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Chapter 1 explains the institutional background to the phenomenon of ‘left-behind’ children in rural China, how these children are represented in the media and scholarly literature, and my unique approach to exploring their lives. Firstly, I focus on the influence of rural-urban migration on family relationships rather than on quantifying the impacts of parents’ migration on different dimensions of the children’s wellbeing, as many previous studies have done. Secondly, I see parental migration as oriented towards educational investment, thereby identifying ‘study’ as central to how the children interpret their parents’ migration and their own obligations to their families. This approach extends extant analyses of children’s experiences of family ‘cultural capital’ accumulation strategies from families where parents and children co-reside to families where parental migration is pivotal to the child raising strategy. Thirdly, I argue that left-behind children are actors in spatially dispersed or multi-local parent-child striving teams rather than the passive recipients of adults’ decisions and migration’s various impacts. I thereby prioritise the children’s perspectives rather than adults’ viewpoints, exploring variation among the children by their gender, age, and academic performance, and by their family’s gendered and generational configurations and class, situated within a wider cultural, institutional and economic context.
Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Wuhan City, China, pediatric cases have gradually increase. It is very important to prevent cross-infection in pediatric fever clinics, how identify children with fever in pediatric fever clinics, and strengthen the management of pediatric fever clinics. According to prevention and control programs, we propose the guidance on the management of pediatric fever clinics during the novel coronavirus pneumonia epidemic period, which outlines in detail optimizes processes, prevents cross-infection, health protection and disinfection of medical staff. The present consideration statement summarizes current strategies on pre-diagnosis, triage, diagnosis, treatment, and prevention of 2019-nCoV infection, which provide practical suggestions on strengthening the management of pediatric fever clinics during the novel coronavirus pneumonia epidemic period.
The aim of this study was to identify relevant content among four important domains for the development and structure of a paediatric cardiac rehabilitation curriculum for young patients with congenital heart disease using a consensus approach.
A three-round e-Delphi study among congenital heart disease and paediatric exercise physiology experts was conducted. Round 1, experts provided opinions in a closed- and open-ended electronic questionnaire to identify specific elements necessary for inclusion in a paediatric cardiac rehabilitation programme. Round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. Round 3, the same experts were asked to re-rate items that did not reach consensus from round 2.
Forty-seven experts were contacted via e-mail to participate on the Delphi panel, 37 consented, 35 completed round 1, 29 completed round 2, and 28 completed the final round. After round 2, consensus was reached in 55 of 60 (92%) questionnaire items across four domains: exercise training, education, outcome metrics, and self-confidence.
This study established consensus towards programme structure, exercise training principles, educational content, patient outcome measures, and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a paediatric cardiac rehabilitation curriculum to be used and tested by exercise physiologists, paediatric and adult congenital cardiologists, and other healthcare team members for optimising the health and wellness of paediatric patients with congenital heart disease.
A 14 -year-old boy presented with chest pain and breathlessness. Echocardiography showed a large pericardial effusion with cardiac tamponade features and suspicion of cardiac mass. Cardiovascular magnetic resonance demonstrated a large, well-defined pericardial mass, suggesting atypical large coronary fistula with pericardial haematoma or primary cardiac/pericardial tumour such as angiosarcoma. Histology confirmed a mixed-type vascular malformation. Sirolimus therapy was initiated.
Recent research supports the importance of PUFA intake in children, particularly of EPA and DHA; however, few verified methods to assess whether PUFA intake is adequate are available.
We assessed the correlation between serum PUFA and lipid concentrations with seafood and PUFA intake measured using a brief-type self-administered diet history questionnaire for Japanese preschool children (BDHQ3y).
Single centre birth cohort in Japan.
A total of 152 36-month-old Japanese children.
Average dietary intake of daily seafood, EPA and DHA was 13·83 (sd 10·36) g, 49·4 (sd 43·5) mg and 98·3 (sd 64·6) mg, respectively. Significant weak-to-moderate correlations were observed between dietary intake and serum EPA (Spearman rho = 0·41, P < 0·001; Pearson r = 0·44, P < 0·001); DHA (Spearman rho = 0·40, P < 0·001; Pearson r = 0·42, P < 0·001) and AA (arachidonic acid) (Spearman rho = 0·33, P < 0·001; Pearson r = 0·32, P < 0·001), whereas no significant correlation was observed for dihomo-γ-linolenic acid (DGLA) (Spearman rho = 0·06, P = 0·484; Pearson r = 0·07, P = 0·387). Correlations between seafood intake and serum EPA and DHA were also moderate (0·39–0·43). A negative correlation between serum TAGs and serum EPA, as well as positive correlations between serum cholesterol (total cholesterol, LDL and HDL) with serum EPA and DHA were observed, whereas no significant correlations between seafood intake and serum lipid profiles. Based on this model, we estimated 61–98 g/week of seafood intake is required to meet current EPA/DHA intake recommendations by the WHO (100–150 mg/d).
