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Children, Volume 8, Issue 12 (December 2021) – 130 articles

Cover Story (view full-size image): One-third of all neonatal deaths are caused by intrapartum-related events, resulting in neonatal respiratory depression. These review strategies involve clinical-decision support during newborn resuscitation, including the visual display of a resuscitation algorithm, peer-to-peer support, expert coaching, and automated guidance. Also review strategies that involve post-event reflection after newborn resuscitation, including delivery room checklists, audits, and debriefing. View this paper.
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Case Report
Selective Bronchial Occlusion for Treatment of a Bronchopleural Fistula in an Extremely Preterm Infant
Children 2021, 8(12), 1208; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121208 - 20 Dec 2021
Viewed by 315
Abstract
Neonatal pulmonary air leak commonly occurs as a complication of mechanical ventilation in infants with underlying hyaline membrane disease. They can commonly be managed conservatively or with the application of a chest drain, but some severe cases pose a significant challenge in finding [...] Read more.
Neonatal pulmonary air leak commonly occurs as a complication of mechanical ventilation in infants with underlying hyaline membrane disease. They can commonly be managed conservatively or with the application of a chest drain, but some severe cases pose a significant challenge in finding an alternative therapeutic solution. Selective bronchial occlusion represents an unconventional rescue therapy for treating bronchopleural fistula resistant to the standard therapy. A 27-week gestation preterm infant ventilated for respiratory distress syndrome developed tension right-sided pneumothorax. Conventional modalities of treatment were tried and were unsuccessful. Intermittent selective bronchial occlusion with a Fogarty’s catheter and high-frequency oscillatory ventilation resulted in considerable improvement in the infant’s clinical condition and radiographic findings. Full article
(This article belongs to the Special Issue Neonatal Respiratory Distress Update)
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Case Report
Case Series of Variable Acute Appendicitis in Children with SARS-CoV-2 Infection
Children 2021, 8(12), 1207; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121207 - 20 Dec 2021
Viewed by 319
Abstract
This case series study consists of six children, aged 5–16 years, admitted to a centralized tertiary paediatric hospital serving a population of 1.9 million with acute appendicitis in the setting of SARS-CoV-2 infection. From the beginning of the pandemic in March 2020 until [...] Read more.
This case series study consists of six children, aged 5–16 years, admitted to a centralized tertiary paediatric hospital serving a population of 1.9 million with acute appendicitis in the setting of SARS-CoV-2 infection. From the beginning of the pandemic in March 2020 until August 2021, 121 COVID-19-positive children were admitted to the hospital. A total of 49 (40.5%) of these patients presented with gastrointestinal symptoms, of which six were diagnosed with acute appendicitis. Five underwent an appendectomy, while one was treated conservatively. To date, it has been reported that appendicitis may have a plausible association with SARS-CoV-2 infection in children. With COVID-19 cases rising, every medical specialist, including all paediatric surgeons, must be ready to treat common acute diseases with SARS-CoV-2 infection as a comorbidity. Providers should consider testing for this infection in paediatric patients with severe gastrointestinal symptoms. Non-surgical treatment of acute appendicitis in children may gain new importance during and after the COVID-19 pandemic. Further studies are needed to prove the link of causality between COVID-19 and acute appendicitis in children. Full article
(This article belongs to the Special Issue Child Health and Surgery)
Communication
Rigid Bronchoscopy in Foreign Body Aspiration Diagnosis and Treatment in Children
Children 2021, 8(12), 1206; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121206 - 20 Dec 2021
Viewed by 290
Abstract
Foreign body aspiration in children is a common condition and can bring about serious undesired results. Fast and accurate diagnosis and foreign body extraction from airways are essential. We performed a retrospective study on rigid bronchoscopy outcomes due to suspected foreign body aspiration. [...] Read more.
Foreign body aspiration in children is a common condition and can bring about serious undesired results. Fast and accurate diagnosis and foreign body extraction from airways are essential. We performed a retrospective study on rigid bronchoscopy outcomes due to suspected foreign body aspiration. A total of 66 children were admitted to the Chair and Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin between 2015 and 2020 and underwent rigid bronchoscopy in general anesthesia due to suspected foreign body aspiration. We analyzed the data, including patients age and sex, reported complaints, and bronchoscopy findings. Analyzed children were aged from 8 months to 17 years old; 74.24% of them were under 3 years old during the procedure, and most of the operated patients were males. In 36.36% cases, no foreign body was identified, and 57.14% foreign bodies were located in right main bronchus. A total of 80.95% of foreign bodies extracted from airways were organic, mostly nuts. Diagnosis and treatment of suspected foreign body aspiration requires consistent cooperation between pediatricians, pulmonologists, anesthesiologists, and otolaryngologists. Full article
(This article belongs to the Special Issue Research Progress of Pediatric Otolaryngology)
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Article
The Effect of the ‘Touch Screen-Based Cognitive Training’ for Children with Severe Cognitive Impairment in Special Education
Children 2021, 8(12), 1205; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121205 - 19 Dec 2021
Viewed by 430
Abstract
Traditional education in special schools have some limitations. We aimed to investigate if the ‘touch screen-based cognitive training’ is feasible and effective for children with severe cognitive impairment (developmental age 18–36 months) in special education. In this case, 29 children were randomly allocated [...] Read more.
