Search Results (34,286)

Background/Objectives: Engaging in physical activity (PA) is crucial for children’s physical and mental health, with PA in childhood influencing lifelong activity levels. However, PA during childhood tends to decrease with age. Childhood friendship networks influence various health behaviors, including physical activity. Centralities are objective measures of an individual’s position and role in friendship networks. The relationship between centrality and PA is inconsistent. This study aimed to determine how centrality affects changes in PA in late childhood longitudinally and to investigate the distribution of centrality in the network. Methods: This prospective cohort study recruited fourth- and fifth-grade children (9–11 years old). A total of 143 children participated. We calculated three centralities—in-degree, closeness, and betweenness—based on social network analysis (SNA). PA was assessed using the physical activity questionnaire for older children (PAQ-C). To explore the relationship between centralities and the percentage change in PA, a multivariate logistic regression analysis was performed. Results: Children with higher closeness had a significantly higher rate of decrease in PA after adjusting for confounding factors. There was no significant association between betweenness and percentage change in PA (p = 0.66) or in-degree and percentage change in PA (p = 0.21). Conclusions: This study highlights the importance of considering social network dynamics in PA interventions, particularly for children with high social closeness. Future research should incorporate objective PA measures and explore broader social networks to enhance intervention strategies, especially for Generation Z and Alpha, who experience unique opportunities and motivations for PA due to pervasive digital environments. Full article

Background/Objectives: Irregular lifestyles, such as sleep deprivation and disordered eating, disrupt the circadian clock and are linked to health issues. This study investigates the relationship among chronotypes, social jet lag, night-snacking habits, and screen time in toddlers. Methods: A survey of 6177 mothers of children aged 3–8 years was conducted in June 2022. Means comparison and multiple regression analyses were used to analyze the data. Results: Toddlers who consumed night snacks were more likely to be evening types and experienced longer social jet lag. Longer screen time during night snacking correlated with evening-type tendencies. Juice and ice cream were identified as evening-type snacks. Conclusions: We suggest that stopping snacks after dinner is crucial to prevent evening-type eating. Especially, high-sugar and high-fat night snacks like juice and ice cream may contribute to nocturnal habits and disrupt circadian rhythms in children. Full article

This study evaluated the level of knowledge among parents in Jazan, Saudi Arabia, regarding substances that can harm child development. The Prevention of Toxic Chemicals in the Environment for Children Tool (PRoTECT) was used for this assessment. A cross-sectional survey using a multi-stage cluster random sampling approach was undertaken among 424 parents who were enlisted from eight primary healthcare centers (PHCCs). The PRoTECT score’s median value was 72 out of 90, suggesting a generally high level of awareness. The study found that individuals with higher education, particularly those with postgraduate degrees, had greater awareness of protecting their children’s health. Interestingly, unemployed individuals and those residing in mountainous areas also demonstrated higher awareness, possibly due to having more time to focus on their children’s health and well-being. Most participants (68.2%) acknowledged the correlation between exposure to toxic chemicals during pregnancy and early childhood, and the subsequent development of neurodevelopmental disorders. The study found a solid foundation of knowledge, with 85.1% of participants interested in learning more about reducing children’s exposure, but it also stressed the need for specific actions to turn awareness into prevention. These findings would help policymakers develop effective strategies, such as targeted educational campaigns, collaboration with healthcare providers, utilization of media channels, and encouragement of community-led initiatives, to reduce children’s exposure to developmental toxicants in line with national and global environmental health initiatives. Future research should focus on longitudinal consciousness and behavior evaluations and regional environmental contaminants. Full article