For children of 2–4 years of age, weekly intake of 61–98 g of seafood is required to meet WHO recommendations of EPA/DHA intake.
A review of the literature demonstrates that relatively little is known about acute psychiatric presentations in children (0–12 years), compared with adolescents or young adults (12 years+). This study aims to review psychiatric presentations of children to a CAMHS Liaison Service at Children’s Hospital Ireland (CHI) at Tallaght University Hospital over a 10-year period.
A retrospective study was undertaken of case notes of all children aged 12 years and under who were referred to the CAMHS Liaison Service between January 2009 and December 2018 (n = 318). Data were anonymised and inputted into SPSSv25 for analysis. The relationships between presentations and methods of self-harm over time were measured using Pearson’s correlation. Associations between categorical variables were analysed using chi-squared tests.
There was a significant increase in presentations of under-12s over the 10-year period (r(8)=0.66, p = 0.02). There was also a significant increase in children presenting with a disturbance of conduct and/or emotions over time (r(8) = 0.79, p < 0.001). There was a significant association between female gender and ingestion (X2 = 12.73, df = 1, p < 0.05) and between male gender and ligature as a method of self-harm (X2 = 5.54, df = 1, p < 0.05). Over half (53%) of children presented with suicidal thoughts and 22% presented with suicidal behaviours. The reported use of ligature as a method of self-harm emerged only from 2012 among cases studied.
Children aged 12 years and under are presenting in increasing numbers with acute mental health difficulties, including suicidal thoughts and behaviours. There is a worrying trend in methods of self-harm, particularly in high lethality behaviours such as attempted strangulation.
CHDs can be complicated by renal injury which worsens morbidity and mortality. Urinary neutrophil gelatinase-associated lipocalin, a sensitive and specific biomarker of renal tubular injury, has not been studied in children with uncorrected CHDs. This study evaluated renal injury in children with uncorrected CHDs using this biomarker.
The patients were children with uncorrected CHDs with significant shunt confirmed on echocardiogram with normal renal ultrasound scan, in the paediatric cardiology clinic of a tertiary hospital. The controls were age-matched healthy children recruited from general practice clinics. Information on bio-data and socio-demographics were collected and urine was obtained for measurement of urinary neutrophil gelatinase-associated lipocalin levels.
A total of 65 children with uncorrected CHDs aged 2 to 204 months were recruited. Thirty-one (47.7%) were males while 36 (55.4%) had acyanotic CHDs. The median urinary neutrophil gelatinase-associated lipocalin level of patients of 26.10 ng/ml was significantly higher than controls of 16.90 ng/ml (U = 1624.50, p = 0.023). The median urinary neutrophil gelatinase-associated lipocalin level of patients with cyanotic and acyanotic CHDs were 30.2 ng/ml and 22.60 ng/ml respectively; (Mann–Whitney U = 368.50, p = 0.116). The prevalence of renal injury using 95th percentile cut-off value of urinary neutrophil gelatinase-associated lipocalin was 16.9%. Median age of patients with renalinjury was 16 (4–44) months.
Children with uncorrected CHDs have renal injury detected as early as infancy. The use of urinary neutrophil gelatinase-associated lipocalin in early detection of renal injury in these children may enhance early intervention and resultant prevention of morbidity and reduction in mortality.
Processing speech can be slow and effortful for children, especially in adverse listening conditions, such as the classroom. This can have detrimental effects on children’s academic achievement. We therefore asked whether primary school children’s speech processing could be made faster and less effortful via the presentation of visual speech cues (speaker’s facial movements), and whether any audio-visual benefit would be modulated by the presence of noise or by characteristics of individual participants. A phoneme monitoring task with concurrent pupillometry was used to measure 7- to 11-year-old children’s speech processing speed and effort, with and without visual cues, in both quiet and noise. Results demonstrated that visual cues to speech can facilitate children’s speech processing, but that these benefits may also be subject to variability according to children’s motivation. Children showed faster processing and reduced effort when visual cues were available, regardless of listening condition. However, examination of individual variability revealed that the reduction in effort was driven by the children who performed better on a measure of phoneme isolation (used to quantify how difficult they found the phoneme monitoring task).
