School-age Subjects Research Articles

Investigation of Oral Health in Children from Urban Slums of Nairobi, Kenya.

For children living in the urban slums of Nairobi (Kenya), primary health conditions are not guaranteed, and oral diseases add further concern at social and institutional levels beyond the general poverty conditions. This study aims at determining the factors that influence the oral health status of children living in Nairobi slums. A cross-sectional study on school-aged subjects was conducted in June 2022 in three urban slum areas of Nairobi through a pediatric dental screening. The PI (Plaque Index), CPITN (Community Periodontal Index of Treatment Needs), and dmft (decayed, missing, and filled teeth index-deciduous) were considered as primary outcomes of dental health. Multivariate statistical analysis, based on ordinal and zero-inflated negative binomial regression models, was conducted to identify determinants of the oral outcomes in a wide set of potential predictors. A sample of 359 children aged 2-17 was examined. The PI was significantly associated with age, the type of bite, and the use of a toothbrush. The CPITN is influenced by different types of malocclusions, abnormal frenulum, dental trauma, and fluorosis. Dietary habits were found to significantly impact the susceptibility to dental caries. Fluorosis and a dental visit in the last year were highlighted as risk and protective factors, respectively, against higher rates of caries. The oral health features of children living in Nairobi slums are differently affected by socio-demographic conditions, dietary habits, dental characteristics, and oral care practices.

POSTURAL VALUATION IN CHILDREN AND ADOLESCENTS: POSTURE CLASSIFICATION

IntroductionAs well known, to this day, the figure of school doctor is absent and much less physical activity is carried out in primary schools. For this reason, the Italian National Fair Play Committee, a meritorious association legally recognized, founded in 1994, in full synergy with Sport and Health, with CONI, Federations and Sports Promotion Bodies, aware of its vocational role, since 2010 had proceeded to establish "Medici Fair Play", as a not just conceptual defense, to integrate the precious action carried out by sports medicine with the verification of suitability for the practice. Aim of the studyThrough a screening project focused on postural problems, named "IOCHIRON, POSTURE IS HEALTH", we prepared a real cornerstone for health prevention and for charitable and useful purposes for the Higher Institute of Health. The initiative provides for a national screening activity in the three-year period 2022-2024, through an assessment with non-invasive tests, to study the structural level posture of over 7 million children and adolescents. This educational path aims to prevent wrong postures in children and adolescents, between 6 and 15 years of age, who are at the peak of growth, with a huge benefit on possible pathologies that could be found when adult, thus saving high costs to the SSN (or NHS).MethodsThe presented observational study represents the first experience carried out by the CeFiRR Structure (Center for Physiotherapy, Rehabilitation and Rehabilitation) at Gemelli Molise S.p.A. 120 school-age subjects were evaluated through a BioPostural questionnaire and an observational form which provided for the evaluation of the asymmetries of: shoulders, scapula, pelvis, knees, hindfoot, trunk rotation (through a scoliosometer), posterior overhang (through the plumb line) and the plantar vault (through static barodopometry).The outcome measures were calculated on the basis of the number of "YES" responses of the BioPostural questionnaire, and on the basis of the number of "YES" evaluations of the observational form.From the interdisciplinary communication and the interpretation of the outcome measures, Posture was classified the in: Asymmetrical, Dysfunctional and Pathological.ResultsThe 42% of the examined subjects presented a shoulder asymmetry (bisacromial line) and a pelvis asymmetry (bisiliac line); the 33% presented a scapulae asymmetry (lower angle of the scapula); and the 9% of the examined subjects presented a flattening of the plantar vault.The BioPostural Questionnaire reflected what was subsequently observed with the observational form and in particular for the number of affirmative answers recorded, it did not suggest further insights into any subject through a Digitalized Biometric analysis, but it highlighted an important number of subjects in the sample who reported: low back pain (85), neck-pain while studying or reading (68). Conclusions The retrospective observational study showed the possibility of observing the adolescent subject in a very short time and with inexpensive instruments (e.g. plumb bob, Bunner's scoliometer, and stabulometric platform) with the collaboration of various health professionals.This experience allowed us to create a classification, in three degrees, of posture which encloses the objective and subjective characteristics of the subject evaluated for a better interpretation of the data, at a territorial and multi-specialist level.The points of weaknesses of the study are represented by the exiguity of the sample examined, and by the difficulty in exposing and finalizing the data collected at a multidisciplinary level, in a field that is still not so much known.For future experiences, it would be necessary to increase the number of subjects examined and standardize the finalization of the data so that they can be ready for use and vision by a greater number of health professionals and medical specialists

