Subjects -> HEALTH AND SAFETY (Total: 1541 journals)
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HEALTH AND SAFETY (722 journals)                  1 2 3 4 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access   (Followers: 4)
Acta Informatica Medica     Open Access   (Followers: 2)
Acta Scientiarum. Health Sciences     Open Access   (Followers: 3)
Adultspan Journal     Hybrid Journal   (Followers: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 12)
Advances in Public Health     Open Access   (Followers: 28)
Adversity and Resilience Science : Journal of Research and Practice     Hybrid Journal   (Followers: 3)
African Health Sciences     Open Access   (Followers: 5)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 7)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 3)
Ageing & Society     Hybrid Journal   (Followers: 47)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 7)
AJOB Empirical Bioethics     Hybrid Journal   (Followers: 3)
Akademika     Open Access   (Followers: 1)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 21)
American Journal of Health Education     Hybrid Journal   (Followers: 36)
American Journal of Health Promotion     Hybrid Journal   (Followers: 34)
American Journal of Health Sciences     Open Access   (Followers: 12)
American Journal of Health Studies     Full-text available via subscription   (Followers: 16)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 32)
American Journal of Public Health     Full-text available via subscription   (Followers: 280)
American Journal of Public Health Research     Open Access   (Followers: 28)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 6)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 8)
Annales des Sciences de la Santé     Open Access  
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 14)
Annals of Health Law     Open Access   (Followers: 6)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal   (Followers: 1)
Applied Research In Health And Social Sciences: Interface And Interaction     Open Access   (Followers: 5)
Apuntes Universitarios     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives of Community Medicine and Public Health     Open Access   (Followers: 2)
Archives of Medicine and Health Sciences     Open Access   (Followers: 5)
Archives of Suicide Research     Hybrid Journal   (Followers: 10)
Archivos de Prevención de Riesgos Laborales     Open Access   (Followers: 1)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 11)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 5)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 12)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 4)
Asian Journal of Medicine and Health     Open Access   (Followers: 1)
Atención Primaria     Open Access   (Followers: 2)
Atención Primaria Práctica     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 6)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 5)
Autism & Developmental Language Impairments     Open Access   (Followers: 16)
Behavioral Healthcare     Full-text available via subscription   (Followers: 8)
Bijzijn     Hybrid Journal   (Followers: 1)
Bijzijn XL     Hybrid Journal  
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
Biosafety and Health     Open Access   (Followers: 5)
Biosalud     Open Access   (Followers: 1)
Birat Journal of Health Sciences     Open Access  
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 7)
BMC Pregnancy and Childbirth     Open Access   (Followers: 24)
BMJ Simulation & Technology Enhanced Learning     Hybrid Journal   (Followers: 12)
Boletin Médico de Postgrado     Open Access  
Brazilian Journal of Medicine and Human Health     Open Access  
British Journal of Health Psychology     Hybrid Journal   (Followers: 50)
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 23)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos de Saúde     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 14)
Canadian Family Physician     Partially Free   (Followers: 13)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 14)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 3)
Canadian Journal of Public Health     Hybrid Journal   (Followers: 27)
Cannabis and Cannabinoid Research     Hybrid Journal   (Followers: 2)
Carta Comunitaria     Open Access  
Case Reports in Women's Health     Open Access   (Followers: 4)
Case Studies in Fire Safety     Open Access   (Followers: 25)
CASUS : Revista de Investigación y Casos en Salud     Open Access   (Followers: 1)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
CES Medicina     Open Access  
CES Salud Pública     Open Access   (Followers: 1)
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access   (Followers: 2)
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia & Salud     Open Access   (Followers: 2)
Ciencia & Trabajo     Open Access   (Followers: 1)
Ciencia e Innovación en Salud     Open Access  
Ciencia y Cuidado     Open Access   (Followers: 1)
Ciencia y Salud     Open Access   (Followers: 4)
Ciencia y Salud Virtual     Open Access  
Ciencia, Tecnología y Salud     Open Access   (Followers: 2)
Cities & Health     Hybrid Journal   (Followers: 2)
Clinical and Experimental Health Sciences     Open Access   (Followers: 1)
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
Clocks & Sleep     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 2)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 6)
Conflict and Health     Open Access   (Followers: 8)
Contraception and Reproductive Medicine     Open Access   (Followers: 2)
Cuaderno de investigaciones: semilleros andina     Open Access   (Followers: 3)
Cuadernos de la Escuela de Salud Pública     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 10)
Current Opinion in Environmental Science & Health     Hybrid Journal   (Followers: 1)
Das österreichische Gesundheitswesen ÖKZ     Hybrid Journal  
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Design for Health     Hybrid Journal  
Digital Health     Open Access   (Followers: 9)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 14)
Diversity and Equality in Health and Care     Open Access   (Followers: 9)
Diversity of Research in Health Journal     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 3)
Drogues, santé et société     Open Access   (Followers: 2)
Duazary     Open Access   (Followers: 1)
Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi / Journal of Duzce University Health Sciences Institute     Open Access  
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 26)
East African Journal of Public Health     Full-text available via subscription   (Followers: 4)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 24)
EcoHealth     Hybrid Journal   (Followers: 5)
Education for Health     Open Access   (Followers: 9)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência : Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 4)
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 5)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 6)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 22)
EsSEX : Revista Científica     Open Access   (Followers: 1)
Estudios sociales : Revista de alimentación contemporánea y desarrollo regional     Open Access   (Followers: 1)
Ethics & Human Research     Hybrid Journal   (Followers: 3)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 7)
Ethiopian Journal of Health Development     Open Access   (Followers: 7)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 8)
Ethnicity & Health     Hybrid Journal   (Followers: 14)
Eurasian Journal of Health Technology Assessment     Open Access  
EUREKA : Health Sciences     Open Access   (Followers: 2)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 5)
European Medical, Health and Pharmaceutical Journal     Open Access   (Followers: 1)
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 9)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 9)
Family & Community Health     Hybrid Journal   (Followers: 14)
Family Medicine and Community Health     Open Access   (Followers: 10)
Family Relations     Partially Free   (Followers: 15)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 2)
Finnish Journal of eHealth and eWelfare : Finjehew     Open Access  
Food and Public Health     Open Access   (Followers: 19)
Food Quality and Safety     Open Access   (Followers: 1)
Frontiers in Digital Health     Open Access   (Followers: 2)
Frontiers in Public Health     Open Access   (Followers: 9)
Frontiers of Health Services Management     Partially Free   (Followers: 4)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access   (Followers: 1)
Ganesha Journal     Open Access  
Gazi Sağlık Bilimleri Dergisi     Open Access  
Geospatial Health     Open Access   (Followers: 1)
Gestão e Desenvolvimento     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 9)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Advances in Health and Medicine     Open Access  
Global Challenges     Open Access  
Global Health : Science and Practice     Open Access   (Followers: 8)
Global Health Annual Review     Open Access   (Followers: 5)
Global Health Journal     Open Access   (Followers: 2)
Global Health Promotion     Hybrid Journal   (Followers: 17)
Global Journal of Health Science     Open Access   (Followers: 10)
Global Journal of Public Health     Open Access   (Followers: 14)
Global Medical & Health Communication     Open Access   (Followers: 2)
Global Mental Health     Open Access   (Followers: 9)
Global Reproductive Health     Open Access   (Followers: 1)
Global Security : Health, Science and Policy     Open Access   (Followers: 1)
Global Transitions     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 9)
Hacia la Promoción de la Salud     Open Access  
Hastane Öncesi Dergisi     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 5)
HCU Journal     Open Access  
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 19)
Health & Justice     Open Access   (Followers: 6)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 15)
Health and Human Rights     Open Access   (Followers: 10)
Health and Research Journal     Open Access   (Followers: 4)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 11)
Health and Social Work     Hybrid Journal   (Followers: 71)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 5)
Health Behavior Research     Open Access   (Followers: 6)

        1 2 3 4 | Last

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Number of Followers: 2  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2227-9067
Published by MDPI Homepage  [233 journals]
  • Children, Vol. 7, Pages 103: Evolving Cognitive Dysfunction in Children
           with Neurologically Stable Opsoclonus–Myoclonus Syndrome

    • Authors: En Lin Goh, Kate Scarff, Stephanie Satariano, Ming Lim, Geetha Anand
      First page: 103
      Abstract: Cognitive and acquired neurodevelopmental deficits have been reported in children with opsoclonus–myoclonus syndrome (OMS) and are known to be associated with more severe and relapsing disease course. However, there is a paucity of data regarding cognitive dysfunction in children with stable neurological disease. We report three children with OMS and evolving cognitive dysfunction in the context of a mild disease course. The children’s ages at disease onset were between 17 and 35 months and they were followed up for 4–10 years. Neuroblastoma was identified in one child. OMS severity scores ranged between 8 and 12/15 at presentation. They underwent immunotherapy and all were in remission by 7 months (range 4–13 months), with treatment maintained for 1 year. One child remained relapse-free, while two others had one clinical relapse each and were immunotherapy-responsive again. In all cases, evolving cognitive dysfunction was reported despite being in remission and stable off treatment for a median of 20 months (range of 12–31 months; two OMS scores of 0/15 and one of 2/15). In children with OMS who have completed treatment and have made full or near full neurological recovery, concerns remain regarding long-term outcome in terms of future learning and cognitive development.
      Citation: Children
      PubDate: 2020-08-19
      DOI: 10.3390/children7090103
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 104: Primary Oro-Facial Manifestations of
           Langerhans Cell Histiocytosis in Pediatric Age: A Bi-Institutional
           Retrospective Study on 45 Cases

    • Authors: Saverio Capodiferro, Angela Tempesta, Luisa Limongelli, Giuseppe Ingravallo, Eugenio Maiorano, Gian Luca Sfasciotti, Maurizio Bossù, Antonella Polimeni, Gianfranco Favia
      First page: 104
      Abstract: Aims: Langerhans Cell Histiocytosis is a rare hematologic disorder usually affecting children and most commonly involving the head and neck region. Primary oro-facial manifestations are rare, and their diagnosis is often challenging as they are numerous and often resemble common pathologies, refractory to conventional medical and/or instrumental treatments. For such reasons, the diagnosis is frequently delayed, as is the following staging and therapy onset. We retrospectively studied 45 pediatric patients affected by Langerhans Cell Histiocytosis with onset in the head and neck, to examine their clinical and radiological features at the early stage. Materials and Methods: The study was a retrospective bi-institutional analysis (Department of Pediatric Dentistry and Pediatric Oncology of “Sapienza” University of Rome, Department of Interdisciplinary Medicine of the University of Bari “Aldo Moro”), which enrolled 45 patients (age range 0–18 year-old) affected by Langerhans Cell Histiocytosis with oro-facial onset. Data regarding clinical appearance, number, site, synchronous or metachronous occurrence, involved tissues/organs, radiographic features and clinical outcomes were collected, listed and overall differentiated by two age ranges (0–10-year-olds and 10–18-year-olds). Results: Patients were 26 males and 19 females, with an average age at the time of diagnosis of 4.8 ± 3.8 years (median = 3.9 years). The most common findings were inflamed, hyperplastic, painful and often ulcerated gingival lesions (22 cases), associated with deciduous tooth mobility and/or dislocation with bone loss in 18 cases, followed by nine single eosinophilic granulomas of the mandible and two of the maxilla. Lesions of the palatal mucosa were observed in six patients; nine patients showed on radiograms the characteristic “floating teeth” appearance in the mandible with synchronous lesions of the maxilla in six. Paresthesia was relatively un-frequent (three cases) and the pathological fracture of the mandible occurred in six. Head/neck lymph nodes involvement was associated with oral lesions in 12 cases and skull lesions in 14. Otitis (media or externa) was detected in four instances, exophthalmia in two, cutaneous rush in nine, contextual presence or subsequent onset of insipidus diabetes in eight. As for therapy, single or multiple small jaw lesions were all surgically removed; chemotherapy with vinblastine alone or associated with corticosteroids was the principal treatment in almost the 80% of cases; more than 50% of patients received corticosteroids, while only three patients received adjunctive radiotherapy. The overall mortality account for less than 9% (four of 45 cases) and recurrence observed in eight patients after therapy. Conclusions: Langerhans Cell Histiocytosis may mimic several oro-facial inflammatory and neoplastic diseases. Considering the potential disabling sequela following head and neck localization of Langerhans Cell Histiocytosis in children, especially at the periodontal tissues with teeth and alveolar bone loss, lesion recognition along with the histological examination of suspicious tissues is mandatory to achieve an early diagnosis and to prevent further organ involvement.
      Citation: Children
      PubDate: 2020-08-19
      DOI: 10.3390/children7090104
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 105: Normal Predicted Reference Values for
           Spirometry in Korean Children and Adolescents

    • Authors: Dong Hyun Kim, Jeong Hee Kim, Dae Hyun Lim
      First page: 105
      Abstract: Pulmonary function tests are useful to evaluate airway obstructions and bronchial responsiveness. We aimed to determine the reference values applicable to Korean children and adolescents. In total, 5590 (2607 males, 2983 females) healthy children aged 4 to 17 years old were recruited from three regions in Korea. Simple and multiple regression analyses were applied using age, height, and weight as variables to predict the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum mid-expiratory flow (MMEF) and the peak expiratory flow rate (PEFR). There were significant correlations between the variables and parameters (P < 0.001). The coefficient of determination (R2) values of polynomial equations with two variables were lower than those with two variables but higher than those of monomial equations based on height. The prediction equations by height were obtained, and the R2 value of the FEV1 was the highest. The predicted spirometric values for males were higher than those for females except for the MMEF. The R2 values for the FEV1 and FVC were higher than previous studies except for the R2 value of the FVC for males in European data. This study provided updated regression equations of normal predicted values for spirometry applicable to Korean children and adolescents.
      Citation: Children
      PubDate: 2020-08-19
      DOI: 10.3390/children7090105
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 106: The Effectiveness of Hippotherapy to Recover
           Gross Motor Function in Children with Cerebral Palsy: A Systematic Review
           and Meta-Analysis

    • Authors: Laura Guindos-Sanchez, David Lucena-Anton, Jose Moral-Munoz, Alejandro Salazar, Ines Carmona-Barrientos
      First page: 106
      Abstract: Cerebral palsy (CP) is a permanent disorder of the posture and movement, which can result in impairments of gross motor function, among others. Hippotherapy (HPT) is an emerging intervention to promote motor recovery in patients with neurological disorders, providing a smooth, precise, rhythmic, and repetitive pattern of movement to the patient. The main objective of this systematic review and meta-analysis of randomized controlled clinical trials was to analyze the effectiveness of HPT interventions on gross motor function in subjects with CP. The following databases were searched in May 2019: PubMed, Scopus, Embase, and Web of Science. The methodological quality of the randomized controlled trials was assessed using the Physiotherapy Evidence Database (PEDro) scale. A total of 10 studies were analyzed in this review, involving 452 participants. Favorable effects were obtained on the gross motor function (Gross Motor Function Measure-66, standardized mean difference (SMD) = 0.81, 95% confidence interval (CI) = 0.47–1.15, Gross Motor Function Measure-88 dimension A SMD = 0.64, 95% CI = 0.30–0.97, dimension B SMD = 0.42, 95% CI = 0.09–0.75, and dimension E SMD = 0.40, 95% CI = 0.06–0.73). The results obtained in the present review show the potential benefit of HPT intervention in improving gross motor function in children with CP.
      Citation: Children
      PubDate: 2020-08-19
      DOI: 10.3390/children7090106
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 107: Combined Effect of Race/Ethnicity and Type of
           Insurance on Reuse of Urgent Hospital-Based Services in Children
           Discharged with Asthma

    • Authors: Jamie M. Pinto, Sarita Wagle, Lauren J. Navallo, Anna Petrova
      First page: 107
      Abstract: Asthma is a leading cause of health disparity in children. This study explores the joint effect of race/ethnicity and insurance type on risk for reuse of urgent services within a year of hospitalization. Data were collected from 604 children hospitalized with asthma between 2012 and 2015 and stratified with respect to combination of patients’ insurance status (public vs. private) and race/ethnicity (white vs. nonwhite). Highest rates for at least one emergency department (ED) revisit (49.5%, 95% CI 42.5, 56.5) and for average revisits (1.03, 95% CI 0.83, 1.22) were recorded in nonwhite children with public insurance. Adjusted models revealed higher chance for ED reuse in white as well as nonwhite children covered by public insurance. Hospitalization rate was not dependent on the combination of social determinants, but on the number of post-discharge ED revisits. The combined effect of race/ethnicity and health insurance are associated with post-discharge utilization of ED services, but not with hospital readmission.
      Citation: Children
      PubDate: 2020-08-20
      DOI: 10.3390/children7090107
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 108: Factors Influencing Sense of Coherence:
           Family Relationships, High School Life and Autism Spectrum Tendency

    • Authors: Tomoko Omiya, Naoko Deguchi, Taisuke Togari, Yoshihiko Yamazaki
      First page: 108
      Abstract: Adolescence is marked by significant life stress. Recently, school refusal and dropouts as well as suicide among Japanese adolescents have increased. Sense of coherence (SOC) is recognized as a competency that helps people deal with stress. The purpose of this study was to examine the factors influencing SOC in male and female high school students. We conducted a survey with 203 pairs of high school students and their mothers, in Tokyo, to explore their SOC, family relationships, school belonging, and autistic traits. Analysis of the data revealed a weak relationship between female students’ SOC and that of their mothers, and no relationship between male students’ SOC and their mothers’ SOC. Feelings of acceptance and recognition from teachers improved students’ SOC, irrespective of gender. Low SOC in mothers had a negative impact on female students’ SOC, and children’s lack of imagination (an autism spectrum tendency) had a negative impact on male students’ SOC. This study revealed the importance of support at home and school according to the needs of both genders.
      Citation: Children
      PubDate: 2020-08-21
      DOI: 10.3390/children7090108
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 109: Does Participation in Sports Influence the
           Prevalence of and Initiation into Multiple Substance Misuse in
           Adolescence' A Two-Year Prospective Analysis

    • Authors: Natasa Zenic, Martina Rezic, Ivana Cerkez Zovko, Hrvoje Vlahovic, Tine Sattler
      First page: 109
      Abstract: Concurrent smoking and harmful drinking (CSHD) in adolescence is an important public health and social problem, while participation in sports is considered as being protective against CSHD. This study aimed to prospectively evaluate the influence of various facets of sports participation on the prevalence of and initiation into CSHD of adolescents. Participants were adolescents from southern Croatia (n = 711, 43.6% females, 16 years of age at study baseline), who were tested at baseline and at follow-up (two years later). Variables included gender, age, sports factors (participation in individual and team sports, sport experience, competitive success, intensity of involvement in sports), and CSHD. The CSHD prevalence did not increase significantly over the course of the study (from 5.6% to 7.5%, p > 0.05). Binomial logistic regression with age and gender as covariates suggested that team sports participation correlated to CSHD prevalence at baseline, and follow-up, with higher risk for CSHD among those adolescents who quit team sports (OR = 9.18 and 2.68, 95%CI = 2.04–22.26 and 1.05–6.83 for baseline and follow-up, respectively), and those never involved in team sports (OR = 9.00 and 3.70, 95%CI = 2.07–39.16 and 1.57–8.72 for baseline and follow-up, respectively). A higher risk of CSHD at baseline was seen among those adolescents who were involved in sports for longer (OR = 1.66, 95%CI = 1.16–2.38). The results are discussed in the context of the fact that the study included adolescents at the age of rigid sports selection (the transition from youth to professional-level sports). Since the majority of participants began CSHD at an earlier age, further studies in subjects of a younger age range are warranted.
      Citation: Children
      PubDate: 2020-08-22
      DOI: 10.3390/children7090109
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 110: High BAL sRAGE is Associated with Low Serum
           Eosinophils and IgE in Children with Asthma

