Search Results (217)

Background: Constipation in children often presents with non-specific symptoms, which can complicate its recognition in the pediatric emergency department (PED). Aim: This study aimed to characterize the clinical presentations, diagnostic context and testing patterns of children discharged with constipation from a tertiary pediatric emergency center. Methods: A retrospective analysis of medical records of patients under 18 years of age was conducted for patients who presented to the PED of a tertiary hospital in northern Poland from 2021–2024 and were ultimately discharged as K59.0 ICD-10 code (constipation). Demographic data, symptoms reported upon admission, and laboratory and imaging tests performed were collected and reviewed. Results: PED visits discharged with ICD-10 code K59.0 accounted for 2.97% of all 34,278 PED visits during study period. Among 1017 patients discharged with ICD-10 code K59.0, only 26.5% reported constipation as their main complaint. The most common complaints were abdominal pain (61.6%), vomiting (14.4%), and urinary symptoms (4.9%). Commonly suspected initial diagnoses were urinary tract infections or acute appendicitis. More complete documentation of constipation-related symptoms showed an exploratory association with less intensive diagnostic testing. Conclusions: Constipation should be routinely considered in children presenting to the PED with abdominal pain, vomiting, urinary symptoms, or rectal bleeding, even when bowel problems are not the main complaint. Structured history taking supported by simple diagnostic tools could help standardize assessment and support patient selection for further testing, although prospective studies are needed to determine clinical outcomes. Full article

Background/Objectives: Type 1 diabetes mellitus (T1DM) in primary school children presents unique challenges due to developmental dependence on adults, limited self-care abilities, and the need for continuous medical supervision. These factors may adversely affect health-related quality of life (HRQoL), particularly in early educational settings. Although diabetes-specific HRQoL assessment is essential for comprehensive pediatric diabetes care, no validated Croatian language instrument has previously been available. This preliminary study aimed to evaluate the initial validity, reliability, and factor structure of the Croatian version of the Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module. Methods: This cross-sectional preliminary study was conducted in a clinical pediatric diabetes care setting in Croatia and included 70 children with T1DM, aged 7–14 years, and their parents or caregivers, recruited using convenience sampling. HRQoL was assessed using the Croatian versions of the PedsQL 4.0 Generic Core Scales and the PedsQL 3.2 Diabetes Module, which was translated using a forward-backward translation procedure. Reliability was evaluated using Cronbach’s α and test–retest reliability using the intraclass correlation coefficient (ICC). Construct validity was examined using Spearman’s correlation analysis and exploratory factor analysis. Results: Children with T1DM reported higher overall HRQoL than parent proxy reports, except for the Diabetes symptoms scale of the PedsQL 3.2 Diabetes Module and the School functioning scale of the PedsQL 4.0 Generic Core Scales. Internal consistency was satisfactory across all scales (Cronbach’s α = 0.71–0.85). Spearman’s correlations between subscales and total scores were strong (ρ = 0.61–0.92). Test–retest reliability was excellent (ICC = 0.982–0.996). Exploratory factor analysis supported construct validity: Bartlett’s test of sphericity was significant for both child (χ² = 1398.57, p < 0.001) and parent reports (χ² = 1302.74, p < 0.001), and the Kaiser–Meyer–Olkin measure indicated acceptable sampling adequacy (child = 0.65; parent = 0.68). Extracted factors explained 66.30% of the variance in child reports and 61.80% in parent reports, with factor loadings ranging from 0.41 to 0.89 and 0.41 to 0.85, respectively. Conclusions: The Croatian version of the PedsQL 3.2 Diabetes Module is an initial valid, reliable, and feasible instrument for assessing diabetes-specific HRQoL in Croatian primary school children with T1DM. Its use may support systematic HRQoL monitoring and improve family-centered pediatric diabetes care. Full article

