Emergent and re-emergent parasites in HIV-infected children: immunological and socio-environmental conditions that are involved in the transmission of Giardia spp. and Cryptosporidium spp.

ABSTRACT INTRODUCTION: Emergent and re-emergent waterborne protozoans have become a worldwide public health problem, especially among vulnerable groups. METHODS: This cross-sectional study evaluated 17 HIV-infected children and their families. RESULTS: A high (76.5%) percentage of parasite-infected children was observed, even among children with CD4+ T-cell counts of >200 cells/mm3. Giardia spp., Cryptosporidium spp. and Cyclospora spp. were observed in 41.2% of these children Low income, poor hygiene practices, and co-infection in domestic, peridomestic and scholastic environments were significant sources of these intestinal infections. CONCLUSIONS: Early diagnosis, timely treatment, and socio-educational interventions may improve the health conditions of this vulnerable population.

Children's play and leisure : connections with emotional competence

O jogo e o lazer são elementos importantes para o desenvolvimento das crianças. O objetivo geral desta tese foi o de investigar o modo como o jogo e o lazer estão relacionados com diferentes aspetos das competências emocional e social das crianças e jovens. Nesta tese foram investigados três aspetos do jogo: o tempo, a forma e o nível social, diferentes formas de lazer, e vários elementos chave do funcionamento sócio-emocional, através da combinação de observações naturalistas, tarefas, questionários e de um método inovador de mensuração, baseado em Identificação por Rádio-Frequência. O panorama que surge dos estudos incluídos nesta tese é que o jogo e o lazer estão relacionados com o funcionamento sócio-emocional, embora de formas distintas, e por vezes inesperadas. Os estudos no recreio revelaram que as crianças envolvem-se predominantemente no jogo de atividade física. Contudo, enquanto que uma forma de jogo de atividade física, o jogo de exercício, foi associado a melhor competência social, a outra forma, o jogo de luta-e-perseguição, foi associado à agressividade. O facto de o jogo de faz-de-conta, em estudos anteriores, ter sido maioritariamente estudado em espaços interiores, pode explicar o porquê das associações negativas encontradas entre o jogo de faz-de-conta, quer em grupo, quer solitário (nas raparigas) e a competência sócio-emocional, que contrastam com a literatura. De facto, as crianças que não conseguem juntar-se aos seus pares no jogo de exercício podem optar por esta alternativa, o que sugere que crianças socialmente competentes poderão retirar maior vantagem das oportunidades existentes, adaptando melhor os seus comportamentos de jogo. As crianças mais velhas têm geralmente mais liberdade de decisão sobre o seu tempo de lazer. Quando perguntámos às crianças mais velhas e aos adolescentes como passavam a sua semana, as atividades de ecrã destacaram-se. Contudo, as atividades de ecrã e as atividades intelectuais foram relacionadas a mais problemas de saúde mental, enquanto que as atividades desportivas foram associadas a melhor saúde mental. Concluindo, diferentes formas de jogo e de lazer podem ter diferentes funções, de uma forma positiva ou negativa, dependendo da situação em que a criança se encontra.

Mortality from Circulatory System Diseases and Malformations in Children in the State of Rio de Janeiro

Abstract Background: The epidemiological profile of mortality in a population is important for the institution of measures to improve health care and reduce mortality Objective: To estimate mortality rates and the proportional mortality from cardiovascular diseases and malformations of the circulatory system in children and adolescents. Methods: This is a descriptive study of mortality from cardiovascular diseases, malformations of the circulatory system, from all causes, ill-defined causes and external causes in children and adolescents in the state of Rio de Janeiro from 1996 to 2012. Populations were obtained from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE) and deaths obtained from the Department of Informatics of the Unified Health System (DATASUS)/Ministry of Health. Results: There were 115,728 deaths from all causes, 69,757 in males. The annual mortality from cardiovascular diseases was 2.7/100,000 in men and 2.6/100,000 in women. The annual mortality from malformations of the circulatory system was 7.5/100,000 in men and 6.6/100,000 in women. Among the specific causes of circulatory diseases, cardiomyopathies had the highest rates of annual proportional mortality, and from malformations of the circulatory system, it occurred due to unspecified malformations of the circulatory system, at all ages and in both genders. Conclusion: Mortality from malformations of the circulatory system was most striking in the first years of life, while cardiovascular diseases were more relevant in adolescents. Low access to prenatal diagnosis or at birth probably prevented the proper treatment of malformations of the circulatory system.

