School Group Research Articles

Retrospective cohort study of COVID-19 among children in Fulton County, Georgia, March 2020–June 2021

ObjectiveTo describe case rates, testing rates and percent positivity of COVID-19 among children aged 0–18 years by school-age grouping.DesignWe abstracted data from Georgia’s State Electronic Notifiable Disease Surveillance System on...

Age-related Changes in Computed Tomography Density of Thyroid Gland in Children: A Single-Center Retrospective Study in Northern China.

The thyroid gland normally presents as a hyperdense organ on noncontrast computed tomography (CT) in adults. The correlation between thyroid gland CT density and its functional status has been studied; however, little is known regarding its density in children with normal thyroid functions. We aimed to assess the correlation between thyroid gland CT density and age in children with normal thyroid functions. From April 2017 to March 2021, we enrolled 74 patients who had normal thyroid functions within 1 month before or after undergoing neck or cervical spine CT for trauma, neck masses, congenital diseases, and airway stenosis. Their CT images were retrospectively analyzed by 2 independent radiologists. Based on age, patients were divided into 4 groups: infant, preschool-aged, school-aged, and adolescence groups. Patients with thyroid gland hypodensity in the infant group (70%, 14 of 20) were significantly more numerous than those in preschool-aged (25%, 4 of 16), school-aged (20%, 5 of 25), and adolescence (15.4%, 2 of 13) groups (P = 0.007, 0.001, and 0.002, respectively, Fisher exact test). The mean CT density of the thyroid gland was also lower in the infant group compared with the densities in other age groups. There was a weak positive correlation between thyroid CT density and age (r = 0.264, P = 0.023, linear regression analysis). Thyroid CT density is related to age in children. The thyroid gland normally has a low density on noncontrast CT in most infants with normal thyroid function.

Executive functions and adaptive behaviour in individuals with Down syndrome.

BackgroundPrevious research has explored executive functions (EFs) and adaptive behaviour in children and adolescents with Down syndrome (DS), but there is a paucity of research on the relationship between the two in this population. This study aims to shed light on the profile of EFs and adaptive behaviour in DS, exploring the differences by age and investigating the relationship between these two domains.MethodParents/caregivers of 100 individuals with DS from 3 to 16 years old participated in the study. The sample was divided into preschoolers (3–6.11 years old) and school‐age children (7–16 years old). Parents/caregivers completed either the Preschool Version of the Behaviour Rating Inventory of Executive Function (for children 2–6.11 years old) or the Second Edition of the same Inventory (for individuals 7 + years old). Adaptive behaviour was assessed with the Vineland Adaptive Behaviour Scale – Interview, Second Edition.ResultsFindings suggest that individuals with DS have overall difficulties, but also patterns of strength and weakness in their EFs and adaptive behaviour. The preschool‐age and school‐age children's EF profiles differed slightly. While both age groups showed Emotional Control as a relative strength and Working Memory as a weakness, the school‐age group revealed further weaknesses in Shift and Plan/Organise. As concerns adaptive behaviour, the profiles were similar in the two age groups, with Socialisation as a strength, and Communication and Daily Living Skills as weaknesses, but with a tendency for preschoolers to obtain intermediate scores for the latter. When the relationship between EFs and adaptive behaviour was explored, Working Memory predicted Communication in the younger group, while in the older group the predictors varied, depending on the adaptive domains: Working Memory was a predictor of Communication, Inhibit of Daily Living Skills, and Inhibit and Shift of Socialisation.ConclusionAs well as elucidating the EF profiles and adaptive behaviour in individuals with DS by age, this study points to the role of EFs in adaptive functioning, providing important information for targeted interventions.