Background/Objectives: Hepatic glycogen storage diseases (GSDs) are rare inherited metabolic disorders requiring lifelong nutritional management and strict metabolic control, which may adversely affect the health-related quality of life (HRQoL). This study aimed to evaluate the HRQoL in children with hepatic GSD using both child and parent reports, compare findings with normative data, and explore associations with biochemical, anthropometric, and nutritional management-related parameters. Methods: The study included 23 children with hepatic GSD and their parents. HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale. Child and parent reports were compared with normative data for healthy and chronically ill children. Agreement between child and parent reports was evaluated with intraclass correlation coefficients, and exploratory associations between variables were assessed using partial Spearman correlation analyses. Results: Total and most subscale PedsQL scores reported by both children and parents were significantly lower than those of healthy peers and children with chronic diseases (p < 0.05). Parents reported lower HRQoL scores than children, particularly in psychosocial, social, and school functioning domains, with low to moderate agreement between reports. Exploratory analyses suggested that body composition and nutritional treatment burden indicators were correlated with selected HRQoL domains. Conclusions: Children with hepatic GSD experience impaired HRQoL from both child and parent perspectives. Integrating HRQoL assessment into routine clinical and nutritional follow-up may help identify unmet psychosocial and dietary support needs and support more individualized nutritional management in children with hepatic GSD. Full article

Background: Early detection of joint damage in haemophilia is essential to prevent haemophilic arthropathy. This study longitudinally evaluated joint health in paediatric patients with haemophilia in Greece using the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) scoring system. Methods: Children aged 5–18 years with haemophilia of any severity, all receiving prophylaxis, were assessed at baseline and during longitudinal follow-up visits scheduled at 6, 12, 24, and 36 months. Evaluations included HEAD-US and Haemophilia Joint Health Score (HJHS), functional ability (PedHAL), health-related quality of life (HRQoL), and pain (BPI). Results: Forty-seven boys (mean age 11.5 ± 3.7 years) were included (severe 83%, moderate 11%, mild 6%). Baseline HEAD-US scores were low (mean ± SE: 0.22 ± 0.069). No significant overall change was observed over time, although left knee showed significant improvement (p < 0.05). Ankles consistently exhibited higher scores compared to other joints (p < 0.05). Synovitis was the most frequent abnormality, while cartilage damage was infrequent and subchondral bone changes were negligible. HEAD-US detected more abnormalities than HJHS. Conclusions: Joint health was well preserved under prophylaxis, with synovitis representing the earliest detectable change, although interpretation is limited by incomplete long-term follow-up. HEAD-US proved more sensitive than clinical assessment, supporting its role in routine longitudinal monitoring. Full article

Background/Objectives: This study compared choroidal morphological changes, including choroidal vascularity index (CVI) and layer-specific choroidal thickness, between aflibercept 8 mg and faricimab-svoa in treatment-naïve polypoidal choroidal vasculopathy (PCV) and pachychoroid neovasculopathy (PNV). Methods: This retrospective study included 66 eyes treated with aflibercept 8 mg (n = 32) or faricimab-svoa (n = 34). Following three monthly loading injections, a pro re nata regimen was employed for 6 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), pigment epithelial detachment (PED) height, and CVI were assessed. Results: Both groups demonstrated significant improvements in BCVA, CMT, SFCT, and PED height at 6 months (all p < 0.05), with no between-group differences. Dry macula rates were 75.0% and 79.4%, respectively. Faricimab-svoa was associated with a significantly greater CVI increase (0.037 vs. 0.018, p = 0.003), driven by a numerically greater reduction in choriocapillaris/Sattler’s layer thickness (−18.9 ± 16.4 μm vs. −13.8 ± 15.8 μm, p = 0.153). Conclusions: Both agents achieved comparable functional and anatomical outcomes in treatment-naïve PCV and PNV. Faricimab-svoa was associated with a greater CVI increase, reflecting differential choroidal remodeling. CVI may serve as a biomarker for differentiating the choroidal effects of second-generation anti-VEGF therapies in pachychoroid spectrum disease. Full article

