Gender disparity in pediatrics: a review of the current literature

Converging paths: Autistic traits, body image concerns, and disordered eating symptoms in women

Autistic traits, such as sensory sensitivities and rigid routines, have been linked to body dissatisfaction (BD) and eating disorders (EDs). However, the interplay between autistic traits, fat- and muscularity-related BD, and disordered eating remains underexplored. This cross-sectional study examined the relationships between autistic traits, BD, and disordered eating in 298 women. Correlations and mediation analyses, alongside bootstrapping techniques, were used to evaluate relationships between variables. Autistic traits were positively associated with "traditional" disordered eating symptoms including food avoidance and selective eating as well as appearance-related aspects of muscle dysmorphia. Autistic traits were positively associated with avoidant-restrictive food intake disorder (ARFID) symptoms. BD was elevated with increasing autistic traits, only in relation to body fat, not muscularity. Only body fat-related BD (BD-F), but not muscularity-related BD (BD-M) mediated the effect of autistic traits on disordered eating symptoms, predicting increases in both ED and body dysmorphic symptoms, as well as reductions in ARFID symptoms. Our findings suggest that women with autistic traits may be more susceptible to internalizing socially perpetuated body ideals or to social feedback towards their appearance, as only stereotypically "female-typed" BD-F, but not "male-typed" dissatisfaction with muscularity (BD-M) mediated the link between autistic traits and disordered eating. Implications are discussed.

Maternal seafood intake, dietary contaminant exposure, and risk of juvenile idiopathic arthritis: exploring gene-environment interactions

Objectives

Juvenile idiopathic arthritis (JIA) originates from a complex interplay between genetic and environmental factors. We investigated the association between seafood intake and dietary contaminant exposure during pregnancy and JIA risk, to identify sex differences and gene-environment interactions.

Methods

We used the Norwegian Mother, Father, and Child Cohort Study (MoBa), a population-based prospective pregnancy cohort (1999-2008). JIA patients were identified through the Norwegian Patient Registry, with remaining mother-child pairs serving as controls. We assessed maternal seafood intake and dietary contaminants typically found in seafood using a food frequency questionnaire completed during pregnancy, mainly comparing high (≥90th percentile, P90) vs low (

Results

We identified 217 JIA patients and 71,884 controls. High vs low maternal intake of lean/semi-oily fish was associated with JIA (aOR 1.51, 95% CI 1.02-2.22), especially among boys (aOR 2.13, 95% CI 1.21-3.75). A significant gene-environment interaction was observed between total fish intake and PRS, with high fish intake associated with JIA primarily in those with low PRS (p<0.03). We found no associations between high vs low exposure to other types of seafood or environmental contaminants and JIA.

Conclusions

We found a modestly increased risk of JIA associated with high intake of lean/semi-oily fish during pregnancy, not explained by estimated exposure to dietary contaminants. Our data suggest a more pronounced association in children with a lower genetic predisposition for JIA.

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Key Words

• MoBa
• contaminants
• fish
• gene-environment interaction
• heavy metals
• juvenile idiopathic arthritis (JIA)
• polygenic risk score
• sex differences

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MESH Headings

• Humans
• Female
• Seafood/adverse effects
• Male
• Gene-Environment Interaction
• Pregnancy
• Arthritis, Juvenile/epidemiology
• Arthritis, Juvenile/etiology
• Arthritis, Juvenile/genetics
• Norway/epidemiology
• Food Contamination
• Adult
• Prenatal Exposure Delayed Effects
• Risk Factors
• Prospective Studies
• Maternal Exposure/adverse effects
• Child
• Child, Preschool
• Genetic Predisposition to Disease
• Adolescent
• Dietary Exposure/adverse effects

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Affiliation(s)

Vilde Øverlien Dåstøl Department of Rheumatology, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
Kristine Løkås Haftorn Department of Rheumatology, Oslo University Hospital, Oslo, Norway
Hamid Khoshfekr Rudsari Department of Rheumatology, Oslo University Hospital, Oslo, Norway
Piotr Pawel Jaholkowski Center for Precision Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo and Oslo University Hospital, Oslo, Norway
Ketil Størdal Department of Pediatric Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
Siri Eldevik Håberg Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
Clarice R. Weinberg Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States
Lisa G. Rider Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, United States
Ole A. Andreassen Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo and Oslo University Hospital, Oslo, Norway Center for Precision Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
Anne Lise Brantsæter Department of Food Safety and Centre for Sustainable Diets, Norwegian Institute of Public Health, Oslo, Norway
Ida Henriette Caspersen Department of Rheumatology, Oslo University Hospital, Oslo, Norway Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
Helga Sanner Department of Rheumatology, Oslo University Hospital, Oslo, Norway Oslo New University College, Oslo, Norway

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Delays in health care seeking for diarrheal disease and associated factors among caregivers of under five children in health centers of northwest Ethiopia: a mixed-method study

BACKGROUND

Approximately 70% of child deaths due to diarrhea are caused by a lack of timely healthcare. However, there was little evidence of factors associated with delays in seeking health care for patients with diarrheal diseases in the study area. Therefore, this study aimed to investigate delays in seeking healthcare for children with diarrhea and identify associated factors among caregivers in health centers of Northwest Ethiopia.

METHOD AND MATERIALS

An institution-based mixed study method was conducted from May to June 2022. Quantitative data were collected from 374 participants who were selected by systematic random sampling using a structured interviewer-administered questionnaire and chart review. The data were analyzed using the Statistical Package for Social Science software version 25. Bivariable and multivariable logistic regression models were used to identify associated factors. Variables with a p- value < 0.05 in the multivariable analysis were considered to be significantly associated. Qualitative data were collected from participants in waiting area after receiving treatments via in-depth interviews and analyzed using open-source software. The qualitative data were transcribed, translated, coded, thematized, and interpreted accordingly.

RESULTS

In this study, 53.48% of patients experienced delays in seeking healthcare for diarrhea. A large family size (adjusted odds ratio (AOR) = 2.64, 95% CI: 1.26-5.4), poor knowledge about diarrhea danger signs (AOR = 3.25, 95% CI: 1.6-6.6), difficulty paying for treatment (AOR = 2.95, 95% CI: 1.6-5.3), not visiting health facilities as the first response to diarrhea (AOR = 3.94, 95% CI: 1.96-7.9), only diarrhea (AOR = 2.39, 95% CI: 1.01-5.63), and no information about early healthcare seeking (AOR = 4.88, 95% CI: 1.91-12.43) were identified; moreover, from the qualitative findings, mothers' perceptions of the illness were mild, poor service provision, and economic problems were determinants of delay. Awareness, barriers, compliance, and perception emerged as themes.

CONCLUSION

The prevalence of delays in seeking healthcare for children with diarrhea was high. This poses a negative health risk to the lives of children and their caregivers. A large family size, poor knowledge about diarrhea danger signs, difficulty paying for treatment, and many others were factors associated with delayed health care seeking. Hence, the government and other concerned stakeholders should give due emphasis to tackling the identified causes of delay in seeking health care for children under five years of age with diarrhea by diverting community focus toward timely care seeking and disease prevention.

The prevalence of anemia and the factors associated with its severity among children aged 6-59 months in Ghana: A multi-level ordinal logistic regression

INTRODUCTION

Anemia is a significant health problem that has a profound impact on young children under the age of five. It can result in severe consequences, such as stunted growth, impaired cognitive and motor development, increased illness, and even death. In Ghana, anemia is the leading cause of child mortality, yet there is a lack of information available on the prevalence of anemia and the factors associated with its severity in children under five in the country. To fill this gap, this study was conducted to investigate the prevalence and determinants of anemia severity among children aged 6-59 months in Ghana.

METHODS

This study used data from the 2022 Ghana Demographic and Health Survey (GDHS) and included a weighted total sample of 3585 children aged 6-59 months. Given the hierarchical nature of the DHS data and the ordinal nature of anemia, a multilevel ordinal logistic regression model was employed. The Brant test was used to determine whether the proportional odds assumption was met (P ≥0.05). Deviance was used for model comparison. For the multivariable analysis, variables with a p-value ≤0.2 in the bi-variable analysis were considered. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was reported as a factor associated with anemia severity in the multivariable multilevel proportional odds model.

