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Children, Volume 6, Issue 2 (February 2019)

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Cover Story (view full-size image) The European white boys and girls who suffered from Kawasaki disease underwent pediatric coronary [...] Read more.
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Open AccessArticle Description of an Innovative Pediatric Individualized Therapeutics Clinic: Working toward Precision Drug Therapy
Received: 23 January 2019 / Revised: 15 February 2019 / Accepted: 19 February 2019 / Published: 25 February 2019
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Abstract
The GOLDILOKs® (Genomic and Ontogeny-Linked Dose Individualization and cLinical Optimization for KidS) Clinic aims to provide families and physicians with data to make more informed decisions with regard to pharmacological therapy by using innovative therapy and genomic technologies. The objectives are two-fold: [...] Read more.
The GOLDILOKs® (Genomic and Ontogeny-Linked Dose Individualization and cLinical Optimization for KidS) Clinic aims to provide families and physicians with data to make more informed decisions with regard to pharmacological therapy by using innovative therapy and genomic technologies. The objectives are two-fold: (1) To describe the utility of the GOLDILOKs® Clinic to referring prescribers by evaluating the type of referrals made to the GOLDILOKs® Clinic and (2) to assess the most often utilized technologies (e.g., genotyping) completed to formulate therapy recommendations. Patient data from July 2010 to June 2016 was retrospectively reviewed following Institutional Review Board (IRB) approval. The GOLDILOKs® Clinic evaluated 306 patients and had increases in annual referrals from 14 in 2010–2011 to 84 in 2016–2017. The children that were referred were predominately Caucasian (82%) and male (59%) with an average age of 12.4 ± 5.9 years. Subspecialty versus primary care referrals accounted for 82% and 18% of referrals, respectively. Adverse drug reactions (n = 166) and poor medication response (n = 179) were the major reasons for referral. However, it must be noted that patients could have multiple reasons for referral. Pharmacogenetic results were extensively used to provide guidance for future therapy in patients with medication-related problems. Genotyping of drug metabolizing enzymes and drug target receptors was performed in 221 patients (72.2%). Recommendations were fully accepted by 63% and partially accepted by 22% of internal provider referrals. Full article
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Open AccessReview Status of Pediatric Cardiac Care in Developing Countries
Received: 30 January 2019 / Revised: 17 February 2019 / Accepted: 20 February 2019 / Published: 25 February 2019
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Abstract
About 1.35 million babies are born with congenital heart disease each year globally. Most of these are expected to lead normal, productive lives if they are treated in time. However, 90% of babies born with congenital heart disease live in regions where medical [...] Read more.
About 1.35 million babies are born with congenital heart disease each year globally. Most of these are expected to lead normal, productive lives if they are treated in time. However, 90% of babies born with congenital heart disease live in regions where medical care is inadequate or unavailable. The privilege of early diagnosis and timely intervention is restricted to only those born in developed countries. Added to the burden of congenital heart disease is rheumatic heart disease, which remains a global health problem in many low-income and middle-income countries. Providing optimal care for all these children is a daunting task, and requires funds and proper planning at various levels of the health care system. This article describes the burden of pediatric heart disease, including lacunae in the current state, as well as challenges and opportunities for providing optimal care to this large population of children. Full article
Open AccessReview Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids
Received: 11 December 2018 / Revised: 7 February 2019 / Accepted: 13 February 2019 / Published: 21 February 2019
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Abstract
Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain [...] Read more.
Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
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Open AccessReview Cardiac Catheterization in Assessment and Treatment of Kawasaki Disease in Children and Adolescents
Received: 27 January 2019 / Revised: 17 February 2019 / Accepted: 20 February 2019 / Published: 21 February 2019
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Abstract
Cardiac catheterization has become a promising tool to assess and treat coronary artery lesions in patients with Kawasaki disease. Significant coronary artery lesions can now be treated via transcatheter route even in small children. Further development and miniaturization of this technology will help [...] Read more.
Cardiac catheterization has become a promising tool to assess and treat coronary artery lesions in patients with Kawasaki disease. Significant coronary artery lesions can now be treated via transcatheter route even in small children. Further development and miniaturization of this technology will help to promote widespread use to the benefit of small children suffering from coronary artery disease. The role of diagnostic and interventional coronary artery procedures in children and adolescents are discussed in this article. Full article
(This article belongs to the Special Issue Kawasaki Disease in Children and Adolescents)
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Open AccessArticle Tobacco Use as a Health Disparity: What Can Pediatric Clinicians Do?
