Les données probantes et les recommandations sur le cannabis à des fins médicales chez les enfants

L'intérêt envers l'utilisation des produits du cannabis à des fins médicales chez les enfants de moins de 18 ans augmente. De nombreux produits du cannabis à des fins médicales contiennent du cannabidiol, du delta-9-tétrahydrocannabinol ou ces deux produits. Malgré les nombreuses prétentions thérapeutiques, peu d'études rigoureuses guident la posologie, l'innocuité et l'efficacité du cannabis à des fins médicales en pédiatrie clinique. Le présent document de principes passe en revue les données probantes à jour et expose les recommandations sur l'utilisation du cannabis à des fins médicales chez les enfants. Les rapports à plus long terme (deux ans) souscrivent à la tolérabilité et à l'efficacité soutenues d'un traitement au cannabidiol chez les patients ayant le syndrome de Lennox-Gastaut ou le syndrome de Dravet. Les extraits de cannabis enrichis de cannabidiol qui renferment de petites quantités de delta-9-tétrahydrocannabinol ont été évalués auprès d'un petit nombre de patients d'âge pédiatrique, et d'autres recherches devront être réalisées pour éclairer les guides de pratique clinique. Étant donné l'utilisation répandue du cannabis à des fins médicales au Canada, les pédiatres devraient être prêts à participer à des échanges ouverts et continus avec les familles au sujet de ses avantages potentiels et de ses risques, ainsi qu'à préparer des plans individuels en vue d'en surveiller l'efficacité, de réduire les méfaits et de limiter les interactions médicamenteuses.

L'accès à des services d'interprétation appropriés, essentiel pour la santé des enfants

Puisque 20 % des Canadiens déclarent avoir une autre langue maternelle que le français ou l'anglais, il n'est pas rare que les professionnels de la santé et les patients maîtrisent des langues différentes. Lorsqu'un médecin et son patient ne peuvent pas communiquer correctement, ils courent le risque de mal se comprendre, ce qui peut se solder par de mauvais résultats cliniques et une réadmission hospitalière. Les services d'interprétation professionnels sont associés à une amélioration de la communication, de l'utilisation des soins, des résultats cliniques et de la satisfaction envers les soins. Il est démontré que le recours à des interprètes non formés ou improvisés, y compris les membres de la famille, accroît les erreurs d'omission, les substitutions, les modifications volontaires et les ajouts. Les enfants et les adolescents n'ont pas acquis une maturité développementale suffisante pour agir en qualité d'interprètes dans le milieu de la santé. Dans un tel contexte, ils sont mis dans une situation inappropriée avec laquelle il peut être difficile de composer et qui peut compromettre durablement à la fois leur propre santé mentale et leur relation avec les autres membres de la famille.

The Association of Children and Their Educational Attainment With Diabetes-related Complications and Mortality Among Older Adults With Type 2 Diabetes: A Nationwide Cohort Study

OBJECTIVE

Socioeconomic resources and family support have been shown to improve adherence to treatment in people with type 2 diabetes (T2D) and are associated with a lower risk of diabetes-related complications and death. We investigated the associations of having children and their educational level with diabetes-related complications and death among older adults with T2D.

METHODS

We included 74,588 adults who were at least 65 years of age at the time of T2D diagnosis over the period from 2000 to 2018 in Denmark and grouped them based on having children (yes [reference]/no), and their children's highest educational level (low/medium/high [reference]). Multistate models were performed with 3 states: T2D diagnosis, diabetes-related complications, and death. All models were stratified by other chronic diseases at baseline (yes/no).

RESULTS

During follow-up (mean, 5.5 years), 14.6% of the adults developed a complication and 24.8% died with or without complications. Not having children was associated with a higher hazard of death without complications among adults without (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.17 to 1.33) and with (HR, 1.10; 95% CI, 1.02 to 1.18) other chronic diseases and after complications among adults without other chronic diseases (HR, 1.25; 95% CI, 1.12 to 1.38). Having children with a lower educational level was associated with a higher hazard of complications (HRlow, 1.14; 95% CI, 1.05 to 1.24; HRmedium, 1.11; 95% CI, 1.05 to 1.17), death without complications (HRlow, 1.26; 95% CI, 1.17 to 1.36; HRmedium, 1.07; 95% CI, 1.02 to 1.14), and after complications (HRlow, 1.22; 95% CI, 1.07 to 1.39) among adults without other chronic diseases.

CONCLUSIONS

Among adults without other chronic diseases, having no children or having children with lower educational levels was associated with a higher hazard of death. Among these adults, having children with lower educational levels was also associated with a higher hazard of diabetes-related complications.

La promotion de l'évolution optimale de la santé mentale chez les enfants et les adolescents

Les dispensateurs de soins pédiatriques sont souvent le premier point de contact des enfants et des adolescents aux prises avec des problèmes de santé mentale, mais ils ne possèdent pas nécessairement les ressources (p. ex., l'accès à une équipe multidisciplinaire) ni la formation nécessaires pour procéder à leur dépistage ou à leur prise en charge. Le présent document de principes conjoint décrit les principaux rôles et les principales compétences à maîtriser pour évaluer et traiter les problèmes de santé mentale chez les enfants et les adolescents, de même que les facteurs qui optimisent le plus possible l'évolution de la santé mentale dans ces groupes d'âge. Il contient des conseils fondés sur des données probantes à propos du dépistage des préoccupations en matière de santé mentale chez les jeunes et leur famille ainsi qu'à propos des échanges sur le sujet. Les interventions préventives et thérapeutiques dont l'efficacité est démontrée en milieu communautaire sont abordées. Le présent document de principes, qui est fondamental, traite également des changements à l'enseignement de la médecine ainsi qu'aux systèmes et aux politiques de santé qui s'imposent pour améliorer la pratique clinique et les efforts de revendications au Canada, y compris les modèles de rémunération appropriés, les approches des soins abordées étape par étape, le financement gouvernemental ciblé, l'enseignement et la formation professionnelle.

Acceptability, Helpfulness, and Utility of the Healthy Lunch Box Booklet (HLBB) for Parents and School-Age Children

Purpose: School lunches are of poor nutritional quality in Canada. Parents play an important role in the preparation of school lunches for young children. This study aimed to evaluate the acceptability and helpfulness of the Healthy Lunch Box Booklet (HLBB) to support parents in packing healthy school lunches for their children.Methods: The HLBB was distributed at four schools in London, Ontario to students in full-day Kindergarten to Grade three. Parents were asked to complete an online survey from April to November 2019.Results: Parents (n = 58) reported the HLBB to be helpful (96.3%) and found the sections on new school lunch and snack ideas and nutritional information (e.g., label reading) particularly useful. Some parents also stated that the HLBB created opportunities to interact with their children regarding school lunch preparation. In terms of perceived impacts, parents reported increased confidence (68.6%) and learning something new (79.6%) about school lunch preparation and felt that their children's diet was impacted accordingly.Conclusions: The HLBB was found to be an acceptable and useful nutrition resource that supports parents in packing healthy school lunches for their children and therefore warrants further study.

Children's Perceptions of the Ontario Student Nutrition Program (OSNP) in Southwestern Ontario, Canada

Purpose: This study aimed to explore children's lived experiences with the Ontario Student Nutrition Program (OSNP), a free, school-based snack program implemented in elementary schools in Southwestern, Ontario, Canada, to gain insights into future school food programs (SFP).Methods: Focus group discussions (n=17) were conducted with 105 children in Grades 5 to 8 in seven elementary schools. Focus groups were audio-recorded, transcribed, and coded for themes using inductive content analysis.Results: Overall, children appreciated the OSNP and felt that it filled a need in students. Children also reported a willingness to try novel food items. For future SFPs, participants recommended that input be sought from children to ensure food preferences were considered. Children also discussed wanting more appealing food offerings that may include some choice. Finally, children also mentioned wanting a fair and equitable distribution of food in classrooms.Conclusions: Children appreciated the OSNP and reported benefits to themselves and their peers. They also provided some valuable recommendations for future SFPs. If a nationally funded SFP is to be considered in Canada, children expressed the need to make the program equitable, while still allowing schools the flexibility to meet their unique needs and preferences.

