Treatment Of School-age Children Research Articles

دراسة مبنية على المجتمع لانتشار البلهارسيا البولية وعوامل اختطارها في مديرتين موبؤتين في محافظة تعز-اليمن

Background: Schistosomiasis is still a major public health problem despite launching preventive chemotherapy campaigns (using Praziquantel) through yearly treatment of school-age children since 2008. Objective: To conclude: prevalence, contributing factors, intensity for Schistosoma Haematobium in Al-Shmaytin & Al-Mwaset districts-Taiz, Yemen. Methods: a cross-sectional study, data on age, sex, marital status, income, education, location, water contact, medical history (MH), urine test results (filtration method used to detect S. haematobium &concentration methods for the detection of infection intensities), were gathered using structured questionnaires between March & April 2021. Sample size calculated using appropriate formula. 298 individuals selected by systematic random sampling. Informed consent obtained. For statistical analysis, SPSS version 24 is used. For “p”-values, the statistical significance was set at 0.05. Results: S. haematobium was found in 17 of 273 respondents, with a prevalence of 6.2%, higher in Al-Shmaytin (9.2%) than in Al-Mwaset (3.5%), and a light-intensity 59%. Adjusted Odds Ratio (AOR) for the following variables (95% confidence interval (CI)): district 3.7 (12 cases from Al-Shmaytin 9.2%), age 1.0 (13 cases from 6-18 years 7.8%), sex 2.8 (13 cases from female 7.4%), marital 0.3 (15 cases from single 8%), educational status 1.3 (15 cases from Illiterate/Essential School 6%), swimming/bathing 2.0 (13 cases 8.6%), wear shoes 0.4 (15 cases from those who do not wear shoes 8.1%), urinate near water 1.7 (8 cases 9.8%), family member with disease 1.0 (5 cases 7.1%), dysuria 1.7 (8 cases 8.3%), and receiving anti-schistosomiasis drugs 0.9 (9 cases among those didn’t receiving drugs 7%). All had low monthly incomes and no sanitation. Prevalent among: secondary school and higher (2, 8.7%), unaware of schistosomiasis (15, 7.4%), and unaware of prophylaxis (16, 7.1%). Conclusions: Hypo-endemic urinary schistosomiasis in study areas. Most patients from Alsafiah, females, 6-18 years, light-intensity, swimming/bathing, single, didn't receive Praziquantel®, urinated near water, had dysuria, didn't wear shoes, had diseased family members, lacked sanitation, were unaware of schistosomiasis and its prevention, lived near water sources, and had low monthly income.

Assessment of the quality of life of school-age children with asthma and sensitization to cat allergens

Background. The medical and social significance of asthma is emphasized by the impact on various aspects of children's lives — physical, emotional, social, educational. The aim of the study: to assess the quality of life of school-age children with asthma and sensitization to cat allergens in the dynamics of treatment. Materials and methods. The study included 128 children aged 6–17 years with asthma and sensitization to cat allergens. A mini-Pediatric Asthma Quality of Life Questionnaire (MiniPAQLQ) was used. Results. All patients have a decrease in quality of life, both overall and in the assessment of symptoms, emotional function and activity. Overall quality of life is inversely correlated with the severity of asthma. There was a statistically significant difference between the overall quality of life after 12 months of treatment in children who received allergen-specific immunotherapy on the background of basic therapy and in children who received only basic therapy in favor of allergen-specific immunotherapy. The same dynamics is indicated according to symptoms, emotional function and activity. A direct correlation between overall quality of life and allergen-specific immunotherapy has been shown. Conclusions. In schoolchildren with asthma and sensitization to cat allergens, there is a decrease in quality of life. Against the background of basic therapy, their positive dynamics is observed, which is statistically significant, except for the assessment of symptoms in children with severe asthma. The inclusion of allergen-specific immunotherapy in the complex treatment of school-age children with asthma and sensitization to cat allergens to improve the quality of life of patients is justified.

Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-Age Children: Trends and Disparities During the COVID-19 Pandemic.