Received: 21 December 2018 / Revised: 5 February 2019 / Accepted: 12 February 2019 / Published: 20 February 2019
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Abstract
Tobacco use is a global health crisis, and has a tremendous and negative impact on health and wellbeing. Tobacco use disproportionately affects members of vulnerable populations, and by acting on multiple socioecological levels, serves to perpetuate and reinforce cycles of poverty. Members of [...] Read more.
Tobacco use is a global health crisis, and has a tremendous and negative impact on health and wellbeing. Tobacco use disproportionately affects members of vulnerable populations, and by acting on multiple socioecological levels, serves to perpetuate and reinforce cycles of poverty. Members of the pediatric medical community can play a key role in interrupting cycles of tobacco use. Providers can serve as powerful allies to vulnerable communities by treating tobacco use in caregivers, counseling youth against using tobacco products, protecting children from the impact of secondhand smoke exposure, and advocating for economic, social, and health policies to disrupt intergenerational smoking. Full article
(This article belongs to the Special Issue Tobacco and Nicotine Use and Exposure Among Children and Adolescents)
Open AccessReview Electronic Cigarettes and Youth in the United States: A Call to Action (at the Local, National and Global Levels)
Received: 17 January 2019 / Revised: 7 February 2019 / Accepted: 14 February 2019 / Published: 20 February 2019
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Abstract
E-cigarettes have emerged and soared in popularity in the past ten years, making them the most common tobacco product used among youth in the United States (US). In this review, we discuss what the Surgeon General has called a public health “epidemic”—the precipitous [...] Read more.
E-cigarettes have emerged and soared in popularity in the past ten years, making them the most common tobacco product used among youth in the United States (US). In this review, we discuss what the Surgeon General has called a public health “epidemic”—the precipitous increase in youth use of e-cigarettes and the health consequences of this behavior. Further, we review tobacco control policy efforts (e.g., Tobacco 21, banning flavors, advertising restrictions, and clean indoor air laws)—efforts proven to be critical in reducing cigarette smoking and smoking-related disease and death among US children and adults—including their potential and challenges regarding managing and mitigating the emergence of e-cigarettes. Finally, we close with a discussion of the efforts of transnational tobacco companies to rebrand themselves using e-cigarettes and other new products. Full article
(This article belongs to the Special Issue Tobacco and Nicotine Use and Exposure Among Children and Adolescents)
Open AccessReview Optimal Inspired Fraction of Oxygen in the Delivery Room for Preterm Infants
Received: 29 January 2019 / Revised: 13 February 2019 / Accepted: 18 February 2019 / Published: 19 February 2019
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Abstract
Postnatal adaptation of preterm infants entails a series of difficulties among which the immaturity of the respiratory system is the most vital. To overcome respiratory insufficiency, caregivers attending in the delivery room use positive pressure ventilation and oxygen. A body of evidence in [...] Read more.
Postnatal adaptation of preterm infants entails a series of difficulties among which the immaturity of the respiratory system is the most vital. To overcome respiratory insufficiency, caregivers attending in the delivery room use positive pressure ventilation and oxygen. A body of evidence in relation of oxygen management in the delivery room has been accumulated in recent years; however, the optimal initial inspired fraction of oxygen, the time to achieve specific oxygen saturation targets, and oxygen titration have not been yet clearly established. The aim of this review is to update the reader by critically analyzing the most relevant literature. Full article
(This article belongs to the Special Issue Emerging Concepts in Neonatal Resuscitation)
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Open AccessArticle Strategies for Coping with Time-Related and Productivity Challenges of Young People with Learning Disabilities and Attention-Deficit/Hyperactivity Disorder
Received: 16 December 2018 / Revised: 25 January 2019 / Accepted: 6 February 2019 / Published: 13 February 2019
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Abstract
Learning disabilities (LD) and attention deficit hyperactivity disorder (ADHD) are characterized by neurological differences that result in difficulties meeting learning and productivity expectations. Young people with LD and ADHD experience difficulties in self-managing academic, social, daily living, and health/wellness demands. Students with LD/ADHD [...] Read more.
