Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013: Findings From the Global Burden of Disease 2013 Study

The Declaration of the National Emergency in Child and Adolescent Mental Health: It Takes a Village

Recognition of the high prevalence of children's mental health conditions and challenges to accessing needed care faced by children and their families have been long-standing concerns, emerging well before the onset of the COVID-19 pandemic. Global data examining the prevalence of at least one mental health and/or substance-use disorder for 2516 million people aged 5 to 24 years in 2019 found that at least 293 million people were affected by at least one mental health disorder and 31 million affected by a substance-use disorder.

Factors influencing the road accidents in low and middle-income countries: a systematic literature review

This paper studies the main factors affecting road traffic accidents (RTAs) using a systematic review. The primary focus is on factors related to road characteristics and driver behaviours. This review also addresses the socioeconomic and demographic factors to provide a clear overview of which groups suffer the most from RTAs. Several factors were found to affect RTAs, notably road characteristics: highways, high-speed roads, unplanned intersections and two-way roads without dividers; driver behaviours: reckless/aggressive driving and riding, excessive speeding, unawareness of traffic laws, and not using safety equipment; and vehicle types: four and two-wheeled. This review found that male and economically productive people with less education were mostly associated with RTAs. In addition, for most of the low and middle-income countries analyzed, there is a lack of quality data relating to RTAs. Nevertheless, this review provides researchers and policy makers with a better understanding of road accidents for improving road safety.

Epidemiological and clinical characteristics of hospitalized unintentional injuries among children in central China from 2017-2023

Objectives

To examine the epidemiological and clinical characteristics of hospitalized unintentional injuries among children in Central China and theoretically propose preventive and control measures.

Methods

We conducted a retrospective study of children aged 0-18 years with unintentional injuries who were admitted to a tertiary hospital in Central China from January 2017 to December 2023. We examined various aspects of the unintentional injuries, including age, gender, urban-rural distribution, external causes, trends, location of injury, cost, and length of stay.

Results

A total of 20,166 children with hospitalized unintentional injuries were enrolled. The median age with IQR was 2.8 (1.6, 5.1) years, with majority of the patients (57.0%) were aged 1-3 years, while the fewest were aged 11-18 years. The male-to-female ratio was 1.8:1, and the urban-to-rural ratio was 1.1:1. The most common external causes were foreign bodies (41.7%), exposure to inanimate mechanical forces (25.1%), and falls (22.1%). The most frequently injured body parts were head (72.5%). The total number of unintentional injuries exhibited an increasing trend from 2017-2022, and a decreasing trend from 2022-2023. The urban-rural distribution reversed after 2020. The overall hospitalization cost was 20,810,870.4 USD, with an median cost of 758.7 (556.4, 1,186.2) USD per person.

Conclusion

Unintentional injuries imposed a heavy burden on society and families. However, the number of cases and the urban-rural distribution showed significant trend changes from 2017-2023. The external causes varied by age group, gender, and region, while prevention and control measures should be developed accordingly.

Impact of an injury hospital admission on childhood academic performance: a Welsh population-based data linkage study

BACKGROUND

While injuries can impact on children's educational achievements (with threats to their development and employment prospects), these risks are poorly quantified. This population-based longitudinal study investigated the impact of an injury-related hospital admission on Welsh children's academic performance.

METHODS

The Secure Anonymised Information Linkage databank, 55 587 children residing in Wales from 2006 to 2016 who had an injury hospital admission (58.2% males; 16.8% born in most deprived Wales area; 80.1% one injury hospital admission) were linked to data from the Wales Electronic Cohort for Children. The primary outcome was the Core Subject Indicator reflecting educational achievement at key stages 2 (school years 3-6), 3 (school years 7-9) and 4 (school years 10-11). Covariates in models included demographic, birth, injury and school characteristics.

RESULTS

Educational achievement of children was negatively associated with: pedestrian injuries (adjusted risk ratio, (95% CIs)) (0.87, (0.83 to 0.92)), cyclist (0.96, (0.94 to 0.99)), high fall (0.96, (0.94 to 0.97)), fire/flames/smoke (0.85, (0.73 to 0.99)), cutting/piercing object (0.96, (0.93 to 0.99)), intentional self-harm (0.86, (0.82 to 0.91)), minor traumatic brain injury (0.92, (0.86 to 0.99)), contusion/open wound (0.93, (0.91 to 0.95)), fracture of vertebral column (0.78, (0.64 to 0.95)), fracture of femur (0.88, (0.84 to 0.93)), internal abdomen/pelvic haemorrhage (0.82, (0.69 to 0.97)), superficial injury (0.94, (0.92 to 0.97)), young maternal age (<18 years: 0.91, (0.88 to 0.94); 19-24 years: 0.94, (0.93 to 0.96)); area based socioeconomic status (0.98, (0.97 to 0.98)); moving to a more deprived area (0.95, (0.93 to 0.97)); requiring special educational needs (0.46, (0.44 to 0.47)). Positive associations were: being female (1.04, (1.03 to 1.06)); larger pupil school sizes and maternal age 30+ years.

CONCLUSION

This study highlights the importance on a child's education of preventing injuries and implementing intervention programmes that support injured children. Greater attention is needed on equity-focused educational support and social policies addressing needs of children at risk of underachievement, including those from families experiencing poverty. VIBES-JUNIOR STUDY PROTOCOL: http://dx.doi.org/10.1136/bmjopen-2018-024755.

Temporal Trends of Physical Fights and Physical Attacks Among Adolescents Aged 12-15 years From 30 Countries From Africa, Asia, and the Americas

PURPOSE

There is a scarcity of literature on temporal trends in physical fighting and physical attacks among the global adolescent population. Therefore, we aimed to examine these trends in a nationally representative sample of school-going adolescents aged 12-15 years from 30 countries in Africa, Asia, and the Americas, for which temporal trends of physical fighting and physical attacks are largely unknown.

METHODS

Cross-sectional data from the Global School-based Student Health Survey 2003-2017 were analyzed. Self-reported data on past 12-month physical fights and physical attacks were collected. For each survey, the prevalence and 95% confidence interval of physical fights and physical attacks were calculated. Linear regression models were used to examine crude linear trends.

RESULTS

Data on 190,493 students aged 12-15 years were analyzed [mean (standard deviation) age 13.7 (1.0) years; 48.9% boys]. The mean prevalence of past 12-month physical fight and physical attack was 36.5% and 37.2%, respectively. Significant decreasing trends in physical fights were observed in 16/30 countries, while significant increasing trends were found in 2/30 countries. For physical attacks, significant decreasing and increasing trends were observed in 13/26 and 1/26 countries, respectively. The remaining countries showed stable trends.

DISCUSSION

It is encouraging that decreasing trends in physical fighting and physical attacks were observed across a large number of countries. However, stable trends were also common, while increasing trends also existed, suggesting that global efforts to address adolescent violence are still required.

Profile of Pediatric Neurosurgery in Nigeria from 1962 to 2021: A Systematic Review

OBJECTIVE

This study aims to provide a comprehensive overview of pediatric neurosurgery in Nigeria, since 1962, by assessing epidemiological data, management strategies, and case outcomes.

METHODS

A systematic bibliometric review of Nigerian neurosurgical literature was reported with the PRISMA guidelines. The Risk of Bias Assessment Tool was applied to all nonrandomized studies, and a descriptive analysis was performed for all variables.

RESULTS

We identified 12,295 pediatric patients from 196 published studies. Most publications (72.4%) occurred in the recent 2 decades, of which 40.3% were observational case reports/series. The patients were predominantly male (57.2%) and aged 0-18 years, with the majority (66.1%) belonging to the 0-5 age range. Most patients (63.4%) presented between 1-12 months. The most common presenting feature was altered consciousness (7.7%), with computed tomography (38.8%) being the most frequently utilized diagnostic imaging modality. The diagnoses with the greatest prevalence (60.2%) were congenital abnormalities such as hydrocephalus and neural tube defects. 57.5% of cases received surgical therapy, with ventriculoperitoneal shunt placement being the most noticeable procedure performed (36.4%). Complications were identified in 9.5% of cases, with a 4.5% death rate. The Glasgow Outcome Score (95.7%) was the primary outcome measure utilized, with positive outcomes reported in 59.3% of cases.

CONCLUSIONS

This review provides significant epidemiological data which emphasizes the country's enormous burden of pediatric neurosurgical cases. The findings can help guide clinical decisions as well as future research and policy development.

Should echocardiogram be undertaken routinely when a child has severe iron deficiency anaemia?

Iron deficiency anaemia (IDA) is common in children. Treatment usually consists of oral iron therapy and, if severe, inpatient hospitalisation with blood transfusion. Providers may also undertake an echocardiogram, depending on availability and the severity of anaemia. A male toddler with nutritional IDA, haemoglobin of 1.7 g/dL (the lowest level in the literature) and hypertension had left ventricular hypertrophy (LVH) on the initial echocardiogram. He was managed acutely with judicious blood transfusion, followed by oral iron supplementation and anti-hypertensive medication at discharge. Repeat echocardiogram a month later demonstrated slight improvement of the LVH but the hypertension persisted at follow-up 6 months later. There was complete resolution of the findings a year later. In chronic nutritional IDA, there can be structural cardiac changes which can affect the acute management and requires close follow-up. It is important to use echocardiography in such severe cases.Abbreviations: CHF: congestive heart failure; CM: cardiomyopathy; DCM: dilated cardiomyopathy; ICU: intensive care unit; IDA: iron deficiency anaemia; IVSd: interventricular septum in diastole; LA: left atrium; LV: left ventricle; LVEDD: left ventricular end-diastolic diameter; LVH: left ventricular hypertrophy; LVM: left ventricular mass; LVPWd: left ventricular posterior wall end-diastole; PRBC: packed red blood cells.

The Minhang Pediatric Biobank cohort study: protocol overview and baseline characteristics

BACKGROUND

Little has been done to establish biobanks for studying the environment and lifestyle risk factors for diseases among the school-age children. The Minhang Pediatric Biobank (MPB) cohort study aims to identify factors associated with health and diseases of school-aged children living in the urban or suburban area of Shanghai.

METHODS

This population-based cohort study was started in all sub-districts/towns of Minhang district of Shanghai in 2014. First-grade students in elementary school were enrolled during the time of their routine physical examinations, with self-administered questionnaires completed by their primary caregivers. Additional information was extracted from multiple health information systems. Urine and saliva samples were collected during the baseline survey and follow-up visits.