Parental support and monitoring as associated with adolescent alcohol and tobacco use by gender and age

BackgroundParental support (PS) and parental monitoring (PM) are known protective factors against adolescent substance use (SU). However, little is known about whether PS and PM may affect SU outcomes differently by gender and age. This study examined the relationship between PS and PM and adolescent SU, specifically alcohol and tobacco use, stratified by gender and age group.MethodsMiddle and high school students (n = 2351, 48.5% Female) completed surveys of self-reported SU, perceived PS and PM, and socioeconomic background. Age group was defined dichotomously as grade 7–8 Middle school and grade 9–10 High school students. PS and PM were each measured using previously validated tools. SU was measured by lifetime and past 30 days cigarette/alcohol use. One-way ANOVA and binary logistic regression models were completed. Odds ratios and means were reported.ResultsPS and PM were significantly and negatively related to all outcome variables regardless of gender and age group. Mean differences in PS and PM were insignificant between age groups. Between genders, PM scores were significantly higher for girls (14.05) compared to boys (13.48) (p < 0.01). Odds Ratios of all four SU types (for alcohol and tobacco use) increased with higher age group, with ORs ranging from 1.45–2.61 (p < .05).ConclusionsPS and PM were protective against SU for all participants, consistent with previous literature. Girls reported greater parental monitoring than boys, irrespective of age-group. While girls experienced higher levels of monitoring, they did not report lower SU than boys. This suggests that monitoring girls more closely than boys appears unnecessary in preventing adolescent SU. Finally, PS was a more significant factor in preventing SU for older adolescents (high school aged group) than for younger adolescents, irrespective of gender suggesting that PS may be more impactful and important as adolescents age. As children mature, particularly from middle school to high school, PS may play a larger role in preventing SU for older adolescents compared to younger ones.

Analysis of upper airway structure development in children with different characteristics

Objective: To analyze the development of upper airway in children with different characteristics. Methods: From June 2018 to June 2020, a total of 425 children younger than 16 years old who underwent head MRI examination and did not have sleep-disordered breathing were included in the study. The length of soft palate, tongue, upper airway, mental spine clivus, adenoid thickness and nasopharyngeal width were measured in the midsagittal plane of MRI image. Single factor variance analysis was used to compare the gender differences of upper airway parameters within certain age groups. Pearson correlation analysis was used to analyze the correlation between upper airway parameters and age. Results: The numbers of subjects in infant, young child, preschool, school age and adolescent group were 80, 86, 90, 90 and 79, respectively. There were 219 males, accounting for 51.5% of the study population. The adenoid thickness in the preschooler group was (1.26±0.26) cm, higher than that in the female group (1.15±0.20) cm (P=0.025). The upper airway length (5.89±0.60) cm and the ratio of upper airway length/mental spine-slope length (0.73±0.08) in males were higher than those in females [(5.31±0.45) cm and 0.67±0.07, respectively, P<0.05]. There was no gender difference in other upper airway parameters among different age groups (all P values>0.05). The length of upper airway, mental spine-slope, tongue, soft palate, the width of nasopharyngeal cavity and the thickness of adenoids were positively correlated with age (r=0.932, 0.912, 0.898, 0.705, 0.734 and 0.168, respectively), all P values<0.05. Adenoid thickness was positively correlated with age from birth to age 5 years (r=0.603, P<0.001), and negatively correlated with age after age 6 years (r=-0.259, P=0.001). Conclusion: There are gender differences in the development of upper airway structure in children of different ages.

Investigating Students’ Digital Literacy Levels during Online Education Due to COVID-19 Pandemic

COVID-19 has brought serious challenges to education and many other sectors. Within the educational context, the main difficulties experienced have been reported as challenges related to not only mechanical impediments—such as technology or infrastructure—but also to methodological and personal features, such as lack of motivation or online learning/teaching experiences. The abrupt transition from face-to-face to online education has created the need for some specific abilities, such as digital literacy on the side of the learners at all educational levels. In this context, this mixed-method study aims to determine the digital literacy levels of learners belonging to different school levels and whether age, gender and school degree were significant variables. This study also investigates the technology-related challenges students experienced during COVID-19 pandemic. The sample consisted of 510 participants representing different school levels, age groups, and genders; in addition, a smaller representative group (n = 30) revealed their own evaluations related to their levels of digital literacy and the technology-related challenges they had about online learning. The findings suggest that there is a statistically significant relationship between students’ digital literacy and their gender and school degree, while age was not found to be a statistically significant variable. The qualitative self-reported data suggested that learners have sufficient levels of digital literacy, and that the major technology-related challenges were reported to be lack of the necessary technologies and difficulties in adapting to a new approach to learning.

