Search Results (8,708)

Background and Objectives: This study aimed to explore the risk factors of histopathological crescent formation in pediatric IgA vasculitis nephritis (IgAVN). Materials and Methods: Enrolled patients with biopsy-proven IgAVN from Zhejiang University’s hospital were split into two groups: 377 with no crescents on histopathology (Group 1) and 364 with crescentic nephritis (Group 2). Collected data included clinical features, lab indicators, histopathological grading, and factors causing glomerular sclerosis. Logistic regression was used to assess factors affecting crescent formation in IgAVN. Double-immunofluorescence assay was used to detect TGF-β1, MCP-1, α-SMA, Collagen I, and FN1 in kidney biopsy specimens. The relationship between kidney fibrosis factors and histopathological grade were analyzed using Chi-square and Pearson tests. Results: A total of 741 patients with IgAVN were included in the study. Univariate logistic regression identified potential factors related to crescent formation, including age, gender, clinical classification, hematuria grade, 24 h urine protein level, peripheral white blood cells (WBCs), serum albumin, Cystatin-C, APTT, and PT. Multivariate analysis revealed statistical significance for age, 24 h urine protein, and WBCs across pathological grades (p < 0.05). Mantel–Haenszel Chi-square tests indicated a linear relationship between IgAVN pathological grade and α-SMA, TGF-β1, MCP-1, and FN1. Pearson correlation analysis confirmed a positive correlation between pathological grade and these markers. Conclusions: Age, 24 h urinary protein, and blood WBCs are identified as risk factors for histopathological crescent formation in children with IgAVN. Additionally, a higher pathological grade is associated with more pronounced fibrosis indicators. Full article

Metro carriages, as enclosed transport microenvironments, have been understudied regarding pollution characteristics and health risks from ACs, especially during high-temperature summers that amplify exposure. This study applied NTS techniques for the first time across three major Chengdu metro lines, systematically identifying sixteen ACs, including hazardous species such as acetophenone, benzonitrile, and benzoic acid that are often overlooked in conventional BTEX-focused monitoring. The TAC concentration reached 41.40 ± 5.20 µg/m³, with half of the compounds exhibiting significant increases during peak commuting periods. Source apportionment using diagnostic ratios and PMF identified five major contributors: carriage material emissions (36.62%), human sources (22.50%), traffic exhaust infiltration (16.67%), organic solvents (16.55%), and industrial emissions (7.66%). Although both non-cancer (HI) and cancer (TCR) risks for all population groups were below international thresholds, summer tourists experienced higher exposure than daily commuters. Notably, child tourists showed the greatest vulnerability, with a TCR of 5.83 × 10⁻⁷, far exceeding that of commuting children (1.88 × 10⁻⁷). Benzene was the dominant contributor, accounting for over 50% of HI and 70% of TCR. This study presents the first integrated NTS and quantitative risk assessment to characterise ACs in summer metro environments, revealing a broader range of hazardous compounds beyond BTEX. It quantifies population-specific risks, highlights children’s heightened vulnerability. The findings fill critical gaps in ACs exposure and provide a scientific basis for improved air quality management and pollution mitigation strategies in urban rail transit systems. Full article

