Children, Volume 6, Issue 3 (March 2019) – 14 articles

Schools have the potential to promote physical activity (PA) in adolescents through physical education (PE) and extra-curricular PA. The aims of this study were to firstly understand the experiences of adolescent females who participated in a school-based walking programme (the Walking In ScHools (WISH) study) and secondly, to assess the potential for schools to further promote PA outside of structured PE. A sample of female participants (n = 45, mean age 13.1 years) who participated in the WISH study were randomly selected to participate in focus group discussions, to explore their experiences of the intervention. In addition, an online survey was distributed to all post-primary schools (n = 208) in Northern Ireland to assess the provision of extra-curricular PA and further evaluate the feasibility of the WISH study. In total, six focus groups were conducted. Walking during the school day was viewed as an acceptable form of PA by adolescent females, providing an opportunity to be active with friends, and helped participants overcome barriers previously associated with being active at school. Responding schools (n = 59) identified adolescent females and non-sporty pupils as sub-groups who would benefit most from participation in a school-based walking programme. This study has highlighted that the delivery of a walking programme within the school setting is acceptable, warranted and practically feasible from the point of view of adolescent females and key stakeholders within the school setting. Full article

Adolescents with hearing loss have been shown to have some emotional difficulties. This study investigated the effectiveness of a resilience training program on the emotional intelligence of mainstreamed adolescent students with hearing loss. In this experimental study, a pre-test, post-test, follow up and control group design was implemented. After receiving informed consents, 122 students with hearing loss in mainstreaming settings were randomly assigned to intervention and control groups (61 students in interventional group and 61 in control). The interventional group received training in groups of 3 to 5, for 6 weeks (two times per week for 75 min). The intervention focused on feelings, thinking (positive, negative) and outcomes of negative thinking, coping strategies, strengths and weakness, problem solving, communication skills, social skills, negotiation, despising and ridiculing, intra- and interpersonal skills. The Connor-Davidson resilience scale (CD-RISC) and the Schutte Emotional Intelligence Scale were used to measure the resilience and the emotional intelligence (EI) of participants respectively just before intervention, as well as at the 6- and 14-week marks. The Friedman Test was used to compare changes in emotional intelligence between interventional and control groups. The intervention increased the resilience scores by 20 points. Although the EI of both groups were similar at the beginning of the research, there was a significant difference between the control and interventional groups in emotional intelligence and its aspects after intervention, at the 6-week and 14-week measurements (p < 0.001). The effect size was 1.5 for the EI total score. The 6-week resilience training program was very effective at improving emotional intelligence and could be readily used to help students with hearing loss improve their emotional abilities. Full article

For the future school performance of a child in the fields of literacy and numeracy, the operational efficiency of working memory is a central predictor. Children affected by dyslexia exhibit specific deficits in the functions of working memory. A software application for elementary school-age children has been specifically developed for this study, attempting to improve the working memory’s operational efficiency. Based on Baddeley’s model of working memory (1986), the phonological loop, the visuo-spatial sketchpad, and the central executive were trained in 18 sessions over a period of six weeks. The group of test subjects undergoing this training was composed of third-graders, of which 43 were and 27 were not affected by dyslexia. The untrained control group was made up of 41 third-graders with dyslexia and 28 without dyslexia. While the short-term effects of the program could not be proven, the present analyses focus on long-term effects. The results obtained from a pre-test/follow-up design reveal that no long-term increases in performance regarding phonological and central executive working memory could be confirmed. Only the visuo-spatial Corsi block span exhibited a training effect over a period of three months. Additionally, training did not show any long-term effect of performance improvement, not even for a subgroup of children with dyslexia and an especially low working memory performance. Thus, even after this study, the question whether working memory can be trained or not remains partly unanswered but leaves us predominantly pessimistic. Full article

The crisis conflicts in Syria have forced a lot of people to relocate and live in mainland Greece, where they are hosted in refugee camps. In the present study, our aim was to assess child morbidity and overall disease burden in two camps in northern Greece during a six-month winter period. A primary health care office was founded in each camp. Refugees of all ages with health problems were examined daily by specialty doctors. Cases were classified into two categories: Infectious or non-infectious. In total, 2631 patients were examined during this period (out of the 3760 refugees hosted). Of these patients, 9.8% were infants, 12.7% were toddlers, and 13.4% were children. Most of the visits for children aged less than 12 years old were due to infectious diseases (80.8%). The most common sites of communicable diseases among children were the respiratory tract (66.8%), the skin (23.2%), and the urinary (3.2%) and gastrointestinal tracts (6.2%). Non-communicable diseases were mostly due to gastrointestinal (20.2%), respiratory (18.2%), surgical (13.1%), and allergic (10.3%) disorders. Infants, toddlers, and children suffered more frequently from respiratory infections, while in adolescents and adults, non-infectious diseases were more common. Toddlers and children were more likely to fall ill in comparison to infants. Conclusions: During the winter period, infectious diseases, especially of the respiratory tract, are the main reason for care seeking among refugees in Greek camps, with toddlers suffering more than other age groups. The overall mortality and referral percentage were low, indicating that adequate primary care is provided in this newly established refugee hosting model. Full article