Adherence to 24-hour movement guidelines among Japanese elementary and junior high school students

Abstract Background For optimal health benefits, the Canadian 24-Hour Movement Guidelines for Children and Youth (aged 5-17 years) recommend an achievement of ≥ 60 minutes of moderate-to-vigorous physical activity (MVPA), &amp;lt;2 h of recreational screen time (ST), and 9-11 h for 5-13 years or 8-10 h for 14-17 years of sleep time (SLT) each day. There is little evidence showing the proportion of the recommendation in Japan, so we need to investigate. The aim of this study thus was to reveal the compliance to the recommendation with a large sample of Japanese elementary and junior high school children. Methods This study included 2408 students enrolled in fifth grade (aged 10-11 years) in 31 elementary schools, and 4360 students enrolled in eighth grade (aged 13-14 years) in 30 junior high schools. Each behaviour was assessed by a self-reported questionnaire. To analyze the differences in adherence to the recommendation between the school-aged group, we conducted a chi-analysis. Results Overall, only 4% of participants complied with all three recommendations, and 20% of the students did not comply with any of the recommendations (χ2=1390.87;p&amp;lt;.001). Compared with MVPA and ST, SLT had a trend to be likely to achieve the recommendation in each school-age group. Elementary school students had a higher percentage of non-adherence to all recommendations (39%) than junior high school students (10.3%). The adherence to the recommendation of the ST &amp; SLT simultaneously had no differences in each age group (11.5% for elementary schoolers and 12.7% for junior high schoolers). However, adherence to the recommendation of MVPA only, ST only, and MVPA &amp; ST were higher in elementary schoolers, and the adherence to the recommendation of SLT only and MVPA &amp; SLT were higher in junior high schoolers. Conclusions The proportion of adherence to at least one of the three recommendations is better in junior high school students than elementary school students in Okinawa, Japan. Key messages Health behaviour required improvement may differ by age group. It is necessary for particularly elementary school children in Okinawa to take proper countermeasures to improve the movement behaviours.

Factors Associated With Children Diagnosed With Attention-Deficit/Hyperactivity Disorder and 30-Day Follow-up Care With Practitioners Among Medicaid Recipients in Georgia.

Background and Objectives:It is important that children prescribed attention-deficit/hyperactivity disorder (ADHD) medication get timely follow-up care. In 2018, only 44% of US Medicaid recipients attended a follow-up visit within 30 days of their first ADHD prescription. The objective of this study was to identify the member and practitioner-related predictors that were associated with children who were diagnosed with ADHD and had a follow-up visit within 30 days (initiation phase) of their first prescription of ADHD medication (Index Prescription Start Date, or IPSD).Methods:A cross-sectional study was conducted to identify the independent predictors of a follow-up visit within 30 days and 2 follow-up visits within 270 days after the initiation phase (continuation and maintenance phase, or C&M phase) for Medicaid recipients. Predictive factors examined included race, school age group, gender, geography of residence, Medicaid service region, newly diagnosed ADHD, hospital admission, emergency department (ED) visit, types of ADHD medication, other psychosocial or behavioral diagnoses, psychosocial or behavioral therapy, prescriber specialty, and school season.Results:There were 2369 members eligible for the initiation phase measure, of whom 330 members were eligible for the C&M phase measure. Multiple regression analysis found that unmet 30-day follow-up was significantly associated with African American children with an existing diagnosis of ADHD (adjusted odds ratio [AOR] = 2.13; 95% confidence interval [CI], 1.64-2.76), middle school-aged children (AOR = 1.49; 95% CI, 1.23-1.80), rural residence (AOR = 1.27; 95% CI, 1.05-1.55), no ED visit (AOR = 1.57; 95% CI, 1.16-2.12), no psychosocial or behavioral therapy prior to the IPSD (AOR = 2.30; 95% CI, 1.65-3.21), and primary care practitioners (AOR = 1.88; 95% CI, 1.45-2.44).Conclusion:Pediatrics was the most common specialty prescribing ADHD medications. Managed care organizations can focus intervention efforts to improve compliance with 30-day follow-up among Medicaid children by targeting the high-risk categories identified above. They can also focus on facilitating communication between behavioral health practitioners and pediatricians about several key points: (1) the importance of using behavioral health therapy prior to prescribing medication; (2) the importance of timely follow-up care; and (3) the importance of medication management in combination with behavioral health therapy.

Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis.

Autistic individuals experience higher co-occurring medical conditions than the general population, and yet the estimates of autistic individuals with epilepsy are not updated. Co-occurrence of epilepsy in autistic individuals often aggravated cognitive impairment and increased the risk of poor long-term prognosis. Thus, an updated systematic review and meta-analysis was conducted to study the relevant articles published from inception to 2020, evaluate the prevalence of epilepsy in autistic individuals, and further explore the putative factors influencing the prevalence. A total of 66 studies from 53 articles were included in this study. The results showed that epilepsy is more common in autistic individuals than in the general population. The prevalence of epilepsy in autistic individuals in the clinical sample-based studies was higher than that in the population-based based cross-sectional or cohort studies. The prevalence of epilepsy in autistic adults was higher than that in autistic children. A significantly increased prevalence of epilepsy was detected in the autistic adolescent group (11-17 years old), and a higher trend of prevalence of epilepsy was observed in the autistic pre-school group (⩽ 6 -years-old) than that of the autistic school-aged group (7-10 years-old). The prevalence of epilepsy increased with age, female rate, and low intellectual function rate of autistic individuals. However, the human development index of countries was negatively associated with the pooled prevalence, which could be attributed to the different levels of awareness, diagnostic technologies, and autism-service support worldwide. About 1/10 autistic individuals also had epilepsy, which was common in the clinical setting, adolescents, adults, females, or patients with intellectual disability and less common in the country with high human development index. Thus, these findings provided critical and innovative views on the prevalence of epilepsy in autistic individuals and contributed to the targeted clinical management and preventive measures.

Dribbling skills training model in football games for elementary school age

The goal achieved from this research and development is to produce a model of soccer dribbling training models for the elementary school age group. This research and development is carried out to be able to obtain information about the development and application of the football dribbling training model for the elementary school level age group. and to find out the effectiveness of the model produced. This research uses Research &amp; Development (R &amp; D) method from Borg and Gall. The subjects in this study were students of SD Negeri 1 Metro Barat from 30 children. The stages in this study are: needs analysis, expert evaluation (initial product evaluation), small group trials, and large group trials (testing fields). Test the effectiveness of the model. With the success of the research proven by questionnaires submitted by experts at 80%, the dribbling training model deserves to be developed in accordance with the research study of the development model of Borg and Gall. Based on the results of the development it can be concluded that: (1) With the soccer dribbling training model for elementary school level children can be developed and applied in dribbling exercises on extracurricular and learning (2) With the soccer dribbling training model for elementary school level that has been developed, there is evidence of an increase of which there are significant differences between before and after getting the model treatment.

THE CORRELATION BETWEEN WATER, SANITATION, AND HYGIENE WITH SOIL-TRANSMITTED HELMINTHS INFECTION AMONG ELEMENTARY SCHOOL CHILDREN OF ARU ISLANDS DISTRICT, MALUKU

ABSTRACTSoil-Transmitted Helminths (STH) infection is the most common intestinal parasite infection in Indonesia. STH infection can interfere with child development and cause cognitive impairment in severe cases. The school-age group is the most susceptible to STH infection because of direct contact with soil in the school yard. STH infection incidence can be avoided by adequate water, healthy latrines, and good hygiene and can be improved by proper interventions. This study aimed to analyze the correlation between Water, Sanitation, and Hygiene (WASH) with STH infection in Aru Islands District, Maluku. This study used a cross-sectional design and was conducted in Elementary Schools in Karangguli and Wokam villages, Aru Islands district, Maluku. One hundred and six stool samples were collected from both villages. The sociodemographic and WASH data were collected using the interview method. Stool samples were collected and examined for STH infection using a direct smear technique on the light microscope. Data statistical analysis was performed by the SPSS program using the Chi-square or Fischer’s Exact test. The examination results showed that 73 students (68.9%) were infected with STH. The bivariate analysis showed that water source (p = 0.000002), defecation place (p = 0.002), and washing hands after defecation (p = 0.048) were all significantly correlated with STH infection. This study concluded that WASH variables which were water source, defecation place, and washing hands after defecation had a significant correlation with STH infection. Keywords: Water, Sanitation, and Hygiene (WASH); soil-transmitted helminths infection; elementary school students.