Learning disabilities (LD) and attention deficit hyperactivity disorder (ADHD) are characterized by neurological differences that result in difficulties meeting learning and productivity expectations. Young people with LD and ADHD experience difficulties in self-managing academic, social, daily living, and health/wellness demands. Students with LD/ADHD must work longer and harder than peers, which makes managing time and productivity a critical skill for school success. This study examined the strategies that college students with LD/ADHD used to overcome obstacles related to time and productivity within their everyday life contexts. A qualitative phenomenological design was used to examine the phenomenon of coping and productive-task performance through strategy use among 52 college students with LD/ADHD. Strategies classified as habit and routine use, reframing, and symptom-specific strategies were identified. Strategy use for addressing time-related and productivity challenges are multidimensional and entailed a mix of cognitive, behavioral, psychological, and socio-environmental strategies. Effective strategy use across life’s contexts was critical to self-managing as a young person with a chronic developmental condition within a college context. The findings provide a much-needed understanding of the multi-faceted challenges and solutions within young adult contexts that are important for guiding the development of interventions for young people with LD/ADHD. Full article
Open AccessReview The Evolution of Risk Classification for Neuroblastoma
Received: 5 December 2018 / Revised: 23 January 2019 / Accepted: 28 January 2019 / Published: 11 February 2019
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Abstract
Neuroblastoma is a tumor with great clinical heterogeneity. Patients in North America are risk-stratified using a number of features including age at diagnosis, disease stage, tumor histology, MYCN status (amplified versus nonamplified), and tumor cell ploidy. In this paper, we review the evidence [...] Read more.
Neuroblastoma is a tumor with great clinical heterogeneity. Patients in North America are risk-stratified using a number of features including age at diagnosis, disease stage, tumor histology, MYCN status (amplified versus nonamplified), and tumor cell ploidy. In this paper, we review the evidence for utilizing these features in the risk classification of neuroblastic tumors. Additionally, we review the clinical and biologic criteria used by various cooperative groups to define low, intermediate, and high-risk disease populations in clinical trials, highlighting the differences in risk classification internationally. Finally, we discuss the development of the International Neuroblastoma Risk Group classification system, designed to begin worldwide standardization of neuroblastoma pretreatment risk classification and allow comparison of clinical trials conducted through different cooperative groups. Full article
(This article belongs to the Special Issue Recent Advances in Diagnosis and Treatment of Neuroblastoma)
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Open AccessArticle A Qualitative Study on Parental and Community Stakeholder Views of the Link between Full-Day Kindergarten and Health in Southern Nevada
Received: 15 January 2019 / Revised: 6 February 2019 / Accepted: 6 February 2019 / Published: 8 February 2019
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Abstract
Studies show that children who attend full-day kindergarten (FDK) experience both academic and developmental benefits compared to children who attend half-day programs. Sectors outside of health, such as education, can have important intended and unintended impacts on health. The purpose of this qualitative [...] Read more.
Studies show that children who attend full-day kindergarten (FDK) experience both academic and developmental benefits compared to children who attend half-day programs. Sectors outside of health, such as education, can have important intended and unintended impacts on health. The purpose of this qualitative study was to understand perceptions of parental and other stakeholders in Southern Nevada (USA) about the education–health link, and to understand priorities regarding how FDK access could affect health. Two 90-minute focus groups were conducted with 14 adult stakeholder participants representing parents, current and former teachers, and community members. Transcripts were analyzed using conventional content analysis. Eight major themes and several subthemes emerged; findings related to each are discussed. ‘Access’ was mentioned most frequently (n = 43), followed by ‘Time’ (n = 25), and ‘Lifetime educational attainment’ (n = 17). Participants were overall in favor of expanding access to FDK and felt that FDK could improve social skills, increase the amount of physical activity, and provide additional time for educators to detect additional learning disabilities when compared to half-day programs. Although the purpose was to understand priorities related to the education–health link, participants spent little time discussing this, suggesting this association is not inherently considered. Health and education stakeholders should collaborate to increase awareness, as this link may serve as an upstream approach to downstream effects on population health outcomes. Full article
(This article belongs to the Section Global and Public Health)
Open AccessEditorial Where are the Ambulatory Care Pediatric Pharmacists?