The aim of this study was to assess rates of primary care provider (PCP) diagnosis and treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) during the COVID-19 pandemic compared with prepandemic years and to investigate disparities in care. We retrospectively analyzed electronic health records from all primary care visits (in-person and telehealth) of children aged 6 to 17 years seen between January 2016 and March 2021 in a community-based primary health care network (n = 77,298 patients). Study outcomes are as follows: (1) number of primary care visits, (2) number of visits with ADHD diagnosis (ADHD-related visits), (3) number of PCP prescriptions for ADHD medications, (4) number of patients with first ADHD diagnoses, and (5) number of first PCP prescriptions of ADHD medications. Interrupted time series analysis evaluated changes in rates of study outcomes during 4 quarters of the pandemic year (March 15, 2020-March 15, 2021) compared with prepandemic years (January 1, 2016-March 14, 2020). Patient demographic characteristics during prepandemic and pandemic years were compared. ADHD-related visits dropped in the first quarter of the pandemic year by 33% (95% confidence interval, 22.2%-43.6%), returning to prepandemic rates in subsequent quarters. ADHD medication prescription rates remained stable throughout the pandemic year. Conversely, rates of first ADHD diagnoses and first medication prescriptions remained significantly lower than prepandemic rates. The proportion of ADHD-related visits for patients living in low-income neighborhoods was lower in the pandemic year compared with prepandemic years. Ongoing treatment for school-age children with ADHD was maintained during the pandemic, especially in high-income families. Socioeconomic differences in ADHD-related care emphasize the need to improve access to care for all children with ADHD in the ongoing pandemic and beyond.

Effects of Parent-Teacher Training on Academic Performance and Parental Anxiety in School-Aged Children With Attention-Deficit/Hyperactivity Disorder: A Cluster Randomized Controlled Trial in Shanghai, China.

Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common chronic neurodevelopmental disorder in childhood, placing a heavy burden on family and society. The treatment of school-aged children with ADHD emphasizes multimodal interventions, but most current research focuses solely on parent training and family functioning. The aim of this study was to examine the effect of parent-teacher training on academic performance and parental anxiety. In an open-label cluster randomized controlled trial from January 2018 to January 2019, 14 primary schools in Shanghai were randomly assigned into the intervention group and the control group, and ADHD screening was conducted for students from grades one to five. Children in both groups received medication as prescribe by their pediatricians. In the intervention group, families and teachers also received parent-teacher training. The training included ADHD behavioral interventions for parents, as well as classroom management skills for teachers. This study screened 9,295 students, 99 children in the control group and 105 children in the intervention group were included in the analysis. The intervention group demonstrated significant improvement in ADHD symptoms and academic performance and decreases in parent stress compared to that in the control group (P < 0.05). This training improved the parents’ perception of ADHD knowledge, treatment options, and drug side effects awareness (P < 0.05). Our study aims to underscore the suitability of such programs in the local nuances of the Chinese context, show application feasibility to pediatricians and psychiatrists, and provide supporting evidence for their utilization within the country’s health and educational systems.

Malaria parasite species composition of Plasmodium infections among asymptomatic and symptomatic school-age children in rural and urban areas of Kinshasa, Democratic Republic of Congo

BackgroundMalaria remains a major public health concern in the Democratic Republic of Congo (DRC), and school-age children are relatively neglected in malaria prevalence surveys and may constitute a significant reservoir of transmission. This study aimed to understand the burden of malaria infections in school-age children in Kinshasa/DRC.MethodsA total of 634 (427 asymptomatic and 207 symptomatic) blood samples collected from school-age children aged 6 to 14 years were analysed by microscopy, RDT and Nested-PCR.ResultsThe overall prevalence of Plasmodium spp. by microscopy, RDT and PCR was 33%, 42% and 62% among asymptomatic children and 59%, 64% and 95% in symptomatic children, respectively. The prevalence of Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale spp. by PCR was 58%, 20% and 11% among asymptomatic and 93%, 13% and 16% in symptomatic children, respectively. Among P. ovale spp., P. ovale curtisi, P. ovale wallikeri and mixed P. ovale curtisi + P. ovale wallikeri accounted for 75%, 24% and 1% of infections, respectively. All Plasmodium species infections were significantly more prevalent in the rural area compared to the urban area in asymptomatic infections (p < 0.001). Living in a rural as opposed to an urban area was associated with a five-fold greater risk of asymptomatic malaria parasite carriage (p < 0.001). Amongst asymptomatic malaria parasite carriers, 43% and 16% of children harboured mixed Plasmodium with P. falciparum infections in the rural and the urban areas, respectively, whereas in symptomatic malaria infections, it was 22% and 26%, respectively. Few children carried single infections of P. malariae (2.2%) and P. ovale spp. (1.9%).ConclusionSchool-age children are at significant risk from both asymptomatic and symptomatic malaria infections. Continuous systematic screening and treatment of school-age children in high-transmission settings is needed.

