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Children, Volume 5, Issue 12 (December 2018)

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Cover Story (view full-size image) The majority of parents of youths with chronic pain report parenting challenges and chronic health [...] Read more.
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Open AccessArticle Establishing Raw Acceleration Thresholds to Classify Sedentary and Stationary Behaviour in Children
Children 2018, 5(12), 172; https://doi.org/10.3390/children5120172
Received: 31 October 2018 / Revised: 12 December 2018 / Accepted: 17 December 2018 / Published: 19 December 2018
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Abstract
This study aimed to: (1) compare acceleration output between ActiGraph (AG) hip and wrist monitors and GENEActiv (GA) wrist monitors; (2) identify raw acceleration sedentary and stationary thresholds for the two brands and placements; and (3) validate the thresholds during a free-living period. [...] Read more.
This study aimed to: (1) compare acceleration output between ActiGraph (AG) hip and wrist monitors and GENEActiv (GA) wrist monitors; (2) identify raw acceleration sedentary and stationary thresholds for the two brands and placements; and (3) validate the thresholds during a free-living period. Twenty-seven from 9- to 10-year-old children wore AG accelerometers on the right hip, dominant- and non-dominant wrists, GA accelerometers on both wrists, and an activPAL on the thigh, while completing seven sedentary and light-intensity physical activities, followed by 10 minutes of school recess. In a subsequent study, 21 children wore AG and GA wrist monitors and activPAL for two days of free-living. The main effects of activity and brand and a significant activity × brand × placement interaction were observed (all p < 0.0001). Output from the AG hip was lower than the AG wrist monitors (both p < 0.0001). Receiver operating characteristic (ROC) curves established AG sedentary thresholds of 32.6 mg for the hip, 55.6 mg and 48.1 mg for dominant and non-dominant wrists respectively. GA wrist thresholds were 56.5 mg (dominant) and 51.6 mg (non-dominant). Similar thresholds were observed for stationary behaviours. The AG non-dominant threshold came closest to achieving equivalency with activPAL during free-living. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
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Open AccessArticle Acceptability and Feasibility of Single-Component Primary School Physical Activity Interventions to Inform the AS:Sk Project
Children 2018, 5(12), 171; https://doi.org/10.3390/children5120171
Received: 16 November 2018 / Revised: 11 December 2018 / Accepted: 11 December 2018 / Published: 17 December 2018
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Abstract
Multi-component school-based interventions provide physical activity (PA) opportunities for children but are often difficult for schools to execute and may not be implemented as intended. The primary aim of this study was to explore the acceptability and feasibility of three brief single-component primary [...] Read more.
Multi-component school-based interventions provide physical activity (PA) opportunities for children but are often difficult for schools to execute and may not be implemented as intended. The primary aim of this study was to explore the acceptability and feasibility of three brief single-component primary school PA interventions targeting 9–10-year-old children. The secondary aim was to examine the effectiveness of the interventions on increasing PA levels and reducing sedentary time. The single-component interventions included active classroom breaks (AB; 3 schools; n = 119 children) Born to Move (BTM) exercise videos (2 schools; n = 50 children), and playground supervisory staff training (2 schools; n = 56 children). Qualitative data from participating children (n = 211), class teachers (n = 6), and playground supervisory staff (n = 8) explored the experiences, acceptability, and feasibility of each intervention component. Accelerometers were worn by 225 children during the last week of implementation. Teachers reported that they were able to implement ABs daily, but BTM videos were more difficult to implement daily because of accessing sufficient space. Playground staff reported difficulties in implementing activities due to children’s age and competing responsibilities on the staffs’ time. Children reported that the ABs and BTM videos were enjoyable. During half hour time windows, including the ABs and BTM videos, children engaged in 4.8 min and 8.6 min of moderate to vigorous PA (MVPA) on average, respectively. ABs and BTM videos positively affected MVPA. ABs were feasible to implement; however, teachers faced some barriers in implementing the BTM videos. Feasibility of playground interventions may be dependent on staff responsibilities and age of the children. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
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Open AccessArticle Stakeholder Engagement in Developing an Electronic Clinical Support Tool for Tobacco Prevention in Adolescent Primary Care
Children 2018, 5(12), 170; https://doi.org/10.3390/children5120170
Received: 20 November 2018 / Revised: 10 December 2018 / Accepted: 12 December 2018 / Published: 17 December 2018
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Abstract
Following guideline recommendations to promote tobacco prevention in adolescent primary care, we developed a patient-facing clinical support tool. The electronic tool screens patients for use and susceptibility to conventional and alternative tobacco products, and promotes patient–provider communication. The purpose of this paper is [...] Read more.