As the rate of international marriage increases, the adaptation of multicultural families and their children—multicultural adolescents—remains an issue requiring continuous monitoring, support, and improvement. This study investigates the mediating effects of parental support on the relationship between bicultural acceptance attitude and self-esteem among multicultural adolescents. Data are derived from 1197 high school sophomores, all of whom were multicultural adolescents, surveyed by the National Youth Policy Institute in 2018. Descriptive statistics, correlation, and hierarchical regression were used during data analysis. Bicultural acceptance attitude, parental support, and self-esteem all showed mutual positive correlations. Parental support had a partial mediating effect on the relationship between bicultural acceptance attitude and self-esteem. Multicultural adolescents exposed to both parent’s cultures are more likely to develop positive self-esteem and a healthy personality if they receive the support of their parents. The self-esteem of multicultural adolescents can be improved by implementing measures to nurture a bicultural acceptance attitude and parental support. Full article

Intestinal anti-endomysium antibodies are a specific marker of celiac disease. The diagnostic accuracy of this marker seems high in pediatric patients and has not yet been investigated in adults, so the aim of this prospective multicentric study was to evaluate the specificity and sensitivity of this marker in childhood and adulthood. Pediatric and adult patients undergoing intestinal endoscopy for any intestinal condition were enrolled. Serological celiac disease markers and HLA type were evaluated in all patients. Intestinal biopsies were analyzed for standard histology and for intestinal anti-endomysium antibodies with biopsy culture assay. In this study, 291 patients (145 adults and 146 children) were included. In the adult population, 34 were diagnosed with celiac disease, 105 were controls, and, in 6, celiac disease was not confirmed. In the pediatric population, 77 were diagnosed with celiac disease, 57 were controls, and, in 12, celiac disease was not confirmed. High diagnostic sensitivity and specificity of intestinal anti-endomysium antibodies were confirmed in children and additionally proven in adults. To conclude, we can affirm that intestinal anti-endomysium antibodies can be detected with high diagnostic accuracy in both children and adults. The implementation of this marker in the diagnostic work-up would help clinicians to correctly identify celiac disease. Full article

Background: Kawasaki disease (KD) is a pediatric vasculitis, leading to coronary artery aneurysms (CAAs) in ~4–14%. Attention to the etiology and course of KD was generated by the close mimic of a SARS-CoV-2-induced phenotype, called multisystem inflammatory syndrome in children (MIS-C). Methods: A total of 1179 cases were collected from 2012 with ~50% of cases retrospectively included. Clinical characteristics were described and risk factors for CAA (persistence) were investigated. Phenotypic patterns of the prospectively included KD patients were evaluated. These patterns were also compared to the seronegative KD and seropositive MIS-C cases identified during the SARS-CoV-2 pandemic. Results: KD mostly affected boys and children < 5 years. IVIG resistance, CAAs, and giant CAAs occurred in 24.5%, 21.4%, and 6.6%, respectively. Giant CAAs were significantly more likely to normalize to a normal Z score in patients that were younger than 2.5 years old at the time of initial giant CAA (χ² test p = 0.02). In our prospective (SARS-CoV-2-seronegative) KD series, there was a diminishing male predominance over time, whereas the proportions of incomplete presentations (p < 0.001) and patients with circulatory shock (p = 0.04) increased since the COVID-19 pandemic. Pre- and post-pandemic KD cases presented with different levels of C-reactive protein, thrombocyte counts, and hemoglobin levels over the years. Compared to pandemic KD, SARS-CoV-2-seropositive MIS-C patients were older (p < 0.001), and more often required intensive care admission (p < 0.001), with a gradual decrease over time between 2020 and 2022 (p = 0.04). KD carried a substantial risk of CAA development in contrast to MIS-C. Conclusion: the phenotypic changes seen over the last twelve years of our prospective follow-up study suggest a spectrum of hyperinflammatory states with potentially different triggering events within this clinical entity. Full article