Does Virtual Reality Affect Children’s Dental Anxiety, Pain, And Behaviour? A Randomised, Placebo-Controlled, Cross-Over Trial

Objective: To evaluate the effect of virtual reality (VR) on dental anxiety, pain, and behaviour at different time points among children undergoing dental treatment under local anaesthesia. Material and Methods: This randomised, two‐armed, within-subject, cross-over, placebo-controlled trial included 76 children. Eligible participants were treated in two dental visits using the following methods: with protective glasses only, without distraction (attention placebo-controlled - APC); and with the treatment condition (i.e., VR). Primary outcomes were dental anxiety and pain; secondary outcome was dental visit behaviour. Heart rate scores were recorded as an objective measure to evaluate dental anxiety and pain. Subjective measurements for each variable were also performed. Results: Significant reduction in dental pain and anxiety was observed in the VR group, according to the heart rate scores; however, no statistical differences were observed according to the self-reported measures. Decreased dental anxiety and pain were associated with the first visit sequence with VR. Dental pain and anxiety scores were lower during local anaesthesia in the VR group than in the APC group. Conclusion: Virtual reality significantly reduced pain and anxiety during local anaesthesia in children undergoing dental treatment; therefore, it may be recommended during dental treatment in school-age children.

Effectiveness of a Manual Therapy Program as Adjuvant Treatment for School-Age Children With Attention-Deficit/Hyperactivity Disorder: A Randomized Pilot Study

Attention-deficit/hyperactivity disorder (ADHD) is a neurobiological disorder. Common symptoms are inattention, hyperactivity, impulsivity, and executive functions deficit, often with comorbidities. Main treatment involves pharmacological and non-pharmacological therapies (cognitive-behavioral therapy, psycho-pedagogical programs). Emerging non-pharmacological treatments include manual therapies (MTs) in mental health. Several MT techniques have shown effectiveness in ADHD. The objectives of this study are as follows: (a) to assess short-term effects and persistence of an MT program on neuropsychological (hyperactivity index through the Conners’ Global Index [CGI]) and neurophysiological (time–frequency domain parameters of heart rate variability [HRV]) variables in ADHD children, and (b) to test the feasibility of the design. This study was approved by the Parc Tauli Corporation Clinical Research Ethics Board (#2017311). Pilot, controlled, multidisciplinary study of eight children with ADHD randomly assigned to control group (CG; n = 4) and intervention group (IG; n = 4). Both followed multimodal treatment, and IG also received an MT program per week for 4 weeks. A physiotherapist and a psychologist analyzed short-term effects (1-week post-program) and persistence (36 weeks). Eight children (boys, 62.5%; girls, 37.5%) with an average age of 10.375 ± 0.74 years were included. Baseline HRV parameters showed basal sympathetic predominance. The MT program increased the parasympathetic activity, which was significantly maintained at 1 to 36 weeks; there were no changes in CG. One-week post-program IG showed significant CGI reduction (–7 points, p = .016*), CG without changes ( p = .41), with significant differences CG – IG ( p = .0097*), and very large effect size ( d = 2.235); 36 weeks post-program showed no effects (IG, p = .293; CG, p = .247), without differences CG – IG ( p = .369). The MT program reduced the hyperactivity index with a 1-week persistence and increased the parasympathetic activity with a 36-week persistence. More investigations are needed to generalize the outcomes. Additional research is planned to further explore the possibilities of MT in psychiatric disorders with autonomic imbalances.