RESULTS

At the end of 2014 academic year, a total number of 8412 children and their parents were recruited, including 4339 boys and 4073 girls. All the participants completed the baseline survey and physical examination, and 7128 urine and 2767 saliva samples were collected. The five most prevalent childhood diseases in this population were dental caries, bronchitis, pneumonia, asthma and overweight/obese.

CONCLUSIONS

The MPB cohort has been successfully established, serving as a useful platform for future research relating to the genetic, environmental and lifestyle risk factors for childhood diseases.

Epidemiological study of pediatric nutritional deficiencies: an analysis from the global burden of disease study 2019

BACKGROUND

Nutritional deficiencies (ND) continue to threaten the lives of millions of people around the world, with children being the worst hit. Nevertheless, no systematic study of the epidemiological features of child ND has been conducted so far. Therefore, we aimed to comprehensively assess the burden of pediatric ND.

METHODS

We analyzed data on pediatric ND between 1990 and 2019 from the Global Burden of Disease study (GBD) 2019 at the global, regional, and national levels. In addition, joinpoint regression models were used to assess temporal trends.

RESULTS

In 2019, the number of prevalent cases of childhood malnutrition increased to 435,071,628 globally. The global age-standardized incidence, prevalence, and DALY rates showed an increasing trend between 1990 and 2019. Meanwhile, the burden of child malnutrition was negatively correlated with sociodemographic index (SDI). Asia and Africa still carried the heaviest burden. The burden and trends of child malnutrition varied considerably across countries and regions. At the age level, we found that malnutrition was significantly more prevalent among children < 5 years of age.

CONCLUSION

Pediatric ND remains a major public health challenge, especially in areas with low SDI. Therefore, primary healthcare services in developing countries should be improved, and effective measures, such as enhanced pre-school education, strengthened nutritional support, and early and aggressive treatment, need to be developed.

Concurrence of anemia and stunting and associated factors among children aged 6 to 59 months in Peru

Anemia and stunting are two health problems in the child population; therefore, their concurrence needs to be quantified. We estimated the prevalence of concurrent anemia and stunting (CAS) in children aged 6-59 months and identified the factors associated with this condition. The data came from the Demographic and Health Survey of Peru (DHS), 2022. The study design was cross-sectional and included 19,191 children. Height and hemoglobin measurement followed the specifications of National Health Institute of Peru. To reduce error in measures, the anthropometry personnel was training, the quality of measuring equipment was ensuring, and protocolized techniques and procedures was applying. Hemoglobin concentration was measured in capillary blood using the Hemocue model Hb 201+. Stunting was defined as a height-for-age Z-score less than minus two standard deviations (SD) from the median, following the 2006 WHO child growth standard. Anemia was classified into mild (10.0 to 10.9 g/dL), moderate (7.0 to 9.9 g/dL), severe (< 7.0 g/dL), and no anemia (11.0 to 14.0 g/dL). We performed a bivariate analysis to evaluate factors associated with CAS. To include variables in the multivariate analysis, we applied a statistical criterion (p < 0.10 in the crude analysis) and an epidemiological criterion. We used a binary logistic hierarchical regression model. The prevalence of CAS was 5.6% (95%CI: 5.2 to 5.9). The modifiable factors associated with higher odds of CAS were: "poorest" (aOR: 3.87, 95%CI: 1.99 to 7.5) and "poorer" (aOR: 2.07, 95%CI: 1.08 to 3.98) wealth quintiles, mother with no formal education or primary (aOR: 2.03, 95%CI: 1.46 to 2. 81), father with no formal education or primary (aOR: 1.55, 95%CI: 1.16 to 2.07), no improved water source (aOR: 1.36, 95%CI: 1.10 to 1.68), no roof with improved material (aOR: 1.49, 95%CI: 1.12 to 1.98) and low birth weight (aOR: 7.31, 95%CI: 4.26 to 12.54). In Peru, five out of every 100 children suffer from anemia and stunting simultaneously; there are modifiable factors that, if addressed, could reduce their prevalence.

The burden attributable to primary headache disorders in children and adolescents in Ethiopia: estimates from a national schools-based study

BACKGROUND

We previously reported high prevalences of headache disorders among children (6-11 years) and adolescents (12-17 years) in Ethiopia. Here we provide data on headache-attributed burden collected contemporaneously from the same study participants. Part of the global schools-based programme within the Global Campaign against Headache, the study is the first to present such data from sub-Saharan Africa.

METHODS

A cross-sectional survey following the generic protocol for the global study was conducted in six schools (urban and rural), in Addis Ababa city and three regions of Ethiopia. The child or adolescent versions of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) structured questionnaires were self-completed under supervision by pupils in class. Headache diagnostic questions were based on ICHD-3 beta but for the inclusion of undifferentiated headache (UdH).

RESULTS

Of 2,349 eligible participants, 2,344 completed the questionnaires (1,011 children [43.1%], 1,333 adolescents [56.9%]; 1,157 males [49.4%], 1,187 females [50.6%]; participating proportion 99.8%). Gender- and age-adjusted 1-year prevalence of headache, reported previously, was 72.8% (migraine: 38.6%; tension-type headache [TTH]: 19.9%; UdH: 12.3%; headache on ≥ 15 days/month (H15+): 1.2%). Mean headache frequency was 2.6 days/4 weeks but, with mean duration of 2.7 h, mean proportion of time with headache was only 1.0% (migraine: 1.4%; TTH: 0.7%; H15+: 9.1%). Mean intensity was 1.8 on a scale of 1-3. Symptomatic medication was consumed on about one third of headache days across headache types. Lost school time reportedly averaged 0.7 days over the preceding 4 weeks, representing 3.5% of school time, but was 2.4 days/4 weeks (12.0%) in the important small minority with H15+. However, actual absences with headache the day before indicated averages overall of 9.7% of school time lost, and 13.3% among those with migraine. Emotional impact and quality-of-life scores reflected other measures of burden, with clear adverse impact gradients (H15 + > migraine > TTH > UdH).

CONCLUSIONS

The high prevalence of headache among children and adolescents in Ethiopia, who represent half its population, is associated with substantial burden. Lost school time is probably the most important consequence. Estimates suggest a quite deleterious effect, likely to be reflected in both individual prospects and the prosperity of society.

Transcranial doppler velocity in iron-deficient Nigerian children with sickle cell anemia

Oral iron supplementation in iron deficient children with sickle cell anemia and normal transcranial Doppler ultrasound (TCD) velocities does not reduce arterial flow in the middle cerebral artery.

Long-term variations of urban-Rural disparities in infectious disease burden of over 8.44 million children, adolescents, and youth in China from 2013 to 2021: An observational study

BACKGROUND

An accelerated epidemiological transition, spurred by economic development and urbanization, has led to a rapid transformation of the disease spectrum. However, this transition has resulted in a divergent change in the burden of infectious diseases between urban and rural areas. The objective of our study was to evaluate the long-term urban-rural disparities in infectious diseases among children, adolescents, and youths in China, while also examining the specific diseases driving these disparities.

METHODS AND FINDINGS

This observational study examined data on 43 notifiable infectious diseases from 8,442,956 cases from individuals aged 4 to 24 years, with 4,487,043 cases in urban areas and 3,955,913 in rural areas. The data from 2013 to 2021 were obtained from China's Notifiable Infectious Disease Surveillance System. The 43 infectious diseases were categorized into 7 categories: vaccine-preventable, bacterial, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. The calculation of infectious disease incidence was stratified by urban and rural areas. We used the index of incidence rate ratio (IRR), calculated by dividing the urban incidence rate by the rural incidence rate for each disease category, to assess the urban-rural disparity. During the nine-year study period, most notifiable infectious diseases in both urban and rural areas exhibited either a decreased or stable pattern. However, a significant and progressively widening urban-rural disparity in notifiable infectious diseases was observed. Children, adolescents, and youths in urban areas experienced a higher average yearly incidence compared to their rural counterparts, with rates of 439 per 100,000 compared to 211 per 100,000, respectively (IRR: 2.078, 95% CI [2.075, 2.081]; p < 0.001). From 2013 to 2021, this disparity was primarily driven by higher incidences of pertussis (IRR: 1.782, 95% CI [1.705, 1.862]; p < 0.001) and seasonal influenza (IRR: 3.213, 95% CI [3.205, 3.220]; p < 0.001) among vaccine-preventable diseases, tuberculosis (IRR: 1.011, 95% CI [1.006, 1.015]; p < 0.001), and scarlet fever (IRR: 2.942, 95% CI [2.918, 2.966]; p < 0.001) among bacterial diseases, infectious diarrhea (IRR: 1.932, 95% CI [1.924, 1.939]; p < 0.001), and hand, foot, and mouth disease (IRR: 2.501, 95% CI [2.491, 2.510]; p < 0.001) among gastrointestinal and enterovirus diseases, dengue (IRR: 11.952, 95% CI [11.313, 12.628]; p < 0.001) among vectorborne diseases, and 4 sexually transmitted and bloodborne diseases (syphilis: IRR 1.743, 95% CI [1.731, 1.755], p < 0.001; gonorrhea: IRR 2.658, 95% CI [2.635, 2.682], p < 0.001; HIV/AIDS: IRR 2.269, 95% CI [2.239, 2.299], p < 0.001; hepatitis C: IRR 1.540, 95% CI [1.506, 1.575], p < 0.001), but was partially offset by lower incidences of most zoonotic and quarantinable diseases in urban areas (for example, brucellosis among zoonotic: IRR 0.516, 95% CI [0.498, 0.534], p < 0.001; hemorrhagic fever among quarantinable: IRR 0.930, 95% CI [0.881, 0.981], p = 0.008). Additionally, the overall urban-rural disparity was particularly pronounced in the middle (IRR: 1.704, 95% CI [1.699, 1.708]; p < 0.001) and northeastern regions (IRR: 1.713, 95% CI [1.700, 1.726]; p < 0.001) of China. A primary limitation of our study is that the incidence was calculated based on annual average population data without accounting for population mobility.

CONCLUSIONS

A significant urban-rural disparity in notifiable infectious diseases among children, adolescents, and youths was evident from our study. The burden in urban areas exceeded that in rural areas by more than 2-fold, and this gap appears to be widening, particularly influenced by tuberculosis, scarlet fever, infectious diarrhea, and typhus. These findings underscore the urgent need for interventions to mitigate infectious diseases and address the growing urban-rural disparity.