Head-to-tail sequences have been reported in human bocavirus (HBoV) 1-4. To reveal their features and functions, HBoV DNA was screened among respiratory specimens from pediatric patients with an acute respiratory infection (ARI) between April 2020 and December 2022, followed by HBoV genotyping. Head-to-tail sequences were detected using nested PCR, TA cloning, and Sanger sequencing, and these findings were confirmed by mNGS and amplicon sequencing. The secondary structure was predicted using the Mfold web server. The results indicated that head-to-tail sequences were detected in 42 specimens through TA cloning from 351 specimens positive for HBoV1 DNA, yielding 92 sequences into 32 types and 2 categories. Additionally, head-to-tail sequences were detected in 16 specimens by amplicon sequencing, yielding 60 sequences categorized into 23 types. The 374nt type, detected in 13 specimens, contains variants 374a and 374b, which differ in the unpaired loop regions of the palindrome or complementary reverse sequences, implying a switch of template chains during the replication process. The mNGS results in three specimens confirmed the presence of circular genome in copies below 1%. In conclusion, head-to-tail sequences of HBoV1 were common in children with ARI and were highly diverse in length and sequences. The variants may be generated by the switch of the template chain in the rolling-circle replication model. Full article

Background and Objectives: Pediatric rhegmatogenous retinal detachment (RRD) represents a challenge for ophthalmologists and vitreoretinal surgeons. In this study, we aim to review the clinical features, and surgical and visual outcomes of pediatric RRD in a tertiary referral center. Materials and Methods: This is a retrospective study using the review of charts for all patients who presented to King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia, from 2005 to 2016. This study included patients 18 years old or younger, had undergone surgical repairs for RRD, and were followed up for 1 year or more. Results: Eighty-nine eyes of 70 children who underwent surgical repair for RRD were included in the current retrospective study. A previous history of intraocular surgeries was present in 31.5%. The majority of cases had known ocular disease or syndromes (n = 58, 65.2%). The majority of eyes which had a primary surgical intervention achieved anatomical success (n = 88). Corneal complications accounted for the majority of complications following primary and secondary surgical interventions. Forty-two percent of the eyes had vision better than 20/200, while thirty-five percent had vision of hand motion or worse. Conclusions: In conclusion, despite the variability in causes of RRD in children, successful anatomical outcomes can be achieved with the proper surgical approach. Visual outcomes are less predictable due to other ocular complications. Full article

This review article aims to summarize current tools used in the diagnosis of adenomyosis with relative pharmacological and surgical treatment and to clarify the relative association between adenomyosis and infertility, considering the importance of an accurate diagnosis of this heterogeneous disease. Among different reported concepts, direction invagination of gland cells from the basalis endometrium deep into the myometrium is the most widely accepted opinion on the development of adenomyosis. Adenomyosis has been increasingly identified in young women with pain, AUB, infertility, or no symptoms by using imaging techniques such as transvaginal ultrasound and magnetic resonance. Furthermore, adenomyosis often coexists with other gynecological conditions, such as endometriosis and uterine fibroids, increasing the heterogeneity of available data. However, there is no agreement on the definition and classification of adenomyotic lesions from both the histopathology and the imaging points of view, and diagnosis remains difficult and unclear. A standard, universally accepted classification system needs to be implemented to improve our understanding and inform precise diagnosis of the type of adenomyosis. This could be the key to designing RCT studies and evaluating the impact of adenomyosis on quality of life in terms of menstrual symptoms, fertility, and pregnancy outcome, given the high risk of miscarriage and obstetric complications. Full article

