage (percentage of chances to avoid caries), p=0.002 and p<0.001, respectively.
 Conclusion: In the present study, we observed a decrease in the Cariogram green sector percentage with low levels of vitamin D and an increase with normal vitamin D levels. Therefore, chances to avoid new dental caries were increased in sufficient levels of vitamin D.

Health Risk Assessment in Children Occupationally and Para-Occupationally Exposed to Benzene Using a Reverse-Translation PBPK Model.

Benzene is a known human carcinogen and one of the ten chemicals of major public health concern identified by the World Health Organization. Our objective was to evaluate benzene's carcinogenic and non-carcinogenic health risks (current and projected) in highly exposed children in Yucatan, Mexico. Benzene exposure was estimated through a reverse-translation, four-compartment, physiologically based pharmacokinetic model (PBPK) based on previously performed urine trans, trans-muconic acid (benzene metabolite) determinations. Using a risk assessment methodology, the carcinogenic and non-carcinogenic risks of benzene were estimated for 6-12-year-old children from a family of shoemakers. The children's hazard quotients for decreased lymphocyte count were 27 and 53 for 4 and 8 h/day exposure, respectively, and 37 for the projected 8 h/day exposure in adults. The risks of developing leukemia were 2-6 cases in 1000 children exposed 4 h/day; 4-10 cases in 1000 children exposed 8 h/day, and 2-9 cases in 1000 adults with an 8 h/day lifetime exposure. Children in Yucatan working in shoe-manufacturing workshops, or living next to them, are exposed to benzene concentrations above the reference concentration and have unacceptably high risks of presenting with non-carcinogenic and carcinogenic hematologic symptoms, now and in the future. Interventions to prevent further exposure and mitigate health risks are necessary.

Psychopathological Risk Assessment in Children with Hyperphenylalaninemia.

Phenylketonuria (PKU) is a rare congenital disorder caused by decreased metabolism of phenylalanine determining cerebral impairments. If untreated, PKU might lead to intellectual disability, seizures and behavioral disorders. The aim of this study is to provide a characterization of the psychopathological profile of a pediatric population diagnosed with PKU at newborn screening. an accurate neuropsychological evaluation of 23 patients (aged 8-18 years) with hyperphenylalaninemia (defined as experimental group, EG) and in 23 age-matched healthy controls (defined as control group, CG) was performed using the Child and Adolescent Behavior Inventory (CABI) and Self-Administrated Psychiatric Scales for Children and Adolescents (SAFA) questionnaires. the CABI test showed significant differences for the sub-scales related to "Irritable mood", "Oppositional-provocative symptoms" and "ADHD" in the EG compared to CG (p = 0.014, p = 0.032, and p = 0.032, respectively). Patients with hyperphenylalaninemia also presented with significant differences both for anxiety disorder scale and depression scale of SAFA test than controls (p = 0.018 and p = 0.009, respectively). children and adolescents with early diagnosis of PKU showed a psychopathological risk profile characterized by an increased risk of experiencing symptoms such as mood deflection, anxiety, attention deficit, oppositional defiant behavior, and obsessive traits than healthy peers. Our findings highlighted the need of the inclusion of a neuropsychiatric evaluation in the management of these patients to improve their overall quality of life.

Dental Caries Risk Assessment in Children 5 Years Old and under via Machine Learning.