Follow up trends among adolescent patients in a weight management program

PurposeAccording to the World Health Organization, obesity has nearly tripled worldwide since 1975. Childhood and adolescent obesity puts individuals at risk for many comorbidities, and interventions should begin in youth to start managing weight. Our purpose was to analyze if age of patients and engagement [measured by bringing a completed food and exercise log (FEL) to visits] in a multidisciplinary weight management program led patients to be more successful with treatment. MethodsA retrospective chart review was performed of adolescents with obesity in a referral-based outpatient obesity management program at an academic tertiary children's hospital. All patients presenting for new weight management visits in 2015 and 2016 had their data collected from their initial visit as well as each subsequent follow-up visit. Patients were included if they were diagnosed with obesity by having a body mass index (BMI) in the 95th percentile or above. 296 subjects were included. 191 subjects had at least one follow-up visit so analysis related to weight change outcomes were limited to those 191 subjects. Results37.5% were elementary school-aged (6 to 11 years), 31.8% middle school-aged (12 to 14 years), and 30.7% high school to college-aged (15 to 20 years). 4.2% of elementary school-aged subjects had significant (>3%) weight loss, 55.6% had no significant weight change, and 40.3% had significant (>3%) weight gain. 12.3% of middle school-aged subjects had significant weight loss, 57.9% had no significant weight change, and 29.8% had significant weight gain. 21.0% of high school and college-aged subjects had significant weight loss, 69.4% had no significant weight change, and 9.7% had significant weight gain. Of those from all ages that had significant weight loss or no significant weight change, FEL were brought to 50% and 70.8% of visits respectively. Of those with significant weight gain, FEL were brought to only 32.1% of visits. The odds ratio of having brought a completed FEL during follow-up visits for those with significant weight gain versus those with no significant weight change was 0.485 (95% CI 0.336-0.700) and for those with significant weight loss versus those with no significant weight change was 0.624 (95% CI 0.402-0.967). ConclusionsOf those with weight gain, the majority were elementary school-aged subjects, and of those with weight loss, the majority were high school to college-aged subjects. This corresponds with recommendations as younger patients are continuing to grow taller and begin puberty while older adolescents should be ending their growth and development and thus encouraged to work on weight loss. Those that brought FEL to more visits were also more likely not to gain weight (no significant change) as compared to those that brought FEL to fewer visits and had significant weight gain. FEL were also brought to fewer visits by those that had weight loss as compared to no change, but the odds of bringing a food log was higher than in those with weight gain. By engaging more with the program, this may indicate that participants remained actively involved with program goals between visits and focused on working towards improved health.

Hallux Limitus Influence on Plantar Pressure Variations during the Gait Cycle: A Case-Control Study.

Hallux limitus is a common foot disorder whose incidence has increased in the school-age population. Hallux limitus is characterized by musculoskeletal alteration that involves the metatarsophalangeal joint causing structural disorders in different anatomical areas of the locomotor system, affecting gait patterns. The aim of this study was to analyze dynamic plantar pressures in a school-aged population both with functional hallux and without. A full sample of 100 subjects (50 male and 50 female) 7 to 12 years old was included. The subjects were identified in two groups: the case group (50 subjects characterized as having hallux limitus, 22 male and 28 female) and control group (50 subjects characterized as not having hallux limitus, 28 male and 22 female). Measurements were obtained while subjects walked barefoot in a relaxed manner along a baropodometric platform. The hallux limitus test was realized in a seated position to sort subjects out into an established study group. The variables checked in the research were the surface area supported by each lower limb, the maximum peak pressure of each lower limb, the maximum mean pressure of each lower limb, the body weight on the hallux of each foot, the body weight on the first metatarsal head of each foot, the body weight at the second metatarsal head of each foot, the body weight at the third and fourth metatarsal head of each foot, the body weight at the head of the fifth metatarsal of each foot, the body weight at the midfoot of each foot, and the body weight at the heel of each foot. Non-significant results were obtained in the variable of pressure peaks between both study groups; the highest pressures were found in the hallux with a p-value of 0.127 and in the first metatarsal head with a p-value 0.354 in subjects with hallux limitus. A non-significant result with a p-value of 0.156 was obtained at the second metatarsal head in healthy subjects. However, significant results were observed for third and fourth metatarsal head pressure in healthy subjects with a p-value of 0.031 and regarding rearfoot pressure in subjects with functional hallux limitus with a p-value of 0.023. School-age subjects with hallux limitus during gait exhibit more average peak plantar pressure in the heel and less peak average plantar pressure in the third and fourth metatarsal head as compared to healthy children aged between 7 and 12 years old.