    • Authors: Jason T. Patregnani, Bonnie A. Brooks, Elizabeth Chorvinsky, Dinesh K. Pillai
      First page: 110
      Abstract: Asthma remains the most common chronic lung disease in childhood in the United States. The receptor for advanced glycation end products (RAGE) has been recognized as both a marker of and participant in pulmonary pathophysiology. While membrane-bound RAGE (mRAGE) perpetuates the type 2 immune response, the soluble form (sRAGE) may act as a decoy receptor for pro-inflammatory ligands. Bronchoalveolar samples from 45 pediatric patients with asthma were obtained. Patients were divided into high and low BAL sRAGE groups using median sRAGE. Descriptive statistical analysis and non-parametric testing were applied. Children in the “high” sRAGE group had a lower median serum eosinophil (0.27 [SE ± 0.04] vs. 0.57 [± 0.06] K/mcl, adjusted p = 0.003) and lower serum IgE level (194.4 [± 60.7] vs. 676.2 ± 140.5) IU/mL, adjusted p = 0.004) as compared to the “low” sRAGE group. When controlling for age and body mass index percentile, absolute eosinophil count (p = 0.03) and serum IgE (p = 0.043) remained significantly lower in the “high” sRAGE group. Children with asthma and high levels of BAL sRAGE have lower serum eosinophil and IgE levels. These findings are consistent with the hypothesis that sRAGE may act as a decoy receptor by binding ligands that normally interact with mRAGE.
      Citation: Children
      PubDate: 2020-08-24
      DOI: 10.3390/children7090110
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 111: Outcomes of Device Closure of Atrial Septal

    • Authors: P. Syamasundar Rao
      First page: 111
      Abstract: Several devices have been designed and tried over the years to percutaneously close atrial septal defects (ASDs). Most of the devices were first experimented in animal models with subsequent clinical testing in human subjects. Some devices were discontinued or withdrawn from further clinical use for varied reasons and other devices received Food and Drug Administration (FDA) approval with consequent continued usage. The outcomes of both discontinued and currently used devices was presented in some detail. The results of device implantation are generally good when appropriate care and precautions are undertaken. At this time, Amplatzer Septal Occluder is most frequently utilized device for occlusion of secundum ASD around the world.
      Citation: Children
      PubDate: 2020-08-25
      DOI: 10.3390/children7090111
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 112: Associations between Learning and Behavioral
           Difficulties in Second-Grade Children

    • Authors: Emanuela Castro, Maria Cotov, Paola Brovedani, Gabrielle Coppola, Tania Meoni, Marina Papini, Tania Terlizzi, Chiara Vernucci, Chiara Pecini, Pietro Muratori
      First page: 112
      Abstract: Learning and behavioral difficulties often emerge during the first years of primary school and are one of the most important issues of concern for families and schools. The study was aimed at investigating the co-occurrence of difficulties between academic learning and emotional-behavioral control in typically developing school children and the moderating role of sex. A sample of 640 second-grade school children participated in the study. This study used the Strengths and Difficulties Questionnaire to measure the emotional and behavioral difficulties and a battery of objective and standardized tests to evaluate the learning skills in children. In this sample 7% to 16% of children performed below the normal range in reading and/or arithmetic tests. Mixed models showed that children’s hyperactive behaviors were positively related to both reading and math difficulties, and emotional problems correlated negatively with reading accuracy. The more children displayed behavioral difficulties, the more they were exposed to the risk of worsening reading and math performance, especially for girls. The result that among different emotional-behavioral problems within the school setting, hyperactivity behaviors and emotional difficulties are related to learning difficulties with a moderate effect of sex, needs to be taken into account in screening and prevention programs for learning difficulties in order to not disregard the complexity of the associated profiles.
      Citation: Children
      PubDate: 2020-08-26
      DOI: 10.3390/children7090112
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 113: Managing Congenital Lobar Overinflation
           Associated with Congenital Heart Disease

    • Authors: Ranjit I. Kylat
      First page: 113
      Abstract: The incidence of congenital lobar overinflation (CLO) is reported at 1 in 20,000–30,000 live births and represents 10% of all congenital lung malformations. The occurrence of concomitant congenital heart disease (CHD) and CLO ranges from 12% to 20%. There are diverging views in the management as to whether early lobectomy or repair of the cardiac defect, with the assumption that respiratory symptomatology would gradually resolve, or a combined lung and cardiac repair would be the ideal first step in the management. In concomitant CLO and CHD, the surgical decision has to be individualized. Prior to surgical intervention a thorough evaluation may be needed with contrast computed tomography (CT) or magnetic resonance imaging (MRI), bronchoscopy, and if needed cardiac catheterization. CLO improves with management of many left to right shunts and in those with anomalous vessels, but early lobectomy or combined approach may be considered in those symptomatic patients with more complex CHD.
      Citation: Children
      PubDate: 2020-08-28
      DOI: 10.3390/children7090113
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 114: Discharging Preterm Infants Home on Caffeine,
           a Single Center Experience

    • Authors: Cheng Ma, Denisse Broadbent, Garrett Levin, Sanjeet Panda, Devaraj Sambalingam, Norma Garcia, Edson Ruiz, Ajay Pratap Singh
      First page: 114
      Abstract: Background: Apnea of prematurity (AOP) affects preterm neonates. AOP, combined with intermittent hypoxemic (IH) events frequently prolongs the length of stay. Caffeine is the preferred medication to treat AOP and may help improve IH events. There is lack of information on the safety of discharging preterm neonates home on caffeine for AOP in the literature. Our objective was to assess safety and benefits, if any, of discharging preterm infants home on caffeine. Methods: After IRB approval, preterm infants discharged home from the neonatal intensive care unit (NICU) on caffeine were compared with those without a discharge prescription for the period of January 2013 to December 2017. Results: A total of 297 infants were started on caffeine, and of those, 87 infants were discharged home on caffeine. There was no difference in length of stay between two groups. Duration of caffeine at home was 31 (28–42) days. The average cost of apnea monitor and caffeine at home per 30 days was USD 1326 and USD 50. There was no difference in number or reasons for emergency department (ED) visits or hospitalizations between two groups. Conclusion: AOP affects almost all preterm infants and along with intermittent hypoxemic events, and is one of the most common reasons for prolonged hospital stay. Discharging stable preterm infants home on caffeine may be safe, especially in those who are otherwise ready to be discharged and are only awaiting complete resolution of AOP/IH events.
      Citation: Children
      PubDate: 2020-08-28
      DOI: 10.3390/children7090114
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 115: The Scarcity of Literature on the

    • Authors: Tiffany H. Taft, Bethany Doerfler, Emily Edlynn, Linda Nguyen
      First page: 115
      Abstract: Gastroparesis (GP) is a chronic, gastric dysmotility disorder with significant morbidity and mortality. The hallmark of GP is the delayed emptying of the contents of the stomach in the absence of any mechanical obstruction. Patients most commonly report chronic symptoms of nausea, vomiting, feeling full quickly when eating, bloating, and abdominal pain. Treatments are limited with relatively poor efficacy. As such, children with GP are at significant risk for the development of psychological co-morbidities. In this paper, we provide a topical review of the scientific literature on the psychological, social, and emotional impacts of gastroparesis in pediatric patients. We aim to document the current state of research, identify gaps in our knowledge with appropriate recommendations for future research directions, and highlight the unique challenges pediatric patients with GP and their families may face as they manage this disease. Based on the current review, research into the psychosocial impacts in children with GP is essentially non-existent. However, when considering research in children with other chronic digestive diseases, children with GP are likely to face multiple psychosocial challenges, including increased risk for anxiety and depression, stigma, and reduced quality of life. These significant gaps in the current understanding of effects of GP across domains of childhood functioning allow for ample opportunities for future studies to address psychosocial outcomes.
      Citation: Children
      PubDate: 2020-08-31
      DOI: 10.3390/children7090115
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 116: Post-Traumatic Stress Symptoms among
           Lithuanian Parents Raising Children with Cancer

    • Authors: Irina Banienė, Nida Žemaitienė
      First page: 116
      Abstract: Background and objectives: The study aims to evaluate post-traumatic stress symptom expression among Lithuanian parents raising children with cancer, including social, demographic, and medical factors, and to determine their significance for the risk of developing post-traumatic stress disorder. Materials and methods: The study was carried out in two major Lithuanian hospitals treating children with oncologic diseases. The cross-sectional study included 195 parents, out of which 151 were mothers (77.4%) and 44 were fathers (22.6%). Post-traumatic stress symptoms were assessed using the Impact of Event Scale-Revised. To collect the sociodemographic, childhood cancer, and treatment data, we developed a questionnaire that was completed by the parents. Main study results were obtained using multiple linear regression. Results: A total of 75.4% of parents caring for children with cancer had pronounced symptoms of post-traumatic stress disorder. The female gender (β = 0.83, p < 0.001) was associated with an increased manifestation of symptoms, whilst higher parental education (β = −0.21, p = 0.034) and the absence of relapse (β = −0.48, p < 0.001) of the child’s disease reduced post-traumatic stress symptom expression. Conclusions: Obtained results confirmed that experiencing a child’s cancer diagnosis and treatment is extremely stressful for many parents. This event may lead to impaired mental health and increased post-traumatic stress disorder (PTSD) risk; hence, it is necessary to provide better support and assistance to parents of children with cancer.
      Citation: Children
      PubDate: 2020-08-31
      DOI: 10.3390/children7090116
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 117: ALT Trends through Childhood and Adolescence
           Associated with Hepatic Steatosis at 24 Years: A Population-Based UK
           Cohort Study

    • Authors: Ahlia Sekkarie, Jean A. Welsh, Kate Northstone, Catherine E. Cioffi, Aryeh D. Stein, Janet Figueroa, Usha Ramakrishnan, Miriam B. Vos
      First page: 117
      Abstract: (1) Background: Alanine aminotransferase (ALT) is used to screen for non-alcoholic fatty liver disease (NAFLD) in children; however, the optimal age to commence screening is not determined. Our objective was to describe whether ALT trends from 9–24 years were associated with hepatic steatosis at 24 years in a population-based UK cohort. (2) Methods: The sample included 1156 participants who were assessed for hepatic steatosis at 24 years and had at least two ALT measurements at 9, 15, 17, and/or 24 years. Controlled attenuation parameter scores were used to assess steatosis (low (<248 dB/m), mild/moderate (248–279 dB/m), severe (>279 dB/m)). Sex-stratified mixed-effects models were constructed to assess the liver enzyme trends by steatosis level. (3) Results: The final sample was 41.4% male and 10.4% had severe steatosis. In both sexes, ALT trends from 9 to 24 years differed in those with low vs. severe steatosis at 24 years (p < 0.001). There was no evidence of differences prior to puberty. At 17 years, the low vs. severe geometric mean ratio (GMR) was 0.69, 95% CI: 0.57–0.85 in males and (0.81, 0.65–1.01) females. At 24 years, the GMR was (0.53, 0.42–0.66) in males and (0.67, 0.54–0.84) females. (4) Conclusions: Higher ALT concentration in adolescence was associated with hepatic steatosis at 24 years. The increased screening of adolescents could strengthen NAFLD prevention and treatment efforts.
      Citation: Children
      PubDate: 2020-09-01
      DOI: 10.3390/children7090117
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 118: Quantifying the Language Barrier—A Total
           Survey of Parents’ Spoken Languages and Local Language Skills as
           Perceived by Different Professions in Pediatric Palliative Care

    • Authors: Larissa Alice Dreier, Boris Zernikow, Julia Wager
      First page: 118
      Abstract: To date, there are no specific figures on the language-related characteristics of families receiving pediatric palliative care. This study aims to gain insights into the languages spoken by parents, their local language skills and the consistency of professional assessments on these aspects. Using an adapted version of the “Common European Framework of Reference for Languages”, the languages and local language skills of parents whose children were admitted to an inpatient pediatric palliative care facility (N = 114) were assessed by (a) medical staff and (b) psychosocial staff. Nearly half of the families did not speak the local language as their mother tongue. The most frequently spoken language was Turkish. Overall, the medical staff attributed better language skills to parents than the psychosocial staff did. According to them, only 27.0% of mothers and 38.5% of fathers spoke the local language at a high level while 37.8% of mothers and 34.6% of fathers had no or rudimentary language skills. The results provide important information on which languages pediatric palliative care practitioners must be prepared for. They sensitize to the fact that even within an institution there can be discrepancies between the language assessments of different professions.
      Citation: Children
      PubDate: 2020-09-01
      DOI: 10.3390/children7090118
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 119: Formative Evaluation of Open Goals: A UK
           Community-Based Multi-Sport Family Programme

    • Authors: Leanne Burton, Kathryn Curran, Lawrence Foweather
      First page: 119
      Abstract: Community parks provide opportunities for physical activity (PA) and facilitate social interactions. This formative evaluation assesses the implementation of ‘Open Goals’ (OG), a novel multi-sport programme aiming to increase family PA and community cohesion, delivered weekly by Liverpool Football Club’s charitable foundation to local parks in Liverpool, North West England. Three Open Goals parks were chosen for the evaluation settings. Formative evaluation measures included: System for Observing Play and Recreation in Communities (SOPARC) observations (n = 10), direct session observations (n = 8), semi-structured interviews with Open Goals coaching staff (n = 3), and informal feedback from families (n = 5) about their experiences of Open Goals. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Within the three evaluation parks, Open Goals reached 107 participants from May–July 2019, through 423 session attendances. Fidelity of the programme was high (M = 69% of session content delivered as intended). Overall park use when OG was offered compared to when it was not offered was not statistically significant (p = 0.051), however, target area use was significantly increased (p = 0.001). Overall physical activity levels in parks were significantly (p = 0.002) higher when Open Goals was being offered, compared to when it was not. Coaches reported that engagement in OG positively affected family co-participation and children’s behavioural development. Contextual issues included environmental and social barriers to programme engagement, including the co-participation element of the programme and criticism of the marketing of OG. It is evident that community-based multi-sport PA programmes endorsed by professional football clubs are well positioned to connect with local communities in deprived areas and to encourage PA and community engagement. This study suggests that such programmes may have the ability to improve park usage in specific areas, along with improving physical activity levels among families, although further research is required. Effective marketing strategies are needed for promotional purposes. Upskilling of coaches in the encouragement of family co-participation may support regular family engagement in PA in local parks.
      Citation: Children
      PubDate: 2020-09-01
      DOI: 10.3390/children7090119
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 120: A Brief Measure of Parental Wellbeing for Use
           in Evaluations of Family-Centred Interventions for Children with
           Developmental Disabilities

    • Authors: Roy McConkey
      First page: 120
      Abstract: Increasing emphasis is placed on the provision of family-centred interventions when children have developmental disabilities with the aim of supporting parents as well as fostering the child’s development. Although various instruments have been developed to assess parental health, stress and quality of life, these are rarely used by practitioners because of the burden they place on informants. A brief measure, rooted in the concept of subjective wellbeing, was developed and tested with over 400 parents of children with ASD participating in a home-based intervention. Consisting of eight items and using a 10-point rating scale, the measure was readily understood and accepted by parents. The items contributed to one main factor that confirmed the measure’s construct validity. The internal reliability of the scale was reasonable, and there was promising evidence of test–retest reliability. There is evidence too for criterion validity through a significant relationship with a measure of parental mental health. The summary score derived from the measure was sensitive to the predicted differences on wellbeing scores by parent characteristics as well as to features of their engagement with the intervention. This brief assessment tool could help practitioners to evidence the impact of their family-centred interventions.
      Citation: Children
      PubDate: 2020-09-01
      DOI: 10.3390/children7090120
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 121: Psychogastroenterology: A Cure, Band-Aid, or

    • Authors: Miranda A. L. van Tilburg
      First page: 121
      Abstract: Psychogastroenterology is a field that focuses on the brain–gut connection. Many children with gut disorders also struggle with psychological and social factors that affect their disease outcomes. Psychological factors have been suggested to be a cure, a band-aid, or a prevention. This article examines the underlying models of disease and health that determine how we understand and treat psychosocial factors in gut diseases. The biomedical and biopsychosocial models are presented and applied to pediatric gut disorders. This article should familiarize clinicians as well as children and their families to the challenges and opportunities for addressing psychosocial factors in gut disease. Psychogastroenterology is best thought of as a cog in a complex treatment machine.
      Citation: Children
      PubDate: 2020-09-03
      DOI: 10.3390/children7090121
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 122: Effects of Childhood Adversity and Its
           Interaction with the MAOA, BDNF, and COMT Polymorphisms on Subclinical
           Attention Deficit/Hyperactivity Symptoms in Generally Healthy Youth

    • Authors: Meng-Che Tsai, Kai-Jyun Jhang, Chih-Ting Lee, Yu-Fang Lin, Carol Strong, Yi-Ching Lin, Yi-Ping Hsieh, Chung-Ying Lin
      First page: 122
      Abstract: We aimed to investigate the effects of childhood adversity and its interaction with the polymorphisms in the monoamine oxidase A (MAOA), brain-derived neurotrophic factor (BDNF), and catechol-O-methyltransferase (COMT) genes on attention and hyperactivity disorder (ADHD) symptoms in a community sample of generally healthy youth. Participants (N = 432) completed questionnaires assessing ADHD symptoms (i.e., inattention, hyperactivity, and impulsiveness) and adverse childhood experiences, such as adverse environments (AEs) and childhood maltreatment (CM). Salivary genomic DNA was used to test polymorphisms in MAOA, BDNF, and COMT genes. A gene score (GS) was created based on the number of risk allele in the studied genes. Multiple linear regressions were used to examine the genetic and environmental effects on ADHD symptoms. The univariate analysis indicated that CM was significantly associated with inattention (β = 0.48 [95% confidence interval 0.16–0.79]), hyperactivity (0.25 [0.06–0.45]), and impulsiveness (1.16 [0.26–2.05]), while the GS was associated with hyperactivity (0.22 [0.11–0.33]) and impulsiveness (0.56 [0.06–1.05]). Only the GS remained significantly associated with hyperactivity (0.25 [0.12–0.37]) and impulsiveness (0.79 [0.20–1.38]) when the gene-environment interaction term was added in the model. No effects were found for AE and the gene-environment interaction term. In conclusion, CM was associated with ADHD symptoms in emerging adulthood. Genetic factors may also play a significant role in the association with these outcomes.
      Citation: Children
      PubDate: 2020-09-03
      DOI: 10.3390/children7090122
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 123: A Model for a Standardized and Sustainable
           Pediatric Anesthesia-Intensive Care Unit Hand-Off Process

    • Authors: Priti G. Dalal, Theodore J. Cios, Theodore K. M. DeMartini, Amit A. Prasad, Meghan C. Whitley, Joseph B. Clark, Leon Lin, Dennis J. Mujsce, Robert E. Cilley
      First page: 123
      Abstract: Background and Objectives: The hand-off process between pediatric anesthesia and intensive care unit (ICU) teams involves the exchange of patient health information and plays a major role in reducing errors and increasing staff satisfaction. Our objectives were to (1) standardize the hand-off process in children’s ICUs, and (2) evaluate the provider satisfaction, efficiency and sustainability of the improved hand-off process. Methods: Following multidisciplinary discussions, the hand-off process was standardized for transfers of care between anesthesia-ICU teams. A pre-implementation and two post-implementation (6 months, >2 years) staff satisfaction surveys and audits were conducted to evaluate the success, quality and sustainability of the hand-off process. Results: There was no difference in the time spent during the sign out process following standardization—median 5 min for pre-implementation versus 5 and 6 min for post-implementation at six months and >2 years, respectively. There was a significant decrease in the number of missed items (airway/ventilation, venous access, medications, and laboratory values pertinent events) post-implementation compared to pre-implementation (p ≤ 0.001). In the >2 years follow-up survey, 49.2% of providers felt that the hand-off could be improved versus 78.4% in pre-implementation and 54.2% in the six-month survey (p < 0.001). Conclusion: A standardized interactive hand-off improves the efficiency and staff satisfaction, with a decreased rate of missed information at the cost of no additional time.
      Citation: Children
      PubDate: 2020-09-03
      DOI: 10.3390/children7090123
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 124: Early versus Delayed Feeding after
           Percutaneous Endoscopic Gastrostomy Placement in Children: A Meta-Analysis