Hemoglobin measurement in venous blood compared with pooled and single-drop capillary blood: a method-comparison study in a controlled and survey setting in Uganda among children and women

BACKGROUND

Standard practice for estimating anemia in population-based surveys is to use a point-of-care device to measure hemoglobin (Hb) in a single drop of capillary blood. Emerging evidence points to larger than expected differences in Hb concentration depending on the blood source.

OBJECTIVE

We evaluated use of different blood sources to measure Hb with a HemoCue 201+ analyzer compared with the reference method of venous blood tested with a Sysmex XN-450 hematology analyzer.

METHODS

Hb concentration in venous, pooled capillary, and single-drop capillary blood were collected in controlled (laboratory) and survey (Demographic Health Survey-8 pilot) settings in Uganda among children 6-59 mo and nonpregnant women 15-49 y. Venous and capillary blood collected from the same individual was tested using a HemoCue 201+ analyzer and the venous blood was also measured with a Sysmex XN-450 hematology analyzer. Agreement between measures was estimated using Lin's concordance correlation coefficient, Bland-Altman plots, and Deming regression. Means and prevalences were compared using paired t-tests and McNemar's tests, respectively.

RESULTS

The limits of agreement between Hb measured using a HemoCue 201+ analyzer and the reference method were lowest for venous (1.1-1.96 g/dL), followed by pooled capillary (1.45-2.27 g/dL), and single-drop capillary blood (2.23-3.41 g/dL). Mean differences were <0.5 g/dL across comparators. There were statistically significant differences in Hb concentration from both types of capillary blood. Anemia prevalence was lower in pooled capillary blood compared with the reference method.

CONCLUSIONS

The variability of Hb measured by capillary blood using the HemoCue 201+ analyzer is higher than venous blood but the extent to which this impacts the validity of Hb and anemia estimates requires further exploration. Future research is also needed to evaluate the implications of using venous compared with capillary blood in population-based surveys. This trial was registered at clinicaltrials.gov (NCT05059457).

Impact of Virtual Reality Simulation on New Nurses' Assessment of Pediatric Respiratory Distress

BACKGROUND

Children often experience respiratory illnesses requiring bedside nurses skilled in recognizing respiratory decompensation. Historically, recognizing respiratory distress has relied on teaching during direct patient care. Virtual reality simulation may accelerate such recognition among novice nurses.

OBJECTIVE

To determine whether a virtual reality curriculum improved new nurses' recognition of respiratory distress and impending respiratory failure in pediatric patients based on assessment of physical examination findings and appropriate escalation of care.

METHODS

New nurses (n = 168) were randomly assigned to complete either an immersive virtual reality curriculum on recognition of respiratory distress (intervention) or the usual orientation curriculum (control). Group differences and changes from 3 months to 6 months after the intervention were examined.

RESULTS

Nurses in the intervention group were significantly more likely to correctly recognize impending respiratory failure at both 3 months (23.4% vs 3.0%, P < .001) and 6 months (31.9% vs 2.6%, P < .001), identify respiratory distress without impending respiratory failure at 3 months (57.8% vs 29.6%, P = .002) and 6 months (57.9% vs 17.8%, P < .001), and recognize patients' altered mental status at 3 months (51.4% vs 18.2%, P < .001) and 6 months (46.8% vs 18.4%, P = .006).

CONCLUSIONS

Implementation of a virtual reality-based training curriculum was associated with improved recognition of pediatric respiratory distress, impending respiratory failure, and altered mental status at 3 and 6 months compared with standard training approaches. Virtual reality may offer a new approach to nurse orientation to enhance training in pediatrics-specific assessment skills.

Assessing the impact and implications of the revised Act on the Aggravated Punishment of Specific Crimes in preventing child traffic injuries in school zones in Korea: an interrupted time series analysis

In 2019, a child's death in Korea led to legislation that imposed stricter penalties for school zone traffic violations. We assessed the impact of that legislation using 2017-2022 Traffic Accident Analysis System data. Adjusted analyses revealed a significant decline in severe injuries in school zones, decreasing from 11 cases to 8 cases per month (p=0.017). The legislation correlated with a reduced risk of all child traffic injuries (risk ratio, 0.987; 95% confidence interval, 0.977 to 0.997; p=0.002), indicating its efficacy in curbing accidents.

Falls from height in children: epidemiology and outcome

INTRODUCTION

Childhood injury is one of the leading causes of death globally, with falls being the sixth leading cause. This study aimed to examine the demographics, patterns of injury and temporal risk factors for falls from height above 3 m in Singapore.

METHODS

This is a retrospective study conducted on patients who presented after a fall to a paediatric emergency department at a tertiary hospital between January 2011 and July 2017. Electronic medical records were reviewed to extract demographics and data on the patterns of injuries. Criteria for inclusion were patients under 18 years of age and the occurrence of fall from a height of 3 m or above.

RESULTS

A total of 149 children met the inclusion criteria. The median age was 10 years and 69.1% were boys. Death occurred in two (1.3%) cases; 84 (56.4%) were admitted and survived. Of those admitted, five (3.4%) required care in the intensive care unit and 11 (7.4%) required surgery. Falls occurred mostly at homes or residential buildings (n = 59, 39.6%). The two cases of mortality were due to falls from windows at homes. Twenty (33.9%) children fell from windows at homes, with two requiring admission to the intensive care unit.

CONCLUSION

Our study shows that falls from windows of homes are an important cause of mortality. Height of fall was also an important predictor of morbidity that led to a higher level of hospitalisation care. Preventive measures should be implemented to ensure safety in high-rise residential buildings to prevent paediatric falls from heights.

CA, Harmon B, Espinola JA, Reck Cechinel L, Batabyal R, Freishtat RJ, Hahn A. Bacterial small RNAs may mediate immune response differences seen in respiratory syncytial virus versus rhinovirus bronchiolitis

Bronchiolitis, a viral lower respiratory infection, is the leading cause of infant hospitalization, which is associated with an increased risk for developing asthma later in life. Bronchiolitis can be caused by several respiratory viruses, such as respiratory syncytial virus (RSV), rhinovirus (RV), and others. It can also be caused by a solo infection (e.g., RSV- or RV-only bronchiolitis) or co-infection with two or more viruses. Studies have shown viral etiology-related differences between RSV- and RV-only bronchiolitis in the immune response, human microRNA (miRNA) profiles, and dominance of certain airway microbiome constituents. Here, we identified bacterial small RNAs (sRNAs), the prokaryotic equivalent to eukaryotic miRNAs, that differ between infants of the 35th Multicenter Airway Research Collaboration (MARC-35) cohort with RSV- versus RV-only bronchiolitis. We first derived reference sRNA datasets from cultures of four bacteria known to be associated with bronchiolitis (i.e., Haemophilus influenzae, Moraxella catarrhalis, Moraxella nonliquefaciens, and Streptococcus pneumoniae). Using these reference sRNA datasets, we found several sRNAs associated with RSV- and RV-only bronchiolitis in our human nasal RNA-Seq MARC-35 data. We also determined potential human transcript targets of the bacterial sRNAs and compared expression of the sRNAs between RSV- and RV-only cases. sRNAs are known to downregulate their mRNA target, we found that, compared to those associated with RV-only bronchiolitis, sRNAs associated with RSV-only bronchiolitis may relatively activate the IL-6 and IL-8 pathways and relatively inhibit the IL-17A pathway. These data support that bacteria may be contributing to inflammation differences seen in RSV- and RV-only bronchiolitis, and for the first time indicate that the potential mechanism in doing so may be through bacterial sRNAs.

The novel LESS (low-cost entrainment syringe system) O2 blender for use in modified bubble CPAP circuits: a clinical study of safety

Background

Bubble continuous positive airway pressure (bCPAP) is used in resource-limited settings for children with respiratory distress. Low-cost modifications of bCPAP use 100% oxygen and may cause morbidity from oxygen toxicity. We sought to test a novel constructible low-cost entrainment syringe system (LESS) oxygen blender with low-cost modified bCPAP in a relevant clinical setting.

Methods

We conducted a clinical trial evaluating safety of the LESS O2 blender among hospitalized children under five years old in rural Cambodia evaluating the rate of clinical failure within one hour of initiation of the LESS O2 blender and monitoring for any other blender-related complications.

Findings

Thirty-two patients were included. The primary outcome (clinical failure) occurred in one patient (3.1%, 95% CI = 0.1-16.2%). Clinical failure was defined as intubation, death, transfer to another hospital, or two of the following: oxygen saturation <85% after 30 min of treatment; new signs of respiratory distress; or partial pressure of carbon dioxide ≥60 mmHg and pH <7.2 on a capillary blood gas. Secondary outcomes included average generated FiO2's with blender use, which were 59% and 52% when a 5 mm entrainment was used vs. a 10 mm entrainment port with 5-7 cm H2O of CPAP and 1-7 L/min (LPM) of flow; and adverse events including loss of CPAP bubbling (64% of all adverse events), frequency of repair or adjustment (44%), replacement (25%), and median time of respiratory support (44 h).

Interpretation

Overall the LESS O2 blender was safe for clinical use. The design could be modified for improved performance including less repair needs and improved nasal interface, which requires modification for the blender to function more consistently.

Developmental differences in children's adaptation to vehicle distance and speed in street-crossing decision-making

INTRODUCTION

Young children cannot effectively adapt their behaviors to vehicles at varied distances and speeds, which is a critical cause of road accidents. However, the impact of this crucial ability on children's street-crossing decision-making and the age at which they acquire it remain unclear.

METHOD

This study examined the crossing decision-making behavior of children at 6, 8, and 11 years of age in facing 51 different videotaped traffic scenarios with varying vehicle distances and speeds. Sixty Chinese elementary school students, with 20 children evenly distributed into each of the three age groups (6 years, 8 years, and 11 years old), participated in a simulated street-crossing task using video projections. Hierarchical logistic regression models were used to analyze how age moderated the effects of vehicular motion factors (vehicle-pedestrian distance, vehicle speed) on children's crossing safety, including dangerous crossing and crossing decision-making.

RESULTS

The results showed that when either vehicle-pedestrian distance decreased or vehicle speed increased all age groups tended to cross less frequently but probability of dangerous crossing increased. Compared to 8-year-old and 11-year-old children, 6-year-old children showed a less pronounced tendency toward both of these crossing decision-making behaviors, and had more dangerous crossing outcomes.

CONCLUSIONS

These findings suggest that inadequate adaptation to vehicle-pedestrian distance and vehicle speed may partly contribute to the inferior safety of street-crossing behavior in 6-year-olds compared to 8-year-olds. No significant differences were observed between 8- and 11-year-old children, suggesting the turning point for this ability might occur between 6 and 8 years of age.