U-Net-based image segmentation of the whole heart and four chambers on pediatric X-ray computed tomography.

This study aimed to determine whether a U-Net-based segmentation method could be used to automatically extract regions of the whole heart and atrioventricular regions from pediatric cardiac computed tomography images with high accuracy. Pediatric cardiac contrast computed tomography images with no abnormalities (n = 20; patient age, 0-13years; mean 5years) were used for segmentation of the whole heart and each atrioventricular region using U-Net. Segmentation accuracy was evaluated using the Dice similarity coefficient. The mean Dice similarity coefficient for the whole-heart segmentation was high at 0.95. There were no significant differences between age categories. The median Dice similarity coefficients for segmentation of the atria and ventricles were good (> 0.86). There were significant differences between age categories at some sites. Differences in the Dice similarity coefficient may have occurred because the target diseases and examination procedures differed according to subject age. There was no clear tendency for similar values between subjects of school age, close to adulthood, and newborns; good agreement was obtained in all age categories. These results suggest that U-Net-based segmentation may be useful for automatic extraction of the whole heart and atrioventricular regions from pediatric computed tomography images.

Virtual Neurocognitive Testing in Craniofacial Surgery.

Digital communication platforms have had an impact on plastic surgery research. Although neurocognitive testing is an important tool for understanding the long-term developmental outcomes of congenital craniofacial conditions, testing has been geographically limited because of its interactive nature. Virtual neurocognitive testing is a facsimile version of in-person testing that allows researchers to overcome this limitation with high fidelity. Ten school-age subjects completed a neurocognitive assessment battery measuring intelligence quotient, academic achievement, and visuomotor skills at an average age of 7.8 ± 1.4 years. The subjects then retook the same battery through an identical virtual testing method approximately 1 year after the initial test. There were no significant differences in verbal intelligence quotient (p = 0.878), performance intelligence quotient (p = 0.813), and full-scale intelligence quotient (p = 0.982) scores obtained through in-person and virtual tests. There were no significant differences between academic achievement letter and word recognition (p = 0.999), math computation (p = 0.619), reading comprehension (p = 0.963), and spelling (p = 0.344) scores. There were no significant differences in visuomotor integration (p = 0.158), visual perception (p = 0.798), and motor coordination (p = 0.796) scores obtained through the two methods. The median at-home time to set up study equipment for the virtual testing was 5.0 minutes (interquartile range, 2.3 minutes). Seventy percent of participants reported that they preferred participating in research from home. All participants stated that the virtual research study was an overall positive experience. Virtual neurocognitive testing is an effective method of performing high-fidelity neurocognitive assessments while overcoming geographic barriers.

The Cardiorespiratory fitness of children and adolescents in Tibet at altitudes over 3,500 meters.