    • Authors: Jun Watanabe, Kazuhiko Kotani
      First page: 124
      Abstract: Early feeding after percutaneous endoscopic gastrostomy (PEG) placement is an accepted practice in the treatment of adult patients and the knowledge is clinically extrapolated in the treatment of children. To verify this treatment in children—as there are some specific features of PEG-related practices in children—the present study aimed to review meta-analyses of early feeding (within 4 h) after PEG placement in children. We searched the PubMed database for articles published until July 2020. A quality assessment was performed using the Grading of Recommendations, Assessment, Development, and Evaluation method. Three randomized controlled trials (208 patients) were eligible for inclusion. No patients died within 72 h. Early feeding resulted in little to no difference in the length of hospital stay (mean difference [MD] −7.47, 95% confidence interval [CI] −25.16 to 10.21; I2 = 95%) and vomiting events (risk ratio 0.84, 95% CI 0.55 to 1.31; I2 = 0%). In a subgroup analysis, early feeding without antibiotics reduced the length of hospital stay in one study (MD −21.60, 95% CI −22.86 to −20.34) but early feeding with antibiotics did not affect the length in two studies (MD 0.28, 95% CI −6.49 to 7.06; I2 = 0%). Overall, the certainty of the evidence was not very high. In summary, early feeding after PEG placement may be a safe alternative to delayed feeding in children. The findings in children seemed similar to those in adults, while there is a need for further studies that specifically investigate PEG placement-related practices in children.
      Citation: Children
      PubDate: 2020-09-03
      DOI: 10.3390/children7090124
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 125: Contextualizing Parental/Familial Influence
           on Physical Activity in Adolescents before and during COVID-19 Pandemic: A
           Prospective Analysis

    • Authors: Barbara Gilic, Ljerka Ostojic, Marin Corluka, Tomislav Volaric, Damir Sekulic
      First page: 125
      Abstract: Parental and familial factors influence numerous aspects of adolescents’ lives, including their physical activity level (PAL). The purpose of this study was to evaluate the changes in PAL which occurred during the COVID-19 pandemic, and to evaluate influence of sociodemographic and parental/familial factors on PAL levels before and during pandemic in adolescents from Bosnia and Herzegovina. The sample included 688 adolescents (15–18 years of age; 322 females) who were tested on two occasions: in January 2020 (baseline; before the COVID-19 pandemic) and in April 2020 (follow-up; during the COVID-19 pandemic lockdown). Variables included PAL (measured by the Physical Activity Questionnaire for Adolescents–PAQ-A) as well as sociodemographic-, parental-, and familial factors. A significant decline in PALs was recorded between baseline and follow-up (t-test: 11.88, p < 0.001). Approximately 50% of adolescents underwent sufficient PAL at baseline, while only 24% of them were achieving sufficient PAL at the time of follow-up measurement. Paternal education was positively correlated (OR (95%CI): baseline: 6.63 (4.58–9.96), follow-up: 3.33 (1.19–7.01)), while familial conflict was negatively correlated (baseline: 0.72 (0.57–0.90), follow-up: 0.77 (0.60–0.99)) with PALs before and during the pandemic. This study highlights the importance of the parent–child relationship and parental/familiar support in promoting physical activity both during regular life and during crises and health challenging situations like the COVID-19 pandemic.
      Citation: Children
      PubDate: 2020-09-03
      DOI: 10.3390/children7090125
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 126: Student Feedback to Tailor the CARD™ System
           for Improving the Immunization Experience at School

    • Authors: Charlotte Logeman, Anna Taddio, C. Meghan McMurtry, Lucie Bucci, Noni MacDonald, Garth Chalmers, Victoria Gudzak, Vibhuti Shah, Joanne Coldham, Cheri Little, Tracy Samborn, Cindy Dribnenki, Joanne Snider
      First page: 126
      Abstract: Increasing the comfort of vaccine delivery at school is needed to improve the immunization experience for students. We created the CARD™ (C—Comfort, A—Ask, R—Relax and D—Distract) system to address this clinical care gap. Originally designed for grade 7 students, this study examined the perceptions of grade 9 students of CARD™. Grade 9 students who had experience with school-based immunizations, either as recipients or onlookers (n = 7; 100% females 14 years old) participated. Students answered pre–post surveys, reviewed CARD™ educational materials and participated in a semi-structured focus group discussion. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis of qualitative data. Participants reported positive perceptions of CARD™ educational materials and that CARD™ could fit into the school immunization process. CARD™ improved knowledge about effective coping interventions and was recommended for education of both nurses and students. The results provide preliminary evidence that CARD™ is acceptable and appropriate for implementation in grade 9 school-based immunizations.
      Citation: Children
      PubDate: 2020-09-04
      DOI: 10.3390/children7090126
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 127: Application of Low-Intensity Modified
           Constraint-Induced Movement Therapy to Improve the Affected Upper Limb
           Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case

    • Authors: Rocío Palomo-Carrión, Rita-Pilar Romero-Galisteo, Elena Pinero-Pinto, Purificación López-Muñoz, Helena Romay-Barrero, Francisco García-Muro San José
      First page: 127
      Abstract: Objective: To assess the functionality of the affected upper limb in children diagnosed with hemiplegia aged between 4 and 8 years after applying low-intensity modified Constraint-Induced Movement Therapy (mCIMT). Methods: Prospective case series study. A mCIMT protocol was applied for five weeks, with two hours of containment per day. The study variables were quality of movement of the upper limb, spontaneous use, participation of the affected upper limb in activities of daily living, dynamic joint position, grasp–release action, grasp strength, supination and extension elbow movements. Four measurements were performed, using the quality of upper extremity test (QUEST) scale, the Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) Evaluation, a hand dynamometer and a goniometer. Results: The sample was composed of eight children with moderate manual ability. Statistically significant differences were detected in all the studied variables (p < 0.05) between the pre-treatment and post–treatment results (Week 0–Week 5), except for upper limb dressing, putting on splints and buttoning up. In the first week, the changes were statistically significant, except for protective extension, grasp strength, grasp–release and all functional variables (level of functionality and participation of the patient’s upper limbs) in the SHUEE Evaluation (p > 0.05). The greatest increase occurred in spontaneous use from Assessment 1 to Assessment 4 (p = 0.01), reaching 88.87% active participation in bimanual tasks. The quality of movement of the upper limb exhibited a significant value due to the increase in dissociated movements and grasp (p = 0.01). Conclusion: A low dose (50 h) of mCIMT increased the functionality of children diagnosed with congenital hemiplegia between 4 and 8 years of age with moderate manual ability.
      Citation: Children
      PubDate: 2020-09-04
      DOI: 10.3390/children7090127
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 128: Prevalence and Associated Factors of
           Emotional and Behavioural Difficulties during COVID-19 Pandemic in
           Children with Neurodevelopmental Disorders

    • Authors: Jacqueline Nonweiler, Fiona Rattray, Jennifer Baulcomb, Francesca Happé, Michael Absoud
      First page: 128
      Abstract: Children and young people (CYP) with neurodevelopmental disorders (NDDs) may be particularly vulnerable to adverse mental health effects due to the COVID-19 pandemic. We conducted a cross-sectional U.K. parent-reported study from 2nd April–2nd June 2020, using the Strengths and Difficulties Questionnaire. CYP with NDDs (n = 371), compared to neurotypical controls, had a higher prevalence of emotional symptoms (42% vs. 15%) and conduct problems (28% vs. 9%), and fewer prosocial behaviours (54% vs. 22%). All groups had worse emotional symptoms than pre-COVID groups, and those with attention-deficit/hyperactivity disorder showed inflated conduct problems, while those with autism spectrum disorder exhibited decreased prosocial behaviours. Females with ASD had higher emotional symptoms compared to males. CYP with NDDs, and those without, showed higher levels of parent-reported mental health problems than comparable cohorts pre-COVID-19.
      Citation: Children
      PubDate: 2020-09-04
      DOI: 10.3390/children7090128
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 129: Peer Support in the Treatment of Chronic Pain
           in Adolescents: A Review of the Literature and Available Resources

    • Authors: James A. Tolley, Marti A. Michel, Amy E. Williams, Janelle S. Renschler
      First page: 129
      Abstract: Peer support has found applications beyond the mental health field and is useful for managing several chronic disorders and supporting healthy lifestyle choices. Communication through telephone and the Internet allows for greater access to those who cannot meet in person. Adolescent chronic pain would seem ideally suited to benefit from online peer support groups. Research is lacking, however, to characterize benefit in terms of pain and function, despite a clear desire among adolescents for access to such programs. More rapid development of online applications is needed for peer support, and research into the associated outcomes will be necessary to optimally design such programs.
      Citation: Children
      PubDate: 2020-09-07
      DOI: 10.3390/children7090129
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 130: Parent–Child Reminiscing about Past Pain as
           a Preparatory Technique in the Context of Children’s Pain: A Narrative
           Review and Call for Future Research

    • Authors: Maria Pavlova, Serena L. Orr, Melanie Noel
      First page: 130
      Abstract: Pain permeates childhood and remains inadequately and/or inconsistently managed. Existing research and clinical practice guidelines have largely focused on factors influencing the immediate experience of pain. The need for and benefits of preparing children for future pain (e.g., painful procedures) has been well established. Despite being a robust predictor of future pain and distress, memories of past painful experiences remain overlooked in pediatric pain management. Just as autobiographical memories prepare us for the future, children’s memories for past pain can be harnessed to prepare children for future painful experiences. Children’s pain memories are malleable and can be reframed to be less distressing, thus reducing anticipatory distress and promoting self-efficacy. Parents are powerful agents of change in the context of pediatric pain and valuable historians of children’s past painful experiences. They can alter children’s pain memories to be less distressing simply by talking, or reminiscing, about past pain. This narrative review summarizes existing research on parent–child reminiscing in the context of acute and chronic pediatric pain and argues for incorporation of parent–child reminiscing elements into preparatory interventions for painful procedures.
      Citation: Children
      PubDate: 2020-09-07
      DOI: 10.3390/children7090130
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 131: Relationship between High Blood Pressure and
           Microalbuminuria in Children Aged 6–9 Years in a South African

    • Authors: Edna Ngoakoana Matjuda, Constance R. Sewani-Rusike, Samuel Nkeh Chungag Anye, Godwill Azeh Engwa, Benedicta Ngwechi Nkeh-Chungag
      First page: 131
      Abstract: Though the association between high blood pressure and microalbuminuria is well established in adults, there is a paucity of information on microalbuminuria in children. This study investigated the relationship between high blood pressure and microalbuminuria in 6–9-year-old children. A cross-sectional study, which included 306 primary school children of age 6–9 years old from urban areas (n = 154) and rural areas (n = 152) of the Eastern Cape Province of South Africa, was conducted. Participants’ anthropometric data were determined and systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured and converted to BP percentiles for age, sex and height. Creatinine and albumin concentrations were assayed in early morning midstream urine and the albumin to creatinine ratio (ACR) was calculated. There was a 42.8% prevalence of elevated blood pressure/high blood pressure (E-BP/H-BP) and a 10.1% prevalence of microalbuminuria. Among the 131 children with E-BP/H-BP, 17 had elevated ACR with a prevalence of 13.95%. SBP and HR increased with increasing range of ACR and, furthermore, SBP was significantly (p < 0.05) higher in children with moderately and severely increased ACR. SBP was associated with ACR and increased SBP predicted microalbuminuria (R2 = 0.42, adj R2 = 0.039, B: 0.120, p = < 0.05). In conclusion, microalbuminuria was present in 6–9-year-old South African children of African Ancestry and a weak association was observed with SBP in children.
      Citation: Children
      PubDate: 2020-09-07
      DOI: 10.3390/children7090131
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 132: Patterns of Urinary Neutrophil
           Gelatinase-Associated Lipocalin and Acute Kidney Injury in Neonates
           Receiving Cardiopulmonary Bypass

    • Authors: Kathleen G. Brennan, Elvira Parravicini, John M. Lorenz, David A. Bateman
      First page: 132
      Abstract: Elevated urinary neutrophil gelatinase-associated lipocalin (uNGAL) predicts acute kidney injury (AKI) in children following cardiopulmonary bypass (CPB) during cardiac surgery, but little is known about uNGAL’s predictive ability in neonates in this setting. We sought to determine the relationship between AKI and post-CPB uNGAL in neonates in the first 72 post-operative hours. Methods: Urine samples for uNGAL analysis were collected at preoperative baseline and serially post-operatively from 76 neonates undergoing CPB. Mixed-effects regression models and logistic models assessed associations between uNGAL and AKI (controlling for sex, gestational age, CPB time, surgical complexity, and age at surgery). Receiver-operator curves were applied to define optimal uNGAL cut-off values for AKI diagnosis. Results: Between 0 and 4 h post-operatively, uNGAL values did not differ between neonates with and without AKI. After 4 h until 16 h post-operatively, significant time-wise separation occurred between uNGAL values of neonates with AKI and those without AKI. Odds ratios at each time point significantly exceeded unity, peaking at 10 h post-operatively (3.48 (1.58, 8.71)). Between 4 and 16 h post-operatively, uNGAL discriminated AKI from no-AKI, with a sensitivity of 0.63 (0.49, 0.75) and a specificity of 0.68 (0.62, 0.74) at a cut-off value of 100 ng/mL. Conclusion: After 4 h until 16 h post-operatively, elevated uNGAL is associated with AKI in neonates receiving CPB during cardiac surgery; however, this relationship is more complex than in older children.
      Citation: Children
      PubDate: 2020-09-09
      DOI: 10.3390/children7090132
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 133: COVID-19: Neurological Considerations in
           Neonates and Children

    • Authors: Carl E. Stafstrom, Lauren L. Jantzie
      First page: 133
      Abstract: The ongoing worldwide pandemic of the novel human coronavirus SARS-CoV-2 and the ensuing disease, COVID-19, has presented enormous and unprecedented challenges for all medical specialists. However, to date, children, especially neonates, have been relatively spared from the devastating consequences of this infection. Neurologic involvement is being increasingly recognized among adults with COVID-19, who can develop sensory deficits in smell and taste, delirium, encephalopathy, headaches, strokes, and peripheral nervous system disorders. Among neonates and children, COVID-19-associated neurological manifestations have been relatively rare, yet reports involving neurologic dysfunction in this age range are increasing. As discussed in this review, pediatric neurologists and other pediatric specialists should be alert to potential neurological involvement by this virus, which might have neuroinvasive capability and carry long-term neuropsychiatric and medical consequences.
      Citation: Children
      PubDate: 2020-09-10
      DOI: 10.3390/children7090133
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 134: Understanding School-Aged Childhood Obesity
           of Body Mass Index: Application of the Social-Ecological Framework

    • Authors: Keeyoon Noh, Jihyun Jane Min
      First page: 134
      Abstract: In order to understand the prevalence of school-aged childhood obesity in the United States and suggest better methods to prevent and treat the public health problem, we examined it with significant and identifiable factors within the social-ecological model. To investigate the association between social-ecological factors and child obesity/overweight (BMI), we used the 5th wave of the Fragile Families and Child Wellbeing Study. The dataset included information on 9-year-old children. The sample size for our study was 2054. We utilized multiple normal distributions for missing values and the Ordinary Least Square regression analysis. Black and Hispanic children were more likely to be obese/overweight than White children; children with higher physical activity were negatively associated with higher obesity; older mothers were more likely to be associated with children’s obesity; family structure was also significantly related to the likelihood of childhood obesity; finally, school environment was significantly associated with child obesity. To combat childhood obesity, more school physical activities should be implemented, such as increasing physical education opportunities as well as building more sizable playgrounds and accessible recreation facilities at school and in communities. School environments also should be pleasant and safe for children. Health practitioners need to assess home environments to intervene for children’s health.
      Citation: Children
      PubDate: 2020-09-13
      DOI: 10.3390/children7090134
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 135: Motivation, Self-Concept and Discipline in
           Young Adolescents Who Practice Rhythmic Gymnastics. An Intervention

    • Authors: Gabriel González-Valero, Félix Zurita-Ortega, José Luis Ubago-Jiménez, Pilar Puertas-Molero
      First page: 135
      Abstract: This study aims to develop an intervention based on TARGET strategies in young people practicing rhythmic gymnastics, with the aim of observing whether motivation, discipline, self-concept and flexibility are improved. This research is a longitudinal study of a quasi-experimental nature. A total of 104 young adolescents between the ages of 11 and 12 years (11.66 ± 0.47) participated in the study, of which 60 belong to the control group and 44 to the experimental group. The intervention programme lasted two months (17 sessions). TARGET strategies were applied to the experimental group during training. While the experimental group continued with its routine training. To measure the psychological variables, the instrument used were the Youth Physical Self-Concept Scale (C-PSQ), Reason Scale for Discipline (RSD) and Success Perception Questionnaire (SPQ), and for flexibility, the tests were applied to the Sit and Reach and Deep trunk flexion test. The results showed that those teenagers who participated in the intervention, obtained an increased climate task, which entails an enjoyment by the practice of physical activity itself, more optimal levels of physical self-concept and discipline, subsequently, obtaining better results of flexibility. While in the control group gymnasts the ego climate and demotivation increased. TARGET strategies applied to young adolescents have positive effects, improve motivation towards physical activity, self-concept and discipline. This results in greater performance in flexibility. This will encourage young adolescents to continue to engage in physical activity in the future.
      Citation: Children
      PubDate: 2020-09-14
      DOI: 10.3390/children7090135
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 136: Stress in Caregivers and Children with a
           Developmental Disorder Who Receive Rehabilitation

    • Authors: Sung Hyun Kim, In Young Sung, Eun Jae Ko, Jieun Park, Nayoung Heo
      First page: 136
      Abstract: This study aimed to evaluate the stress levels of caregivers and children with developmental disorders who were receiving rehabilitation treatment. The relationships between stress levels and factors such as early rehabilitation and home rehabilitation were quantified. Methods: This study was conducted in children with development disorders, aged from 1.5 years to 18 years, who were undergoing rehabilitation. The Korean version of the Child Behavior Checklist (K-CBCL) and the Adult Self-Report (K-ASR) were used to evaluate stress levels in children and caregivers, respectively. Results: Questionnaires were provided to 150 caregivers who agreed to participate. However, only 76 copies of the K-CBCL and 75 copies of the K-ASR were collected. The mean K-CBCL and K-ASR t scores were in the normal range. The K-CBCL score correlated positively with the K-ASR score (p value < 0.5). K-CBCL externalizing problems score correlated positively with the age at the start of rehabilitation, and the K-CBCL and K-ASR externalizing problems scores correlated negatively with home treatment delivered by caregivers. Conclusions: Stress levels of children and caregivers were closely related. Home rehabilitation provided by caregivers reduced stress in both caregivers and children. Early rehabilitation did not impart additional psychological burden on caregivers or children.
      Citation: Children
      PubDate: 2020-09-15
      DOI: 10.3390/children7090136
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 137: Bidirectional Ductal Shunting and Preductal
           to Postductal Oxygenation Gradient in Persistent Pulmonary Hypertension of
           the Newborn

    • Authors: Amy Lesneski, Morgan Hardie, William Ferrier, Satyan Lakshminrusimha, Payam Vali
      First page: 137
      Abstract: Background: The aim was to evaluate the relationship between the direction of the patent ductus arteriosus (PDA) shunt and the pre- and postductal gradient for arterial blood gas (ABG) parameters in a lamb model of meconium aspiration syndrome (MAS) with persistent pulmonary hypertension of the newborn (PPHN). Methods: PPHN was induced by intermittent umbilical cord occlusion and the aspiration of meconium through the tracheal tube. After delivery, 13 lambs were ventilated and simultaneous 129 pairs of pre- and postductal ABG were drawn (right carotid and umbilical artery, respectively) while recording the PDA and the carotid and pulmonary blood flow. Results: Meconium aspiration resulted in hypoxemia. The bidirectional ductal shunt had a lower postductal partial arterial oxygen tension ([PaO2] with lower PaO2/FiO2 ratio—97 ± 36 vs. 130 ± 65 mmHg) and left pulmonary flow (81 ± 52 vs. 133 ± 82 mL/kg/min). However, 56% of the samples with a bidirectional shunt had a pre- and postductal saturation gradient of < 3%. Conclusions: The presence of a bidirectional ductal shunt is associated with hypoxemia and low pulmonary blood flow. The absence of a pre- and postductal saturation difference is frequently observed with bidirectional right-to-left shunting through the PDA, and does not exclude a diagnosis of PPHN in this model.
      Citation: Children
      PubDate: 2020-09-15
      DOI: 10.3390/children7090137
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 138: COVID-19 Impact on Behaviors across the
           24-Hour Day in Children and Adolescents: Physical Activity, Sedentary
           Behavior, and Sleep