RESULTS

A study conducted in Ghanaian children aged 6-59 months found that 49.1% of them had anemia (95% CI: 47.4%-50.7%). The results indicated that 27.6% of patients had mild anemia, while 21.4% had moderate to severe anemia. Factors that were significantly associated with higher odds of childhood anemia included being 6-23 months old, male, having a maternal age of 15-24 or 25-34 years, belonging to poorer or wealthier households, having a higher birth order, being stunted, having maternal anemia, no media exposure, and living in the Northern, Upper East, or Upper West regions.

CONCLUSION

Anemia among children aged 6-59 months in Ghana is a major public health concern. It is recommended to improve access to the media, address maternal anemia through targeted interventions, and strengthen the wealth status of families. Furthermore, preconception care for mothers during pregnancy should be supported to reduce anemia in the long-term. Additionally, the early detection and management of stunted children should be strengthened to decrease childhood anemia.

Clinical Outcomes and Complication Rates of Ventriculoperitoneal Shunts in Hydrocephalic Infants with Meningomyelocele: A Ten-Year Review at a Single Institution

BACKGROUND/OBJECTIVES

This study aimed to investigate the surgical treatment and management of hydrocephalus in infants with meningomyelocele and compare the single-center experience with the previous studies.

METHODS

This retrospective study included 81 infants (47 females and 34 males) who underwent meningomyelocele closure surgery and subsequent ventriculoperitoneal (VP) shunt surgery for hydrocephalus. Clinical and demographic data were retrospectively collected from hospital records, focusing on variables such as the timing of VP shunt placement relative to MMC closure, postoperative complications, and the need for shunt revisions. Patients were followed for a mean duration of 58.11 months to monitor long-term outcomes and identify factors associated with shunt failures and infections.

RESULTS

The mean follow-up period since birth was 58.11 (33.72) months. Shunt problems affected 30% (25/81) of patients with mechanical causes (8/25) and infections (6/25). A proximal mechanical malfunction/dysfunction was seen in 32% (8/25) of the shunts. Shunt infections occurred in 23% (19/81) of infants, and the mean time for shunt infection onset following the VP shunt procedure was 0 (0-39) median (min-max) months. Overall, 8 (9.9%) infants had short-term shunt infections, whereas 11 (13.6%) had long-term shunt infections. The mean length of the intensive care unit stay was 35.75 (25.28) days. Significant difference was seen in the number of shunt reoperations for short- and long-term infections (p < 0.001). All infants had at least one operation before the infection of their shunt system. Male gender was significantly associated with long-term shunt infections (p = 0.021). The study revealed methicillin-resistant coagulase-negative staphylococcus to be the most common isolated organism from infected shunts at 72.7% (6/11).

CONCLUSIONS

This study demonstrates that hydrocephalic infants with meningomyelocele undergoing VP shunt surgery face notable risks of infection and mechanical complications, with methicillin-resistant coagulase-negative staphylococcus identified as the most common pathogen. The findings emphasize the importance of comprehensive postoperative care and targeted infection management to improve outcomes in this vulnerable population.

Prevalence of Anemia and its associated factors among 6-59 months age children visiting public hospitals at Afar Region, Northeast Ethiopia: a hospital-based cross-sectional study

BACKGROUND

Anemia is a significant global public health issue among children aged 6 to 59 months, particularly in low-income countries like Ethiopia. Studies focusing on pastoral communities, especially in the Afar Region, often underestimate the prevalence of anemia in these children. To address this information gap, this study aimed to determine the prevalence of anemia and its associated factors among children aged 6 to 59 months in public hospitals in the Afar Region of northeastern Ethiopia.

METHOD

A hospital-based cross-sectional study was conducted among children aged 6 to 59 months, using systematic random sampling, at public hospitals in the Afar Region from February 28 to April 30, 2023.The data collection tool was adapted from the Ethiopian National Food Consumption Survey and the World Health Organization Infant and Young Child Feeding guidelines. Data entry was performed using EpiData version 4.2 and Anthroplus software for anthropometric measurements. Data analysis was conducted using SPSS version 26. Binary logistic regression models were applied to identify predictors of anemia, with a p-value of ≤ 0.05 considered statistically significant.

RESULT

Among the 306 children aged 6 to 59 months, the overall prevalence of anemia was 46.41 (95 CI: 43.8-48.9 ). Of the 142 anemic children aged 6 to 59 months, 62 (43.66 ) had mild anemia, 60 (42.25 ) had moderate anemia, and 20 (14.08 ) had severe anemia. Key factors associated with anemia included mothers with no formal education, the lowest family monthly income, a family size greater than five, and rural residence. Additionally, a previous diagnosis of parasitic infection, children aged 24-35 months, early weaning, a malaria diagnosis within the past three months, and diarrhea in the last two weeks were significant predictors of anemia in children aged 6 to 59 months.

CONCLUSION

In the current study, anemia in children aged 6 to 59 months was classified as severe and is regarded as a critical public health issue. This suggests that more efforts should be made to significantly decrease anemia by actively involving rural mothers with no formal education and low income who have children aged 6-59 months, focusing on the prevention and management of malaria, diarrhea, and parasitic infections.

Utilization of Healthcare Services in Patients with Chronic Diseases under 18 Years Old: Differences and Contributing Factors

Pediatric patients with chronic conditions frequently have unmet care needs, make extensive use of healthcare services, and often encounter fragmented, non-centered care. This study aimed to analyze the differences in the utilization of primary care (PC) and hospital care (HC) services by these patients according to sex, age, and complexity and to identify associated factors. A cross-sectional study was conducted in a basic health area of Madrid, including patients under 18 years. Among these patients, 15.7% had ≥1 chronic disease, 54.1% were male, the average age was 9.5 years, 3.5% had complexity, and 11.3% had multimorbidity. The mean number of contacts/year with the healthcare system was 9.1, including 8.3 contacts/year with PC (4.9 with pediatricians and 1.9 with nurses) and 0.8 contacts/year with HC (0.8 in external consultations and 0.01 hospitalizations). The factors associated with PC utilization were complexity; female sex; European origin; and diseases like asthma, epilepsy, stroke, recurrent urinary infection, attention deficit hyperactivity disorder, and anxiety, while older age was negatively associated. Thyroid disorders were significantly associated with HC utilization. These findings could help guide the design of optimized pediatric patient-centered care approaches to coordinate care across healthcare services and reduce high healthcare utilization, therefore improving the healthcare outcomes and quality of life for these patients.

Association between high-risk fertility behaviors and neonatal mortality in Ethiopia: A multilevel mixed-effects logit models from 2019 Ethiopian mini demographic and health survey

Objectives

This study aimed to explore the association between high-risk fertility behaviors and neonatal mortality in Ethiopia.

Study design

A community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini-Demographic and Health Survey.

Methods

Mixed-effects logit regression models were fitted to 5527 children nested within 305 clusters. The definition of high-risk fertility behavior was adopted from the 2019 EMDHS. The fixed effects (the association between the outcome variable and the explanatory variables) were expressed as adjusted odds ratios (ORs) with 95 % confidence intervals and measures of variation explained by intra-class correlation coefficients, median odds ratio, and proportional change invariance.

Results

The presence of births with any multiple high-risk fertility behaviors was associated with a 70 % higher risk of neonatal mortality (AOR = 1.7, (95 % CI: 1.2, 2.3) than those with no high-risk fertility behavior. From the combined risks of high-risk fertility behaviors, the combination of preceding birth interval <24 months and birth order four or higher had an 80 % increased risk of neonatal mortality (AOR = 1.8, (95 % CI, 1.2, 2.7) as compared to those who did not have either of the two. The 3-way risks (combination of preceding birth interval <24 months, birth order 4+, and mother's age at birth 34+) were associated with approximately four times increased odds of neonatal mortality (AOR (95 % CI:3.9 (2.1, 7.4)].

Conclusions

High-risk fertility behavior is a critical predictor of neonatal mortality in Ethiopia, with three-way high-risk fertility behaviors increasing the risk of neonatal mortality fourfold. In addition, antenatal follow-up was the only non-high fertility behavioral factor significantly associated with the risk of neonatal mortality in Ethiopia.

Incidence and predictors of neonatal seizures among neonates admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. A prospective follow-up study

Introduction

Neonatal seizures are the most common neurological problem among newborns. To date, scientific studies on the incidence and predictors of neonatal seizures in African countries, including Ethiopia are scarce. Therefore, this study aimed to assess the incidence and predictors of neonatal seizures among neonates admitted to Debre Markos comprehensive Specialized Hospital.