Airport systems rely on tightly connected digital and physical components, so cyber disruptions can affect both service performance and passenger movement. Existing airport simulation studies often focus on either queue-based passenger processing or pedestrian movement but rarely combine both in a framework suited for cyber-resilience analysis. This paper presents a hybrid simulation framework that integrates discrete-event simulation (DES), JuPedSim-based microscopic pedestrian modeling, and structured large language model (LLM) decision support to examine how cyber disruptions propagate through passenger-facing airport operations. The DES layer models service processes such as check-in, information desks, and security screening, while the pedestrian layer models movement, congestion, route choice, and spatial occupancy. Under degraded display or guidance conditions, the LLM generates structured passenger-level post-security decisions, such as going directly to the gate, checking a display, asking staff, waiting, visiting optional activity areas, or first moving to a wrong intermediate area. The framework is evaluated through a 500-passenger terminal case study with one baseline case and four disruption cases. Results show that check-in and security degradation produce the largest throughput loss, queue growth, and completion-time increase, while guidance degradation mainly affects post-security behavior. Spatial heatmaps further show where bottlenecks emerge and how congestion shifts across the terminal. Additional Rotterdam checkpoint validation, Palma benchmark analysis, and LLM ablation results support the framework’s ability to reproduce plausible queue, timing, throughput, and behavior-sensitive disruption patterns. The study provides a practical methodology for exploratory airport cyber-resilience assessment under coupled service, movement, and degraded-guidance conditions. Full article

Background/Objectives: Drooling is a common and clinically relevant issue in children with neurodevelopmental conditions, with important consequences for daily functioning, social participation, and caregiver burden. The lack of validated tools in Italian makes it difficult to quantify the impact of drooling on daily life, support appropriate care pathways, and evaluate the effectiveness of interventions. The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Italian version of the Drooling Impact Scale (DIS) in a pediatric population. Methods: The DIS is a 10-item caregiver-reported outcome measure, with each item rated on an ordinal 0–10 scale, designed to assess the functional and psychosocial impact of drooling. It was translated using a standard forward–backward procedure, followed by expert review and cognitive debriefing with caregivers. Caregivers of children aged ≥2 years with heterogeneous neurodevelopmental conditions and feeding/swallowing impairments were consecutively recruited from a tertiary pediatric hospital. Psychometric properties were assessed in line with COSMIN recommendations, including internal consistency (Cronbach’s α), structural validity through exploratory factor analysis, inter-rater and test–retest reliability (intraclass correlation coefficients, ICC), measurement error (standard error of measurement, SEM; smallest detectable change, SDC), and construct validity through correlation with the Pediatric Quality of Life Inventory (PedsQL). Results: The Italian DIS was completed by caregivers of 126 children. It showed excellent internal consistency (Cronbach’s α = 0.92). Factor analysis indicated a clear dominant factor, explaining 56.5% of the variance, while additional factors contributed only marginally. Agreement between caregivers was excellent (ICC = 0.94), and test–retest reliability was good (ICC = 0.85). Measurement error analysis yielded SEM = 8.66, SDC_individual = 24.00, and SDC_group = 2.14. As expected, DIS scores were associated with health-related quality of life. Conclusions: The Italian version of the DIS appears to be a reliable and structurally sound instrument for assessing the impact of drooling in children with neurodevelopmental conditions. It may be useful in both clinical practice and research, although further studies are needed to explore its responsiveness and confirm these findings in different settings. Full article

Urban flexibility research is expanding across buildings, electric vehicles (EVs), distributed energy resources (DERs), storage, positive energy districts (PEDs), digital twins, and interoperability platforms. These strands are often reviewed separately, although urban distribution operators must manage their combined impacts on the same feeders. This paper presents a PRISMA 2020-aligned systematic review with evidence mapping and narrative synthesis of feeder-aware coordination in smart-city electricity systems. Searches of Scopus, Web of Science, IEEE Xplore, ScienceDirect, and citation chasing identified 312 records; 127 studies were included after screening and eligibility assessment, 101 entered the quantitative mapping sample, and 31 formed the deep-synthesis anchor core. Sparse contingency tables were analyzed with Monte-Carlo permutation chi-square tests and bootstrap confidence intervals for Cramér’s V, while ordinal variables were summarized with medians and interquartile ranges. Explicit feeder grounding was concentrated in grid-oriented and EV-oriented studies, whereas many AI/digital-twin and interoperability studies were less often validated against distribution-network operation. Economic and peak-flexibility indicators were reported far more often than interoperability, cybersecurity, or validation-maturity indicators in the anchor core. The synthesis also showed that deployment-oriented work depends on clearer treatment of standards, co-simulation workflows, regulatory instruments, and stakeholder roles. The evidence base is heterogeneous, English-only, and single-coded, so the quantitative results are descriptive rather than population-level. The review contributes a transparent three-layer corpus design (127 included/101 mapped/31 anchor), a domain-specific specialization of SGAM/IEEE 2030 for urban feeder orchestration, an operational digital-twin definition and validation ladder, a retrofittable benchmarking framework, and a practical roadmap for DSOs, municipalities, aggregators, EV operators, building managers, and ICT providers. Full article