Relationship of physical activity with motor skills, aerobic fitness and body fat in preschool children: a cross-sectional and longitudinal study (Ballabeina).

Adiposity, low aerobic fitness and low levels of activity are all associated with clustered cardiovascular disease risk in children and their high prevalence represents a major public health concern. The aim of this study is to investigate the relationship of objectively measured physical activity (PA) with motor skills (agility and balance), aerobic fitness and %body fat in young children. This study is a cross-sectional and longitudinal analyses using mixed linear models. Longitudinal data were adjusted for baseline outcome parameters. In all, 217 healthy preschool children (age 4-6 years, 48% boys) participated in this study. PA (accelerometers), agility (obstacle course), dynamic balance (balance beam), aerobic fitness (20-m shuttle run) and %body fat (bioelectric impedance) at baseline and 9 months later. PA was positively associated with both motor skills and aerobic fitness at baseline as well as with their longitudinal changes. Specifically, only vigorous, but not total or moderate PA, was related to changes in aerobic fitness. Higher PA was associated with less %body fat at baseline, but not with its change. Conversely, baseline motor skills, aerobic fitness or %body fat were not related to changes in PA. In young children, baseline PA was associated with improvements in motor skills and in aerobic fitness, an important determinant of cardiovascular risk.

Physical activity attenuates the influence of FTO variants on obesity risk: a meta-analysis of 218,166 adults and 19,268 children.

BACKGROUND: The FTO gene harbors the strongest known susceptibility locus for obesity. While many individual studies have suggested that physical activity (PA) may attenuate the effect of FTO on obesity risk, other studies have not been able to confirm this interaction. To confirm or refute unambiguously whether PA attenuates the association of FTO with obesity risk, we meta-analyzed data from 45 studies of adults (n = 218,166) and nine studies of children and adolescents (n = 19,268). METHODS AND FINDINGS: All studies identified to have data on the FTO rs9939609 variant (or any proxy [r(2)>0.8]) and PA were invited to participate, regardless of ethnicity or age of the participants. PA was standardized by categorizing it into a dichotomous variable (physically inactive versus active) in each study. Overall, 25% of adults and 13% of children were categorized as inactive. Interaction analyses were performed within each study by including the FTO×PA interaction term in an additive model, adjusting for age and sex. Subsequently, random effects meta-analysis was used to pool the interaction terms. In adults, the minor (A-) allele of rs9939609 increased the odds of obesity by 1.23-fold/allele (95% CI 1.20-1.26), but PA attenuated this effect (p(interaction)  = 0.001). More specifically, the minor allele of rs9939609 increased the odds of obesity less in the physically active group (odds ratio  = 1.22/allele, 95% CI 1.19-1.25) than in the inactive group (odds ratio  = 1.30/allele, 95% CI 1.24-1.36). No such interaction was found in children and adolescents. CONCLUSIONS: The association of the FTO risk allele with the odds of obesity is attenuated by 27% in physically active adults, highlighting the importance of PA in particular in those genetically predisposed to obesity.

Long-term effect of a school-based physical activity program (KISS) on fitness and adiposity in children: a cluster-randomized controlled trial.