Longitudinal fibular deficiency (LFD), or fibular hemimelia, is congenital partial or complete absence of the fibula. We aimed to compare the lower limb function of children and young people with LFD to that of unaffected peers. A cross-sectional study of Australian children and young people with LFD, and of unaffected peers, was undertaken. Twenty-three (12 males) children and young people with LFD (74% of those eligible) and 213 unaffected peers, all aged 7–21 years were subject to the Knee Osteoarthritis Outcome Score (KOOS/KOOS-Child) and the Cumberland Ankle Instability Tool (CAIT/CAIT-Youth). Linear regression models compared affected children and young people to unaffected peers. Participants with LFD scored lower in both outcomes (adjusted p < 0.05). The difference between participants with LFD and unaffected peers was significantly greater among younger participants than older participants for KOOS activities and sports domain scores (adjusted p ≤ 0.01). Differences in the other KOOS domains (pain/symptoms/quality of life) and ankle function (CAIT scores) were not affected by age (adjusted p ≥ 0.08). Children and young people with LFD on average report reduced lower limb function compared to unaffected peers. Knee-related activities and sports domains appear to be worse in younger children with LFD, and scores in these domains become closer to those of unaffected peers as they become older. Full article

Smoke-free ordinances and policies protect youth from exposure to secondhand smoke (SHS) and cigarette use. This study investigated whether smoke-free ordinances also protect youth from the use of other tobacco products. We compared the prevalence of SHS exposure, cigarette smoking, cigar smoking, smokeless tobacco use, and e-cigarette use among high school students living in a municipality with or without a smoke-free ordinance and in homes with and without smoke-free policies. Data were analyzed using the 2017 Mississippi Youth Tobacco Survey (n = 1923). Smoke-free ordinances were found to be associated with lower prevalence of SHS exposure (41.9% vs. 51.5%), cigarette smoking (5.1% vs. 11.4%), and cigar smoking (7.2% vs. 10.9%). There were no differences in smokeless tobacco use (6.6% vs. 6.5%) or e-cigarette use (11.2% vs 12.1%). Smoke-free homes were associated with lower prevalence of SHS exposure (38.0% vs 74.6%), cigarette smoking (4.8% vs. 17.6%), cigar smoking (6.4% vs. 16.4%), smokeless tobacco use (4.9% vs. 13.2%), and e-cigarette use (9.6% vs. 19.5%), p < 0.05 for all comparisons. The results suggest that smoke-free ordinances and policies protect against exposure to tobacco smoke and use of combustible tobacco products, but smoke-free ordinances do not protect from smokeless tobacco and e-cigarette use. Tobacco-free, rather than smoke-free, ordinances might offer more protection. Full article

The etiology of epilepsy is variable and sometimes multifactorial. Clinical course and response to treatment largely depend on the precise etiology of the seizures. Along with the electroencephalogram (EEG), neuroimaging techniques, in particular, magnetic resonance imaging (MRI), are the most important tools for determining the possible etiology of epilepsy. Over the last few years, there have been many developments in data acquisition and analysis for both morphological and functional neuroimaging of people suffering from this condition. These innovations have increased the detection of underlying structural pathologies, which have till recently been classified as “cryptogenic” epilepsy. Cryptogenic epilepsy is often refractory to anti-epileptic drug treatment. In drug-resistant patients with structural or consistent functional lesions related to the epilepsy syndrome, surgery is the only treatment that can offer a seizure-free outcome. The pre-operative detection of the underlying structural condition increases the odds of successful surgical treatment of pharmacoresistant epilepsy. This article provides a comprehensive overview of neuroimaging techniques in epilepsy, highlighting recent advances and innovations and summarizes frequent etiologies of epilepsy in order to improve the diagnosis and management of patients suffering from seizures, especially young patients and children. Full article

Since the description of surgery for patent ductus arteriosus in late 1930s, an innumerable number of advances have taken place in the management of congenital heart defects (CHDs). In this review the current status of treatment of seven of the most common acyanotic CHDs was reviewed. The discussion included indications for, and timing of, intervention and methods of intervention. The indications are, by and large, determined by the severity of the lesion. Pressure gradients in obstructive lesions and the magnitude of the shunt in left-to-right shunt lesions are used to assess the severity of the lesion. The timing of intervention is different for each lesion and largely dependent upon when the criteria for indications for intervention were met. Appropriate medical management is necessary in most patients. Trans-catheter methods are preferable in some defects while surgery is a better option in some other defects. The currently available medical, trans-catheter, and surgical methods to treat acyanotic CHD are feasible, safe, and effective. Full article