Background and Objectives: Dual-task training (DTT) is an innovative therapeutic approach that involves the simultaneous application of two tasks, which can be motor, cognitive, or a combination of both. Children with cerebral palsy (CP) often exhibit impairments in balance, motor skills, and gait, conditions that may be amenable to improvement through DTT. The aim of this study was to determine the effectiveness of DTT in enhancing balance, walking speed, and gross motor function-related balance in children with CP. Materials and Methods: In accordance with PRISMA guidelines, a comprehensive systematic review with meta-analysis (SRMA) was conducted. Electronic databases like PubMed Medline, Scopus, Web of Science, CINAHL, and PEDro were searched up to March 2025, with no language or publication date restrictions. Only randomized controlled trials (RCTs) examining the effectiveness of DTT on balance, gross motor function, and walking speed in children with CP were included. The methodological quality and risk of bias of the included RCTs were assessed using the PEDro scale. Pooled effects were calculated using Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI) within random-effects models. Results: Eight RCTs, providing data from 216 children, were included. Meta-analyses suggested that DTT was more effective than conventional therapies for increasing functional (SMD = 0.65; 95% CI 0.18 to 1.13), dynamic (SMD = 0.61; 95% CI 0.15 to 1.1), and static balance (SMD = 0.46; 95% CI 0.02 to 0.9), as well as standing (SMD = 0.75; 95% CI 0.31 to 1.18; p = 0.001) and locomotion dimensions (SMD = 0.65; 95% CI 0.22 to 1.08) of the Gross Motor Function Measure (GMFM) and walking speed (SMD = 0.46; 95% CI 0.06 to 0.87). Subgroup analyses revealed that a motor–cognitive dual task is better than a motor single task for functional, dynamic, and static balance and standing and locomotion dimensions for the GMFM. Conclusions: This SRMA, including the major number of RCTs to date, suggests that DTT is effective in increasing balance, walking and gross motor function-related balance in children with CP. Full article

Background: Cochlear implantation (CI) in pediatric patients with cochlear nerve deficiencies (CND) remains controversial due to a highly variable clinical population, lack of evidence-based guidelines, and mixed research findings. This study assessed current clinical perspectives and practices regarding CI candidacy in children with CND among hearing healthcare professionals in the USA. Methods: An anonymous 19-question online survey was distributed to CI clinicians nationwide. The survey assessed professional background, experience with aplasia and hypoplasia, and perspectives on CI versus auditory brainstem implant (ABI) candidacy, including imaging practices and outcome expectations. Both multiple-choice and open-ended responses were analyzed to identify trends and reasoning. Results: Seventy-two responses were analyzed. Most clinicians supported CI for hypoplasia (60.2%) and, to a lesser extent, for aplasia (41.7%), with audiologists more likely than neurotologists to favor CI. Respondents cited lower risk, accessibility, and the potential for benefit as reasons to attempt CI before ABI. However, many emphasized a case-by-case approach, incorporating imaging, electrophysiological testing, and family counseling. Only 22.2% considered structural factors the best predictors of CI success. Conclusions: Overall, hearing health professionals in the USA tend to favor CI as a first-line option, while acknowledging the limitations of current diagnostic tools and the importance of individualized, multidisciplinary decision-making in CI candidacy for children with CND. Findings reveal a high variability in clinical perspectives on CI implantation for pediatric aplasia and hypoplasia and a lack of clinical consensus, highlighting the need for more standardized assessment and imaging protocols to provide greater consistency across centers and enable the development of evidence-based guidelines. Full article

Objectives: Norovirus outbreaks occur in densely populated environments, such as long-term care facilities, hospitals, and schools. On 22 October 2022, an outbreak of acute gastroenteritis was reported at a kindergarten in Korea. An epidemiologic investigation was conducted to identify the source of the infection and prevent further spread. Methods: Rectal swab and environmental samples were collected for bacterial and viral testing. A retrospective cohort study was conducted among 114 kindergarteners at the kindergarten. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated to assess associations of contact with the primary case, as well as food and water consumption. Results: Of the kindergarteners, 28 out of 114 (24.6%) met the case definition. The primary case occurred on 19 October, and subsequent cases began on 21 October. Sharing the same four-year-old class as the primary case (RR, 2.56; 95% CI, 1.35–4.87), being in the same regular class (RR, 2.37; 95% CI, 1.27–4.41), being on the same floor during after-school class (RR, 3.49; 95% CI, 1.74–7.00), and attending the same English class (RR, 1.98; 95% CI, 1.05–3.72) were statistically significant. Consumption of drinking water on the third floor and fourth floor on 20 October had significantly higher and lower RRs, respectively. Norovirus was detected in 9 out of 18 rectal swab samples (50.0%). Conclusions: This norovirus outbreak at the kindergarten was presumed to have been caused by person-to-person transmission from the primary case. Isolation and restriction of symptomatic children in kindergartens should be thoroughly implemented. Additionally, enhanced surveillance among family members of affected individuals is necessary to prevent further outbreaks. Full article