Received: 1 February 2019 / Accepted: 4 February 2019 / Published: 7 February 2019
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Abstract
This editorial describes the purposes and content of the Special Issue for the development of a national pediatric pharmacotherapy collaborative practice network. A collaborative practice network from a population health perspective is needed to better manage the medication-related needs of children with special [...] Read more.
This editorial describes the purposes and content of the Special Issue for the development of a national pediatric pharmacotherapy collaborative practice network. A collaborative practice network from a population health perspective is needed to better manage the medication-related needs of children with special health care needs and medical complexity (CSHCN-CMC). Over the last 25 years, the pharmacy profession has been engaged in organized efforts both to elevate practice and educational standards for pediatric pharmacy practice and to design medication management systems that benefit children and their families and caregivers. Moreover, alignment with pediatric clinical pharmacologists will aid in the development of new practice-based research paradigms that can be applied in the clinical setting. Formalized multi-disciplinary collaboration (CPAs) with new approaches to specialized electronic medication systems and comprehensive medication management (CMM) is necessary to improve the pharmacotherapy outcomes of pediatric patients. Full article
Open AccessFeature PaperReview The Role of Probiotics in Preventing Allergic Disease
Received: 20 November 2018 / Revised: 16 January 2019 / Accepted: 1 February 2019 / Published: 5 February 2019
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Abstract
The prevalence of allergic disorders has been increasing worldwide and significantly impacts the quality of life of the atopic individual. There has been an increased interest in the role of probiotics for the prevention and treatment of allergic disorders, given the recent evidence [...] Read more.
The prevalence of allergic disorders has been increasing worldwide and significantly impacts the quality of life of the atopic individual. There has been an increased interest in the role of probiotics for the prevention and treatment of allergic disorders, given the recent evidence that atopy risk may be associated with a dysbiosis of the gut microbiome. Research in this area is ongoing with some studies showing possible benefits of probiotics, with seemingly little to no risk. While these studies suggest that there may be a promise in probiotic use for the prevention or treatment of allergy, further evidence is needed to determine its efficacy, optimal dosing, and strains needed for treatment. In this review, we discuss recently published studies examining the benefits, risks, and role of probiotics in preventing atopic dermatitis, asthma, allergic rhinitis, and food allergy. Full article
Open AccessReview Pediatric Epilepsy Mechanisms: Expanding the Paradigm of Excitation/Inhibition Imbalance
Received: 10 January 2019 / Revised: 31 January 2019 / Accepted: 31 January 2019 / Published: 5 February 2019
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Abstract
Mechanisms underlying seizures and epilepsy have traditionally been considered to involve abnormalities of ion channels or synaptic function. Those considerations gave rise to the excitation/inhibition (E/I) imbalance theory, whereby increased excitation, decreased inhibition, or both favor a hyperexcitable state and an increased propensity [...] Read more.
Mechanisms underlying seizures and epilepsy have traditionally been considered to involve abnormalities of ion channels or synaptic function. Those considerations gave rise to the excitation/inhibition (E/I) imbalance theory, whereby increased excitation, decreased inhibition, or both favor a hyperexcitable state and an increased propensity for seizure generation and epileptogenesis. Several recent findings warrant reconsideration and expansion of the E/I hypothesis: novel genetic mutations have been identified that do not overtly affect E/I balance; neurotransmitters may exert paradoxical effects, especially during development; anti-seizure medications do not necessarily work by decreasing excitation or increasing inhibition; and metabolic factors participate in the regulation of neuronal and network excitability. These novel conceptual and experimental advances mandate expansion of the E/I paradigm, with the expectation that new and exciting therapies will emerge from this broadened understanding of how seizures and epilepsy arise and progress. Full article
(This article belongs to the Special Issue Advances in Pediatric Epilepsy)
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Open AccessCase Report Use of Lisdexamfetamine to Treat Obesity in an Adolescent with Severe Obesity and Binge Eating
Received: 30 November 2018 / Revised: 29 January 2019 / Accepted: 31 January 2019 / Published: 4 February 2019
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Abstract
Approximately two-thirds of US children and adolescents have either obesity or overweight status, with almost 24% of adolescents (ages 12–19 years) afflicted with severe obesity, defined as >1.2 × the 95th BMI percentile for age/gender. Despite the increasing disproportionate rise in severe or [...] Read more.