The Relationship Between Sensory Processing and Attachment Patterns: A Scoping Review

Background. Clinicians and researchers have observed that sensory processing and attachment difficulties frequently co-occur; however, little is known about which sensory processing and attachment patterns are interrelated across populations. Purpose. To review evidence of empirical relationships between sensory processing and attachment patterns across the life span. Method. Using the Arksey and O'Malley framework, four databases were searched up to June 2021 for studies that investigated relationships between sensory processing and attachment patterns. Findings. Twenty-two studies met inclusion criteria: nine considered sensory and attachment patterns in children/adolescents and thirteen in adults. In children, sensory modulation was positively associated with attachment security. In adults, more extreme patterns of sensory modulation (e.g., higher sensory sensitivity) were generally associated with attachment insecurity. Implications. Findings indicate empirical relationships between sensory processing and attachment constructs in children and adults that warrant further investigation. Occupational therapists should consider both sensory processing and attachment patterns when planning interventions.

Age, Sex and Relationship Strengths: Internalizing Symptom Differences in Children and Youth Within a Clinical Sample

BACKGROUND

Internalizing problems such as depression, anxiety and anhedonia are particularly problematic due to their covert nature. Due to their deleterious effects on psychological well-being, social connection and education, it is important to understand the development of internalizing problems and their unique contributors.

OBJECTIVES

Examine whether internalizing symptoms vary by (i) age, and (ii) sex, and whether (iii) relationship strengths are associated with sex and internalizing symptoms.

METHOD

Using a polynomial model with Tweedie distribution with log link, this study examined relationships for 18,701 clinically referred children and adolescents between 4 and 18 years of age assessed using the interRAI Child and Youth Mental Health assessment.

RESULTS

Internalizing symptoms reported by children and adolescents varied by age and sex. Sex differences in internalizing symptoms became prominent after about six years of age with female adolescents reporting higher levels when compared to male peers. An increase in relationship strengths corresponded with a decrease in internalizing symptoms for both sexes. However, the pattern depended on sex. In our sample, females required a greater number of relationship strengths to observe a decrease in internalizing symptoms.

CONCLUSIONS

The current study illustrates a difference in internalizing symptoms between females and males with respect to age and relationship strengths. The results may have implications for prevention and intervention strategies geared towards internalizing symptoms for children and adolescents.

La négligence en matière de soins médicaux : travailler auprès des enfants, des adolescents et des familles

Les soins de santé sont un droit fondamental pour tous les enfants. Lorsque les besoins de santé de l'enfant ne sont pas respectés, quelle qu'en soit la raison, les professionnels de la santé doivent réfléchir aux obstacles en cause et aux processus nécessaires pour trouver des solutions. Des obstacles sociaux, économiques ou autres peuvent empêcher les parents d'accéder aux soins pour leur enfant. Il arrive que les avis, les priorités ou les valeurs des professionnels de la santé de l'enfant divergent de ceux des parents, ce qui compromet les soins à l'enfant. Dans certains cas, l'abstention des personnes qui s'occupent de l'enfant à assurer les soins nécessaires peut être considérée comme de la négligence en matière de soins médicaux. Des habiletés et des connaissances particulières peuvent aider les professionnels de la santé à éviter de telles situations et à collaborer avec efficacité avec la famille lorsque ces situations se produisent. Le présent document de principes offre une approche que peuvent utiliser les professionnels de la santé pour promouvoir l'intérêt supérieur, le bien-être et la sécurité des enfants ou des adolescents vulnérables à la négligence en matière de soins médicaux.

Le retour en classe et le port du masque pendant la pandémie de COVID-19 : le point de vue des élèves d’après une étude de simulation scolaire

Objectifs

La présente étude s’est penchée sur le point de vue des enfants relativement au retour en classe après le confinement imposé par la pandémie, sur le port du masque en classe et sur la santé mentale des enfants et des parents pendant la pandémie.

Méthodologie

La présente étude transversale a fait partie d’un exercice de simulation scolaire de deux jours au cours duquel les élèves ont été répartis au hasard entre diverses recommandations sur le port du masque. Au moyen d’analyses régression multiple, les chercheurs ont analysé le compte rendu des parents sur la santé mentale et, après la simulation, celui des élèves sur l’anxiété liée à la COVID-19 et le port du masque. Les élèves plus âgés ont participé à des groupes de travail semi-structurés pour compléter les données du questionnaire.

Résultats

Sur les 190 élèves de la présente étude, 31 % ne dépassaient pas la quatrième année et 95 % avaient hâte de rentrer en classe. La plus grande anxiété des parents ou des proches (β= 0,67; p <0,001) et leur niveau de scolarité plus bas (β=1,86; p <0,002) étaient prédicteurs d’une plus grande anxiété des enfants à l’égard de la COVID-19. Les élèves plus âgés étaient plus susceptibles de trouver le port du masque nuisible aux interactions avec leurs camarades que les plus jeunes (χ2[1]=31,16; p <0,001) et pour leur capacité à comprendre l’enseignant (χ2[1]=13,97; p <0,001). Les élèves du groupe sans masque étaient plus susceptibles de craindre de contracter la COVID-19 à l’école (χ2[1]=10,07; p <0,05) que ceux du groupe qui le portaient, et d’anticiper éprouver de la difficulté à le porter (χ2[1]=18,95; p <0,001).

Conclusions

Chez les enfants anxieux à cause de la COVID-19, l’anxiété des parents et l’information sur la COVID-19 pourraient être des cibles d’intervention. De futures recherches devraient porter sur les effets de la mise en œuvre prolongée de mesures sanitaires d’atténuation des risques sur la réussite scolaire et la santé mentale des enfants.

Les profils de santé mentale des enfants et adolescents autistes pendant la pandémie de COVID-19

Objectifs

Les confinements dans les provinces canadiennes ont malmené la santé mentale des enfants pendant la pandémie de COVID-19, et les enfants autistes y ont été particulièrement vulnérables. La présente étude visait à recenser les sous-groupes d’enfants autistes ayant des profils distincts de modification à leur santé mentale, afin de comprendre les facteurs propres aux enfants, aux parents et au système qui y sont associés et d’éclairer de futures interventions.

Méthodologie

Les chercheurs ont extrait les données d’une vaste cohorte ontarienne (n=1 570), dont faisaient partie 265 enfants autistes (âge moyen=10,9 ans, 76 % de sexe masculin). Ils ont utilisé l’analyse des nuées dynamiques pour répartir les profils de santé mentale distincts en six mesures (humeur, anxiété, symptômes de trouble obsessionnel-compulsif, irritabilité, inattention, hyperactivité) et ont examiné les différences entre les groupes. Ils ont également étudié les caractéristiques des enfants qui ont accédé à des services aigus en santé mentale.

Résultats

Le nombre optimal de grappes était fixé à deux. La première incluait ceux qui avaient éprouvé une détérioration de leur santé mentale dans les six mesures (61,3 %, intervalle de confiance à 95 %=54,9 à 67,4) et la seconde, les jeunes dont la santé mentale n’avait pas changé (38,7 %, intervalle de confiance à 95 %=32,6 à 45,1). Des facteurs étaient associés à la détérioration de la santé mentale des enfants : plus de symptômes internalisés préexistants et de forts taux de stress liés à la COVID-19. Les problèmes de santé mentale des parents et les facteurs propres aux systèmes, tels que la perte de soutien à l’apprentissage, l’accès aux médecins et les difficultés matérielles, étaient aussi liés à cette détérioration. L’accès à des services aigus en santé mentale découlait d’abord de l’insécurité financière et de la perte de services.

Conclusions

Plus de la moitié des enfants autistes ont éprouvé une détérioration de leur santé mentale, et les caractéristiques individuelles (troubles de santé mentale préexistants, stress lié à la COVID-19), parentales (santé mentale des parents) et systémiques (perte de services et difficultés matérielles) y étaient reliées, ce qui ouvrait la voie à des interventions cliniques et politiques multiniveaux.

Is Repetitive Transcranial Magnetic Stimulation (rTMS) Ready for Clinical Use as a Treatment Tool for Mental Health Targets in Children and Youth?

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation tool with potential for broad application in individuals with neuropsychiatric conditions. As in adults, most rTMS research in youth has focused on treatment-resistant depression. A limited number of rTMS studies have also been conducted in children and youth with primary diagnoses of Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD) or Tourette's syndrome. Across the available rTMS literature, rTMS appears to be well tolerated with few adverse effects reported when applied to child and youth research samples. However, the potential efficacy of rTMS treatment for a variety of targets in children and youth remains unclear, due in part to limitations of the current literature, including studies using diverse protocols, potential for bias in existing clinical trial designs, variability in the research samples, and the use of heterogenous outcome measures. While rTMS is unlikely to take the place of more accessible treatments (e.g., psychopharmacological, psychosocial, psychotherapeutic), rTMS may provide a valuable alternative treatment option, particularly for those individuals where conventional treatments are inaccessible, poorly tolerated, or ineffective. A more robust body of well-designed, controlled trials, is needed in order to clarify rTMS treatment efficacy across relevant neuropsychiatric conditions, optimize treatment protocols, and meet the critical need for novel mental health interventions in children and youth.