Epidemiology of intestinal helminthiases in a rural community of Ethiopia: Is it time to expand control programs to include Strongyloides stercoralis and the entire community?

BackgroundSoil transmitted helminths are highly prevalent worldwide. Globally, approximately 1.5 billion people are infected with Ascaris lumbricoides, Trichuris trichiura or hookworm. Endemic countries carry out periodic mass treatment of at-risk populations with albendazole or mebendazole as a control measure. Most prevalence studies have focused on school aged children and therefore control programs are implemented at school level, not at community level. In this study, the prevalence of intestinal helminths, including Strongyloides stercoralis, was examined using a comprehensive laboratory approach in a community in north-western Ethiopia.MethodsA cross-sectional survey was conducted on 792 individuals ≥5 years old in randomly selected houses in a rural district. Stools were examined using three techniques: a formol-ether concentration, the Baermann technique and a real time polymerase chain reaction test (these last two specific for S. stercoralis). Statistical analyses were performed between two large age groups, children (≤14 years old) and adults (≥15 years old).ResultsThe prevalence of helminths was 91.3%; (95% CI: 89.3–93.3%). Hookworm was the most prevalent, 78.7% (95% CI 75.6–81.4%), followed by S. stercoralis 55.7% (95% CI 52.2–59.1%). Co-infection with both was detected in 45.4% (95% CI 42.0–49.0%) of the participants. The mean age of hookworm-infected individuals was significantly higher than non-infected ones (p = 0.003). Also, S. stercoralis infection was significantly associated with age, being more prevalent in adults (p = 0.002).ConclusionsThis is the highest prevalence of S. stercoralis detected in Ethiopia so far. Our results highlight the need of searching specifically for infection by this parasite since it usually goes unnoticed if helminth studies rely only on conventional diagnostic techniques, i.e. Kato-Katz. Moreover, the focus of these programs on children undermines the actual prevalence of hookworm. The adult population acts as a reservoir for both hookworm and S. stercoralis and this fact may negatively impact the current control programs in Ethiopia which only target treatment of school aged children. This reservoir, together with a lack of adequate water, sanitation and hygiene, increases the probability of re-infection in children. Finally, the high prevalence of S. stercoralis found calls for a comprehensive diagnostic approach in endemic areas in addition to a revision of control measures that is, adding ivermectin to current albendazole/mebendazole, since it is the drug of choice for S. stercoralis.

Evaluation of the efficacy of drug treatment based on measurement of the oxidative stress, using reactive oxygen metabolites and biological antioxidant potential, in children with autism spectrum disorder and attention deficit hyperactivity disorder

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disorder, mainly characterized by impairment of social communication and restricted interests. ASD is frequently accompanied by attention deficit hyperactivity disorder (ADHD), which is characterized by carelessness, hyperactivity and impulsivity (ASD/ADHD). It has been suggested that ASD and ADHD are associated with oxidative stress, that is, that patients with ASD/ADHD are in a state of increased oxidative stress. There are currenr tly no objective or biological test criteria for evaluating the efficacy of drug therapy in these patients. The purpose of this study was to evaluate whether oxidative stress markers [serum reactive oxygen metabolites (d-ROMs) levels and biological antioxidant potential (BAP)] can be used as objective indicators for evaluating the efficacy of drug treatment in ASD/ADHD patients.MethodsThe subjects of this study subjects were 50 Japanese patients with ASD/ADHD aged 4 to 14 years old. Serum samples were obtained from the patients to measure the serum levels of d-ROMs and the serum BAP. The study subjects were divided into two age groups: preschool children (4 to 6 years old) and school-age children (7 to 14 years old), and the serum levels of d-ROMs, serum BAP, serum BAP/d-ROMs ratio (hereinafter, the prefix serum will be dropped), and scores on the Parent-interview ASD Rating Scales-Text Revision (PARS-TR) and ADHD Rating Scale (ADHD-RS) were determined before and after drug therapy and compared between the two groups. In addition, changes in the d-ROMs, BAP and BAP/d-ROMs ratio and changes in the scores on the PARS-TR and ADHD-RS after treatment were also analyzed.ResultsSignificant decrease of the d-ROMs, BAP, and scores on the PARS-TR and ADHD-RS, with a significant increase of the BAP/d-ROMs ratio, was observed after treatment. In addition, a significant correlation was observed between the changes in the d-ROMs and changes in the scores on the PARS-TR and ADHD-RS after treatment in the school-age ASD/ADHD children.ConclusionOur results suggest the possibility that the serum level of d-ROMs may be useful as an objective assessment marker to supplement the subjective assessment of the effects of drug treatment in school-age children with ASD/ADHD.