Using Interactive Platform “Round” to Organize Online Leisure Activities for Children During the Pandemic

The speed with which interactive platforms are being modernized is increasing every year. The number of their users and consequently, the demand in such platforms are also rising. Quarantine restrictions and regulations related to COVID-19 revealed the problems of organizing both communication and leisure activities online. Since the advent of instant messengers in the 1990s, people have learned to communicate in a hybrid mode and to find friends over the Internet. Online communication, however, has always been occasional and could easily be switched to offline interaction. In view of the imposed restrictions during the pandemic, people were forced to stay isolated. The impact of the restrictions on organized leisure activities for children was also damaging. Online leisure activities were presented at best by online team games. Such online games, however, cannot replace the educational goals and learning outcomes of offline activities. From spring to summer 2020, all Russian schoolchildren and students studied online on various educational platforms. While several models of distance learning and teaching were implemented in the field of education (via Zoom, Microsoft Teams and other platforms), leisure activities were not adapted to an online format. At the same time, organized leisure activities are recognized as the main means for the socialization of children. It is noteworthy that the primary school age group became the most vulnerable. Our research aim was to analyze modern interactive platforms, identify their potential in organizing leisure activities, and determine the conditions for using the platform “Round” for leisure activities of primary school children. As a result of the study, the possibilities of introducing the platform “Round” for organizing leisure activities for children with different developmental levels and/or with difficult socio-economic conditions, who do not have the opportunity to receive additional education services, were identified.

Redefining the age-specific therapeutic ranges of lamotrigine for patients with epilepsy: A step towards optimizing treatment and increasing cost-effectiveness

ObjectiveThe pharmacokinetics of lamotrigine exhibits age-related characteristics. Nevertheless, current evidence regarding the therapeutic range of lamotrigine has been derived almost exclusively from studies in adult patients, and the applicability of this therapeutic range to the pediatric population remains unclear. The purpose of this study was to establish the appropriate age-specific therapeutic ranges of lamotrigine corresponding to adequate clinical responses for patients with epilepsy. MethodsThis prospective cohort study of therapeutic drug monitoring included 582 Chinese epilepsy patients receiving lamotrigine monotherapy. Patients were divided into three age-related subgroups: (1) toddler and school-age group (2–12 years old, n = 168), (2) adolescent group (12–18 years old, n = 171), and (3) adult group (>18 years old, n = 243). Patients with a reduction in seizure frequency of 50 % or greater than baseline were defined as responders, and the remaining patients were non-responders. The relationship between lamotrigine serum concentrations and clinical response was assessed using multivariate logistic regression analysis. A receiver operating characteristic curve was generated to determine the representative cut-off values of lamotrigine trough levels, to distinguish responders from non-responders. The upper margin of the therapeutic range of lamotrigine was determined by developing concentration-effect curves for the three age-related subgroups. ResultsThe median trough levels of lamotrigine were significantly higher in responders than in non-responders from all three age-related groups (P < 0.0001). Results of logistic regression analysis revealed that higher serum concentrations of lamotrigine predicted a higher probability that seizure frequency would be reduced by more than 50 % compared to baseline (adjusted odds ratio: 1.228, 95 % CI: 1.137–1.327; P < 0.0001), and younger children were less likely to be responders (adjusted odds ratio: 1.027, 95 % CI: 1.012–1.043; P = 0.001). Based on a trade-off between sensitivity and specificity, the optimal cut-off values for lamotrigine trough concentrations corresponding to clinical response were 3.29 mg/L, 2.06 mg/L, and 1.61 mg/L in the toddler and school-age group, adolescent group, and adult group, respectively. By reducing interpatient variability, the results of the concentration-effect curves suggested no additional clinical benefit from a continued increase of doses for lamotrigine concentrations exceeding 9.08 mg/L, 8.43 mg/L, and 10.38 mg/L in the toddler and school-age group, adolescent group, and adult group, respectively. In conclusion, the therapeutic ranges of lamotrigine trough concentrations corresponding to adequate clinical response were 3.29–9.08 mg/L in the toddler and school-age group, 2.06–8.43 mg/L in the adolescent group, and 1.61–10.38 mg/L in the adult group. ConclusionsThe study determined age-specific therapeutic ranges corresponding to optimal clinical efficacy for lamotrigine. Our findings lay the foundation for catalyzing novel opportunities to optimize treatment and reduce therapeutic costs. Based on the age-specific therapeutic ranges identified in this study, individualized and cost-effective algorithms for lamotrigine treatment of epilepsy patients may be developed and validated in larger cohort studies of therapeutic drug monitoring.