When the world stops: The impact of COVID-19 on physical activity and physical literacy

Matched pre-during pandemic comparison (160 children) revealed a substantial reduction in physical activity (p < 0.001, r_rb = 0.83), environmental participation (p = 0.046, r_rb = 0.16), movement valuation (p < 0.001, r_rb = 0.61), and parent perceptions of children's physical literacy (p < 0.001, r_rb = 0.56). Examining physical activity trajectories, higher pre-pandemic physical literacy protected children from pandemic related activity decline. Emerging from the pandemic, interventions should address children's eroded belief in movement and consider physical literacy levels of children in individualizing movement opportunities for restoration of activity levels. Novelty: A substantial reduction in physical activity was associated with children who had lower physical literacy and resulted in reductions in children's valuation of movement.

Anthropometric Measurements and Laboratory Investigations in Children and Youth With Type 1 Diabetes Before and During the COVID-19 Pandemic

OBJECTIVES

Our aim in this study was to compare rates of anthropometric, blood pressure (BP) and glycated hemoglobin (A1C) measurements and laboratory screening for hypothyroidism, nephropathy and dyslipidemia in children and youth with type 1 diabetes (T1D), 1 year before and after the onset of COVID-19.

METHODS

Clinical data were analyzed from a voluntary registry of children and youth with T1D followed at the BC Children's Hospital between March 2019 and 2021. Logistic and Poisson mixed-effect models were used.

RESULTS

Four hundred forty patients, with median (interquartile range) age and time since diagnosis 12.7 (9.5 to 15.4) and 4.7 (2.6 to 7.9) years, respectively, were included. Clinic visits were all in-person before March 2020, and 99% via telemedicine afterward. The number of visits per patient was 2 (2 to 3), with a 6% increase during the pandemic (relative risk [RR], 1.06; 95% confidence interval [CI], 1.01 to 1.10). There was a substantial decrease in height, weight and BP measurements (RR, 0.32; 95% CI, 0.28 to 0.36; RR, 0.34, 95% CI, 0.31 to 0.38; RR, 0.005, 95% CI, 0.002 to 0.014, respectively); only 49% of patients had anthropometric and 1% BP data during the pandemic year, compared with >97% before the pandemic. A1C measurements dropped from 3 (2 to 4) to 1 (1 to 2) per patient per year (RR, 0.53; 95% CI, 0.48 to 0.57). Rates of screening investigations were suboptimal before the pandemic, and these rates continued to decline.

CONCLUSIONS

Shifting to telemedicine allowed ongoing care during the pandemic, but the frequency of anthropometric, BP and A1C measurements decreased dramatically. A combined telemedicine/in-person model may be needed to ensure adequate care for this population.

Intakes of nutrients and food categories in Canadian children and adolescents across levels of sugars intake: cross-sectional analyses of the Canadian Community Health Survey 2015 Public Use Microdata File

Dietary recommendations to reduce sugars consumption may influence choices of sugars-containing foods and affect the intake of key micronutrients. We compared intakes of nutrients and food sources stratified by quintiles of total sugars in Canadian children (2-8 y) and adolescents (9-13 y, 14-18 y) using 24-hour dietary recalls from the 2015 Canadian Community Health Survey-Nutrition. Energy intakes did not differ across quintiles of sugars intake. Those with lower sugars intakes (Q1/Q3) generally had higher protein, fat, sodium, niacin, folate, and zinc and lower vitamin C compared with those with the highest sugars intakes (Q5). Q1 also had lower potassium but higher saturated fat compared with Q5. Further, Q1 generally had higher protein, fats, and niacin compared with Q3, while children in Q3 had higher potassium and riboflavin and older adolescents had higher calcium and fibre. Q5 had highest intakes of multiple sugar-containing food categories (e.g., fruit, confectionary, milks, cakes/pies/pastries), with higher sugars-sweetened beverages in adolescents. Q3 had higher fruit, milks, and fruit juice compared with Q1 and lower sugars/syrups/preserves, confectionary, and fruit juices compared with Q5. Certain nutrient-dense food sources of sugars (fruit, milks) may help increase key nutrients (potassium, calcium, fibre) in older adolescents with low sugars intakes. However, in those with the highest sugars intakes, nutrient-poor foods may displace nutrient-dense foods. Novelty: Canadian children and adolescents with lower sugars intake have better intakes of some nutrients. Energy intakes did not differ across sugars intake. Older adolescents with mean intakes of total sugars had better intakes of some key nutrients (potassium, calcium, fibre).

[Study Of The Availability Of Medicine For Childhood In Senegal]

INTRODUCTION

In Senegal, the main causes of death are the pneumonia, the diarrhea and the malaria. The malnutrition is an underlying factor in more than a third of the deaths, because it returns the more vulnerable children to the serious illnesses. The general objective of this research is to study the availability and the price of medicine in the therapeutic care of the children of less than 5 years old in the region of Dakar in Senegal.

METHODOLOGY

Our study is of transverse, descriptive concerned the public sanitary, the wholesalers, the private pharmacies, The population of study concerns the old children at least of 5ans. The methods used were the interviews by means of questionnaire.

RESULTS

The group of antibiotics, acid anti, antidotes, vitamins, diuretics, antiemetic's, and psychotropic were not available. As regards generic medicines, relatively low availability of 30,4 %, 23,8 % and 16,7 % is respectively observed in the public, private and denominational sectors. The availability of generic medicines in Dakar was from 81 % in the public sector and from 113 % in the private sector.

CONCLUSION

The findings make it imperative for all other relevant medicine drugs in order to reduce the mortality rate.

La prise en charge des nourrissons, des enfants et des adolescents vulnérables à l’infection par le virus de l’hépatite C

L’infection par le virus de l’hépatite C touche de 0,5 % à 1,0 % de la population canadienne. La plupart des infections pédiatriques découlent d’une transmission verticale ou, chez les adolescents et les jeunes adultes, de comportements à haut risque comme l’utilisation de drogues injectables et les activités sexuelles non protégées. Il est désormais recommandé que tous les nourrissons, les enfants et les adolescents qui présentent au moins un facteur de risque soient soumis au dépistage de l’infection par le virus de l’hépatite C. Il est démontré que le traitement de la forme chronique de cette infection au moyen d’antiviraux à action directe provoque une suppression virologique soutenue chez 97 % à 100 % des enfants dès l’âge de trois ans. Les pédiatres et les médecins de famille ont un rôle important à jouer pour informer les adolescents des risques et des modes de prévention de l’infection par le virus de l’hépatite C, ainsi que pour revendiquer, auprès du gouvernement et des autorités sanitaires, l’adoption de stratégies d’intervention globales de réduction des méfaits ciblant les jeunes à risque, des traitements accessibles et le dépistage prénatal systématique de ce virus.

A sex-related mediating effect of uric acid in the association between body composition and blood pressure in children and adolescents

The increase in blood pressure (BP) during somatic growth might have direct determinants but also mediating factors. We investigated whether uric acid (UA) and other metabolic factors would mediate the association between body composition components and BP. A cross-sectional study was conducted in 928 children and adolescents (aged 6-18 years), in which body composition and blood biochemistry were evaluated. Structural equation modeling was performed to test the direct and indirect pathways between systolic blood pressure (SBP) and body composition parameters. Muscle mass (MM) showed a strong direct effect on BP, regardless of sex. In girls, a mediating pathway through UA was not significant, but the association between fat mass (FM) and MM with SBP was mediated by the cluster of metabolic factors. In boys, both MM and FM were associated with SBP through a mediating pathway via UA, but not via the cluster of metabolic factors. The association between body composition and BP in children and adolescents has a complex design and also has a sex-specific mediating component. The increase in the UA levels may affect BP levels early in boys. Also, metabolic changes elicited by FM contribute to the increase in BP at an early age in girls. Novelty: MM showed a strong direct effect on BP, regardless of sex. In girls, the association between FM and MM with SBP was mediated by the cluster of metabolic factors. In boys, both MM and FM were associated with SBP through a mediating pathway via UA.