Background: Dental caries is a prevalent, complex, chronic illness that is avoidable. Better dental health outcomes are achieved as a result of accurate and early caries risk prediction in children, which also helps to avoid additional expenses and repercussions. In recent years, artificial intelligence (AI) has been employed in the medical field to aid in the diagnosis and treatment of medical diseases. This technology is a critical tool for the early prediction of the risk of developing caries. Aim: Through the development of computational models and the use of machine learning classification techniques, we investigated the potential for dental caries factors and lifestyle among children under the age of five. Design: A total of 780 parents and their children under the age of five made up the sample. To build a classification model with high accuracy to predict caries risk in 0–5-year-old children, ten different machine learning modelling techniques (DT, XGBoost, KNN, LR, MLP, RF, SVM (linear, rbf, poly, sigmoid)) and two assessment methods (Leave-One-Out and K-fold) were utilised. The best classification model for caries risk prediction was chosen by analysing each classification model’s accuracy, specificity, and sensitivity. Results: Machine learning helped with the creation of computer algorithms that could take a variety of parameters into account, as well as the identification of risk factors for childhood caries. The performance of the classifier is almost unbiased, making it generalizable. Among all applied machine learning algorithms, Multilayer Perceptron and Random Forest had the best accuracy, with 97.4%. Support Vector Machine with RBF Kernel (with an accuracy of 97.4%) was better than Extreme Gradient Boosting (with 94.9% accuracy). Conclusion: The outcomes of this study show the potential of regular screening of children for caries risk by experts and finding the risk scores of dental caries for any individual. Therefore, in order to avoid dental caries, it is possible to concentrate on each individual by utilizing machine learning modelling.

Evaluation of the Methyl and Inorganic Mercury in Infant Formula Milk and Cereals Samples: Estimated Risk Assessment in Children under 2.0 Years

Evaluation of the Methyl and Inorganic Mercury in Infant Formula Milk and Cereals Samples: Estimated Risk Assessment in Children under 2.0 Years

Cardiometabolic Risk Assessment in Children and Young Adults with Hemophilia

IntroductionA significant challenge in the aging hemophilia population is cardiovascular disease (CVD). It is relevant to study cardiometabolic risk factors in children, because the origins of CVD begin in childhood. Risk factors include obesity, hypertension, abnormal lipid profile, and family history of CVD. The prevalence of cardiometabolic risk factors in children with hemophilia is unknown. The objective of this study was to quantify these risk factors and to evaluate the impact of overweight/obesity on target joints and factor consumption.MethodsMales, 5-20y old, with congenital hemophilia A or B, were enrolled in a cross-sectional study at Rady Children's Hospital San Diego Hemophilia Treatment Center (HTC). Study procedures included standardized measurement of weight, height, waist circumference and blood pressure (BP), and non-fasting laboratory measurement of glucose (<200 mg/dL is normal) and lipid panel (to calculate non-high-density lipoprotein [non-HDL-C]; result was categorized as normal, borderline high, or high per age-based norms). Body mass index (BMI) percentile was determined for children <18 years, and BMI was calculated for adults. Weight category of underweight, normal weight, overweight or obese was assigned based on established norms for BMI percentile and BMI. Waist:height ratio (WHtR) was calculated; >0.5 is considered a cardiometabolic risk factor. (Pre) hypertension was defined as systolic BP (SBP) and/or diastolic BP (DBP) ≥90% for children <18y and SBP >140 or DBP >90 for adults. Parents and adult patients completed questionnaires regarding demographics, personal and family history of CVD, and physical activity. Clinical data were abstracted from the medical record. Descriptive statistics were used to characterize the population. Student's t-test, correlation and chi square test were performed to analyze the data.ResultsForty-three males (mean 12y, range 5-20y, including 6 young adults) were enrolled. The majority were White race (88%) and Hispanic ethnicity (65%). Twenty-three (53.5%) had severe hemophilia A including 2 with high titer inhibitors.No subjects reported congenital heart disease, kidney disease, diabetes mellitus, glucose intolerance, hypercholesterolemia, (pre) hypertension, or cardiovascular events. Two subjects reported a diagnosis of overweight/obesity, and both were referred to a weight and wellness program. A summary of cardiometabolic risk factors is shown in Table 1. Subjects with normal weight had more days of >60 minutes of physical activity compared to those with overweight/obesity (5.2 ± 2.4d v. 3.8 ± 2.5d; p=0.07).Thirty-one (72%) were on continuous prophylaxis including all 21 subjects with severe hemophilia A without inhibitor. The mean prophylactic factor dose in units (IU)/kg/week was 118 IU, range 64 -187. There was no difference between subjects with normal weight (125 IU/kg/week, range 71-187) and subjects with overweight /obesity (111 IU/kg/week, range 64-174); p=0.26, but higher weight was correlated with higher total factor consumption (cor=0.84; p <0.001), up to 12,000 IU per week. There was no difference in history of target joints based on weight category (30% in normal weight v. 25% in overweight/obese, χ2= 0.11, p=0.74).ConclusionsA high proportion of subjects had modifiable risk factors for CVD which were not previously recognized by the patient or parent. Longitudinal follow-up is warranted to define the natural history of CVD in this population. The HTC team, including a genetic counselor, physical therapist and dietician, can identify risk factors for CVD and develop interventions to target cardiovascular risk reduction. Increasing days of physical activity may lead to decreased overweight/obesity, improved outcomes, and less factor consumption. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Caries Risk Assessment in Children Aged 6-12 years based on Parental Knowledge and Its Relationship with BMI and DMFT in Ahvaz

