Search Results (3,055)

Background/Objectives: The aim of this study was to evaluate the tolerability and effectiveness of subcutaneous immunotherapy (SCIT) in allergic adults and children treated with a polymerized-glutaraldehyde undiluted mixture of house dust mites (HDMs) under routine clinical practice. Methods: This was an observational, ambispective, controlled, real-world, multicenter study including patients ≥ 5 years with allergic rhinitis (AR), due to Dermatophagoides sensitization. Patients who started AIT with a D. pteronyssinus/D. farinae extract and those who continued symptomatic treatment were included in the treatment (DP&DF) and untreated (UT) groups, respectively. We evaluated adverse reactions (ARs) and changes in effectiveness variables through changes in symptoms, disease control, medication use, and patient- and investigator-reported outcomes. Results: We included 130 patients in the DP&DF group, and 90 (69.2%) adults, 23 adolescents (17.7%), 17 (13.1%) children, and 94 patients in the UT group. Patients received treatment for a mean (SD) of 9.01 (3.1) months at the time of evaluation. Seven (5.4%) patients, all adults, reported eight ARs, five local and three systemic (mean rate of 0.62 ARs per 100 injections); all recovered, and epinephrine was not required. The proportion of patients reporting no rhinitis symptoms at follow-up significantly increased (+13.6%; p < 0.001). Rhinitis frequency, intensity, and control significantly improved overall and in specific age groups. Similarly, the proportion of patients reporting no asthma symptoms at follow-up significantly increased (+29.0%; p < 0.001). The use of all symptomatic medications significantly decreased, while the UT group showed no significant changes, except for worsened asthma classification and control in specific age groups. Both investigators and patients perceived a marked improvement in symptoms and medication use, with high satisfaction scores reported on the visual analogue scale. Conclusions: A subcutaneous allergen extract with a mixture of HDMs is safe and effective for allergic rhinitis and asthma in adults and children in the real-world setting. Full article

Background/Objectives: Venovenous extracorporeal membrane oxygenation (VV ECMO) supports reversible respiratory failure when mechanical ventilation fails. Technological advances and specialized teams now enable ECMO initiation at referring centers, even for high-risk transports. This study aimed to evaluate the safety of pediatric patients on ECMO support during medical transfer, based on a single-center experience and a systematic review of the literature. Methods: A retrospective analysis was conducted on all pediatric patients supported with ECMO transferred from regional hospitals to our university hospital (January 2023–September 2025), focusing on transport-related mortality and morbidity. We also performed a systematic review of original articles (2015–2025) using the PubMed, Embase, and Cochrane databases. Results: Fourteen critically ill children with a median age of 16 months (range: 2 months to 11 years) and acute respiratory failure were transferred to our hospital’s Intensive Therapy Unit. All transported patients in the local cohort were supported with VV ECMO. Transport distances ranged from 5 to 520 km (median: 151 km). No mortality or serious adverse events occurred during transfer. Two technical issues were noted. In the systematic review, 14 articles met the inclusion criteria, reporting a total of 900 transfers, mainly primary ECMO initiations (779–86.6%). The number of ground transports was 337, which accounted for 37.4%. Adverse events were reported in 252 out of 900, which was 28%. One death during transport was reported (mortality: 1‰). Conclusions: All transports were safely performed by our experienced multidisciplinary mobile ECMO team. Both our experience and literature review confirmed low mortality in pediatric ECMO transport, despite potential life-threatening adverse events. Full article

Background/Objectives: Children with developmental disabilities (DD) may experience feeding problems that increase their risk of malnourishment. However, data concerning factors linked to feeding problems in children with DD are lacking. The present study aimed to investigate feeding problems and their associated factors in children with DD who are fed orally. This cross-sectional study included data from 160 children with DD aged 2–18 years, recruited from 9 disability centers and schools located in Madinah, Saudi Arabia. Methods: A total of 666 envelopes were distributed randomly to children to take home. Caregivers were asked to provide sociodemographic, health, and nutrition information. Feeding problems were assessed using a validated screening tool for eating/feeding problems (STEP-AR), which included 17 items divided into 5 subdomains (Aspiration risk, Food refusal, Food selectivity, Nutrition behaviors, and Skill). Phone interviews were conducted with caregivers within two weeks of data collection for dietary assessment. Results: The most frequently reported feeding problems involved feeding skills and food selectivity, with 39.3% unable to feed themselves, 33.1% showing overeating behavior, and 31.2% exhibiting pica-like behavior. Chewing difficulties (28.7%), limited food intake (25.6%), and swallowing challenges (21.2%) were moderately reported, while aspiration-related problems were less common. Multiple linear regression analysis revealed significant positive associations between feeding problems and caregiver education level, family income, caregiver’s relationship to the child, and the child’s living arrangement. Dietary intake was not associated with feeding problems. Conclusions: The findings of this study indicate a range of feeding problems and key sociodemographic factors associated with feeding problems in children with DD. These results highlight the need for targeted interventions such as behavioral support and caregiver education to effectively address and manage feeding challenges in children. Full article