Inadequate vitamin D status is associated with lower food plus supplemental intake of vitamin D in children of South Asian ethnicity living in the National Capital Region of Canada

Vitamin D status, measured in a Vitamin D Standardization Program certified laboratory, was assessed among children of South Asian and European ethnicity living in the national capital region of Canada to explore factors that may account for inadequate status. Demographic information, dietary and supplemental vitamin D over 30 d prior to measurement of serum 25-hydroxyvitamin D (25OHD), and anthropometry were measured (age 6.0-18.9 y; n = 58/group; February-March 2015). No group related differences in age, height and body mass index (BMI) Z-scores or in food vitamin D intakes were observed. Standardized serum 25OHD was lower in South Asian children (mean ± SD: 39.0 ± 16.8 nmol/L vs. European: 58.4 ± 15.8 nmol/L). A greater proportion of South Asian children had serum 25OHD <40 nmol/L (56.9 vs. 8.6%, P < 0.0001) and fewer took supplements (31 vs. 50%, P = 0.0389). In a multi-factorial model (r2 = 0.54), lower vitamin D status was associated with overweight/obese BMI and older age (14-18 y); no interaction with ethnicity was observed. Lower vitamin D status was associated with lower total vitamin D intake only in South Asian children. This study reinforces the importance of public health actions towards meeting vitamin D intake recommendations among those of high-risk deficiency. Novelty: A higher proportion of South Asian vs. European children had inadequate vitamin D status. Lower vitamin D status was associated with a BMI in the overweight/obese range. Lower vitamin D status was associated with lower total vitamin D intake in South Asian but not European children.

Heart rate variability improves in 3-5-year-old children following a 6-month physical activity-based intervention: the Active Early Learning (AEL) cluster randomised controlled trial

Heart rate variability (HRV) measurement provides non-invasive assessment of autonomic stability and cardiometabolic disease risk. Insufficient physical activity in early childhood may contribute to negative cardiometabolic health. The Active Early Learning (AEL) study was a 6-month randomised controlled trial investigating the effects of a physical activity-based program incorporating movement within the daily curriculum of preschool children. The current study assessed the effects of the AEL intervention on HRV as a measure of cardiac vagal control. Children aged between 3-5 years and enrolled in a preschool with an attendance of ≥15 children were eligible. Physical activity was recorded using an Actigraph wGT3x accelerometer worn at the waist of participants over 3 consecutive days. A Polar H10 chest strap measured HRV with the HF-band and RMSSD representing cardiac vagal control. After 6 months of the AEL trial, linear mixed model analyses revealed a significant intervention effect for increased HF (p = 0.044). The control group did not demonstrate changes in cardiac vagal control after the intervention ceased. Independent of age, sex, physical activity and BMI, the AEL study elicited significant improvements in the cardiac vagal control of participants who received the intervention. Findings highlight the importance of investigating HRV for assessing the cardiometabolic health in young children. ANZCTR trial registration number: ACTRN12619000638134. Novelty: The AEL curriculum improved child HRV independent of age, sex, physical activity and BMI. Heart rate and RR intervals did not demonstrate changes for the intervention and control groups. Multivariate programs for developing physical competence, confidence, knowledge and motivation may improve child health.

Efficacy of CO-OP Approach With and Without Parental Coaching: RCT Study Protocol: Efficacité de l'approche CO-OP avec et sans coaching parental : protocole d'essai clinique randomisé

BACKGROUND.

Developmental coordination disorder (DCD) leads to decreased occupational performance and restricted participation. Cognitive Orientation to daily Occupational Performance Approach (CO-OP) is effective, and as parental support is a key element, it seems relevant to investigate.

PURPOSE.

To describe a study protocol that will compare CO-OP with and without Occupational Performance Coaching (OPC) on activity and participation of children with DCD.

METHOD.

Randomized controlled with seven to 12-year-olds, assigned to either experimental (CO-OP+OPC) or control (CO-OP) group, both receiving traditional CO-OP, with four additional parental group sessions for the experimental group.

KEY ISSUES.

Actual and perceived occupational performance and satisfaction of children's chosen goals and participation, motor performance and executive function. Measures will be obtained at baseline, post-intervention, and at 3-month follow-up.

IMPLICATIONS.

Detailed description of an intervention protocol may help further replication and may contribute to clarify if a boost on parents' participation promotes better outcomes for children with DCD.

TRIAL REGISTRATION.

Clinical Trials, NCT02893852. (https://clinicaltrials.gov/ct2/show/NCT02893852).

The effect of dairy products and non-dairy snacks on food intake, subjective appetite and cortisol levels in children: a randomized control study

Dairy snacks are available in various physical forms and their consumption is linked to improved metabolic health. The objective of this study was to determine the effect of dairy snacks of different physical forms on short-term food intake (FI), subjective appetite, and the stress hormone, cortisol, in children. Following a repeated-measures crossover design, 40 children aged 9-14 years randomly consumed 1 of 5 isoenergetic (180 kcal) snacks per study session. These snacks included solid (potato chips, cookies, and cheese), semi-solid (Greek yogurt), and fluid (2% fat milk) snacks. FI was measured 120 min after snack consumption. Subjective appetite was measured at 0 (immediately before the snack), 15, 30, 45, 60, 90, and 120 min. Salivary cortisol (n = 18) was measured after the Greek yogurt and cookie snacks at 0, 30, 60, 90, and 120 min. FI did not differ between snacks (P = 0.15). The Greek yogurt (P < 0.0001) and cheese (P = 0.0009) snacks reduced average appetite compared with the 2% fat milk snack. Salivary cortisol levels were not affected by snack (P = 0.84). This study demonstrates that dairy snacks are as effective as other popular snacks at influencing subsequent FI. However, solid and semi-solid dairy snacks are more effective at repressing subjective appetite than a fluid dairy snack. Registered at ClinicalTrials.gov (NCT02484625). Novelty: Milk, Greek yogurt and cheese have a similar effect on short-term food intake in children as popular potato chips and cookie snacks. Solid, semi-solid and liquid snacks have a similar effect on short-term food intake in children.

Profiles of Depressive Symptoms and Diabetes Distress in Preadolescents With Type 1 Diabetes

OBJECTIVES

Diabetes distress and depressive symptoms are common psychosocial concerns for people with diabetes. These are related, yet distinct, mood states, which have each been related to diabetes management and glycated hemoglobin (A1C) among adolescents and adults with diabetes. However, they have not been examined concurrently in preadolescents with type 1 diabetes. Understanding the overlaps and distinctions between diabetes distress and depressive symptoms in youth would help guide decisions about psychosocial screening in diabetes clinical practice. In this study, we aimed to categorize preadolescents based on clinical cutoffs of concurrently administered measures of depressive symptoms and diabetes distress, and identify clinical and demographic characteristics of each group.

METHODS

One hundred eighty youth (age range, 9 to 13 years; age [mean ± standard deviation], 11.3±1.3 years; 55% female; 56% Caucasian; mean A1C, 8.4±1.6% [68 mmol/mol]) completed measures of diabetes distress, depressive symptoms and quality of life. Daily blood glucose monitoring frequency was calculated from meter download. A1C values were obtained from electronic medical records.

RESULTS

Depressive symptoms and diabetes distress each significantly correlated with A1C and quality of life. Although most (69%) participants had no clinically significant elevations in either diabetes distress or depressive symptoms, 14% had elevated depressive symptoms only and 17% had elevated distress without concurrent elevated depressive symptoms. Groups differed based on A1C, quality of life and insurance status.

CONCLUSIONS

Routine assessment of both depressive symptoms and diabetes distress may help to identify preadolescents with type 1 diabetes who require psychosocial support.

Barriers and facilitators to meeting recommended physical activity levels among new immigrant and refugee children in Saskatchewan, Canada

Newcomers are often healthy when they arrive in Canada, yet experience health declines shortly thereafter, possibly due to lifestyle changes. As part of the Healthy Immigrant Children study, this mixed-methods study aims to analyze possible predictors of physical activity among 300 newcomer children, and explore their lived experiences using a sub-sample of 19 parents and 24 service providers. Data collection involved questionnaires concerning socioeconomic status and physical activity, anthropometric measurements, and in-depth interviews. Participants aged 5 years and older largely met physical activity recommendations (82.9%), while none of the 3-4-year-olds did. Males were more active than females, especially among older ages. Many participants engaged in too much screen time (53.4-90.0%). Age and income predicted physical activity among males, while parents' education level was the only significant predictor among females. Barriers to physical activity included: recreational physical activity being an unfamiliar concept, gender limitations, financial resources, safety concerns, and children's preference for screen time. Schools played a central role in newcomer children's health by providing accessible opportunities for physical activity. Newcomer families preferred to have their children involved in culturally relevant physical activities. Given the growing newcomer population, it is important to support active lifestyle practices among them. Novelty: About 83% of newcomer children aged 5 years and older met physical activity recommendations, while none of the 3-4-year-olds did. Age and income predicted males' physical activity, while parents' education level predicted females' physical activity. Schools provide accessible opportunities for newcomer children to engage in physical activity.