Traditional education in special schools have some limitations. We aimed to investigate if the ‘touch screen-based cognitive training’ is feasible and effective for children with severe cognitive impairment (developmental age 18–36 months) in special education. In this case, 29 children were randomly allocated to intervention (n = 17, ‘touch screen-based cognitive training’, 30 min/session, 3 times/week, 12 weeks) and control (n = 12, traditional education) groups. Psychoeducational Profile-Revised (PEP-R), Early Childhood Behavior Questionnaire (ECBQ), Sequenced Language Scale for Infants (SELSI), Pediatric Evaluation of Disability Inventory (PEDI), and Goal Attainment Scale (GAS) were measured before and after 12 weeks of education. The ‘touch screen-based cognitive training’ was applicable in special education. When repeated measures analysis of variance (ANOVA) was used, significant groupⅹtime effect was found for GAS, and significant group effect was found for ECBQ (attentional shifting) and GAS. When adjusting for pre-education measurements, the intervention had a significant effect on the post-education measurements of ECBQ (attentional shifting) and GAS (p < 0.05). No relationship existed between the degree of improvements and the severeness of developmental delay in the measurements. ‘Touch screen-based cognitive training’ in special school was feasible and it improved cognition in children with severe cognitive impairment (developmental age 18–36 months), irrespective of the severeness of the developmental delay. Full article
(This article belongs to the Special Issue Physical Medicine and Rehabilitation in Children)
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Article
The Use of Auto-Titrating Continuous Positive Airway Pressure (AutoCPAP) for Obstructive Sleep Apnea Syndrome in Children with Obesity
Children 2021, 8(12), 1204; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121204 - 19 Dec 2021
Viewed by 453
Abstract
Background: Positive airway pressure can be an effective and safe therapy for children with obstructive sleep apnea syndrome (OSAS). Few studies have assessed the safety and efficacy of autoCPAP in pediatric patients with obesity. Methods: This was a retrospective chart review of children [...] Read more.
Background: Positive airway pressure can be an effective and safe therapy for children with obstructive sleep apnea syndrome (OSAS). Few studies have assessed the safety and efficacy of autoCPAP in pediatric patients with obesity. Methods: This was a retrospective chart review of children with obesity (Body Mass Index (BMI) > 99th percentile), ages 2–18, diagnosed with OSAS (Obstructive Apnea-Hypopnea Index (OAHI) > 1/h) and used autoCPAP with 30-day adherence. Exclusion criteria included patients with complex comorbidities. Adherence was defined as autoCPAP use ≥4 h/night for at least 21/30 days. Baseline PSG OAHI was compared to the AHI from the 30-day autoCPAP compliance report. We also compared autoCPAP 30-day 95th percentile pressures with the pressures from PAP titration. Results: The study included 19 children, ranging 5–15 years old. The median BMI was 99.6th percentile and average adherence was 25/30 nights with mean of 7.3 h/night. The median OAHI was 12.3/h on baseline PSG and the 30-day autoCPAP download AHI decreased to 1.7/h. No adverse outcomes were identified. The average difference between 95th percentile autoCPAP pressure and PAP titration pressure was 0.89 cmH20. Conclusion: Our study suggests autoCPAP is effective and safe for the treatment of OSAS in pediatric patients with obesity. Using autoCPAP may reduce delays in treatment. Additional research is needed to verify the long-term effectiveness of autoCPAP in this population. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)
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Review
Digital Technologies for Children and Parents Sharing Self-Management in Childhood Chronic or Long-Term Conditions: A Scoping Review
Children 2021, 8(12), 1203; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121203 - 18 Dec 2021
Viewed by 408
Abstract
Worldwide, the prevalence of chronic (or long-term) conditions in children and young people from birth to 18 years (children) is increasing. Promoting competent and effective self-management skills early in the trajectory is important to improve adherence to treatment and optimise quality of [...] Read more.
Worldwide, the prevalence of chronic (or long-term) conditions in children and young people from birth to 18 years (children) is increasing. Promoting competent and effective self-management skills early in the trajectory is important to improve adherence to treatment and optimise quality of life. Successful self-management, therefore, requires parents and children who are developmentally able to develop a range of complex skills, including the use of digital technologies. This scoping review aimed to identify primary research investigating digital technologies for children and parents sharing self-management in childhood chronic illnesses. A comprehensive search of electronic databases was conducted. Nineteen papers were included, assessed for quality and methodological rigour using the Hawker tool and thematically analysed. Three themes were identified: (i) the feasibility and acceptability of using technology, (ii) the usability of technologies and (iii) the effect of technologies on adherence and self-management skills. The results indicate that technologies such as mobile apps and websites can assist the management of long-term conditions, are an acceptable method of delivering information and can promote the development of effective self-management skills by parents and children. However, future technology design must include children and parents in all stages of development. Full article
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Article
Association between Sleep Time and Blood Pressure in Korean Adolescents: Cross-Sectional Analysis of KNHANES VII
Children 2021, 8(12), 1202; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121202 - 18 Dec 2021
Viewed by 438
Abstract
Background: Hypertension is highly related to sleep, and there have been a number of studies on sleep deprivation and the occurrence of hypertension. However, there is still insufficient research on the relationship between hypertension and various factors related to sleep. Thus, this study [...] Read more.
Background: Hypertension is highly related to sleep, and there have been a number of studies on sleep deprivation and the occurrence of hypertension. However, there is still insufficient research on the relationship between hypertension and various factors related to sleep. Thus, this study attempted to investigate the relationship between hypertension and sleep time-related variables in Korean adolescents. Methods: A total of 1470 adolescents (709 girls and 761 boys) between 12 and 18 years of age were enrolled through the Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII). The systolic and diastolic blood pressure were measured. Sleep time-related variables such as sleep onset time, wake time, and sleep duration (weekday and weekend, each) were also investigated using a questionnaire. We performed multivariate regression analyses to determine the independent effects of the variables. Results: Systolic blood pressure was negatively correlated with the wake time (r = −0.081; p = 0.002) and sleep onset time (r = −0.088; p = 0.001) on weekends. There was a positive correlation between diastolic blood pressure and weekday sleep onset time (r = 0.158; p = 0.000) and weekend sleep onset time (r = 0.184; p = 0.000). The sleep duration on weekdays and weekends showed a negative correlation (r = −0.136; p = 0.000, r = −0.088; p = 0.001, respectively). In the multivariate linear regression analysis results, the sleep onset time on weekends was significantly correlated with elevated diastolic blood pressure. Conclusions: Delayed sleep onset time on weekends was significantly associated with increased diastolic blood pressure in Korean adolescents. Further investigation is needed to confirm the clinical significance of these findings. Full article
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Case Report
Neuroleptic Malignant Syndrome in Children with Autism Spectrum Disorder (ASD): A Case Report and Brief Review of Recent Literature
Children 2021, 8(12), 1201; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121201 - 18 Dec 2021
Viewed by 391
Abstract
Neuroleptic malignant syndrome (NMS) is a rare, life-threatening, idiosyncratic adverse reaction to antipsychotic drugs. Despite the increasing rates in the prescription of antipsychotics in pediatric patients with autism spectrum disorder (ASD), little is known about the occurrence and hallmarks of NMS in this [...] Read more.