BackgroundCardiorespiratory fitness (CRF) is the core element of health-related physical fitness evaluation. High pressure and low oxygen in Tibet (over 3,500 m above sea level) may negatively impact the residents’ CRF. The 20-m shuttle run test (20mSRT) is the most popular field-based assessment and estimate of CRF in children and adolescents worldwide. However, normative CRF data for the children and adolescents residing in China’s plateau region are unavailable, which prevents comparability among those living at high-altitudes around the world.PurposeTo measure the CRF of Chinese children and adolescents aged 9–18 years living in Tibet at altitudes exceeding 3,500 m, and to identify correlations between this metric and demographic characteristics (age, sex, and ethnicity). These data were then compared with those generated in the lowland (Shanghai, China) and various global regions.Methods20mSRT performance (number of completed laps) and predicted peak oxygen consumption (VO2peak) were used as indicators of CRF. We measured the CRF of 1,717 healthy children and adolescents aged 9–18 years living in Tibet. The CRF data from school-age subjects in Shanghai (2,437 boys and 2,396 girls) and worldwide (1,142,026 students from 50 countries/regions in Africa, Asia, Europe, Latin America, North America, and Oceania) were collated from published papers.ResultsThe average CRF of the participants from Tibet was 39.8 mL/kg/min. The male subjects (n = 876; 41.1 ± 4.42 mL/kg/min) had a higher average CRF than their female counterparts (n = 841; 37.8 ± 5.40 mL/kg/min). CRF decreased with age in both sexes at statistical significance (F = 1249.9, p for trend 0.05). The indigenous Tibetans (n = 1289; 40.1 ± 3.71 mL/kg/min) had a significant higher average CRF than those of Han descent (n = 394; 38.9 ± 4.70 mL/kg/min) (p < 0.05).ConclusionsChildren and adolescents aged 7–18 years residing above 3,500 m in Tibet displayed lower CRF traits compared with their counterparts from the plains area and other high altitude places. CRF varied according to age, sex, and ethnic group. Given the importance of CRF in children and adolescents, effective intervention strategies should be implemented to improve CRF in children and adolescents on the plateau.

Prevalence and Associated Factors of Anemia among Muslim Students, Nakhon Si Thammarat, Thailand: A Cross-Sectional Study.

Anemia is a global public health problem. The prevalence of anemia among different ages, genders or ethnic groups must be clarified in order to solve problems. This study proposed to determine the prevalence and factors related to anemia among the Muslim school-age population in Nakhon Si Thammarat, Thailand. Socio-demographic and anthropometric data were collected by a structured questionnaire. Blood samples were collected from 200 school-age subjects. The thalassemia screening was performed with KKU-OF and KKU-DCIP reagents. The prevalence of anemia in this study was 36.5%, divided into males and females, 33.3% and 39.1%, respectively. The means of Hb, Hct, MCV, MCH, and MCHC in the anemic group were significantly lower. The positive results for KKU-OF or KKU-DCIP or both were 15.0%, 2.5%, and 1.0%, respectively. The result of positive OF test was a significantly independent factor for anemia. The number of family members was 5 to 7 and more than 7 persons are related factors for anemia in this study. In summary, the contribution of thalassemia and socio-economic factor are associated factors to anemia in this population. These findings should be addressed in public health strategies for the control of anemia of school-aged Muslims in the region.

Effectiveness of four doses of pertussis vaccine during infancy diminished in elementary school age: A test-negative case-control study in Japan

ObjectiveThe Japanese national immunization program recommends that children receive 4 doses of acellular pertussis vaccine between 3 months and 2 years of age. Nevertheless, the number of pertussis cases is increasing in elementary school children aged 6–12 years. Therefore, a test-negative case-control study was conducted to assess the effectiveness of the pertussis vaccine program. MethodsSubjects included children aged ≥3 months who visited a collaborating hospital due to pertussis-specific cough between October 2017 and November 2019. All subjects underwent diagnostic tests for pertussis, and those diagnosed as positive were regarded as cases. Subjects diagnosed as pertussis-negative were classified as controls. Vaccination history was collected using a questionnaire administered to parents with reference to immunization records. Logistic regression models were employed to calculate the odds ratio (OR) and 95% confidence interval for laboratory-confirmed pertussis. ResultsOf 187 recruited subjects (120 cases and 67 controls), questionnaire responses were obtained for 145 subjects (95 cases and 50 controls). Compared with unvaccinated subjects, the vaccine effectiveness (VE) of 4 doses was 70% among all subjects and reached to 90% with marginal significance among subjects under 6 years of age. However, among school-aged subjects, the VE was not suggestive of protection against pertussis (VE: 8%). For vaccinees given 4 doses, the OR for developing pertussis increased significantly with longer duration since the fourth dose (compared with <4.5 years, OR of 6.0–8.2 years = 5.74; OR of ≥8.3 years = 3.88; P for trend by duration < 0.01). ConclusionEffectiveness of administering 4 doses of pertussis vaccine during infancy decreases with time passed since the fourth dose. This regimen does not protect school-aged children against pertussis.