Psychometric properties and construct validity of PLAYself: a self-reported measure of physical literacy for children and youth

PLAYself is a tool designed for self-description of physical literacy in children and youth. We examined the tool using both the Rasch model and Classical Test Theory to explore its psychometric properties. A random selection of 300 children aged 8-14 years (47.3% female) from a dataset of 8513 Canadian children were involved in the Rasch analysis. The 3 subscales of the measure demonstrated good fit to the Rasch model, satisfying requirements of unidimensionality, having good fit statistics (item and person fit residuals = -0.17-1.47) and internal reliability (Person Separation Index = 0.70-0.82), and a lack of item bias and problematic local dependency. In a separate comparable sample, 297 children also aged 8-14 years (53.9% female) completed the PLAYfun, Physical Self-Description Questionnaire (PSDQ), Physical Activities Measure-Revised (MPAM-R), a physical activity inventory (PLAYinventory), and repeated the PLAYself 7 days later. The tests with this sample confirmed test-retest reliability (intraclass correlation coefficient = 0.81-0.84), and convergent and construct validity consistent with contemporary physical literacy definitions. Overall, the PLAYself demonstrated robust psychometric properties, and is recommended for researchers and practitioners who are interested in assessing self-reported physical literacy. Novelty: The PLAYself is a self-reported measure of physical literacy This study validates the measure using the Rasch model and classical test theory The PLAYself was found to have strong psychometric properties.

Measurement properties of the Physical Literacy Assessment for Youth (PLAY) Tools

The Physical Literacy Assessment for Youth (PLAY) Tools are a suite of tools to assess an individual's physical literacy. The purpose of this study is to examine the psychometric properties of the PLAY Tools, including inter-rater reliability, internal consistency, validity and the associations between the tools. In this study, 218 children and youth (aged 8.4 to 13.7 years) and a parent/guardian completed the appropriate physical literacy assessments (i.e., PLAYbasic, PLAYfun, PLAYparent and PLAYself) and the Bruiniks-Oseretsky Test of Motor Proficiency (BOT-2). Inter-rater reliability for PLAYfun was excellent (intraclass correlation coefficient = 0.94). The PLAYbasic, PLAYfun total, running and object control scores, and PLAYparent motor competence domain were higher in males than females, and PLAYfun locomotor skills were lower in males than females (p < 0.05). Age was positively correlated with PLAYbasic and PLAYfun (r = 0.14-0.32, p < 0.05). BOT-2 was positively correlated with PLAYfun and PLAYbasic (r = 0.19-0.59, p < 0.05). PLAYbasic is a significant predictor of PLAYfun (r² = 0.742, p < 0.001). PLAYfun, PLAYparent and PLAYself were moderately correlated with one another. PLAYfun, PLAYparent and PLAYself demonstrated acceptable internal consistency (α = 0.74-0.87, ω = 0.73-0.87). The PLAY Tools demonstrated moderate associations between one another, strong inter-rater reliability and good construct and convergent validity. Continued evaluation of these tools with other populations, such as adolescents, is necessary. Novelty: In school-age children, the PLAY Tools demonstrated strong inter-rater reliability, moderate associations with one another, acceptable internal consistency and good construct and convergent validity. The results suggest that that PLAY Tools are an acceptable method of evaluation for physical literacy in school-age children.

Treatment-related weight gain and metabolic complications in children with mental health disorders: potential role for lifestyle interventions

Over 1 million Canadian children are estimated to have a mental health disorder, which are commonly treated with medications, such as second-generation antipsychotics (SGAs). Estimates suggest that SGA prescriptions to children are increasing in Canada. Although these medications are important and lifesaving components of psychiatric treatment, they are not without side effects. For some children, SGA treatment is associated with adverse metabolic complications including rapid weight gain, dyslipidemia, elevated blood pressure, and risk for type 2 diabetes. It is not clear why these complications develop, but it is assumed that SGAs stimulate appetite and food intake, and reduce resting energy expenditure leading to weight gain and that the metabolic complications occur secondary to the weight gain. Understanding the mechanisms underlying these complications is key to being able to identify children at risk and prevent and optimize treatment. In this narrative review, we provide an overview of the literature pertaining to the weight gain and metabolic complications in children treated with SGAs, highlighting the scope of the problem and the current limited research on how diet and physical activity can be used to prevent or lessen the severity of the metabolic complications and improve the long-term health trajectories of SGA-treated children. Novelty: Children are increasingly being treated with second-generation antipsychotics for mental health disorders. Dietary and physical activity assessments are not commonly considered in clinical settings. Randomized controlled trials of lifestyle interventions are needed to determine the effectiveness of mitigating the cardiometabolic complications in second-generation antipsychotic-treated children.

Thiamine-Responsive Megaloblastic Anemia-Related Diabetes: Long-Term Clinical Outcomes in 23 Pediatric Patients From the DPV and SWEET Registries

OBJECTIVES

To describe clinical presentation and long-term outcomes in a large cohort of children diagnosed with thiamine-responsive megaloblastic anemia (TRMA)-related diabetes.

METHODS

Data from the Diabetes Patienten Verlaufsdokumentation (DPV) and Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference (SWEET) registries were used to identify cases. Complementary information was collected through a chart review of each case. Descriptive analyses with medians and interquartile ranges and numbers (proportions) were tabulated.

RESULTS

We identified 23 cases (52% male) in the 2 registries. Eighteen (78%) had genetic confirmation of TRMA. Median age at diabetes onset was 1.4 (quartiles 0.8 to 3.6) years and median age at initiation of thiamine treatment was 5.9 (2.4 to 12.4) years. At their most recent visit, patients' median age was 14.3 (8.1 to 17.5) years, glycated hemoglobin level was 6.9% (6.1% to 7.9%), insulin dose was 0.9 (0.4 to 1.2) units/kg per day and thiamine dose was 200 (100 to 300) mg/day. Three patients were not treated with insulin or antidiabetic drugs. There was no difference in diabetes outcomes in patients with initiation of thiamine ≤1 year after diabetes onset compared to patients with initiation of thiamine >1 year after diabetes onset.

CONCLUSIONS

This is the longest case series of pediatric TRMA-related diabetes reported to date. Diabetes onset often occurs several years before initiation of thiamine supplementation. Early initiation of thiamine (within 1 year of diabetes onset) was not linked to improved diabetes outcome. However, the role of thiamine in pancreatic function needs further assessment. Patients with TRMA-related diabetes maintained good glycemic control even after 9 years (median) of follow up.

Effect of Fish Oil on Insulin Sensitivity in Children: A Systematic Review and Meta-Analysis of Randomized, Controlled Trials

OBJECTIVES

Fish oil has been shown to reduce the risk of metabolic disorders. However, the effects of fish oil intervention on glucose metabolism and insulin sensitivity are still controversial, especially in children. The current meta-analysis aimed to evaluate the effects of fish oil intervention on insulin sensitivity in children.

METHODS

The Cochrane Library, PubMed, Embase, Web of Science, ClinicalTrials.gov and China National Knowledge Infrastructure databases were searched up to August 2020 for relevant studies evaluating fish oil intake compared with placebo on insulin sensitivity indications (Homeostatic Model for Insulin Resistance). A fixed-effects model was used to calculate the pooled effect.

RESULTS

A total of 13 studies with 1,132 participants (567 in placebo group and 565 in fish oil group) were included in the meta-analysis. Compared with the placebo group, fish oil intervention had beneficial effects on insulin sensitivity in the pooled analysis (weighted mean difference, -0.219; 95% confidence interval, -0.392 to -0.046; p=0.013). In subgroup analyses, when the fish oil intervention period was short-term (≤6 months), low dose (eicosapentaenoic acid + docosahexaenoic acid dose <1.5 g/day) and high ratio (eicosapentaenoic acid to docosahexaenoic acid ≥1), it could improve insulin sensitivity. No heterogeneity was found for the pooled and subgroup analyses.

CONCLUSION

Fish oil intervention has a beneficial effect on insulin sensitivity in children.

Emerging insights in weight management and prevention: implications for practice and research

Recent advances in foundational research on energy balance and weight loss shed new light on earlier findings. Emerging evidence and insights around mental illness and client-centred, weight-inclusive approaches have implications for practitioners. This paper provides an overview of opinions from invited experts who presented at the Canadian Nutrition Society Thematic Conference in January 2019. Novelty: Weight loss involves an interplay of multiple factors, not diet alone. There is no "best diet" or treatment approach for weight loss. Future research should involve minimizing weight loss countermeasures and new health system-based approaches aimed at improving health.