    • Authors: Lauren C. Bates, Gabriel Zieff, Kathleen Stanford, Justin B. Moore, Zachary Y. Kerr, Erik D. Hanson, Bethany Barone Gibbs, Christopher E. Kline, Lee Stoner
      First page: 138
      Abstract: In the wake of the COVID-19 pandemic, social restrictions to contain the spread of the virus have disrupted behaviors across the 24-h day including physical activity, sedentary behavior, and sleep among children (5–12 years old) and adolescents (13–17 years old). Preliminary evidence reports significant decreases in physical activity, increases in sedentary behavior, and disrupted sleep schedules/sleep quality in children and adolescents. This commentary discusses the impact of COVID-19-related restrictions on behaviors across the 24-h day in children and adolescents. Furthermore, we suggest recommendations through the lens of a socio-ecological model to provide strategies for lasting behavior change to insure the health and well-being of children and adolescents during the COVID-19 pandemic.
      Citation: Children
      PubDate: 2020-09-16
      DOI: 10.3390/children7090138
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 139: Pulmonary Hypertension with Prolonged Patency
           of the Ductus Arteriosus in Preterm Infants

    • Authors: Ranjit Philip, Vineet Lamba, Ajay Talati, Shyam Sathanandam
      First page: 139
      Abstract: There continues to be a reluctance to close the patent ductus arteriosus (PDA) in premature infants. The debate on whether the short-term outcomes translate to a difference in long-term benefits remains. This article intends to review the pulmonary vasculature changes that can occur with a chronic hemodynamically significant PDA in a preterm infant. It also explains the rationale and decision-making involved in a diagnostic cardiac catheterization and transcatheter PDA closure in these preterm infants.
      Citation: Children
      PubDate: 2020-09-16
      DOI: 10.3390/children7090139
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 140: Efficacy of Olanzapine for High and Moderate
           Emetogenic Chemotherapy in Children

    • Authors: So Rae Lee, Su Min Kim, Min Young Oh, Jae Min Lee
      First page: 140
      Abstract: This study was conducted to investigate the safety and efficacy of olanzapine for high and moderate emetogenic chemotherapy in children and young adults. We retrospectively reviewed the records of pediatric patients (n = 13) with cancer who had been administered olanzapine as an anti-emetic drug (AED) during a high and moderate emetogenic chemotherapy block from January 2018 to March 2020. Patients were administered other prophylactic AEDs according to practice guidelines. The mean age of the patients was 14.1 ± 5.5 years. The total number of chemotherapy cycles was 41. Twenty-one (51.2%) chemotherapy blocks were high emetogenic chemotherapy and 20 (48.8%) blocks were moderate emetogenic chemotherapy. Olanzapine was used for prophylaxis in 20 (48.8%) blocks of chemotherapy and rescue in 21 (51.2%). Of the 41 cycles, a complete response to olanzapine was achieved in 31 (75.6%), partial response in 6 (14.6%), and no response in 4 (9.8%). The mean dose was 0.07 ± 0.04 mg/kg/dose and 2.50 ± 1.37 mg/m2/dose. Adverse effects included somnolence, hyperglycemia, fatigue, and disturbed sleep. Our findings indicate that olanzapine was effective and safe for treating chemotherapy-induced nausea and vomiting in children. A prospective controlled study is needed to confirm these findings.
      Citation: Children
      PubDate: 2020-09-16
      DOI: 10.3390/children7090140
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 141: Comparison of Blood Pressure and Kidney
           Markers between Adolescent Former Preterm Infants and Term Controls

    • Authors: Eveline Staub, Natalie Urfer-Maurer, Sakari Lemola, Lorenz Risch, Katrina S. Evers, Tatjana Welzel, Marc Pfister
      First page: 141
      Abstract: Background: Preterm infants are at an increased risk of developing hypertension and chronic kidney disease later in life. No recommendations exist for blood pressure (BP) and renal follow up for these patients. Aim: To compare BP and serum and urinary kidney markers between preterm-born adolescents and term-born controls. Methods: BP measurements in 51 preterm-born (≤32 weeks gestational age) and 82 term-born adolescents at the age of 10–15 years were conducted. Stepwise regression analysis explored the association between BP and participant characteristics. Kidney markers measured in the serum and urine were creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and uromodulin. Kidney markers measured in the serum were cystatin C, beta-2 microglobulin, and beta trace protein. Results: Systolic BP was significantly higher in preterm boys compared with term boys, but not in girls, and low birth weight was associated with higher BP in boys. In the preterm group, maternal hypertension/preeclampsia and adolescent height were associated with higher systolic BP. Serum creatinine and NGAL were significantly higher in the preterm group. Conclusions: Our study confirms an inverse sex-dependant relationship between birth weight and BP at adolescent age. The higher serum creatinine and NGAL in the preterm group may indicate that premature birth affects kidney function in the long term.
      Citation: Children
      PubDate: 2020-09-17
      DOI: 10.3390/children7090141
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 142: Changes in Ankle Range of Motion, Gait
           Function and Standing Balance in Children with Bilateral Spastic Cerebral
           Palsy after Ankle Mobilization by Manual Therapy

    • Authors: Pong Sub Youn, Kyun Hee Cho, Shin Jun Park
      First page: 142
      Abstract: The aim of this study was to investigate the effect of ankle joint mobilization in children with cerebral palsy (CP) to ankle range of motion (ROM), gait, and standing balance. We recruited 32 children (spastic diplegia) diagnosed with CP and categorized them in two groups: the ankle joint mobilization (n = 16) group and sham joint mobilization (n = 16) group. Thus, following a six-week ankle joint mobilization, we examined measures such as passive ROM in ankle dorsiflexion in the sitting and supine position, center of pressure (COP) displacements (sway length, area) with eyes open (EO) and closed (EC), and a gait function test (timed up and go test (TUG) and 10-m walk test). The dorsiflexion ROM, TUG, and 10-m walk test significantly increased in the mobilization group compared to the control group. Ankle joint mobilization can be regarded as a promising method to increase dorsiflexion and improve gait in CP-suffering children.
      Citation: Children
      PubDate: 2020-09-18
      DOI: 10.3390/children7090142
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 143: Elementary Classroom Teachers’
           Self-Reported Use of Movement Integration Products and Perceived
           Facilitators and Barriers Related to Product Use

    • Authors: Roddrick Dugger, Aaron Rafferty, Ethan Hunt, Michael Beets, Collin Webster, Brian Chen, Jeff Rehling, Robert Glenn Weaver
      First page: 143
      Abstract: Movement integration (MI) products are designed to provide children with physical activity during general education classroom time. The purpose of this study was to examine elementary classroom teachers’ self-reported use of MI products and subsequent perceptions of the facilitators of and barriers to MI product use. This study utilized a mixed-methods design. Elementary classroom teachers (n = 40) at four schools each tested four of six common MI products in their classroom for one week. Teachers completed a daily diary, documenting duration and frequency of product use. Following each product test, focus groups were conducted with teachers to assess facilitators and barriers. MI product use lasted for 11.2 (Standard Deviation (SD) = 7.5) min/occasion and MI products were used 4.1 (SD = 3.5) times/week on average. Activity Bursts in the Classroom for Fitness, GoNoodle, and Physical Activity Across the Curriculum were most frequently used. Facilitators of and barriers to MI product use were identified within three central areas—logistics, alignment with teaching goals, and student needs and interests. Teachers were receptive to MI products and used them frequently throughout the week. When considering the adoption of MI products, teachers, administrators, and policy makers should consider products that are readily usable, align with teaching goals, and are consistent with student needs and interests.
      Citation: Children
      PubDate: 2020-09-18
      DOI: 10.3390/children7090143
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 144: Identification of Missense ADGRV1 Mutation as
           a Candidate Genetic Cause of Familial Febrile Seizure 4

    • Authors: Ji Yoon Han, Hyun Joo Lee, Young-Mock Lee, Joonhong Park
      First page: 144
      Abstract: Febrile seizure (FS) is related to a febrile illness (temperature > 38 °C) not caused by an infection of central nervous system, without neurologic deficits in children aged 6–60 months. The family study implied a polygenic model in the families of proband(s) with single FS, however in families with repeated FS, inheritance was matched to autosomal dominance with reduced disease penetrance. A 20 month-old girl showed recurrent FS and afebrile seizures without developmental delay or intellectual disability. The seizures disappeared after 60 months without anti-seizure medication. The 35 year-old proband’s mother also experienced five episodes of simple FS and two episodes of unprovoked seizures before 5 years old. Targeted exome sequencing was conducted along with epilepsy/seizure-associated gene-filtering to identify the candidate causative mutation. As a result, a heterozygous c.2039A>G of the ADGRV1 gene leading to a codon change of aspartic acid to glycine at the position 680 (rs547076322) was identified. This protein’s glycine residue is highly conserved, and its allele frequency is 0.00002827 in the gnomAD population database. ADGRV1 mutation may have an influential role in the occurrence of genetic epilepsies, especially those with febrile and afebrile seizures. Further investigation of ADGRV1 mutations is needed to prove that it is a significant susceptible gene for febrile and/or afebrile seizures in early childhood.
      Citation: Children
      PubDate: 2020-09-18
      DOI: 10.3390/children7090144
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 145: Parental Attitudes toward Artificial
           Intelligence-Driven Precision Medicine Technologies in Pediatric

    • Authors: Bryan A. Sisk, Alison L. Antes, Sara Burrous, James M. DuBois
      First page: 145
      Abstract: Precision medicine relies upon artificial intelligence (AI)-driven technologies that raise ethical and practical concerns. In this study, we developed and validated a measure of parental openness and concerns with AI-driven technologies in their child’s healthcare. In this cross-sectional survey, we enrolled parents of children <18 years in 2 rounds for exploratory (n = 418) and confirmatory (n = 386) factor analysis. We developed a 12-item measure of parental openness to AI-driven technologies, and a 33-item measure identifying concerns that parents found important when considering these technologies. We also evaluated associations between openness and attitudes, beliefs, personality traits, and demographics. Parents (N = 804) reported mean openness to AI-driven technologies of M = 3.4/5, SD = 0.9. We identified seven concerns that parents considered important when evaluating these technologies: quality/accuracy, privacy, shared decision making, convenience, cost, human element of care, and social justice. In multivariable linear regression, parental openness was positively associated with quality (beta = 0.23), convenience (beta = 0.16), and cost (beta = 0.11), as well as faith in technology (beta = 0.23) and trust in health information systems (beta = 0.12). Parental openness was negatively associated with the perceived importance of shared decision making (beta = −0.16) and being female (beta = −0.12). Developers might support parental openness by addressing these concerns during the development and implementation of novel AI-driven technologies.
      Citation: Children
      PubDate: 2020-09-20
      DOI: 10.3390/children7090145
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 146: Pain Symptomatology and Management in
           Pediatric Ehlers–Danlos Syndrome: A Review

    • Authors: Estée C. H. Feldman, Daniel P. Hivick, P. Maxwell Slepian, Susan T. Tran, Pradeep Chopra, Rachel Neff Greenley
      First page: 146
      Abstract: Ehlers–Danlos syndromes (EDS) are a group of connective tissue disorders that manifest with hyperextensibility of joints and skin, and general tissue fragility. While not a major criterion for clinical diagnosis, pain is a frequently endorsed symptom across subtypes of EDS. As such, the present review aims to summarize research to date on pain characteristics and management, and the relationship between such pain symptomatology and quality of life in pediatric EDS. Characteristics of pain, including theorized etiology, relative intensity and extent of pain are described, as well as descriptions of frequently endorsed pain sites (musculoskeletal, and non-musculoskeletal). Interventions related to the management of musculoskeletal (e.g., pharmaceutical intervention, physical therapy) and non-musculoskeletal pain (e.g., pharmaceutical and psychological interventions) are discussed, highlighting the need for additional research related to pediatric pain management in the context of hypermobility syndromes. In addition, the relationship between pain in pediatric EDS and quality of life is described. Finally, limitations of literature to date are described and recommendations for future lines of research are outlined.
      Citation: Children
      PubDate: 2020-09-21
      DOI: 10.3390/children7090146
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 147: Association between Exercise-Induced Changes
           in Cardiorespiratory Fitness and Adiposity among Overweight and Obese
           Youth: A Meta-Analysis and Meta-Regression Analysis

    • Authors: Antonio García-Hermoso, Mikel Izquierdo, Alicia M. Alonso-Martínez, Avery Faigenbaum, Jordi Olloquequi, Robinson Ramírez-Vélez
      First page: 147
      Abstract: The aim of this study was to determine the minimum change in cardiorespiratory fitness (CRF) required to reduce adiposity (percent body fat) in exercise programs for overweight and obese youth. Studies were identified through a systematic search of five databases. Studies were limited to randomized controlled trials (RCTs) of exercise training (e.g., aerobic, strength, concurrent) that assessed percent body fat and CRF for both exercise and control groups in overweight and obese children and adolescents. A series of meta-regressions were conducted to explore links between change in CRF (maximum oxygen consumption, ml/kg/min) and change in percent body fat. Twenty-three RCTs were included (n = 1790, 59% females). Meta-regression analysis suggested that increases of at least 0.38 mL/kg/min in CRF (p < 0.001) were considered to be a clinically important reduction of percent body fat (−2.30%, 95% confidence interval −3.02 to −1.58; p < 0.001; I2 = 92.2%). Subgroup analysis showed that increases of at least 0.17 mL/kg/min in CRF favored a reduction of percent body fat of −1.62% (95% confidence interval −2.04 to −1.20; p < 0.001; I2 = 69.9%). In conclusion, this change in CRF could be considered by pediatric researchers, youth fitness specialists, and health care providers to determine the effectiveness in body fat reductions through exercise.
      Citation: Children
      PubDate: 2020-09-21
      DOI: 10.3390/children7090147
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 148: Effects of Social Media and Smartphone Use on
           Body Esteem in Female Adolescents: Testing a Cognitive and Affective Model

    • Authors: Hwajin Yang, Joy Jiaqi Wang, Germaine Y. Q. Tng, Sujin Yang
      First page: 148
      Abstract: We examined the predictive relations of social media and smartphone use to body esteem in female adolescents and the mechanism that underlies these relations. As a result of frequent social media and smartphone use, adolescents are continually exposed to appearance-related media content. This likely reinforces a thin ideal and fosters appearance-based comparison and increases fear of external evaluation. Hence, we investigated a cognitive-affective framework in which the associations of social media and smartphone use with body esteem are serially mediated by cognitive internalization of an ideal body image, appearance comparisons, and social appearance anxiety. By testing female adolescents (N = 100) aged 13 to 18, we found that excessive social media use leads to unhealthy body esteem via intensified cognitive internalization, which aggravates appearance comparisons and anxiety regarding negative appearance evaluation. Further, we found that screen time for specific smartphone activities also harmed body esteem, independent of social media use. However, overall smartphone screen time did not affect body esteem when social media use was taken into consideration. Our findings underscore the multifactor mechanism that elucidates the negative impacts of social media and smartphone activities on body esteem in female adolescents, who are developmentally susceptible to poor body esteem.
      Citation: Children
      PubDate: 2020-09-21
      DOI: 10.3390/children7090148
      Issue No: Vol. 7, No. 9 (2020)
  • Children, Vol. 7, Pages 94: Robotic Stereotactic Assistance (ROSA) for
           Pediatric Epilepsy: A Single-Center Experience of 23 Consecutive Cases

    • Authors: Jonathon H. Nelson, Samantha L. Brackett, Chima O. Oluigbo, Srijaya K. Reddy
      First page: 94
      Abstract: Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA®) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the clinical experience, anesthetic and operative management, and treatment outcomes for pediatric patients with intractable epilepsy undergoing ROSA® neurosurgery at a single-center institution. Patients who underwent implantation of stereoelectroencephalography (SEEG) leads for intractable epilepsy with ROSA® were retrospectively evaluated between August 2016 and June 2018. Demographics, perioperative management details, complications, and preliminary seizure outcomes after resective or ablative surgery were reviewed. Nineteen children who underwent 23 ROSA® procedures for SEEG implantation were included in the study. Mean operative time was 148 min. Eleven patients had subsequent resective or ablative surgery, and ROSA® was used to assist with laser probe insertion in five patients for seizure foci ablation. In total, 148 SEEG electrodes were placed without any perioperative complications. ROSA® is minimally invasive, provides superior accuracy for electrode placement, and requires less time than traditional surgical approaches for brain mapping. This emerging technology may improve the perioperative outcomes for pediatric patients with intractable epilepsy since large craniotomies are avoided; however, long-term follow-up studies are needed.
      Citation: Children
      PubDate: 2020-08-07
      DOI: 10.3390/children7080094
      Issue No: Vol. 7, No. 8 (2020)
  • Children, Vol. 7, Pages 95: Physical Fitness Promotion among Adolescents:
           Effects of a Jump Rope-Based Physical Activity Afterschool Program

    • Authors: Xiaofeng Yang, Joonyoung Lee, Xiangli Gu, Xiaoxia Zhang, Tao Zhang
      First page: 95
      Abstract: The major purpose of this study was to examine the effects of a jump rope-based physical activity afterschool program on middle school students’ physical fitness. Sixty students (Mage = 13.37, SD = 0.58; 53.3% female) participated in a 12-week jump rope-based afterschool program (45 min/time, three times/week). Participants were randomly assigned to three groups: (a) freestyle rope skipping (N = 20), traditional jump rope (N = 20), and a control group (N = 20). Physical fitness tests, including muscular strength (standing long jump, right-hand grip, and left-hand grip), flexibility, body composition, and bone mineral density (BMD) were measured in pre- and post-tests. A 2 (time) × 3 (groups) repeated measure multivariate analysis of variance (MANOVA) was performed. The results found significant improvements in muscular strength (standing long jump, right-hand grip, and left-hand grip) in both intervention groups (p < 0.001; ds = 0.2–0.44). Only the freestyle rope skipping group had increased BMD (p < 0.05, d = 0.33). Compared to the traditional jump rope, the freestyle rope skipping group showed significantly higher improvement in flexibility (p < 0.05, d = 0.83). These findings suggest that the jump rope-based afterschool program with freestyle rope skipping would be more effective than traditional jump rope to promote physical fitness performance among adolescents.
      Citation: Children
      PubDate: 2020-08-14
      DOI: 10.3390/children7080095
      Issue No: Vol. 7, No. 8 (2020)
  • Children, Vol. 7, Pages 96: The Addition of Intravenous Propofol and
           Ketorolac to a Sevoflurane Anesthetic Lessens Emergence Agitation in
           Children Having Bilateral Myringotomy with Tympanostomy Tube Insertion: A
           Prospective Observational Study

