Status Of Children Research Articles

Longitudinal Changes in Refractive Error Among Preschool Children Aged 1–6 Years: The Changsha Children Eye Study

PurposeTo investigate the longitudinal changes in refractive error of preschool children and explore the factors related to these changes and the timing of intervention.MethodsThe refractive data of preschool children aged 1–6 years were collected from 16 community Health Service Centers in Changsha during April 2016 to July 2019 for the retrospective cohort study. The refractive data of each participant was measured with a hand-held vision screener without cycloplegia. A follow-up for all the included participants was performed. The spherical equivalent change was calculated, subsequently, an analysis of risk factors related to the change was performed.ResultsFour thousand nine hundred twenty-one cases were included in the study with the follow-up for 1–2 years. The refractive status was found smoothly changed in 67.8% of children. The overall initial SE was 0.62 ± 1.13 D, and the average SE change was −0.20 ± 1.23 D per year. However, profound myopic shift was observed in 32.2% of children. The change of SE in 3-year-old group is most overt. The proportions of 1–6 years old who showed moderate and severe myopic shift (SE change ≥–1.00 D) were 21.6, 18.9, 28.2, 25.5, 13.4, and 10%, respectively. At the first visit, the younger children with greater hyperopic state exhibited more noticeable myopic shift, no significant difference was found in gender.ConclusionThe shift from hyperopia to myopia in preschool children is smooth, with −0.20D change on average per year. We suggest that an optometry screening should start at 3-year-old to track children's refractive status. We recommend that preschool children whose SE changes more than −1.00 D per year go to the ophthalmology department for further examination. Our study also found that at the first visit, the younger the child is and the more positive initial SE is, the degree of shift of myopia is greater.

361 Predictors of Iron Status in Children With ESKD

361 Predictors of Iron Status in Children With ESKD

Marriage, Parentage and Child Registration in Iran: Legal Status of Children of Unmarried Parents

In the contemporary legal system in Iran, child registration is closely tied to Islamic marriage. The Civil Registration Law foresees a process for registering a child born to Islamically married parents. This raises the question of what happens to children whose parents are not married. This paper uses literature review and content analysis methods and focuses on the Iranian law, press and media pieces, Shi’i rulings, and academic literature on child ‘legitimacy’ and the unregistered child phenomenon to answer this question. I explore the relationship between Iran’s marriage and parentage law and the child registration process. The paper discusses the consequences of rendering children legally ‘illegitimate’ for children’s rights. The conclusion addresses the potential in the Shi’i school of Islam to improve religious rulings and, consequently, the possibility of changing discriminatory laws regarding the rights of children born to unmarried parents.

Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization: Field-Based Randomized Controlled Trial.

BackgroundCountries’ Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries.ObjectiveWe aim to assess whether involving community volunteers (CVs) to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children’s vaccination timeliness, completeness, and coverage.MethodsThis was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness.ResultsOverall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5%) and 718 (98.4%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6%) and 636 (97.7%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette–Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi +Hb) dose 3 (aOR 2.0, 95% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group.ConclusionsFindings support that involving CVs to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children’s vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts.Trial RegistrationPan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548

Diet, Sun, Physical Activity and Vitamin D Status in Children with Inflammatory Bowel Disease.