Approximately two-thirds of US children and adolescents have either obesity or overweight status, with almost 24% of adolescents (ages 12–19 years) afflicted with severe obesity, defined as >1.2 × the 95th BMI percentile for age/gender. Despite the increasing disproportionate rise in severe or extreme childhood obesity, many children in weight management programs do not achieve a healthy weight. Most often, these patients will go on to require metabolic and bariatric surgery (MBS), but challenges and limitations may prohibit MBS on adolescents. Thus, tertiary care pediatric weight management centers are compelled to treat select pediatric obesity subtypes presenting with disease progression and disability with the available adult FDA-approved therapeutic modalities, specifically pharmacotherapy, in order to alleviate the disease state and provide relief to the patient. Here, we describe a case of severe pediatric obesity where a dedicated multidisciplinary pediatric weight management team at a tertiary care center utilizes a progressive pharmacotherapeutic approach with enormous benefits to the patient, highlighting the urgent gap and clinical care needs of this special population niche of severe adolescent obesity. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
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Open AccessArticle Cognitive Functioning in Patients with Pediatric-Onset Multiple Sclerosis, an Updated Review and Future Focus
Received: 2 January 2018 / Revised: 28 January 2019 / Accepted: 31 January 2019 / Published: 4 February 2019
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Abstract
Pediatric-onset multiple sclerosis (POMS) is relatively rare, but as technology and neuroimaging advance, an increasing number of cases are identified, and our understanding of how multiple sclerosis (MS) impacts the developing brain improves. There are consistent findings in the literature highlighting the impact [...] Read more.
Pediatric-onset multiple sclerosis (POMS) is relatively rare, but as technology and neuroimaging advance, an increasing number of cases are identified, and our understanding of how multiple sclerosis (MS) impacts the developing brain improves. There are consistent findings in the literature highlighting the impact of MS and other demyelinating diseases on cognitive functioning and cognitive development. We also have a better understanding of how POMS impacts psychosocial functioning and functional outcomes in daily living. This paper hopes to review findings associated with cognitive and psychosocial functioning in patients with POMS, as well as explore more recent advances in the field and how they relate to cognitive and psychosocial outcomes. We also discuss the ongoing need for future studies with a focus on better understanding deficits and disease correlates, but also preventative measures and potential rehabilitation. Full article
(This article belongs to the Special Issue Multiple Sclerosis and Demyelinating Disorders in Children)
Open AccessArticle Can Wearable Cameras Be Used to Validate School-Aged Children’s Lifestyle Behaviours?
Received: 1 November 2018 / Revised: 24 January 2019 / Accepted: 30 January 2019 / Published: 1 February 2019
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Abstract
Wearable cameras combined with accelerometers have been used to estimate the accuracy of children’s self-report of physical activity, health-related behaviours, and the contexts in which they occur. There were two aims to this study; the first was to validate questions regarding self-reported health [...] Read more.
Wearable cameras combined with accelerometers have been used to estimate the accuracy of children’s self-report of physical activity, health-related behaviours, and the contexts in which they occur. There were two aims to this study; the first was to validate questions regarding self-reported health and lifestyle behaviours in 9–11-year-old children using the child’s health and activity tool (CHAT), an accelerometer and a wearable camera. Second, the study sought to evaluate ethical challenges associated with taking regular photographs using a wearable camera through interviews with children and their families. Fourteen children wore an autographer and hip-worn triaxial accelerometer for the waking hours of one school and one weekend day. For both of these days, children self-reported their behaviours chronologically and sequentially using the CHAT. Data were examined using limits of agreement and percentage agreement to verify if reference methods aligned with self-reported behaviours. Six parent–child dyads participated in interviews. Seven, five, and nine items demonstrated good, acceptable, and poor validity, respectively. This demonstrates that the accuracy of children’s recall varies according to the behaviour or item being measured. This is the first study to trial the use of wearable cameras in assessing the concurrent validity of children’s physical activity and behaviour recall, as almost all other studies have used parent proxy reports alongside accelerometers. Wearable cameras carry some ethical and technical challenges, which were examined in this study. Parents and children reported that the autographer was burdensome and in a few cases invaded privacy. This study demonstrates the importance of adhering to an ethical framework. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
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Open AccessArticle Stability and Change in Longitudinal Associations between Child Behavior Problems and Maternal Stress in Families with Preterm Born Children, Follow-Up after a RCT-Study
Received: 19 December 2018 / Revised: 28 January 2019 / Accepted: 28 January 2019 / Published: 31 January 2019
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Abstract
The Tromsø Intervention Study on Preterms (TISP) randomized 146 preterm-born children either to the Mother-Infant Transaction Program (MITP) or to a preterm control group. Previously, significant reductions of child behavior problems and maternal stress have been reported in the intervention group. This follow-up [...] Read more.
