Search Results (665)

Background: Neurogenic bladder (NB) in children may lead to recurrent urinary tract infections (UTIs), renal deterioration, and a reduced quality of life. Clean intermittent catheterization (CIC) is the standard of care, but in some patients, CIC may be unfeasible due to anatomical, sensory, or compliance issues. Button cystostomy (BC) has emerged as a minimally invasive, bladder-preserving alternative. This study aimed to assess the feasibility, safety, and outcomes in the long-term of BC in pediatric NB patients. Methods: Retrospective analysis was conducted on children with NB who underwent endoscopic BC placement between January 2020 and December 2024 in a tertiary pediatric center. Demographic data, operative time, complications, and follow-up outcomes were collected. All procedures used an endoscopic approach with cystoscopic guidance for safe device placement. Results: Thirty-three patients (25 males; median age 7.96 years) underwent BC placement. Most had spinal dysraphism (63.6%). The mean operative time was 48.5 ± 6 min. During a mean follow-up of 2.1 ± 1.4 years, five patients (15.2%) had febrile UTIs and two had minor leakage. No major complications occurred. Four buttons were removed due to clinical improvement (N = 1), the fashioning of a continent derivation (N = 1) and implantation of a sacral neuromodulator (N = 2); two patients accepted CIC. Satisfaction was reported by 93.9% of families. Conclusions: BC is an effective, minimally invasive alternative for urinary drainage in children with NB, even when compared to continent diversion techniques such as the Mitrofanoff, due to its lower invasiveness, greater feasibility, and lower complication rate. Broader adoption may be warranted, but prospective studies are needed to confirm long-term outcomes. Full article

Rehabilitation devices such as actuated lower-limb exoskeletons can provide essential mobility assistance for pediatric patients with gait impairments. Enhancing their control systems under conditions of user variability and dynamic disturbances remains a significant challenge, particularly in active-assist modes. This study presents a human-in-the-loop control architecture for a pediatric lower-limb exoskeleton, combining outer-loop admittance control with robust inner-loop trajectory tracking via a non-singular terminal sliding-mode (NSTSM) controller. Designed for active-assist gait rehabilitation in children aged 8–12 years, the exoskeleton dynamically responds to user interaction forces while ensuring finite-time convergence under system uncertainties. To enhance adaptability, we augment the inner-loop control with a twin delayed deep deterministic policy gradient (TD3) reinforcement learning framework. The actor–critic RL agent tunes NSTSM gains in real-time, enabling personalized model-free adaptation to subject-specific gait dynamics and external disturbances. The numerical simulations show improved trajectory tracking, with RMSE reductions of 27.82% (hip) and 5.43% (knee), and IAE improvements of 40.85% and 10.20%, respectively, over the baseline NSTSM controller. The proposed approach also reduced the peak interaction torques across all the joints, suggesting more compliant and comfortable assistance for users. While minor degradation is observed at the ankle joint, the TD3-NSTSM controller demonstrates improved responsiveness and stability, particularly in high-load joints. This research contributes to advancing pediatric gait rehabilitation using RL-enhanced control, offering improved mobility support and adaptive rehabilitation outcomes. Full article

Background: Considering the critical role of physical activity (PA) beginning in early childhood education and the demonstrated validity and reliability of contemporary technological measurement tools, this paper aimed to systematically review and analyze studies comparing PA levels in preschool-aged children during weekdays versus weekend days, using objective technological devices, and highlight what factors correlate with children’s PA. Methods: The search strategy was designed based on the PICOS framework. A systematic review was conducted using two databases (PubMed and Web of Science) to identify studies that included preschool children doing PA during weekdays, measured through technological devices, and compared to PA during weekend days. Study quality was evaluated using the MINORS scale. Results: From 1959 articles, 30 documents met the inclusion criteria, encompassing 32,251 preschool children. Conclusions: The results suggest that preschoolers were generally more active on weekdays than weekends, although it could depend more on contextual or individual factors than on the day of the week. In this sense, parental/maternal behavior (sedentary behavior, shared activities during weekend days, parents’ educational level, and parental/maternal screen time) influences children’s PA level, as well as other factors such as gender, morphology, motor competence level, the type of activity (indoor vs. outdoor), age, meeting PA guidelines, and the community transportation environment. Considering these factors, professionals working in preschools or kindergartens, as well as parents/mothers, should consider these factors to foster children’s PA level from early childhood, which could influence children’s lifespan. Full article