Following guideline recommendations to promote tobacco prevention in adolescent primary care, we developed a patient-facing clinical support tool. The electronic tool screens patients for use and susceptibility to conventional and alternative tobacco products, and promotes patient–provider communication. The purpose of this paper is to describe the iterative stakeholder engagement process used in the development of the tool. During the pre-testing phase, we consulted with scientists, methodologists, clinicians, and Citizen Scientists. Throughout the development phase, we engaged providers from three clinics in focus groups. Usability testing was conducted via in-depth, cognitive interviewing of adolescent patients. Citizen Scientists (n = 7) played a critical role in the final selection of educational content and interviewer training by participating in mock-up patient interviews. Cognitive interviews with patients (n = 16) ensured that systems were in place for the feasibility trial and assessed ease of navigation. Focus group participants (n = 24) offered recommendations for integrating the tool into clinical workflow and input on acceptability and appropriateness, and anticipated barriers and facilitators for adoption and feasibility. Engaging key stakeholders to discuss implementation outcomes throughout the implementation process can improve the quality, applicability, and relevance of the research, and enhance implementation success. Full article
(This article belongs to the Special Issue Tobacco and Nicotine Use and Exposure Among Children and Adolescents)
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Open AccessReview Pediatric Fatty Liver and Obesity: Not Always Just a Matter of Non-Alcoholic Fatty Liver Disease
Children 2018, 5(12), 169; https://doi.org/10.3390/children5120169
Received: 23 November 2018 / Revised: 10 December 2018 / Accepted: 10 December 2018 / Published: 13 December 2018
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Abstract
Obesity-related non-alcoholic fatty liver disease (NAFLD) represents the most common cause of pediatric liver disease due to overweight/obesity large-scale epidemics. In clinical practice, diagnosis is usually based on clinical features, blood tests, and liver imaging. Here, we underline the need to make a [...] Read more.
Obesity-related non-alcoholic fatty liver disease (NAFLD) represents the most common cause of pediatric liver disease due to overweight/obesity large-scale epidemics. In clinical practice, diagnosis is usually based on clinical features, blood tests, and liver imaging. Here, we underline the need to make a correct differential diagnosis for a number of genetic, metabolic, gastrointestinal, nutritional, endocrine, muscular, and systemic disorders, and for iatrogenic/viral/autoimmune hepatitis as well. This is all the more important for patients who are not in the NAFLD classical age range and for those for whom a satisfactory response of liver test abnormalities to weight loss after dietary counseling and physical activity measures cannot be obtained or verified due to poor compliance. A correct diagnosis may be life-saving, as some of these conditions which appear similar to NAFLD have a specific therapy. In this study, the characteristics of the main conditions which require consideration are summarized, and a practical diagnostic algorithm is discussed. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
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Open AccessReview Pediatric Integrative Medicine in Academia: Stanford Children’s Experience
Children 2018, 5(12), 168; https://doi.org/10.3390/children5120168
Received: 18 September 2018 / Revised: 28 November 2018 / Accepted: 29 November 2018 / Published: 12 December 2018
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Abstract
Pediatric integrative medicine is an emerging field which, to date, has not been described in detail in academic medical centers in the United States. Early research of pediatric integrative medicine modalities shows promise for the treatment of common pediatric conditions such as irritable [...] Read more.