Methods

An institutional-based prospective follow-up study was conducted in Debre Markos comprehensive specialized hospital from February 1, 2022 to January 30, 2023. A systematic random sampling technique was used to select a total of 198 neonates. Data were entered into Epi-Data 4.2 and then exported to STATA version 14.1 for analysis. The Kaplan-Meier survival curve and the log-rank test were computed to explore the descriptive statistics. Variables with a p-value ≤0.2 in bi-variable Cox-regression were selected for multivariable Cox-regression analysis. Finally, a p-value of <0.05 was used to declare the statistical significance of the association with the outcome variable.

Results

The overall incidence rate of neonatal seizures was 35 per 1000 person-day observations. The mean follow-up time for this study was 123.4 h. The cumulative survival probability of neonates' at 0 to 24 and 0-72 h was 89.8 % and 81.71 %, respectively. The statistically significant predictors for the incidence of neonatal seizures were perinatal asphyxia (AHR = 10.95; 95%CI: 4.81, 24.93), subgaleal hemorrhage (AHR = 5.17; 95%CI: 2.09, 12.79), and gestational age <37 weeks (AHR = 4.62; 95%CI: 1.62, 13.22).

Conclusions

The incidence rate of neonatal seizures in this study was high. Neonates born with gestational age <37 weeks, having perinatal asphyxia, and having subgaleal hemorrhage were statistical predictors for the incidence of neonatal seizures. Thus, healthcare professionals should give special attention to neonates born with gestational age <37 weeks, prevent perinatal asphyxia and subgaleal hemorrhage.

Effects of undernutrition on mortality of HIV-infected children after initiation of antiretroviral therapy in Ethiopia: A systematic review and meta-analysis

Background

Undernutrition is the leading cause of mortality among children infected with HIV particularly in resource-deprived settings. Despite several studies were disclosed the effect of undernutrition on mortality of children living with HIV in Ethiopia, the findings were fragmented and inconclusive. Therefore, this review aimed to determine the pooled effects of undernutrition on mortality of children infected with HIV in Ethiopia.

Methods

The search were performed using international online electronic data bases (MEDLINE/though PubMed, Google scholar, Hinari, Scopus and open Google). The review included only retrospective/prospective cohort studies reporting the effects of undernutrition on mortality of children infected with HIV. Heterogeneity between included studies was assessed using Cochrane Q-test and the I2 statistics. Sub-group analysis was done by study regions, sample size and publication year.

Results

A total of 1345 articles were identified from databases. Among these, 14 studies met the inclusion criteria and included in the study. Meta-analysis of 4 studies revealed that stunting has a significant effect on mortality of children infected with HIV (AHR: 3.36; 95 % CI: 2.95-3.77). Of 14 included studies, 6 articles indicated that wasting has a significant effect on mortality in children infected with HIV (AHR: 3.93; 95 % CI: 2.56-5.30) as compared to their counterparts. Furthermore, the pooled effect of 8 studies showed that underweight has 3.4 times hazard of death among children who lived with HIV as compared to well-nourished children.

Conclusion

This review revealed that undernutrition has deleterious effect on mortality of children infected with HIV/AIDS by disease progression and prone the children to serious opportunistic infections. From the study, the authors recommended that nutritional status of children on antiretroviral therapy need to be evaluated regularly.

Comparison of Baseline Characteristics, Sociodemographics, and Gynecological Risk Factors Associated with Secondary Infertility of Females in Pakistan

Introduction

Secondary infertility is characterized by the inability to conceive for a period of 1 year, after having previously conceived at least once.

Objectives

To explore the risk factors of secondary infertility and compare sociodemographics and anthropometric variables of each studied group.

Methods

Study was conducted at University Institute of Public Health, Faculty of Allied Health Sciences, The University of Lahore, collecting data from Gilani Ultrasound Center in 18 months after approval of synopsis. Total 690 females (345 cases and 345 controls) were enrolled. Participants were included in case group if they were 20-45 years of age, having any parity, and confirmed diagnosis of secondary infertility.

Results

The mean age of cases and controls was 33.08 ± 4.17 years and 31.37 ± 4.36 years, respectively. The mean body mass index (BMI) in cases was 27.61 ± 4.27 kg/m2, and in controls the mean BMI was 25.52 ± 4.30 kg/m2. There was not a significant difference among religion that shows no association (p = 0.73) with secondary infertility as profession has association with it (p = 0.01). History of polycystic ovary syndrome, pelvic inflammatory disease, endometriosis, uterine fibroids, menorrhagia, intermenstrual bleeding, and history of abortion are associated with secondary infertility.

Conclusions

While several sociodemographic features and medical disorders have been associated to secondary infertility, it is vital to stress that not all of these factors are controllable by medical therapy. Factors like age and certain medical issues may be unaffected by intervention. However, for controllable variables like BMI and certain medical diseases, focused therapies and lifestyle changes may reduce the chance of subsequent infertility.

A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar

Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.

Multisystem inflammatory syndrome in 1.2 million children: longitudinal cohort study of risk factors

BACKGROUND

We identified patient characteristics associated with an increased risk of developing MIS-C.

METHODS

We conducted a longitudinal cohort study of 1,195,327 patients aged 0-19 years between 2006 and 2021, including the first two waves of the pandemic (February 25-August 22, 2020 and August 23, 2020-March 31, 2021). Exposures included prepandemic morbidity, birth outcomes, and family history of maternal disorders. Outcomes included MIS-C, Kawasaki disease, and other Covid-19 complications during the pandemic. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for the association between patient exposures and these outcomes using log-binomial regression models adjusted for potential confounders.

RESULTS

Among 1,195,327 children, 84 developed MIS-C, 107 Kawasaki disease, and 330 other Covid-19 complications during the first year of the pandemic. Prepandemic hospitalizations for metabolic disorders (RR 11.3, 95% CI 5.61-22.6), atopic conditions (RR 3.34, 95% CI 1.60-6.97), and cancer (RR 8.11, 95% CI 1.13-58.3) were strongly associated with the risk of MIS-C, compared with no exposure. These same exposures were also associated with Kawasaki disease and other Covid-19 complications. However, birth characteristics and history of maternal morbidity were not associated with MIS-C development.

CONCLUSIONS

Children with pre-existing morbidity have a considerably elevated risk of MIS-C.

IMPACT

Morbidities that predispose children to multisystem inflammatory syndrome (MIS-C) are unclear. In this study, prepandemic hospitalizations for metabolic disorders, atopic conditions, and cancer were associated with an elevated risk of MIS-C. Birth characteristics and family history of maternal morbidity were not, however, associated with MIS-C. Pediatric morbidities may play a greater role in MIS-C onset than maternal or perinatal characteristics, and may help clinicians better recognize children at risk for this complication.

If you build it who will come? Case mix data of a new rural paediatric outpatient clinic

INTRODUCTION

There is limited current evidence describing the case mix data of rural paediatric outpatient clinics. Collection and analysis of this data is essential for health service planning, facilitating the identification of areas of need within specific communities to support contextualised delivery of paediatric health care.

OBJECTIVE

To describe the case mix of patients seen during the initial 12 months of a rural paediatric service, providing evidence to inform rural health service planning.

DESIGN

A retrospective cohort study.

RESULTS

There were 149 initial consultations during the study period. Behavioural/developmental problems were found in 71.8% of patients and physical problems were present in 64.4% of patients. This resulted in 38.9% of patients having a combination of problem types. 42.9% of patients were referred to or already accessing allied health services, while 20% were accessing specialised paediatric support services such as the National Disability Insurance Scheme and child protection services. Investigations were ordered for 45% of patients, with medications prescribed in 43% of cases. Only 5.4% of patients were discharged after their initial appointment. There were significant differences in problems identified on the referral compared to at the initial appointment demonstrating the value of this service to a rural community.

CONCLUSION

The case mix data illustrates a rural paediatric cohort with a complex and chronic burden of disease especially in terms of behavioural and developmental problems. These findings add to the literature on rural paediatric patient care and demonstrate the value of an embedded paediatric service in a medium sized rural town.

Review of Medicinal Plants Traditionally Used to Treat Diarrhea by the People in the Amhara Region of Ethiopia

Background

Diarrheal illness is the second-most common cause of death in under-five children. Worldwide, it results in about 1.7 billion illnesses and 525,000 deaths among under-five children annually. It is the leading cause of malnutrition among under-five children. Different people use medicinal plants to treat diarrhea. The present study aimed to review the medicinal plants used to treat diarrhea by the people in the Amhara region and to diagnose whether the antidiarrheal activities of the medicinal plants have been confirmed by studies using animal models.