    • Authors: Brandon d’Eon, Thomas Hackmann, A. Stuart Wright
      First page: 96
      Abstract: The aim of this prospective observational study was to determine if children undergoing bilateral myringotomy and tympanostomy tube insertion with a sevoflurane anesthetic plus intravenous propofol and ketorolac experienced a lower incidence of emergence agitation than those receiving a sevoflurane anesthetic alone. Duration of procedure, length of stay in post-anaesthesia care and level of nursing effort required to care for patients were also assessed. In this study, 49 children younger than 13 years of age received a sevoflurane anesthetic. Fifty-one percent of these patients also received a single injection of propofol 1 mg/kg and ketorolac 0.5 mg/kg at the end of the procedure. Patients were assessed for emergence agitation using the Pediatric Anesthesia Emergence Delirium scale in the post-anaesthesia care unit. Four children receiving a sevoflurane anesthetic alone experienced emergence agitation, while no children receiving propofol and ketorolac experienced emergence agitation (p = 0.05). The length of stay until discharge from the hospital was 6.98 min longer for patients receiving propofol and ketorolac but did not reach statistical significance (p = 0.23). Nurses reported greater ease in caring for patients receiving the propofol and ketorolac injection (recovery questionnaire score 4.50 vs. 3.75, p = 0.002). In this study, adding a single injection of intravenous propofol and ketorolac to the end of a brief sevoflurane anesthetic for bilateral myringotomy with tube insertion was associated with a lower incidence of emergence agitation without significantly increasing the time to discharge from the hospital.
      Citation: Children
      PubDate: 2020-08-15
      DOI: 10.3390/children7080096
      Issue No: Vol. 7, No. 8 (2020)
  • Children, Vol. 7, Pages 97: Targeted Therapy for Pulmonary Hypertension in
           Premature Infants

    • Authors: Shannon N. Nees, Erika B. Rosenzweig, Jennifer L. Cohen, Gerson A. Valencia Villeda, Usha S. Krishnan
      First page: 97
      Abstract: Pulmonary hypertension (PH) is common in premature infants with bronchopulmonary dysplasia (BPD) and is associated with significant mortality. Despite expert consensus suggesting the use of targeted therapies such as phosphodiesterase inhibitors, endothelin receptor antagonists, and prostanoids, there is little data on safety and outcomes in infants with BPD-associated PH (BPD-PH) treated with these medications. We sought to describe the pharmacologic management of BPD-PH and to report outcomes at our institution. Premature infants with BPD-PH born between 2005 and 2016 were included. Follow-up data were obtained through January 2020. A total of 101 patients (61 male, 40 female) were included. Of these, 99 (98.0%) patients were treated with sildenafil, 13 (12.9%) with bosentan, 35 (34.7%) with inhaled iloprost, 12 (11.9%) with intravenous epoprostenol, and nine (8.9%) with subcutaneous treprostinil. A total of 33 (32.7%) patients died during the study period and 10 (9.9%) were secondary to severe to pulmonary hypertension. Of the surviving patients, 57 (83.8%) had follow-up data at a median of 5.1 (range 0.38–12.65) years and 44 (77.2%) were weaned off PH medications at a median 2.0 (range 0–8) years. Mortality for BPD-PH remains high mostly due to co-morbid conditions. However, for those patients that survive to discharge, PH therapies can frequently be discontinued in the first few years of life.
      Citation: Children
      PubDate: 2020-08-15
      DOI: 10.3390/children7080097
      Issue No: Vol. 7, No. 8 (2020)
  • Children, Vol. 7, Pages 98: Motor Performance in Children Diagnosed with
           Cancer: A Longitudinal Observational Study

    • Authors: Lotta Hamari, Päivi M. Lähteenmäki, Heidi Pukkila, Mikko Arola, Anna Axelin, Sanna Salanterä, Liisa S. Järvelä
      First page: 98
      Abstract: Children with cancer are dealing with different side and long-term effects caused by cancer and its treatments, like vinca-alkaloids, which may have negative effects on motor performance. However, the affected areas of motor performance (aiming and catching, balance, manual dexterity) and the differences in these areas between boys and girls and diagnoses are not frequently reported in a longitudinal design. Therefore, the aim of this study was to investigate how motor performance changes over the course of cancer treatment. The study was conducted with 3-to 16-year-old children with cancer (N = 36) in 2013–2017. The five assessment points were 0, 2, 6, 12 and 30 months from diagnosis. Movement-ABC2 was used to assess motor performance. We found that aiming and catching skills decreased significantly during the follow-up (p < 0.05). Balance was affected at the 2-month measurement point (p < 0.05) and more in children with acute lymphoblastic leukemia than in children with other cancer diagnoses (p < 0.05). Girls performed better than boys in manual dexterity at 6, 12 and 30 months (p < 0.05, p < 0.05, p < 0.05, respectively). Individual monitoring of motor performance with standardized tests and physical activity/exercise programs during and after treatment are needed.
      Citation: Children
      PubDate: 2020-08-15
      DOI: 10.3390/children7080098
      Issue No: Vol. 7, No. 8 (2020)
  • Children, Vol. 7, Pages 99: Unique Case of Congenital Duodenal Atresia and
           a Choledochal Cyst and the Hypothesis of Their Embryological Evolution

    • Authors: Brittany Downing, Mohammad Y. Bader, Frank P. Morello, Ranjit I. Kylat
      First page: 99
      Abstract: The concomitant occurrence of duodenal atresia (DA) and a choledochal cyst (CC) has rarely been reported. Knowledge of both the presentation and management of this rare co-occurrence is imperative in avoiding potential complications and sequelae, such as biliary metaplasia. Herein we describe a female infant born at 32 weeks gestational age who was diagnosed with duodenal atresia and annular pancreas postnatally, who had subsequent findings of malrotation and a choledochal cyst, as seen from contrast imaging. Uncomplicated repair of the DA and obstruction was performed at 4 days of life. She re-presented 2 years later with non-bloody, nonbilious emesis and was found to have elevated amylase, lipase and liver enzymes. Imaging revealed dilated intra-hepatic ducts, a distended gallbladder and a large choledochal cyst. She underwent a cholecystostomy tube placement followed by a definitive choledochal cyst excision with immediate improvement following surgery and full resolution of symptoms before discharge.
      Citation: Children
      PubDate: 2020-08-18
      DOI: 10.3390/children7080099
      Issue No: Vol. 7, No. 8 (2020)
  • Children, Vol. 7, Pages 100: Signaling Pathways Involved in the
           Development of Bronchopulmonary Dysplasia and Pulmonary Hypertension

    • Authors: Rajamma Mathew
      First page: 100
      Abstract: The alveolar and vascular developmental arrest in the premature infants poses a major problem in the management of these infants. Although, with the current management, the survival rate has improved in these infants, but bronchopulmonary dysplasia (BPD) is a serious complication associated with a high mortality rate. During the neonatal developmental period, these infants are vulnerable to stress. Hypoxia, hyperoxia, and ventilation injury lead to oxidative and inflammatory stress, which induce further damage in the lung alveoli and vasculature. Development of pulmonary hypertension (PH) in infants with BPD worsens the prognosis. Despite considerable progress in the management of premature infants, therapy to prevent BPD is not yet available. Animal experiments have shown deregulation of multiple signaling factors such as transforming growth factorβ (TGFβ), connective tissue growth factor (CTGF), fibroblast growth factor 10 (FGF10), vascular endothelial growth factor (VEGF), caveolin-1, wingless & Int-1 (WNT)/β-catenin, and elastin in the pathogenesis of BPD. This article reviews the signaling pathways entailed in the pathogenesis of BPD associated with PH and the possible management.
      Citation: Children
      PubDate: 2020-08-18
      DOI: 10.3390/children7080100
      Issue No: Vol. 7, No. 8 (2020)
  • Children, Vol. 7, Pages 101: Assessment of Parents’ Oral Health Literacy
           and Its Association with Caries Experience of Their Preschool Children

    • Authors: Abdul Habeeb Adil, Sumaiya Zabin Eusufzai, Aimi Kamruddin, Wan Muhamad Amir Wan Ahmad, Nafij Bin Jamayet, Mohmed Isaqali Karobari, Mohammad Khursheed Alam
      First page: 101
      Abstract: (1) Purpose: To assess the oral health literacy (OHL) of parents and its association with the caries experience of their preschool children attending the Hospital University Sains Malaysia (HUSM), Kota Bharu, Kelantan, Malaysia. (2) Materials and Methods: This is a descriptive cross-sectional study involving a systematic random sampling method, using a sample of 230 parent/preschool child dyads. Among 230 parents, 24 were males and 206 were females (mean age 31.43 ± 5.82); among 230 children, 92 were boys and 138 were girls (mean age 4.82 ± 1.04) attending the pedodontics clinic, HUSM, who participated and met the inclusion criteria. A structured, self-administered oral health literacy questionnaire including sociodemographic factors was used in this study. A child’s oral examination was performed to check the dmft (decayed, missing, filled teeth) status. Statistical analysis was done using descriptive and Spearman’s correlation analysis and multivariate regression analysis. (3) Results: The mean dmft score of children in relation to the OHL level of parents showed a significant difference (p < 0.00). The mean dmft score of children in relation to the OHL level of parents showed the following relationships: Inadequate (7.49 ± 4.10) followed by marginal (3.28 ± 2.67) and then adequate (0.55 ± 1.55). The incidence of caries amongst children in relation to parental employment was more associated with unemployed parents (6.11 ± 4.43) than with employed parents (2.79 ± 3.65). The caries experience amongst children in relation to education of their parents revealed a significant difference (p < 0.001), and the mean dmft score was high amongst preschool children with primary school qualified parents (10.7 ± 4.10) followed by high school (7.04 ± 3.68), vocational (5.81 ± 3.57), diploma (2.61 ± 2.81), and university (1.29 ± 2.27), respectively. The results revealed a valid significant difference (negative correlation, rs = −0.753 **) between the OHL of parents with the dmft score of their preschool children. The age and gender of parents was not significantly associated with OHL, whereas ethnicity (positive correlation, rs = 0.283 **), education (positive correlation, rs = 0.865 **), and employment (negative correlation, rs = −0.490 **) were found to be significant. Conclusion: We conclude that there is a significant association between the OHL of parents with the dmft score of their preschool children. The logistic regression showed that after adjustment for sociodemographic factors, parents’ gender (OR = 0.067, 95% CI: 0.012–0.360), parents’ employment status (OR = 3.247, 95% CI: 0.897–11.754), parents’ OHL score (OR = 0.042, 95% CI: 0.016–0.114), and child age (OR = 2.195, 95% CI: 1.249–3.857) were significantly associated with dental caries in children. Our study concluded that parents’ employment status, age, gender, OHL, and child’s age were significantly associated with the caries experience of their preschool children.
      Citation: Children
      PubDate: 2020-08-18
      DOI: 10.3390/children7080101
      Issue No: Vol. 7, No. 8 (2020)
  • Children, Vol. 7, Pages 102: Serious Illness Conversations in Pediatrics:
           A Case Review

    • Authors: Camara van Breemen, Jennifer Johnston, Matthew Carwana, Peter Louie
      First page: 102
      Abstract: The Serious Illness Conversation Guide program developed by Ariadne Labs, a Joint Center for Health Systems Innovation, includes a list of patient-centered questions designed to assist clinicians to gain a more thorough understanding of their patient’s life in order to inform future care decisions. In July 2017, specialist pediatric palliative care clinicians at Canuck Place Children’s Hospice (CPCH) (Vancouver, BC, Canada), adapted the original guide to use with parents of children with serious illness. This tool is referred to as the Serious Illness Conversation Guide-Peds (SICG-Peds). Using the SICG-Peds, along with enhanced communication skills, can help illuminate the parents’ (child’s) understanding of illness and the values they hold. Expanding the application of the guide will promote goal-based, efficient, comprehensive and consistent communication between families and clinicians and help ensure that seriously ill children receive care that is tailored to their needs through the disease trajectory. This paper explores the guide through the lens of a case study. The steps—seeking permission, assessing understanding, sharing prognosis and exploring key topics (hopes, fears, strengths, critical abilities and trade-offs)—as well as formulating clinician recommendations, are described.
      Citation: Children
      PubDate: 2020-08-18
      DOI: 10.3390/children7080102
      Issue No: Vol. 7, No. 8 (2020)
  • Children, Vol. 7, Pages 149: The Utility of Gait Deviation Index (GDI) and
           Gait Variability Index (GVI) in Detecting Gait Changes in Spastic
           Hemiplegic Cerebral Palsy Children Using Ankle–Foot Orthoses (AFO)

    • Authors: Majewska Joanna, Szczepanik Magdalena, Bazarnik-Mucha Katarzyna, Szymczyk Daniel, Lenart-Domka Ewa
      First page: 149
      Abstract: Background: Cerebral palsy (CP) children present complex and heterogeneous motor disorders that cause gait deviations. Clinical gait analysis (CGA) is used to identify, understand and support the management of gait deviations in CP. Children with CP often use ankle–foot orthosis (AFO) to facilitate and optimize their walking ability. The aim of this study was to assess whether the gait deviation index (GDI) and the gait variability index (GVI) results can reflect the changes of spatio-temporal and kinematic gait parameters in spastic hemiplegic CP children wearing AFO. Method: The study group consisted of 37 CP children with hemiparesis. All had undergone a comprehensive, instrumented gait analysis while walking, both barefoot and with their AFO, during the same CGA session. Kinematic and spatio-temporal data were collected and GVI and GDI gait indexes were calculated. Results: Significant differences were found between the barefoot condition and the AFO conditions for selected spatio-temporal and kinematic gait parameters. Changes in GVI and GDI were also statistically significant. Conclusions: The use of AFO in hemiplegic CP children caused a statistically significant improvement in spatio-temporal and kinematic gait parameters. It was found that these changes were also reflected by GVI and GDI. These findings might suggest that gait indices, such as GDI and GVI, as clinical outcome measures, may reflect the effects of specific therapeutic interventions in CP children.
      Citation: Children
      PubDate: 2020-09-25
      DOI: 10.3390/children7100149
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 150: Genetic and Environmental Risk Factors for
           Isolated Hemangiomas in Infants

    • Authors: Anna Materna-Kiryluk, Katarzyna Wiśniewska, Barbara Więckowska, Katarzyna Wróblewska-Seniuk, Beata Jaroszewska-Świątek, Ewa Helwich, Anna Latos-Bieleńska
      First page: 150
      Abstract: The goal of this analysis is to identify risk factors for infantile hemangiomas (IH) to better delineate hemangioma predisposition. We analyzed live birth children with isolated cutaneous hemangioma that were reported to the Polish Registry of Congenital Malformations from across Poland between the years 1998 and 2016. Lower birthweight and gestational age were the most significant risk factors associated with IH. We also observed a trend for a higher risk of IH with a lower level of maternal and paternal education. Moreover, mothers with IH have a higher probability of having a child with IH compared to fathers. However, this association is only present when the child is female. Similarly, a higher risk of hemangioma in a female child is found among mothers having relatives of the first degree with IH, compared to fathers with a similar pedigree. Our results suggest the role of exogenous factors in the etiology of IH. The analysis of familial cases suggests a multifactorial model of inheritance. The study indicates that female gender is an important risk factor for the expression of familial IH. Potential interaction of genetic risk factors with exposure to female sex hormones may play a role in the development of IH.
      Citation: Children
      PubDate: 2020-09-25
      DOI: 10.3390/children7100150
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 151: An Evaluation of the Implementation of a UK
           School-Based Running Program

    • Authors: Anna E. Chalkley, Ash C. Routen, Jo P. Harris, Lorraine A. Cale, Trish Gorely, Lauren B. Sherar
      First page: 151
      Abstract: The adoption of school-based running programs has rapidly increased over the last five years in the UK and globally. However, there is currently a lack of information on how these initiatives are implemented, and whether they are generalizable and/or sustainable. This study evaluated the implementation (including reach, fidelity, and dose) of a school-based running program over seven months to inform future delivery. This observational study used a mixed-method, single-group, before-and-after design strengthened by multiple interim measurements to evaluate the implementation of an optional school-based running program. Five state-funded primary schools in Leicestershire, UK, participated, with 17 teachers and 189 (81 boys (47.4%) and 90 girls (52.6%)) Year 5 pupils (aged 9–10 years) from eight classes. During the 2016/2017 academic year, data were collected via several measures (including interviews, focus groups, observations, questionnaires, and teacher implementation logs) at multiple levels (i.e., school and individual) and at multiple time points during implementation. Follow up qualitative data were also collected during 2017/2018. The school-based running program achieved good reach, with 100% of pupils opting to participate at some point during the academic year. All schools implemented the program with good fidelity, although the level of implementation varied between schools and over time. The average number of sessions held per week ranged from 0.94–3.89 with the average distance accumulated per pupil per week ranging from 0.02 to 2.91 kilometers and boys being more likely than girls to be classed as high-level participators. Despite an initial drop off in participation over time, all schools remained engaged in the program and continued to implement it until the end of the school year. Contextual features (e.g., staff capacity and resources) differed between schools and influenced the quality of implementation and the frequency of delivery. The school-based running program is simple, inexpensive, and versatile and can be implemented by schools with relative ease. However, schools are diverse settings, with unique challenges to ongoing delivery. Thus, planned adaptations, specific to each school’s context, are likely necessary to sustain participation in the longer term and should be considered prior to implementation.
      Citation: Children
      PubDate: 2020-09-25
      DOI: 10.3390/children7100151
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 152: Global Dietary Patterns and Functional
           Gastrointestinal Disorders

    • Authors: Cara Hannah Axelrod, Miguel Saps
      First page: 152
      Abstract: Functional Gastrointestinal Disorders (FGIDs) are common. In the United States alone, approximately 25 million Americans are estimated to have at least one FGID. Nonpharmacological treatment options include psychological/behavioral approaches, and dietary interventions that can vary across countries. The aim of this review is to evaluate the available evidence for dietary interventions for the treatment of childhood FGIDs amongst various cultures and regions of the world. This review includes clinical trials of dietary therapies for the treatment of FGIDs in children posted on or before 13 July 2020 in PubMed. Overall, the consensus view suggests that the westernization of diets is linked to the development of FGIDs, and diets low in Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAPs) may reduce abdominal symptoms. However, more work is needed to confirm these findings.
      Citation: Children
      PubDate: 2020-09-27
      DOI: 10.3390/children7100152
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 153: Nebulizer Care and Inhalation Technique in
           Children with Cystic Fibrosis

    • Authors: Argyri Petrocheilou, Athanasios G. Kaditis, Evgenia Troupi, Ioanna Loukou
      First page: 153
      Abstract: Nebulizers are used by the great majority of cystic fibrosis patients for delivery of cornerstone treatments. Inhalation technique and adequate disinfection and maintenance are important for optimizing medication delivery. In this study, inhalation technique and nebulizer disinfection/maintenance were assessed in cystic fibrosis patients by direct observation in clinic and completion of a scoring sheet. A total of 108 patients were recruited. The maximum inhalation technique score was attained by 30.5% and adequate inhalation technique score by 74.08% of patients. The inhalation technique score was best with the vibrating mesh nebulizer (p = 0.038), while patient age and number of nebulized medications did not affect ITS significantly (p > 0.05). Nebulizer disinfection/maintenance score was excellent in only 31.48%. Most families kept the nebulizer clean and used appropriate disinfection method, but only half of them replaced the nebulizer and nebulizer cup at the recommended time intervals. Nebulizer disinfection/maintenance score was positively affected by a number of nebulized medications and negatively by years of equipment use (p = 0.009 and p = 0.001, respectively). Even though inhalation technique and disinfection/maintenance practices were found to be adequate in a large proportion of cases, there is still a need for regular review and education. The type of nebulizer was associated with improved inhalation technique, but more data are required before making specific recommendations.
      Citation: Children
      PubDate: 2020-09-27
      DOI: 10.3390/children7100153
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 154: Gastric Flora in Gastrostomy Fed Children
           with Neurological Impairment on Antacid Medication