PRACTICAL APPLICATIONS

Preventive measures aimed to reduce crossing risks for children should consider children's developmental stages.

International pediatric transplant association (IPTA) guidance on developing and/or expanding pediatric solid organ transplantation programs in low- and middle-income countries

Pediatric solid organ transplantation (SOT) is a preferred treatment for medically suitable children with end-stage organ failure. Still, many of them have no access to transplantation owing to socioeconomic constraints or lack of transplant facilities in low- and middle-income countries (LMIC). Establishing pediatric SOT programs in LMIC offers children the opportunities to receive transplant care in more familiar home environments as well as help curtail transplant tourism and improve transplant outcomes as pediatric transplantation would be performed ethically and legally. The International Pediatric Transplant Association (IPTA) is a professional organization aiming to promote safe, ethical, and high-quality pediatric transplantation worldwide. This society paper describes major obstacles to pediatric SOT in LMIC and provides guidance on developing and/or expanding pediatric SOT programs in such countries. We also summarize available resources from the IPTA Outreach Program to help establish and support pediatric SOT programs in LMIC.

Types of On-Screen Content and Mental Health in Kindergarten Children

Importance

Excessive screen time has been associated with a higher risk for mental health problems, but whether the associations differ by screen content types is unclear.

Objective

To examine the allocation of and longitudinal changes in screen exposure across different content types and to explore their associations with mental health in children aged 3 to 6 years.

Design, Setting, and Participants

This cohort study used 3-wave, lagged generalized estimating equation models to analyze data from the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) study in Shanghai, China. The cohort was a representative sample of kindergarten children. Data were collected between November 2016 and May 2019 when children were aged 3 to 4 years (wave 1), 4 to 5 years (wave 2), and 5 to 6 years (wave 3). Data analysis was performed between June 2022 and May 2023.

Exposure

Screen exposure (total daily time and time with each type of content, including educational programs, entertainment programs, non-child-directed programs, electronic games, and social media) was collected when children were aged 3, 5, and 6 years.

Main Outcomes and Measures

Mental health of children at age 3, 5, and 6 years was reported by parents using the Strengths and Difficulties Questionnaire.

Results

Of the 15 965 children included in the representative sample, 8270 were males (51.7%) and the mean (SD) age at wave 1 was 3.73 (0.30) years. As children developed from ages 3 to 6 years, the proportion of screen exposure to educational programs (≤1 hour per day: 45.0% [95% CI, 43.5%-46.5%] to 26.8% [95% CI, 25.3%-28.3%]) and entertainment programs (≤1 hour per day: 44.4% [95% CI, 42.8%-45.9%] to 32.1% [95% CI, 30.4%-33.9%]) decreased, whereas exposure to social media increased (≤1 hour per day: 1.5% [95% CI, 1.2%-1.9%] to 27.1% [95% CI, 25.5%-28.7%]). The associations between on-screen content and mental health varied. For a given total screen time, a higher proportion of screen exposure to educational programs was associated with a lower risk for mental health problems (adjusted odds ratio [AOR], 0.73; 95% CI, 0.60-0.90), whereas non-child-directed programs were associated with a higher risk for such problems (AOR, 2.82; 95% CI, 1.91-4.18). Regardless of the content, total screen time was consistently associated with mental health problems.

Conclusions and relevance

Results of this study indicated that both total screen time and different types of content were associated with mental health problems in children aged 3 to 6 years. Limiting children's screen time, prioritizing educational programs, and avoiding non-child-directed programs are recommended.

Long-term effect of indomethacin on a rat model of neonatal hypoxia ischemic encephalopathy through behavioral tests

BACKGROUND

Many medical experts prescribe indomethacin because of its anti-inflammatory, analgesic, tocolytic, and duct closure effects. This article presents an evaluation of the enduring impact of indomethacin on neonatal rats with hypoxic-ischemic (HI) insults, employing behavioral tests as a method of assessment.

METHODS

The experiment was conducted on male Wistar-Albino rats weighing 10 to 15 g, aged between seven and 10 days. The rats were divided into three groups using a random allocation method as follows: hypoxic ischemic encephalopathy (HIE) group, HIE treated with indomethacin group (INDO), and Sham group. A left common carotid artery ligation and hypoxia model was applied in both the HIE and INDO groups. The INDO group was treated with 4 mg/kg intraperitoneal indomethacin every 24 h for 3 days, while the Sham and HIE groups were given dimethylsulfoxide (DMSO). After 72 h, five rats from each group were sacrificed and brain tissue samples were stained with 2,3,5-Triphenyltetrazolium chloride (TCC) for infarct-volume measurement. Seven rats from each group were taken to the behavioral laboratory in the sixth postnatal week (PND42) and six from each group were sacrificed for the Evans blue (EB) experiment for blood-brain barrier (BBB) integrity evaluation. The open field (OF) test and Morris water maze (MWM) tests were performed. After behavioral tests, brain tissue were obtained and stained with TCC to assess the infarct volume.

RESULTS

The significant increase in the time spent in the central area and the frequency of crossing to the center in the INDO group compared with the HIE group indicated that indomethacin decreased anxiety-like behavior (p < 0.001, p < 0.05). However, the MWM test revealed that indomethacin did not positively affect learning and memory performance (p > 0.05). Additionally, indomethacin significantly reduced infarct volume and neuropathological grading in adolescence (p < 0.05), although not statistically significant in the early period. Moreover, the EB experiment demonstrated that indomethacin effectively increased BBB integrity (p < 0.05).

CONCLUSIONS

In this study, we have shown for the first time that indomethacin treatment can reduce levels of anxiety-like behavior and enhance levels of exploratory behavior in a neonatal rat model with HIE. It is necessary to determine whether nonsteroidal anti-inflammatory agents, such as indomethacin, should be used for adjuvant therapy in newborns with HIE.

Utilization of Machine Learning Approaches to Predict Mortality in Pediatric Warzone Casualties

BACKGROUND

Identification of pediatric trauma patients at the highest risk for death may promote optimization of care. This becomes increasingly important in austere settings with constrained medical capabilities. This study aimed to develop and validate predictive models using supervised machine learning (ML) techniques to identify pediatric warzone trauma patients at the highest risk for mortality.

METHODS

Supervised learning approaches using logistic regression (LR), support vector machine (SVM), neural network (NN), and random forest (RF) models were generated from the Department of Defense Trauma Registry, 2008-2016. Models were tested and compared to determine the optimal algorithm for mortality.

RESULTS

A total of 2,007 patients (79% male, median age range 7-12 years old, 62.5% sustaining penetrating injury) met the inclusion criteria. Severe injury (Injury Severity Score > 15) was noted in 32.4% of patients, while overall mortality was 7.13%. The RF and SVM models displayed recall values of .9507 and .9150, while LR and NN displayed values of .8912 and .8895, respectively. Random forest (RF) outperformed LR, SVM, and NN on receiver operating curve (ROC) analysis demonstrating an area under the ROC of .9752 versus .9252, .9383, and .8748, respectively.

CONCLUSION

Machine learning (ML) techniques may prove useful in identifying those at the highest risk for mortality within pediatric trauma patients from combat zones. Incorporation of advanced computational algorithms should be further explored to optimize and supplement the diagnostic and therapeutic decision-making process.

A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain

ABSTRACT

Graded exposure treatment (GET) is a theory-driven pain treatment that aims to improve functioning by exposing patients to activities previously feared and avoided. Combining key elements of GET with acceptance-based exposure, GET Living (GL) was developed for adolescents with chronic pain (GL). Based on robust treatment effects observed in our single-case experimental design pilot trial of GL (NCT01974791), we conducted a 2-arm randomized clinical trial comparing GL with multidisciplinary pain management (MPM) comprised of cognitive behavioral therapy and physical therapy for pain management (NCT03699007). A cohort of 68 youth with chronic musculoskeletal pain (M age 14.2 years; 81% female) were randomized to GL or MPM. Owing to COVID-19 restrictions, 54% of participants received zoom video delivered care. Assessments were collected at baseline, discharge, as well as at 3-month and 6-month follow-up. Primary outcomes were self-reported pain-related fear and avoidance. Secondary outcomes were child functional disability and parent protective responses to child pain. As hypothesized, GL improved in primary and secondary outcomes at 3-month follow-up. Contrary to our superiority hypothesis, there was no significant difference between GL and MPM. Patients reported both GL and MPM (in person and video) as credible and were highly satisfied with the treatment experience. Next steps will involve examining the single-case experimental design data embedded in this trial to facilitate an understanding of individual differences in treatment responses (eg, when effects occurred, what processes changed during treatment within the treatment arm). The current findings support GET Living and MPM for youth with chronic pain.

Review of the India Adolescent Health Strategy in the context of disease burden among adolescents

Background

A nuanced understanding of the health needs of adolescents in the context of the India Adolescent Health Strategy (IAHS) is needed to inform policy interventions for improving the health and well-being of adolescents in India.

Methods

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we identified the top ten causes of years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) disaggregated by sex and age group (10-14 and 15-19 years) for India and its states in 2019. To inform the IAHS of refinement or expansion in focus needed to improve adolescent health in India, we reviewed the extent to which the top 10 causes of disease burden are addressed in the IAHS, and the availability of and age- and sex-disaggregation in the service utilisation data for adolescents captured in the Adolescent Friendly Health Clinic monitoring information system (AFHC MIS) and Health Management Information System (HMIS). We also reviewed the availability of and age-and sex-disaggregation in the data capture at the population level for the IAHS outcome indicators in the data sources identified in the IAHS operational framework.

Findings

Females in the 10-14 and 15-19 years age groups suffered 6.75 million and 9.25 million DALYs, respectively, 39.1% and 44.2% of which were YLLs; the corresponding DALYs for males were 6.71 million and 9.65 million (42.3% and 41.1% YLLs), respectively. Within the 6 thematic areas of the IAHS, most strategies and indicators identified are for sexual and reproductive health followed by nutrition, and broadly these conditions accounted for YLDs and not YLLs in adolescents. Significant gaps in the IAHS in comparison to the disease burden for fatal diseases and conditions were seen across injuries, communicable diseases, and non-communicable diseases. Injuries accounted for 65.9% and 45.3% of YLLs in males and females aged 15-19 years, and 40.8% in males aged 10-14 years. Specifically, road injuries (15.3%, 95% UI 11.0-18.0) and self-harm (11.3%, 95% UI 8.7-14.2) accounted for most of the injury deaths in 15-19 years whereas drowning (7.7% 95% UI 5.8-9.6) and road injuries (6.9%, 95% UI 4.7-8.6) accounted for the most injury deaths in 10-14 years males. However, only self-harm and gender-based violence are specifically addressed in the IAHS with non-specific interventions for other injuries. Diarrhoea, lower respiratory infections, malaria, encephalitis, tuberculosis, typhoid, cirrhosis, and hepatitis are the other disease conditions accounting for YLLs and DALYs in adolescents but these are neither addressed in the IAHS nor in service provision under the AFHC MIS. There is no age- or sex-disaggregation in the cause of death data captured in the HMIS to allow an understanding of mortality in adolescents. For the IAHS outcome indicators at the population level, data capture for the 10-14 years irrespective of sex was largely missing from the population surveys and none of the surveys captured data for either females or males aged 15-19 years for physical inactivity and mental health indicators.