Background/Objective: The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19. Objective: This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco. Methods: This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021. Results: The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids. Conclusions: This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided. Full article

(1) The beach areas of Galveston, Texas, USA are heavily used for recreational activities and often experience elevated fecal indicator bacteria levels, representing a potential threat to ecosystem services, human health, and tourism-based economies that rely on suitable water quality. (2) During the span of 15 months (March 2022–May 2023), water samples that exceeded the U.S. Environmental Protection Agency-accepted alternative Beach Action Value (BAV) for enterococci of 104 MPN/100 mL were analyzed via microbial source tracking (MST) through quantitative polymerase chain reaction (qPCR) assays. The Bacteroides HF183 and DogBact as well as the Catellicoccus LeeSeaGull markers were used to detect human, dog, and gull fecal sources, respectively. The qPCR MST data were then utilized in a quantitative microbial risk assessment (QMRA) to assess human health risks. Additionally, samples collected in July and August 2022 were sequenced for 16S rRNA and matched with fecal sources through the Bayesian SourceTracker2 program. (3) Overall, 26% of the 110 samples with enterococci exceedances were positive for at least one of the MST markers. Gull was revealed to be the primary source of identified fecal contamination through qPCR and SourceTracker2. Human contamination was detected at very low levels (<1%), whereas dog contamination was found to co-occur with human contamination through qPCR. QMRA identified Campylobacter from canine sources as being the primary driver for human health risks for contact recreation for both adults and children. (4) These MST results coupled with QMRA provide important insight into water quality in Galveston that can inform future water quality and beach management decisions that prioritize public health risks. Full article

This study investigated pesticide residues in 580 vegetable samples collected from markets in Serbia, encompassing potatoes, carrots, celery, radishes, horseradish, ginger, onions, and leeks. In total, 33 distinct pesticides were detected using validated HPLC-MS/MS and GC-MS/MS analytical methods. Multiple residues were identified in 19 samples, while 29 samples exceeded established maximum residue levels (MRLs). Acute and chronic dietary risks were assessed for both adults and children. Although individual hazard quotients (HQs) for adults and children remained below the threshold of concern (HQ < 1), the cumulative acute risk reached up to 63.1% of the Acute Reference Dose (ARfD) for children and 51.1% ARfD for adults, with ginger and celery posing the highest risks. Similarly, cumulative chronic risks remained below the safety threshold, with the Acceptable Daily Intake (ADI) percentages reaching a maximum of 5.9% ADI for adults and increased vulnerability of 11.0% ADI among children. Monte Carlo simulations were applied to account for variability and uncertainty in chronic exposure estimates. The hazard index (HI) results showed that adverse health effects for both population groups remained within acceptable safety limits (HI < 1), although higher susceptibility was observed in children. Sensitivity analysis identified body weight and vegetable consumption rates as the most influential factors affecting chronic risk variability. Full article

Phubbing, a relatively new phenomenon in the field of digital risks, refers to the act of ignoring someone in favor of focusing on a smartphone during face-to-face interactions. Parental phubbing, a specific form of this behavior, is a prevalent negative parenting practice that can affect parent–child relationships and child development. However, the impact of parental phubbing on the emotional and behavioral development of preschool children remains unclear. This study aims to explore the relationship between parental phubbing and preschoolers’ behavioral problems, as well as test whether parents’ mindful attention awareness (MAA) acts as a mediator between them. Method: A questionnaire was administered to 138 Italian parents (mean age = 38.5, SD = 6.2) of 138 kindergarten preschoolers (mean age = 3.9, SD = 1.03). Questionnaires included the Generic Scale of Phubbing (GSP), the Mindful Attention Awareness Scale (MAAS), and the Strengths and Difficulties Questionnaire (SDQ). Results: Analyses revealed a significant negative correlation between the MAAS and SDQ total scores, a positive correlation between the GSP total score and the SDQ total score, and a negative correlation between the GSP total score and the MAAS total score. The mediation analysis did not show a direct effect of GSP on SDQ, suggesting that parental phubbing did not directly predict children’s behavioral difficulties. Nevertheless, the indirect effect measured by bootstrapping was significant, indicating that parental MAA fully mediated the relationship between parental phubbing and preschoolers’ problematic behaviors. Conclusions: Although further research is needed, parental mindfulness may influence phubbing behaviors in parents providing valuable insights for early interventions aimed at reducing problem behaviors in young children. Full article