Background: The prevalence of dental caries in childhood is one of the problems related to children’s oralhealth. The aim of this study was to determine the risk of caries in children aged 6-12 years based on parentalinformation and its relationship with BMI and DMFT in Ahvaz.Methods and materials: The necessary permits were obtained from the Ahvaz Education Department, andthen 300 samples of the city’s primary schools were selected. Students were examined with a disposabledental mirror and the number of decayed, missed, and restored permanent and deciduous teeth was recordedin the DMFT table. After that, the questionnaire was completed with the help of parents. The validity of thisquestionnaire was confirmed by 5 pediatric dentists and the reliability of this questionnaire was confirmedby conducting a pilot study on 10 children based on Cornbach coefficient of 0.85.Results: Maternal occupation was associated with moderate caries risk (p = 0.007). Economic situation wasassociated with low risk (p = 0.0001). The mean weight of the child in the high risk group was significantlyhigher than the low risk groups (p <0.001) and medium risk (p <0.001). The mean DMFT in the low riskgroup was significantly lower than the medium risk (p <0.001) and high risk groups (p <0.001). The meanBMI in the high risk group was significantly higher than the medium risk groups (p <0.001) and low risk (p<0.001).Conclusion: Economic status, mother’s job and child’s weight are associated with caries risk. Also, DMFTand BMI index have a direct and significant relationship with the risk of caries.

Cardiovascular Risk Assessment in Children With Chronic Cholestatic Liver Diseases.

Chronic cholestatic liver diseases are often associated with disturbed lipid metabolism, which may potentially increase cardiovascular (CV) risk but the evidence is scarce. The aim of the study was to assess factors associated with increased CV risk in children with Alagille syndrome (AGS) and biliary atresia (BA). We investigated 17 patients with AGS, ages 11.0 years (8.4-13.4) and 19 with BA, ages 13.5 years (10.4-15.1) in whom we performed thorough biochemical assessment including lipid profiles and oxidative stress biomarkers, blood pressure (BP)-systolic, diastolic and mean, carotid intima-media thickness (cIMT), and pulse wave velocity (PWV). There were abnormal lipid profiles in 82% of children with AGS and 52.6% with BA. In AGS group, we observed significantly higher levels of TC, LDL C, APO B, lower glutathione concentration and glutathione peroxidase activity and lower blood pressure, lower cIMT (P = 0.02), cIMT-SDS (P = 0.04), and PWV (P = 0.04). We, however, observed elevated blood pressure in 2/19 patients with BA and none-with AGS (BA vs AGS: P = 0.12), whereas cIMT-SDS was increased only in 2/17 patients with AGS and in 6/19 with BA (P = 0.24), and abnormal PWV-SDS values were detected in 3/17 of AGS and 8/19 of BA patients (P = 0.15). Neither presence of dyslipidemia nor Lp-X correlated with vascular parameters. Children with BA and AGS may present with increased cardiovascular risk factors but vascular parameters are not directly related to lipid abnormalities. cIMT and BP should be considered for clinical practice in these cholestatic disorders so as to determine individuals with potential CV risk.