Interpretation

The considerable differences seen in the IAHS thematic focus as compared with the leading causes of fatal and non-fatal disease burden in adolescents in India, and in the availability of population-level data to monitor the outcome indicators of the IAHS can pose substantial limitations for improving adolescent health in India. The findings in this paper can be utilized by decision makers to refine action aimed at improving adolescent health and well-being.

Funding

Bill & Melinda Gates Foundation.

Enhancing Pediatric Mental Health Care in an Outpatient Primary Care Setting Using the Keep Your Children/Yourself Safe and Secure (KySS) Program: A Multidisciplinary Quality Improvement Project

INTRODUCTION

This project aimed to enhance access to pediatric mental primary health care.

METHOD

The Keep Your Children/Yourself Safe and Secure (KySS) training was offered to a multidisciplinary team at a Federally Qualified Health Clinic in the Midwest United States. Confidence was measured using the Healthcare Provider Confidence Scale (HPCS). Frequencies of visits and mental health referrals were compared preintervention/postintervention. HPCS scores were compared using Wilcoxon rank-sum and Cohen's d.

RESULTS

Referrals in 2022 were greater than in 2020 but less than in 2021 (p = .25). The total number of visits declined from 431 in 2021 to 385 in 2022. HPCS (n = 9) scores trended higher following the KySS Program in prescribing and general positive beliefs.

DISCUSSION

Referrals to mental health providers increased, although not significantly. The number of mental health visits varied between 2020-2022. Provider confidence was not significantly affected, whereas beliefs in prescribing did increase significantly. More work is necessary to understand the impact of delivery to a multidisciplinary team.

Knockdown of Slfn5 alleviates lipopolysaccharide-induced pneumonia by regulating Janus kinase/signal transduction and activator of transcription pathway

Background

In recent years, the incidence of pneumonia has been increasing, which is the main cause of death and morbidity of children and the elderly in the world. Slfn5 is implicated in multiple cancers, and Slfn5 promotes epithelial-mesenchymal transition and metastasis in lung cancer. However, the influences of Slfn5 in pneumonia have not yet been completely cleared. Herein, we aimed to explore the underlying effects and regulatory mechanisms of Slfn5 in lipopolysaccharide (LPS)-induced pneumonia in mice and A549 cells.

Methods

Mice were intratracheally administered 5 mg/kg LPS to construct pneumonia model. In vitro, A549 cells were treated with 10 µg/mL LPS to construct cellular pneumonia model. Slfn5 expression was detected using immunohistochemistry and western blotting. Haematoxylin and eosin staining, TUNEL (terminal deoxynucleotidyl transferasemediated deoxyuridine triphosphate‑biotin nick end‑labelling), and western blotting were performed to assess pathological injury and inflammation. MTT [3(4,5‑dimethyl‑2‑thiazolyl)‑2,5‑diphenyl‑2‑H‑tetrazolium bromide], flow cytometry, and enzyme-linked immunosorbent assay analysis were performed to analyze cell viability, apoptosis, and inflammation. Gene set enrichment analysis was performed to explore the mechanism of Slfn5 in pneumonia.

Results

Slfn5 expression was upregulated in LPS-induced pneumonia in mice and A549 cells. In mice, knockdown of Slfn5 weakened LPS-induced lung injury and inflammation and decreased the expression of p-JAK2, p-JAK3, and p-STAT3. In LPS-stimulated A549 cells, downregulation of Slfn5 expression increased and Slfn5 overexpression decreased cell viability. Downregulation of Slfn5 expression decreased and Slfn5 overexpression increased cell apoptosis, inflammation and the expression of p-JAK2, p-JAK3, and p-STAT3. AG490, an inhibitor of the JAK/STAT pathway, reversed the damaging effects of Slfn5 overexpression.

Conclusions

In the LPS-induced pneumonia model, Slfn5 knockdown alleviated LPS-induced lung injury by regulating the JAK/STAT pathway.

The relationship between time spent on social media and adolescent alcohol use: a longitudinal analysis of the UK Millennium Cohort Study

BACKGROUND

To estimate the effect of social media use in 14 year olds on risk of and inequalities in alcohol use and binge drinking at 17 years.

METHODS

Using the UK-representative Millennium Cohort Study, the relationship between time spent on social media (assessed using questionnaires [n = 8987] and time-use-diaries [n = 2520]) with frequency of alcohol use in the past month and binge drinking was estimated using adjusted odds ratios (AORs) or adjusted relative risk ratios (ARRRs). Associations within low and high parental education groups were compared to examine effect modification. Analyses accounted for pre-specified confounders, baseline outcome measures (to address reverse causality), sample design, attrition and item-missingness (through multiple imputation).

RESULTS

Questionnaire-reported time spent on social media was associated with increased risk of alcohol use and binge drinking in a dose-response manner. Compared to 1-< 30 min/day social media users, 30 min-<1 h/day users were more likely to report alcohol use ≥6 times/month (ARRR 1.62 [95% confidence interval 1.20 to 2.20]) and binge drinking (AOR 1.51 [1.22 to 1.87]), as were 1-<2 h/day users (ARRR 2.61 [1.90 to 3.58]; AOR 2.06 [1.69 to 2.52]) and ≥2 h/day users (ARRR 4.80 [3.65 to 6.32]; AOR 3.07 [2.54 to 3.70]). Social media measured by time-use-diary was associated with higher risks, although not always demonstrating a dose-response relationship. The effect of social media use (vs no-use) on binge drinking was larger in the higher (vs lower) parental education groups. Analyses repeated in complete case samples, and with adjustment for baseline outcome measures revealed consistent findings.

CONCLUSIONS

Findings suggest social media use may increase risk of alcohol use and binge drinking. Regulatory action protecting adolescents from harmful alcohol-related social media content is necessary.

Evolving trends and burden of iron deficiency among children, 1990-2019: a systematic analysis for the global burden of disease study 2019

Objectives

We aimed to provide a timely, comprehensive, and reliable assessment of the burden of iron deficiency (ID) in children between 1990 and 2019 at the global, regional, and national levels to inform policymakers in developing locally appropriate health policies.

Methods

Data related to ID among children younger than 15 years old were analyzed by sex, age, year, socio-demographic index (SDI), and location according to the Global Burden of Disease Study 2019 (GBD 2019). Age-standardized rates were used to compare the burden between different regions and countries. Furthermore, the Joinpoint regression model was used to assess temporal trends from 1990 to 2019.

Results

In 2019, the number of prevalent cases and disability-adjusted life years (DALYs) for ID in children were 391,491,699 and 13,620,231, respectively. The global age-standardized prevalence and DALY rates for childhood ID in 2019 were 20,146.35 (95% confidence interval: 19,407.85 to 20,888.54) and 698.90 (466.54 to 1015.31) per 100,000, respectively. Over the past 30 years, the global prevalence of ID among children has been highest in low-SDI regions, particularly in Western Sub-Saharan Africa, South Asia, and Eastern Sub-Saharan Africa. Since 1990, the prevalence and DALY of ID in children have been declining in most geographic regions. Nationally, Ecuador, China, and Chile have shown the most significant decreases in prevalence. The greatest decline in age-standardized DALY rate was observed in Ecuador, while Burkina Faso experienced the highest increase. Bhutan had the highest prevalence and DALY rates in 2019. On the age level, the prevalence was relatively higher among the <5 years age group. At the gender dimension, the prevalence of ID in children overall was more pronounced in girls than in boys, as was the case for DALY.

Conclusion

Although the burden of ID in children has been declining, this disease remains a major public health problem, especially in countries with low SDI. Children younger than 5 years of age are an important group for whom targeted measures are needed to reduce the burden of ID.

Characteristics of injury mechanisms in children and differences between urban and rural areas in central China

BACKGROUND

Some studies lack detailed analyses of the differences and characteristics of pediatric injury mechanisms between urban and rural areas.

OBJECTIVE

We aim to understand the characteristics, trends, and mortality rates of injury mechanisms in children in urban and rural areas in central China.

RESULTS

In a study involving 15,807 pediatric trauma patients, it was observed that boys constituted the majority (65.4%) and those aged ≤ 3 years were the most prevalent (28.62%). Falls (39.8%), burns (23.2%), and traffic accidents (21.1%) were identified as the top three injury mechanisms. The head (29.0%) and limbs (35.7%) were found to be the most susceptible to injury. Additionally, children between the ages of 1-3 years exhibited a higher likelihood of sustaining burn injuries compared to other age groups. The main causes of burn injury were hydrothermal burns (90.3%), flame burns (4.9%), chemical burns (3.5%), and electronic burns (1.3%). In urban areas, the major injury mechanisms were falls (40.9%), traffic accidents (22.4%), burns (20.9%), and poison (7.1%), whereas, in rural areas, they were falls (39.5%), burns (23.8%), traffic accidents (20.8%), and penetration (7.0%). Over the past decade, the overall incidences of pediatric trauma have been decreasing. In the past year, the number of injured children was the highest in July, and the overall mortality rate due to trauma was 0.8%.

CONCLUSION

Our findings revealed that in different age groups, the injury mechanisms are different in urban and rural areas. Burns are the second leading cause of trauma in children. A decrease in pediatric trauma over the past 10 years indicates targeted measures and preventive intervention may effectively prevent pediatric trauma.

Rapid increases in BMI waist to height ratio during adolescence and subsequent neurobehavioral deficits

OBJECTIVE

The aim of this study was to explore prospective relationships between changing patterns of BMI/waist to height ratio (WHtR) during adolescence and subsequent neurobehavioral development.