In the course of inflammatory bowel disease (IBD) malabsorption may lead to a vitamin D deficiency and calcium–phosphate misbalance. However, the reports on the vitamin D status in children with IBD are few and ambiguous. Here, we are presenting complex analyses of multiple factors influencing 25OHD levels in IBD children (N = 62; Crohn’s disease n = 34, ulcerative colitis n = 28, mean age 14.4 ± 3.01 years, F/M 23/39) and controls (n = 47, mean age 13.97 ± 2.57, F/M 23/24). Additionally, calcium–phosphate balance parameters and inflammatory markers were obtained. In children with IBD disease, activity and location were defined. Information about therapy, presence of fractures and abdominal surgery were obtained from medical records. All subjects were surveyed on the frequency and extent of exposure to sunlight (forearms, partially legs for at least 30 min a day), physical activity (at least 30 min a day) and diet (3 days diary was analyzed with the program DIETA 5). The mean 25OHD level was higher in IBD patients compared to controls (18.1 ng/mL vs. 15.5 ng/mL; p = 0.03). Only 9.7% of IBD patients and 4.25% of controls had the optimal vitamin D level (30–50 ng/mL). Despite the higher level of 25OHD, young IBD patients showed lower calcium levels in comparison to healthy controls. There was no correlation between the vitamin D level and disease activity or location of gastrointestinal tract lesions. Steroid therapy didn’t have much influence on the vitamin D level while vitamin D was supplemented. Regular sun exposure was significantly more common in the control group compared to the IBD group. We found the highest concentration of vitamin D (24.55 ng/mL) with daily sun exposure. There was no significant correlation between the vitamin D level and frequency of physical activity. The analysis of dietary diaries showed low daily intake of vitamin D in both the IBD and the control group (79.63 vs. 85.14 IU/day). Pediatric patients, both IBD and healthy individuals, require regular monitoring of serum vitamin D level and its adequate supplementation.

Food Parenting Practices and Feeding Styles and Their Relations with Weight Status in Children in Latin America and the Caribbean.

While a growing body of literature looks at the associations between food parenting practices, and feeding styles, and child’s weight status in developed countries, little is known for less developed countries, in general, and the Latin America and the Caribbean (LAC) region, in particular. This study systemically reviews and synthesizes existing evidence on the associations between child caregivers’ food parenting practices and feeding styles and 2 to 12-year-old child weight status. Keywords were used to search in PubMed, Web of Science, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature. Among the ten eligible articles, all of them reported significant associations between food parenting practices and feeding styles and child weight status. Existing studies have limitations, mainly related to cross-sectional convenience samples, which limit the generalization of the results. Additionally, small sample, heterogeneous feeding measures and weight related outcomes were other limitations. Future research is needed to understand caregiver–child interactions in the food situation and its link to child weight status in 2 to 12-year-old children in areas of LAC with diverse forms of malnutrition and contextual factors of countries.

Nexus between maternal underweight and child anthropometric status in South and South-East Asian countries

ObjectivesMaternal underweight and childhood malnutrition are life-threatening public health concerns in several South and South-East Asian nations. The aim of this study was to better design interventions and prevent malnutrition of children in the region by exploring the association of maternal underweight with children's anthropometric status. MethodsThe Demographic and Health Survey's (DHS) most recent nationally representative data from eight South and South-East Asian states, collected between 2014 and 2018, were pooled for the present study. A multivariable logistic regression model was designed to explore the association between maternal underweight and child anthropometric status. Owing to the hierarchical structure of the DHS data, the study also employed the multilevel logistic regression technique. ResultsAmong the total participants (N = 213 730), 22.66% of women were found to be underweight, whereas 39.03%, 35.88%, and 22.11% of their children had stunting, underweight, and wasting, respectively. The logistic regression model showed that the children from underweight mothers were 1.27 (95% confidence interval [CI]. 1.24–1.30), 1.69 (95% CI, 1.65–1.73), and 1.48 (95% CI, 1.45–1.52) times more likely to experience stunting, underweight, and wasting, respectively, than those with healthy-weight mothers. The significant association between maternal underweight and stunting, underweight, as well as wasting was additionally established by the multilevel logistic regression analysis. ConclusionsFindings indicate that maternal underweight is positively associated with children's anthropometric status, such as stunting, underweight, and wasting. The information from this research will guide actors and policymakers to scale up interventions with all-inclusive nutritional issues and promote healthier weight status among mothers to ensure higher odds of healthier anthropometric status in their children in the South and South-East Asian countries.