Links between sleep and daytime behaviour problems in children with Down syndrome.

In the general population, sleep problems have an impact on daytime performance. Despite sleep problems being common among children with Down syndrome, the impact of sleep problems on daytime behaviours in school-age children with Down syndrome is an understudied topic. Our study examined the relationship between parent-reported and actigraphy-measured sleep duration and sleep quality with parent and teacher reports of daytime behaviour problems among school-age children with Down syndrome. Thirty school-age children with Down syndrome wore an actigraph watch for a week at home at night. Their parent completed ratings of the child's sleep during that same week. Their parent and teacher completed a battery of measures to assess daytime behaviour. Parent reports of restless sleep behaviours on the Children's Sleep Habits Questionnaire, but not actigraph-measured sleep efficiency, was predictive of parent and teacher behavioural concerns on the Nisonger Child Behaviour Rating Form and the Vanderbilt ADHD Rating Scales. Actigraph-measured sleep period and parent-reported sleep duration on the Children's Sleep Habits Questionnaire was predictive of daytime parent-reported inattention. Actigraph-measured sleep period was predictive of parent-reported hyperactivity/impulsivity. The study findings suggest that sleep problems have complex relationships to both parent-reported and teacher-reported daytime behaviour concerns in children with Down syndrome. These findings have implications for understanding the factors impacting behavioural concerns and their treatment in school-age children with Down syndrome.

ESCAschool study: trial protocol of an adaptive treatment approach for school-age children with ADHD including two randomised trials

BackgroundThe ESCAschool study addresses the treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) in a large multicentre trial. It aims to investigate three interrelated topics: (i) Clinical guidelines often recommend a stepped care approach, including different treatment strategies for children with mild to moderate and severe ADHD symptoms, respectively. However, this approach has not yet been empirically validated. (ii) Behavioural interventions and neurofeedback have been shown to be effective, but the superiority of combined treatment approaches such as medication plus behaviour therapy or medication plus neurofeedback compared to medication alone remains questionable. (iii) Growing evidence indicates that telephone-assisted self-help interventions are effective in the treatment of ADHD. However, larger randomised controlled trials (RCTs) are lacking. This report presents the ESCAschool trial protocol. In an adaptive treatment design, two RCTs and additional observational treatment arms are considered.MethodsThe target sample size of ESCAschool is 521 children with ADHD. Based on their baseline ADHD symptom severity, the children will be assigned to one of two groups (mild to moderate symptom group and severe symptom group). The adaptive design includes two treatment phases (Step 1 and Step 2). According to clinical guidelines, different treatment protocols will be followed for the two severity groups. In the moderate group, the efficacy of telephone-assisted self-help for parents and teachers will be tested against waitlist control in Step 1 (RCT I). The severe group will receive pharmacotherapy combined with psychoeducation in Step 1. For both groups, treatment response will be determined after Step 1 treatment (no, partial or full response). In severe group children demonstrating partial response to medication, in Step 2, the efficacy of (1) counselling, (2) behaviour therapy and (3) neurofeedback will be tested (RCT II). All other treatment arms in Step 2 (severe group: no or full response; moderate group: no, partial or full response) are observational.DiscussionThe ESCAschool trial will provide evidence-based answers to several important questions for clinical practice following a stepped care approach. The adaptive study design will also provide new insights into the effects of additional treatments in children with partial response.Trial registrationGerman Clinical Trials Register (DRKS) DRKS00008973. Registered 18 December 2015.