This study explored the experiences of Hungarian minority parents of children with severe disabilities from Romania. Examining individual life paths and becoming a parent is difficult in all aspects, but the issue of parental responsibility for raising a child with a severe disability suggests a much more complex approach. Participants were parents (female = 8; male = 3) who were purposively sampled from an urban setting (Bihor area) and whose children attended SEN schools in the same area. Data were collected using semi-structured interviews and were thematically analysed. It turned out from the interviews that the challenges parents of children with severe disabilities encounter at home, school, and in society are accumulated emotional stress and exhaustion; however, they also face material challenges. The analysis also revealed that the parents were unsure of what was expected of them in making educational or habilitation–rehabilitation decisions on behalf of their children. The parents’ difficulty with decision-making and their unpreparedness put them under serious stress, often characterized by depressive life stages. The findings reveal the need for ongoing professional development and the establishment of organizational–community networks. Parents of children with disabilities face serious, unresolved challenges that are difficult to overcome. In order to overcome these challenges, we need to develop policies that take the needs of parents into consideration. Full article

This study aims to assess the ecological and human health risks associated with four heavy metals (Cd, Cr, Cu, and Zn) in the soil of a dumpsite in Targuist city, Morocco. In total, 16 surface soil samples were collected from the dumpsite and its nearby areas following leaching drain flows. The pollution load index (PLI), geo-accumulation index (Igeo), and potential ecological risk index (RI) were subsequently determined. In addition, hazard quotient (HQ) and health index (HI) were used to assess the non-carcinogenic and carcinogenic risks associated with the soil heavy metal contents. The PLI indicated significant contamination by the studied heavy metals. On the other hand, the Igeo values suggested no Cr contamination, moderate contamination by Cu and Zn, and severe contamination by Cd. The RI indicated a dominant contribution from Cd, with minor contributions from Cu, Zn, and Cr accounting for 92.47, 5.44, 1.11, and 0.96%, respectively, to the potential ecological risk in the study area. The non-carcinogenic health risks associated with exposure of the nearby population to the soil heavy metals at the dumpsite and burned solid waste-derived air pollution were below the threshold value of 1 for both children and adults. Although carcinogenic risks were observed in the study area, they were acceptable for both children and adults according to the United States Environmental Protection Agency (USEPA). However, carcinogenic risks associated with Cr were unacceptable according to the Italian Legislation. Finally, strategies to mitigate the risks posed by the dumpsite were also discussed in this study. Full article

Individuals with Autism Spectrum Disorder (ASD) often experience sensory hyperreactivities that interfere with daily life activities. White noise, characterized by its uniformity and its ability to mask environmental sounds, may serve as a tool to improve sensory and emotional regulation in children with ASD. The primary objective was to evaluate the response to white noise in improving self-regulation in minors with ASD. As a secondary objective, the study assessed whether there were differences in the response to white noise between patients with ASD and those with ASD and Intellectual Disability (ID). This study was conducted in the Child and Adolescent Psychiatry and Psychology Department of Hospital Clínic of Barcelona. A total of 54 patients, aged between 7 and 17 years, were included. The patients were divided into two groups: Group 1 consisted of patients diagnosed with ASD (n = 21), and Group 2 included patients diagnosed with ASD and ID (n = 33). White noise was offered to the patients, and their response was evaluated before and after the exposure using the Conners Teacher Rating Scale. Overall, the response to white noise in the sample was positive, with a significant difference in scores on the Conners Teacher Rating Scale (p < 0.001). When dividing the sample into the ASD group and the ASD + ID group, it was observed that the ASD + ID group tolerated white noise better and had a longer exposure time, although both groups showed improved scores on the Conners Teacher Rating Scale. White noise may be a valuable tool to enhance well-being in individuals with ASD, reduce motor restlessness, and increase attention span and emotional stability. However, its effectiveness varies across individuals. It is recommended to tailor its use to individual needs and to extend future research by incorporating physiological measures and larger sample sizes. Full article