Pediatric integrative medicine is an emerging field which, to date, has not been described in detail in academic medical centers in the United States. Early research of pediatric integrative medicine modalities shows promise for the treatment of common pediatric conditions such as irritable bowel syndrome, acute and chronic pain, headache, and allergy, among others. In light of the growing prevalence of pediatric illnesses and patient complexity, it is crucial to emphasize the patient’s overall well-being. As academic centers around the world start to develop pediatric integrative medicine programs, the aim of this manuscript is to briefly highlight evidence of effective integrative treatments in pediatric subspecialties, to describe the establishment of our integrative medicine program, to summarize its early efforts, and to discuss potential barriers and keys to success. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
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Open AccessArticle Interactive Dyadic Physical Activity and Spatial Proximity Patterns in 2-Year-Olds and Their Parents
Children 2018, 5(12), 167; https://doi.org/10.3390/children5120167
Received: 19 November 2018 / Revised: 1 December 2018 / Accepted: 7 December 2018 / Published: 11 December 2018
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Abstract
This study aimed to characterize daily physical activity (PA) behaviors in 2-year-old girls and boys and their parents, with and without an objective measure of dyadic spatial proximity. Urban-dwelling parent–toddler dyads (N = 110) wore accelerometers for 7 days, and parents completed [...] Read more.
This study aimed to characterize daily physical activity (PA) behaviors in 2-year-old girls and boys and their parents, with and without an objective measure of dyadic spatial proximity. Urban-dwelling parent–toddler dyads (N = 110) wore accelerometers for 7 days, and parents completed a sociodemographic questionnaire. Accelerometers were initialized to collect PA and Bluetooth-based proximity data. After applying wear-time algorithms, n = 65 dyads were further analyzed using a dyadic analysis statistical methodology. Toddler–parent sedentary and light PA time were respectively interdependent, conditional on child sex and child-parent proximity, but moderate–vigorous physical activity (MVPA) time was not. Toddlers were significantly more active on weekdays and weekends than their parents, and no differences were found in daily PA volumes between girls and boys. In dyads with proximity data (n = 34), analyses of joint (i.e., proximal and mutual) PA time showed that girls participated in significantly more joint PA with their mothers than boys. Children who engaged in ≥60 min of MVPA/day participated in ~2 h of joint PA/day, on average, while children with <60 min of MVPA/day engaged in ~30 min less joint-PA time with their mothers. Boys and girls who participated in higher daily MVPA volumes engaged in joint PA with their mothers across greater relative distances, as compared to less active boys who engaged in joint PA at closer relative distances to their mothers. Toddlers who engaged in ≥60 min of daily MVPA participated in joint PA with their mothers at greater relative distances and for longer durations than less active children. Further research on the dyadic activity–proximity relationship is needed across early childhood development. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
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Open AccessArticle Parental Satisfaction with Caregiving for Children with Developmental Disabilities: Development of a New Assessment Tool
Children 2018, 5(12), 166; https://doi.org/10.3390/children5120166
Received: 6 October 2018 / Revised: 6 December 2018 / Accepted: 6 December 2018 / Published: 11 December 2018
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Abstract
Parents of children with developmental disabilities face many challenges. Those who are less satisfied with the care-giving that their children receive may require extra support. This paper reports the development of a Parental Satisfaction with Caring for a child with Developmental Disability Index [...] Read more.
Parents of children with developmental disabilities face many challenges. Those who are less satisfied with the care-giving that their children receive may require extra support. This paper reports the development of a Parental Satisfaction with Caring for a child with Developmental Disability Index (PSCDDI), with items derived from literature reviews and pilot testing in Iran. The index was field tested with 256 parents caring for children with a diagnosis of intellectual disability, autism, or attention deficit hyperactivity disorder (ADHD), and who were attending centres in four locations across Iran. A factor analysis of responses to the self-completion questionnaire identified two main factors, i.e., personal satisfaction and satisfaction with the child, with six items for each factor. The two factors had good internal consistency and reasonable test-retest reliability. Binary logistic regressions identified significant predictors of personal satisfaction that supported the validity of the scale.: Clinicians and service providers could use this scale as part of their assessment strategy to identify parents who may require additional support, especially those with teenage female children, and those with a diagnosis of autism or behavior problems. Full article
Open AccessArticle Rhabdomyosarcoma and Extraosseous Ewing Sarcoma
Children 2018, 5(12), 165; https://doi.org/10.3390/children5120165
Received: 28 October 2018 / Revised: 30 November 2018 / Accepted: 4 December 2018 / Published: 10 December 2018
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Abstract
Rhabdomyosarcoma (RMS) is a malignant tumor that represents the most common form of pediatric soft tissue sarcoma. It arises from mesenchymal origin and forms part of the group of small round blue cell tumors of childhood. It has a constant annual incidence of [...] Read more.