Background/Objective: This study’s aim is to evaluate the anatomical and functional effects of selective retina therapy (SRT) in patients with central serous chorioretinopathy (CSC) accompanied by serous pigment epithelial detachment (PED). Methods: This retrospective study included 32 eyes from 32 patients with CSC and serous PED treated with SRT. Pulse energy and micropulse number were adjusted based on test spot visibility on fundus photographs. Best-corrected visual acuity (BCVA; logMAR), central foveal thickness (CFT), subretinal fluid (SRF) height, PED height, and subfoveal choroidal thickness were assessed at baseline and at 1, 2, and 3 months post-treatment. Retinal sensitivity was evaluated using microperimetry at baseline and 3 months. Results: At 3 months after SRT, complete SRF resolution was achieved in 78.1% of eyes (25/32). Mean BCVA improved significantly from 0.29 ± 0.30 logMAR at baseline to 0.20 ± 0.29 logMAR (p = 0.006). Mean CFT decreased from 284.7 ± 91.3 µm to 165.7 ± 94.8 µm (p < 0.001). Mean SRF height decreased from 150.5 ± 74.6 µm to 20.9 ± 48.3 µm (p < 0.001), and mean PED height decreased from 101.7 ± 96.9 µm to 33.3 ± 37.6 µm (p < 0.001). Retinal sensitivity showed a non-significant improvement at 3 months (p = 0.108). Reduction in PED height was moderately correlated with reduction in SRF height (r = 0.446, p = 0.011). Conclusions: SRT was associated with reductions in PED and SRF in CSC. These findings should be interpreted cautiously given the absence of a control group and the potential for spontaneous changes in SRF and PED. Full article

The carriage of portable electronic devices (PED) powered by lithium-ion batteries in the aircraft cabin today is a fact. Passengers carry several such batteries in mobile phones, tablets, laptops, e-cigarettes, power banks, etc. Even though rare, there is a remaining risk that a Li-ion battery experiences thermal runaway. This typically results in the emission of smoke and gas as well as the emergence of flames and fire, thus posing a threat to safe operation. To meet this challenge, procedures have been defined, and additional mitigation means have emerged on the market. This study presents an anonymized assessment of additional mitigation means. For this, manufacturers provided samples of their product on a voluntary basis to test the potential to contain a Li-ion battery fire. Furthermore, handling was evaluated by a panel of cabin crew members. As a result, a series of recommendations for additional mitigation means and procedures was derived. Full article

Background: Congenital sucrase–isomaltase deficiency (CSID) may mimic functional gastrointestinal disorders (FGIDs) and is likely underrecognized in pediatric practice. This study aimed to determine the frequency of sucrase–isomaltase (SI) gene variants among children with FGIDs and to evaluate genotype–phenotype associations and treatment-related quality-of-life outcomes. Methods: In this prospective cross-sectional study, children aged 0–18 years diagnosed with FGIDs according to Rome IV criteria were enrolled between May 2022 and January 2023. All patients underwent next-generation sequencing for SI gene variants. Clinical characteristics, FGID subtypes, and anthropometric data were recorded. Variant-positive patients received dietary sucrose restriction, and selected patients were treated with sacrosidase enzyme replacement. Symptom severity was assessed using the Numeric Rating Scale, and quality of life was evaluated with the Pediatric Quality of Life Inventory (PedsQL 4.0). Results: Among 290 children with FGIDs, SI gene variants were identified in 17 patients (5.9%). Variants were more frequently detected in children with irritable bowel syndrome–like symptoms. Clinical presentation was heterogeneous, and no consistent genotype–phenotype correlation was observed. Dietary intervention was associated with symptom improvement in compliant patients, while sacrosidase therapy led to significant improvements in both child- and parent-reported PedsQL scores. Conclusions: Sucrase–isomaltase deficiency is not uncommon among children with FGIDs and should be considered, particularly in those with IBS-like symptoms or diet-related complaints. Integrating genetic evaluation with targeted dietary and enzyme-based therapy may improve symptom control and quality of life in selected pediatric patients. Full article