Obesity is usually related to insulin resistance and glucose metabolism disorders. The relationship between insulin resistance and epicardial adipose tissue and atrial electromechanical delay has been described in previous studies.
This study aims to demonstrate the effects of metformin on epicardial adipose tissue and electromechanical delay in patients using metformin for insulin resistance.
Materials and methods:
A total of 30 patients using metformin for insulin resistance were included in the study. Pre-treatment and post-treatment epicardial adipose tissue and electromechanical delay were evaluated.
There was a statistically significant decrease in epicardial adipose tissue thickness after 3 months of metformin therapy (6.4 ± 2.1 versus 4.7 ± 2.0; p = 0.008). Furthermore, the inter-atrial and intra-atrial electromechanical delay also significantly decreased after 3 months of metformin monotherapy (23.6 ± 8.2 versus 18.1 ± 5.8; p < 0.001, 9.1 ± 2.9 versus 6.3 ± 3.6; p = 0.003, respectively).
In this study, we show that metformin monotherapy significantly decreases epicardial adipose tissue thickness and electromechanical delay in obese children.
Canada has resettled more than 57,000 Syrian refugees since 2015 (Government of Canada, 2017). However, little is known about refugee children’s language and literacy development. The present study evaluated Syrian refugee children’s performance on language and literacy measures in English and Arabic, and examined whether the simple view of reading model is applicable in both of their languages. Participants consisted of 115 Syrian refugee children 6–13 years of age. They received a battery of language and literacy measures including word reading, vocabulary, oral narratives, and reading comprehension in both English and Arabic. Compared to the normative samples, refugee children performed poorly on English standardized measures. They also demonstrated difficulties in Arabic, as more than half of the children were not able to read in the language. Despite the relatively low performance, there was evidence to support the simple view of reading model in both languages. In addition, oral language skills played a larger role in English reading comprehension in the older group than the younger group. This age-group comparison was not carried out in Arabic due to reduced sample size. Theoretical and practical implications of the findings are discussed.
Chapter 8 investigates the evacuation of approximately 40,000 Dutch children out of the famine-affected areas. In the 1940s, the Netherlands enjoyed an extensive health- and family care system and had a strong civil society. Many networks were therefore in place to efficiently organise relief. These child evacuations were only one aspect of relief efforts but, similar to the child-feeding initiatives, they highlight the active role of ordinary people and grassroots initiatives in taking emergency measures. Shared ideas on the importance of the continuation of family life, even under extreme circumstances, and protecting the future of Dutch society were key to this communal response to the famine conditions.
Chapter 7 provides a detailed account of social self-organisation at the local level, the constitution of the main NGO during the famine, local child-feeding initiatives, as well as women’s food protests. This chapter demonstrates that the final months of war presented a period of declining legitimacy of state authority in the food system, which led to the rise of new types of organisations: local self-organised relief and self-help entities. Emerging from existing networks, these civil society organisations occupied a central position between the household and state levels and effectively took over care and relief responsibilities. These community efforts can be qualified as a great success and are crucial to explaining why certain groups – children in particular – fared better during the famine than others.
Excess body weight confers a high risk to human health. Body weight variation between subjects can be partially explained by genetic differences. The aim of this study was to investigate the association of genetic variants in the ADIPOQ (rs2241766) and LEP (rs7799039) genes with body weight trajectories in children from birth to six years of age. This was a prospective cohort (PREDI Study). Socioeconomic, biological and anthropometric data were collected at four time points: at birth in the maternity unit; 1-2 years old, 4-5 years old, and 6 years old at the participant’s home. Genotyping was performed by PCR-RFLP. Poisson regression and linear mixed-effect regression models were used to address the association of ADIPOQ and LEP genotypes with BMI. Excessive body weight at pre-pregnancy (β=0.339, p=0.01) and excessive gestational weight gain (β=0.51, p<0.001) were associated with children’s BMI trajectory from birth to six years. The ADIPOQ-rs2241766 TG or GG genotype was associated with a higher risk of excess body weight in the first six years of life (both sexes: RR=1.25, 95%CI: 1.01-1.56; female: RR=1.67, 95%CI: 1.20-2.31). BMI increased over the years according to the presence of the TG or GG genotype (β=0.01, 95%CI: 0.01-0.02), particularly in females (β=0.02, 95%CI: 0.01-0.04). The ADIPOQ-rs2241766 TG and GG genotypes increased the risk of excess body weight in children from birth to six years of age and had a positive effect on body weight trajectories in girls. The LEP-rs7799039 genetic variant was not associated with body weight trajectory in children.