Neuroleptic malignant syndrome (NMS) is a rare, life-threatening, idiosyncratic adverse reaction to antipsychotic drugs. Despite the increasing rates in the prescription of antipsychotics in pediatric patients with autism spectrum disorder (ASD), little is known about the occurrence and hallmarks of NMS in this specific population. NMS appears to be part of the larger catatonia domain, based on the frequent relationship between ASD and catatonia, on the shared, when not overlapping, clinical features with malignant catatonia, and on the effectiveness of catatonia treatments on the NMS/MC symptoms. The intrinsic difficulties of exploring NMS in ASD in controlled studies accounts for the subsequent lack of available information. Based on recent reports and on our case report, clinical features of NMS in the pediatric ASD population appear to be the same as the non-ASD population. Further studies are needed to confirm these results. Full article
(This article belongs to the Special Issue Adolescent Psychopharmacology and Related Metabolic Disturbances)
Review
Pediatric Cardio-Oncology Medicine: A New Approach in Cardiovascular Care
Children 2021, 8(12), 1200; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121200 - 18 Dec 2021
Viewed by 448
Abstract
Survival for pediatric patients diagnosed with cancer has improved significantly. This achievement has been made possible due to new treatment modalities and the incorporation of a systematic multidisciplinary approach for supportive care. Understanding the distinctive cardiovascular characteristics of children undergoing cancer therapies has [...] Read more.
Survival for pediatric patients diagnosed with cancer has improved significantly. This achievement has been made possible due to new treatment modalities and the incorporation of a systematic multidisciplinary approach for supportive care. Understanding the distinctive cardiovascular characteristics of children undergoing cancer therapies has set the underpinnings to provide comprehensive care before, during, and after the management of cancer. Nonetheless, we acknowledge the challenge to understand the rapid expansion of oncology disciplines. The limited guidelines in pediatric cardio-oncology have motivated us to develop risk-stratification systems to institute surveillance and therapeutic support for this patient population. Here, we describe a collaborative approach to provide wide-ranging cardiovascular care to children and young adults with oncology diseases. Promoting collaboration in pediatric cardio-oncology medicine will ultimately provide excellent quality of care for future generations of patients. Full article
(This article belongs to the Special Issue Cardio-Oncology in Children)
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Article
Effects of Physical Exercise on Prosocial Behavior of Junior High School Students
Children 2021, 8(12), 1199; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121199 - 18 Dec 2021
Viewed by 294
Abstract
Objective: This study aims to investigate whether physical activity can promote students’ prosocial behavior by analyzing the relationship between sports participation and the prosocial behavior of junior high school students. Methods: Based on the 2014–2015 China education panel survey (CEPS), the relationship between [...] Read more.
Objective: This study aims to investigate whether physical activity can promote students’ prosocial behavior by analyzing the relationship between sports participation and the prosocial behavior of junior high school students. Methods: Based on the 2014–2015 China education panel survey (CEPS), the relationship between regular athletic sports and prosocial behavior was evaluated among eighth-grade students by ordinary least squares (OLS) estimation and propensity score matching (PSM) and the relationship between OLS and PSM was evaluated by Rosenbaum’s bounds test for a robustness test; the observations were analyzed for heterogeneity to identify those who benefit more from sports. Results: The OLS results showed that sporting behavior increased prosocial behavior scores by 4%, and the PSM results showed that regular physical exercise increased students’ prosocial behavior tendencies by over 0.2 standard deviations from the mean prosocial behavior score (standardized). According to the Rosenbaum’s bounds test, the estimates were robust and reliable, and the results of the heterogeneity analysis showed that with males and students whose fathers had more than 9 years of education, the students showed more significant improvements in prosocial behavior. Conclusion: Physical activity has a significant positive effect on students’ prosocial behavior, and gender and the father’s education are significantly related to prosocial behavior. Full article
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Article
There Is an Inverse Correlation between Basic Motor Skills and Overweight in Schoolchildren Aged 8 to 12
Children 2021, 8(12), 1198; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121198 - 18 Dec 2021
Viewed by 308
Abstract
In the last three decades, childhood obesity has become a 21st century epidemic, a product of social development. The purpose of this study was to analyze the repercussions that overweight and obesity have for the basic motor skills of a group of children [...] Read more.
In the last three decades, childhood obesity has become a 21st century epidemic, a product of social development. The purpose of this study was to analyze the repercussions that overweight and obesity have for the basic motor skills of a group of children in primary school, as well as their interrelations. We analyzed a sample of 287 students from Spain, aged between 8 and 12 years. Anthropometric data were taken to determine their Body Mass Index (BMI). A scale of assessment of basic motor skills was used to evaluate their motor skills. The BMI data revealed that 11% of this sample was considered obese, and 26% was overweight. Children showed higher competence in locomotor skills than in object control and turn and rolling skills, for which motor competence levels were lower. Likewise, there was an inverse relationship between BMI and basic motor skills; children with obesity had the lowest levels of motor skills, and there was a significant difference regarding non-obese children (p ≤ 0.05). These results showed that overweight and obese children have lower basic motor skills, which can lead to the abandonment of physical activity and the preference for other activities that reinforce a sedentary lifestyle. Full article
(This article belongs to the Special Issue Physical Activity and Exercise Science for Children)
Article
Factors Associated with the Dual Use of Electronic Cigarettes and Cigarettes among Thai Undergraduate Students Who Smoked Cigarettes
Children 2021, 8(12), 1197; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121197 - 17 Dec 2021
Viewed by 358
Abstract
This study proposed to identify factors associated with the dual use of electronic cigarettes (e-cigarettes) and cigarettes among undergraduate students who smoked cigarettes. This cross-sectional study employed a self-administered, anonymous online questionnaires to collect information from undergraduate smokers in northern Thailand. Of the [...] Read more.