Background/Objectives: Professional quality of life influences patient care, staff well-being, and organizational efficacy. The COVID-19 pandemic placed pressure on healthcare professionals, disrupting their professional quality of life and imposing a psychological burden. In Greece, these issues were intensified by a decade of economic crisis, marked by constrained healthcare budget, personnel shortages, and insufficient resources. This study investigates the pandemic’s impact on the professional quality of life of Greek healthcare professionals to support targeted interventions. Methods: A cross-sectional study was conducted using descriptive statistics. The participants were a convenience sample of 246 healthcare professionals from a Greek regional university hospital with at least one year of experience and who had worked with COVID-19-positive or potentially exposed but asymptomatic patients. Data were collected between March and June 2021 using the Professional Quality of Life Scale (version 5). Results: Of the 246 participants, 81.3% were women and 33.8% were aged 50 or older. Moderate concern and fear regarding COVID-19 were reported, with 34.6% extremely afraid of transmitting the virus to family or friends and 22.8% to patients or their families. Overall professional quality of life was moderate: compassion satisfaction was moderate to high, while burnout and secondary traumatic stress were moderate to low. Higher compassion satisfaction was linked to holding a position of responsibility. Burnout was associated with having children, permanent employment, years of experience, and increased pandemic-related fear. Higher secondary traumatic stress was associated with older age, more years of experience, and greater pandemic-related fear. Conclusions: These findings support international research and highlight that the moderate levels observed indicate intrinsic motivation based on professionalism in patient care, providing evidence of resilience and coping mechanisms that reduce psychological consequences on well-being due to the pandemic. Full article

This article reports on a comparative case study that examined the ground rules used to facilitate a dialogic space in two discrete and diverse research studies: Year 5 & 6 children learning to code with ScratchMaths as part of their mathematics programmes, and crop farmers in rural east Africa developing their practice through various communications. The intention was to see if there were common actions or principles important for the establishment of ground rules in dialogic spaces in general. Understanding the nature of dialogic space has become increasingly important in many areas of education. STEM subjects, particularly when integrated, frequently involve collaborative interaction, and utilise a dialogical approach. Some initial aspects of ground rules were collaboratively identified, with both studies then independently analysed to identify emerging themes related to these ground rules. Several key elements emerged: developing the processes for interaction and communication; developing trust between participants; developing respectful dialogue; teacher roles; and facilitating collaborative work and the co-construction of meaning. The comparative case study suggested that these were important for other education work when establishing dialogic space. Full article

Background: Acute viral respiratory infections are a major cause of morbidity among young children, with respiratory syncytial virus (RSV) being the leading pathogen. In Jordan and globally, most RSV research has focused on hospitalized patients, while data from emergency departments (EDs) and outpatient settings remain limited. Methods: This cross-sectional study was conducted at two major Jordanian hospitals between November 2022 and March 2023. Children under five years of age presenting to EDs or outpatient clinics with symptoms of acute respiratory infection were enrolled. Nasopharyngeal specimens were tested for RSV, and subtypes (RSV-A and RSV-B) were identified using multiplex RT-PCR. Results: Of 229 enrolled children, 92 (40.2%) tested positive for RSV, with RSV-B accounting for 81.5% of positive cases. RSV positivity was higher in ED presentations than in outpatient clinics (46% vs. 35%). Wheezing (72.8% vs. 39.4%, p < 0.001) and dyspnea (33.7% vs. 14.6%, p = 0.001) were significantly more frequent among RSV-positive patients. Independent predictors of RSV positivity included non-referred outpatient visits (OR = 15.26), non-referred ED visits (OR = 42.93), younger age, and prior systemic steroid use. Conclusions: RSV poses a substantial burden in outpatient and ED settings. Identified demographic and clinical predictors may help target high-risk groups for future preventive interventions. Full article