Methods

The author searched 21 articles from worldwide databases up to December 2022 using Boolean operators ("AND" and "OR") and the terms "ethnobotanical studies," "ethnobiology," "traditional medicine," "ethnobotanical knowledge," and "Amhara region."

Results

From the 21 studies reviewed, 50 plant species grouped into 28 families were reported to treat diarrhea by the people in the Amhara region. The top most used families were Lamiaceae (12%), Fabaceae (8%), Asteraceae, Cucurbitaceae, Euphorbiaceae, and Poaceae (6% each). The modes of administration of the plant parts were orally 98.88% and topically 1.12%. The different extracts of 18 (or 36%) of the medicinal plants traditionally used to treat diarrhea by the people in the Amhara region have been proven experimentally in animal models.

Conclusions

The people in the Amhara region use different medicinal plants to treat diarrhea. Most of them take the medicinal plants orally. The traditional claim that 60% of medicinal plants are antidiarrheal has been confirmed in in vitro studies.

Gender bias in pediatric care: Health professionals' opinions and perceptions

Introduction

Gender bias in healthcare is understood as a misconception of the differences between males and females that may generate healthcare disparities and discrimination against one sex. However, is not well known how this implicit bias is manifested in pediatric clinical praxis. Thus, the goal of this study is to explore and analyse the attitudes of health personnel toward a possible gender bias in pediatric care in Catalonia.

Methods

We undertake a descriptive and exploratory study applying a qualitative research methodology based on hermeneutic phenomenology and Grounded Theory using the focus group technique. The opinions collected were classified into four categories and 22 subcategories, and subsequently analyzed.

Results

Three main ideas stood out regarding situations that might be affected by gender bias: (1) attitudes of health personnel and perceptions with regard to mental health problems and (to a lesser extent) to physical health problems; (2) the role of the child's family and the professional's assessment of this role; and (3) the professional's attention to children of the opposite sex, especially in the case of genital examinations.

Discussion

The results stand out that differential attitudes depending on the gender of the child have been observed in clinical practice in pediatrics, which may have an impact on health inequality. Hence, academic training that includes the study and prevention of implicit biases in professional activity, campaigns aimed at the general population on how to detect implicit biases and promoting gender equity in education, should help to avoid the negative consequences of these misconceptions.

Recommendations for the use of pediatric data in artificial intelligence and machine learning ACCEPT-AI

ACCEPT-AI is a framework of recommendations for the safe inclusion of pediatric data in artificial intelligence and machine learning (AI/ML) research. It has been built on fundamental ethical principles of pediatric and AI research and incorporates age, consent, assent, communication, equity, protection of data, and technological considerations. ACCEPT-AI has been designed to guide researchers, clinicians, regulators, and policymakers and can be utilized as an independent tool, or adjunctively to existing AI/ML guidelines.

Level of modern health-seeking behavior for common childhood illnesses and its associated factors among mothers of under-five children in southern Ethiopia: A community based study

Background

Health-seeking behavior is an action taken by an individual who perceives to have a health problem. Many childhood morbidities and mortalities are associated with a low level of a mother's healthcare-seeking behavior. However, there are limited studies about modern health-seeking behavior among mothers of ill under-five children in the study area.

Objective

To assess the level of modern health-seeking behavior of mothers/caregivers and associated factors for childhood illness in Hawassa city, Sidama, Ethiopia 2021.

Methods

A community-based cross-sectional study was conducted from November 15 to December 15, 2021, in Hawassa City. Eight kebeles were selected by using simple random sampling methods. A total of 366 mothers with children less than five years were included in this study and an interviewer-administered questionnaire was used to collect data. Data entry, cleaning, and analysis were done by using Statistical Package for Social sciences version 24 and logistic regression was used to determine the presence of association, and significance was declared at p-value <0.05.

Result

The study found that 70.2% of mothers/caregivers seek modern health care for their child's illnesses. Number of Antenatal care follow up ([AOR(Adjusted Odds Ratio) = 2.106; 95% CI(Confidence Interval) (1.097-4.042)), urban residence ([AOR = 2.688; 95% CI (1.403-5.149)), perceived severity of illness ([AOR2.832; 95% CI1.101-7.290)), four or above birth order (5.501; 95% CI (1.761-17.184)) and symptoms guiding severity of illness ([AOR = 4.664; 95% CI (1.918-11.342)) were associated with modern health-seeking behavior.

Conclusion

The overall modern health-seeking behaviors of mothers of under-five children are higher than in previous studies. However, a still significant proportion of mothers do not seek modern health care for their ill children. mothers/caregivers' residence, birth order, number of Antenatal care follow-ups, perceived severity of childhood illness, and perceived guiding symptoms of severity are the significant predictors of mothers' healthcare-seeking behavior.

Sex-Specific Differences in Congenital Diaphragmatic Hernia Mortality

OBJECTIVE

To compare disease severity and mortality differences between female and male patients with congenital diaphragmatic hernia (CDH).

STUDY DESIGN

We queried the CDH Study Group (CDHSG) database for CDH neonates managed between 2007 and 2018. Female and males were compared in statistical analyses using t tests, χ² tests, and Cox regression, as appropriate (P ≤ .05).

RESULTS

There were 7288 CDH patients, of which 3048 (41.8%) were female. Females weighed less on average at birth than males (2.84 kg vs 2.97 kg, P < .001) despite comparable gestational age. Females had similar rates of extracorporeal life support (ECLS) utilization (27.8% vs 27.3%, P = .65). Although both cohorts had equivalent defect size and rates of patch repair, female patients had increased rates of intrathoracic liver herniation (49.2% vs 45.9%, P = .01) and pulmonary hypertension (PH) (86.6% vs 81.1%, P < .001). Females had lower survival rates at 30-days (77.3% vs 80.1%, P = .003) and overall lower survival to discharge (70.2% vs 74.2%, P < .001). Subgroup analysis revealed that increased mortality was significant among those who underwent repair but were never supported on ECLS (P = .005). On Cox regression analysis, female sex was independently associated with mortality (adjusted hazard ratio 1.32, P = .02).

CONCLUSION

After controlling for the established prenatal and postnatal predictors of mortality, female sex remains independently associated with a higher risk of mortality in CDH. Further study into the underlying causes for sex-specific disparities in CDH outcomes is warranted.

Potential fish yield and biology of some fish in Lake Hertale, Afar regional state, Ethiopia

The Afar region is characterized by an arid and semi-arid climate with erratic rainfall and is prone to frequent droughts despite being endowed with fresh and saline water bodies along the Awash River Basin. Lake Hertale is one of those fresh water bodies located in the middle of the Awash River Valley. The lake's fishery is presumed not to have been exploited before. The study attempted to describe some physico-chemical parameters, fish species composition, estimate production potential which are relevant to develop a lake fishery with the prospect of contributing to food and nutrition security. The nutrient and chlorphyl-a measurements indicated eutrophic state but with apparently comparative low primary biomass. Conductivity, dissolved oxygen and temperature were within the optimal range for warm water species along with slightly alkaline pH. It was found that Lake Hertale is home to four important fish species, namely, Nile Tilapia (Oreochromis niloticus), barbs (Lebobarbus intermidus), African catfish (Clarias gariepinus) and Common carp (Cyprinus carpio), Nile crocodiles, several species of birds and hippopotamus. Labeobarbus constituted 56%, followed by Nile tilapia with 31% of the total population. The African Catfish constituted only 9% of the catch. The mean lengths of African Catfish and Labeobarbus were 47.2 and 38 cm respectively. The mean lengths of Nile tilapia and Common carp were 22.8 and 21.7 cm respectively. The fish production potential of the lake was estimated from 94.3 to 238 tons per year, with an average production of 145.7 tons per year. The estimate production potential can support up to 21 to 28 fishers, with an average number of 25 fishermen to sustainably utilize the lake's fishery potential. Lake Hertale and other adjacent lakes in the Afar region of Ethiopia can complement to the fight against hunger and malnutrition. Besides, through appropriate fishery development intervention, it is possible to create employment for the predominantly pastoralist Afar community.