The Effect of Artificial Intelligence on the Nutritional Status of Children After Cardiac Surgery: Randomized Controlled Trial

Background Malnutrition is the most common problem in congenital heart disease patients. Health-based mobile apps play an important role in the planning and tracking of diet for better nutritional status. Objective The aim of this paper was to assess the effect of artificial intelligence on the nutritional status of children after cardiac surgery in comparison to the usual care group. We also aimed to assess the usefulness of a diet-related mobile app in comparison to the usual care group. Methods This is a two-arm randomized controlled trial, which was conducted at a tertiary care hospital, Rawalpindi. The study duration was 6 months from February 2021 until July 2021. The sample size was calculated to be 88. The intervention group was given a diet-related mobile app, and the usual care group was handed a pamphlet with diet instructions on discharge. Results The mean weight of all participants was 15 (SD 5.7) kg at the time of discharge. However, at the end of the 8th week, the mean weight of the participants in the usual care group was 16.5 (SD 7.2) kg and that of the intervention group was 17.1 (SD 5) kg. The average calories consumed by the usual care group was 972 (SD 252) kcal and 1000.75 (SD 210) kcal by the intervention group after 8 weeks of discharge. The average proteins consumed by the usual care group was 34.3 (SD 12.5) grams and 39 (SD 6.4) grams by the intervention group after 8 weeks of discharge. At the end of the intervention, the preferred diet planning tool for 79% of the participants was mobile app. At the 8th week, 93% of the participants considered the visual cues useful, 80% thought that the mobile app’s language was understandable, 79% thought nutritional goal setting is a useful feature in the mobile app, and 55% thought the recipes provided in the app were useful. Conclusions This study showed strength for the future of scalable modern technology for self-nutrition monitoring. There was a slight increase in the weight and nutritional intake of both groups, as the intervention period was limited. Trial Registration ClinicalTrials.gov NCT04782635; https://www.clinicaltrials.gov/ct2/show/NCT04782635

Women’s Empowerment to Improve Nutritional Status in Children: A Systematic Review

Women's empowerment considered vital in child nutrition and being considered important throughout the first 1000 days of life. Inadequate access to food and child feeding practices are the root causes of nutritional problems in children. Mothers play an essential role in parenting, particularly when it comes to child feeding. However, there are no systematic review available in regarding the correlation between women's empowerment and child nutrition. The aims of this study is to review the correlation between women's empowerment and nutritional status in children, more research should use a longitudinal study design to conduct pathway and lifecycle analysis in appropriate populations to clarify the relationship between women's empowerment and nutritional status in children.
 We included English materials published between Science Direct, Pubmed, Research Gate and Google Scholar was used to find studies related to women's empowerment and children's nutritional status between 2016- 2021. 1025 studies were generated using tittle and abstract. We scanned the whole text of 538 of them, as well as 25 other research that the authors were aware of. Only 8 papers met our criteria for inclusion. Within three categories of empowerment, information was extracted and synthesized: resources, agency, and achievement. Accessing and distributing resources for household childcare is a challenge. Agency is a process of women's empowerment that includes mobility, decision-making, authority, motivation, skill, knowledge, and mother's role, all of which can help mothers improve their children's nutrition. The well-being of family members, nutritional status, and anthropometric rise as age progresses are all benefits of women's empowerment.
 Women's empowerment was found to be connected with nutritional status WAZ, HAZ, WHZ, and child anthropometry in general, however the data were inconsistent. These inconsistencies were most likely caused by population features, situations, or methods/ conceptualizations of women's empowerment, as well as the specific domains researched. This study also found that different categories of women's empowerment may have varied relationships with child nutrition. Future study should focus on harmonizing definitions of women's empowerment, as well as determining which essential dimensions it should contain and how it should be quantified. In order to determine which policies and programs enhance women's empowerment and, as a result, foster child nutritional well-being, rigorous evaluation work is also required.

Clinical outcomes of dental treatment under general anesthesia and its effects on the caries activity and body growth of children: a 2-year retrospective study.