The Tromsø Intervention Study on Preterms (TISP) randomized 146 preterm-born children either to the Mother-Infant Transaction Program (MITP) or to a preterm control group. Previously, significant reductions of child behavior problems and maternal stress have been reported in the intervention group. This follow-up study examines whether the MITP may have affected the longitudinal adaptation between mothers and their children from two until nine years, expressed as associations between different behavioral problems and parenting stress reported by mothers. Associations between internalizing, attentional, and social problems and different dimensions of parenting stress were analyzed in separate models that included effects of time and group status. The MITP did not influence the development of longitudinal associations as no significant three-way interaction (stress*group*time) was found. Significant stress by group interactions was only found in reports on children’s attentional problems when analyzed with parent- or interaction-related stress. Mothers who had participated in the MITP reported weaker stress–behavior associations than control mothers. This effect was moderated by two independent variables, namely children’s birthweight and years of maternal education for the parent–child difficult interaction stress. Full article
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Open AccessArticle Addressing Marginality and Exclusion: The Resettlement Experiences of War-Affected Young People in Quebec, Canada
Received: 18 December 2018 / Revised: 25 January 2019 / Accepted: 27 January 2019 / Published: 30 January 2019
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Accessing meaningful forms of support can be an onerous experience for young people resettling from war-affected contexts. In addition to facing linguistic and financial barriers in this process, these young people negotiate care systems that are often structurally and culturally insensitive to their [...] Read more.
Accessing meaningful forms of support can be an onerous experience for young people resettling from war-affected contexts. In addition to facing linguistic and financial barriers in this process, these young people negotiate care systems that are often structurally and culturally insensitive to their unique needs, values, beliefs, and intersectional experiences of oppression. Drawing on interviews with 22 young people from war-affected areas living in Quebec, Canada, this paper critically examines how dominant cultural norms and social relations in Quebec’s health, social and educational services network shape their experiences in seeking care, healing and belonging. Alternative care systems and approaches, as proposed by the participants, are then explored. The findings emphasize the need for spaces and care services where war-affected young people’s identities and lived realities are validated and represented. Full article
Open AccessCommunication New Cosmetic Formulation for the Treatment of Mild to Moderate Infantile Atopic Dermatitis
Received: 20 December 2018 / Revised: 22 January 2019 / Accepted: 22 January 2019 / Published: 29 January 2019
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Abstract
Atopic dermatitis (AD) is a chronic cutaneous inflammatory disorder, characterized by skin barrier disruption. Dermacare is a new cosmetic formulation, which enhances moisturization, reinforces and repairs the skin barrier, and prevents cutaneous microbiota imbalance. To demonstrate its safety and efficacy, a prospective, open-label, [...] Read more.