Obrigatoriedade e gratuidade da educação nos Estados Parte do Mercosul

O objetivo deste artigo é analisar os ordenamentos normativos associados à obrigatoriedade e à gratuidade da educação nos Estados Parte do Mercosul. Alicerçado em referenciais teóricos que discutem a temática e tendo por base a análise documental, o artigo examina a constituição nacional, a lei geral da educação e demais ordenamentos que regulamentam a obrigatoriedade e a gratuidade. Entre seus resultados, revela que declarações e demais documentos editados por organismos internacionais contribuíram para tal normatização no âmbito de cada país. Demonstra ainda que, no caso do Mercosul, a educação é considerada elemento importante para o desenvolvimento e a integração da região. Entretanto, embora o trabalho identifique avanços no que diz respeito à regulamentação da ampliação da escolarização, tais documentos não foram suficientes para garantir a efetividade do acesso dos sujeitos em idade escolar.

Early Detection of Behavioral and Emotional Problems in School-Aged Children and Adolescents: The Parent Questionnaires.

Introduction:Early detection of behavioral and emotional problems in children and adolescents is relevant. For this purpose, the use of questionnaires completed by parents is applicable. Parent questionnaires are also useful preliminary support to the clinical investigation.Methods:Validated tools for the analysis of behavioral and emotional problems suitable for school-age subjects are analyzed in their characteristics and possibilities of use.Results:The following are the main characteristics of the instruments examined. The Child and Adolescent Symptom Inventory 4&5, Parent Checklist (CASI-4&5) and Behavior Assessment System For Children - Parent Rating Scales 2&3 (BASC-2&3) include a high number of questions, with exploration extended to almost all possible pathologies.The Child Behavior Check-List (CBCL) has less items (113), but only 48 refer to DSM pathologies. The use of CASI, BASC and CBCL carries a cost because they are copyrighted.The Pediatric Symptom Checklist (PSC) has 35 items, but only 17 have a reference to 3 clinical areas. The Strength & Difficulties Questionnaire (SDA) is very short (25 items) and concerns only the main externalizing and internalizing disorders. The Child and Adolescent Behavior Inventory (CABI) has 75 items and explores a wide range of psycho-pathological issues, likewise CASI and BASC. PSC, SDA and CABI can be used free of charge.Conclusion:The comparison of the characteristics of the aforementioned questionnaires can guide the psychiatrist and the epidemiologist in choosing the most suitable tool for what is proposed to be assessed, in relation to practicability, extension of the areas explored and costs.

【論文摘要】The Association of Long-term PM2.5 Absorbance Exposure with Carotid-intima-media Thickness in Young Taiwanese

Background/Synopsis: The contribution of long-term air pollution exposures to subclinical atherosclerosis in young age has not been fully studied. Objectives/Purpose: This study is to evaluate to assess the associations of carotid intima-media thickness (CIMT) values in adolescents or young adults with one-year exposures to different sizes of particulate matter (PM) and traffic-related exhausts. Methods/Results: We recruited 789 school age subjects who resided in Taipei City and participated in the YOung TAiwanese (YOTA) Cohort between 1992 and 2000. Of all study subjects, 303 subjects were elevated blood pressures (EBP) and 486 subjects had normal BP (NBP) in the childhood. The CIMT values at different segments were measured at the age of 12-30 in the follow-up health examination from 2006 to 2008. Land-use regression models were used to estimate participants' one-year exposures to particulate matter (PM) of different sizes and traffic-related exhausts, including PM2.5 absorbance, nitrogen oxides, and nitrogen dioxides. Generalized linear regression was applied to assess the associations of CIMT values in adolescents or young adults with one-year exposures to six air pollutants. Our findings indicate one-year exposure to PM2.5 absorbance is associated with increased mean and maximum CIMT at different carotid segments. Specifically, exposure to PM2.5 absorbance among subjects who exhibited elevated childhood blood pressure is associated with an increases in mean CMIT at common carotid artery by 3.94% (95%CI: 0.24, 7.64), carotid bulb by 7.77% (95%CI: 2.95, 12.95), and internal carotid artery by 4.75% (95%CI: 0.67, 8.84). Similar increases in the maximum CIMT values were evident at the aforementioned sites. Moreover, older age, gender and health status (overweight, elevated blood pressure, hyperglycemia and hypercholesterolemia), coupled with high level exposure to PM2.5 absorbance (≥2.18 10-5 m-1; 75th percentile), are particularly at risk for developing increased CIMT. Conclusion: Long-term exposure to PM2.5 absorbance is positively associated with subclinical atherosclerosis in adolescents or young adults. The atherosclerosis developed since early childhood depending on individual cardiovascular risk factors including overweight, hypertension, hyperglycemia, or hypercholesterolemia, and can be modified by PM2.5 absorbance concentration.