    • Authors: Bradley De Souza, Susan E. Richardson, Eyal Cohen, Sanjay Mahant, Yaron Avitzur, Sarah Carsley, Adam Rapoport
      First page: 154
      Abstract: This prospective cohort study aimed to: (1) describe types, concentrations and sensitivity profiles of bacteria found in gastric aspirates of neurologically impaired children; (2) compare flora between outpatients and those admitted with aspiration pneumonia; and (3) examine predictors of bacterial colonization. Gastric aspirates from gastrostomy fed, neurologically impaired children on antacid medication were measured for pH and sent for microbiological testing. The outpatient arm included 26 children at their baseline; the inpatient arm included 31 children with a clinical diagnosis of aspiration pneumonia. Descriptive statistics summarized the ecology and resistance patterns of microbial flora. Predictors of total bacterial colonization were explored with linear regression. High concentrations of potentially pathogenic fecal-type bacteria were detected in 50/57 (88%) gastric aspirates. pH was found to be the only predictor of bacterial growth; children with gastric pH ≥ 4 had significantly higher concentrations of aerobic growth, while those with no bacterial growth had a pH < 4. Further studies to evaluate optimal gastric pH, the role of gastric bacteria in causing aspiration pneumonia, and the optimal empiric therapy for aspiration pneumonia are recommended.
      Citation: Children
      PubDate: 2020-09-29
      DOI: 10.3390/children7100154
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 155: Learning from Wildfire Disaster Experience in
           California NICUs

    • Authors: Amy L. Ma, Ronald S. Cohen, Henry C. Lee
      First page: 155
      Abstract: Wildfires have been affecting California greatly, and vulnerable patients in neonatal intensive care units (NICUs) are not exempt. Our aim was to learn how personnel working in NICUs of California hospitals handled issues of neonatal transfer during wildfire disasters in recent years, with an ultimate goal to share lessons learned with healthcare teams on disaster preparedness. We identified California fires through newspaper articles and the list. We determined which hospitals were affected and contacted members of the healthcare team through connections via the California Perinatal Quality Care Collaborative (CPQCC) database. We audio recorded interviews over phone or remote conferencing software or by written survey. We coded and analyzed transcripts and survey responses. While describing disaster preparedness, equipment (such as bassinets and backpacks), ambulance access/transport and documentation/charting were noted as important and essential. Teamwork, willingness to do other tasks that are not part of typical job descriptions, and unconventional strategies contribute to the success of keeping NICU babies safe when California wildfire strikes. Healthcare teams developed ingenious and surprising ways to evacuate NICU babies.
      Citation: Children
      PubDate: 2020-10-01
      DOI: 10.3390/children7100155
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 156: Perinatal Femoral Fracture: A Ten-Year
           Observational Case Series Study

    • Authors: Vito Pavone, Andrea Vescio, Marco Montemagno, Claudia de Cristo, Ludovico Lucenti, Piero Pavone, Gianluca Testa
      First page: 156
      Abstract: Background: perinatal femoral fractures (PFF) are relative rare birth-related fractures. Among treatment options, Bryant traction reported satisfactory outcomes in PFF of children under 3 years of age. The aim of this study is to assess the risk factors, diagnosis, management, and outcome in the 10-year multicentric experiences of all newborns treated for PFF in Catania city hospitals. Methods: 15,628 children, hospitalized in four neonatal units, were retrospectively reviewed. The following data were collected: gender, birth weight, gestational age, presentation, mode delivery, and fracture type according to AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). In each case, diagnosis was achieved after the clinical examination and X-Ray exam. Each patient underwent Bryant’s skin traction of the affected limb, and was clinically followed for at least two years. Results: eight newborns were included in the study (five males). The average birth weight was 2.656 kg with a gestational age of 37.5 weeks; 4 cases were preterm birth; 5 patients had a cephalic presentation. According to the AO PCCF classification, three fractures were ranked 32-D/4.1 and five were 32-D/5.1. The entire cohort had an excellent outcome. Conclusions: prematurity, low birth weight, and caesarean section could be PFF risk factors. Bryant’s skin traction is an effective option to achieve an excellent outcome.
      Citation: Children
      PubDate: 2020-10-01
      DOI: 10.3390/children7100156
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 157: Participation in Everyday Activities of
           Children with and without Neurodevelopmental Disorders: A Cross-Sectional
           Study in Spain

    • Authors: Nerea Blanco-Martínez, Laura Delgado-Lobete, Rebeca Montes-Montes, Nuria Ruiz-Pérez, Marcos Ruiz-Pérez, Sergio Santos-del-Riego
      First page: 157
      Abstract: Children with neurodevelopmental disorders (NDDs) often report significant difficulties performing activities of daily living (ADLs), which may restrict their daily participation. The aim of this study was to investigate the differences in ADLs participation between children with NDDs and typically developing (TD) children, and to explore the associations between different daily participation contexts. A cross-sectional study was conducted that included twenty children with a medical diagnosis of an NDD and 26 sex- and age-matched TD controls. The daily participation across home, community, school, and instrumental living activities was measured using the Child and Adolescent Scale of Participation (CASP). The results show that children with NDDs engaged in lower participation in all CASP contexts (Δ = 1.7–5.5, p < 0.001) and had a significantly higher prevalence of moderate or severe restricted participation than their TD peers (OR = 23.4, 95% CI = 3.6–154.2, p < 0.001). Additionally, a strong association was found between the different contexts of participation (r = 0.642–0.856). Overall, the children with NDDs experienced significant participation restrictions on their daily activities. This study adds to the growing evidence showing that intervention strategies in this population should adopt a participation-oriented approach.
      Citation: Children
      PubDate: 2020-10-01
      DOI: 10.3390/children7100157
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 158: The Evaluation of Dental Anxiety in Primary
           School Children: A Cross-Sectional Study from Romania

    • Authors: Ramona Vlad, Anca Maria Pop, Peter Olah, Monica Monea
      First page: 158
      Abstract: Current data report that high levels of dental anxiety in children have a negative impact on oral health. The aim of this study was to measure dental anxiety, based on the Abeer Children Dental Anxiety Scale (ACDAS) used as a self-reported measure and to correlate its values with the salivary cortisol levels. The study was conducted in 2019 and included 389 children aged 6–9 years old; evaluation of dental anxiety and saliva sampling were performed. The influence of gender on the presence of dental anxiety was analyzed using Fisher’s exact test, the salivary cortisol level was compared between anxious and non-anxious children and was further correlated with the ACDAS score (p < 0.05). Girls had higher odds of experiencing dental anxiety (odds ratio: 1.533, p = 0.041). Salivary cortisol levels were higher in anxious compared to non-anxious children (median 1.251 vs. 1.091 ng/mL, p < 0.001) and showed a positive moderate correlation with the ACDAS score (r = 0.411, p < 0.001). Children aged 6–9 years have a high prevalence of dental anxiety, with girls being more susceptible to this condition. Salivary cortisol levels are higher in anxious children and correlate positively with the ACDAS score, proving that ACDAS can be used for the detection of dental anxiety.
      Citation: Children
      PubDate: 2020-10-02
      DOI: 10.3390/children7100158
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 159: Prevalence of Rotavirus-Associated Acute
           Gastroenteritis Cases in Early Childhood in Turkey: Meta-Analysis

    • Authors: Mustafa Güzel, Orhan Akpınar, Muhammet Burak Kılıç
      First page: 159
      Abstract: Background: Rotavirus is globally the most common viral pathogen in childhood gastroenteritis. This study aimed to estimate the number of Turkish children suffering from early-childhood gastroenteritis by rotavirus by performing a meta-analysis. Methods: Meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Following the guidelines, primary studies were found reporting the prevalence of rotavirus gastroenteritis in Turkey. We performed a computerized search of published studies in national and international databases from 1990 to 2018. We selected 38 out of 721 studies for our study. Meta-analysis was carried out using R statistical software. The Cochrane Q statistic was calculated to assess the heterogeneity of the study results. Heterogeneity among studies was evaluated using the I2 statistic. Effect-size estimate was reported with 95% confidence interval. Results: On the basis of 38 selected articles, 80,113 children up to five years of age were diagnosed with symptoms of acute gastroenteritis, of whom the stool samples of 13,651 children were positive for rotavirus. The pooled prevalence of rotavirus was 19% in children younger than five years of age with acute gastroenteritis. In terms of seasonal prevalence, the highest prevalence rate was found in winter. Conclusion: This study supports the major prevalence of early-childhood gastroenteritis by rotavirus among Turkish children. Therefore, the decision to adopt immunization programs to prevent rotavirus infection might be helpful in Turkey.
      Citation: Children
      PubDate: 2020-10-02
      DOI: 10.3390/children7100159
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 160: Normal Percentiles for Respiratory Rate in
           Children—Reference Ranges Determined from an Optical Sensor

    • Authors: Anthony Herbert, John Pearn, Stephen Wilson
      First page: 160
      Abstract: (1) Background: Increased respiratory rates (RRs) are described in several medical conditions, including pneumonia, bronchiolitis and asthma. There is variable methodology on how centiles for RR are derived in healthy children. Available age percentiles for RR have been generated using methods that have the potential themselves to alter the rate. (2) Methods: An optical respiratory sensor was used to measure RR. This technique enabled recording in awake children without the artefact of the observer’s presence on the subject’s RR. A cross-sectional sample of healthy children was obtained from maternity wards, childcare centres and schools in Brisbane, Queensland, Australia. (3) Results: RRs were observed in 560 awake and 103 sleeping children of which data from 320 awake and 94 sleeping children were used to develop centile charts for children from birth to 13 years of age. RR is higher when children are awake compared to asleep. There were significant differences between awake and sleeping RR in young children. The awake median RR was 59.3 at birth and 25.4 at 3 years of age. In comparison, the median sleeping RR was 41.4 at birth and 22.0 at 3 years. (4) Conclusions: The centile charts will assist in determining abnormal RRs in children and will contribute to further systematic reviews related to this important vital sign. This is particularly in relation to the data on children aged from 0 to 3 years, where data are presented on both the awake and sleeping state. Many studies in the literature fail to acknowledge the impact of sleep state in young children on RR.
      Citation: Children
      PubDate: 2020-10-02
      DOI: 10.3390/children7100160
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 161: Integrated Strength and Fundamental Movement
           Skill Training in Children: A Pilot Study

    • Authors: Fay Grainger, Alison Innerd, Michael Graham, Matthew Wright
      First page: 161
      Abstract: Competence in fundamental movement skills is essential to enable children to be physically active. We investigated the effect of an integrated fundamental movement skill with a strength training intervention on children’s fundamental movement skills. Seventy-two (53% female) 10- to 11-year-old children from three primary schools assented to take part in this study (87% compliance). Schools were randomly allocated to a control (no intervention; n = 21), fundamental movement skill (FMS) (n = 18) or FMS and strength (FMS+; n = 20) group. Interventions were delivered twice weekly for four weeks, in addition to normal physical education. FMS competence was measured through the Canadian agility and movement skills assessment (CAMSA) (product-process) and through countermovement jump (CMJ) and 40-m sprint tests (product). Improvements were observed in the CAMSA in both FMS (4.6, 95% confidence intervals 2.9 to 6.4 Arbitrary Units (AUs), second-generation p-value (pδ) = 0.03) and FMS+ (3.9, 2.1 to 5.3 AU, pδ = 0.28) with no difference beyond our minimum threshold of 3 AU observed between these intervention groups (pδ = 1). Clear improvements in CMJ were observed in FMS+ relative to the control (25, 18 to 32%, pδ = 0) and FMS groups (15, 6.1 to 24%, pδ = 0). These preliminary data suggest combined FMS and strength training warrants further investigation as a tool to develop fundamental movement skills in children.
      Citation: Children
      PubDate: 2020-10-03
      DOI: 10.3390/children7100161
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 162: Successful Hematopoietic Stem Cell
           Transplantation from a Matched Related Donor with Beta-Thalassemia Minor
           for Severe Aplastic Anemia

    • Authors: Mi Young Jung, Young Tae Lim, Hyunji Lim, Jeong Ok Hah, Jae Min Lee
      First page: 162
      Abstract: The first-line treatment for severe aplastic anemia (SAA) patients is hematopoietic stem cell transplantation (HSCT), with full-matched related donors considered the most suitable. We report a case of SAA in which the patient successfully underwent HSCT from a donor with β-thalassemia minor. The patient in this case underwent HSCT from a human leukocyte antigen (HLA)-matched younger brother with β-thalassemia minor. A 7-year-old girl was referred to our facility following a 6-month history of easy bruising and pallor. Laboratory examinations showed pancytopenia and hypocellular bone marrow with cellularity of <5%. She was diagnosed with acquired SAA, and HLA typing of her family members was performed. Her younger brother was an HLA-matched sibling but had β-thalassemia minor. Since his hemoglobin levels were maintained at 10–11 d/dL, he was considered a suitable HSCT donor. The conditioning regimen included fludarabine, cyclophosphamide, and anti-thymocyte globulin. The CD34+ and CD3+ cell counts were 6.6 × 106/kg and 0.48 × 108/kg, respectively. White blood cell engraftment was evident on day +11. Regimen-associated toxicities, such as anorexia and enteritis, were mild; no infections occurred, and no symptoms of acute graft-versus-host disease (GVHD) were observed. The 30-day follow-up bone marrow examination revealed normocellular marrow with 80%–90% cellularity. Acute or chronic GVHD has not been reported, and good performance status has been observed throughout the 5 years after HSCT. β-thalassemia minor patients can be considered as bone marrow donors for SAA patients.
      Citation: Children
      PubDate: 2020-10-04
      DOI: 10.3390/children7100162
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 163: Language-Related Disparities in Pain
           Management in the Post-Anesthesia Care Unit for Children Undergoing
           Laparoscopic Appendectomy

    • Authors: Anjali A. Dixit, Holly Elser, Catherine L. Chen, Marla Ferschl, Solmaz P. Manuel
      First page: 163
      Abstract: Race and ethnicity are associated with disparities in pain management in children. While low English language proficiency is correlated with minority race/ethnicity in the United States, it is less frequently explored in the study of health disparities. We therefore investigated whether English language proficiency influenced pain management in the post-anesthesia care unit (PACU) in a cohort of children who underwent laparoscopic appendectomy at our pediatric hospital in San Francisco. Our primary exposure was English language proficiency, and our primary outcome was administration of any opioid medication in the PACU. Secondary outcomes included the amount of opioid administered in the PACU and whether any pain score was recorded during the patient’s recovery period. Statistical analysis included adjusting for demographic covariates including race in estimating the effect of language proficiency on these outcomes. In our cohort of 257 pediatric patients, 57 (22.2%) had low English proficiency (LEP). While LEP and English proficient (EP) patients received the same amount of opioid medication intraoperatively, in multivariable analysis, LEP patients had more than double the odds of receiving any opioid in the PACU (OR 2.45, 95% CI 1.22–4.92). LEP patients received more oral morphine equivalents (OME) than EP patients (1.64 OME/kg, CI 0.67–3.84), and they also had almost double the odds of having no pain score recorded during their PACU recovery period (OR 1.93, CI 0.79–4.73), although the precision of these estimates was limited by small sample size. Subgroup analysis showed that children over the age of 5 years, who were presumably more verbal and would therefore undergo verbal pain assessments, had over triple the odds of having no recorded pain score (OR 3.23, CI 1.48–7.06). In summary, English language proficiency may affect the management of children’s pain in the perioperative setting. The etiology of this language-related disparity is likely multifactorial and should be investigated further.
      Citation: Children
      PubDate: 2020-10-04
      DOI: 10.3390/children7100163
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 164: Effect of Scaling Task Constraints on the
           Learning Processes of Under-11 Badminton Players during Match-Play

    • Authors: Enrique Ortega-Toro, Juan Carlos Blanca-Torres, José María Giménez-Egido, Gema Torres-Luque
      First page: 164
      Abstract: Scaling equipment and the playing space according to junior badminton players’ characteristics and needs is a key aspect to design optimal learning environments. The purpose of the study is to analyze the incidence of reducing the court size (from 13.40 m × 5.18 m to 11.88 m × 5.18 m) and net height (from 1.55 m to 1.30 m) for under-11 badminton players on the following technical and tactical variables: (a) service area; (b) stroke effectiveness; (c) kinds of technical strokes; (d) players’ hitting area; (e) shuttle landing area; (f) shuttle flight; and (g) rally length. Twenty-eight badminton players (mean age of players: 9.81 ± 0.93) were selected and played a badminton competition (B) with the current federative rules and a mini-badminton competition (MB) with the altered net height and court dimensions. The results showed that a lower net height and a shorter court would increase the frequency and variability of strokes and play patterns, introducing quantifiable changes considered beneficial for children in their first stages, both in training and competition.
      Citation: Children
      PubDate: 2020-10-04
      DOI: 10.3390/children7100164
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 165: Something Else Going On' Diagnostic
           Uncertainty in Children with Chronic Pain and Their Parents

    • Authors: Vivek Tanna, Lauren C. Heathcote, Marissa S. Heirich, Gillian Rush, Alexandra Neville, Melanie Noel, Joshua W. Pate, Laura E. Simons
      First page: 165
      Abstract: Diagnostic uncertainty, the perceived lack of an accurate explanation of the patient’s health problem, remains relatively unstudied in children. This study examined the prevalence, familial concordance, and correlates of diagnostic uncertainty in children and their parents presenting to a multidisciplinary pain clinic in the United States. One hundred and twenty-six parents and 91 of their children (Mage = 13.93 years, range = 8–18 years) completed a brief three-item measure of diagnostic uncertainty, as well as measures of pain-related distress and functioning. Forty-eight percent of children and 37% of parents believed something else was going on with the child’s pain that doctors had not found out about yet. Across the three items, 66%–77% of children and their parents agreed in their endorsement of diagnostic uncertainty. Parents who believed that something else was going on with their child’s pain had children with higher avoidance of pain-related activities (F = 5.601, p = 0.020) and lower pain willingness (F = 4.782, p = 0.032). Neither parent nor child diagnostic uncertainty was significantly related to the child’s pain-related functioning. Diagnostic uncertainty, particularly in parents, is relevant in the experience of pediatric chronic pain and warrants further investigation as both a risk factor and therapeutic target.
      Citation: Children
      PubDate: 2020-10-04
      DOI: 10.3390/children7100165
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 166: Identifying Downregulation of Autophagy
           Markers in Kawasaki Disease

    • Authors: Fu-Chen Huang, Ying-Hsien Huang, Ho-Chang Kuo, Sung-Chou Li
      First page: 166
      Abstract: Kawasaki disease (KD) is the most common cause of heart disease acquired in childhood. Even if treated with high-dose intravenous immunoglobulin G (IVIG) at the early stage; children are still at risk of developing coronary artery lesions. Accumulating evidence suggests that autophagy is enhanced in various heart diseases. Evaluating the pathogenic role of autophagy in KD and coronary artery lesions (CAL) may aid in identifying a potential therapeutic target for the treatment or prevention of the disease. Blood samples were obtained from 20 children with KD at the onset of disease and 21 days after IVIG therapy. Twenty children with other causes of febrile disease and 20 healthy children were included as controls. Total RNA was extracted from white blood cells; and autophagy-related gene mRNA expression levels were measured using real-time polymerase chain reaction. The patients with KD had downregulated levels of LC3B mRNA (0.50 ± 0.06 vs. 1.67 ± 0.15; p < 0.001), BECN1 mRNA (0.70 ± 0.08 vs. 1.43 ± 0.23; p < 0.05), and ATG16L1 mRNA (0.28 ± 0.04 vs. 0.96 ± 0.16; p < 0.01) compared to the febrile control group. The values of these parameters all increased significantly 21 days after the IVIG therapy as follows: LC3B mRNA (1.77 ± 0.29 vs. 0.50 ± 0.06; p < 0.001), BECN1 mRNA (1.67 ± 0.36 vs. 0.70 ± 0.08; p < 0.05), and ATG16L1 mRNA (2.96 ± 0.43 vs. 0.28 ± 0.04; p < 0.001), while the level of ATG16L1 mRNA persists low in KD patients with CAL. Our results showed the autophagy-related genes expressions in KD and their change after IVIG administration. This suggests that autophagy may have a protective effect on KD.
      Citation: Children
      PubDate: 2020-10-04
      DOI: 10.3390/children7100166
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 167: Headache in Children: Selected Factors of