Background/Objectives: The assessment of platelet kinetics (APK) is recommended for patients with chronic idiopathic thrombocytopenic purpura (chITP). The aim of this study was to examine the importance of APK as a prognostic instrument in the selection of therapy in children with chITP. Methods: Retrospective, observational research, which included chITP children who were treated and subjected to APK in Serbia for 25 years (total number was 152). Results: In the acute phase of the disease, 15% of patients had life-threatening bleeding, 15% were asymptomatic, and there were no cases of fatal bleeding. Mean platelet life was 0.89 ± 0.47 days. A total of 45% of patients had normal platelet production, and 35% had very low production. Among the patients, 55% exhibited splenic platelet sequestration, 35% had mixed sequestration, and 10% showed hepatic platelet sequestration. Platelet lifespan and production indices were less reliable parameters, due to numerous contradictory results, especially when compared with the location of platelet sequestration. Distribution of bleeding and therapy-resistant patients was dominant with mixed sequestration. Good therapy responders had dominant splenic sequestration. In the chronic phase of the disease, initial therapy was sufficient for 40–45% of patients, while another 25% required second-line therapy, regardless of platelet sequestration location. A total of 25% percent of patients had undergone splenectomy, and all of them were in stable remission. The remaining 10%, which represented the most severe cases, required all available therapies, had equally mixed and liver sequestration, and splenectomy showed no effect. Conclusions: APK may be a determining factor for the selection of splenectomy as a therapeutic option in case of predominantly splenic sequestration. Although the platelet production index has been explored in several studies, its clinical relevance remains controversial. In our findings, it did not contribute to therapeutic decision-making and may even lead to misinterpretation. The factors distinguishing the minority of bleeding and therapy-resistant patients with similar laboratory profiles remain unclear. Full article

Background/Objectives: Dental anxiety in children is a common issue that can hinder the delivery of effective dental care. Traditional approaches to managing this are often insufficient or involve pharmacological interventions. This study shows the potential of virtual reality (VR) to aid in reducing anxiety in children undergoing simple dental procedures. By immersing children in relaxing VR environments (such as beaches, forests, mountains, or underwater scenes with calm music), the objective is to assess VR’s effectiveness in calming pediatrics patients during these procedures. Methods: Children scheduled for minor dental treatments wore a wearable device that monitored pulse, perspiration, and stress levels. Each child’s baseline data was collected without the VR headset, followed by data collection during VR exposure before and during dental procedures. VR scenarios ranged from soothing nature scenes to animated cartoons, designed to foster relaxation. Results: The data collected showed a reduction in physiological indicators of stress, such as lower heart rate and reduced perspiration, when the VR headset was used. Children appeared more relaxed, with a calmer response during the procedure itself, compared to baseline levels without VR. Conclusions: This study provides preliminary evidence supporting VR as an effective tool for reducing anxiety and stress in pediatric dental patients. By offering an engaging, immersive experience, VR can serve as an alternative or complementary approach to traditional anxiety management strategies in pediatric dentistry, potentially improving patient comfort and cooperation during dental procedures. Further research could determine if VR may serve as an alternative to local anesthesia for non-intrusive pediatric dental procedures. Full article

Background: Tooth agenesis, particularly hypodontia, poses a clinical and esthetic challenge in growing patients due to limitations in definitive implant placement before skeletal maturity. Traditional solutions such as removable prostheses or orthodontic space closure often fail to provide adequate long-term stability, function, and tissue preservation. In recent years, orthodontic mini-implants have emerged as a promising interim solution. This narrative review aims to synthesize current clinical evidence on the use of orthodontic mini-implants as temporary prosthetic abutments in children and adolescents with hypodontia or post-traumatic tooth loss. Methods: A literature search was conducted using PubMed and Google Scholar databases, covering studies published between January 2004 and March 2025. Inclusion criteria were clinical reports involving skeletally immature patients with congenital or traumatic tooth loss treated with mini-implants, with mandatory radiographic diagnostics and outcome data. Data extracted included patient demographics, etiology, implant site, imaging, follow-up, complications, and outcomes. A total of 17 studies comprising 42 cases were analyzed and summarized in tabular form. Results: Patients aged 6 to 16 years were treated primarily for agenesis of maxillary lateral or central incisors. The mean follow-up duration was 36.9 months. CBCT was used in 28.6% of cases. Mini-implants demonstrated high clinical success with stable soft tissue contours and preservation of alveolar volume. Complications were reported in 21.4% of cases and included crown debonding, minor infraocclusion, soft tissue irritation, and rare instances of osseointegration. Conclusions: Orthodontic mini-implants may provide a minimally invasive and reversible approach to interim tooth replacement in growing patients. Preliminary evidence suggests favorable outcomes in terms of stability, esthetics, and tissue preservation, but further prospective research is needed to validate their long-term effectiveness and standardize clinical application. Full article