Rhabdomyosarcoma (RMS) is a malignant tumor that represents the most common form of pediatric soft tissue sarcoma. It arises from mesenchymal origin and forms part of the group of small round blue cell tumors of childhood. It has a constant annual incidence of 4.5 cases per 1,000,000 children. The known histological diagnosis of the two major subtypes (embryonal and alveolar) has been recently enhanced by tumor biological markers and molecular differentiation diagnostic tools that have improved not only the updated classification based on risk stratification, but also the treatment approach based on the clinical group. Ewing sarcoma (ES) is a round cell tumor, highly malignant and poorly differentiated that is currently the second most common malignant bone tumor in children. In rare instances, it develops from an extraskeletal origin, classified as extraosseous Ewing sarcoma (EES). We provide an updated, evidence-based and comprehensive review of the molecular diagnosis, clinical and diagnostic approach and a multidisciplinary medical and surgical management according to the latest standard of care for the treatment of pediatric RMS and EES. Full article
(This article belongs to the Special Issue Pediatric Surgical Oncology)
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Open AccessArticle Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital
Children 2018, 5(12), 164; https://doi.org/10.3390/children5120164
Received: 14 November 2018 / Revised: 2 December 2018 / Accepted: 3 December 2018 / Published: 10 December 2018
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Abstract
Limited studies exist regarding the timing, location, or physicians involved in do-not-resuscitate (DNR) order placement in pediatrics. Prior pediatric studies have noted great variations in practice during end-of-life (EOL) care. This study aims to analyze the timing, location, physician specialties, and demographic factors [...] Read more.
Limited studies exist regarding the timing, location, or physicians involved in do-not-resuscitate (DNR) order placement in pediatrics. Prior pediatric studies have noted great variations in practice during end-of-life (EOL) care. This study aims to analyze the timing, location, physician specialties, and demographic factors influencing EOL care in pediatrics. We examined the time preceding and following the implementation of a pediatric palliative care team (PCT) via a 5-year, retrospective chart review of all deceased patients previously admitted to inpatient services. Thirty-five percent (167/471) of the patients in our study died with a DNR order in place. Sixty-two percent of patients died in an ICU following DNR order placement. A difference was noted in DNR order timing between patients on general inpatient units and those discharged to home compared with those in the ICUs (p = 0.02). The overall DNR order rate increased following the initiation of the PCT from 30.8% to 39.2% (p = 0.05), but no change was noted in the rate of death in the ICUs. Our study demonstrates a variation in the timing of death following DNR order placement when comparing ICUs and general pediatric floors. Following the initiation of the PCT, we saw increased DNR frequency but no change in the interval between a DNR order and death. Full article
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Open AccessReview Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use
Children 2018, 5(12), 163; https://doi.org/10.3390/children5120163
Received: 24 August 2018 / Revised: 27 November 2018 / Accepted: 3 December 2018 / Published: 5 December 2018
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Abstract
As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia [...] Read more.