METHODS

In this prospective cohort study, randomized stratified sampling was used to recruit six middle schools and 609 students in Shanghai, China. In Grades 6, 7, and 9, the Youth Self Report scale was used to assess student neurobehavioral status and anthropometric measurements were conducted to calculate BMI z scores and WHtRs. Longitudinal data were analyzed using latent class mixture modeling to delineate trajectories of BMI z scores ("stable," "decreasing," "rapidly increasing") and WHtRs ("stable," "rapidly increasing"), and their associations with neurobehavioral status in Grade 9 were assessed.

RESULTS

In Grades 6 through 9 (ages 11-15 years), the prevalence of overall obesity and abdominal obesity ranged from 10.7% to 13.0% and 13.0% to 19.8%, respectively. Compared with the stable BMI z score trajectory, the rapidly increasing BMI z score trajectory was longitudinally associated with delinquent behavior, aggressive behavior, and externalizing problems (incidence rate ratio: 1.564-1.613, adjusted p < 0.05). Compared with the stable WHtR trajectory, the rapidly increasing WHtR trajectory significantly predicted increased risks of social problems and delinquent behavior (incidence rate ratios: 1.776-1.967, adjusted p < 0.05). Significant associations of the rapidly increasing BMI z score/WHtR trajectories with subsequent neurobehavioral deficits were observed among girls (adjusted p < 0.05) but not among boys (adjusted p > 0.05).

CONCLUSIONS

Rapid increases in BMI or WHtR during adolescence could predict subsequent neurobehavioral deficits, especially for externalizing behaviors. Timely intervention for weight control may be considered to promote adolescent mental health.

Quality assessment in initial paediatric trauma care: Systematic review from prehospital care to the paediatric intensive care unit

BACKGROUND

Trauma is the most common cause of death and disability in the paediatric population. There are a huge number of variables involved in the care they receive from health care professionals.

AIM

The aim of this study was to review the available evidence of initial paediatric trauma care throughout the health care process with a view to create quality indicators (QIs).

STUDY DESIGN

A systematic review was performed from Cochrane Library, Medline, Scopus and SciELO between 2010 and 2020. Studies and guidelines that examined quality or suggested QI were included. Indicators were classified by health care setting, Donabedian's model, risk of bias and the quality of the publication with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment.

RESULTS

The initial search included 686 articles, which were reduced to 22, with 15 primary and 7 secondary research articles. The snowball sampling technique was used to add a further seven guidelines and two articles. From these, 534 possible indicators were extracted, summarizing them into 39 and grouping the prehospital care indicators as structure (N = 5), process (N = 12) and outcome (N = 3) indicators and the hospital care indicators as structure (N = 4), process (N = 10) and outcome (N = 6) indicators. Most of the QIs have been extracted from US studies. They are multidisciplinary and in some cases are based on an adaptation of the QIs of adult trauma care.

CONCLUSIONS

There was a clear gap and large variability between the indicators, as well as low-quality evidence. Future studies will validate indicators using the Delphi method.

RELEVANCE TO CLINICAL PRACTICE

Design a QI framework that may be used by the health system throughout the process. Indicators framework will get nurses, to assess the quality of health care, detect deficient areas and implement improvement measures.

Mid-upper arm circumference as a screening tool for identifying underweight adolescents

Background

Mid-upper arm circumference (MUAC) is a potentially credible alternative method for body mass index (BMI) to assess nutritional status. We aimed to assess the correlation between MUAC and BMI- Z-score and to identify a reliable MUAC cut-off point to detect underweight (BMI- Z-score of < -2 standard deviation) Sudanese adolescents.

Methods

A cross-sectional study was conducted in eastern Sudan. After obtaining adolescents' age and sex, their weight, height, and MUAC were measured using the standard procedures. The MUAC (cm) cut-off corresponding to underweight was calculated using receiver operating characteristic (ROC) curve analysis.

Results

In total, 390 adolescents were enrolled in the study and 205 (52.6%) of them were females. The median (interquartile range, IQR) age was 15.1 (14.0-16.3) years. The medians (IQR) of MUAC and BMI- Z-score were 22.0 (20.0-24.0) cm and - 0.62 (-1.5-0.3), respectively. MUAC was positively correlated with BMI Z-score in all participants (r = 0.534, p < 0.001), in females (r = 0.715, p < 0.001), and in males (r = 0.404, p < 0.001). Of the 390 enrolled adolescents, 61(15.6%) were underweight. The MUAC cut-off for underweight was ≤21.2 cm in all participants (Youden's Index, YI = 0.50; sensitivity = 82.0%; specificity = 68.0%, AUROCC = 0.78), in females (YI = 0.66, sensitivity = 86.0%, specificity = 80.0%, AUROCC = 0.87), and in males (YI = 0.32, sensitivity = 80.0%, specificity = 52.0%, AUROCC = 0.69).

Conclusion

MUAC has good accuracy results and can be adopted for community-based screening of underweight adolescents.

Red cell distribution width as a prognostic marker for complications of community-acquired pneumonia in children: a comparison with Proadrenomedullin and Copeptin

BACKGROUND

Community-acquired pneumonia (CAP) is the most common leading cause of morbidity and mortality in children; so, early identification of patients with CAP, who are at risk of complications or high mortality, is very critical to identify patients who need early admission to the intensive care unit.

PURPOSE OF THE STUDY

To explore the prognostic value of Red Cell Distribution Width (RDW), Proadrenomedullin and Copeptin in the prediction of complicated CAP in children.

METHODS

99 children were enrolled in the study, which was done at the Pediatric Department of Minia University Hospital. Measurement of serum Proadrenomedullin, Copeptin, and RDW was done to all participating children in the first 24 h of admission. Assessment of the severity of CAP was done using the Pediatric Respiratory Severity Score (PRESS).

RESULTS

The values of RDW, Proadrenomedullin, and Copeptin were significantly higher in the complicated CAP group than in the uncomplicated one (P value < 0.01). There were significant positive correlations between RDW and Proadrenomedullin with PRESS (r 0.56 for both). For the prediction of complications, RDW at cutoff point > 17.4, has 77.7% of sensitivity and 98.6% of specificity, followed by Pro ADM at cutoff point > 5.1 nmol/L, of 74% of sensitivity and 90.2% of specificity. For the prediction of mortality, RDW at cutoff point > 17.4 has 81.25% of sensitivity and 89.16% of specificity.

CONCLUSION

The RDW is a reliable predictor of poor outcomes in pediatric CAP.

Proton Pump Inhibitor Use and Risk of Serious Infections in Young Children

Importance

Proton pump inhibitor (PPI) use may lead to infections through alteration of the microbiota or direct action on the immune system. However, only a few studies were conducted in children, with conflicting results.

Objective

To assess the associations between PPI use and serious infections in children, overall and by infection site and pathogen.

Design, Setting, and Participants

This nationwide cohort study was based on the Mother-Child EPI-MERES Register built from the French Health Data System (SNDS). We included all children born between January 1, 2010, and December 31, 2018, who received a treatment for gastroesophageal reflux disease or other gastric acid-related disorders, namely PPIs, histamine 2 receptor antagonists, or antacids/alginate. The index date was defined as the first date any of these medications was dispensed. Children were followed up until admission to the hospital for serious infection, loss of follow-up, death, or December 31, 2019.

Exposure

PPI exposure over time.

Main Outcomes and Measures

Associations between serious infections and PPI use were estimated by adjusted hazard ratios (aHRs) and 95% CIs using Cox models. PPI use was introduced as time-varying. A 30-day lag was applied to minimize reverse causality. Models were adjusted for sociodemographic data, pregnancy characteristics, child comorbidities, and health care utilization.

Results

The study population comprised 1 262 424 children (median [IQR] follow-up, 3.8 [1.8-6.2] years), including 606 645 who received PPI (323 852 male [53.4%]; median [IQR] age at index date, 88 [44-282] days) and 655 779 who did not receive PPI (342 454 male [52.2%]; median [IQR] age, 82 [44-172] days). PPI exposure was associated with an increased risk of serious infections overall (aHR, 1.34; 95% CI, 1.32-1.36). Increased risks were also observed for infections in the digestive tract (aHR, 1.52; 95% CI, 1.48-1.55); ear, nose, and throat sphere (aHR, 1.47; 95% CI, 1.41-1.52); lower respiratory tract (aHR, 1.22; 95% CI, 1.19-1.25); kidneys or urinary tract (aHR, 1.20; 95% CI, 1.15-1.25); and nervous system (aHR, 1.31; 95% CI, 1.11-1.54) and for both bacterial (aHR, 1.56; 95% CI, 1.50-1.63) and viral infections (aHR, 1.30; 95% CI, 1.28-1.33).

Conclusions and Relevance

In this study, PPI use was associated with increased risks of serious infections in young children. Proton pump inhibitors should not be used without a clear indication in this population.

Disparity in spectrum of infectious diseases between in-school and out-of-school children, adolescents, and youths in China: findings from a successive national surveillance from 2013 to 2021

Background

An accelerated epidemiological transition, economic development and urbanization have brought rapid reductions but a potential disparity in infectious diseases burdens in-school and out-of-school children, adolescents, and youths in China. This paper assesses the disparity in spectrum of infectious diseases between two groups, and described disparity's variation by age, year and province, and determined the priority diseases.

Methods

A total of 7,912,274 new incident cases (6,159,021 in school and 1,753,253 out of school) aged 6-21 years across 43 notifiable infectious diseases have been collected based on China's Notifiable Infectious Disease Surveillance System from 2013 to 2021. All infectious diseases are categorized into seven categories: vaccine preventable, bacteria, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. We used the index of incidence rate ratio (IRR) of by specific disease, category, year, and age to assess the disparity between those out-of-school and in-school, and determine their separate priority diseases.

Findings

From 2013 to 2021, a small disparity of notifiable infectious diseases existed with higher average yearly incidence for out-of-school children, adolescents, and youth than that in-school (327.601 v.s. 319.677 per 100,000, IRR = 1.025, 95%CI: 1.023-1.027, standardized IRR = 1.169, 95%CI: 1.155-1.183), and it gradually narrowed by surveillance years with IRR from 1.351 in 2013 to 1.015 in 2021 due to large decreased disparity in compulsory education stage group. Such disparity was mainly driven by sexually transmitted and bloodborne diseases, bacteria diseases, vectorborne diseases, quarantinable diseases and zoonotic diseases. However, vaccine preventable diseases, gastrointestinal and enterovirus diseases showed higher incidence of infectious diseases for those in-school than that out-of-school, particularly for seasonal influenza, mumps and hand-foot-and-mouth disease. Meanwhile, such disparity is obvious in most of ages and in eastern and coastal regions of China, and the narrowing trend is attributed to six categories diseases, except for sexually transmitted and bloodborne diseases with gradually widened disparity between two groups with surveillance years with IRR from 22.939 in 2013 to 23.291 in 2021 due to large disparity for those who have completed compulsory education.