Background: Since the introduction of rental e-scooters, they have become a popular mode of transportation not only in German cities but in other cities as well. However, this rapid increase in usage has coincided with a significant rise in associated injuries and accidents, outpacing those related to bicycles. A disproportionate number of these incidents involve alcohol consumption and young people under the age of 25, with a low incidence of helmet use. Following the example of driver training for children on bicycles, we carried out driver safety training with e-scooters and examined the results scientifically. Methods: The study conducted three voluntary driving safety training sessions in Berlin and Munich, with participants completing questionnaires before and after the training to measure their knowledge and skills (on a scale between 0 and 5; 0 = totally insecure and 5 = absolutely secure). The training included a technical introduction, practical exercises, and an educational component on injury data and prevention strategies. During the statistical analysis, the novice drivers (group 1) were compared to the non-novice drivers (group 2). Results: Out of 136 participants, 103 completed the training (a response rate of 75.7%). The mean age of the participants was 37.1 years, and 52.4% of them were female. A total of 59% had never used an e-scooter and were therefore assigned to group 1 (group 2 = experienced drivers). Both groups showed significant improvements in both knowledge of traffic laws and driving skills. Conclusions: The findings suggest that driving safety training potentially enhances the safe operation of e-scooters. However, the training demands a high level of time and motivation, making it less attractive for younger drivers who are most prone to accidents. Therefore, we recommend the use of digital driving safety training before the first use of e-scooters. Full article

Background/Objectives: The effects of online physical activity (PA) interventions on executive function (EF) and Attention-Deficit Hyperactivity Disorder (ADHD) symptoms are promising; nonetheless, their benefits for Latinx youth remain unclear. Methods: This study explores levels of adherence, cognitive and behavioral outcomes and acceptability of an online PA intervention, Zing Performance, among a Latinx youth sample; only a few of the participants completed their condition (n = 6). Results: There was wide variability in adherence levels at mid-treatment (n = 5) and high-level adherence at post-treatment (n = 2). A Mann–Whitney test yielded a statistically significant (p = 0.004) improvement in the treatment group’s inattention symptoms at mid-treatment (n = 5), compared to the Waitlist Control; (WLC; n = 6). EF and hyperactivity/impulsivity were not significantly different. Further, pre-, mid- and post-participant trajectory data revealed that one participant benefited significantly from treatment, one participant demonstrated little to no response to treatment, and most of the WLC participants remained in the severity ranges throughout the 12 weeks. The parents of the two children who completed treatment reported high levels of acceptability informally and on the quantitative measure. Conclusions: Exploratory findings support further investigation of Zing among Latinx families with cultural consideration to study procedures. The lessons learned from this study are valuable for future research procedures and interventions with this marginalized population. Full article

Background: Children of mothers exposed to adverse childhood experiences (ACEs) may be at increased risk of sleep disruptions, such as night waking, due to potential suboptimal caregiving or living conditions. Mothers’ ACEs are also associated with maternal depressive symptoms, which in turn are associated with children’s screen time and sleep disruptions, revealing relevant, but unexplored, mediation pathways. This Canadian study investigated if mothers’ ACEs were associated with their 5-year-old children’s sleep disruptions (1) directly and (2) indirectly through independent or serial mediation via maternal depressive symptoms and/or children’s screen time. Methods: Data (n = 622; maternal mean age 32.3 years, 88.4% white) came from the longitudinal APrON Study. ACEs were measured 1 year postpartum. Mother’s depressive symptoms were measured across prenatal and postnatal timepoints. Children’s evening screen time (i.e., number of days in a week children engaged in one hour of screen time before bedtime) and sleep disruptions (number of days in a week their child wakes up multiple times) were measured at 5 years postpartum using adapted scales (52.9% male). PROCESS was used to assess for mediation. Results: Mothers’ ACEs had an indirect effect on their children’s sleep disruptions through mothers’ mean depressive symptoms (effect = 0.018, 95% CI [0.006, 0.034]), but not through children’s screen time. No other effects (i.e., direct, total) were observed. Conclusions: Although replication studies are warranted, this novel study reveals that the effects of maternal ACEs on children’s sleep disruptions may operate indirectly with effects potentiated through maternal depressive symptoms, thus serving as a target for intervention. Full article