As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia and sedation as part of their hospitalization, for both acute and chronic illnesses. Opioids are frequently administered to manage pain symptoms, reduce anxiety and agitation, and diminish physiological stress responses. Opioids are also regularly prescribed to youth with chronic pain. These medications may be prescribed during the initial phase of a diagnostic workup, during an emergency room visit; as an inpatient, or on an outpatient basis. Following treatment for underlying pain conditions, it can be challenging to appropriately wean and discontinue opioid therapies. Weaning opioid therapy requires special expertise and care to avoid symptoms of increased pain, withdrawal, and agitation. To address this challenge, there have been enhanced efforts to implement opioid-reduction during pharmacological therapies for pediatric pain management. Effective pain management therapies and their outcomes in pediatrics are outside the scope of this paper. The aims of this paper were to: (1) Review the current practice of opioid-reduction during pharmacological therapies; and (2) highlight concrete opioid weaning strategies and management of opioid withdrawal. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
Open AccessArticle Katalyst Pilot Study: Using Interactive Activities in Anatomy and Physiology to Teach Children the Scientific Foundation of Healthy Lifestyles
Children 2018, 5(12), 162; https://doi.org/10.3390/children5120162
Received: 16 October 2018 / Revised: 26 November 2018 / Accepted: 27 November 2018 / Published: 28 November 2018
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Abstract
This pilot study evaluated the impact of the Katalyst curriculum, a fifth-grade experiential learning program, on students’ knowledge of a healthy lifestyle’s impact on body functions. Katalyst’s interactive curriculum spans two days and includes four, 60-min stations on body systems: cardiovascular/endocrine, gastrointestinal, neurological, [...] Read more.
This pilot study evaluated the impact of the Katalyst curriculum, a fifth-grade experiential learning program, on students’ knowledge of a healthy lifestyle’s impact on body functions. Katalyst’s interactive curriculum spans two days and includes four, 60-min stations on body systems: cardiovascular/endocrine, gastrointestinal, neurological, and respiratory/musculoskeletal. Three schools were recruited, and two schools completed the intervention sessions. Prior to beginning the stations, fifth-grade students completed a 37-item questionnaire to assess knowledge and perceptions. Students completed the same survey at the end of the Katalyst intervention. Teachers at the school also completed a survey post intervention to provide feedback on the program. Frequency and paired analyses were conducted on student responses and summative content analysis on teacher and volunteer feedback. The School 1 completer (n = 63) baseline mean knowledge score was 66.2%. The School 2 completer (n = 47) baseline mean knowledge score was 67.3%. Following the Katalyst intervention, both schools showed a statistically significant increase in the mean post score to 70.3% (p = 0.0017) and 78.4%(p < 0.0001) at School 1 (n = 63) and School 2 (n = 47), respectively. Teacher feedback (n = 7) revealed that Katalyst was effective in meeting state educational health standards and teachers perceived that the students benefitted from the program more than “reading about the body systems in a textbook or health magazine”. The Katalyst pilot study appeared to improve fifth-grade students’ knowledge of body systems and health. Katalyst aligned with state educational standards and is supported by teachers for an experiential learning opportunity. The Katalyst curriculum could be a potential avenue for health educators in Appalachia. Full article
Open AccessConference Report Parenting in the Context of Children’s Chronic Pain: Balancing Care and Burden
Children 2018, 5(12), 161; https://doi.org/10.3390/children5120161
Received: 1 November 2018 / Revised: 21 November 2018 / Accepted: 23 November 2018 / Published: 27 November 2018
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Abstract
Parents of youth with chronic health conditions encounter numerous challenges in supporting their children across pediatric treatment contexts. Structural barriers to care, such as access issues and coordinating care across school, health, and family settings, can exacerbate challenges to daily functioning. Parents are [...] Read more.