    • Authors: Joanna Sordyl, Ewa Małecka-Tendera, Beata Sarecka-Hujar, Ilona Kopyta
      First page: 167
      Abstract: Headaches are common complaints in children. The International Classification of Headache Disorders, 3rd edition (beta version), defines more than 280 types of headaches. Primary headaches refer to independent conditions that cause pain and include migraine, tension-type headaches (TTH), and trigeminal autonomic cephalalgias (TACs). Several agents are involved in the pathogenesis of headaches. The factors associated with predisposition to atherosclerosis seem to be particularly important from the clinical point of view. The influence of obesity on the incidence of headaches has been well established. Moreover, idiopathic headaches, especially migraine, are thought to be one of the first signs of disorders in lipid metabolism and atherosclerosis. The risk of migraine increases with increasing obesity in children. Another factor that seems to be involved in both obesity and headaches is the adiponectin level. Recent data also suggest new potential risk factors for atherosclerosis and platelet aggregation such as brain-derived neurotrophic factor (BDNF), sCD40L (soluble CD40 ligand), serpin E1/PAI I (endothelial plasminogen activator inhibitor), and vascular endothelial growth factor (VEGF). However, their role is controversial because the results of clinical studies are often inconsistent. This review presents the current knowledge on the potential markers of atherosclerosis and platelet aggregation, which may be associated with primary headaches.
      Citation: Children
      PubDate: 2020-10-04
      DOI: 10.3390/children7100167
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 168: Randomized Longitudinal Study Comparing Three
           Nasal Respiratory Support Modes to Prevent Intermittent Hypoxia in Very
           Preterm Infants

    • Authors: Maximilian Gross, Anette Poets, Renate Steinfeldt, Michael S. Urschitz, Katrin Böckmann, Bianca Haase, Christian F. Poets
      First page: 168
      Abstract: Nasal continuous positive airway pressure (NCPAP) devices using variable (vf-) and continuous (cf-) flow or synchronized nasal intermittent positive pressure ventilation (s-NIPPV) are used to prevent or treat intermittent hypoxia (IH) in preterm infants. Results concerning which is most effective vary. We aimed to investigate the effect of s-NIPPV and vf-NCPAP compared to cf-NCPAP on the rate of IH episodes. Preterm infants with a gestational age of 24.9–29.7 weeks presenting with IH while being treated with cf-NCPAP were monitored for eight hours, then randomized to eight hours of treatment with vf-NCPAP or s-NIPPV. Data from 16 infants were analyzed. Due to an unexpectedly low sample size, the results were only reported descriptively. No relevant changes in the rate of IH events were detected between cf- vs. vf-NCPAP or between cf-NCPAP vs. s-NIPPV. Although limited by its small sample size, s-NIPPV, vf- and cf-NCPAP seemed to be similarly effective in the treatment of IH in these infants.
      Citation: Children
      PubDate: 2020-10-05
      DOI: 10.3390/children7100168
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 169: Pulmonary Exacerbation of Undiagnosed
           Toxocariasis in Intensively-Treated High-Risk Neuroblastoma Patients

    • Authors: Szymon Janczar, Monika Bulas, Justyna Walenciak, Dobromila Baranska, Marek Ussowicz, Wojciech Młynarski, Beata Zalewska-Szewczyk
      First page: 169
      Abstract: Toxocariasis is one of the most common zoonoses, with high seroprevalence in apparently healthy individuals. Neuroblastoma is an aggressive childhood cancer. The cure rates are improving due to dose-dense chemotherapy, progress in surgical practice, myeloablative therapy with autologous stem cell transplantation, and recently, anti-GD2 immunotherapy. This is associated with a burden of complications, some of which are relatively specific for neuroblastoma treatment. Based on previous reports of Toxocara canis infection in high-risk neuroblastoma patients and cases of pulmonary exacerbation from our center in this disease, we propose that toxocariasis is a specific complication of intensive pediatric cancer treatment and advocate for active surveillance.
      Citation: Children
      PubDate: 2020-10-05
      DOI: 10.3390/children7100169
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 170: Preschool Teachers’ Beliefs towards
           Children with Autism Spectrum Disorder (ASD) in Yemen

    • Authors: Sahar Mohammed Taresh, Nor Aniza Ahmad, Samsilah Roslan, Aini Marina Ma’rof
      First page: 170
      Abstract: It is perplexing that some preschool teachers not only advise parents who have children with autism spectrum disorder (ASD) to go to religious healers, but also attribute such neurological disorders to the curse of the “evil eye” or vaccines. Although it is now the twentieth century, this behavior simply reflects the concerns of over-protective teachers and the cultural misperceptions about the actual definition of ASD. In Yemen, the term “ASD”, with its wide range of symptoms, is still ambiguous among preschool teachers. Thus, in a rather insightful piece for the education community, this study has attempted to look beneath the surface of the beliefs (religious belief–social belief–personal belief) of Yemeni preschool teachers regarding ASD. Based on the data collected from 213 teachers (20–30\31–40-~≥40 age) in the Taiz district, this study found that misconceptions specific to autism spectrum disorder were strongly evidenced among teachers who taught preschoolers. Due to personal ignorance and growing superstitions, these teachers tend to believe the society’s perceptions of ASD, thus resulting in the ignorance of scientific views. However, the mass media can increase this group’s awareness of ASD by continually assessing the inaccurate views on ASD, and correcting them. And by influencing the teachers to take a more conceptual scientific approach in serving their special needs students, furthermore, by informing preschool teachers of children’s rights in normal life in the future through providing children with an optimal chance of development by early intervention.
      Citation: Children
      PubDate: 2020-10-06
      DOI: 10.3390/children7100170
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 171: Non-Contact Video-Based Neonatal Respiratory

    • Authors: Scott L. Rossol, Jeffrey K. Yang, Caroline Toney-Noland, Janine Bergin, Chandan Basavaraju, Pavan Kumar, Henry C. Lee
      First page: 171
      Abstract: Respiratory rate (RR) has been shown to be a reliable predictor of cardio-pulmonary deterioration, but standard RR monitoring methods in the neonatal intensive care units (NICU) with contact leads have been related to iatrogenic complications. Video-based monitoring is a potential non-contact system that could improve patient care. This iterative design study developed a novel algorithm that produced RR from footage analyzed from stable NICU patients in open cribs with corrected gestational ages ranging from 33 to 40 weeks. The final algorithm used a proprietary technique of micromotion and stationarity detection (MSD) to model background noise to be able to amplify and record respiratory motions. We found significant correlation—r equals 0.948 (p value of 0.001)—between MSD and the current hospital standard, electrocardiogram impedance pneumography. Our video-based system showed a bias of negative 1.3 breaths and root mean square error of 6.36 breaths per minute compared to standard continuous monitoring. Further work is needed to evaluate the ability of video-based monitors to observe clinical changes in a larger population of patients over extended periods of time.
      Citation: Children
      PubDate: 2020-10-06
      DOI: 10.3390/children7100171
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 172: Trunk Lateral Flexor Endurance and Body Fat:
           Predictive Risk Factors for Low Back Pain in Child Equestrian Athletes

    • Authors: Antonio Cejudo, Angélica Ginés-Díaz, Olga Rodríguez-Ferrán, Fernando Santonja-Medina, Pilar Sainz de Baranda
      First page: 172
      Abstract: Low back pain (LBP) is the most common overuse musculoskeletal injury suffered by child equestrian athletes (CEA). Despite this, little is known about the risk factors related to LBP in these athletes, and very limited research has been conducted on this topic. This study was designed to investigate predictive risk factors for LBP in CEA. The purposes of this research were to determine whether anthropometric, range of motion (ROM), core endurance and sagittal spinal morphotype measures are risk factors for LBP and to establish a diagnostic cutoff value for those factors associated with LBP. Nineteen CEA between the ages of 12 and 17 years were voluntarily recruited. Potential risk factors evaluated included corporal composition, lower limb ROM, core endurance and sagittal spinal measures. Associations and predictions were calculated between these risk factors and the LBP during the last 12 months. Almost half of the CEA have suffered at least one episode of LBP. Two risk factors and cutoff values were identified as predictors of LBP in CEA: having a high body fat higher than 23% (p = 0.01) and trunk lateral flexor endurance lower to 65 s (p = 0.021), body fat being the strongest predictor.
      Citation: Children
      PubDate: 2020-10-09
      DOI: 10.3390/children7100172
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 173: Good Subjective Outcomes, Stable Knee and
           High Return to Sport after Tibial Eminence Avulsion Fracture in Children

    • Authors: Stefano Stallone, Filippo Selleri, Giovanni Trisolino, Alberto Grassi, Luca Macchiarola, Marina Magnani, Eleonora Olivotto, Stefano Zaffagnini, Stefano Stilli, Fabio Catani
      First page: 173
      Abstract: Avulsion fracture of the tibial spine (TSA) is uncommon in children, although its incidence is increasing with the earlier practice of competitive sport activities. This study aims to report mid to long term outcomes in children who sustained a TSA, with a special focus on a return to sport activities. Skeletally immature patients with a TSA, treated in two orthopedic hospitals, were evaluated for range of motion and knee laxity using KT1000, KiRA and Rolimeter. The pediatric International Knee Documentation Committee score (Pedi-IKDC) and the Hospital for Special Surgery pediatric Functional Activity Brief Scale (Pedi-FABS) questionnaires were recorded during the latest visit. Forty-two children were included. Twenty-six were treated nonoperatively and 16 underwent surgery. At a mean follow-up of 6.9 ± 3.6 years, 36 patients completed the questionnaires and 23 patients were tested with arthrometers. Among them, 96% had normal knee laxity. The Pedi-IKDC score averaged 96.4 ± 5.7 points, while the mean Pedi-FABS was 22.2 ± 5.9 points, without statistically significant differences between groups. Twenty-eight patients (78%) returned to their previous level of sport activity (eight amateur, 13 competitive, seven elite athletes). Eight patients (22%) quit sport, mostly because of re-injury fear. If properly treated, pediatric TSAs achieve a high rate of successful healing, with complete restoration of knee stability and an early return to sport activities.
      Citation: Children
      PubDate: 2020-10-09
      DOI: 10.3390/children7100173
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 174: Dietary Diversity and Nutritional Status of
           Preschool Children in North West Province, South Africa: A Cross Sectional

    • Authors: Perpetua Modjadji, Dineo Molokwane, Patricia Ogechi Ukegbu
      First page: 174
      Abstract: Preschool children consume diets inadequate to meet their macro and micronutrient requirements, which ultimately affect their nutritional status due to lack of dietary diversity. A cross sectional study was conducted to investigate the association between dietary diversity scores (DDS) and the nutritional status of 379 preschool children in North West Province of South Africa. A 24 h qualitative recall by mothers of their children’s food consumption was used to calculate DDS based on 12-foods groups following Food and Agriculture Organization protocols. DDS was calculated by counting each of 12-food groups and classified as low (≤4), medium (5–8) and high (9–12). The weight and height of children were measured and height-for-age (HAZ), weight-for-age (WAZ) and BMI-for-age (BAZ) z-scores were calculated based on 2006 WHO standards. Stunting, underweight and thinness were defined as HAZ, WAZ and BAZ < −2SD, respectively. Linear and logistic regression analyses were used to assess the association between DDS and the nutritional indicators. Mean age for children was 4 ± 0.7 years, and the prevalence of stunting (29%), underweight (13%) and thinness (6%) was observed. Mean DDS was 4.39 ± 1.55 out of 12-food groups, with a prevalence of 61% and 39% for low and medium DDS, respectively. Cereals (100%) accounted for the main food group consumed, while fish and other seafood (17%) were the least consumed. Consumption of a diversified diet was associated with lower odds of being stunted [AOR = 0.25, 95%CI: 0.10 to 0.92] among the four-year olds, while in the unadjusted model, 5-year-olds had lower odds of being underweight [OR = −0.32, 95%CI: −0.57 to 0.07]. The findings of this study reinforce the importance of continued nutrition education of mothers, caregivers and preschool staff on the need to ensure consumption of diverse food sources in order to improve the nutritional status of children. Further studies are recommended on the association of DDS with the nutritional status, and factors associated with low dietary diversity among preschool children.
      Citation: Children
      PubDate: 2020-10-09
      DOI: 10.3390/children7100174
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 175: Psychometric Analyses of the Indian (Hindi)
           Version of the Child Perception Questionnaire (CPQ11–14)

    • Authors: Santosh Kumar Tadakamadla, Garima Mangal, Mir Faeq Ali Quadri, Maryam Nayeem, Jyothi Tadakamadla
      First page: 175
      Abstract: The current research aims to evaluate the reliability and validity of the Hindi Child Perception Questionnaire (CPQ11–14) in a child population of India. A randomly selected sample of children aged 11–14 years (n = 331) and their parents completed the Hindi translation of CPQ11–14 and the Parental-Caregiver Perceptions Questionnaire (P-CPQ), respectively, in this cross-sectional study. Children also provided a self-rating of oral health and were examined for dental caries. Exploratory Factor Analysis (EFA) was conducted to assess the dimensionality of the Hindi-CPQ11–14. Internal consistency and reliability on repeated administration were evaluated. Convergent and divergent validities were determined by estimating correlation coefficients between items and the hypothesised subscales. Concurrent validity was assessed using multiple linear regression analyses. The four factors extracted in EFA had a total variance of 38.5%, comprising 31 items. Cronbach’s alpha for the internal consistency of the overall scale was 0.90; reliability on repeated administration was 0.92. All the Hindi CPQ11–14 items had an item-hypothesised subscale correlation coefficient of ≥0.4, and these were greater than item-other hypothesised subscale correlations, demonstrating good convergent and divergent validities respectively. Hindi-CPQ11–14 was associated with self-ratings of the oral health and overall P-CPQ scores demonstrating good concurrent validity. Hindi-CPQ11–14 showed a factor structure different from the English CPQ11–14 and exhibited good validity and reliability.
      Citation: Children
      PubDate: 2020-10-09
      DOI: 10.3390/children7100175
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 176: Making a Decision between Acute Appendicitis
           and Acute Gastroenteritis

    • Authors: Yi-Ting Lu, Po-Cheng Chen, Ying-Hsien Huang, Fu-Chen Huang
      First page: 176
      Abstract: Acute appendicitis is one of the most common pediatric abdominal emergencies. Early diagnosis is vital for a positive outcome. However, it may initially present with diarrhea and vomiting, mimicking acute gastroenteritis, thus delaying prompt surgery. Differentiating appendicitis from gastroenteritis in a timely manner poses a challenge. Therefore, we aim to investigate the predictors that help distinguish acute appendicitis from acute gastroenteritis. We conducted a retrospective case-control study, evaluating children admitted due to abdominal pain with diarrhea. Subjects were divided into two groups according to the final diagnoses: acute appendicitis and acute gastroenteritis. We adopted multiple logistic regression analysis and the area under the receiver operating characteristic curve to identify independent predictors of acute appendicitis and select the best model. A total of 32 patients diagnosed with appendicitis and 82 patients with gastroenteritis were enrolled. Five independent predictors of acute appendicitis included vomiting, right lower quadrant (RLQ) pain, stool occult blood (OB), white blood cell (WBC) count, and C-reactive protein (CRP). The revised combined model exhibited a higher degree of discrimination and outperformed the pediatric appendicitis score (PAS) model. In conclusion, our study was proved to be helpful for assessing cases with abdominal pain and diarrhea in order to more accurately distinguish appendicitis from gastroenteritis in children in a timely manner.
      Citation: Children
      PubDate: 2020-10-11
      DOI: 10.3390/children7100176
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 177: Building the First Statewide Quality
           Improvement Collaborative, the CPQCC: A Historic Perspective

    • Authors: Jeffrey B. Gould
      First page: 177
      Abstract: The California Perinatal Quality Improvement Collaborative (CPQCC), founded in 1997, was the country’s first statewide perinatal quality improvement collaborative. Our goal was to improve the quality and outcomes of perinatal healthcare in California by developing a collaborative network of public and private obstetric and neonatal providers, insurers, public health professionals, and business groups to support a system for benchmarking and performance improvement activities for perinatal care. In this presentation, we describe how viewing the CPQCC as a complex value-driven organization, committed to identifying and addressing the needs of both its stakeholder partners and neonatal intensive care unit (NICU) members, has shaped the course of its development.
      Citation: Children
      PubDate: 2020-10-12
      DOI: 10.3390/children7100177
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 178: Tracking Children’s Physical Activity
           Patterns across the School Year: A Mixed-Methods Longitudinal Case Study

    • Authors: Irfan Khawaja, Lorayne Woodfield, Peter Collins, Adam Benkwitz, Alan Nevill
      First page: 178
      Abstract: Despite the breadth of health benefits associated with regular physical activity (PA), many children in the UK are not sufficiently active enough to meet health guidelines, and tend to become less active as they mature into and throughout adolescence. Research has indicated that children’s school, home and neighbourhood environments can all significantly influence their opportunities to engage in moderate-to-vigorous physical activity (MVPA). However, less is known about how children’s MVPA patterns within these key environments may change across the school year. The current mixed-methods case study aims to explore this issue by tracking key stage 2 (KS2) and key stage 3 (KS3) children’s MVPA patterns across the school year. Fifty-eight children (29 boys, 29 girls, KS2 = 34, KS3 = 24) wore an integrated global positioning systems (GPS) and heart rate (HR) monitor over four consecutive days in the first term of school (autumn), before these measurements were repeated in the two remaining school terms (winter–summer). A subsample of children (n = 6–8 per group) were invited to take part in one of six focus groups each term to further explore their PA behaviours and identify the barriers and facilitators to PA. The children’s MVPA was significantly lower (p = 0.046) in term 2 (winter/spring term) than during the warmer terms (autumn and summer). All the locations showed reductions in MVPA in term 2, except indoor MVPA, which increased, and MVPA on foot in the neighbourhood, which remained consistent. Focus groups revealed location, friends, and the variety of options to be associated with MVPA, and poor weather, parental permission, and time limitations to be barriers to MVPA. This mixed-methodological, repeated-measures design study highlights differences in the activity patterns and perceptions of children over the school year. Future studies should implement longitudinal, multi-method approaches to gain deeper insight into how children’s PA behaviours differ over time. Consequently, this can inform future health policies promoting children’s PA throughout the year.
      Citation: Children
      PubDate: 2020-10-12
      DOI: 10.3390/children7100178
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 179: Talking to Children and Families about
           Chronic Pain: The Importance of Pain Education—An Introduction for
           Pediatricians and Other Health Care Providers

    • Authors: Helen Koechlin, Cosima Locher, Alice Prchal
      First page: 179
      Abstract: Chronic pain in children and adolescents is a common and debilitating health problem. This narrative review will give a brief overview on what pediatric chronic pain is and what treatment options there are for children and adolescents. The specific emphasis will be on pediatric chronic pain education and communication: this narrative review aims to show how important a good patient–health care provider relationship is—it builds the foundation for successful communication—and how this relationship can be established. In addition, we will present five steps that health care providers can perform to explain pediatric chronic pain to patients and their parents and what to keep in mind in their clinical routine. Our review is intended for pediatricians and other health care providers who treat pediatric patients with chronic pain but might feel uncertain on how to best communicate with them.
      Citation: Children
      PubDate: 2020-10-12
      DOI: 10.3390/children7100179
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 180: How Do We Monitor Oxygenation during the
           Management of PPHN' Alveolar, Arterial, Mixed Venous Oxygen Tension or
           Peripheral Saturation'