Urban plazas in hot-humid climates face severe heat exposure risks due to high sky view factors and limited shading, yet conventional thermal mitigation strategies predominantly rely on plaza-wide performance metrics that misalign with actual pedestrian exposure patterns. This study proposes a pedestrian-oriented microclimate optimization framework that integrates agent-based pedestrian movement simulation (PedSim) with coupled CFD microclimate modeling to enhance outdoor thermal comfort precisely where people walk and congregate. A representative urban plaza (32,300 m²) in a hot-humid climate was analyzed under extreme summer design conditions. Three scenarios were systematically compared: (1) baseline configuration, (2) plaza-wide greening optimization (uniform distribution), and (3) pedestrian-oriented optimization guided by exposure-weighted movement hotspots. Microclimatic variables were simulated using urbanMicroclimateFoam (OpenFOAM), incorporating coupled airflow, heat/moisture transport, radiation, and vegetation modules. Thermal comfort was quantified using Mean Radiant Temperature (MRT) and the Universal Thermal Climate Index (UTCI) at both plaza-wide and pedestrian hotspot scales. Winter simulations were further conducted to assess seasonal trade-offs. Results demonstrate that under identical green coverage ratio (6.6%), the pedestrian-oriented strategy achieves substantially greater thermal comfort improvements in high-use areas. Compared to the baseline, hotspot MRT and UTCI were reduced by up to 5.0 °C and 3.0 °C, respectively, whereas the plaza-wide scheme yielded only marginal improvements (ΔUTCI < 1 °C). Notably, the pedestrian-oriented layout outperformed plaza-wide optimization within hotspots by 0.8 °C UTCI reduction without compromising winter thermal comfort, maintaining 100% thermally comfortable area ratios in both scenarios. This research reveals that the spatial configuration of vegetation is equally critical as coverage quantity for pedestrian thermal exposure. By explicitly linking tree placement to movement patterns, the proposed framework offers a human-centered, resource-efficient pathway for climate-responsive urban design, providing actionable insights for mitigating heat stress in densely populated open spaces without increasing green infrastructure costs. Full article

Background: Functional gastrointestinal disorders (FGIDs) are highly prevalent among infants. Exclusive breastfeeding has been consistently associated with better gastrointestinal health. However, current evidence regarding the associations between early feeding practices and infant gastrointestinal development remains limited. Objectives: To examine the associations between early feeding practices at 1 month of age and gastrointestinal symptoms and overall gastrointestinal burden in infants during the first 12 months of life. Methods: In this multicenter prospective cohort study, 669 healthy mother–infant pairs were finally included. According to feeding practices at 1 month of age, infants were categorized into three groups: exclusive direct breastfeeding (EDB, n = 236, 35.28%), bottle-fed expressed breastmilk (EBB, n = 150, 22.42%), and mixed feeding (MF, n = 283, 42.30%). Gastrointestinal (GI) symptoms were assessed using the Infant Gastrointestinal Symptom Questionnaire (IGSQ) and symptom items from the PedsQL™ Infant Scales. Generalized estimating equations (GEEs) were used to assess the associations. Results: Infants in the EDB group had the lowest incidence of GI symptoms and lower IGSQ scores throughout the follow-up period. Compared with EDB, the MF group showed higher IGSQ scores (β = 0.95, p = 0.002) and higher odds of constipation (OR = 1.64, p < 0.001), vomiting (OR = 1.70, p < 0.001), and swallowing difficulty (OR = 1.79, p = 0.002); these associations remained robust across multiple sensitivity analyses. The EBB group showed higher odds of certain symptoms in the main analysis, but sensitivity analyses (e.g., time-varying exposure) indicated that these associations were not robust, except for bloating (OR = 1.31, p = 0.042). Conclusions: The EDB is the optimal strategy for infant gastrointestinal health and should be prioritized. The MF is robustly associated with increased odds of constipation, vomiting, swallowing difficulty, and overall gastrointestinal burden. The EBB may slightly increase the odds of bloating, which can be mitigated by paced feeding and adequate burping. Full article