Saliva DNA Methylation Detects Nascent Smoking in Adolescents.

Objectives: Early identification of smoking, essential for the successful implementation of interventions, arrests the escalation of smoking and smoking-associated risk behaviors in adolescents. However, because nascent smoking is typically episodic and infrequent, enzyme-linked immunoassay reagent-based approaches that detect cotinine, a key nicotine metabolite, are not effective in identifying adolescents in the earliest stages of smoking. Epigenetic methods may offer an alternative approach for detecting early-stage smokers. In prior work, we and others have shown that the methylation status of cg05575921 of whole-blood DNA accurately predicts smoking status in regularly smoking adults and is sensitive to nascent smoking. Yet, the blood draws necessary to obtain DNA for this method may be poorly accepted by adolescents. Saliva could be an alternative source of DNA. However, the ability of saliva DNA methylation status to predict smoking status among adolescents is unknown. Methods: To explore the possibility of using salivary DNA for screening purposes, we examined the DNA methylation status at cg05575921 in saliva DNA samples from 162 high school aged subjects for whom we also had paired serum cotinine values. Results: Overall, the reliability of self-report of nicotine/tobacco use in these adolescents was poor with 67% of all subjects whose serum levels of cotinine was ≥2 ng/mL (n = 75) denying any use of nicotine-containing products in the past 6 months. However, the correspondence of the two biological measures of smoking was high, with serum cotinine positivity being strongly correlated with cg05575921 methylation (p < 0.0001). Receiver operating characteristic (ROC) analyses showed that cg05575921 methylation status could be used to classify those with positive serum cotinine values (≥2 ng/mL) from those denying smoking and have undetectable levels of cotinine. Conclusions: We conclude that saliva DNA methylation assessments hold promise as a means of detecting nascent smoking.

ВІКОВІ ОСОБЛИВОСТІ ФОРМУВАННЯ РЕЗЕРВНИХ МОЖЛИВОСТЕЙ РОЗУМОВОЇ ДІЯЛЬНОСТІ У ДІТЕЙ, ПІДЛІТКІВ ТА ЮНАКІВ

Introduction . Functional reserves of mental performance characterize the hidden ability of a person to process information that can be implemented in extreme activities. In order to evaluate the functioning of the central nervous system and human mental performance, indicators of speed and quality of processing are variously used in terms of the complexity of sensorimotor reactions. A quantitative characteristic of the functional reserves of mental performance can be the relation between the maximum possible result of mental performance and the result at the level of the state of relative rest. Purpose. The task was to propose a method and to investigate the level of functional reserve of mental performance of children, adolescents and young people by using the reverse regime of the presentation of stimuli. Methods. In the pilot study, 116 subjects of school age took part. The research was conducted using the computer device Diagnostic1M in the imposed mode. Result. It was proved that the number of errors was based on the speed of presentation of stimuli, the signal modality and the age of the subjects. It is established that during processing of figurative stimuli the level of functional reserve of mental efficiency is higher than in the processing of verbal signals. The functional reserve of mental performance is dependent on the age of the subjects and the modalities of the signals. Originality . Can be used for psychophysiological diagnostics, determination of professional orientation, professional and sports selection. Conclusion . Determination of the individual level of the functional reserve of mental performance of a person, this method, provides the accuracy and reliability of the indicators of the hidden possibilities of a person on the processing of information that can be implemented in extreme mental activity.

Síntomas prefrontales en la vida diaria: normalización y estandarización del inventario de síntomas prefrontales abreviado en población española

The short Prefrontal Symptoms Inventory (PSI-20) is a questionnaire that investigates symptoms of prefrontal malfunctioning in daily life. It has been shown to have good psychometric properties and has been applied in the general population and clinical samples from Spain and other Spanish-speaking countries. To normalise and standardise the PSI-20 in a broad sample of subjects of all ages in a Spanish population. The PSI-20 was administered to 4704 subjects: in one sample made up of 2474 subjects from the Spanish general population, over 18 years of age, and in another consisting of 2230 school-age subjects (15-17 years old), representative of the population of Madrid. The effect of the interaction of sex, age and level of education on the scores was observed, although the effect of level of education was low. As expected, the adolescents, still undergoing their process of maturation, obtained higher scores on all the subscales and the questionnaire as a whole. Females scored significantly higher on symptoms of poor emotional control, and males achieved higher scores on symptoms of poor control over social behaviour. Tables were developed differentiated by sex and for those above and below 18 years of age. The data presented allow us to interpret the scores obtained in the PSI-20 in the Spanish population, including subjects under 18 and adults.