Background/Objectives: Malnutrition is an imbalance of nutrients required for growth, development, and organ function. Its impact on bone development is known, but its effects on cartilage remain unclear. This study aimed to evaluate the femoral cartilage thickness in children with primary malnutrition. Methods: In this cross-sectional observational study, 83 children with primary malnutrition and 62 age- and sex-matched healthy controls were included. Patients with primary malnutrition were classified as mild, moderate and severe. Femoral cartilage thickness measurements of all children were taken by ultrasound from the femoral lateral condyle, femoral medial condyle and intercondylar area for both knees with the patient in a supine position with the knees flexed 90 degrees. Results: The right lateral, right medial, left lateral, and left medial femoral cartilages were significantly thicker in patients with malnutrition compared to those without malnutrition (p = 0.002, 0.004, <0.001, and 0.001, respectively). A significant negative correlation was found between age, weight Z-score, and height Z-score and triceps skinfold thickness. Conclusions: Distal femoral cartilage thickness is significantly greater in children with primary malnutrition. This demonstrates the effect of nutritional factors on cartilage tissue and suggests that children with chronic malnutrition are at risk for both knee joint problems and short stature later in life. Full article

The quality of water in households can be affected by plumbing design and materials, water usage patterns, and source water quality characteristics. These factors influence stagnation duration, disinfection residuals, metal release, and microbial activity. In particular, stagnation can degrade water quality and increase lead release from lead service lines. This study employs numerical modeling to assess how combined corrosion control and flushing strategies affect lead levels in household taps with lead service lines under reduced water use. To estimate potential health risks, the U.S. EPA model is used to predict the percentage of children likely to exceed safe blood lead levels. Lead exceedances are assessed based on various regulatory requirements. Results show that exceedances at the kitchen tap range from 3 to 74% of usage time for the 5 µg/L standard, and from 0 to 49% for the 10 µg/L threshold, across different scenarios. Implementing corrosion control treatment in combination with periodic flushing proves effective in lowering lead levels under the studied low-consumption scenarios. Under these conditions, the combined strategy limits lead exceedances above 5 µg/L to only 3% of usage time, with none above 10 µg/L. This demonstrates its value as a practical short-term strategy for households awaiting full pipe replacement. Targeted flushing before peak water use reduces the median time that water remains stagnant in household pipes from 8 to 3 h at the kitchen tap under low-demand conditions. Finally, the risk model indicates that the combined approach can reduce the predicted percentage of children with blood lead levels exceeding 5 μg/dL from 61 to 6% under low water demand. Full article

Shaken Baby Syndrome (SBS) is one of the primary causes of fatal head trauma in infants and young children, occurring in about 33 per 100,000 infants annually in the U.S., with mortality rates being between 15% and 38%. Survivors frequently endure long-term disabilities, such as cognitive deficits, visual impairments, and motor dysfunction. Diagnosing SBS remains difficult due to the lack of visible injuries and delayed symptom onset. Existing detection methods—such as neuroimaging, biomechanical modeling, and infant monitoring systems—cannot perform real-time detection and face ethical, technical, and accuracy limitations. This study proposes an inertial measurement unit (IMU)-based detection system enhanced with machine learning to identify aggressive shaking patterns. Findings indicate that wearable-based motion analysis is a promising method for recognizing high-risk shaking, offering a non-invasive, real-time solution that could minimize infant harm and support timely intervention. Full article