Background: Families caring for children with medical complexity (CMC) face sustained psychosocial demands that may impair health-related quality of life (HRQoL) and mental health. A clear map of how these outcomes are assessed and which factors shape them is needed to guide family-centered care. Methods: We conducted a scoping review following the Joanna Briggs Institute guidelines, and reports were prepared according to the PRISMA guidelines. Searches were conducted in PubMed, CINAHL, and EMBASE (January 2011 to December 2023) to find studies reporting on health-related quality of life (HRQoL) and/or mental health outcomes (anxiety, depression, burden) of family members and/or caregivers of CMC, including operationalization based on complex chronic condition (CCC) classifications, technology dependency, or the Pediatric Medical Complexity Algorithm (PMCA). Two reviewers independently screened records and recorded data, and the findings were synthesized narratively and thematically. Results: Sixty-seven studies met the inclusion criteria and spanned cross-sectional, cohort, case–control, pre–post and qualitative designs across conditions such as epilepsy, congenital heart disease, cerebral palsy, technology dependence and cancer. Common measures were PedsQL™ Family Impact Module, SF-36/12, HADS, Beck inventories and Zarit burden scales. Across the included studies, caregivers, predominantly mothers, frequently reported poorer HRQoL and higher levels of anxiety, depressive symptoms, or burden than comparison groups when these were available. Six recurrent themes emerged: (1) gendered caregiving with disproportionate maternal burden; (2) socio-economic gradients and financing models shaping outcomes; (3) culture, religion and spirituality as coping resources; (4) family and social support buffering distress; (5) school participation and coordinated services potentially reducing burden; and (6) interdependence between caregiver and child outcomes. Conclusions: Heterogeneous CMC definitions, outcome measures, and study designs limited comparability across studies. The mapped evidence suggests that family HRQoL and mental health outcomes are shaped by interacting clinical, social, and contextual factors. These findings may inform more family-centered and equity-oriented approaches to care. Future research should harmonize CMC definitions, standardize outcome measures, and prospectively evaluate multicomponent interventions. Full article

Background. Overcrowding in emergency departments (EDs), particularly pediatric emergency departments (PEDs), remains a significant challenge that affects patient outcomes and the efficiency of healthcare. Rapid diagnostic tests (RDTs) for respiratory viruses could be a promising tool for improving patient management by enabling prompt etiological diagnoses. This study investigated whether positive RDT results for influenza or adenovirus were associated with differences in length of stay (LOS) in a tertiary PED during epidemic seasons. Methods. A retrospective cohort study was conducted at IRCCS Istituto Giannina Gaslini, Genoa, Italy, over two epidemic seasons (December–February, 2023–2025). All consecutive pediatric patients presenting with fever and respiratory symptoms who underwent rapid diagnostic testing for influenza and/or adenovirus during two epidemic seasons were included. LOS was assessed as the time from triage to discharge (TTD) and from physician assignment to discharge (ATD). Patients were stratified by positive versus negative RDT results. Analyses between groups used the Mann–Whitney U-test for continuous variables and chi-square or Fisher’s exact test for categorical variables. A two-tailed p-value < 0.05 was considered significant. Results. Of the 1238 patients analyzed, the median age was 3.3 years (IQR 1.4–7.2), with male predominance (58.1%). A total of 330 patients (26.6%) tested positive. Compared with negative results, positive RDTs were associated with shorter median TTD (217.0 vs. 239.0 min, p < 0.001) and ATD (66.0 vs. 148.5 min, p < 0.001), which was consistent in both the influenza and adenovirus subgroups. No significant difference in 72 h readmission rates was observed between groups. Conclusions. Among children tested with RDTs for influenza and adenovirus, positive results were associated with reduced PED LOS without increasing early return visits. While these findings suggest a potential role in supporting patient flow, conclusions regarding the broader impact on PED overcrowding should be drawn with caution. Further prospective studies, including non-tested controls and additional viral targets, are required. Full article