The association between sixteen genome-wide association studies-related allergic diseases loci and childhood allergic rhinitis in a Chinese Han population

BackgroundAllergic rhinitis (AR) is one of the most common respiratory diseases in children. It is caused by a combination of genetic and environmental factors. Moderate-to-severe AR decreases the quality of life and social performance in children. ObjectiveTo investigate whether polymorphisms in previously published genome-wide association studies (GWAS) allergic disease loci are associated with childhood AR and the severity of AR symptoms in a Chinese Han population. MethodsA case-control study was conducted in 503 pediatric patients with AR and 393 control Chinese school-aged subjects. AR severity was classified as mild or moderate-to-severe according to the AR and its Impact on Asthma (ARIA) guidelines. Overall, 16 tagged single-nucleotide polymorphisms (tSNPs) of published GWAS associations with allergic diseases were selected. All subjects were genotyped and analyzed for the 16 selected tSNPs using the improved multiplex ligation detection reaction (iMLDR) technique. ResultsBoth rs7130588_AG and rs7927894_CT genotypes in EMSY region were associated with a significantly increased risk of AR (1.75-fold and 1.50-fold) compared to the AA and CC genotypes, respectively, specific to moderate-to-severe AR. The difference of rs7130588 genotypes in cases vs. controls was still statistically significant under the additive model after multiple test correction to adjust the false discovery rate (FDR) with an adjusted odds ratio of 1.818 and 95% confidence interval (CI) of 1.240–2.664 (PFDR = 0.0349). The rs7130588_G allele was only associated with a high risk of moderate-to-severe AR (1.85-fold, Page and gender_adjustment = 0.003). The rs2227284_TG genotype at the IL4 locus was significantly associated with a 0.65-fold decreased risk of AR compared to the TT genotype. The protective effect of the rs2227284_G allele was also found in different severity of AR. Haplotype analysis showed a significantly increased AR risk associated with the haplotype G-T-T (rs7130588-rs2155219-rs7927894) and a protective effect with the haplotype C-G-C (rs2243250-rs2227284-s2243290). ConclusionsThe loci in EMSY and IL4 can be considered as a hereditary marker for childhood AR. The rs7130588_G allele seems to predispose only to moderate-to-severe AR, though other mechanisms are also likely to be involved.

Lead, Mercury, and Cadmium Exposure in the Korean General Population.

BackgroundLead (Pb), mercury (Hg), and cadmium (Cd) are well-known environmental pollutants. They are unnecessary in the biological processes of humans. This study was performed to estimate the representative background exposure levels to the metals by measuring concentrations in whole blood of the Korean general population.MethodsThis population-based cross-sectional study included 4,000 subjects (1,886 males and 2,114 females) 0–83 years of age in 2010 and 2011. Adult subjects (≥ 19 years of age) were collected by sex- and age-stratified probability method, and preschool- and school-aged subjects were recruited by a cluster sampling method. Written consent was provided prior to blood sampling. Pb and Cd blood concentrations were determined by a flameless atomic absorption spectrophotometry, and blood Hg was analyzed by a direct Hg analyzer.ResultsThe geometric mean, median and 95th percentile of blood Pb was 1.82 µg/dL, 1.83 µg/dL, and 3.78 µg/dL, respectively. The respective values were 2.92 µg/L, 2.87 µg/L, 9.12 µg/L for Hg, and 0.56 µg/L, 0.59 µg/L, 2.20 µg/L for Cd. Blood Pb and Hg were higher in males than in females, but no sex difference was observed, respectively, in subjects 0–4 years of age for Pb and in subjects less than 20 years for Hg. However, blood Cd was higher in females than in males and no sex difference was observed in subjects < 30 years of age.ConclusionThis study provides representative data of human exposure to Pb, Hg, and Cd covering whole age groups of the general population in Korea.