This study proposed to identify factors associated with the dual use of electronic cigarettes (e-cigarettes) and cigarettes among undergraduate students who smoked cigarettes. This cross-sectional study employed a self-administered, anonymous online questionnaires to collect information from undergraduate smokers in northern Thailand. Of the 494 participants, 82.8% were dual users of e-cigarettes and cigarettes. The two main reasons for using e-cigarettes were an absence of cigarette smoke odor (76.8%) and availability of flavors (70.7%). Undergraduate smokers who initiated smoking at ≥18 years old were more likely to be dual users than those who initiated smoking at younger age (adjusted odds ratio [aOR]: 2.79, 95% confidence intervals [CI]: 1.32–5.89, p = 0.007). Undergraduate smokers who smoked ≥11 cigarettes daily were more likely to be dual users than those who smoked less (aOR: 2.64, 95% CI: 1.52–4.61, p = 0.001). Conversely, undergraduate smokers who had attempted to quit during the past year were less likely to be dual users (aOR: 0.26, 95% CI: 0.12–0.56, p = 0.001). In conclusion, dual use of e-cigarettes and cigarettes among undergraduate smokers was associated with older age at cigarette smoking initiation, a higher number of cigarettes smoked daily, and having no past year’s cigarette quit attempts. Full article
(This article belongs to the Section Global and Public Health)
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Article
Assessment of Platelet Mitochondrial Respiration in a Pediatric Population: A Pilot Study in Healthy Children and Children with Acute Lymphoblastic Leukemia
Children 2021, 8(12), 1196; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121196 - 17 Dec 2021
Viewed by 331
Abstract
Characterization of mitochondrial respiration in peripheral blood cells has recently emerged as a potential biomarker for the assessment of the severity of hematological malignancies (HM) in adults. Whether changes in platelet respiratory function occur in children with or without HM it is unknown. [...] Read more.
Characterization of mitochondrial respiration in peripheral blood cells has recently emerged as a potential biomarker for the assessment of the severity of hematological malignancies (HM) in adults. Whether changes in platelet respiratory function occur in children with or without HM it is unknown. The present pilot study was double-aimed: (i) to investigate whether platelet respiration is age-dependent in non-HM children and (ii) to assess the platelet mitochondrial respiration in children with newly diagnosed acute lymphoblastic leukemia (ALL). Blood samples obtained from age-grouped children (10–11, 13–14 and 16–17 years) with non-HM and children with ALL (10–11 years) were used to isolate platelets via differential centrifugation. High-resolution respirometry studies of isolated platelets were performed according to a protocol adapted to evaluate complex I and II-supported respiration. An age-related decrease in respiration was observed in the non-HM pediatric population and had comparable values for the 13–14 and 16–17 years. groups. In children with ALL, a significant increase in C I-supported active respiration and decrease in maximal noncoupled respiration were found at the disease onset. In conclusion, in a pediatric population, platelet mitochondrial respiration is age-dependent. Platelet respiratory dysfunction occurs in children with newly-diagnosed ALL, an observation that warrants further investigation of this change as a disease biomarker. Full article
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Article
Effectiveness of Hypnoanalgesia in Paediatric Dermatological Surgery
Children 2021, 8(12), 1195; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121195 - 17 Dec 2021
Viewed by 425
Abstract
Background and objective. Stress in surgical settings has subtle psychological and physiological repercussions in children. The objective is to evaluate whether hypnosedation is effective in reducing the doses of sedation and analgesia required during the periprocedural period in children undergoing dermatological surgery, without [...] Read more.
Background and objective. Stress in surgical settings has subtle psychological and physiological repercussions in children. The objective is to evaluate whether hypnosedation is effective in reducing the doses of sedation and analgesia required during the periprocedural period in children undergoing dermatological surgery, without negatively affecting pain and satisfaction. Patients and methods: A prospective, longitudinal, observational study where paediatric patients (aged 5–16 years) scheduled for dermatological surgery were analysed according to whether they received hypnosis or distraction during surgery (both common procedures at the centre). As outcome measurements we used sedation doses (propofol) during surgery and the need for analgesia; pain assessment post-surgery and at 24 h using a visual analogue scale (VAS) or revised face pain scale (FPS-r) (both 0–10) depending on age, as well as patient and guardian satisfaction (on a scale of 0–10). Results: Of the 68 patients eligible during the follow-up period, 65 were included. Of these, 33 were treated with hypnosis and 32 with distraction. Children who underwent hypnosis required less total propofol (45.5 ± 11.8 mg vs. 69.3 ± 16.8 mg; p < 0.001) and metamizole in the immediate postoperative period (34.4% vs. 65.6%; p = 0.018). After 24 h, they required less ibuprofen (9.1% vs. 28.1%; p = 0.048) and paracetamol (48.5% vs. 75.0%; p = 0.028). Mean pain according to VAS or FPS-r at 24 h was 3.1 with hypnosis vs. 4.3 with distraction (p < 0.001). Overall satisfaction was higher in the hypnosis group (8.7 ± 0.1 vs. 8.1 ± 0.2; p = 0.009). Conclusions: Hypnoanalgesia in children undergoing dermatological outpatient surgery could not only reduce sedation and analgesia requirements, but also improve child and guardian(s) satisfaction. Full article
(This article belongs to the Section Integrative Pediatrics)
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Review
Improving Newborn Resuscitation by Making Every Birth a Learning Event
Children 2021, 8(12), 1194; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121194 - 16 Dec 2021
Viewed by 494
Abstract
One third of all neonatal deaths are caused by intrapartum-related events, resulting in neonatal respiratory depression (i.e., failure to breathe at birth). Evidence-based resuscitation with stimulation, airway clearance, and positive pressure ventilation reduces mortality from respiratory depression. Improving adherence to evidence-based resuscitation is [...] Read more.