Protective and risk activities for emotional and behavioural well-being of children and adolescents during the COVID-19 lockdown

BACKGROUND

The lockdown imposed to contain the COVID-19 pandemic brought deep changes in the daily life of Italian children and adolescents, increasing the time spent at home. This study aims to explore how activities that children and adolescents carried out at home during the lockdown were related to their emotional and behavioural well-being.

METHOD

Parents completed an anonymous online survey on how much time their children and adolescents dedicated to social networks, solitary screen time, play time and to a series of parent-child dyadic activities. They also reported on their offspring's emotional difficulties and behavioural problems.

RESULTS

The use of social networks had a negative impact on children's emotional difficulties, while it promoted well-being in adolescents. Pertaining to solitary screen activities, these were associated with more behavioural problems in both children and adolescents. Regarding parent-child dyadic activities, get along with the parent was associated with less emotional difficulties and behavioural problems in children and with less behavioural problems in adolescents. Furthermore, for adolescents, the more they talked with the parent, the less behavioural problems they evidenced.

CONCLUSION

The current study may help to identify activities that could be promoted and those that should be limited to effectively menage home time, in order to ultimately safeguard the emotional and behavioural well-being of children and adolescents.

Factors associated with mothers' health care-seeking behaviours for childhood fever in Burkina Faso: findings from repeated cross-sectional household surveys

INTRODUCTION

Fever is one of the most frequent reasons for paediatric consultations in Burkina Faso, but health care-seeking behaviours and the factors associated with health care-seeking in the event of childhood fever are poorly documented. This study aims to analyse the health care-seeking behaviours and the factors associated with health care-seeking for childhood fever in Burkina Faso.

METHODS

This study used the data from the baseline and endline surveys conducted to evaluate the impact of the Performance-Based Financing program in Burkina Faso. Univariate and multivariate binary logistic regression analyses were used to identify the factors associated with appropriate healthcare-seeking for childhood fever. Odds ratios were estimated to assess the strength of associations and 95% confidence intervals (CIs) were used for significance tests. Data were cleaned, coded and analysed using Stata software version 16.1.

RESULTS

Among the children under five who had a fever, 75.19% and 79.76% sought appropriate health care in 2013 and 2017, respectively. Being 24-59 months old (AOR: 0.344, 95% CI 0.182-0.649 in 2013 and AOR: 0. 208, 95% CI 0.115-0.376 in 2017), living in a very wealthy household (AOR: 2.014, 95% CI 1.149-3.531 in 2013 and AOR: 2.165, 95% CI 1.223-3.834 in 2017), having a mother with a secondary or higher level of education or having made at least four antenatal care visits were significantly associated with seeking appropriate health care for childhood fever. Living in an area where the health facility is safe was also significantly associated with seeking appropriate care for childhood fevers.

CONCLUSIONS

The findings underscore the need to concentrate efforts aiming at sensitizing the population (especially women of childbearing age) to improve sanitation and the use of family planning (household composition), skilled antenatal care and postnatal care to help reduce the prevalence of fever in children under five and improve the use of medical healthcare for childhood fever.

Mediterranean Diet in Developmental Age: A Narrative Review of Current Evidences and Research Gaps

Numerous studies in recent decades have shown that Mediterranean diet (MD) can reduce the risk of developing obesity in pediatric patients. The current narrative review summarizes recent evidence regarding the impact of MD across the different stages of child development, starting from fetal development, analyzing breastfeeding and weaning, through childhood up to adolescence, highlighting the gaps in knowledge for each age group. A literature search covering evidence published between 1 January 2000 and 1 March 2022 and concerning children only was conducted using multiple keywords and standardized terminology in PubMed database. A lack of scientific evidence about MD adherence concerns the age group undergoing weaning, thus between 6 months and one year of life. In the other age groups, adherence to MD and its beneficial effects in terms of obesity prevention has been extensively investigated, however, there are still few studies that correlate this dietary style with the incidence of non-communicable diseases. Furthermore, research on multi-intervention strategy should be implemented, especially regarding the role of education of children and families in taking up this healthy dietary style.

Assessing adolescent diet and physical activity behaviour, knowledge and awareness in low- and middle-income countries: a systematised review of quantitative epidemiological tools

PURPOSE

Quantitative epidemiological tools are routinely used to assess adolescent diet and physical activity (PA) constructs (behaviour, knowledge, and awareness) as risk factors for non-communicable diseases. This study sought to synthesize evidence on the quantitative epidemiological tools that have been used to assess adolescent diet and PA constructs in low to middle-income countries (LMIC).

METHODS

A systematised review was conducted using 3 databases (EbscoHost, Scopus and Web of Science).

RESULTS

We identified 292 LMIC studies assessing adolescent diet and PA. Identified studies predominantly explored behavioural (90%) constructs with a paucity of studies investigating knowledge and awareness. The majority of studies used subjective (94%) and self-administered (78%) tools. Only 39% of LMIC studies used tools validated for their contexts.

CONCLUSIONS

The findings highlight the need for more contextual tools for assessing adolescent diet and PA in LMICs. Diet and PA measurement tools used in future research will need to incorporate measures of knowledge and awareness for a more comprehensive understanding of the epidemiology of diet and PA in adolescents. Furthermore, there is a need for more evidence on the reliability and validity of these tools for use, in both cross sectional and longitudinal studies, in LMIC contexts.

Intellectual disability associated with craniofacial dysmorphism due to POLR3B mutation and defect in spliceosomal machinery

Background

Intellectual disability (ID) is a clinically important disease and a most prevalent neurodevelopmental disorder. The etiology and pathogenesis of ID are poorly recognized. Exome sequencing revealed a homozygous missense mutation in the POLR3B gene in a consanguineous family with three Intellectual disability with craniofacial anomalies patients. POLR3B gene encoding the second largest subunit of RNA polymerase III.

Methods

We performed RNA sequencing on blood samples to obtain insights into the biological pathways influenced by POLR3B mutation. We applied the results of our RNA-Seq analysis to several gene ontology programs such as ToppGene, Enrichr, KEGG.

Results

A significant decrease in expression of several spliceosomal RNAs, ribosomal proteins, and transcription factors was detected in the affected, compared to unaffected, family members.

Conclusions

We hypothesize that POLR3B mutation dysregulates the expression of some important transcription factors, ribosomal and spliceosomal genes, and impairments in protein synthesis and splicing mediated in part by transcription factors such as FOXC2 and GATA1 contribute to impaired neuronal function and concurrence of intellectual disability and craniofacial anomalies in our patients. Our study highlights the emerging role of the spliceosome and ribosomal proteins in intellectual disability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12920-022-01237-5.

Sex and gender differences in chronic kidney disease and access to care around the globe

The difference between sex, the biological construct, and gender, the social construct, may be most evident in settings of vulnerability. Globally, chronic kidney disease is more prevalent among women, but the prevalence of end-stage kidney failure, and especially receipt of kidney replacement therapy, is higher in men. These differences likely reflect a combination of physiological and social/structural risk factors that independently modulate kidney disease and/or its progression. The distribution of the most common risk factors such as hypertension and obesity differ between men and women and may impact disease risk differentially. Social and structural gender-related inequities remain stark across the globe. More women live in poverty, receive less education, and are more dependent on others for health care decision making, but men may have a higher risk of injury, occupational exposures, and less access to screening, prevention, and primary care. In this article, we explore how social determinants of health affect kidney disease risk and access to care differentially across genders, and differently across the globe. We also describe specific challenges experienced by boys and girls with kidney disease, how culture and geography may impact kidney care in places where resources are particularly limited such as sub-Saharan Africa, and give examples of social and structural circumstances that place young men and women at high risk of kidney disease in Mexico and Central America, illustrated by case vignettes. The coronavirus disease-2019 pandemic has raised awareness of pervasive gender-based inequities within all societies. This applies to kidney disease and is not new. The nephrology community must add its voice to the calls for action, for a more just society overall, and for the recognition of the roles of sex and gender as modulators of kidney disease risk and access to care.

Individual and community-level factors of perinatal mortality in the high mortality regions of Ethiopia: a multilevel mixed-effect analysis

BACKGROUND

Even though perinatal mortality has declined globally; it is still the major public health concern in sub-Saharan Africa countries. Ethiopia is one of the sub-Saharan countries which contribute the highest-burden of perinatal mortality with a devastating rate in some of the regions. Therefore, this study aimed to identify the determinants of perinatal mortality in the high mortality regions of Ethiopia.