Interpretation

A huge achievement has been achieved in reducing the burden and disparity of infectious diseases between out-of-school and in-school children, adolescents, and youths in China, particularly for the compulsory education stage population. The priorities for the coming decades will be to extend successful strategies to a broad scope and promote education, particularly for the investment of social health resources and the improvement of personal health literacy in the non-compulsory education stage. This should involve extending the years of compulsory school, improving sex health education, strengthening monitoring, expanding immunization programs coverage and prioritizing the prevention and control of sexually transmitted diseases and tuberculosis among out-of-school population.

Funding

National Natural Science Foundation of China and Beijing Natural Science Foundation.

Reducing physical restraints in pediatrics: A quality improvement mixed-methods analysis of implementing a clinical debriefing process after behavioural health emergencies in a Children's Hospital

INTRODUCTION

An increasing number of pediatric patients with mental and behavioral health (MBH) conditions present to Emergency Department (ED) and inpatient settings with behavioral events that require physical restraint (PR). PR usage is associated with adverse outcomes. Clinical debriefing (CD) programs have been associated with improved performance but have not been studied in this population. After implementing an MBH-CD program in our Children's Hospital, we aimed to decrease the baseline (7/2018-3/2021) rate of a second PR episode (2PR) by 50 % in the ED and inpatient settings over two years.

METHODS

A multidisciplinary team implemented an MBH-CD process in April 2021 for hospital teams to use immediately after behavioral events. We included patients ≤18 years old, with an ED or inpatient discharge MBH diagnosis, between July 2018 and June 2023. Pre- and post-implementation secondary outcomes included the ED median duration of PR and the ED PR time per 1000 h of ED care. ED and inpatient mean length of stay (LOS) and mean monthly visits (MMV) in pre- and post-implementation were also compared. Qualitative analysis identified major themes.

RESULTS

Post-implementation, the ED significantly decreased 2PR rate by 67 %; in inpatients, no significant change was demonstrated. Median duration of ED PR decreased from 112 to 71 min (p = 0.006) and ED PR time significantly decreased by 82 % (14.8 to 2.7 h per 1000 h). In the post-implementation period, mean LOS (ED and inpatient) and MMV (ED only) were significantly higher. Fifty-one percent of 494 behavioral alerts were debriefed. Median debriefing duration was 6 min (IQR 4,10). Common themes included cooperation and coordination (23 %) and clinical standards (14 %).

DISCUSSION

Clinical debriefing implementation was associated with significant improvement in ED patient outcomes. Inpatient outcomes were unchanged, but debriefings in both settings should enable frontline teams to continuously identify opportunities to improve future outcomes.

Lactate Clearance as an Early Prognostic Marker of Mortality for Pediatric Trauma

Background While lactate clearance (LC) has already been shown as a prognostic indicator in clinical studies, its certain character needs to be defined in pediatric trauma. This research aimed to evaluate the correlation between early lactate clearance and mortality in pediatric trauma.Patients and methods A retrospective cohort study was conducted in a university hospital. Repeated LC was measured at admission, at the 2nd, 6th, and 12th hours post-admission. The association of lactate clearance with mortality was analyzed and using receiver operating characteristic (ROC) to determine the threshold levels of lactate clearance and also logistic regression analysis was performed to determine whether LC was an independent risk factor.Results Seventy-eight patients were included and overall mortality was 13%. LC values of the non-survivors was significantly lower than survivors for LC0-2 h (28.60±14.26 vs 4.64±15.90), LC0-6 h (46.63±15.23 vs 3.33±18.07), LC0-12 h (56.97±15.53 vs 4.82±22.59) (p:<0.001, p:<0.001 and p:<0.001, respectively). Areas under the curve of lactate clearance at the 2nd, 6th, and 12th hours after therapy start were a significant predictor for mortality (p:<0.001, p:<0.001, and p:<0.001, respectively). Threshold values of LC were 12.9, 19.5 and 29.3%, respectively.Conclusion Lactate clearance was a beneficial tool to estimate outcomes of pediatric trauma. Poor lactate clearance was a significant marker for poor prognosis.

A snapshot in time: a 1-month review of all referrals to paediatric liaison psychiatry services in Dublin following emergency department presentation

INTRODUCTION

An emerging picture has seen increasing numbers of young people with mental health crisis attend paediatric emergency departments in Ireland. Following paediatric review, many are referred to in-house paediatric liaison psychiatry (PLP) services. This pilot study describes referral patterns and practice over a 1-month period across three Dublin centres.

METHODS

Case notes of all referrals to PLP were reviewed to extract relevant clinical and administrative data. For those admitted, costs associated with length of stay were estimated. Clinical profile, management and intra-hospital pathway differences were explored.

RESULTS

Fifty-nine young people under 16 years presented to one of the three EDs with an acute MH presentation. The sample consisted of 39 females (66%) with a mean age of 13.7 years. The majority (n = 34, 58%) presented out of hours. A substantial portion of youths presenting (n = 37, 63%) were admitted, and had a mean duration of stay of 4.51 days. There were differences between hospitals in terms of frequency of presentation with self-harm, admission rates and length of stay.

DISCUSSION

Different PLP service configuration, staffing and funding streams may explain some of the differences observed across centres, although the findings should be interpreted with caution given the limited sample size. Standardisation of service provision and management is needed for PLP services. Additional community CAMHS resourcing is needed to support the development of alternative pathways for youth in need of urgent MH review.

Comparative study of diagnostic efficacy of sputum and bronchoalveolar lavage fluid specimens in community-acquired pneumonia children treated with fiberoptic bronchoscopy

BACKGROUND

Community-acquired pneumonia (CAP) is usually diagnosed in children, and the type of respiratory specimen is critical. Differences in pathogens detection between induced sputum (IS) and bronchoalveolar lavage fluid (BALF) have not been evaluated.

METHODS

In 2018, paired sputum and BALF samples from CAP hospitalised children with indications for bronchoalveolar lavage (BAL) were subjected to multiplex PCR for the detection of 11 common respiratory pathogens.

RESULTS

A total of 142 children with paired sputum and BALF were tested. The overall positivity rate was 85.9% (122/142) for sputum and 80.3% (114/142) for BALF. The two specimens presented almost perfect agreement between the detection on M. pneumoniae, influenza A, influenza B, bocavirus and RSV. In contrast, adenovirus had the lowest kappa value of 0.156, and a false negative rate (FNR) of 66.7%. Rhinovirus had the highest false positive rate (FPR) as 18.5%. The consistent rate was significantly higher in school-age children than those under 1 year old (p = .005). Bacterial co-infection in BALF specimens were observed in 14.8% (21/142). Of the 11 discordant pairs of specimens, 9 cases were sputum(+)/BALF(-) with adenovirus predominating.

CONCLUSION

Our findings suggest that the consistency of results between sputum and BALF is pathogen specific. Careful consideration needs to be given to whether sputum can be used as a substitute for BALF when children are young or co-infections with bacteria are suspected.

High specificity of metagenomic next-generation sequencing using protected bronchial brushing sample in diagnosing pneumonia in children

Background

Lower respiratory tract infections are the leading cause of morbidity and mortality in children worldwide. Timely and accurate pathogen detection is crucial for proper clinical diagnosis and therapeutic strategies. The low detection efficiency of conventional methods and low specificity using respiratory samples seriously hindered the accurate detection of pathogens.

Methods

In this study, we retrospectively enrolled 1,032 children to evaluate the performance of metagenomics next-generation sequencing (mNGS) using bronchoalveolar lavage fluid (BALF) sample and protected bronchial brushing (BB) sample in diagnosing pneumonia in children. In addition, conventional tests (CTs) were also performed.

Results

The specificity of BB mNGS [67.3% (95% CI 58.6%-75.9%)] was significantly higher than that of BALF mNGS [38.5% (95% CI 12.0%-64.9%)]. The total coincidence rate of BB mNGS [77.6% (95% CI 74.8%-80.5%)] was slightly higher than that of BALF mNGS [76.5% (95% CI 68.8%-84.1%)] and CTs [38.5% (95% CI 35.2%-41.9%)]. During the epidemics of Mycoplasma pneumoniae, the detection rate of M. pneumoniae in the >6-year group (81.8%) was higher than that in the 3-6-year (78.9%) and <3-year groups (21.5%). The highest detection rates of bacteria, fungi, and viruses were found in the <3-year, >6-year, and 3-6-year groups, respectively. mNGS detection should be performed at the duration of 5-7 days after the start of continuous anti-microbial therapy or at the duration of 6-9 days from onset to mNGS test.

Conclusions

This is the first report to evaluate the performance of BB mNGS in diagnosing pulmonary infections in children on a large scale. Based on our findings, extensive application of BB mNGS could be expected.

Diarrhea Prevalence and Associated Factors among Children in Azezo Sub-City, Northwest Ethiopia: A Community-Based Cross-Sectional Study

Globally, diarrheal disease continues to be a major cause of morbidity and mortality among children under 5 years of age, especially in low-income countries such as Ethiopia. However, there is still limited evidence in the study area quantifying the burden of diarrheal disease among children under 5 years. A community-based cross-sectional study was conducted in April 2019 to estimate the prevalence of childhood diarrhea and to identify its associated factors in Azezo sub-city, northwest Ethiopia. A simple random sampling technique was applied to recruit the eligible cluster villages with children under 5 years. Data were collected by interviewing mothers or guardians using structured questionnaires. The completed data were entered into EpiInfo version 7 and exported to SPSS version 20 for analysis. Binary logistic regression model was used to identify factors associated with diarrheal disease. Adjusted odds ratio (AOR) with 95% CI was used to measure the strength of association between the dependent and independent variable. The period prevalence of diarrheal disease among children under 5 years was 24.9% (95% CI: 20.4-29.7%). Age group between 1 and 12 months [AOR: 9.22, 95% CI: (2.93-29.04)] and 13 and 24 months [AOR: 4.44, 95% CI: (1.87-10.56)], as well as low monthly income (AOR: 3.68, 95% CI: (1.81-7.51)] and poor handwashing practice [AOR: 8.37, 95% CI: (3.12-22.52), were significantly associated with high risk of childhood diarrhea. In contrast, small family size [AOR: 0.32, 95% CI: (0.16-0.65)], and immediate consumption of prepared meals [AOR: 0.39, 95% CI: (0.19-0.81)] were significantly associated with low risk of childhood diarrhea. Diarrheal diseases were a common health problem among children under 5 years of age in Azezo sub-city. Therefore, an appropriate hygiene intervention program through health education is recommended with a focus on identified risk factors to reduce the burden of diarrheal diseases.