One third of all neonatal deaths are caused by intrapartum-related events, resulting in neonatal respiratory depression (i.e., failure to breathe at birth). Evidence-based resuscitation with stimulation, airway clearance, and positive pressure ventilation reduces mortality from respiratory depression. Improving adherence to evidence-based resuscitation is vital to preventing neonatal deaths caused by respiratory depression. Standard resuscitation training programs, combined with frequent simulation practice, have not reached their life-saving potential due to ongoing gaps in bedside performance. Complex neonatal resuscitations, such as those involving positive pressure ventilation, are relatively uncommon for any given resuscitation provider, making consistent clinical practice an unrealistic solution for improving performance. This review discusses strategies to allow every birth to act as a learning event within the context of both high- and low-resource settings. We review strategies that involve clinical-decision support during newborn resuscitation, including the visual display of a resuscitation algorithm, peer-to-peer support, expert coaching, and automated guidance. We also review strategies that involve post-event reflection after newborn resuscitation, including delivery room checklists, audits, and debriefing. Strategies that make every birth a learning event have the potential to close performance gaps in newborn resuscitation that remain after training and frequent simulation practice, and they should be prioritized for further development and evaluation. Full article
(This article belongs to the Special Issue Newborn Resuscitation: Advances in Training and Practice)
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Article
Allergic Comorbidity Is a Risk Factor for Not Attending Scheduled Outpatient Visits in Children with Asthma
Children 2021, 8(12), 1193; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121193 - 16 Dec 2021
Viewed by 322
Abstract
Asthma is one of the most common chronic diseases in children globally. Previous studies have shown that not attending asthma primary care consultations is associated with poorer treatment adherence and increased risk of loss of asthma control on a short-term basis. Here, we [...] Read more.
Asthma is one of the most common chronic diseases in children globally. Previous studies have shown that not attending asthma primary care consultations is associated with poorer treatment adherence and increased risk of loss of asthma control on a short-term basis. Here, we investigated long-term patterns and predictors of not attending scheduled asthma outpatient visits during 5-years of follow-up in 146 children with asthma. Of the 146 children, 67 (46%) did not attend at least one scheduled appointment, amounting to a total of 122 (10.8%) missed of 1133 scheduled appointments. In a multivariate analysis adjusting for total scheduled visits in the 5-year period any allergic sensitization was a significant risk factor for not attending ≥1 scheduled appointment (aOR = 6.6 (95% CI, 1.3–39.7), p = 0.03), which was not the case for asthma treatment step or lung function. Furthermore, atopic predisposition decreased the risk of non-attendance (aOR = 0.36 (0.13–0.92), p = 0.04). We found no association between non-attendance, treatment adherence or loss of asthma control. This study highlights that allergic comorbidity, but not degree of asthma severity, identifies a group of children with asthma who are prone to not attend scheduled outpatient appointments. Full article
(This article belongs to the Special Issue Allergic Rhinitis in Childhood)
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Case Report
A Case of William’s Syndrome in a Ugandan Child: A Feasible Diagnosis Even in a Low-Resource Setting
Children 2021, 8(12), 1192; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121192 - 16 Dec 2021
Viewed by 458
Abstract
Background: Williams–Beuren syndrome (WS) is a rare, complex, congenital developmental disorder including cardiovascular manifestations, intellectual disability and a peculiar cognitive and behavior profile. Supravalvular aortic stenosis (SVAS) is the most frequent cardiovascular abnormality in WS children. Data on WS patients in sub-Saharan Africa [...] Read more.
Background: Williams–Beuren syndrome (WS) is a rare, complex, congenital developmental disorder including cardiovascular manifestations, intellectual disability and a peculiar cognitive and behavior profile. Supravalvular aortic stenosis (SVAS) is the most frequent cardiovascular abnormality in WS children. Data on WS patients in sub-Saharan Africa are scarce. A genetic study is usually required for a definite diagnosis, but genetic testing is often unavailable in developing countries and the combination of a typical clinical phenotype and echocardiographic profile helps to confirm the diagnosis. Case Report: We report the case of a 5-year-old Ugandan child admitted to a large no profit hospital after he was initially managed as a case of infective endocarditis. A physical examination revealed the typical features of WS. A cardiac echo showed severe SVAS (peak gradient 80 mmHg) with a normal anatomy and function of the aortic valve and mild valvular pulmonary stenosis. The child also had a moderate intellectual disability and a characteristic facies consistent with WS. Conclusion: We present the first reported case of WS in Uganda. Cardiac echo and a characteristic clinical picture could be enough to exclude more common causes of heart failure (i.e., rheumatic heart disease) and to make the diagnosis even when specific genetic tests are not available. Full article
(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)
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Opinion
Human Microbiome in Children, at the Crossroad of Social Determinants of Health and Personalized Medicine
Children 2021, 8(12), 1191; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121191 - 16 Dec 2021
Viewed by 361
Abstract
The evolving field of microbiome research offers an excellent opportunity for biomarker identification, understanding drug metabolization disparities, and improving personalized medicine. However, the complexities of host–microbe ecological interactions hinder clinical transferability. Among other factors, the microbiome is deeply influenced by age and social [...] Read more.
The evolving field of microbiome research offers an excellent opportunity for biomarker identification, understanding drug metabolization disparities, and improving personalized medicine. However, the complexities of host–microbe ecological interactions hinder clinical transferability. Among other factors, the microbiome is deeply influenced by age and social determinants of health, including environmental factors such as diet and lifestyle conditions. In this article, the bidirectionality of social and host–microorganism interactions in health will be discussed. While the field of microbiome-related personalized medicine evolves, it is clear that social determinants of health should be mitigated. Furthermore, microbiome research exemplifies the need for specific pediatric investigation plans to improve children’s health. Full article
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Article
The Effectiveness of an Integrated Treatment for Functional Speech Sound Disorders—A Randomized Controlled Trial
Children 2021, 8(12), 1190; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121190 - 16 Dec 2021
Viewed by 359
Abstract
Background: The treatment of functional speech sound disorders (SSDs) in children is often lengthy, ill-defined, and without satisfactory evidence of success; effectiveness studies on SSDs are rare. This randomized controlled trial evaluates the effectiveness of the integrated SSD treatment program PhonoSens, which focuses [...] Read more.