Feasibility and Acceptability of Physical Activity Monitoring as an Educational Tool in Management of Pediatric Type 1 Diabetes

OBJECTIVES

The spontaneous, sporadic and sometimes unpredictable nature of children's physical activity causes fluctuations in blood glucose level and challenges for children with type 1 diabetes. Physical activity monitoring has potential utility. In this study, we explored the perceptions of physical activity monitoring among health-care professionals and assessed the feasibility and acceptability of using it in the management of pediatric type 1 diabetes.

METHODS

Seven health-care professionals from 1 pediatric diabetes centre in the United Kingdom were involved in a focus group. Data were analyzed thematically. Physical activity monitoring using a wrist-worn monitor was tested for feasibility with 13 children aged 7 to 11 years with type 1 diabetes. The primary outcome was feasibility (i.e. recruitment, adherence, data completion, adverse events and acceptability). Secondary measures were glycemic control, parental self-efficacy for diabetes management and parental fear of hypoglycemia.

RESULTS

Health-care professionals valued having an awareness of the level, type and intensity of children's physical activity. They identified unmet training and resource needs that would facilitate them in being able to give physical activity advice to children and families. Recruitment rate was 20%, adherence to the activity monitoring was good and the study completion rate was 62%. No adverse events were reported. Physical activity monitoring was considered acceptable by parents.

CONCLUSIONS

Physical activity monitoring could be a feasible part of routine clinical practice, but further research is needed to understand whether health-care professionals are best placed to implement it and what impact it has on health outcomes.

Translating "protein foods" from the new Canada's Food Guide to consumers: knowledge gaps and recommendations

The revised version of Canada's Food Guide, released in January 2019, issued new guidance by combining meat and alternatives with milk and alternatives into a single group called "protein foods" and emphasized selecting plant-based foods from this category more often. Though the changes represent a simple depiction of a healthy plate, the new Food Guide has opened knowledge gaps about protein foods and exposed new concerns about the interpretation and implementation of the Food Guide among vulnerable groups, particularly children and the elderly. To address key knowledge and research gaps, nutrition leaders need to reach a consensus on key messages to best inform the development of tools and resources to support practitioners in translating messages to consumers, including foodservice standards. Among consumers, families with young children are a primary target for these resources as they develop their life-long habits to ensure they have the knowledge and skills to select, prepare, and consume nutrient-rich protein foods. The new Food Guide provides an opportunity to address the existing knowledge gaps, develop tools and resources to support health professionals, and design interventions that will help Canadian families choose, prepare, and eat nutrient-rich protein foods. Novelty An updated Canadian regulatory framework is needed for protein labelling and content/health claims. There are knowledge gaps about protein foods consumption and food literacy needed to optimize nutritional health. Mandatory nutrition policies are needed to safeguard the provision of high-quality protein foods across institutions that serve children and older adults.

Starting strong: Dietary, behavioral, and environmental factors that promote "strength" from conception to age 2 years

Beginning with conception and continuing through childhood and adolescence, the word "strength" connotes the totality of optimal early bone and tissue growth; neural wiring of the brain; and acquisition of fine motor, gross motor, language, and socioemotional skills. The robustness of each of these attributes depend on 3 critical epigenetic (external) factors: the quality of nutrition; positive adult nurturing; and experiences acquired within a stimulating, safe environment that affords free exploration. This review highlights the relationship between the epigenetic factors in the period of conception to age 2 years and a child's future health, cognitive capacity, and social aptitude, which collectively comprise their "strength". This paper was presented as part of the 2018 Strength Summit conference entitled, The Role of Strength in Optimal Health and Well-being. Novelty Strength in infants signifies the totality of optimal early growth and neural wiring of the brain. Strength at this life stage also includes the acquisition of motor, language, and socioemotional skills. Three epigenetic factors are critical during birth to 24 months: nutrition, nurturing, and free exploration.

[Management of Acute Malnutrition in Children in a Sahelian Secondary Hospital]

Malnutrition among children under five is a major public health problem in low-income countries, and contributes significantly to mortality in this age group. The purpose of this work was to evaluate the epidemiological and clinical profile of malnourished children at the Nara hospital in north of Mali.

METHOD

It was a retrospective and descriptive study, from 01/01/2016 to 31/12/2016. Children aged 6 months to 59 months admitted for acute malnutrition were included.

RESULTS

Four hundred and sixty-one children had malnutrition, representing 15% of consultations and 50% of hospitalizations. The median age was 26 months (2 months-93 months). The sex ratio was 0.92 (M = 222, F = 239). Nineteen percent of the patients had progressive weaning (n = 90), and it was brutal in 371 patients (80%). The distribution of patients according to the Z-score was as follows: Z-score <-1 (n = 15, 3%), Z-score <-2 (n = 46, 10%), Z-score <-3 (n = 400, 87%). Mean MUAC was 105 mm (99mm-124mm). Hypoglycemia was noted in 45% (n = 204). The marasmus cases accounted for 80% (n = 367) kwashiorkor 10% (n = 48). The mixed form of malnutrition accounted for 10% (n = 46). The disease associated with malnutrition were pneumonia (n = 219, 47%), malaria (n = 115, 25%) and gastroenteritis (n = 68, 15%). The F75 milk was administered predominantly for 3 months in 93% of cases. For phase 2 of treatment, Plumpy Nut and F100 milk were respectively administered in 88% and 12%. The nutritional recovery rate was 95% (n = 435). Five percent of the patients died (n = 26). Pneumonia was the cause of death in 85% of cases. The cure rate for marasmus and kwashiorkor cases was respectively 94% and 93%.

CONCLUSION

Acute malnutrition remains frequent in the Sahelian environment. Better knowledge of mothers about weaning and dietary diversification will improve the nutritional status of children.

[Determinants of acute malnutrition among children aged 6-59 months in Menaka health district]

BACKGROUND

Acute malnutrition continues to be a real public health problem due to morbidity and mortality. The aim of this study was to determine the risk factors related to acute malnutrition among children aged 6-59 months in the health district of Menaka.

METHODS

This is a case-control study that was conducted in the health district of Menaka over a period of six (6) months from January to June 2019. Data collection was done for patients in recovery and nutrition education units and for controls, in health centers and in the general population. Subjects were matched on age and sex. Data analysis was done using SPSS software version 20.0.

RESULTS

Children with no immunization or incorrect immunization (OR = 18.17 [3.49-94.56]), children not fed exclusively with breast milk before 6 months (OR = 16.44 [3 , 93-68.8]) and lack of compliance with the principle of spacing births (OR = 9.93 [1.65-59.8]) were strongly implicated in the occurrence of acute malnutrition.

CONCLUSION

Efforts should be made by the authorities to improve population's living conditions, which would improve the nutritional status of children under five and also reduce acute malnutrition prevalence.

Changing trends in measles vaccination status between 2004 and 2014 among children aged 12-23 months in Bangladesh

OBJECTIVE

To assess the current measles vaccination status in Bangladesh, explain changing differentials in measles vaccination, and determine contexts that may improve measles vaccination coverage.

METHODS

Secondary data analysis of datasets (2004-2014) from the nationally representative Bangladesh Demographic and Health Surveys that followed stratified, multi-stage cluster sampling design conducted both in urban and rural contexts.

RESULTS

5468 children aged 12-23 months were surveyed, of whom 892 (16%) reported non-compliance to measles vaccine. After simultaneous adjusting for covariates in multivariate logistic regression, children who came from a poor socio-economic background, who had mothers with no formal schooling, who were underweight, of higher birth order (≥4), who had adolescent mothers, who had a history of home delivery and who had no exposure to media were observed to be significantly associated with lack of measles vaccination. Measles vaccination coverage among children of adolescent mothers was consistently low. Despite lack of media exposure, measles vaccination status gradually increased from 26% in 2004 to 33% in 2014. Lack of maternal education was no longer associated with measles vaccination status in 2007, 2011 and 2014. Stunted children continued to be associated with lack of measles immunisation in 2014. Children with higher birth order demonstrated 53% excess risk for not being immunised with measles vaccine. Mothers with no exposure to mass media were two times more likely to have children without measles immunisation as indicated by BDHS 2014 data.

CONCLUSIONS

Our findings will help policy makers formulate strategies for expanding measles vaccination coverage in order to achieve further reduction in disease burden and mortality in Bangladesh.