Background: The World Health Organization and the Australian physical activity guidelines, in line with contemporary research, recommend regular muscle-strengthening activities for optimal muscular fitness in children and adolescents. However, the extent to which muscle-strengthening or muscular fitness receives curricular emphasis is unknown in Australia. Objectives: To examine to what extent the Australian Health and Physical Education Curriculum, Foundation to Year 10 (AHPEC; F–10) addresses and/or promotes muscular fitness. Methods: This study involved a mixed-methods content analysis of the AHPEC F–10 using: (i) conceptual analysis to identify muscular fitness-related terms; and (ii) relational analysis to examine alignment between muscular fitness content and curriculum rationale/aims. A search of national and international physical activity guidelines and school-based muscular fitness intervention literature generated a keyword set to guide abstraction from the AHPEC. Curriculum aim, rationale, level descriptions, achievement standards and content were coded to determine the extent to which muscular fitness was embedded. Intercoder reliability was established via consensus meetings. Muscular fitness content coverage was quantified as the proportion of directly aligned muscular fitness relevant content points per stage and aggregated primary (F–6), secondary (7–10), and F–10 scores. Results: A review of 32 national and one international physical activity guidelines identified 88 muscular fitness activities in total, with some activities appearing in multiple guidelines; 53.1% of national guidelines did not provide explicit muscular fitness examples, and where examples existed, they emphasised accessible modes (e.g., climbing, bodyweight tasks, jumping, and lifting). Additionally, analysis of school-based muscular fitness intervention literature identified 22 distinct muscular fitness activities to guide abstraction. Muscular fitness was absent in the AHPEC rationale and aims, was largely inferred in primary years level description and achievement standards and became more explicit in secondary achievement standards. Direct alignment of content with muscular fitness was non-existent or low across stages of learning (Foundation = 0%, Stage 1 = 0%, Stage 2 = 6.1%, Stage 3 = 9.1%, Stage 4 = 8.6%, Stage 5 = 8.8%). Overall, muscular fitness content coverage averaged 3.8% in primary, 8.7% in secondary, and 5.4% across F–10. Conclusions: The AHPEC treats muscular fitness as a low priority in primary schooling and a minor content area in secondary, yielding developmental messaging that is less aligned with contemporary evidence and physical activity guidelines. Full article

Numerous factors contributed to coronavirus 2019 (COVID-19) disease recovery and death rates. In many countries, socioeconomics, morbidities, the experience of symptoms and access to healthcare services are major contributors to recovery and death rates. A retrospective cohort study was conducted to determine the morbidity, mortality, survival probability, and risk factors associated with COVID-19 among children in the Free State province, South Africa. A total of 846 patients’ records were used in the study. Using SPSS version 28 software, survival probability was determined using Kaplan–Meier estimation curves and Cox regression was used to determine the effect of sociodemographics and clinical manifestation information on time of death. The COVID-19 mortality rate was 13.12% in our study. There were more female patients (60%) than male patients (40%). In total, 71 patients had two or more morbidities, while 414 patients were asymptomatic. Patients between 5 and 18 years old were at twice the risk of dying of COVID-19, and male children were at a higher risk as well. Having more than one symptom was also a risk for dying in this study. Severe COVID-19 is attributed to numerous factors, and these are closely associated with surrounding environments and public health systems. The findings are important for the clinical management of similar diseases and circumstances in the future. Full article

Background/Objectives: Many elementary school-aged children (i.e., 5 to 12 years old) experience sleep difficulties that negatively impact their daytime functioning. Despite this high prevalence, sleep education is rarely included in school curricula and evidence-based interventions are limited. To better understand this gap, a needs assessment was conducted to inform the development of a sleep education program. Method: Semi-structured virtual interviews were conducted with 14 elementary school teachers in Nova Scotia, Canada. Participants were asked 20 questions about their students’ sleep and its impact, teachers’ needs and practices in sleep education, what a sleep education program would look like, and how it could be delivered. During the interview, participants watched the online ABCs of SLEEPING storybook as a potential foundation for developing a sleep education program, and interview themes were analyzed using deductive thematic analysis. Results: All teachers identified poor sleep as an issue impacting students’ behavior and learning, and reported that they had a lack of resources to teach sleep education. Teachers believed the storybook could be used with their students and integrated into the curriculum. Recommended modifications include making the storybook available for families, adding interactive activities and student discussions, providing teacher resources, and tailoring the content to be suitable for both lower and upper elementary school-aged students. Most teachers indicated that the storybook could be adapted for upper elementary students with more age-appropriate vocabulary and visuals. Conclusions: The findings from this needs assessment will inform the development of an elementary school sleep education program using the ABCs of SLEEPING storybook as the foundation of the program, while noting limitations such as sample diversity. Full article