Disaster risk reduction (DRR) education is considered increasingly necessary, particularly for children. DRR educational interventions aim to enhance knowledge and attitudes related to self-protective capacity. However, comparative studies on students in areas prone to different disasters and comprehensive criteria covering both knowledge and attitudes toward behavior remain limited. A short DRR course was developed for primary schools across three regions (mountainous, low-lying, and coastal) in Hue City, one of Vietnam’s most vulnerable areas to extreme weather events. This study aimed to comprehensively evaluate student performance by applying Bloom’s taxonomy and treatment-control pre-post-follow-up design with panel analysis methods. From December 2022 to September 2023, three surveys, involving 517 students each, were conducted in six schools (three schools received the course and surveys, while the other three only participated in surveys). The intervention revealed similarities and differences between the groups. The course positively impacted on some elements of knowledge and preparedness intentions in students from low-lying and mountainous regions (including ethnic minorities). Higher-grade students in the mountainous region showed improvement in intentions, but not in attitudes toward self-protection. No gender differences in intentions were found. Although limited overall improvements, the study’s various methods, approaches and continuous assessment can be applied globally to design, implement, and assess DRR education courses effectively. Full article

Acute myeloid leukemia (AML) accounts for only about 15–20% of pediatric leukemia and an overall incidence of 1.4 cases per 200,000 children under the age of 15 years. The majority of pediatric AML occurs de novo, often as the result of somatic first hits in utero. A minority of pediatric AML occurs in response to a predisposition syndrome, such as a bone marrow failure syndrome, or other inherited mutations and copy number changes. While the overall survival of pediatric patients with AML is approximately 70%, survival at the individual level is dependent on the abnormality detected either through cytogenomic analyses or sequencing for mutations in responsible genes. Indeed, de novo infant AML carries a more sobering prognosis than that of pediatric AML. This review describes many of the common genomic abnormalities associated with pediatric AML and characterizes their detection from a laboratory assessment perspective. Pediatric AML is primarily a disease of gene rearrangements rather than of gene mutations, and, as such, clinical cytogenetics takes a primary role. Full article

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (U.S.) and a major contributor to several cancers, including cervical, anal, penile, and oropharyngeal cancers. Although a safe and effective vaccine is available, HPV vaccination rates remain suboptimal, particularly among racial, ethnic, and immigrant minority groups. This study explored multiple factors, such as cultural, social, and structural influences, influencing HPV vaccine decision-making among Cape Verdean immigrant parents in the U.S., a population currently underrepresented in HPV research. Methods: Qualitative study using individual, in-depth interviews with Cape Verdean immigrant parents of children aged 11 to 17 years living in the U.S. Interviews were transcribed verbatim and analyzed thematically using the social ecological model (SEM) to identify barriers and facilitators at the intrapersonal, interpersonal, organizational, community, and policy levels. Results: Forty-five Cape Verdean parents (27 mothers, 18 fathers) participated. Fathers were significantly older than mothers (50.0 vs. 41.1 years, p = 0.05). Most were married or partnered (60%), had at least a high school education (84.4%), and reported annual household incomes of US$50,000 or more (66.7%), with no significant gender differences. Nearly all spoke Creole at home (95.6%). Fathers had lower acculturation than mothers (p = 0.05), reflecting less adaptation to U.S. norms and language use. Most parents had limited knowledge of HPV and the vaccine, with gendered beliefs and misconceptions about risk. Only seven mothers (25.9%) reported receiving a provider recommendation; all indicated that their children had initiated vaccination (1 dose or more). Mothers were the primary decision-makers, though joint decision-making was common. Trust in providers was high, but poor communication and the lack of culturally and linguistically appropriate materials limited informed decision-making. Stigma, misinformation, and cultural taboos restricted open dialogue. Trusted sources of information included schools, churches, and Cape Verdean organizations. While parents valued the U.S. healthcare system, they noted gaps in public health messaging and provider engagement. Conclusions: Findings revealed that HPV vaccine uptake and hesitancy among Cape Verdean immigrant parents in the U.S. were influenced by individual beliefs, family dynamics, healthcare provider interactions, cultural norms, and structural barriers. These findings highlight the need for multilevel strategies such as culturally tailored education, community engagement, and improved provider communication to support informed vaccination decisions in this population. Full article