Background: The treatment of functional speech sound disorders (SSDs) in children is often lengthy, ill-defined, and without satisfactory evidence of success; effectiveness studies on SSDs are rare. This randomized controlled trial evaluates the effectiveness of the integrated SSD treatment program PhonoSens, which focuses on integrating phonological and phonetic processing according to the Integrated Psycholinguistic Model of Speech Processing (IPMSP). Methods: Thirty-two German-speaking children aged from 3.5 to 5.5 years (median 4.6) with functional SSD were randomly assigned to a treatment or a wait-list control group with 16 children each. All children in the treatment group and, after an average waiting period of 6 months, 12 children in the control group underwent PhonoSens treatment. Results: The treatment group showed more percent correct consonants (PCC) and a greater reduction in phonological processes after 15 therapy sessions than the wait-list control group, both with large effect sizes (Cohen’s d = 0.89 and 1.04). All 28 children treated achieved normal phonological abilities: 21 before entering school and 7 during first grade. The average number of treatment sessions was 28; the average treatment duration was 11.5 months. Conclusion: IPMSP-aligned therapy is effective in the treatment of SSD and is well adaptable for languages other than German. Full article
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Case Report
Evaluation of a Hypersensitivity Inhibitor Containing a Novel Monomer That Induces Remineralization—A Case Series in Pediatric Patients
Children 2021, 8(12), 1189; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121189 - 16 Dec 2021
Viewed by 433
Abstract
Background: Recently, tooth deformities have been frequently encountered by pediatric dentists. Severe enamel hypomineralization sometimes induces pain such as hyperesthesia, but composite resin restoration is difficult because it often detaches without any cavity preparation. Resin-based hypersensitivity inhibitors for tooth physically seal the dentinal [...] Read more.
Background: Recently, tooth deformities have been frequently encountered by pediatric dentists. Severe enamel hypomineralization sometimes induces pain such as hyperesthesia, but composite resin restoration is difficult because it often detaches without any cavity preparation. Resin-based hypersensitivity inhibitors for tooth physically seal the dentinal tubules. It was reported that hypersensitivity inhibitor containing novel adhesive monomers forms apatite and induces remineralization in vitro. Therefore, these case series assessed the clinical effects of remineralization and the suppression of hypersensitivity by Bio Coat Ca (Sun Medical, Shiga, Japan). Methods: After mechanical tooth cleaning was performed, the hypersensitivity inhibitors were applied and cured by light exposure. Changes in hypersensitivity were determined by visual analog scale (VAS). The improvement of hypomineralization was evaluated by the change in color tone based on the digital images of intraoral photographs. Results: After repeated monthly treatments, these cases showed decreased hypersensitivity after the fourth application, while the opaque white and brownish color improved on the seventh application. Conclusion: This novel hypersensitivity inhibitor with calcium salt of 4-methacryloxyethyl trimellitic acid (C-MET) and 10-methacryloyloxydecyl dihydrogen calcium phosphate (MDCP) not only suppressed hypersensitivity but also improved cloudiness and brown spots in recently erupted permanent teeth in presented cases. Full article
(This article belongs to the Section Pediatric Dentistry)
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Article
Cardio-Respiratory Events and Food Autonomy Responses to Early Uni-Modal Orofacial Stimulation in Very Premature Babies: A Randomized, Controlled Study
Children 2021, 8(12), 1188; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121188 - 16 Dec 2021
Viewed by 317
Abstract
Uni-modal orofacial stimulation (OFS) for preventing very preterm infants’ oral disorders is highly controversial. Our study sought to demonstrate that OFS reduced cardio-respiratory events and improved food autonomy in a population of very preterm infants. Our study was randomized, controlled, prospective, and unicentric. [...] Read more.
Uni-modal orofacial stimulation (OFS) for preventing very preterm infants’ oral disorders is highly controversial. Our study sought to demonstrate that OFS reduced cardio-respiratory events and improved food autonomy in a population of very preterm infants. Our study was randomized, controlled, prospective, and unicentric. The preterm included were born between 26–29 weeks gestational age (GA) with a corrected postnatal age <33 weeks GA. They were randomized into two groups: the experimental group underwent OFS, according to a protocol established, over 10 consecutive days, and the control group underwent no OFS. The primary outcome was the number of cardiorespiratory events: apnea–bradycardia (with or without desaturations) or number of isolated desaturations, which were evaluated at four separate times. Measurements occurred during the first, fourth and eighth independent feedings. Seventeen patients were included in the experimental group and 18 in the control group. The number of cardiorespiratory events for all independent feeding times was significantly reduced in the OFS group (p = 0.003) with univariate analysis, but not with multivariable analysis. The quantity of milk ingested during the first autonomous feeding was higher in the experimental group. The acquisition of food autonomy and the duration of hospitalization were similar in the two groups. While our study does not affirm that an early unimodal OFS improves premature infants’ cardiorespiratory evolution and/or the acquisition of food autonomy, it does indicate an improved food efficiency during their first autonomous feedings. Full article
(This article belongs to the Special Issue Neurodevelopmental Disabilities in Neonates)
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Case Report
Somatic and Abdominal Acupuncture for Pain Treatment in Adolescent Complex Regional Pain Syndrome (CRPS) of the Upper Limb: A Case Report
Children 2021, 8(12), 1187; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121187 - 16 Dec 2021
Viewed by 409
Abstract
Complex regional pain syndrome (CRPS) is still poorly understood. It is a pain disorder in which pain is disproportionate to the initial stimulus. There is no specific therapy for CRPS, but it can be managed by a combination of treatments. We report a [...] Read more.
Complex regional pain syndrome (CRPS) is still poorly understood. It is a pain disorder in which pain is disproportionate to the initial stimulus. There is no specific therapy for CRPS, but it can be managed by a combination of treatments. We report a 13-year-old girl with CRPS of the upper limb treated with somatic and abdominal acupuncture. She described a severe, pulsating pain in the left wrist and hand, with hypersensitivity, allodynia, a marked reduction in strength, and swelling and sweating at the level of the fingers. Pain began three months previously, after a trauma to the left wrist. The diagnostic tests performed were negative. At the first visit we recommended oral tramadol. During the first two sessions we used somatic acupuncture. At the third session, the girl reported suffering intolerable pain in the affected limb during the previous sessions, so we decided to use abdominal acupuncture. After 8 sessions of abdominal acupuncture the pain completely disappeared. Acupuncture could be a potential alternative when conservative therapy with physical and medical treatment fails, but more often parents and adolescents prefer this therapy since other comorbidities are often present in pediatric populations and abdominal acupuncture could be a valuable alternative aid. Full article
(This article belongs to the Special Issue Management of Chronic Pain in Adolescents and Children)
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Article
Anthropometric Indices of Giardia-Infected Under-Five Children Presenting with Moderate-to-Severe Diarrhea and Their Healthy Community Controls: Data from the Global Enteric Multicenter Study
Children 2021, 8(12), 1186; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121186 - 15 Dec 2021
Viewed by 380
Abstract
Among all intestinal parasitosis, giardiasis has been reported to be associated with delayed growth in malnourished children under 5 living in low- and middle-income countries. Relevant data on the nutritional status of children aged 0–59 months presenting with moderate-to-severe diarrhea (MSD) and giardia [...] Read more.