To analyze clinical outcomes of dental treatment under general anesthesia (DGA) and its effects on children's caries activity status and body growth within 2years after the treatment. The case data and 2-year follow-up records of children who underwent DGA from February 2017 to February 2018 were collected and analyzed. The general characteristics of the sample, the success rates of treatment procedures, the caries recurrence rate, the caries activity test scores, and the BMI of all the children were described. The caries activity levels between children with and without caries recurrence at 24months after DGA were compared before and after DGA to explore the relationship between caries activity level and caries recurrence. The correlation between BMI level and caries recurrence was explored using Cox regression analysis. A total of 94 children consisting of 46 boys and 48 girls were included in this study. The average dmft score before DGA was 13.90. Within 2years after the treatment, composite fillings and strip crowns of the anterior teeth achieved similar success rates, around 90%; SSCs showed a similar success rate to composite fillings of posterior teeth (P = 1.000); the clinical success rate of pulpectomy was 90.43%. All the children showed no caries relapse at 1month after DGA. The number of children with caries relapse at 6-, 12-, and 24-month post-treatment was 24 (25.53%), 35 (37.23%), and 53 (56.38%), respectively. The caries activity scores at each follow-up were significantly lower than those before the treatment (P < 0.0001). Children with caries relapse within 2years after DGA showed no significantly different caries activity scores than children without caries relapse before and after the treatment. The proportion of children with normal BMI at 12months after DGA was significantly higher than that before DGA (P = 0.007), and the difference was still very significant at 24months after DGA (P < 0.0001). Statistical results showed a correlation between BMI level before DGA and caries recurrence (P < 0.001). Dental treatment under general anesthesia achieves acceptable clinical outcomes in this study. Children's caries activity scores decrease significantly. Low or high BMI levels before DGA drift towards normal after the treatment. Acceptable outcomes are achieved within 2years after dental treatment under general anesthesia. However, children with abnormal BMI before the treatment tend to have caries relapse.

Pattern and Profile of Co-Sleeping in School-Aged Children

This cross-sectional study was conducted among parents of children aged 5-12 years to determine the prevalence and pattern of co-sleeping among children,and sleep problems associated with it. Out of 275 children, 269 (97.8%) co-slept. Among co-sleepers, bed-sharers were 131 (48.7%) and room-sharers 138 (51.3%). Factors associated with bed-sharing were child's age and socio-economic status. Wake-up resistance and night terrors were more in bed-sharing children.

Stages, risk factors and prevention of early childhood caries

Early childhood caries is a common condition that affects children and young infants. In addition to the effect of the condition on the child's oral health, it has been furtherly shown that many systemic consequences are usually associated. Therefore, it has been reported that these conditions can significantly impair the quality of life of corresponding families based on economic and health-related burdens. Affected children usually present with variable degrees of the condition, and some complications might be associated. Many risk factors have been reported in the literature for developing the condition in children. These include the presence of certain bacterial pathogens (especially through vertical transmission), dietary habits, and poor oral hygiene. Evidence indicates that these risk factors significantly contribute to the development of early childhood caries and the importance of the child's socioeconomic status and his caregivers. Targeting these factors would significantly reduce the risk of developing the condition, in addition to fluoridation as suggested by various relevant investigations.

The Oxidative status in Children with Autism receiving Melatonin

Objectives: To determine the changes in the levels of Malondialdehyde (MDA) and antioxidant enzymes such as superoxide dismutase (SOD) and catalase (CAT) in autistic children receiving melatonin supplementation to evaluate its antioxidant role in autism. Methods: A follow-up study was carried out in the Department of therapeutics and clinical pharmacy, Baghdad College of Medical Sciences, Baghdad - Iraq. The study was performed on 55 autistic children who had recruited from several private institutions specialized in autistic children care, Baghdad, Iraq between June 2018 and November 2018. The levels of melatonin, MDA, SOD and CAT were measured in the serum of 55 patients before and after receiving melatonin supplementation for three months. Results: The results revealed statistically significant differences in the levels of melatonin, MDA, SOD and CAT between patients before and after receiving melatonin supplement. Furthermore, melatonin levels showed significant positive correlations with both SOD and CAT in addition to a significant positive correlation between SOD and CAT while MDA levels showed significant negative correlations with melatonin, SOD and CAT in autistic patients before and after receiving the supplement. Conclusions: Melatonin levels, CAT and SOD activity showed to be improved significantly by melatonin supplementation with a concomitant reduction in the levels of MDA as an indicator of a decrease in an oxidative stress in autistic children.