Total body skeletal muscle mass and diet in children aged 6-8 years: ANIVA Study

The objective was to assess if there was any relationship between the amount of skeletal muscle mass (SMM) in children aged 6-8 years and their nutritional intake. The Valencian Anthropometry and Child Nutrition (ANIVA) study is a cross-sectional study with children aged between 6-8 years (n = 1988) from schools in Valencia. Children were distributed into 4 groups for comparison: normal and high SMM and by sex. Anthropometric data were obtained following World Health Organization protocols. Nutritional intake was measured using a prospective 3-day food journal and the KIDMED questionnaire. Of the whole child sample, 63.9% had high SMM values. No differences were found in adherence to a Mediterranean diet or absolute energy intake. Significant differences were found in the proportion of energy intake in relation to estimated energy requirements and between nutritional intake of certain macro or micronutrients with SMM. This study provides values of SMM for children. Children's adherence to a Mediterranean diet was not related to total SMM. At the same time, the consumption of excess calories or overeating is associated with SMM, with those children overeating more having lower SMM values. The differences in the intake of the other macro- and micronutrients were not associated with children's SMM.

Is Age a Risk Factor for Cerebral Edema in Children With Diabetic Ketoacidosis? A Literature Review

Cerebral edema (CE) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA) in children with type 1 diabetes. CE is frequently mentioned as being more common in young children. The primary objective of this study was to review the evidence suggesting that younger age is a risk factor for the development of CE during DKA. The secondary objective was to assess if younger children are at a higher risk of DKA and severe DKA. A literature review was performed, and studies which reported the frequency of CE, DKA and severe DKA in children <3 and 3 to 5 years of age were included. Among the 6 studies reporting the frequency of CE that were identified, 5 good-quality studies found no significant association between younger age and higher risk of CE. Twenty-seven studies (DKA frequency: 11.3% to 54%) reported DKA frequency as a function of age. Most published studies found a higher frequency of DKA in children <5 years of age (20/25 studies), and in particular in those in the first 2 to 3 years of life (8/8 studies). There was inconclusive evidence to determine whether the severity of DKA was influenced by age. In conclusion, the commonly held view that CE is more common in younger children is not supported by the existing literature. Published data suggest that DKA (and possibly severe DKA) is more common in very young children. Regardless of age, all children with DKA should be monitored carefully for the development of CE.

Physical literacy improves with the Run Jump Throw Wheel program among students in grades 4-6 in southwestern Ontario

The purpose of this study was to determine whether the introduction of a fundamental movement skills (FMS) program to grade 4-6 physical education (PE) classes could improve students' physical literacy (PL) and influence the amount of effort exerted in PE class. Athletics Canada's grassroots Run Jump Throw Wheel (RJTW) Program was delivered for 10 weeks during PE classes (2 schools: four grade 4, four grade 5, two grade 6, one split grade 5-6 class, and one split grade 6-7 class, totalling 310 students). Participants completed the Canadian Assessment of Physical Literacy (CAPL) and wore heart rate monitors and pre- and postintervention. The CAPL score increased 3.3 (±8.8) points from the pretest to the post-test (t = 6.47, p < 0.001). Improvements were not significantly different by grade or gender, but those in the suburban-area school improved more so than those attending the rural-area school (F_[1,294] = 4.82, p < 0.004). Among those participants that increased their PL (n = 186), the CAPL scores increased by 8.6 (±5.9) points versus those that decreased (n = 110; -5.6 ± 4.8 points), F_[1,294] = 452.11, p < 0.001. No significant differences in time spent in physical activity were observed between the pre- and post-test (i.e., 17.0 ± 7.0 min and 19.3 ± 7.0 min, respectively, t = 1.70, p = 0.091). The RJTW program increased participants' overall FMS, as well as their knowledge and understanding regarding these FMS, both key components of PL.

Canadian newcomer children's bone health and vitamin D status

Adequate calcium intake and supply of vitamin D during childhood play important roles in ensuring adequate bone mass gain to achieve optimal peak bone mass. The Healthy Immigrant Children study employed a mixed-method cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3-13 years who had been in Canada for less than 5 years. This paper presents bone mineral content and vitamin D status data along with qualitative data that deepen the understanding of newcomer bone health status. A significantly higher percentage of refugee children (72.3%) had insufficient (<50 nmol/L) or deficient (<30 nmol/L) serum vitamin D compared with immigrants (53.2%). Vitamin D deficiency was most common among ethnic minority girls. Newcomer children with higher intakes of vitamin D, younger newcomer children, and those from western Europe or the United States had higher serum vitamin D levels. Immigrants had significantly higher mean total body bone mineral content compared with refugees. Total body fat, serum vitamin D, calcium intake, height, height by calcium intake, total body fat by calcium intake, and total body fat by height predicted total body bone mineral content levels. Vitamin D deficiency among newcomer children may be related to lack of knowledge regarding children's vitamin D requirements in the Canadian environment, dietary habits established in country of origin, low income that limits healthy dietary choices, and lifestyle habits that limit exposure to sunlight. Results suggest a need to screen newcomer children and pregnant women for vitamin D deficiency and support early intervention.

"Snips and Snails and Puppy Dog Tails": Boys and Behaviour in the USA

In The Adventures of Tom Sawyer and Huckleberry Finn, Mark Twain introduced two of the most iconic boys in American literature. Tom and Huck become heroic figures, despite their penchant for bad behaviour. Indeed, it is their propensity to be impulsive, break rules and defy authority that win them the day. Today, however, Tom Sawyer and Huck Finn have become the posterboys for a psychiatric disorder, Attention Deficit Hyperactivity Disorder, or ADHD. I trace how and why attitudes about pathological boys' behaviour reversed during the twentieth century, from a focus on shy, introverted, and physically passive boys to the very opposite - boys like Tom and Huck. I argue that, rather than imposing limits on childhood behaviour, we should be more accepting and encouraging of all types of children.

Understanding the potential contribution of a third "T" to FITT exercise prescription: the case of timing in exercise for obesity and cardiometabolic management in children

Currently, exercise prescription relies heavily on parameters included in the FITT principle: frequency, intensity, time (duration), and type of exercise. In this paper, the benefits of including timing (FITT+T), referring to when exercise is performed in relation to meal-time, is discussed. Current research indicates that timing is outcome-specific. Total energy and lipid intakes, and postprandial hypertriglyceridemia can be reduced when exercise is performed pre-meal, while glycemic control is improved with post-meal exercise. Although findings indicate that timing can aid in obesity management and cardiometabolic-risk reduction, most research involves adult subjects and acute investigations. Some research with children, concerning the effect of timing on appetite, indicates that pre-meal exercise helps regulate energy balance, but also identifies key differences in response compared with adults. Overall, current findings support the benefits of timing, but research is required to establish guidelines that are specific to the pediatric population and their health-related goals, while incorporating other FITT components.

Effect of potatoes and other carbohydrate-containing foods on cognitive performance, glycemic response, and satiety in children

Dietary carbohydrates have been shown to influence cognitive performance and satiety in children. However, it remains unclear whether the carbohydrate source is a primary determinant of cognitive performance and satiety. The objective was to compare the effects of white potatoes and other carbohydrate-containing foods on cognitive performance, glycemic response, and satiety in children. On 6 separate mornings, in random order, children (n = 22) consumed 50 g of available carbohydrates from microwaved mashed potatoes (prepared from fresh potatoes then frozen), deep-fried potato strips (French fries), hash browns, white rice, white beans, or skipped a meal. Cognitive performance, glycemic response, and satiety were measured over 180 min. Cognitive performance was measured using a battery of tests assessing verbal declarative memory, spatial memory, short-term memory, working memory, and information processing speed. Although cognitive performance after the treatment meals did not differ from meal skipping, children recalled more words after French fries (9.1 ± 0.4 words) compared with mashed potatoes (8.2 ± 0.3 words; p = 0.001) and white rice (8.4 ± 0.3 words; p = 0.04) on the verbal declarative memory test. Blood glucose concentrations were higher after white rice compared with white beans, mashed potatoes, and hash browns (p < 0.05). Change from baseline subjective average appetite (mm/kcal) was lower after mashed potatoes compared with all other treatment meals (p < 0.05). In conclusion, verbal declarative memory was higher after French fries and subjective average appetite was lower after mashed potatoes. Future longitudinal studies are needed to confirm these short-term findings and to elucidate the mechanism of action.