Purpose: The aim was to analyze the accuracy of digital models and 3D-printed casts from full-arch digital impressions using two intraoral scanners (iTero^TM and Primescan^TM). Materials and methods: A crossover reliability study was designed, scanning children and teenagers with iTero^TM and Primescan^TM. Accuracy was evaluated by measuring intercanine, intermolar, and ipsilateral canine–molar distances intraorally and comparing these measurements with those from plaster casts, digital models obtained with intraoral scanners, and 3D-printed casts. A paired comparison and a general linear model with a one-way repeated measures ANOVA procedure were carried out with a confidence level of 95% (p ≤ 0.05). Results: A total of 51 subjects were analyzed (mean age 12.35 ± 2.57). Statistical differences (p < 0.05) were found in the upper and lower arch regarding accuracy in comparison to intraoral measurements, except for the iTero^TM-printed cast and canine–molar upper right and intercanine lower distances (p > 0.05 for all comparisons). Regarding a comparison between reproduction methods, the plaster cast oversized the intercanine upper distance in comparison with both intraoral scanners’ digital models and the Primescan^TM-printed cast (p = 0.001), but there were no differences in the lower arch (p > 0.05 for all comparisons). Conclusion: Intraoral scanners reproduce tooth structures with similar accuracy to conventional methods. Full article

Background: Urinary tract infections (UTIs) are very common bacterial infections in children. Early detection of renal parenchymal involvement in this setting can help clinicians make more effective treatment choices. The aim of this pilot study was to assess the ability of plasma and urinary neutrophil gelatinase-associated lipocalin (pNGAL and uNGAL) levels, measured using an automated system, to accurately predict renal parenchymal involvement in children with febrile UTIs. Methods: This prospective single-center study included 28 children aged ≥ 4 years with a first episode of febrile UTIs. All patients underwent magnetic resonance imaging. pNGAL, uNGAL, procalcitonin, C-reactive protein (CRP), and white blood cells were measured before antibiotic therapy. Results: The receiver operating characteristic (ROC) area under the curve for predicting acute pyelonephritis was 0.6 for pNGAL, 0.8 for CRP, 0.4 for PCT, and 0.4 for uNGAL. The ROC analyses showed an optimal cutoff of 141.0 ng/mL for pNGAL (sensitivity, 54.2%; specificity, 75.0%; positive predictive value, 92.9%; and negative predictive value, 21.4%). Conclusion: pNGAL and uNGAL did not effectively aid the early prediction of renal parenchymal involvement in children ≥ 4 years with febrile UTIs. The novelties of this study were the use of MRI as the gold standard and an automated biochemical method to measure NGAL. Full article

Aim: The aim of this study was to evaluate corneal cross-linking (CXL) for keratoconus in pediatric patients. Materials and methods: After keratometric qualification according to the Amsler–Krumeich system, corneal collagen cross-linking was performed using ultraviolet light and photosensitizing riboflavin drops in 111 eyes of 74 children with a mean age of 15 ± 1.67 years. None of the children studied wore contact lenses before the procedure. Visual acuity, intraocular pressure, keratometry, and pachymetry parameters were analyzed before and after corneal cross-linking. Results: Visual acuity was 0.64 ± 0.31 and 0.66 ± 0.29 before CXL and at the end of the follow-up, respectively; the difference was not statistically significant. The mean intraocular pressure before CXL was 14.48 ± 3.13 mmHg, while the mean value at the end of the follow-up was 14.23 ± 3.03 mmHg; no statistically significant difference was found. Pre- and post-CXL astigmatism was 3.98 ± 2.34 Dcyl and 3.63 ± 1.86 Dcyl, respectively; the difference was not statistically significant. The mean keratometry before CXL was 47.99 ± 3.96 D; the mean post-follow-up value was 47.74 ± 3.63 D. The mean corneal thickness (pachymetry) at the apex of the keratoconus—the thinnest zone of the cornea—before CXL was 492.16 ± 38.75 µm, while the mean value at the end of the follow-up was 479.99 ± 39.71 µm; the difference was statistically significant. Conclusions: Corneal cross-linking is an effective method for preventing keratoconus progression in children. However, further and detailed ophthalmic follow-up of patients who underwent CXL before the age of 18 is highly advisable. Full article