Predictive model for intra-familial child maltreatment re-reports and recurrence in South Korea: Analysis of national child protection services case records

BackgroundChild maltreatment recurrence has a significant negative impact on child well-being and may indicate low effectiveness of child protection services (CPS). In South Korea, 10.4% of child maltreatment cases in 2016 had previous CPS involvement. Identifying and understanding significant predictors of child maltreatment re-reports and recurrence has been a critical task in maltreatment research. However, this task has rarely been attempted in South Korea. ObjectiveThis study aimed to examine child maltreatment re-reports and recurrence among children involved in CPS in Korea, identify correlates of child maltreatment re-reports and recurrence with predictors, and explore the consistency or inconsistency of correlates between re-reports and recurrence. MethodsThe present study analyzed 5349 case records from the National Child Maltreatment Data System, which included information collected by Korean CPS regarding maltreatment, child, parent or perpetrator, and service characteristics. ResultsResults showed that the recurrence rate was 5.9% over the two-year period. In contrast to previous studies, neglect was not found to be a significant predictor of recurrence. Perpetrators' problem-solving skills and survival stress, as well as children's disability status, were significant predictors of recurrence. Receiving welfare assistance was a significant predictor of re-reports (AOL = 1.42, p < 0.01) but not a significant predictor of recurrence. ConclusionCompared to other empirical studies conducted in several countries, we found similarities and differences regarding predictors of child maltreatment re-reports and recurrences. The results reiterate the importance of family intervention to prevent maltreatment recurrence.

Salivary Antioxidant Capacity and Oral Health Status in Children with Visual Impairments—A Cross-Sectional Study

Abstract Background Children with visual impairment are at a higher risk for developing dental disease, and imbalances in the antioxidant levels may play an important role in the development and management of oral diseases. Aim Our aim was to evaluate and compare the oral health status and salivary total antioxidant capacity (TAC) in children with and without visual impairment. Methods Oral health was evaluated among 6 to 11 years old children with and without visual impairment (50 each) using World Health Organization oral health assessment form for caries prevalence, gingival health, and oral hygiene levels. Unstimulated saliva was collected and assayed for TAC using the phosphomolybdic method. Statistical Analysis The data collected were tabulated, and the results, thus, obtained were subjected to statistical analysis using EZR software—version 1.37. The variables between the two groups were compared using the Mann–Whitney U test and Fisher's exact test. A correlation test was done using Spearman's correlation test. Results The mean TAC levels among children with and without visual impairment were 49.17 (±25.702) and 156.67 (±56.031) µg/mL, respectively, which was statistically significant (p &lt; 0.001). The children with visual impairment showed a significantly higher number of carious lesions compared with the control group (p &lt; 0.001). Oral hygiene status and gingival health status were significantly poorer in children with visual impairments than the children in the control group (p &lt; 0.001). Conclusions Oral health was significantly poorer, and salivary TAC levels were significantly lower in children with visual impairment. There may be an inverse correlation between salivary TAC and oral health status. Clinical Significance: Since these children have been shown to have poorer oral health status, a baseline assessment of their salivary antioxidant capacity may indicate the need to reinforce oral care efforts and supplement them using an antioxidant-rich diet.

Clinical parameters influencing the results of anterior rhinomanometry in children.