Effect of dairy and nondairy snacks on postprandial blood glucose regulation in 9-14-year-old children

In adults, dairy consumption improves short-term blood glucose regulation. It is unknown if these short-term benefits extend to children of different weight statuses. The objective of this study was to investigate the effect of a dairy and nondairy snack in both normal-weight (NW) and overweight/obese (OW/OB) children on blood glucose regulation and food intake (FI). In a repeated-measures crossover design, 11 NW and 7 OW/OB children (age: 9-14 years), consumed, in random order, a dairy (Greek yogurt, 198.9 g, 171 kcal, 0 g fat, 17 g protein) or nondairy (mini sandwich-type cookies, 37.5 g, 175 kcal, 7.5 g fat, 1.3 g protein) snack containing 25 g of available carbohydrates. Ad libitum FI was measured 120 min after snack consumption. Blood glucose, insulin, C-peptide, and glucagon-like peptide-1 (GLP-1) were measured at 0 min (before the snack), and at 30, 60, 90, and 120 min after snack consumption. Insulin secretion was calculated from deconvolution of C-peptide. Hepatic insulin extraction was calculated as C-peptide divided by insulin. FI did not differ between snacks (P = 0.55). Mean blood glucose was lower (P < 0.001) and insulin higher (P < 0.0001) in the 120 min after consuming the dairy snack. C-Peptide concentrations (P = 0.75) and insulin secretion (P = 0.37) were not different between snacks. The increase in insulin was explained by reduced hepatic insulin extraction (P < 0.01). Consumption of the dairy snack also increased mean GLP-1 concentrations (P < 0.001). In conclusion, consumption of a dairy snack by NW and OW/OB children results in reduced postprandial blood glucose concentrations and elevated circulating insulin compared with a nondairy snack possibly because of delayed hepatic insulin extraction.

Youth get a D+ grade in physical activity: How can we change public health messages to help reverse this trend?

The purpose of this paper is to critique how the promotion of physical activity (PA) is communicated and offer evidence-based alternative framings to encourage PA in youth. We argue that PA promotion messaging should not be tied to outcomes that focus on changing physical appearance, preventing or treating diseases, or sport performance or competition. From a public health perspective, we suggest that PA should instead focus on campaigns, policies, and programs that tie PA to enjoyment, wellbeing, and play.

Chronic health disparities among refugee and immigrant children in Canada

There are knowledge gaps in our understanding of the development of chronic disease risks in children, especially with regard to the risk differentials experienced by immigrants and refugees. The Healthy Immigrant Children study employed a mixed-methods cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3-13 years who had been in Canada for less than 5 years. Quantitative data regarding socioeconomic status, food security, physical activity, diet, and bone and body composition and anthropometric measurements were collected. Qualitative data regarding their experiences with accessing health care and their family lifestyle habits were gathered through in-depth interviews with the parents of newcomer children. Many newcomers spoke about their struggles to attain their desired standard of living. Regarding health outcomes, significantly more refugees (23%) had stunted growth when compared with immigrants (5%). Older children, those with better-educated parents, and those who consumed a poorer-quality diet were at a higher risk of being overweight or obese. Sixty percent of refugees and 42% of immigrants had high blood cholesterol. Significant health concerns for refugee children include stunting and high blood cholesterol levels, and emerging trends indicate that older immigrant children from privileged backgrounds in low-income countries may be more at risk of overweight and obesity. A variety of pathways related to their families' conceptualization of life in Canada and the social structures that limit progress to meeting their goals likely influence the development of health inequity among refugee and immigrant children. Public health initiatives should address these health inequities among newcomer families.

Magnitude and pattern of improvement in processes of care for hospitalised children with diarrhoea and dehydration in Kenyan hospitals participating in a clinical network

OBJECTIVE

WHO recommends optimisation of available interventions to reduce deaths of under-five children with diarrhoea and dehydration (DD). Clinical networks may help improve practice across many hospitals but experience with such networks is scarce. We describe magnitude and patterns of changes in processes of care for children with DD over the first 3 years of a clinical network.

METHODS

Observational study involving children aged 2-59 months with DD admitted to 13 hospitals participating in the clinical network. Processes of individual patient care including agreement of assessment, diagnosis and treatment according to WHO guidelines were combined using the composite Paediatric Admission Quality of Care (PAQC) score (range 0-6).

RESULTS

Data from 7657 children were analysed and improvements in PAQC scores were observed. Predicted mean PAQC score for all the hospitals at enrolment was 59.8% (95% CI: 54.7, 64.9) but showed a wide variation (variance 10.7%, 95% CI: 5.8, 19.6). Overall mean PAQC score increased by 13.8% (95% CI: 8.7-18.9, SD between hospitals: ±8.2) in the first 12 months, with an average 0.9% (95% CI: 0.3-1.5, SD ± 1.0) increase per month and plateaued thereafter, and changes were similar in two groups of hospitals joining the network at different times.

CONCLUSION

Adherence to guidelines for children admitted with DD can be improved through participation in a clinical network but improvement is limited, not uniform for all aspects of care and contexts and occurs early. Future research should address these issues.

[Caracteristics Of Severe Malaria In Child From 0 To 5 Years At The Hospital Of Sikasso In Mali]

In Mali, malaria is a major public health problem. The region of Sikasso is classified according to the geo-climatic facies as a zone with a long seasonal transmission of malaria greater than 6 months.

OBJECTIVE

To describe the epidemiological, clinical and therapeutic characteristics of children aged 0- 5 years hospitalized for severe malaria in the pediatric ward of the Sikasso hospital. Variables analyzed were epidemiological, clinical, paraclinical, therapeutic and evolutionary.

PATIENTS AND METHODS

This is a retrospective, 12-month (January-December 2014) cross-sectional study of all 0-5-year-olds hospitalized for severe malaria at the Sikasso Regional Hospital.

RESULTS

The hospital frequency of severe malaria was 55.82%. The age group of 12-35 months was the most concerned (45.3%). The peak frequency was in August (21.2%). Anemic, mixed (anemia and neurological) and neurological forms were the most frequent. Artemether and quinine were the antimalarials used. The use of a blood transfusion was frequent (82.8%). The lethality was 10% and the mixed form (anemia and neurology) was the most lethal ((P<10^-6).

CONCLUSION

Malaria remains a national concern in Mali. Improving the quality of care and prevention must be a priority to reduce the lethality that remains high.

Effect of multiple micronutrient fortified milk consumption on vitamin D status among school-aged children in rural region of Morocco

Vitamin D deficiency is a health problem in both developed and developing countries. The aim of this study was to determine the effect of multi-vitamin fortified milk consumption on vitamin D status among children living in the mountainous region of Morocco. Children aged 7 to 9 years (n = 239; 49% of girls vs 51% of boys) participated in a double-blind longitudinal study, where they were divided in 2 groups: a fortified group that received daily 200 mL of fortified ultra-high-temperature (UHT) milk enriched with 3 μg of vitamin D₃ and a nonfortified group that received 200 mL of nonfortified UHT milk with a natural abundance of vitamin D₃ (about 1.5 μg). Blood samples were collected 3 times (at baseline, then at the fourth and ninth months). The average weight, height, and z score of body mass index for age of participants were 22.8 ± 2.6 kg, 121.5 ± 5.2 cm, and -0.2 ± 0.6 kg/m², respectively. At baseline, 47.5% of children had a concentration of 25-hydroxyvitamin D below 50 nmol/L. At the end of the study the prevalence of vitamin D <50 nmol/L decreased significantly by 37.6% in the fortified group. These results reveal prevalent vitamin D insufficiency (<50 nmol/L) during winter among rural Moroccan school-aged children, which seems to be better improved by consuming the fortified milk instead of the nonfortified one.

The effectiveness of voluntary policies and commitments in restricting unhealthy food marketing to Canadian children on food company websites

Marketing unhealthy foods and beverages to children (M2K) fosters poor dietary patterns, increasing obesity and noncommunicable disease risk. Federal restrictions on M2K have been under development in Canada since 2016; however, at present, M2K is mostly self-regulated by food companies. This study aimed to compare M2K on Canadian websites of food companies with and without voluntary policies or commitments in this area. A systematic content analysis of company websites was conducted in spring/summer 2017 for major packaged food (n = 16), beverage (n = 12), and restaurant chain (n = 13) companies in Canada. M2K policies were sourced from company websites and published corporate documents. Sixteen companies (43%) reported national and/or global M2K policies, while 21 companies (57%) had no published policies. The websites of Canadian companies (n = 154) were scanned for child-directed products and marketing; type and frequency of marketing techniques were recorded. Child-directed marketing appeared on 19 websites of 12 companies (32%), including 9 companies with M2K policies. Websites featured products with unconventional flavours, colours, shapes, or child-oriented packaging, and used promotional characters, contests, games, activities, or lettering and graphics appealing to children. The nutritional quality of products marketed to children was evaluated using a nutrient profile model developed by Health Canada for proposed M2K regulations. Of the 217 products marketed to children, 97% exceeded Health Canada's proposed ∼5% Daily Value threshold for saturated fat, sodium, and/or sugars, 73% of which were products from 9 companies with policies. These findings highlight the limitations of self-regulation in restricting M2K on food company websites, reinforcing the need for government regulations.