Focal atrial tachycardia accounts for up to 10–15% of supraventricular tachycardiasubstrates in patients < 30 years. In this study, we aimed to demonstrate the outcome of transcatheter ablation procedures performed through three-dimensional electroanatomic mapping systems using minimal fluoroscopy in a paediatric cohort with focal atrial tachycardia.
Forty-nine consecutive patients with focal atrial tachycardia who underwent an electrophysiologic study and a transcatheter ablation procedure in our hospital from September 2014 to February 2020 were included into the study.
The mean weight of the patients was 48.63 ± 15.4 kg, and the mean age was 14.56 ± 3.5 (5.5–18.4) years. The tachycardia was defined as incessant in 26 patients. Thirteen patients had left ventricular systolic dysfunction with a mean left ventricular ejection fraction of 38.47 ± 12.4% on echocardiography. The mean procedure time was 148.7 ± 94.5 minutes. Transseptal puncture and thus fluoroscopy were required in nine patients. The mean fluoroscopy time was 4.51 ± 5.9 minutes. No fluoroscopy was needed in ablations performed in the right atrium. The acute success rate of the ablation procedures was 97.9%. The mean follow-up period was 50.71 ± 23.5 months. Recurrence was noted in two patients (4.2%).
The outcomes of three-dimensional electroanatomic mapping-guided transcatheter ablation procedures are promising with high acute success, low recurrence and complication rates in children with focal atrial tachycardia. The use of fluoroscopy can be significantly decreased with three-dimensional mapping systems in this group of patients.
This chapter explores social morality on the home front focusing on the commentary about the public behaviour of soldiers’ wives, anxiety about a supposed increase in incidences of female drunkenness, and concern about prostitution and the spread of venereal disease. It tracks the number of wartime arrests of women for drunkenness and child neglect. The chapter argues that the hostility to separation women transcended the nationalist movement, and that while there were many incidences of soldiers’ wives arrested for drunken behaviour, the rhetoric exaggerated the reality with total convictions for drunkenness declining in wartime Ireland after the first year of the war. The chapter further explores concern with sexual immorality in wartime, focusing on venereal disease and illegitimate births. It also examines the women’s patrols established to limit the public interaction between working-class women and the soldiers. The chapter concludes that the public behaviour of working-class women in Ireland altered little as a consequence of the war, but there was nevertheless greater censure of problems evident before 1914. While the separation allowances brought women greater control over their domestic spaces, the surveillance of state and society confined women to narrowly defined codes of behaviour.
This study aims to evaluate the validity and reliability of the Turkish version of the Child Three-Factor Eating Questionnaire for primary and secondary school students.
A methodological, descriptive and correlational study design was adopted.
The study was conducted in the western and central regions of Turkey.
This methodological–descriptive–correlational study was conducted with 351 children between July 2018 and August 2018. The mean age of children is 10·74 ± 1·79 (8–14).
The scale consists of seventeen items and three sub-dimensions (restraint, uncontrolled eating and emotional eating), which explained 52·88 % of the total variance. All the factor loadings were >0·40 in both exploratory factor analysis and confirmatory factor analysis (CFA). In CFA, all of the fit indices were >0·85, and root mean square error of approximation was <0·08. For the whole of the scale, Cronbach’s α was 0·81 and it was found that Cronbach’s α values of all sub-dimensions were >0·70.
The results of the study show that the Child Three-Factor Eating Questionnaire for primary and secondary school students is a valid and reliable measurement tool for Turkish sampling.
Non-cardiac chest pain is a common and persistent problem for children; yet, typically, there is no clear medical cause. To date, no behavioural and/or psychological factors have been studied to explain chest pain in a pre-school paediatric sample. We hypothesized that pre-school children with medically unexplained chest pain would have higher rates of behavioural problems compared to healthy controls.
We assessed 41 pre-school children with non-cardiac chest pain and 68 age matched children with benign heart murmurs as the control group using the Child Behaviour Check List-1 1/2–5 to evaluate emotional and behavioural problems.
Internalizing problem scores comprising emotionally reactive, anxiety/depression, and somatic complaints were higher in children with non-cardiac chest pain than in the control group. Among the possible factors, the factor that is related to behaviour problem scores, in univariate analysis, was a significant and inverse correlation between maternal education and behaviour problem scores. Also, maternal employment status was associated with behavioural problems. Children with a housewife mother were more susceptible to having such behavioural problems. Based on multiple regression analyses, being in the non-cardiac chest pain group was found to be significantly related to internalizing problems in our total sample.
These results suggest that pre-school children with non-cardiac chest pain may experience increased levels of certain behavioural comorbidities. Systematic behavioural screening could increase the detection of behavioural problems and improve care for this population. Future studies of non-cardiac chest pain in pre-school children should include larger samples and comprehensive diagnostic assessments as well as long-term follow-up evaluations.