Nasal obstruction is a frequent symptom in both adults and children and it is a common reason to see an otorhinolaryngologist. Endoscopy of the nasal cavity and the epipharyngeal space along with anterior rhinomanometry is regarded the gold standard since many years to estimate the severity of nasal obstruction in the particular patient. Endoscopy shows anatomical reasons for an obstruction, whereas the nasal flow volume and nasal resistance can be determined using anterior rhinomanometry. Currently, there are only few data available for rhinomanometry results in children. The purpose of the present study was to evaluate the application of this technique in the pediatric population for objective evaluation of nasal flow. Whether it achieves reproducible results and which clinical parameters have some influence on the results were studied. 427 children (average age of 8.5years, range 7months through 17years) who were admitted to evaluate nasal patency or for allergy testing were examined. After clinical examination and endoscopy of the nasal cavity and epipharyngeal space, anterior rhinomanometry was performed before and after application of decongestant nose drops separately for each nose side in 334 children. The nasal flow with a pressure of 150 Pasc was measured and served for statistical evaluation. Flow values were correlated to clinical and endoscopic parameters along with results of allergy tests (prick tests). Reproducible rhinomanometric measurements were possible in children age 3years and older. However, the standard deviation and variation of measurements were significant in this cohort of patients. Statistically highest significant correlations were found between flow measurements and body height along with the age of the children (p < 0.01) and status following adenoidectomy (p < 0.05). No statistically significant correlations were found between rhinomanometry and results of prick tests. The study demonstrates that rhinomanometry can be applied in the pediatric population for objective evaluation of nasal obstruction and for determining the effects of decongestant nose drops. The highest correlation was found between nasal flow and children's body height, children's age and status following adenoidectomy. The correlation between nasal flow and clinically/endoscopically determined degree of nasal obstruction was lower. However, definition of normal flow values for particular age groups is challenging since the results showed high variation and standard deviation. Yet with regard to individual patient, the technique achieves reliable results in nasal provocation tests, which are widely used for allergy testing in children. When performed in children it should always be considered that there are age-specific requirements for the examination and interpretation of results in this patient cohort.

Screen Time, Age and Sunshine Duration Rather Than Outdoor Activity Time Are Related to Nutritional Vitamin D Status in Children With ASD.

Objective: This study aimed to investigate the possible association among vitamin D, screen time and other factors that might affect the concentration of vitamin D in children with autism spectrum disorder (ASD).Methods: In total, 306 children with ASD were recruited, and data, including their age, sex, height, weight, screen time, time of outdoor activity, ASD symptoms [including Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS) and Autism Diagnostic Observation Schedule–Second Edition (ADOS-2)] and vitamin D concentrations, were collected. A multiple linear regression model was used to analyze the factors related to the vitamin D concentration.Results: A multiple linear regression analysis showed that screen time (β = −0.122, P = 0.032), age (β = −0.233, P < 0.001), and blood collection month (reflecting sunshine duration) (β = 0.177, P = 0.004) were statistically significant. The vitamin D concentration in the children with ASD was negatively correlated with screen time and age and positively correlated with sunshine duration.Conclusion: The vitamin D levels in children with ASD are related to electronic screen time, age and sunshine duration. Since age and season are uncontrollable, identifying the length of screen time in children with ASD could provide a basis for the clinical management of their vitamin D nutritional status.

Propofol context-sensitive decrement times in children.

Plasma drug concentration is the variable linking dose to effect. The decrement time required for plasma concentration of anesthetic agents to decrease by 50% (context-sensitive half-time) correlates with the time taken to regain consciousness. However, the decrement time to consciousness may not be 50%. An effect compartment concentration is associated more closely with return of consciousness than plasma concentration. An alternative decrement time, the time required for propofol to decrease to a predetermined effect compartment concentration associated with movement (eg, 2µg.ml-1 ), was used to simulate time for the concentration to decrease from steady state at a typical targeted effect compartment concentration 3.5µg.ml-1 in children. These times were short and reflected a decrement time to consciousness (CSTAWAKE ) increase that was small with longer infusion time. CSTAWAKE ranged from 7.5min in 1-year-old infant given propofol for 15min to 13.5min in a 15-year-old adolescent given a 2-hour infusion. Changes in decrement time with age reflect maturation of drug clearance. Neonates had prolonged increment times, 10min after 15min infusion and 18min after 120min infusion using a target concentration of 3.5µg.ml-1 . Decrement times to a targeted arousal concentration are context-sensitive. Use of a higher target concentration of 6µg.ml-1 doubled decrement times. Decrement times are associated with variability: delayed recovery beyond these simulated times is likely more attributable to the use of adjuvant drugs or the child's clinical status. An understanding of propofol decrement times can be used to guide recovery after anesthesia.