Background/Objectives: RELiZORB immobilized lipase cartridge (ILC) is a single-use digestive enzyme cartridge that connects in-line with enteral feeding circuits to hydrolyze triglycerides in enteral formulas. It is cleared by the FDA for pediatric and adult use. Limited data have been published regarding the effect of ILC use on growth in children younger than 5 years of age. Methods: We performed a retrospective evaluation of real-world data extracted from a third-party reimbursement program database. All patients in the program database who initiated ILC use with enteral formula when 1 to 4 years of age between 2019 and 2023 were included. Baseline and follow-up weight, height/length, and body mass index (BMI) data were collected for up to 12 months. Results: A total of 186 patients from 90 clinics in the United States were included. A subset (143 patients) with baseline and follow-up growth measurements was included in the efficacy analysis population; 76% were diagnosed with cystic fibrosis. Mean weight and BMI z-scores improved significantly (0.63 [p < 0.001] and 0.53 [p = 0.006], respectively) from baseline to 12 months after initiation of ILC use. Significant improvement in the mean weight z-score was observed after 3 months. Among people with cystic fibrosis (pwCF) who initiated ILC use when 2 to 4 years of age, those with a BMI ≥ 50th percentile increased from 22% at baseline to 43% after 12 months (p = 0.021). Improvement in weight-for-length was also observed in 1-year-old pwCF. Conclusions: Real-world evidence showed that initiation of ILC use was associated with significant improvements in mean weight and BMI z-scores among young children. Full article

The HIV epidemic in Romania started in the late eighties with a large cohort of children nosocomially infected with subtype F1 strains, in parallel with sexual transmission. The purpose of the present study was to investigate the transmitted drug resistance (TDR), subtype distribution, and transmission clusters among persons diagnosed with HIV between 2019 and 2022 in Romania. The prototype of a person recently diagnosed with HIV in Romania is male, 20–50 years old, a late presenter, infected with F1, B, or A subtype. The rate of TDR varied over time, from 5% in 2019 to 15% in 2022. TDR affected mainly the first generation of NNRTIs and the PI class. The rate of late presentation was almost 60%, with 35% of persons qualifying as very late presenters. Subtype F1 is still preponderant in Romania, whereas other subtypes (B, A) and recombinants account for a quarter of HIV-1 new cases. Several transmission networks were identified in the study population, two of them associated with TDR in subtypes F1 and A1. The largest cluster consisted of 26 sequences, originating from Western Romania and introduced around 2007. Molecular clock analysis indicated different origin time points for different clusters, with the most recent in subtypes A1 and B, and the oldest in subtype F1. In conclusion, the HIV-1 epidemic in Romania is currently driven by sexual transmission, with MSM contribution continuously rising in recent years; there are also increases in TDR and the circulation of HIV-1 strains other than F1 (subtype B, A, recombinants). Full article

Deleterious variants in SCN5A lead to a wide clinical spectrum that includes pathologies characterized by life-threatening cardiac events (CEs). In the pediatric population, early identification, management, and risk stratification of these pathologies are the main current challenges. This study analyzed a Spanish pediatric cohort (≤18 years) carrying rare SCN5A variants to explore genotype–phenotype correlations. A retrospective descriptive cohort study, including clinical, demographic, and genetic data of probands and their relatives, was conducted. Out of 100 children studied, 69 had definitively deleterious SCN5A variants (26 females, 38%; median age: 3 years, IQR 1–12). The main diagnoses were isolated Brugada syndrome (BrS) (31; 45%); isolated long QT syndrome type 3 (LQT3) (5; 7%); isolated progressive cardiac conduction disease (PCCD) (1; 2%); isolated familial atrial fibrillation (1; 2%); overlapping phenotypes (7; 10%) including: BrS-PCCD (2; 2.8%); BrS-LQT3 (1; 1.4%); premature ventricular contraction-dilated cardiomyopathy (1; 1.4%); BrS-LQT3-PCCD (1; 1.4%); BrS-PCCD-sick sinus syndrome (SSS) (1; 1.4%) and BrS-PCCD-SSS-familial atrial fibrillation (1; 1.4%). Of them, 13 (19%) patients presented with CEs (cardiogenic syncope, ventricular tachycardia/fibrillation, sudden cardiac arrest/death, and appropriate implantable cardio defibrillator shock). These findings underscore the utility of genetic testing for early diagnosis, risk stratification, and personalized management, enhancing preventive strategies for CE prevention in pediatrics. Full article