Assessing the interruption of the transmission of human helminths with mass drug administration alone: optimizing the design of cluster randomized trials

BackgroundA method is outlined for the use of an individual-based stochastic model of parasite transmission dynamics to assess different designs for a cluster randomized trial in which mass drug administration (MDA) is employed in attempts to eliminate the transmission of soil-transmitted helminths (STH) in defined geographic locations. The hypothesis to be tested is: Can MDA alone interrupt the transmission of STH species in defined settings? Clustering is at a village level and the choice of clusters of villages is stratified by transmission intensity (low, medium and high) and parasite species mix (either Ascaris, Trichuris or hookworm dominant).ResultsThe methodological approach first uses an age-structured deterministic model to predict the MDA coverage required for treating pre-school aged children (Pre-SAC), school aged children (SAC) and adults (Adults) to eliminate transmission (crossing the breakpoint in transmission created by sexual mating in dioecious helminths) with 3 rounds of annual MDA. Stochastic individual-based models are then used to calculate the positive and negative predictive values (PPV and NPV, respectively, for observing elimination or the bounce back of infection) for a defined prevalence of infection 2 years post the cessation of MDA. For the arm only involving the treatment of Pre-SAC and SAC, the failure rate is predicted to be very high (particularly for hookworm-infected villages) unless transmission intensity is very low (R0, or the effective reproductive number R, just above unity in value).ConclusionsThe calculations are designed to consider various trial arms and stratifications; namely, community-based treatment and Pre-SAC and SAC only treatment (the two arms of the trial), different STH transmission settings of low, medium and high, and different STH species mixes. Results are considered in the light of the complications introduced by the choice of statistic to define success or failure, varying adherence to treatment, migration and parameter uncertainty.

Organizational skills training, neurofeedback, and/or pharmacotherapy in the treatment of school-aged children with attention-deficit hyperactivity disorder

<br><b>Background</b> Attention deficit hyperactivity disorder (ADHD) is the most common developmental and neurobehavioral disorder in childhood. It is characterized by hyperactivity, impulsivity, and/or inattention.<br><b>Objective</b> To study the efficacy of implementation of different interventional modalities including medication (MED; atomoxetine) either alone or in combination with behavioral therapy (organization skills training; OST) or cognitive training (neurofeedback training; NFT) in alleviation of the core symptoms of ADHD and its comorbid conduct problem among school-aged children with ADHD.<br><b>Participants and methods</b> This was a multigroup design study with preassessment and postassessment with the Arabic form of Conners’ Parent Rating Scale short form (CPRS-48). Participants were 45 school-aged children (age range from 6 to 10 years) with a diagnosis of ADHD according to the <i>Diagnostic and Statistical Manual of Mental Disorders</i>-5 diagnostic criteria. Children were recruited from the Pediatric Behavioral Outpatient Clinic of Alexandria University Children Hospital, Alexandria, Egypt, and they were allocated into the groups: group OST and MED (<i>n</i>=15); group NFT and MED (<i>n</i>=15); and group MED (<i>n</i>=15).<br><b>Results</b> Combined OST and MED showed a significant decrease in hyperactivity/impulsivity (<i>P</i>=0.011) and comorbid conduct problem scores (<i>P</i>=0.030) on postinterventional assessment with CPRS-48. However, no statistically significant difference was found among the other studied groups, groups NFT and MED or group MED, either on ADHD core symptoms or its comorbid conduct problem.<br><b>Conclusion</b> Combined OST and MED showed significant efficacy in the alleviation of ADHD core symptoms and comorbid conduct problem.<br>

Writing Process Products in Intermediate-Grade Children With and Without Language-Based Learning Disabilities.