METHOD

A secondary data analysis was done using the 2016 Ethiopian Demographic and Health Survey data. The outcomes of 4120 pregnancies reaching ≥ 7 months of gestational age were considered for the analysis. A multilevel mixed logistic regression model was fitted to identify the predictors of perinatal mortality. Finally, a statistically significant association was declared at a p-value of ≤ 0.05.

RESULT

The study found that birth interval < 2 years (AOR = 3.71, 95%CI:2.27, 6.07),having no antenatal care (AOR = 2.43,95%CI:1.15,5.38), initiating breastfeeding after 1 h(AOR = 4.01,95%CI:2.49,6.51), being distant from health institutions (AOR = 1.99, 95%CI: 1.24, 3.22), having previous terminated pregnancy (AOR = 4.68, 95%CI:2.76,7.86), being mothers not autonomous(AOR = 1.96, 95%CI:1.19,3.20),being no media exposure (AOR = 2.78, 95%CI:1.48,5.59),being households ≤ 4 family sizes (AOR = 4.12, 95%CI:2.19,7.79), having ≥ 6 parity (AOR = 2.48, 95%CI:1.21, 5.22) were associated with a high odds of perinatal mortality.

CONCLUSION

The study concludes that birth interval, antenatal care, time for breastfeeding initiation, distance from health institutions, previous history of terminated pregnancy, maternal autonomy, media exposure, family size, and parity were predictors of prenatal mortality. Therefore, programmatic emphases to maternal waiting service utilization for mothers distant from health institutions and media advertising regarding the complications related to pregnancy, childbirth and on its respective direction that the mothers should follow could reduce perinatal mortality in high mortality regions of Ethiopia.

Patterns, Outcomes and Predictors of Pediatric Medical Admissions at Gadarif Hospital in Eastern Sudan

BACKGROUND

The reduction of childhood mortality is a reliable indicator of a national health system's progress and improvement. Sudan's population is still suffering from communicable diseases, with a considerably higher mortality rate among children. Efforts are therefore needed to reduce mortality and achieve the Millennium Development Goals and Sustainable Development Goals. This study was conducted to determine the morbidity, mortality and outcomes of children admitted to Gadarif Hospital in eastern Sudan.

METHOD

A retrospective study was conducted by reviewing the medical files of pediatric patients who were admitted to Gadarif Hospital between March 1, 2019 and March 31, 2020.

RESULT

A total of 740 medical files were reviewed. Most, 453 (61.2%) of the admissions were males. The median (interquartile range) age was 3.0 (8.0) years and 433 (58.8%) of the admissions were under 5 years of age. The median (interquartile range) of the length of hospital stay was 9.0 (12.0) days. Visceral leishmaniasis, malnutrition, severe malaria, sickle cell disease, acute watery diarrhea, severe anemia (regardless of its cause), septicemia and acute respiratory infection were the most common causes of admission. The mortality rate was 5.7%, and it was significantly higher in females than males [24/287 (8.4%) vs. 18/453 (4.0%), P = 0.01] and in children under 5 years [36/433 (8.3%) vs. 6/307 (2.0%), P < 0.001]. Malnutrition, visceral leishmaniasis, septicemia and meningitis/encephalitis were the main diseases causing death in the study population. The case fatality rate was not significantly different in malnutrition than in visceral leishmaniasis [9/93 (9.7%) vs. 7/178 (3.9%), P = 0.05].

CONCLUSION

The main causes of morbidity and mortality for children admitted to Gadarif Pediatric Hospital were communicable diseases. The mortality rate was 5.7%. Females and children under 5 years were the most vulnerable groups for fatality.

Nationwide epidemiological characteristics of chronic fatigue syndrome in South Korea

BACKGROUND

Chronic fatigue syndrome (CFS) is a long-term disabling illness accompanied by medically unexplained fatigue. This study aimed to explore the epidemiological characteristics of CFS in South Korea.

METHODS

Using the nationwide medical records provided by the Korean Health Insurance Review & Assessment Service (HIRA), we analyzed the entire dataset for CFS patients diagnosed by physicians in South Korea from January 2010 to December 2020.

RESULTS

The annual mean incidence of CFS was estimated to be 44.71 ± 6.10 cases per 100,000 individuals [95% CI: 40.57, 48.76], and the prevalence rate was 57.70 ± 12.20 cases per 100,000 individuals [95% CI: 49.40, 65.79]. These two rates increased by 1.53- and 1.94-fold from 2010 to 2020, respectively, and showed an increasing trend with aging and an approximately 1.5-fold female predominance.

CONCLUSIONS

This study is the first to report the nationwide epidemiological features of CFS, which reflects the clinical reality of CFS diagnosis and care in South Korea. This study will be a valuable reference for studies of CFS in the future.

A new era: improving use of sociodemographic constructs in the analysis of pediatric cohort study data

Given the diversity of sex, gender identity, race, ethnicity, and socioeconomic position (SEP) in children across the United States, it is incumbent upon pediatric and epidemiologic researchers to conduct their work in ways that promote inclusivity, understanding and reduction in inequities. Current child health research often utilizes an approach of "convenience" in how data related to these constructs are collected, categorized, and included in models; the field needs to be more systematic and thoughtful in its approach to understand how sociodemographics affect child health. We offer suggestions for improving the discourse around sex, gender identity, race, ethnicity, and SEP in child health research. We explain how analytic models should be driven by a conceptual framework grounding the choices of variables that are included in analyses, without the automatic "adjusting for" all sociodemographic constructs. We propose to leverage newly available data from large multi-cohort consortia as unique opportunities to improve the current standards for analyzing and reporting core sociodemographic constructs. Improving the characterization and interpretation of child health studies with regards to core sociodemographic constructs is critical for optimizing child health and reducing inequities in the health and well-being of all children across the United States. IMPACT: Current child health research often utilizes an approach of "convenience" in how data related to sex, race/ethnicity, and SEP are collected, categorized, and included in models. We offer suggestions for how scholars can improve the discourse around sex, gender identity, race, ethnicity, and SEP in child health research. We explain how analytic models should be driven by a conceptual framework grounding the choices of variables that are included in analyses. We propose to leverage newly available large cohort consortia of child health studies as opportunities to improve the current standards for analyzing and reporting core sociodemographic constructs.

Sex differences in associations between birth characteristics and childhood cancers: a five-state registry-linkage study

BACKGROUND

There is a well-recognized male excess in childhood cancer incidence; however, it is unclear whether there is etiologic heterogeneity by sex when defined by epidemiologic risk factors.

METHODS

Using a 5-state registry-linkage study (cases n = 16,411; controls n = 69,816), we estimated sex-stratified odds ratios (OR) and 95% confidence intervals (95% CI) between birth and demographic characteristics for 16 pediatric cancers. Evidence of statistical interaction (p-interaction < 0.01) by sex was evaluated for each characteristic in each cancer.

RESULTS

Males comprised > 50% of cases for all cancers, except Wilms tumor (49.6%). Sex interacted with a number of risk factors (all p-interaction < 0.01) including gestational age for ALL (female, 40 vs. 37-39 weeks OR: 0.84, 95% CI 0.73-0.97) and ependymoma (female, 40 vs. 37-39 OR: 1.78, 95% CI 1.14-2.79; female, ≥ 41 OR: 2.01. 95% CI 1.29-3.14), birth order for AML (female,  ≥ 3rd vs. 1st OR: 1.39, 95% CI 1.01-1.92), maternal education for Hodgkin lymphoma (male, any college vs. < high school[HS] OR: 1.47, 95% CI 1.03-2.09) and Wilms tumor (female, any college vs. HS OR: 0.74, 95% CI 0.59-0.93), maternal race/ethnicity for neuroblastoma (male, black vs. white OR: 2.21, 95% CI 1.21-4.03; male, Hispanic vs. white OR: 1.86, 95% CI 1.26-2.75; female, Asian/Pacific Islander vs. white OR: 0.28, 95% CI 0.12-0.69), and paternal age (years) for hepatoblastoma in males (< 24 vs. 25-29 OR: 2.17, 95% CI 1.13-4.19; ≥ 35 vs. 25-29 OR: 2.44, 95% CI 1.28-4.64).

CONCLUSIONS

These findings suggest etiologic heterogeneity by sex for childhood cancers for gestational age, maternal education, and race/ethnicity and paternal age.