Behavioral and emotional problems and related risk factors of primary school children aged 6-11 in Guangdong, China

BACKGROUND

China has seen rapid urbanization and industrialization in recent decades and children behavioral and emotional problems accompanied have been a heavy burden on family and society. We therefore aimed to estimate the prevalence and risk factors of behavioral and emotional problems in primary school children aged 6-11 in an urbanized area of China.

METHODS

Primary school children aged 6-11 from 15 primary schools were enrolled from Shunde District, Guangdong. The Child Behavior Checklist (CBCL) was used to assess behavioral and emotional problems and then determined risk factors associated with the behavioral and emotional problems.

RESULTS

In total, 12 868 were included in the present analysis. The prevalence of total behavioral and emotional problems was 8.4% (95% CI, 7.9%-8.9%), which was gradually increased with age in both boys and girls. The prevalence was higher in boys than girls (9.8% vs. 6.8%, p < .001) and in children without siblings than those with siblings (9.9% vs. 8.1%, p = .006). In boys, age was positively associated with delinquent behavior, depression, poor contact, compulsive activity, social withdrawal, attention problems and aggressive behavior and was negatively associated with schizoid (p < .05). While in girls, age was positively associated with delinquent behavior, somatic complaints, social withdrawal and schizoid/compulsive activity but was negatively associated with aggressive behavior and sexual problems (p < .05).

CONCLUSION

Behavioral and emotional problems are common in primary school children in the urbanized area of China and are associated with sex and siblings. These findings suggest that close attention should be given to these primary school children.

Active or passive maternal smoking increases the risk of low birth weight or preterm delivery: Benefits of cessation and tobacco control policies

In France, maternal smoking, active or passive, remains one of the highest in Europe. At the same time, there is an increase in the number of low birth weight (<2500 g) and premature (<37 weeks of amenorrhea) newborns. The objective of this narrative review is to examine the impact of active or passive maternal smoking on birth weight or prematurity rates, and to consider the benefits of policies to stop or control smoking. This is a narrative review that analyzes and discusses the major articles published over the past 20 years regarding the role of active or passive maternal smoking on the risk of low birth weight or preterm delivery. Articles were selected using the following keywords: maternal smoking, low birth weight, preterm birth, smoking cessation, passive smoking, exhaled carbon monoxide, tobacco control policies. Active smoking is associated, in a dose-response relationship, with increased risks of low birth weight and preterm delivery. Passive smoking, mainly related to the presence of a smoking spouse, increases the risk of low birth weight and preterm birth. Our review confirmed also the benefits of smoking cessation, even in the third trimester, in reducing the risk of small for gestation age or fetal growth restriction and preterm birth. Several studies of tobacco control policies have been shown to be effective in significantly reducing maternal smoking. There is sufficient evidence to infer a causal link between active or passive maternal smoking and low birth weight or preterm delivery. This causal link is compelling and sufficient to justify intensifying efforts to promote rapid progress in tobacco control policies, with the vision of a tobacco-free generation, and smoking cessation with best practices during preconception or pregnancy.

Control variables of serum ferritin concentrations in hospitalized newborn infants: an observational study

Both iron excess and deficiency are deleterious to cellular and organ homeostasis. Serum ferritin levels serve as a biomarker of iron storage; however, their distribution and determinants in sick newborn infants remain unclear. This study aimed to investigate the reference range and independent variables of serum ferritin in hospitalized newborn infants. All newborn infants who were hospitalized at a tertiary neonatal center within 24 h of birth were retrospectively reviewed for the period of April 2015 through March 2017. Serum ferritin levels were assessed using venous blood samples obtained at admission and their independent variables were explored. The study population comprised 368 infants (36.2 ± 2.8 weeks gestation and 2319 ± 623 g at birth), whose median serum ferritin level was 149 µg/L (inter-quartile range: 81-236). The multivariable model used to explain serum ferritin values comprised hemoglobin, lactate dehydrogenase, blood pH, and maternal hypertensive disorders in pregnancy (all p < 0.01, adjusted for sex and birth weight). Serum ferritin values in hospitalized newborn infants were comparable to those previously reported using umbilical cord blood. Our novel findings indicated the association between blood pH, lactate dehydrogenase, and ferritin levels, suggesting the influence of antenatal hypoxia-ischemia and stress to serum ferritin levels.

Transcranial Doppler Ultrasonography detection on cerebrovascular flow for evaluating neonatal hypoxic-ischemic encephalopathy modeling

Objective

This study aimed to investigate the feasibility of Transcranial Doppler Ultrasonography (TCD) in evaluating neonatal hypoxic-ischemic encephalopathy (NHIE) modeling through monitoring the alteration of cerebrovascular flow in neonatal hypoxic-ischemic (HI) rats.

Methods

Postnatal 7-day-old Sprague Dawley (SD) rats were divided into the control group, HI group, and hypoxia (H) group. TCD was applied to assess the changes of cerebral blood vessels, cerebrovascular flow velocity, and heart rate (HR) in sagittal and coronal sections at 1, 2, 3, and 7 days after the operation. For accuracy, cerebral infarct of rats was examined by 2,3,5-Triphenyl tetrazolium chloride (TTC) staining and Nissl staining to simultaneously verify the establishment of NHIE modeling.

Results

Coronal and sagittal TCD scans revealed obvious alteration of cerebrovascular flow in main cerebral vessels. Obvious cerebrovascular back-flow was observed in anterior cerebral artery (ACA), basilar artery (BA), middle cerebral artery (MCA) of HI rats, along with accelerated cerebrovascular flows in the left internal carotid artery (ICA-L) and BA, decreased flows in right internal carotid artery (ICA-R) relative to those in the H and control groups. The alterations of cerebral blood flows in neonatal HI rats indicated successful ligation of right common carotid artery. Besides, TTC staining further validated the cerebral infarct was indeed caused due to ligation-induced insufficient blood supply. Damage to nervous tissues was also revealed by Nissl staining.

Conclusion

Cerebral blood flow assessment by TCD in neonatal HI rats contributed to cerebrovascular abnormalities observed in a real-time and non-invasive way. The present study elicits the potentials to utilize TCD as an effective means for monitoring the progression of injury as well as NHIE modeling. The abnormal appearance of cerebral blood flow is also beneficial to the early warning and effective detection in clinical practice.

Healthcare utilization and costs of singaporean youth with symptoms of depression and anxiety: results from a 2022 web panel

BACKGROUND

There is evidence that the prevalence of depression and anxiety among youth is increasing and that these factors contribute to high healthcare costs and poor school performance. The goal of this study is to provide up-to-date estimates of the prevalence and economic burden of depression and anxiety among youth in Singapore.

METHODS

Using an existing web panel, 991 parents filled out the PHQ-4 screener on behalf of 1,515 youth. 104 of these parents whose children (ages 4 to 21) had symptoms consistent with depression or anxiety filled out a full survey with questions on mental health symptoms, school absences, school performance, and healthcare utilization. The survey was fielded between April and June 2022. Publicly available prices were used to estimate the cost associated with the observed rates of health service use.

FINDINGS

Based on parental responses, 11.7% (95% CI:10.2 - 13.5%) of youth had symptoms consistent with depression and 12.8% (95% CI:11.2 - 14.6%) had symptoms consistent with anxiety. In total, 16.2% (95% CI:14.5 - 18.3%) were reported to have symptoms consistent with at least one of these conditions. These youths missed an average of 190 (95% CI: 126-254) hours of school per year due to their mental health conditions and parents reported that school and daily activities performance was significantly degraded. Per capita annual healthcare costs averaged S$10,250 (95% CI: 7,150-13,350), with 64% of youth receiving emergency or inpatient services. In aggregate, annual costs associated with these conditions were estimated to be S$1.2 billion (95% CI:S$1.1bn - S$1.4bn).

INTERPRETATION

Even with significant potential for underreporting, these results reveal concerning rates of Singaporean youth with symptoms consistent with depression or anxiety, many of whom remain untreated. Results also reveal the short-term economic burden caused by these symptoms and hint at longer-term consequences resulting from poor school performance. This study should represent a call to action for Singapore to address poor mental health among youth.

Epidemiology of major paediatric trauma in a European Country - trends of a decade

OBJECTIVES

This study investigates causes, characteristics and temporal trends of paediatric major trauma over a 10-year period and assesses potential preventive areas.

METHODS

Single-centre retrospective study of paediatric trauma patients admitted to a Paediatric Intensive Care Unit (PICU) in a tertiary university hospital in Europe with a level 1 paediatric trauma centre, from 2009 to 2019. Paediatric major trauma patients were defined as patients aged < 18 years with Injury Severity Score > 12, admitted for intensive care for more than 24 h following trauma. Demographic, social and clinical information, including place and mechanism of trauma, injury pattern, pre-hospital and in-hospital procedures, and length of stay in PICU was extracted from PICU medical records.

RESULTS

Total 358 patients included (age 11 ± 4,9 years; 67% male); 75% were involved in road traffic accidents: 30% motor vehicle collision, 25% pedestrian, 10% motorcycle and bicycle each. Falls from height injured 19% of children, 4% during sports activities. Main injuries were to head/neck (73%) and extremities (42%). The incidence of major trauma was highest in teenagers and did not show a decreasing trend during the study years. All fatalities (1,7%; n = 6) were related to head/neck injuries. Motor vehicle collisions resulted in higher need for blood transfusion (9 vs. 2 mL/kg, p = 0,006) and the highest ICU-mortality (83%; n = 5). Children in motorcycle accidents had longer ICU length-of-stay (6,4 vs. 4,2 days, p = 0,036). Pedestrians had 25% higher risk of head/neck injuries (RR 1,25; 1,07 - 1,46; p = 0,004), and higher incidence of severe brain injury (46% vs. 34%, p = 0,042). Most children in motor-vehicle/bicycle accidents were not using restraints/protective devices (45%) or were using them inappropriately (13%).

CONCLUSIONS

Over the last decade, the absolute numbers of paediatric major trauma did not decrease. Road traffic accidents remain the leading cause of injury and death. Teenagers are at highest risk for severe trauma. Appropriate use of child restraints and protective equipment remain key for prevention.