Pertussis-associated persistent cough in previously vaccinated children

To evaluate the role of Bordetella pertussis infection, 96 otherwise healthy 7- to 17-year-old subjects who were suffering from a cough lasting from 2 to 8 weeks were prospectively recruited. At enrolment, a nasopharyngeal swab and an oral fluid sample were obtained to search for pertussis infection by the detection of B. pertussis DNA and/or an elevated titre of anti-pertussis toxin IgG. Evidence of pertussis infection was found in 18 (18.7 %; 95 % confidence interval, 11.5-28.0) cases. In 15 cases, the disease occurred despite booster administration. In two cases, pertussis was diagnosed less than 2 years after the booster injection, whereas in the other cases it was diagnosed between 2 and 9 years after the booster dose. This study used non-invasive testing to show that pertussis is one of the most important causes of long-lasting cough in school-age subjects. Moreover, the protection offered by acellular pertussis vaccines currently wanes more rapidly than previously thought.

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea.

Continuous positive airway pressure (CPAP) is effective but challenging for children with obstructive sleep apnea (OSA). High-flow air via open nasal cannula (HFNC) as treatment in children remains controversial. We report the efficacy of HFNC in children with OSA and CPAP intolerance, a titration protocol, and a discussion of potential mechanisms. Patients aged 1 to 18 years with OSA (defined by obstructive apnea-hypopnea index [OAHI] greater than 1 event/h) and CPAP intolerance were enrolled. Routine polysomnography data obtained during 1 night wearing HFNC was compared with diagnostic data by Wilcoxon rank-sum test. Ten school-age subjects (representing all patients attempting HFNC at our institution to date) with varied medical conditions, moderate to severe OSA, and CPAP intolerance wore HFNC from 10 to 50 L/min of room air with oxygen supplementation if needed (room air alone for 6 of the 10). HFNC reduced median OAHI from 11.1 events/h (interquartile range 8.7-18.8 events/h) to 2.1 events/h (1.7-2.2 events/h; P = .002); increased oxyhemoglobin saturation (SpO2) mean from 91.3% (89.6% to 93.5%) to 94.9% (92.4% to 96.0%; P < .002); increased SpO2 nadir from 76.0% (67.3% to 82.3%) to 79.5% (77.2% to 86.0%; P = .032); decreased SpO2 desaturation index from 19.2 events/h (12.7-25.8 events/h) to 6.4 events/h (4.7-10.7 events/h; P = .013); and reduced heart rate from 88 bpm (86-91 bpm) to 74 bpm (67-81 bpm; P = .004). Stratified analysis of the 6 subjects with only room air via HFNC, the OAHI, obstructive hypopnea index, and mean SpO2 still demonstrated improvements (P = .031). High-flow nasal cannula reduces respiratory events, improves oxygenation, reduces heart rate, and may be effective for CPAP intolerant children with moderate to severe OSA. Our data suggest HFNC warrants further study and consideration by payers as OSA therapy.

Prevalence and injury profile in Portuguese children and adolescents according to their level of sports participation.

It is becoming increasingly apparent that sports can present danger in the form of injuries. The extent of this problem calls for preventive actions based on epidemiological research. Two questionnaires (LESADO and RAPIL II) were distributed in four schools to 651 subjects aged between 10 and 18 years, involved in different levels of physical activity (PA) - recreative sports, school sports, federated sports and no sports participation (except physical education classes). Bone age was evaluated through Tanner-Whitehouse III method and anthropometric measures according to ISAK. From 247 subjects (37.9%) it was reported a sports injury during the previous six months. The most injured body areas were lower limbs (53.8%), followed by upper limbs (29.0%) and the type of injuries found was strains (33.7%), sprains (27.1%) and fractures (23.1%). The most frequent causes were direct trauma (51.9%), indirect trauma (29.5%) and overuse (12.7%). A high percentage was relapses and chronic injuries (40.9%). The OR for age group ≥16 years was 2.26 suggesting that those ≥16 years were 2.26 times more likely to have an injury than the younger subjects and concerning the PA level, school and federated sports subjects were 4.21 and 4.44 times more likely to have an injury than no sports participation subjects. Sports injuries in school age subjects were predominantly minor conditions where sprains and strains were the major injuries. They resulted mostly of trauma situations and lower and upper limbs were the most affected areas. Injury occurrence increased with age and was higher in school and federated athletes.