    • Authors: Praveen Chandrasekharan, Munmun Rawat, Satyan Lakshminrusimha
      First page: 180
      Abstract: Oxygen is a pulmonary vasodilator and plays an important role in mediating circulatory transition from fetal to postnatal period. Oxygen tension (PO2) in the alveolus (PAO2) and pulmonary artery (PaO2) are the main factors that influence hypoxic pulmonary vasoconstriction (HPV). Inability to achieve adequate pulmonary vasodilation at birth leads to persistent pulmonary hypertension of the newborn (PPHN). Supplemental oxygen therapy is the mainstay of PPHN management. However, optimal monitoring and targeting of oxygenation to achieve low pulmonary vascular resistance (PVR) and optimizing oxygen delivery to vital organs remains unknown. Noninvasive pulse oximetry measures peripheral saturations (SpO2) and a target range of 91–95% are recommended during acute PPHN management. However, for a given SpO2, there is wide variability in arterial PaO2, especially with variations in hemoglobin type (HbF or HbA due to transfusions), pH and body temperature. This review evaluates the role of alveolar, preductal, postductal, mixed venous PO2, and SpO2 in the management of PPHN. Translational and clinical studies suggest maintaining a PaO2 of 50–80 mmHg decreases PVR and augments pulmonary vasodilator management. Nevertheless, there are no randomized clinical trials evaluating outcomes in PPHN targeting SpO2 or PO2. Also, most critically ill patients have umbilical arterial catheters and postductal PaO2 may not be an accurate assessment of oxygen delivery to vital organs or factors influencing HPV. The mixed venous oxygen tension from umbilical venous catheter blood gas may assess pulmonary arterial PO2 and potentially predict HPV. It is crucial to conduct randomized controlled studies with different PO2/SpO2 target ranges for the management of PPHN and compare outcomes.
      Citation: Children
      PubDate: 2020-10-13
      DOI: 10.3390/children7100180
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 181: Preliminary Study on the Echo-Assisted
           Intersphincteric Autologous Microfragmented Adipose Tissue Injection to
           Control Fecal Incontinence in Children Operated for Anorectal

    • Authors: Giovanni Parente, Valentina Pinto, Neil Di Salvo, Simone D’Antonio, Michele Libri, Tommaso Gargano, Vincenzo Davide Catania, Giovanni Ruggeri, Mario Lima
      First page: 181
      Abstract: Aim of the study: To assess the efficacy of a novel technique (echo-assisted intersphincteric autologous microfragmented adipose tissue injection, also called “anal-lipofilling”) in the management of non-responsive fecal incontinence in children born with anorectal malformations (ARMs). Methods: Following ethical committee approval (CHPED-MAR-18-02), anal-lipofilling was proposed to patients with fecal incontinence not responsive to medications or bowel management (bowel enema and/or transanal irrigation automatic systems), then a prospective study was conducted. Anal-lipofilling consisted of three phases: lipoaspiration from the abdominal wall, processing of the lipoaspirate with a Lipogems system and intersphincteric injection of the processed fat tissue via endosonographic assistance. A questionnaire based on Krickenbeck’s scale (KS) was administered to the patients to evaluate the clinical outcome. Main Results: Four male patients (three recto-urethral fistula, and one recto-perineal fistula) underwent the anal-lipofilling procedure at a mean age of 13.0 ± 4.2 yrs. There were no complications during or after the procedure. From an initial assessment of the patients there was an improvement in the bowel function at a median follow up of 6 months, with better scores at KS (100% Soiling grade three pre-treatment vs. 75% grade one post-treatment). Conclusions: Even if our Study is preliminary, echo-assisted anal-lipofilling could be considered as a feasible and safe alternative technique in the management of the fecal incontinence in non-responding ARMs patients. More studies are still necessary to support the validity of the implant of autologous adipose tissue in the anal sphincter as a therapy for fecal incontinence in children born with ARMs.
      Citation: Children
      PubDate: 2020-10-13
      DOI: 10.3390/children7100181
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 182: An Autoencoder-Based Deep Learning Classifier
           for Efficient Diagnosis of Autism

    • Authors: Harshini Sewani, Rasha Kashef
      First page: 182
      Abstract: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by a lack of social communication and social interaction. Autism is a mental disorder investigated by social and computational intelligence scientists utilizing advanced technologies such as machine learning models to enhance clinicians’ ability to provide robust diagnosis and prognosis of autism. However, with dynamic changes in autism behaviour patterns, these models’ quality and accuracy have become a great challenge for clinical practitioners. We applied a deep neural network learning on a large brain image dataset obtained from ABIDE (autism brain imaging data exchange) to provide an efficient diagnosis of ASD, especially for children. Our deep learning model combines unsupervised neural network learning, an autoencoder, and supervised deep learning using convolutional neural networks. Our proposed algorithm outperforms individual-based classifiers measured by various validations and assessment measures. Experimental results indicate that the autoencoder combined with the convolution neural networks provides the best performance by achieving 84.05% accuracy and Area under the Curve (AUC) value of 0.78.
      Citation: Children
      PubDate: 2020-10-14
      DOI: 10.3390/children7100182
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 183: Cognitive Assessment and Rehabilitation for
           Pediatric-Onset Multiple Sclerosis: A Scoping Review

    • Authors: Wei-Sheng Lin, Shan-Ju Lin, Ting-Rong Hsu
      First page: 183
      Abstract: Cognitive impairment is increasingly recognized as an important clinical issue in pediatric multiple sclerosis (MS). However, variations regarding its assessment and remediation are noted in clinical arena. This scoping review aims to collate available evidence concerning cognitive assessment tool and cognitive rehabilitation for pediatric MS. We performed a systematic search of electronic databases (MEDLINE, PubMed, CINAHL Plus, and Web of Science) from inception to February 2020. Reference lists of included articles and trial registers were also searched. We included original studies published in English that addressed cognitive assessment tools or cognitive rehabilitation for pediatric-onset MS. Fourteen studies fulfilled our inclusion criteria. Among them, 11 studies evaluated the psychometric aspects of various cognitive assessment tools in the context of pediatric MS, and different neuro-cognitive domains were emphasized across studies. There were only three pilot studies reporting cognitive rehabilitation for pediatric-onset MS, all of which used home-based computerized programs targeting working memory and attention, respectively. Overall, more systematic research on cognitive assessment tools and rehabilitation for pediatric MS is needed to inform evidence-based practice. Computer-assisted cognitive assessment and rehabilitation appear feasible and deserve further studies.
      Citation: Children
      PubDate: 2020-10-15
      DOI: 10.3390/children7100183
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 184: Communicating with Youth about Pain:
           Developmental Considerations

    • Authors: Natacha D. Emerson, Brenda Bursch
      First page: 184
      Abstract: Background: Pain experiences can negatively impact children and adolescents, leading to trauma symptoms and nonadherence to important health behaviors. Developmentally-tailored communication strategies may mitigate this risk. Methods: This article reviews cognitive and linguistic developmental factors, within the familial and cultural context, that are important to consider when communicating with youth about acute, procedural, and/or chronic pain. Results: Youth undergoing acute or procedural pain benefit from pain education, truthful information about the procedure, and advance preparation. The use of analogies may be particularly helpful for patient understanding of chronic pain development, maintenance, and treatment. Youth with developmental disabilities may express pain differently than their normative peers, requiring adaptation of communication strategies. Conclusion: Developmentally-tailored pain communication is an important tool for caregivers and healthcare providers that may foster adaptive functioning in youth who experience pain.
      Citation: Children
      PubDate: 2020-10-15
      DOI: 10.3390/children7100184
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 185: The Impact of Moderate-Dose Acetylsalicylic
           Acid in the Reduction of Inflammatory Cytokine and Prevention of
           Complication in Acute Phase of Kawasaki Disease: The Benefit of
           Moderate-Dose Acetylsalicylic Acid

    • Authors: Jung Eun Kwon, Da Eun Roh, Yeo Hyang Kim
      First page: 185
      Abstract: Background: Acetylsalicylic acid (ASA) is part of the recommended treatment of Kawasaki disease (KD). Controversies remain regarding the optimal dose of ASA. We aimed to evaluate the impact of different doses of ASA on inflammation control while minimizing adverse effects in the acute phase treatment of KD. Methods: The enrolled 323 patients with KD were divided into three groups according to ASA dose: moderate-dose (30–50 mg/kg/day), high-dose (80–100 mg/kg/day), and non-ASA. Results: High-dose ASA group showed a significantly shorter duration of fever from the start of treatment to remission than other groups. Baseline level and delta score of interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor-α, and transforming growth factor β were not statistically different among the groups. The number of patients who received additional treatments in the non-ASA group was more than other groups. Coronary artery dilatation was not significantly different among the groups. One patient with high-dose ASA was diagnosed with Reye syndrome. Conclusion: Different doses of ASA did not show any differences in changes of inflammatory bio-makers and cytokines. However, high-dose ASA showed occurrence of Reye syndrome, and non-ASA showed intravenous immunoglobulin refractoriness. We suggest that moderate-dose ASA may be beneficial for the treatment of patients in the acute phase of KD.
      Citation: Children
      PubDate: 2020-10-16
      DOI: 10.3390/children7100185
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 186: Longitudinal Predictors of Self-Regulation at
           School Entry: Findings from the All Our Families Cohort

    • Authors: Erin Hetherington, Sheila McDonald, Nicole Racine, Suzanne Tough
      First page: 186
      Abstract: Self-regulation is the ability to manage emotions, modulate behaviors, and focus attention. This critical skill begins to develop in infancy, improves substantially in early childhood and continues through adolescence, and has been linked to long-term health and well-being. The objectives of this study were to determine risk factors and moderators associated with the three elements of self-regulation (i.e., inattention, emotional control, or behavioral control) as well as overall self-regulation, among children at age 5. Participants were mother–child dyads from the All Our Families study (n = 1644). Self-regulation was assessed at age 5. Risk factors included income, maternal mental health, child sex, and screen time, and potential moderation by parenting and childcare. Adjusted odds ratios of children being at risk for poor self were estimated using multivariable logistic regression. Twenty-one percent of children had poor self-regulation skills. Risk factors for poor self-regulation included lower income, maternal mental health difficulties, and male sex. Childcare and poor parenting did not moderate these associations and hostile and ineffective parenting was independently associated with poor self-regulation. Excess screen time (>1 h per day) was associated with poor self-regulation. Self-regulation involves a complex and overlapping set of skills and risk factors that operate differently on different elements. Parenting and participation in childcare do not appear to moderate the associations between lower income, maternal mental health, male sex, and screen time with child self-regulation.
      Citation: Children
      PubDate: 2020-10-16
      DOI: 10.3390/children7100186
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 187: Primary Transverse Closure Compared to Open
           Wound Treatment for Primary Pilonidal Sinus Disease in Children

    • Authors: Michèle Pfammatter, Tobias E. Erlanger, Johannes Mayr
      First page: 187
      Abstract: We aimed to compare the outcome of two different operative methods to correct pilonidal sinus disease (PSD) in children, i.e., excision and open wound care (OW) versus excision and primary transverse closure (PC) of the wound. In this retrospective, observational study, we extracted data from the medical records of 56 patients who underwent surgery for PSD at our institution between 1 January 2006 and 31 December 2016. To test whether the primary variable, i.e., rate of PSD recurrence, differed between the two surgical groups, a logistic regression model was fitted. Secondary explanatory variables were total length of stay (LOS) at the hospital, complications, sex and age of patients, seniority of the surgeon in charge, and volume of excised specimen. Overall, 32 (57%) children and young adults underwent OW, while 24 (43%) patients were treated by PC. Mean age at operation was 15.5 years in either group. PSD recurred in 12 of 32 (37.5%) children in the OW group and in 3 of 24 (12.5%) children in the PC group (ratio: 0.19, 95% confidence interval [95% CI] 0.03–1.07). Thus, treatment of primary PSD by PC proved superior with respect to PSD recurrence. Moreover, our study did not bring to light any high-grade complications in the PC group, and postoperative pain was minimal. Less invasive treatment approaches for chronic PSD are typically performed in an outpatient setting and offer reduced morbidity, low rates of PSD recurrence, and shortened periods of time to return to work or social activities. More radical operations of PSD should be reserved for recurrent PSD where less invasive approaches have failed several times.
      Citation: Children
      PubDate: 2020-10-17
      DOI: 10.3390/children7100187
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 188: Parent and Family Functioning in Pediatric
           Inflammatory Bowel Disease

    • Authors: Grace Cushman, Sharon Shih, Bonney Reed
      First page: 188
      Abstract: Although the impact of pediatric inflammatory bowel disease (IBD) extends beyond the patient to their parents and families, the focus of previous literature has largely been on investigating the patient’s medical and psychosocial functioning, with less consideration of the family system. Having a comprehensive understanding of parent and family functioning within the context of pediatric IBD is important given the role parents and family members have in the successful management of the disease and caring of the child. The current review paper aggregates the empirical research regarding parent and family functioning, including comparisons to normative samples, other illness groups, and how functioning relates to child psychosocial and health outcomes. Extant literature on parents and families in pediatric IBD has largely focused on the variables of parenting stress, parent psychosocial functioning, parent quality of life, and family functioning. Summary findings elucidate the complex relationships between parents, families, and children affected by IBD and highlight the importance of assessing parent and family functioning within pediatric IBD. The current review also offers implications for clinical practice, notes the limitations of the present literature, and provides recommendations for future research.
      Citation: Children
      PubDate: 2020-10-17
      DOI: 10.3390/children7100188
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 189: Ultrastructural Changes of Blood Cells in
           Children with Generalized Purulent Peritonitis: A Cross-Sectional and
           Prospective Study

    • Authors: Ulyana Halyuk, Olena Lychkovska, Oksana Mota, Vasyl Kovalyshyn, Natalia Kech, Petro Pokotylo, Olena Trutiak, Bożena Zboina, Grzegorz Józef Nowicki, Barbara Ślusarska
      First page: 189
      Abstract: In conditions of abdominal sepsis with indications of first- or second-stage shock, blood cells undergo significant ultrastructural changes that cause impaired gas exchange, changes in reactivity, and decompensation of organs and systems functions. This paper presents a cross-sectional prospective study aimed at researching the ultrastructure of blood cells in children experiencing abdominal septic shock against the background of generalized purulent peritonitis of appendicular origin. This study was conducted with 15 children aged 6–12 who were undergoing treatment for generalized appendicular purulent peritonitis, with first- or second-stage abdominal septic shock, in emergency care. The changes in the ultrastructure of erythrocytes did not correspond to changes characteristic of eryptosis, which confirms their occurrence under the influence of such pathogenic factors as intoxication, metabolic, water–electrolyte balance, and acid–base disorders. Ultrastructural changes of granulocytes indicate their hyperactivation, which leads to the exhaustion of membrane synthetic resources, membrane destruction, ineffective expenditure of bactericidal factors on substrates that are not subject to destruction. In lymphocytes, disorganization of the nuclear membrane and intracellular membranes, uneven distribution of chromatin, the hypertrophied Golgi apparatus, and a large number of young mitochondria, lysosomes, ribosomes, vesicles manifesting the disruption of metabolism, stress and decompensation of energy supply and protein synthesis systems, have been demonstrated. In conditions of abdominal sepsis with indications of first- or second-stage shock, blood cells undergo substantial ultrastructural changes causing gas exchange disruption, changes in reactivity, as well as decompensation of organs and system functioning.
      Citation: Children
      PubDate: 2020-10-17
      DOI: 10.3390/children7100189
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 190: Neuro-Behavioral Phenotype in 16p11.2
           Duplication: A Case Series

    • Authors: Annio Posar, Paola Visconti
      First page: 190
      Abstract: Duplications of chromosome 16p11.2, even though rare in the general population, are one of the most frequent known genetic causes of autism spectrum disorder and of other neurodevelopmental disorders. However, data about the neuro-behavioral phenotype of these patients are few. We described a sample of children with duplication of chromosome 16p11.2 focusing on the neuro-behavioral phenotype. The five patients reported presented with very heterogeneous conditions as for characteristics and severity, ranging from a learning disorder in a child with normal intelligence quotient to an autism spectrum disorder associated with an intellectual disability. Our case report underlines the wide heterogeneity of the neuropsychiatric phenotypes associated with a duplication of chromosome 16p11.2. Similarly to other copy number variations that are considered pathogenic, the wide variability of phenotype of chromosome 16p11.2 duplication is probably related to additional risk factors, both genetic and not genetic, often difficult to identify and most likely different from case to case.
      Citation: Children
      PubDate: 2020-10-19
      DOI: 10.3390/children7100190
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 191: Attitude towards People with Disability of
           Nursing and Physiotherapy Students

    • Authors: Petronila Oliva Ruiz, Gloria Gonzalez-Medina, Alejandro Salazar Couso, María Jiménez Palomares, Juan Rodríguez Mansilla, Elisa María Garrido Ardila, María Nieves Merchan Vicente
      First page: 191
      Abstract: Background: Attitudes are a component of our behaviour. Health professionals should have a global perspective of disability. They must provide treatment to people with disability and care for them, but they also should accept them with no judgements or discrimination. The general objective of this study was to know the attitude towards people with disability of nursing and physiotherapy students at the University of Cadiz. Methods: This was a descriptive, correlational, transversal and synchronous study. A total of 200 students participated in the study (91 from the bachelor’s degree in nursing and 109 from the bachelor’s degree in physiotherapy). The ‘Attitudes towards people with disability scale’ was used. Results: The mean score for both groups of students was 157.05 (SD = 14.14). Conclusions: Attitudes towards disability of nursing and physiotherapy students at the University of Cadiz tend to be positive. However, this was considered not sufficient since they will be health professionals in the future.
      Citation: Children
      PubDate: 2020-10-20
      DOI: 10.3390/children7100191
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 192: Identification of and Associations among Low,
           Middle, and High Body Composition Trajectories from Age 5- to 17-Years

    • Authors: Teresa A. Marshall, Alexandra M. Curtis, Joseph E. Cavanaugh, John J. Warren, Steven M. Levy
      First page: 192
      Abstract: Our objective was to identify sex-specific age 5- to 17-year body composition (body mass index (BMI), % body fat, fat mass index, fat-free mass index) trajectories, compare trajectories assigned using age 5 (AGE5) data to those assigned using all available (ALL) data, and compare BMI assignments to other body composition assignments. Cluster analysis was used to identify low, medium, and high trajectories from body composition measures obtained from dual energy x-ray absorptiometry (DXA) scans at 5, 9, 11, 13, 15, and 17 years in a birth cohort followed longitudinally (n = 469). Moderate agreement was observed for comparisons between AGE5 data and ALL data cluster assignments for each body composition measure. Agreement between cluster assignments for BMI and other body composition measures was stronger using ALL data than using AGE5 data. Our results suggest that BMI, % body fat, fat mass index, and fat free mass index trajectories are established during early childhood, and that BMI is a reasonable predictor of body composition appropriate to track obesity in public health and clinical settings.
      Citation: Children
      PubDate: 2020-10-20
      DOI: 10.3390/children7100192
      Issue No: Vol. 7, No. 10 (2020)
  • Children, Vol. 7, Pages 193: High Levels of Stress Due to the SARS-CoV-2
           Pandemic among Parents of Children with and without Chronic Conditions
           across the USA

    • Authors: Miranda A.L. van Tilburg, Emily Edlynn, Marina Maddaloni, Klaas van Kempen, Maria Díaz-González de Ferris, Jody Thomas
      First page: 193
      Abstract: Background: The 2020 SARS-CoV-2 pandemic led to community-wide measures affecting parents and children such as school/daycare closures, job losses, and interruptions in medical care for children with chronic diseases. This is the first study to describe the level of stress and mental health of parents of either healthy children or children with chronic conditions, during the 2020 pandemic. Methods: A representative sample of US parents was recruited from 10–17 April 2020. Parents completed online questionnaires about the past 7 days, including the Perceived Stress Scale, Resilient Coping Scale, Self-Efficacy Scale, Kansas Marital Satisfaction Scale, Parental Stress Scale, PROMIS Anxiety and Depression scales and various other pandemic-related stress questions Results: Levels of stressors (e.g., job loss, school closures, etc.) were high during this time (e.g., 79% of children attended home/online school) and parents reported being moderately to highly stressed. Rates of clinical anxiety (44.6%) and depression (42.2%) were high. Parents of children with chronic conditions reported higher levels of stress and worse mental health, but did not differ from other parents in dealing with stress or interruptions in work, child schooling, and marital satisfaction. Discussion: The COVID-19 pandemic has introduced unprecedented levels of stress for parents, especially those of children with chronic conditions. Mental health effects are expected to continue for months/years and preparation is needed to meet an increasing demand for mental health care.
      Citation: Children
      PubDate: 2020-10-21
      DOI: 10.3390/children7100193
      Issue No: Vol. 7, No. 10 (2020)
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