Penggunaan Kontrasepsi pada Perempuan dengan HIV di Dunia

Background: HIV infection is a public health problem. In 2019, more than 38 million people were living with HIV, and more than 1.7 million people contracted HIV. On the other hand, it was reported that infant morbidity and mortality remained high, with more than 160,000 infants contracting HIV and more than 100,000 dying from AIDS-related causes. Increased access and improved service programs to control HIV transmission from mother to child are in line with the increasing number of pregnant women with HIV. Women with HIV and their partners need to plan carefully before deciding to have children. Women living with HIV and their partners need to take advantage of services that provide information and contraceptive tools to prevent unplanned pregnancies. The study aimed to understand how HIV-infected women chose contraceptives.Method: Search for articles with a systematic review using four databases consisting of Pubmed, Science Direct, Sage, and Emerald Insight with a publication range of 2017-2020. The keywords used were contraceptive use AND HIV women. The inclusion criteria used were women with HIV aged 15-49 years and used a cross-sectional design.Results: The findings indicated that injections, condoms, and implants were the most common methods of contraception used by women with HIV. Motivation for contraceptive use in women with HIV is influenced by age, marital status, knowledge, number of children, education, previous history of contraceptive use, history of childbirth, lack of fertility desires, income, residence, CD4 count, child's HIV status and partner's HIV status.

Subclinical Hypothyroidism as the Most Common Thyroid Dysfunction Status in Children With Down's Syndrome.

IntroductionThyroid dysfunctions are one of the most common abnormalities coexisting in children with Down’s syndrome (DS) and have been reported in up to 54% of cases.Aim of the StudyThe purposes of this retrospective study were to investigate the course of subclinical hypothyroidism in children with DS, to evaluate the thyroid function of these subjects in relation to the risk of developing overt thyroid disease and autoimmunity, and to identify clinical and biochemical characteristics of patients prescribed L-T4 therapy in children and adolescents with DS and SH.Material and MethodsThe records of DS patients referred to the Endocrinology Outpatient Clinic between 2010 and 2015 for screening of thyroid function were observed till the end of 2019 June and analyzed retrospectively. The children diagnosed with congenital hypothyroidism, acute lymphoblastic leukemia, and seizures and treated with drugs that may have interfered with thyroid function like lithium, antiepileptic, or iodinated drugs and glucocorticoids were excluded from the study.ResultsThe data of 77 DS patients were collected, evaluated, and analyzed. The study group consisted of 73 patients (32 girls and 41 boys with the mean age at baseline of 3.0 ± 4.5 years). A total of 63/73 (87%) children were diagnosed with SH. The 16/63 (25.4%) patients were followed-up without the treatment (group SH-T0), and therapy with levothyroxine (L-T4) was introduced in 47/63 (74.6%) SH children with a mean dosage of 1.8 ± 1.0 μg/kg/day (group SH-T1). Thyroxine supplementation did not improve growth expressed as ΔhSDS (0.1 ± 1.3, ranged −2.1 to 3.8 in SH-T0 vs. 0.0 ± 0.7, ranged −1.7 to 1.4 in SH-T1, p = 0.96) and ΔBMI Z-score (0.3 ± 0.9, ranged −0.9 to 2.6 in SH-T0 vs. 0.3 ± 1.1, ranged −2.1 to 2.9 in SH-T1, p = 0.65). Positive anti-TPO and anti-TG antibodies were detected in 7/63 (11.1%) DS cases.ConclusionsSH is the most frequent presentation of thyroid gland dysfunction in DS children. A small percentage of patients develop an overt hypothyroidism, particularly in females with mostly positive titer of antithyroid autoantibodies.