Difficulties with written expression are an important consideration in the assessment and treatment of school-age children. This study evaluated how intermediate-grade children with and without written language difficulties fared on a writing task housed within the Hayes and Berninger (2014) writing process framework. Sixty-four children completed a writing task whereby they planned, wrote, and revised a narrative story across 3 days. Children had extended time to produce an outline, first draft, and final copy of their story. Language transcription approaches were used to obtain measures reflecting writing productivity, complexity, accuracy, and mechanics, in addition to measures of planning and revision. Results indicated that children with writing difficulties produced poorer quality stories compared with their peers yet were not significantly different across all measures. Children with typical development produced longer stories with better spelling accuracy. Writing process measures predicted significant amounts of variance in writing quality across the sample. Writing should be considered as part of language assessment and intervention, whether as the sole language difficulty or alongside difficulties with speaking, listening, or reading in children with language-based learning difficulties. Implications for translation of research to practice and service delivery are provided.

Assessment of global guidelines for preventive chemotherapy against schistosomiasis and soil-transmitted helminthiasis: a cost-effectiveness modelling study

WHO guidelines recommend annual treatment for schistosomiasis or soil-transmitted helminthiasis when prevalence in school-aged children is at or above a threshold of 50% and 20%, respectively. Separate treatment guidelines are used for these two helminthiases, and integrated community-wide treatment is not recommended. We assessed the cost-effectiveness of changing prevalence thresholds and treatment guidelines under an integrated delivery framework. We developed a dynamic, age-structured transmission and cost-effectiveness model that simulates integrated preventive chemotherapy programmes against schistosomiasis and soil-transmitted helminthiasis. We assessed a 5-year treatment programme with praziquantel (40 mg/kg per treatment) against schistosomiasis and albendazole (400 mg per treatment) against soil-transmitted helminthiasis at 75% coverage. We defined strategies as highly cost-effective if the incremental cost-effectiveness ratio was less than the World Bank classification for a low-income country (gross domestic product of US$1045 per capita). We calculated the prevalence thresholds for cost-effective preventive chemotherapy of various strategies, and estimated treatment needs for sub-Saharan Africa. Annual preventive chemotherapy against schistosomiasis was highly cost-effective in treatment of school-aged children at a prevalence threshold of 5% (95% uncertainty interval [UI] 1·7-5·2; current guidelines recommend treatment at 50% prevalence) and for community-wide treatment at a prevalence of 15% (7·3-18·5; current recommendation is unclear, some community treatment recommended at 50% prevalence). Annual preventive chemotherapy against soil-transmitted helminthiasis was highly cost-effective in treatment of school-aged children at a prevalence of 20% (95% UI 5·4-30·5; current guidelines recommend treatment at 20% prevalence) and the entire community at 60% (35·3-85·1; no guidelines available). When both helminthiases were co-endemic, prevalence thresholds using integrated delivery were lower. Using this revised treatment framework, we estimated that treatment needs would be six times higher than WHO guidelines for praziquantel and two times higher for albendazole. An additional 21·3% (95% Bayesian credible interval 20·4-22·2) of the population changed from receiving non-integrated treatment under WHO guidelines to integrated treatment (both praziquantel and albendazole). Country-specific economic differences resulted in heterogeneity around these prevalence thresholds. Annual preventive chemotherapy programmes against schistosomiasis and soil-transmitted helminthiasis are likely to be highly cost-effective at prevalences lower than WHO recommendations. These findings support substantial treatment scale-up, community-wide coverage, integrated treatment in co-endemic settings that yield substantial cost synergies, and country-specific treatment guidelines. Doris Duke Charitable Foundation, Mount Sinai Hospital-University Health Network AMO Innovation Fund, and Stanford University Medical Scholars Programme.

Successful Control of Soil-Transmitted Helminthiasis in School Age Children in Burkina Faso and an Example of Community-Based Assessment via Lymphatic Filariasis Transmission Assessment Survey.