While the consequences of cyberbullying victimization have received some attention in the literature, to date, little is known about the multiple types of strains in adolescents’ lives, such as whether cyberbullying victimization and peer rejection increase their vulnerability to depression and anxiety. Even though some research found that adolescents with disabilities show higher risk for cyberbullying victimization, most research has focused on typically developing adolescents. Thus, the present study focused on examining the moderating effect of peer rejection in the relationships between cyberbullying victimization, depression, and anxiety among adolescents with autism spectrum disorder. There were 128 participants (89% male; ages ranging from 11–16 years old) with autism spectrum disorder in the sixth, seventh, or eighth grade at 16 middle schools in the United States. Participants completed questionnaires on cyberbullying victimization, peer rejection, depression, and anxiety. Results revealed that cyberbullying victimization was associated positively with peer rejection, anxiety, and depression among adolescents with autism spectrum disorder. Further, peer rejection was linked positively with depression and anxiety. Peer rejection moderated the positive relationship between cyberbullying victimization and depression, but not anxiety. Implications for prevention programs and future research are discussed. Full article

During the first decade of federal regulation of electronic nicotine delivery systems (ENDS), the e-cigarette industry has rapidly grown. Recently, the U.S. Surgeon General and Commissioner of the Food and Drug Administration each declared the rapid rise in rates of youth using these products to be an “epidemic.” While a foundational basis for regulating ENDS has been in effect since 2016, deferred enforcement has contributed to acute rise in use by youth. The Agency has undertaken several initiatives to address the problem and warned manufacturers that if current youth trends continue, it will be “game over.” Full article

Based on the results of our surveys involving several municipal departments of education that support the enrollment of children requiring medical care in general schools, this report describes Japanese systems to support inclusive education for these children, the current status of such support, and related challenges. The municipal departments of education that systematically support inclusive education for children requiring medical care began to promote such education in their communities before the initiation of nationwide enrollment support for the children. In addition, their sections in charge of enrollment support also manage affairs related to human rights education, rather than general affairs for special support and education. Such a variation in the sections in charge resulted in differences in the purposes of support. Further nationwide surveys should be conducted to develop universal design principles and comprehensively support inclusive education for children requiring medical care. Full article

Hematological values of neonates need to be interpreted taking into account the fact that the reference ranges depend on the age of the neonate. We aimed to derive two general mathematical models for reference ranges for hemoglobin concentration (cHb) and hematocrit (Hct) levels in neonates as a function of gestational age (GA) and postnatal age (PNA), since it is known that GA and PNA are independent factors determining cHb and Hct. For this purpose, cHb and Hct values from the data set of Henry and Christensen (2015, Clin. Perinatol., 42, 483–497) from about 100,000 neonates (GA: 22–42 weeks, PNA: 0–28 days) were used and general models with two quadratic functions were derived. To the best of our knowledge, the models we have developed are the first published ones to provide reference ranges for cHb and Hct for neonates incorporating the parallel dependence on GA and PNA. Full article

Tobacco use begins in adolescence for the majority of smokers. The purpose of this study was to increase screening and reporting of tobacco use in hospitalized adolescents at a tertiary care children’s hospital. We completed a nursing focus group to understand challenges and completed four iterative Plan-Do-Study-Act cycles, which included: (1) in-person nursing education regarding tobacco use screening, (2) addition of an e-cigarette-specific screening question, (3) the creation and dissemination of an educational video for nursing, and (4) adding the video as a mandatory component of nursing orientation. Run charts of the percentage of patients screened who reported tobacco use were created. Absolute counts of tobacco products used were also captured. From January 2016 to September 2018, 12,999 patients ≥13 years of age were admitted to the hospital. At baseline, 90.1% of patients were screened and 4.8% reported tobacco use. While the absolute number of adolescents reporting e-cigarette use increased from zero patients per month at baseline to five, the percentage of patients screened and reporting tobacco use was unchanged; the majority of e-cigarette users reported use of other tobacco products. This study demonstrates that adding e-cigarettes to screening increases reporting and suggests systems level changes are needed to improve tobacco use reporting. Full article

From examinations of the literature on the influence that exposure to violence and coping strategies have on delinquent behavior and emotional outcomes, this study addresses the association between violent victimization and the moderating effects of coping strategies among 500 African-American adolescents who exhibit both externalizing behaviors such as delinquency and internalizing symptoms, including anxiety and depression. The investigation examines the development of the aforementioned adjustment problems in response to victimization, and the findings indicate a relationship between the specific indices of victimization, including peer violence, and the symptomatology and coping mechanisms utilized by the youth in this study. Suggestions for future research in this area are discussed. Full article