Meta-Analysis of Zinc Deficiency and Its Influence Factors in Children Under 14-year-old in China

Background: In recent years, zinc deficiency in children has attracted global attention. There are some differences in zinc deficiency in different countries and regions. However, there are few multi-center and large-sample studies on zinc deficiency in children in mainland China. Objective: To evaluate the status of zinc deficiency and its influence factors in children under 14-year-old in mainland China, and to provide evidence-based evidence for the strategy of prevention and treatment of zinc deficiency in children. Methods: PubMed, Embase, CNKI and other databases were searched about the cross-sectional survey literature on zinc deficiency and its influencing factors of under 14-year-old children in mainland China from 2005 to 2021. Stata 14.0 statistical software was used for Meta-analysis. Two independent reviewers identified eligible studies. Results: We identified 55 studies with 292,877 healthy children and adolescents in the Meta-analysis. The overall zinc deficiency rate was 27.0% (95% CI 22.8%-31.3%). From coastal areas of China showed that the zinc deficiency rate was 21.7% (95% CI 16.2%-27.1%) as 29.6% (95% CI 24.9%- 34.4%) from inland area of China. The zinc deficiency rate in the male group was greater than in the female group, and the difference was statistically significant [OR=1.052, 95% CI (1.019, 1.087), p=0.002]. The zinc deficiency rate in infant group was higher than that in toddler group [OR=1.38, 95% CI (1.16, 1.64), p=0.000], preschool group [OR=1.475, 95% CI (1.163, 1.870), p=0.001], and school-age group [OR=1.746, 95% CI (1.257, 2.425), p=0.001], with statistical significance. There was no significant difference in zinc deficiency rate between the toddler group and the preschool group [OR=1.059, 95% CI (0.918, 1.222), p=0.429], the toddler group and the school-age group [OR=1.136, 95% CI (0.848, 1.523), p=0.394], and the preschool group and the school-age group [OR=0.986, 95% CI (0.754, 1.291), p=0.919]. There was no statistically significant difference in zinc deficiency rate between the groups of well-educated and the poor-educated dietary provider. (OR=1.095, 95% CI (0.867, 1.383), p=0.446), and no statistical significance in zinc deficiency rate between urban group and rural group [OR=1.152, 95% CI (0.810, 1.637), p=0.432]. Conclusions: At present, zinc deficiency in children and adolescents in mainland China is still serious, especially in infants. The zinc deficiency rate in male children was more serious than that of female children. The zinc deficiency rate of children in inland areas was higher than that in coastal areas. Factors such as different educational level of food providers and different areas from urban or rural were not the major influencing factors of zinc deficiency.

Lettura e comprensione: una revisione sistematica della letteratura

Reading is a fundamental activity for the development of linguistic comprehension. To the aim of investigating the relationship between reading practice and comprehension, a systematic review of the literature was conducted, taking into account empirical research studies. The totality of the studies found positive effects on comprehension. The results also revealed that this area of study is mostly focused on the primary school age group. Indeed, it is nearly always related to other aspects of language development but also to the promotion of a positive attitude towards reading, motivation, socialization, emotional skills and understanding of reality. Little heed seems to be paid to the optimal way of reading. The results suggest the need for a greater reflection on this practice and a more precise identification of how to implement reading aloud in order to identify concrete actions to support reading, both in scholastic and extra-scholastic contexts.