CARDEC-PEL: Comparison of Two Methods of Caries Risk Assessment in Children

CARDEC-PEL: Comparison of Two Methods of Caries Risk Assessment in Children

Nutritional Risk Assessment in Children with Cancer: A Longitudinal Study in North East of Iran

Background Children with cancer are in risk of malnutrition. Nutritional risk assessmentis more importance in developing countries. The aim of present study was to investigate the nutritional risk in admitted children with cancer. Materials and Methods One hundred admitted children newly diagnosed with cancer were studied at the time of admission, after 3 and 6 months.Demographic characteristics and anthropometrics indexes were recorded via standard and calibrated tools. Nutritional risk assessed according to modified Screening Tool for Assessment of Malnutrition in Pediatrics (STAMP).Statistical analysis was performed using SPSS software (version 16.0). Results Of the 100 children 55 patients (55%) were female. The average age was 3.46±3.3 years. Hematologic tumors constituted 73.5% of patient. All patients were in nutritional risk. There was no patient with low nutritional risk during study; 17 patients (17%), 53 patients (56.4%), and 41 patients (43.6%) diagnosed with medium nutritional risk at the time of admission, after 3 and 6 months, respectively; 83 patients (83%), 41 patients (43.6%), and 40 patients (43%) diagnosed with high nutritional risk at the time of admission, after 3 and 6 months, respectively. Difference was significant (p<0.001).After 6 months,weight, height, mid-upper arm circumference (MUAC), and body mass index (BMI) increased compared with the time of admission (p<0.05). Conclusion According to modified STAMP results, all studied patients were in the nutritional risk. Nutritional risk decreased during study. The nutritional risk decreased after 6 months in children newly diagnosed with cancer compared with the time of admission.

Health Risk Assessment in Children by Arsenic and Mercury Pollution of Groundwater in a Mining Area in Sonora, Mexico

A highly acidic spill from one of the most important copper mines in the Americas (Buenavista del Cobre) occurred in Sonora, Mexico in August, 2014. 40,000 m3 of metals-enriched sulphate solution escaped into the Sonora River representing the worst ecological disaster in Mexican history. The spill affected the economy, water accessibility and the health of residents near the river. Despite the economic importance of mining in this area, no environmental assessment was undertaken. There is no information about the health impact of this event on the local population. The study assesses the health risk among children exposed to arsenic and mercury via groundwater in five communities located in a mining area into the Sonora River Basin, Mexico. Local drinking water from the localities was sampled one year after the spill and it was analyzed for arsenic and mercury by Atomic Absorption Spectrometry coupled with Hydride Generation (AAS/HG). Further, some of the traditional local foods were sampled and analyzed for the same elements. Results indicate that levels of arsenic in drinking water did not exceed the Mexican Norm (25 μg As/L) or the EPA Guideline (10 μg As/L). The concentrations of mercury exceeded the WHO and Mexican Legislation value (1.0 μg Hg/L). The Hazard Quotient (HQ) values for arsenic were >1 in 42% of children exposed and for mercury in 67% of the children. Foods concentrations contained in the ranges of 9.2 to 62.0 μg As/Kg and 0.28 to 42 μg Hg/Kg for arsenic and mercury respectively. These values are below the Codex Alimentarius limits. Children affected by mining activities are at risk of developing chronic diseases associated with low arsenic and mercury exposure via groundwater consumption, without consideration of the contribution from these metals by other important exposures routes.

Medical Student Knowledge of Current Recommendations for Glucose Screening and Obesity-Related Risk Assessment in Children

Surveillance data regarding diabetes rates among Appalachian youth are limited. Risk factors for type 2 diabetes among children include obesity, food insecurity, physical inactivity, and familial history. Child obesity runs especially high in Appalachian Ohio, where at least 22% of third graders are obese, compared to 14.3% in suburban counties. In addition to this, one in four children in Appalachian Ohio live below the federal poverty level and many can be expected to have parents with type 2 diabetes, given the high prevalence among adults in the region. Therefore, medical students must be knowledgeable about screening recommendations. We distributed a modified version of the National Cancer Institute’s Physician Survey of Practice on Diet, Physical Activity, and Weight Control: Questionnaires on Child/Adolescent Care to osteopathic medical students at one university. Descriptive and frequency analyses were used to analyze students’ knowledge and attitudes related to childhood obesity and diabetes. Participants in this study were 238 first- through fourth-year medical students (62% pre-clinical, 38% in clinical rotations) Time spent working directly with pediatric patients in a clinical setting differed between pre-clinical and clinical students (21.4 ± 62.0 h vs. 129.7 ± 195.8 h, p&amp;lt;0.001 respectively). Most students (74%) indicated being unfamiliar with obesity screening recommendations. Few correctly identified BMI percentile cut-points for child overweight (21.2%), obesity (23.7%), and normal weight (29.4%). Students indicated they would initiate glucose screening approximately 4.5 years earlier in overweight/obese patients with risk factors than those with perceived lower risk (p&amp;lt;0.001). Although students recognize the need for earlier diabetes screening in children with additional risk factors and/or family history, there is a need to emphasize systematic approaches to diabetes risk reduction in medical school. Disclosure E.H. Guseman: None. J. Whipps: None. L.L. Jensen: None. E.A. Beverly: None.