Among all intestinal parasitosis, giardiasis has been reported to be associated with delayed growth in malnourished children under 5 living in low- and middle-income countries. Relevant data on the nutritional status of children aged 0–59 months presenting with moderate-to-severe diarrhea (MSD) and giardia infection were collected from sentinel health facilities of the Global Enteric Multicenter Study’s (GEMS) seven field settings, placed in diverse countries of Sub-Saharan Africa and South Asia between, December 2007 and February 2011. Then, this study analyzed a robust dataset of study participants (n = 22,569). Children having giardiasis with MSD constituted as cases (n = 1786), and those without MSD constituted as controls (n = 3470). Among the seven field sites, symptomatic giardiasis was 15% and 22% in Asian and African sites, respectively, whereas asymptomatic giardia infection (healthy without MSD) in Asian and African sites was 21.7% and 30.7%, respectively. Wasting and underweight were more frequently associated and stunting less often associated with symptomatic giardiasis (for all, p < 0.001). Symptomatic giardiasis had a significant association with worsening of nutritional status in under-five children. Improved socio-economic profile along with proper sanitation and hygienic practices are imperative to enhance child nutritional status, particularly in resource limited settings. Full article
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Article
“It’s Very Stressful for Children”: Elementary School-Aged Children’s Psychological Wellbeing during COVID-19 in Canada
Children 2021, 8(12), 1185; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121185 - 15 Dec 2021
Viewed by 383
Abstract
Emerging evidence suggests that the COVID-19 pandemic and associated public health measures, including lockdowns and school closures, have been negatively affecting school-aged children’s psychological wellbeing. To identify supports required to mitigate the negative impacts of the COVID-19 pandemic, we gathered in-depth information on [...] Read more.
Emerging evidence suggests that the COVID-19 pandemic and associated public health measures, including lockdowns and school closures, have been negatively affecting school-aged children’s psychological wellbeing. To identify supports required to mitigate the negative impacts of the COVID-19 pandemic, we gathered in-depth information on school-aged children’s and parents’ lived experiences of COVID-19 and perceptions of its impact on psychological wellbeing in grade 4–6 students in Canada. In this qualitative study, we conducted telephone-based semi-structured interviews with parents (n = 15) and their children (n = 16) from six schools in small and mid-sized northern prairie communities in Canada. Interviews were analyzed through thematic analysis. Three interrelated themes have emerged. First, the start of COVID-19 brought sudden and stressful changes to children’s lives. Second, disruptions to daily life led to feelings of boredom and lack of purpose. Third, limited opportunities for social interaction led to loneliness and an increase in screen time to seek social connection with peers. Results underscore the need for resilience building and the promotion of positive coping strategies to help school-aged children thrive in the event of future health crises or natural disasters. Full article
Article
The Arabic Version of the Faces Pain Scale-Revised: Cultural Adaptation, Validity, and Reliability Properties When Used with Children and Adolescents
Children 2021, 8(12), 1184; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121184 - 15 Dec 2021
Viewed by 351
Abstract
The Faces Pain Scale-Revised (FPS-R) is widely used to assess pain intensity in young people. The aims of this research were to study the convergent and discriminant validity and reliability properties of a culturally adapted version of the FPS-R for its use with [...] Read more.
The Faces Pain Scale-Revised (FPS-R) is widely used to assess pain intensity in young people. The aims of this research were to study the convergent and discriminant validity and reliability properties of a culturally adapted version of the FPS-R for its use with Arabic-speaking individuals. The sample consisted of 292 students living in Lebanon. They were interviewed online, asked to imagine themselves in one of two given situations based on their age (8–12 and 13–18 years old), and then asked rate the intensity of pain they would experience using the FPS-R-Arabic and a Numerical Rating Scale (NRS-11-Arabic). They were also asked to respond to the Pain Catastrophizing Scale (PCS-C-Arabic). Two weeks later, participants were asked to repeat the same procedure. The data showed strong associations between the scores of the FPS-R-Arabic and NRS-11-Arabic (r = 0.72; p < 0.001), which were higher than the associations of the scores of the FPS-Arabic with the PCS-C-Arabic scores (z = 7.36, p < 0.001). The associations between the FPS-R-Arabic scores on the two measurements were also strong (r = 0.76; p < 0.001). The findings support the convergent and discriminant validity and reliability of the FPS-R-Arabic scores when used to measure pain intensity in young people aged 8 to 18 years old. Full article
Article
Change in Pediatric Health Care Spending and Drug Utilization during the COVID-19 Pandemic
Children 2021, 8(12), 1183; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121183 - 15 Dec 2021
Viewed by 326
Abstract
Objective: To evaluate how the restrictive measures implemented during the SARS-CoV-2 pandemic have influenced the incidence of the most common children’s diseases and the consumption of medications in 2020 compared to 2019. Methods: We involved all family pediatricians of the local health authority [...] Read more.