Atopic dermatitis (AD) is a chronic cutaneous inflammatory disorder, characterized by skin barrier disruption. Dermacare is a new cosmetic formulation, which enhances moisturization, reinforces and repairs the skin barrier, and prevents cutaneous microbiota imbalance. To demonstrate its safety and efficacy, a prospective, open-label, and multicenter study was carried out on patients diagnosed with mild to moderate AD. Transepidermal water loss (TEWL), clinical severity, Desquamation Index, Patient/Investigator Global Assessments, quality of life index, and tolerance were assessed. Adverse events were recorded. Daily application of the new treatment was well tolerated, and adverse events were absent. After 14 days, TEWL showed a 36.7% significant decrease (p = 0.035). At the end of the 28-day treatment, the Desquamation Index showed a reduction in 70% of patients; Eczema Area and Severity Index were reduced by 70.4% (p = 0.002); and skin irritation showed a significant reduction (p = 0.024). Likewise, Patient and Investigator Global Assessments reported a significant improvement in conditions and an overall global worsening when patients restarted their normal treatment. Parent’s Index of Quality of Life Index significantly increased by 36.4% (p < 0.05) with Dermacare. In conclusion, a regular use of this new formulation can reduce the risk of relapse and extend the steroid-free treatment periods. Full article
(This article belongs to the Special Issue Atopic Dermatitis and Psoriasis in Children)
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Open AccessReview Significance of Coronary Revascularization for Coronary-Artery Obstructive Lesions Due to Kawasaki Disease
Received: 5 December 2018 / Revised: 21 January 2019 / Accepted: 24 January 2019 / Published: 29 January 2019
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Abstract
As an acquired ischemic heart disease in childhood, coronary-artery disease caused by Kawasaki disease (KD) has been known worldwide since the mid-1970s. KD patients who develop coronary-artery obstructive disease often need revascularization some time in their life. Coronary-artery revascularization for KD coronary lesions [...] Read more.
As an acquired ischemic heart disease in childhood, coronary-artery disease caused by Kawasaki disease (KD) has been known worldwide since the mid-1970s. KD patients who develop coronary-artery obstructive disease often need revascularization some time in their life. Coronary-artery revascularization for KD coronary lesions can be done with the surgical coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) procedures. However, the characteristics of coronary-arterial lesions caused by KD significantly differ from atherosclerotic coronary disease in adults. Therefore, it is much more difficult to determine the optimal time and selection of a coronary-artery revascularization procedure for KD sequelae. CABG using the internal thoracic artery has been accepted as a very useful and beneficial procedure since the mid-1980s, even in small children. Although the use of PCI in the late period can be effective in some adolescent and adult patients, the small vessel size and severe coronary-artery calcification are often limiting factors for its use in children. Therefore, CABG is a better approach for severe leftanterior descending artery and multiple-vessel disease in children and adolescents with KD coronary sequelae. Good coronary revascularization can improve the long-term outcomes of patients with severe KD complications. Full article
(This article belongs to the Special Issue Kawasaki Disease in Children and Adolescents)
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Open AccessArticle Epilepsy in Children with Autistic Spectrum Disorder
Received: 31 December 2018 / Revised: 22 January 2019 / Accepted: 22 January 2019 / Published: 25 January 2019
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The comorbidity of autistic spectrum disorder (ASD) and epilepsy has been widely discussed but many questions still remain unanswered. The aim of this study was to establish the occurrence of epilepsy among children with ASD to define the type of epileptic seizures and [...] Read more.
The comorbidity of autistic spectrum disorder (ASD) and epilepsy has been widely discussed but many questions still remain unanswered. The aim of this study was to establish the occurrence of epilepsy among children with ASD to define the type of epileptic seizures and syndromes, the age of onset of epilepsy, EEG abnormalities, the used antiepileptic drugs and the therapeutic responses for seizures and autistic behavior, as well as to find some correlations between epilepsy and gender, etiology and intellectual disability (ID). A retrospective study of medical files of 59 patients (aged 1–18 years) with ASD during a 5-year period was performed. ASD diagnosis was based on the DSM-5 diagnostic criteria. The patients were examined with a detailed medical history, physical and neurological examination, as well as some additional functional, imaging, laboratory and genetic investigations ASD etiology was syndromic in 9, probable syndromic in 9, and idiopathic in 41 children. ID was established in 90% of ASD children, and epilepsy in 44.4%. The onset of epilepsy prevailed before 7 years of age. The most common seizure types were focal with or without secondary generalization (53.4%). Focal epileptiform EEG abnormalities prevailed. Therapeutic response to seizures was good: 58% were seizure-free, while 27% had >50% seizure reduction but no improvement in autistic behavior. There was no correlation between epilepsy and either occurrence or degree of ID. There was a correlation between the frequency of epileptic seizures and the degree of ID. There was no significant difference among epilepsy rates in different etiologic, gender, and ID groups, probably because of the high percentage of ID and because this was a hospital-based study. Our study showed a significant percentage of epilepsy in ASD population and more than 1/4 were of symptomatic etiology. Those could be managed with specific treatments based on the pathophysiology of the gene defect. Full article
(This article belongs to the Special Issue Advances in Pediatric Epilepsy)
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