Parents of youth with chronic health conditions encounter numerous challenges in supporting their children across pediatric treatment contexts. Structural barriers to care, such as access issues and coordinating care across school, health, and family settings, can exacerbate challenges to daily functioning. Parents are often concomitantly managing their child’s chronic condition, their own health care needs, work and family demands. For these parents, accomplishing a manageable “work-life balance” feels elusive, if not impossible, when a chronic health condition is part of family life. Based on a recent symposium presentation, combined perspectives from the disciplines of pediatric psychology, parenting, and human development and family studies consider key challenges and opportunities to assist parent coping with stress associated with caregiving amidst pervasive changes in healthcare service delivery. Two innovative interventions to support parents in both an outpatient (“Parents as Coping Coaches”) and an inpatient (“Putting Parents FIRST”) context are described, with commonalities and unique aspects highlighted for each. These programs are considered in reference to a rapidly changing healthcare landscape, growing focus on the family as a core context for care, and importance of parent/caregiver self-care and crucial role in supporting children’s long-term health and resiliency. Full article
Open AccessReview Development of the Gut Microbiome in Children, and Lifetime Implications for Obesity and Cardiometabolic Disease
Children 2018, 5(12), 160; https://doi.org/10.3390/children5120160
Received: 23 October 2018 / Revised: 19 November 2018 / Accepted: 22 November 2018 / Published: 27 November 2018
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Abstract
Emerging evidence suggests that microbiome composition and function is associated with development of obesity and metabolic disease. Microbial colonization expands rapidly following birth, and microbiome composition is particularly variable during infancy. Factors that influence the formation of the gut microbiome during infancy and [...] Read more.
Emerging evidence suggests that microbiome composition and function is associated with development of obesity and metabolic disease. Microbial colonization expands rapidly following birth, and microbiome composition is particularly variable during infancy. Factors that influence the formation of the gut microbiome during infancy and childhood may have a significant impact on development of obesity and metabolic dysfunction, with life-long consequences. In this review, we examine the determinants of gut microbiome composition during infancy and childhood, and evaluate the potential impact on obesity and cardiometabolic risk. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
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Open AccessArticle Exploring the Effect of Perceptions on Children’s Physical Activity in Varying Geographic Contexts: Using a Structural Equation Modelling Approach to Examine a Cross-Sectional Dataset
Children 2018, 5(12), 159; https://doi.org/10.3390/children5120159
Received: 1 November 2018 / Revised: 16 November 2018 / Accepted: 19 November 2018 / Published: 27 November 2018
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Abstract
Most Canadian children are not meeting the recommended 60 min of moderate-to-vigorous physical activity per day. Research suggests that children’s perceptions of their environment have an influence on their physical activity behaviours, but there is a lack of generalizability among previous work. The [...] Read more.
Most Canadian children are not meeting the recommended 60 min of moderate-to-vigorous physical activity per day. Research suggests that children’s perceptions of their environment have an influence on their physical activity behaviours, but there is a lack of generalizability among previous work. The purpose of this study was to assess the mediating effect of children’s perceptions of barriers to physical activity on the relationship between their environments and their level of moderate-to-vigorous physical activity (measured with accelerometers). Structural equation modelling stratified by gender was used to assess the research objective in a sample of 546 participants aged 8–14 years old from Northwestern and Southwestern Ontario, Canada. In both models stratified by gender, perceptions of barriers did not significantly mediate the relationship between urbanicity and physical activity. Independent of all other factors, there was no significant relationship between urbanicity and physical activity in girls, but there was in boys. These results offer insight into potential processes by which perceptions impact physical activity and provide initial information to further our understanding of the behavioural aspects of physical activity through multiple levels of analysis. Researchers must continue to improve efforts for quantifying the experience of children’s daily activity contexts. Full article
(This article belongs to the Section Global and Public Health)
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Open AccessReview Minimally Invasive Surgery in Pediatric Surgical Oncology
Children 2018, 5(12), 158; https://doi.org/10.3390/children5120158
Received: 30 September 2018 / Revised: 13 November 2018 / Accepted: 22 November 2018 / Published: 26 November 2018
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The application of minimally invasive surgery (MIS) to resect pediatric solid tumors offers the potential for reduced postoperative morbidity with smaller wounds, less pain, fewer surgical site infections, decreased blood loss, shorter hospital stays, and less disruption to treatment regimens. However, significant controversy [...] Read more.