Socioeconomic inequalities in 29 childhood diseases: evidence from a 1,500,000 children population retrospective study

BACKGROUND

Socioeconomic position (SEP) powerfully affects health status in the childhood population. However, the knowledge of which diseases are more affected by SEP and whose outcomes could be improved by having a more equitable society remains uncertain on a population basis.

METHODS

We measured socioeconomic and gender inequalities in the pre-COVID-19 era for 29 diseases in the entire childhood population in Catalonia to identify which diseases are most impacted by inequalities. This population-based study included 1,449,816 children under 15 years old from 2014 to 2017 (48.52% girls) and each of their registered diagnoses within the Catalonia National Health System. We calculated frequency measures by SEP and their sex ratios for each disease. We estimated four regression-based inequality measures: slope index of inequality, relative index of inequality (RII), absolute population-attributable fraction, and population-attributable fraction.

RESULTS

Twenty-five of the 29 diseases examined showed SEP inequalities. The diseases with the greatest inequalities in both sexes were tuberculosis, obesity, adjustment and anxiety disorders, essential hypertension, poisoning, short gestation, low birth weight, foetal growth retardation and intrauterine hypoxia and birth asphyxia and trauma (RII ≥ 2.0); only food allergy showed the opposite pattern (RII < 1.0). Overall, 80,188 (7.80%) of the disease events in boys and 74,921 (8.88%) in girls would be avoided if all children had the same disease rate as those in the medium-high SEP group, with tuberculosis, intrauterine hypoxia and birth asphyxia and trauma, obesity, and short gestation, low birth weight, foetal growth retardation being those that could be reduced the most in relative terms, and dermatitis, injuries, acute bronquitis, and being overweight those that could be reduced the most in absolute terms. Girls present higher RII than boys for respiratory allergy, asthma, dermatitis, being overweight, and obesity (p < 0.05). In contrast, boys showed higher RII compared to girls only in congenital anomalies (p < 0.05).

CONCLUSIONS

Socioeconomic and gender inequalities are widely present in childhood health. This indicates that SEP plays a common role in their development although it varies in magnitude according to each disease. It is also a phenomenon that comprises all SEP groups in society. Action needs to be taken to ensure a fairer start in life in terms of health.

Genetics and Epigenetics of One-Carbon Metabolism Pathway in Autism Spectrum Disorder: A Sex-Specific Brain Epigenome?

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition affecting behavior and communication, presenting with extremely different clinical phenotypes and features. ASD etiology is composite and multifaceted with several causes and risk factors responsible for different individual disease pathophysiological processes and clinical phenotypes. From a genetic and epigenetic side, several candidate genes have been reported as potentially linked to ASD, which can be detected in about 10–25% of patients. Folate gene polymorphisms have been previously associated with other psychiatric and neurodegenerative diseases, mainly focused on gene variants in the DHFR gene (5q14.1; rs70991108, 19bp ins/del), MTHFR gene (1p36.22; rs1801133, C677T and rs1801131, A1298C), and CBS gene (21q22.3; rs876657421, 844ins68). Of note, their roles have been scarcely investigated from a sex/gender viewpoint, though ASD is characterized by a strong sex gap in onset-risk and progression. The aim of the present review is to point out the molecular mechanisms related to intracellular folate recycling affecting in turn remethylation and transsulfuration pathways having potential effects on ASD. Brain epigenome during fetal life necessarily reflects the sex-dependent different imprint of the genome-environment interactions which effects are difficult to decrypt. We here will focus on the DHFR, MTHFR and CBS gene-triad by dissecting their roles in a sex-oriented view, primarily to bring new perspectives in ASD epigenetics.

Sex differences in expression of immune elements emerge in children, young adults and mice with osteosarcoma

BACKGROUND

Males < 40 years old are more likely to be diagnosed with and die from osteosarcoma (OS). The underlying mechanisms may depend on sex differences in immune response.

METHODS

We used SEER data to estimate survival differences between males and females aged < 40 years at OS diagnosis. In NCI TARGET-OS cases, we determined sex differences in gene expression, conducted Gene Set Enrichment Analysis (GSEA), and applied the LM22 signature to identify biologic sex differences. We compared sex differences in gene expression profiles in TARGET-OS to those observed in Sleeping Beauty (SB) transposon mutagenesis accelerated Trp53R270H-mutant mouse-OS and healthy adult osteoblasts.

RESULTS

Males had worse 17-year overall survival than females (SEER p < 0.0001). From 87 TARGET-OS cases, we observed 1018 genes and 69 pathways that differed significantly by sex (adjusted p < 0.05). Pathway and gene lists overlapped with those from mice (p = 0.03) and healthy osteoblasts (p = 0.017), respectively. Pathways that differed significantly by sex were largely immune-based and included the PD-1/PD-L1 immunotherapy pathway. We observed sex differences in M2 macrophages (LM22; p = 0.056) and M1-M2 macrophage transition (GSEA; p = 0.037) in TARGET-OS. LM22 trends were similar in mice. Twenty-four genes differentially expressed by sex in TARGET-OS had existing cancer therapies.

CONCLUSIONS

Sex differences in OS gene expression were similar across species and centered on immune pathways. Identified sex-specific therapeutic targets may improve outcomes in young individuals with OS.

Two-Source Capture-Recapture Method to Estimate the Incidence of Acute Flaccid Paralysis in the Marches Region (Italy)

A combination of high infant immunization coverage and surveillance of acute flaccid paralysis (AFP) cases, plays a critical role in polio eradication. This study aimed to estimate the incidence of AFP, to evaluate the completeness of AFP ascertainment during the years, age groups and gender, and to define the main associated diagnosis among children aged under 15 in the Marches region of Italy. Analysis was performed on data from the active AFP surveillance system and the hospital discharge records in the 2006-2014 period. The two-source capture-recapture method was applied. After cross-validation, 30 AFP compatible conditions as defined by the WHO were identified, with an incidence estimate of 1.91 cases of AFP per 100,000 children under 15 years (95% CI = 1.4-2.6/100,000). Guillain-Barrè syndrome was the most common diagnosis. A significant difference (p < 0.05) has been registered in the estimated probability of case ascertainment in females. The reasons for the lower reporting of cases in females are unknown. Specific research and the implementation of a more sensitive surveillance system are essential in verifying potential inequalities and to succeed in the polio eradication initiative.

Structure of communities in semantic networks of biomedical research on disparities in health and sexism

Introducción.

Como una iniciativa para mejorar la calidad de la atención sanitaria, en la investigación biomédica se ha incrementado la tendencia centrada en el estudio de las disparidades en salud y sexismo.

Objetivo.

Caracterizar la evidencia científica sobre la disparidad en salud definida como la brecha existente entre la distribución de la salud y el posible sesgo por sexo en el acceso a los servicios médicos.

Materiales y métodos.

Se hizo una búsqueda simultánea de la literatura científica en la base de datos Medline PubMed de dos descriptores fundamentales: Healthcare disparities y Sexism. Posteriormente, se construyó una red semántica principal y se determinaron algunas subunidades estructurales (comunidades) para el análisis de los patrones de organización de la información. Se utilizó el programa de código abierto Cytoscape para el analisis y la visualización de las redes y el MapEquation, para la detección de comunidades. Asimismo, se desarrolló código ex profeso disponible en un repositorio de acceso público.

Resultados.

El corpus de la red principal mostró que los términos sobre las enfermedades del corazón fueron los descriptores de condiciones médicas más concurrentes. A partir de las subunidades estructurales, se determinaron los patrones de información relacionada con las políticas públicas, los servicios de salud, los factores sociales determinantes y los factores de riesgo, pero con cierta tendencia a mantenerse indirectamente conectados con los nodos relacionados con condiciones médicas.

Conclusiones.

La evidencia científica indica que la disparidad por sexo sí importa para la calidad de la atención de muchas enfermedades, especialmente aquellas relacionadas con el sistema circulatorio. Sin embargo, aún se percibe un distanciamiento entre los factores médicos y los sociales que dan lugar a las posibles disparidades por sexo.