Multiple Mycotoxins in Rice: Occurrence and Health Risk Assessment in Children and Adults of Punjab, Pakistan.

Mycotoxin contamination in rice can create a health risk for the consumers. In this study, the measurement of 23 mycotoxins in rice samples (n = 180) was performed using a validated LC–MS/MS method. A food frequency questionnaire was used to get rice consumption data for the assessment of mycotoxin dietary exposure, before calculating the health risk in adults and children of north and south regions of the Pakistani Punjab province. The prevalence of aflatoxin B1 (56%), aflatoxin B2 (48%), nivalenol (28%), diacetoxyscirpenol (23%), fumonisin B1 (42%), zearalenone (15%), HT-2 toxin (10%), deoxynivalenol (8%), and ochratoxin A (6%) was estimated in samples with a mean concentration range between 0.61 and 22.98 µg/kg. Aflatoxin degradation by traditional Pakistani cooking recipes was evaluated and observed to be 41–63%. The dietary exposure to aflatoxins exceeded the tolerable daily intake at all levels, and ochratoxin A and zearalenone posed health risk at high contamination and high consumption levels. The margin of aflatoxin B1 exposure ranged between 10 and 69 in adults and 10 and 62 in children. The mean cancer risk by aflatoxin B1 exposure was 0.070 (adults) and 0.071 (children) cases/year/100,000 people in South Punjab population, and 0.122 (adults) and 0.127 (children) cases/year/100,000 people in North Punjab population. This study will provide new insights for the planning and management of mycotoxins in Pakistan.

Health Risk Assessment of Children in the Environmental Pollution Region of Kardzhali for the Period 1991-2013

For more than 55 years is the environmental pollution region of Kardzhali in Bulgaria has been due to intense emissions from mining-processing, smelter plant and processing of nonmetallic minerals. The main source of pollution in those years is smelter plant (Lead and Zinc Complex), but from 2011 to 2012 respectively, lead and zinc production was gradually stopped. One of the mechanisms to assess the health risk among the population is to conduct biological monitoring, to make biological materials to determine the concentration of heavy metals in them. The most vulnerable group is children. The aim of this study is to benchmark the results of the biological monitoring of children aged between 9 to 14 years in the city of Kardzhali for the 1991-2013 periods. Biological monitoring includes determination of lead in the blood of 356 children from two schools in the city of Kardzhali (located near and far away from OCK-AD) and one in Krumovgrad (for control). In accordance with the methodology in Bulgaria (included children), drawing of USA methodology received results in the following: According to the individual results for the period 1991-2002, when smelter plant has worked, in 71% of the children in Kardzhali values of lead in the blood are below 100 μg/l, in 24% between 100 and 200 μg/l and in 5% over 200 μg/l. In 2013, when the company ceased operation in 92% of surveyed children the levels of lead in the blood is below 100 μg/l, in 7% from 100 to 200 μg/l and in 1% above 200 μg/l. The results indicate a link between air pollution with lead aerosols and the level of lead in the blood of children In the intensive work of the plant during 1991-2002 years in 29% of children amounts of lead in the blood is above 100 μg/l. In 2013 (when closed proceedings) only 8% of children are with lead content in the blood of more than 100 μg/l. The blood of the children in the control group demonstrated no lead content at 100% of children.