Background: Childhood obesity is a global health concern. Early development of fundamental movement skills (FMS) and adherence to the Mediterranean diet (MD) are key modifiable factors for prevention. This study assessed the effectiveness of a multidisciplinary, school-based intervention for childhood obesity prevention. Methods: Children aged 3–5 years from a preschool in Messina, Italy, participated in a 9-month intervention integrating nutritional education and physical activity. FMS were evaluated using the MOBAK test. Anthropometric measurements and MD adherence (through the Kid-Med questionnaire) were collected. Caregivers completed an online survey reporting lifestyle changes. Results: Significant improvements were observed in FMS: object control (score 1) increased from 2.67 ± 1.78 to 4.28 ± 1.82, locomotor skills (score 2) from 4.69 ± 1.96 to 5.83, 5.83 ± 1.70, and total MOBAK score (score 3) from 7.35 ± 3.09 to 10.11± 2.94. (p < 0.001 for all). Kid-Med scores significantly improved from (3.79 ± 2.31 vs. 5.03 ± 2.69) (p = 0.0027), indicating enhanced MD adherence. Post-intervention, adherence was classified as poor (27.4%), moderate (53.2%), and optimal (19.4%). Although only a minority of parents reported lifestyle changes, over 50% noted increased fruit and vegetable intake in their children. Males showed higher FMS scores and waist circumference compared to females. Conclusions: A school-based multidisciplinary intervention significantly improved motor competence and dietary habits in preschool children. These findings underscore the importance of early, integrated strategies involving families and educators to support healthy development and prevent childhood obesity. Full article

Background: Vietnam is experiencing a significant “double burden” of malnutrition, characterized by the persistent challenge of undernutrition, particularly stunting in ethnic minority and mountainous regions, alongside a rising prevalence of overweight and obesity. Understanding dual nutritional status and its related factors in adolescents from these vulnerable areas is crucial for effective intervention. Objective: The current study explored the nutritional status of ethnic minority secondary school students in some mountainous provinces in the northwest of Vietnam and identified some related factors. Methods: We conducted a cross-sectional study over six months (June–December 2023), involving 1847 ethnic minority high school students from Son La and Dien Bien provinces, recruited through convenience sampling in primary healthcare settings. Nutritional status was determined using WHO 2006 Child Growth Standards, specifically height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores (BAZ). A 4-point scale assessed nutritional practices, including food consumption frequency and eating habits. Results: This study identified a stunting (HAZ < −2 SD) prevalence of 16.7% and wasting (BAZ < −2 SD) of 5.6%; overweight/obesity (BAZ > +1 SD) prevalence was 8.2%. Key factors related to stunting were being male, having more siblings, poor/near-poor household economic status, low maternal education level, and frequent occurrences of gastrointestinal and respiratory diseases. A higher risk of overweight/obesity was associated with consuming more than three meals daily, nocturnal snacking, frequent intake of fried foods, insufficient consumption of vegetables and fruits, and inadequate daily physical activity. Conclusions: Our study shows a comprehensive picture of malnutrition among children in ethnic minority areas. Essential nutritional intervention programs, projects, and models are a top priority to reduce the disease burden for children’s bright future and to enhance socio-economic development in the mountainous regions of Vietnam. Full article

Background: Mirror therapy (MT) creates a cerebral illusion of a normal movement in a paretic limb. Although mirror therapy has been studied as a suitable intervention for children with Unilateral Cerebral Palsy (UCP), a comprehensive understanding of its full range of benefits is still lacking. Thus, the aim of this systematic review and meta-analysis was to determine all motor and sensory effects of MT in children and adolescents with UCP. Methods: Clinical trials focused on the application of MT in the upper limb (UL) of children and adolescents with UCP were included. A search was performed in PubMed, Cochrane Library, Web of Science, and LILACS databases. Eleven studies were included in this systematic review. The PEDro scale and the MINORS scale were applied to evaluate the methodological quality of randomized and non-randomized controlled trials, respectively. The Risk of Bias tool was also employed to evaluate the potential bias. In addition, the TIDieR checklist was used to assess the quality of intervention reporting. A random-effects model was used for the meta-analysis. Results: The studies included children with UCP from three to eighteen years, classified in Manual Ability Classification System levels I–IV. Motor effects of MT were found in nine studies. Also, two studies reported sensory effects on registration, perception, and proprioception abilities. Qualitative and quantitative analysis showed that MT improved manual dexterity and tactile registration in children and adolescents with UCP. Conclusions: MT is a therapy capable of inducing motor and sensory improvements in the affected UL of children with UCP. Full article