Objective: Interstitial fibrosis/tubular atrophy (IFTA) is a common, irreversible, and progressive form of chronic kidney allograft injury, and it is considered a critical predictor of kidney allograft outcomes. The extent of IFTA is estimated through a graft biopsy, while a non-invasive test is lacking. The aim of this study was to evaluate the feasibility and accuracy of an MRI radiomic-based machine learning (ML) algorithm to estimate the degree of IFTA in a cohort of transplanted patients. Approach: Patients who underwent MRI and renal biopsy within a 6-month interval from 1 January 2012 to 1 March 2021 were included. Stable MRI sequences were selected, and renal parenchyma, renal cortex and medulla were segmented. After image filtering and pre-processing, we computed radiomic features that were subsequently selected through a LASSO algorithm for their highest correlation with the outcome and lowest intercorrelation. Selected features and relevant patients’ clinical data were used to produce ML algorithms using 70% of the study cases for feature selection, model training and validation with a 10-fold cross-validation, and 30% for model testing. Performances were evaluated using AUC with 95% confidence interval. Main results: A total of 70 coupled tests (63 patients, 35.4% females, mean age 52.2 years) were included and subdivided into a wider cohort of 50 for training and a smaller cohort of 20 for testing. For IFTA ≥ 25%, the AUCs in test cohort were 0.60, 0.59, and 0.54 for radiomic features only, clinical variables only, and a combined radiomic–clinical model, respectively. For IFTA ≥ 50%, the AUCs in training cohort were 0.89, 0.84, and 0.96, and in the test cohort, they were 0.82, 0.83, and 0.86, for radiomic features only, clinical variables only, and the combined radiomic–clinical model, respectively. Significance: An ML-based MRI radiomic algorithm showed promising discrimination capacity for IFTA > 50%, especially when combined with clinical variables. These results need to be confirmed in larger cohorts. Full article

Rehabilitating heritage buildings is a common practice in developed countries. In contrast, developing countries experiencing conflict lack the financial support and qualified experts to restore heritage buildings. This article focuses on the restoration of the al-Khader building in the Gaza Strip, part of a UNESCO project aimed at preserving historical buildings. This study aims to explore the challenges and impacts of the adaptive reuse of the al-Khader building as a children’s library for the local community and to explore the impact of this project on sustainable development and its importance locally, as well as the role of this building restoration and rehabilitation through Quintuple Helix dimensions. Qualitative methodology was used, including field observation and interviews, to present the project stages during restoration in 2016. The interviews were conducted with library users, employees, and visitors to evaluate their experience in 2019. The research revealed that the restoration process faced several challenges, including a lack of experience and professional workers in conservation work. Despite challenges, the building’s transformation positively affected heritage preservation and the local community, aligning with 11 Sustainable Development Goals—directly with 7 goals (SDGs 4, 7, 8, 11, 12, 16, and 17) and indirectly with 4 goals (SDGs 1, 5, 9, and 13). The findings emphasise the role of the library’s rehabilitation in contributing to the success of the Quintuple Helix in economic and civil society systems and the need to enhance the consideration of government, education, and environmental systems. Finally, this project, which external donors funded, increased awareness among local people of the importance of heritage buildings. Unfortunately, due to the ongoing conflict in Gaza, the current status of the building is unknown. This study, therefore, serves as necessary documentation of the building as it was in 2023 and prior. Full article

Congenital diarrhoeas and enteropathies (CODE) are a heterogeneous group of disorders. Many affected infants present with catastrophic dehydration in the first few days of life, although the clinical phenotype is variable. Advances in the understanding of underlying pathomechanisms and genetic testing, as well as improved management, in particular intravenous nutrition support, have allowed affected patients to survive well beyond childhood. Awareness and understanding of these rare diseases are hence needed, both amongst paediatricians and adult physicians. In this review, we discuss the different groups of disorders based on a review of the current literature and provide a diagnostic and therapeutic approach. Many of the subtypes of CODE result in the need for prolonged or indefinite parenteral nutrition. Further research is needed to identify new CODE to improve the recognition and management of these children, which can assist in developing new targeted therapies and potentially a long-term cure. Full article