Vitamin D Deficiency in Autism Spectrum Disorder: A Cross-Sectional Study

Vitamin D plays a role in central nervous system (CNS) development. Recent literature focused on vitamin D status in children and adolescents with autism spectrum disorder (ASD), but with inconsistent results. Our case-control study is aimed at evaluating serum 25-hydroxyl-vitamin D (25(OH)D) concentration in children with ASD (ASD group, n = 54) compared to children affected by other neurological and psychiatric disorders (non-ASD group, n = 36). All patients were admitted at the Complex Operative Unit of Child Neuropsychiatry, Polyclinic of Bari, Italy. 25(OH)D was quantified by chemiluminescence immunoassay and level defined as: deficiency (<20 ng/mL); insufficiency (20-30); normality (30-100); toxicity (>100). Statistical analysis was performed using SPSS20 (significance < 0.05). The ASD group showed 25(OH)D a mean level significantly lower than control (p = 0.014). Multivariable logistic regression analysis showed an association between ASD and vitamin D deficiency (p = 0.006). The nature of such association is unclear. Vitamin D deficiency may probably act as a risk factor for the development of ASD. Further studies are needed to unravel the role of vitamin D in ASD etiology and investigate its therapeutic potential.

Systematic review and meta-analysis of the prevalence of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)

BACKGROUND

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has been emerging as a significant health issue worldwide. This study aimed to systemically assess the prevalence of CFS/ME in various aspects of analyses for precise assessment.

METHODS

We systematically searched prevalence of CFS/ME from public databases from 1980 to December 2018. Data were extracted according to 7 categories for analysis: study participants, gender and age of the participants, case definition, diagnostic method, publication year, and country of the study conducted. Prevalence data were collected and counted individually for studies adopted various case definitions. We analyzed and estimated prevalence rates in various angles: average prevalence, pooled prevalence and meta-analysis of all studies.

RESULTS

A total of 1291 articles were initially identified, and 45 articles (46 studies, 56 prevalence data) were selected for this study. Total 1085,976 participants were enrolled from community-based survey (540,901) and primary care sites (545,075). The total average prevalence was 1.40 ± 1.57%, pooled prevalence 0.39%, and meta-analysis 0.68% [95% CI 0.48-0.97]. The prevalence rates were varied by enrolled participants (gender, study participants, and population group), case definitions and diagnostic methods. For example, in the meta-analysis; women (1.36% [95% CI 0.48-0.97]) vs. men (0.86% [95% CI 0.48-0.97]), community-based samples (0.76% [95% CI 0.53-1.10]) vs. primary care sites (0.63% [95% CI 0.37-1.10]), adults ≥ 18 years (0.65% [95% CI 0.43-0.99]) vs. children and adolescents < 18 years (0.55% [95% CI 0.22-1.35]), CDC-1994 (0.89% [95% CI 0.60-1.33]) vs. Holmes (0.17% [95% CI 0.06-0.49]), and interviews (1.14% [95% CI 0.76-1.72]) vs. physician diagnosis (0.09% [95% CI 0.05-0.13]), respectively.

CONCLUSIONS

This study comprehensively estimated the prevalence of CFS/ME; 0.89% according to the most commonly used case definition CDC-1994, with women approximately 1.5 to 2 folds higher than men in all categories. However, we observed the prevalence rates are widely varied particularly by case definitions and diagnostic methods. An objective diagnostic tool is urgently required for rigorous assessment of the prevalence of CFS/ME.

Gender-dependent radiotherapy: The next step in personalised medicine?

Individuals do not react to radiation in a homogeneous manner. Recent radiogenomic research has proven that individual polymorphisms can correlate with treatment response most likely due to variation in the ability to recognise and repair DNA breaks. The difference in radiosensitivity between genders has been well documented, yet most radiotherapeutic guidelines are based solely on population averages rather than demographic subgroups such as age, race and gender. This paper is a review of the burgeoning literature available on the differences in efficacy and outcome of radiotherapy between genders. The work examines the effect of radiation on gender both from a tumour control as well as normal tissue toxicity perspective. While the literature reporting such findings is limited, the results show a small but significant difference in response to radiotherapy between sexes. Prospective and retrospective studies for evaluating these gender-specific differences are encouraged as a next step in personalised medicine.

Sex ratio among childhood cancers by single year of age

BACKGROUND

The male excess in childhood cancer incidence is well-established; however, the underlying biologic mechanisms remain unknown. Examining the association between male sex and childhood cancer by single year of age and tumor type may highlight important periods of risk such as variation in growth and hormonal changes, which will inform etiologic hypotheses.

METHODS

Using data from the Surveillance, Epidemiology, and End Results (SEER) 18 registries (2000-2015), incidence rate ratios (IRR) and 95% confidence intervals (95% CI) were estimated as the measure of association between male sex and childhood cancer by single year of age (0-19).

RESULTS

The IRR for male cancer overall was 1.19 (95% CI, 1.18-1.20) and was similar in magnitude at nearly every year of age. Burkitt lymphoma was strongly associated with male sex (IRRs ≥2 at each year of age). Increased incidence was observed among males for acute lymphoblastic leukemia, Hodgkin and non-Hodgkin lymphomas for nearly all years of age. Medulloblastoma was the only central nervous system tumor with a significant male predominance at nearly every age. Male sex displayed a consistent inverse association with nephroblastoma and thyroid carcinoma over the ages studied.

CONCLUSIONS

Male sex was positively associated with most cancers. The higher incidence rates observed in males remained consistent over the childhood and adolescent periods, suggesting that childhood and adolescent hormonal fluctuations may not be the primary driving factor for the sex disparities in childhood cancer. The observed incidence disparities may be due to sex differences in exposures, genetics, or immune responses.

Record linkage to enhance consented cohort and routinely collected health data from a UK birth cohort

Background

In longitudinal health research, combining the richness of cohort data to the extensiveness of routine data opens up new possibilities, providing information not available from one data source alone. In this study, we set out to extend information from a longitudinal birth cohort study by linking to the cohort child’s routine primary and secondary health care data. The resulting linked datasets will be used to examine health outcomes and patterns of health service utilisation for a set of common childhood health problems. We describe the experiences and challenges of acquiring and linking electronic health records for participants in a national longitudinal study, the UK Millennium Cohort Study (MCS).

Method

Written parental consent to link routine health data to survey responses of the MCS cohort member, mother and her partner was obtained for 90.7% of respondents when interviews took place at age seven years in the MCS. Probabilistic and deterministic linkage was used to link MCS cohort members to multiple routinely-collected health data sources in Wales and Scotland.

Results

Overall linkage rates for the consented population using country-specific health service data sources were 97.6% for Scotland and 99.9% for Wales. Linkage rates between different health data sources ranged from 65.3% to 99.6%. Issues relating to acquisition and linkage of data sources are discussed.

Conclusions

Linking longitudinal cohort participants with routine data sources is becoming increasingly popular in population data research. Our results suggest that this is a valid method to enhance information held in both sources of data.

The association between sex and most childhood cancers is not mediated by birthweight

BACKGROUND

Male sex is associated with an increased risk of childhood cancer as is high birthweight. Given that sex determination precedes birthweight we conducted a mediation analysis to estimate the direct effect of sex in association with childhood cancer tumor type with birthweight as the mediator.

METHODS

Cases (n = 12,632) and controls (n = 64,439) (ages 0-14 years) were identified from population-based cancer and birth registries in Minnesota, New York, and Washington states (1970-2014). An inverse odds weighting (IOW) mediation analysis was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) as the measure of association between sex and cancer.

RESULTS

A significant indirect effect was observed for sex and lymphoid leukemia, mediated by birthweight (indirectOR: 1.03; 95% CI: 1.02-1.04). We observed significant direct effects for male sex and lymphoid leukemia (directOR: 1.16; 95% CI: 1.08-1.25), Hodgkin lymphoma (directOR: 1.48; 95% CI: 1.22-1.81), Burkitt lymphoma (directOR: 5.02; 95% CI: 3.40-7.42), other non-Hodgkin lymphoma (directOR: 1.42; 95% CI: 1.18-1.70), intracranial embryonal tumors (directOR: 1.49; 95% CI: 1.26-1.76), hepatoblastoma (directOR: 1.90; 95% CI: 1.40-2.59), and rhabdomyosarcoma (directOR: 1.47; 95% CI: 1.19-1.81). There were also inverse associations for extracranial GCTs (directOR: 0.41; 95% CI: 0.26-0.63) and thyroid carcinoma (directOR: 0.35; 95% CI: 0.25-0.50).

CONCLUSION

Significant direct effects for sex and numerous childhood cancer types suggests sex-specific factors such as differences in gene expression from the autosomes or the X chromosome, rather than birthweight, may underlie sex differences in tumor risk.