The application of minimally invasive surgery (MIS) to resect pediatric solid tumors offers the potential for reduced postoperative morbidity with smaller wounds, less pain, fewer surgical site infections, decreased blood loss, shorter hospital stays, and less disruption to treatment regimens. However, significant controversy surrounds the question of whether a high-fidelity oncologic resection of childhood cancers can be achieved through MIS. This review outlines the diverse applications of MIS to treat pediatric malignancies, up to and including definitive resection. This work further summarizes the current evidence supporting the efficacy of MIS to accomplish a definitive, oncologic resection as well as appropriate patient selection criteria for the minimally invasive approach. Full article
(This article belongs to the Special Issue Pediatric Surgical Oncology)
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Open AccessReview Endocrine Disruptors and Autism Spectrum Disorder in Pregnancy: A Review and Evaluation of the Quality of the Epidemiological Evidence
Children 2018, 5(12), 157; https://doi.org/10.3390/children5120157
Received: 21 October 2018 / Revised: 13 November 2018 / Accepted: 19 November 2018 / Published: 23 November 2018
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Abstract
Exposure to environmental contaminants during pregnancy has been linked to adverse health outcomes later in life. Notable among these pollutants are the endocrine disruptors chemicals (EDCs), which are ubiquitously present in the environment and they have been measured and quantified in the fetus. [...] Read more.
Exposure to environmental contaminants during pregnancy has been linked to adverse health outcomes later in life. Notable among these pollutants are the endocrine disruptors chemicals (EDCs), which are ubiquitously present in the environment and they have been measured and quantified in the fetus. In this systematic review, our objective was to summarize the epidemiological research on the potential association between prenatal exposure to EDCs and Autism Spectrum Disorder (ASD) published from 2005 to 2016. The Navigation Guide Systematic Review Methodology was applied. A total of 17 studies met the inclusion criteria for this review, including: five cohorts and 12 case-control. According to the definitions specified in the Navigation Guide, we rated the quality of evidence for a relationship between prenatal exposure to EDCs and ASD as “moderate”. Although the studies generally showed a positive association between EDCs and ASD, after considering the strengths and limitations, we concluded that the overall strength of evidence supporting an association between prenatal exposure to EDCs and later ASD in humans remains “limited” and inconclusive. Further well-conducted prospective studies are warranted to clarify the role of EDCs on ASD development. Full article
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Open AccessBrief Report Implementation of a Competency-Based, Interdisciplinary Pediatric Palliative Care Curriculum Using Content and Format Preferred by Pediatric Residents
Children 2018, 5(12), 156; https://doi.org/10.3390/children5120156
Received: 20 October 2018 / Revised: 15 November 2018 / Accepted: 19 November 2018 / Published: 22 November 2018
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Abstract
Palliative care competencies at the pediatric resident training level expand learned knowledge into behavior. The objective of this study was to investigate mode of palliative care education delivery preferred by pediatric residents and to report on participatory approach to resident palliative care curriculum [...] Read more.
Palliative care competencies at the pediatric resident training level expand learned knowledge into behavior. The objective of this study was to investigate mode of palliative care education delivery preferred by pediatric residents and to report on participatory approach to resident palliative care curriculum design. A one-hour monthly palliative care curriculum was designed and implemented in a participatory manner with 20 pediatric residents at a free-standing Midwestern children’s hospital. Outcome measures included pediatric residents’ personal attitude and perceived training environment receptivity before and after implementation of a palliative care competency-based curriculum. An 18-item survey utilizing Social Cognitive Theory Constructs was administered at baseline and after palliative care curriculum implementation (2017–2018 curricular year). Pediatric residents prioritized real case discussions in group format (16/20) over other learning formats. Topics of highest interest at baseline were: discussing prognosis and delivering bad news (weighted average 12.9), pain control (12.3), goals of care to include code status (11.1), and integrative therapies (10.7). Summary of ordinal responses revealed improvement in self-assessment of personal attitude toward palliative care and training environment receptivity to palliative care domains after year-long curriculum implementation. Curricular approach which is attentive to pediatric residents’ preferred learning format and self-assessment of their behaviors within their care setting environment may be beneficial in competency-based primary palliative training. Full article
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