To evaluate the effect of school-based nutrition interventions (SBNI) involving schoolchildren and adolescents in sub-Saharan Africa (SSA) on child nutrition status and nutrition-related knowledge, attitudes and behaviour.
A systematic review on published school nutrition intervention studies of randomised controlled trials, controlled clinical trials, controlled before-and-after studies or quasi-experimental designs with control. Nine electronic bibliographic databases were searched. To be included, interventions had to involve changes to the school’s physical and social environments, to the school’s nutrition policies, to teaching curriculum to incorporate nutrition education and/or to partnership with parents/community.
Schools in SSA.
School-aged children and adolescents, aged 5–19 years.
Fourteen studies met our inclusion criteria. While there are few existing studies of SBNI in SSA, the evidence shows that food supplementation/fortification is very effective in reducing micronutrient deficiencies and can improve nutrition status. Secondly, school nutrition education can improve nutrition knowledge, but this may not necessarily translate into healthy nutrition behaviour, indicating that nutrition knowledge may have little impact without a facilitating environment. Results regarding anthropometry were inconclusive; however, there is evidence for the effectiveness of SBNI in improving cognitive abilities.
There is enough evidence to warrant further trials of SBNI in SSA. Future research should consider investigating the impact of SBNI on anthropometry and nutrition behaviour, focusing on the role of programme intensity and/or duration. To address the high incidence of micronutrient deficiencies in low- and middle-income countries, food supplementation strategies currently available to schoolchildren should be expanded.
Several studies have reported anxiety disorders in children with high intellectual potential (HIP). However, there are discrepant results possibly as a result of methodological biases (different/absent definitions of HIP, small sample sizes, non-validated/adapted/specific tools for assessing anxiety and a single observational source).
To examine more thoroughly the relationships between HIP and anxiety in large samples of children using clear definitions of HIP, different observational sources and specific assessments of anxiety.
Children with HIP (n = 211, total IQ ≥130) were compared with children without HIP (n = 397, total IQ <130) for anxiety using different observational sources (child psychiatric diagnosis, parental evaluation and child's self-evaluation). Intellectual functioning was assessed using the Wechsler Intelligence Scale.
There were significantly more children with HIP who had anxiety disorders than children without HIP based on the child psychiatric diagnosis. Moreover, based on the child's self-evaluation, children with a high Verbal Comprehension Index (VCI ≥130) were significantly more anxious than children with a VCI <130, whereas children with a high Perceptual Reasoning Index (PRI ≥130) were significantly less anxious than children with a PRI <130. Finally, there was no significant relationship between levels of intellectual functioning and anxiety according to parental observation.
The results highlight the importance of using multiple observational sources and conducting analyses on different dimensions of intellectual functioning (such as VCI and PRI), rather than only on the composite total IQ score. High verbal potential might be a factor of vulnerability for anxiety, whereas high perceptual reasoning might be a protective factor. Further studies are necessary to understand better the mechanisms underlying these results.
To examine the associations of dietary diversity with anaemia and iron status among primary school-aged children in South Africa.
An analysis was conducted with pooled individual data from the baseline surveys from three previously conducted independent intervention studies. Two different dietary diversity scores (DDS) were calculated based on data from 1-day (1-d) and 3-day (3-d) dietary recall periods, respectively. Logistic regression analysis was performed to examine the associations of dietary diversity with anaemia and iron status.
KwaZulu-Natal and North West provinces, South Africa.
Children (n 578) 5- to 12-year-old.
A DDS ≤ 4 was associated with higher odds of being anaemic (1-d P = 0·001; 3-d P = 0·006) and being iron deficient (ID) (3-d P < 0·001). For both recall periods, consumption of ‘vegetables and fruits other than vitamin A-rich’ and ‘animal-source foods (ASF)’ was associated with lower odds of being anaemic (both P = 0·002), and ‘organ meats’ with lower odds of being ID (1-d P = 0·045; 3-d P < 0·001). Consumption of ‘meat, chicken and fish’ was associated with lower odds of being anaemic (P = 0·045), and ‘vegetables and fruits other than vitamin A-rich’, ‘legumes, nuts and seeds’ and ‘ASF’ with lower odds of being ID for the 3-d recall period only (P = 0·038, P = 0·020 and P = 0·003, respectively).
In order to improve anaemia and iron status among primary school-aged children, dietary diversification, with emphasis on consumption of vegetables, fruits and ASF (including organ meats), should be promoted.