Childhood obesity increases chronic disease risk, but no comprehensive synthesis has evaluated the impact of school-based combined nutrition education and physical activity interventions on cardiometabolic biomarkers in children aged 3 to 12 years. This systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251085194). Five databases were systematically searched through June 2025. Twelve randomized controlled trials involving 18,231 children were included and assessed using the PEDro scale. Ten trials demonstrated significant improvements in at least one cardiometabolic biomarker. Blood pressure (8 studies) outcomes showed systolic reductions of 1.41–6.0 mmHg in six studies. Glucose metabolism (5 studies) improved in two studies with reductions of 0.20–0.22 mmol/L. Lipid profiles (7 studies) improved in three studies, including total cholesterol (−0.32 mmol/L). Insulin levels (5 studies) decreased significantly in two investigations. Anthropometric improvements included BMI and body fat. Physical activity increased by >45 min/week and dietary habits improved significantly. Programs with daily implementation (90-min sessions 4x/week), longer duration (≥12 months), family involvement (parent education), and curriculum integration (classroom lessons) showed superior effectiveness. Interventions targeting children with overweight/obesity demonstrated higher changes compared to the general population. However, methodological limitations included a lack of assessor blinding, absence of subject/therapist blinding, and inadequate retention rates. School-based interventions combining nutrition and physical activity can produce significant improvements in cardiometabolic biomarkers, supporting comprehensive, sustained multicomponent programs for early chronic disease prevention. Full article

Air pollution is linked to childhood mortality and morbidity in low- and middle-income countries globally. There is growing evidence linking air pollution to asthma and other respiratory diseases in children. Studies have shown that children are likely to experience asthma due to their narrow airways and their heightened sensitivity to environmental irritants. This study aims to investigate the relationship between ambient air pollution and respiratory diseases in children under the age of 5. The study will be conducted in the informal township of Alexandra, north of Johannesburg, South Africa. A quantitative approach will be used in this cross-sectional analytical study. Data will be collected using different tools that include a questionnaire to determine the prevalence of asthma and respiratory disease and potential risk factors. While environmental air pollution will be measured using Radiello passive samplers and Gillian pumps. Data will be analyzed using the latest version of the STATANow/MP 19.5 software. Furthermore, health risk assessment will be conducted for lifetime non-carcinogenic and carcinogenic risk estimation following the USEPA framework. The study will identify environmental triggers that exacerbate asthma and other respiratory conditions in other similar community settings and will contribute to the body of knowledge in public health. Ethical approval was obtained from the Research Ethics Committee, Faculty of Health Sciences at the University of Johannesburg. Full article

Seafood contamination by heavy metals is a growing public health concern, particularly in regions like Tunisia where seafood is a major dietary component. This study assessed concentrations of cadmium (Cd), copper (Cu), lead (Pb), and zinc (Zn) in the muscle tissue of the red shrimp Parapenaeus longirostris, collected in 2023 from four coastal regions: Bizerte, Monastir, Kerkennah, and Gabes. Metal analysis was conducted using flame atomic absorption spectroscopy. This species was chosen due to its ecological and economic importance. The study sites were chosen based on their differing levels of industrial, urban, and agricultural influence, providing a representative overview of regional contamination patterns. Mean concentrations were 1.04 µg/g for Zn, 0.59 µg/g for Cu, 1.56 µg/g for Pb, and 0.21 µg/g for Cd (dry weight). Pb was the most prevalent metal across sites. Statistically significant variation was observed only for Cu (p = 0.0334). All metal concentrations were below international safety limits set by FAO/WHO and the European Union. Compared to similar studies, the levels reported were similar or slightly lower. Human health risk was evaluated using target hazard quotient (THQ), hazard index (HI), and cancer risk (CR) values. For adults, THQ ranged from 5.44 × 10⁻⁶ to 8.43 × 10⁻⁴, while for children it ranged from 2.40 × 10⁻⁵ to 3.72 × 10⁻³. HI values were also well below 1, indicating negligible non-carcinogenic risk. CR values for Cd and Pb in both adults and children fell within the acceptable risk range (10⁻⁶ to <10⁻⁴), suggesting no significant carcinogenic concern. This study provides the first field-based dataset on metal contamination in P. longirostris from Tunisia, contributing valuable insights for seafood safety monitoring and public health protection. Full article