Analysis of the concise etiology of pleural effusion in 3707 pediatric patients in a single clinical center

Purpose: To summarize the concise etiology of pleural effusion in 3707 patients over a period of 13 years at the Children’s Hospital of Chongqing Medical University. Methods: A total of 3707 patients with pleural effusion were included from January 2007 to December 2019 at our hospital. According to etiology, pleural effusion was divided into infectious pleural effusion and noninfectious pleural effusion. The infection factors were further subdivided as being caused by tuberculous, paragonimiasis, parapneumonic factors (including multiple bacterias, multiple viruses, mycoplasma, chlamydia, chlamydia, fungus and fever, blood routine examination shows increased white blood cells and neutrophils). The noninfectious factors were further subdivided into neoplastic, trauma, other causes. They were also divided into the infants and young children group (3 y and below), the preschool group (3–6 y) and the school-age group (above 6 y) depending on age. Results: Among the 3707 children, there were 2925 (78.9%) patients with infectious pleural effusions, and 782 (21.1%) patients with noninfectious pleural effusions. The incidence of infectious pleural effusions caused by parapneumonic factors decreased significantly with increasing age; however, parapneumonic factors remained the primary etiology of infectious pleural effusion in each group. The incidence of infectious pleural effusions caused by tuberculosis and paragonimiasis increased significantly with increasing of age. Tumor was the primary cause of noninfectious pleural effusion. The incidence of noninfectious pleural effusion caused by tumor and other causes increased significantly with increasing age. The incidence of noninfectious pleural effusion caused by trauma in the preschool group was significantly greater than that of the infants and young children group and school-age group. The number of noninfectious pleural effusion caused by other causes in the school-age group were significantly greater than those of in the infants and young children group and preschool group. Conclusion: In our center, pediatric pleural effusion was primarily caused by infections. parapneumonic factors were the primary causes of infectious pleural effusions. The proportion of noninfective pleural effusions in the etiology of pleural effusion in children was small; however, some were difficult to treat, requiring long-term treatment and possibly poor prognosis. Therefore, multidisciplinary treatment should be combined.

SCREENING OF PRIMARY SCHOOL STUDENTS FOR AMBLYOPIA AND AMBLYOGENIC FACTORS IN ALEXANDRIA, EGYPT

Amblyopia is a cause of lifelong visual impairment if not detected and managed at an early age. Children with amblyopia may not be aware, nor complain of defective vision. Thus, the need for screening programmes to aid early detection and treatment of this condition. Children in the school age group are easily accessible. Amblyopia is defined as unilateral or less commonly bilateral decrease of best corrected visual acuity caused by vision deprivation or abnormal binocular interaction for which no causes can be detected by the physical examination of the eye.Amblyopia is mainly assosciated with factors affect clarity of received image or equality of visual input between both eyes. These factors are known as amblyogenic factors. Amblyopia is classified to strabismic, refractive and deprivational amblyopia.The best way for management of amblyopia is prevention by screening and early detection of amblyogenic factors. The aim of the study is to determine the prevalence and risk factors of amblyopia among primary school students in Alexandria, Egypt.

604 Epidemiology and Microbiologic Profile of Pediatric Burn Patients: Eight-years’ Experience in a Tertiary Hospital

Abstract Introduction Burn injury is major morbidity and is the third most common cause of mortality among the pediatric population. Methods This study retrospectively analyzed pediatric burn admissions from a tertiary hospital in an 8-year period from 2009–2016. A total of 218 pediatric patients were reviewed for demographics, burn incidence, characteristics, cause of burn and microbiologic profile. Results There were 107(49.08%) Infants, 47 (21.56%)Toddlers, 32 (14.68%) Preschoolers, 17 (7.79%) belonged to school age and 15 (6.88%) were adolescent. Most of the admitted patients were within the city 122 (56%) while 96 (44%) were from other localities outside the city. Scald burn was the most common cause of burn with 160 (73.39%) cases and was highest in the infant age group (49.8%). The mean total body surface area was 10%, the highest being caused by flame burn at 13% TBSA among toddlers and preschoolers having the highest total body surface area involved (12%). The most commonly involved body area is the chest (13.6%). The mean transfer time from injury to the admission of patients coming from within and outside the city was 8.8 and 28 hours respectively. The mean length of hospital stay was 9.08 days. There was also a decrease in mean transfer time and hospital stay from 2009 to 2016. Flame burn accounted for the longest hospital stay at 20.27 days. Microbiologic profile of burn wound cultures showed a predominance of gram-negative rods (90%) with Enterobacter cloacae and Klebsiella pneumonia as common isolates. Culture studies also showed amoxicillin-clavulanic, ampicillin-sulbactam, and cefuroxime have the highest resistance, while most isolates are still susceptible to Amikacin, Ertapenem, Meropenem, and Ciprofloxacin. Conclusions Patients belonging to the school-age group has the highest mean number of hospital days (27.3 days). On review of culture study results from wound tissue samples, Gram-negative rods were the most common and Enterobacter cloacae were the most common isolate. Antibiotics such as Amoxicillin clavulanic, ampicillin-sulbactam, cefuroxime, and ceftazidime had high resistance rates and therefore should not be initially used for patients suspecting of the infected burn wound.