Objective: To evaluate how the restrictive measures implemented during the SARS-CoV-2 pandemic have influenced the incidence of the most common children’s diseases and the consumption of medications in 2020 compared to 2019. Methods: We involved all family pediatricians of the local health authority of Latina, from which we requested data of monthly visits in 2019 and 2020 for six common diseases disseminated through droplets and contact, and the territorial and integrative pharmaceutical unit of the area, from which we requested data of the net expenditure regarding the most commonly used drugs at pediatric age. Results: There was significant reduction in the incidence of the evaluated diseases and in the consumption of investigated drugs between 2019 and 2020 in the months when the restrictive measures were in place, with an attenuation of this effect during the months of the gradual loosening of those measures. Conclusion: Nonpharmaceutical intervention measures have caused changes in the diffusion of common pediatric diseases. We believe that the implementation of a reasonable containment strategy, even outside of the pandemic, could positively influence the epidemiology of infectious and allergic diseases in children, and healthcare system spending. Full article
(This article belongs to the Section Pediatric Infectious Diseases)
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Article
Foreign Body Ingestion in Children: Epidemiological, Clinical Features and Outcome in a Third Level Emergency Department
Children 2021, 8(12), 1182; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121182 - 15 Dec 2021
Viewed by 411
Abstract
Ingestion of foreign bodies is a frequent pediatric cause of access to the Emergency Department (ED). The aim of this study was to determine the epidemiological and clinical features of pediatric patients with a diagnosis of foreign body ingestion and to identify the [...] Read more.
Ingestion of foreign bodies is a frequent pediatric cause of access to the Emergency Department (ED). The aim of this study was to determine the epidemiological and clinical features of pediatric patients with a diagnosis of foreign body ingestion and to identify the factors associated with an urgent invasive procedure or hospitalization. This is a retrospective study conducted on a population of 286 pediatric patients (0–17 years) evaluated for foreign body ingestion at the Pediatric ED of “Fondazione Policlinico Universitario A. Gemelli, IRCSS” between October 2014 and June 2019. Data concerning age and gender, underlying diseases, type of foreign body, symptoms and signs, instrumental tests, specialist visits, treatment and outcome were analyzed. The majority of foreign bodies were coins (23%). Symptoms recurred in 50% of the foreign bodies with esophageal localization and between the 92 (32%) patients with symptoms the most common was vomiting (7%). X-rays was performed in 61% of patients. Among all patients, 253 patients (88.8%) had been discharged, 21 (7%) had been hospitalized, and four (1.4%) were sent to an outpatient facility. Besides, 17 (5.9%) patients had been transferred to the Observation Unit. Of the hospitalized patients (21 (7.3%)), clinical observation was performed for 57% and endoscopic procedure for 45%. Our data confirm that the ESPGHAN-ESGE guidelines application prevents interventions that are not necessary, avoiding diagnostic and therapeutic delays. Full article
Article
The EU Strategy on the Rights of the Child and the European Child Guarantee—Evidence-Based Recommendations for Alternative Care
Children 2021, 8(12), 1181; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121181 - 14 Dec 2021
Viewed by 503
Abstract
Protection and promotion of child rights are referred to as a central purpose of the European Union (EU). Therefore in 2021, the EU Strategy on the Rights of the Child and the European Child Guarantee were published to enable children to have the [...] Read more.
Protection and promotion of child rights are referred to as a central purpose of the European Union (EU). Therefore in 2021, the EU Strategy on the Rights of the Child and the European Child Guarantee were published to enable children to have the best possible life in the EU and worldwide. Member states were invited to implement the directions of both documents into practice. The present study analyses and showcases the evidence on how to progress implementation of the Strategy and the Guarantee regarding alternative care in Portugal. A literature review was conducted based on international literature. Evidence-based recommendations for the Portuguese transition process towards quality, family and community-based care are stated. De-institutionalisation and strengthening specific services—kinship care, special guardianship, and foster care—are advocated, namely specialising the workforce, and promoting training for kinship carers and prospective special guardians. To conclude, the revision and monitoring of the measures for children in need of alternative care are suggested as well as integrating and publishing data from the diverse services of the alternative care system. Full article
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Article
Standards of Nutritional Care for Patients with Cystic Fibrosis: A Methodological Primer and AGREE II Analysis of Guidelines
Children 2021, 8(12), 1180; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121180 - 14 Dec 2021
Viewed by 418
Abstract
Although many Clinical Practice Guidelines (CPGs) have been published for the care of patients with Cystic Fibrosis (CF), including a variety of nutrition recommendations, the quality of these CPGs has never been evaluated. The aim of this study was to compare, review, and [...] Read more.
Although many Clinical Practice Guidelines (CPGs) have been published for the care of patients with Cystic Fibrosis (CF), including a variety of nutrition recommendations, the quality of these CPGs has never been evaluated. The aim of this study was to compare, review, and critically appraise CPGs for the nutritional management of CF, throughout the lifespan. We searched PubMed, Guidelines International Network (GIN), ECRI Institute, and Guidelines Central for CPGs, with information on the nutritional management of CF. Retrieved CPGs were appraised by three independent reviewers, using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument and checklist. A total of 22 CPGs (seven solely nutrition oriented), by 14 different publishers, were retrieved. The Thoracic Society of Australia and New Zealand CPGs scored the highest overall quality (94.4%), while the Paediatric Gastroenterology Society/Dietitians Association of Australia CPGs had the lowest score (27.8%). Great variation in AGREE II domain-specific scores was observed in all CPGs, suggesting the existence of different strengths and weaknesses. Despite the availability of several CPGs, many appear outdated, lacking rigor, transparency, applicability, and efficiency, while incorporating bias. Considering that CPGs adherence is associated with better outcomes and the need for improving life expectancy in patients with CF, the development of CPGs of better quality is deemed necessary. Full article
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Article
Digital Identities of Young People from the South of Spain: An Online Sexual Differentiation
Children 2021, 8(12), 1179; https://0-doi-org.brum.beds.ac.uk/10.3390/children8121179 - 14 Dec 2021
Viewed by 395
Abstract
Through a mixed methodological approach, we want to know how adolescents aged between 14 and 16 years from the south of Spain express and identify themselves on social networks, with respect to their sex. As such differences can determine gender inequality, we will [...] Read more.
Through a mixed methodological approach, we want to know how adolescents aged between 14 and 16 years from the south of Spain express and identify themselves on social networks, with respect to their sex. As such differences can determine gender inequality, we will analyse differences between females and males regarding the expression of identity on social networks. Analysis of obtained results demonstrates that many relevant attributes still emerge such as the socio-cultural representation of gender as sex in social networks. Differences emerged between the identity expressions of females and males which can generate inequalities favouring females and males. This implies a series of repercussions and, ultimately, defines the so-called digital gender divide. Taking into account these results we could intervene in the population of children to carry out prevention activities focused on social networks. Full article
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