BackgroundBurkina Faso is endemic with soil-transmitted helminth infections. Over a decade of preventive chemotherapy has been implemented through annual lymphatic filariasis (LF) mass drug administration (MDA) for population aged five years and over, biennial treatment of school age children with albendazole together with schistosomiasis MDA and biannual treatment of pre-school age children through Child Health Days. Assessments were conducted to evaluate the current situation and to determine the treatment strategy for the future.Methodology/Principal FindingsA cross-sectional assessment was conducted in 22 sentinel sites across the country in 2013. In total, 3,514 school age children (1,748 boys and 1,766 girls) were examined by the Kato-Katz method. Overall, soil-transmitted helminth prevalence was 1.3% (95% CI: 1.0–1.8%) in children examined. Hookworm was the main species detected, with prevalence of 1.2% (95% CI: 0.9–1.6%) and mean egg counts of 2.1 epg (95% CI: 0–4.2 epg). Among regions, the Centre Ouest region had the highest hookworm prevalence of 3.4% (95% CI: 1.9–6.1%) and mean egg counts of 14.9 epg (95% CI: 3.3–26.6 epg). A separate assessment was conducted in the Centre Nord region in 2014 using community-based cluster survey design during an LF transmission assessment survey (TAS). In this assessment, 351 children aged 6–7 years and 345 children aged 10–14 years were examined, with two cases (0.6% (95% CI: 0.2–2.1%)) and seven cases (2.0% (95% CI: 1.0–4.1%)) of hookworm infection was identified respectively. The results using both age groups categorized the region to be 2% to <10% in STH prevalence according to the pre-defined cut-off values.Conclusions/SignificanceThrough large-scale preventive chemotherapy, Burkina Faso has effectively controlled STH in school age children in the country. Research should be conducted on future strategies to consolidate the gain and to interrupt STH transmission in Burkina Faso. It is also demonstrated that LF TAS provides one feasible and efficient platform to assess the STH situation for post LF MDA decision making.

A Comprehensive View of Stuttering: Implications for Assessment and Treatment

Comprehensive assessment and treatment for school-age children who stutter is critical in effectively managing the affective, behavioral, and cognitive components of the disorder. Using a framework established by the World Health Organization's (WHO's) International Classification of Functioning, Disability, and Health (ICF; WHO, 2001), this paper provides specific assessment and treatment goals for working with school-age children who stutter. It is meant to be a practical guide for clinicians working in the school setting.

Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. It is unclear whether the diagnosis includes children with different aetiologies for their pain. For the majority no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended.To determine the effectiveness of dietary interventions for recurrent abdominal pain in school-age children.The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched . Where appropriate, search filters were employed. Researchers working in this area were asked to identify relevant studies.Randomised or quasi-randomised studies of any dietary treatment versus placebo or no treatment in school-age children with a diagnosis of RAP or functional gastrointestinal disorder based on the Rome II criteria.Two authors independently assessed trials for inclusion, assessed quality and extracted data. Where appropriate studies were pooled using a random effects meta-analysis.Seven trials were included in this review. Two trials, including 83 participants, compared fibre supplements with placebo (Christensen 1982, Feldman 1985), with data from one study reported in two papers (Christensen 1982, Christensen 1986). The pooled odds ratio for improvement in the frequency of abdominal pain was 1.26 (0.25, 6.29). Two trials, including 90 participants (Lebenthal 1981, Dearlove 1983) compared lactose-containing with lactose-free diets. Neither reported data in a form which could be used in the meta-analysis and the former trial had a loss to follow-up of 45%. We were not able to obtain further data for either trial. Three trials (Bausserman 2005, Gavronska 2007, Young 1997) comparing supplementation with Lactobacillus with placebo met the inclusion criteria but only two (Bausserman 2005, Gavronska 2007), including a total of 168 children, provided analysable data. The pooled odds ratio for improvement of symptoms was 1.17 (95% CI 0.62, 2.21).There is a lack of high quality evidence on the effectiveness of dietary interventions. This review provides no evidence that fibre supplements, lactose free diets or lactobacillus supplementation are effective in the management of children with RAP.

Epidemiologic Models, Key Logs, and Realizing the Promise of WHA 54.19

Epidemiologic Models, Key Logs, and Realizing the Promise of WHA 54.19

The clinical efficacy of prophylactic therapy of the bronchial asthma in children with an early and late onset of the disease

The results of the clinical efficacy of basic treatment of school-age children with bronchial asthma have been presented. It has been found that patients with an early-onset phenotype of asthma had a higher risk of not gaining control over the symptoms of the disease (odds ratio – 6,0) and exacerbations (odds ratio – 2,7) compared with children whose disease set in after six years.