Hair levels of heavy metals and essential elements in Chinese children with autism spectrum disorder

BackgroundDisproportional heavy metals and essential elements were reported in children with autism spectrum disorder (ASD) that is obscure in etiology. Inevitably, the association is biased by diet and environmental factors. MethodsFifty pairs, one with ASD and the other living together from the same special school with cerebral palsy (CP), were recruited in Hangzhou (China), aged from 2 to 11 years old (74.0 % male). All samples were divided into two subgroups: preschool-aged (2–5 years old) and school-aged (6–10 years old). Heavy metals (As, Hg, Pb) and essential elements (Al, Ca, Cu, Mg, Mn, Zn) in hair were quantified by inductively coupled plasma mass spectrometry analysis and flame atomic absorption spectroscopy. ResultsThe children with ASD generally had lower hair levels of Mn (ASD 0.124 μg/g, CP 0.332 μg/g, P = 0.001) compared to the children with CP. After stratification for age, there were no significant differences detected in preschool-aged group. In school-aged group, the results exhibited the children with ASD had higher hair Pb (1.485 μg/g, 0.690 μg/g, P = 0.007) and Cu/Zn ratio (0.092, 0.060, P = 0.003), while hair Hg (0.254 μg/g, 0.353 μg/g, P = 0.016)、Mn (0.089 μg/g, 0.385 μg/g, P = 0.002)、Mg (17.81 μg/g, 24.53 μg/g, P = 0.014) and Zn (100.15 μg/g, 135.83 μg/g, P = 0.007) showed an opposite pattern. ConclusionsThese results suggest an imbalance of Mn in Chinese children with ASD.

The Causes of Chest Pain in Children and the Criteria for Targeted Myocardial Enzyme Testing in Identifying the Causes of Chest Pain in Children.

Aims: Chest pain is a common complaint at pediatric cardiology clinics and often leads to an extensive cardiac evaluation. In this study, we analyzed the causes of chest pain in Chinese children and developed diagnostic procedures and criteria for targeted myocardial enzyme testing.Methods and Results: We retrospectively analyzed the clinical data of patients aged below 18 years visiting our hospital for chest pain between 2005 and 2019. Based on auxiliary exams and clinical diagnosis, we developed diagnostic procedures and criteria for targeted myocardial enzyme testing in children with chest pain. A total of 7,251 children were included in this study. The chest pain was of cardiac origin in 581 patients (8.0%). The incidence of non-cardiac chest pain was significantly higher in the preschool group and the school-age group than in the adolescent group (93.5 vs. 93.8 vs. 90.3%, P < 0.05). Among children with cardiac chest pain, the most common concomitant symptom was chest tightness (67.0%). Myocardial enzyme testing was performed in 5,408 patients and was abnormal in 453 patients. We developed a diagnostic procedure and criteria for targeted myocardial enzyme testing using pertinent history, physical examination, and ECG findings or UCG finding. Applying the diagnostic procedure and criteria could lead to the reduction in myocardial enzyme testing while still capturing all cardiac diagnoses.Conclusion: In children, chest pain is mostly benign and rarely cardiac. During diagnosis, targeted myocardial enzyme testing based on medical history and physical examination can effectively reduce resource use.