BACKGROUND: School-based intervention studies promoting a healthy lifestyle have shown favorable immediate health effects. However, there is a striking paucity on long-term follow-ups. The aim of this study was therefore to assess the 3 yr-follow-up of a cluster-randomized controlled school-based physical activity program over nine month with beneficial immediate effects on body fat, aerobic fitness and physical activity. METHODS AND FINDINGS: Initially, 28 classes from 15 elementary schools in Switzerland were grouped into an intervention (16 classes from 9 schools, n = 297 children) and a control arm (12 classes from 6 schools, n = 205 children) after stratification for grade (1st and 5th graders). Three years after the end of the multi-component physical activity program of nine months including daily physical education (i.e. two additional lessons per week on top of three regular lessons), short physical activity breaks during academic lessons, and daily physical activity homework, 289 (58%) participated in the follow-up. Primary outcome measures included body fat (sum of four skinfolds), aerobic fitness (shuttle run test), physical activity (accelerometry), and quality of life (questionnaires). After adjustment for grade, gender, baseline value and clustering within classes, children in the intervention arm compared with controls had a significantly higher average level of aerobic fitness at follow-up (0.373 z-score units [95%-CI: 0.157 to 0.59, p = 0.001] corresponding to a shift from the 50th to the 65th percentile between baseline and follow-up), while the immediate beneficial effects on the other primary outcomes were not sustained. CONCLUSIONS: Apart from aerobic fitness, beneficial effects seen after one year were not maintained when the intervention was stopped. A continuous intervention seems necessary to maintain overall beneficial health effects as reached at the end of the intervention. TRIAL REGISTRATION: ControlledTrials.com ISRCTN15360785.

ESCMID* guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp.

Invasive candidiasis (IC) is a relatively common syndrome in neonates and children and is associated with significant morbidity and mortality. These guidelines provide recommendations for the prevention and treatment of IC in neonates and children. Appropriate agents for the prevention of IC in neonates at high risk include fluconazole (A-I), nystatin (B-II) or lactoferrin ± Lactobacillus (B-II). The treatment of IC in neonates is complicated by the high likelihood of disseminated disease, including the possibility of infection within the central nervous system. Amphotericin B deoxycholate (B-II), liposomal amphotericin B (B-II), amphotericin B lipid complex (ABLC) (C-II), fluconazole (B-II), micafungin (B-II) and caspofungin (C-II) can all be potentially used. Recommendations for the prevention of IC in children are largely extrapolated from studies performed in adults with concomitant pharmacokinetic data and models in children. For allogeneic HSCT recipients, fluconazole (A-I), voriconazole (A-I), micafungin (A-I), itraconazole (B-II) and posaconazole (B-II) can all be used. Similar recommendations are made for the prevention of IC in children in other risk groups. With several exceptions, recommendations for the treatment of IC in children are extrapolated from adult studies, with concomitant pharmacokinetic studies. Amphotericin B deoxycholate (C-I), liposomal amphotericin B (A-I), ABLC (B-II), micafungin (A-I), caspofungin (A-I), anidulafungin (B-II), fluconazole (B-I) and voriconazole (B-I) can all be used.

Vincristine and intestinal pseudo-obstruction in children: report of 5 cases, literature review, and suggested management.

Summary: Intestinal pseudo-obstruction is a rare complication resulting from a variety of disorders. Symptoms include abdominal pain, nausea, vomiting, diarrhea, constipation, and malnutrition. Vincristine-related pseudo-obstruction has been reported in the literature, but its description in children and recommendations for management are lacking. A review of the literature revealed 21 reported pediatric cases of vincristine-related pseudo-obstruction. Most have, however, been attributed to a drug interaction with itraconazole, accidental vincristine overdose, or liver failure. Potential genetic causes are rarely addressed. We present here 5 cases of pseudo-obstruction related to vincristine without any identifiable predisposing factors, and a suggested algorithm for management

Validation of the French version of the Hierarchical Personality Inventory for Children (HiPIC): Influence of gender and age on personality traits from 8 to 12 years

The study was designed to investigate the psychometric properties of the French version and the cross-language replicability of the Hierarchical Personality Inventory for Children (HiPIC). The HiPIC is an instrument aimed at assessing the five dimensions of the Five-Factor Model for Children. Subjects were 552 children aged between 8 and 12 years, rated by one or both parents. At the domain level, reliability ranged from .83 to .93 and at the facet level, reliability ranged from .69 to .89. Differences between genders were congruent with those found in the Dutch sample. Girls scored higher on Benevolence and Conscientiousness. Age was negatively correlated with Extraversion and Imagination. For girls, we also observed a decrease of Emotional Stability. A series of exploratory factor analyses confirmed the overall five-factor structure for girls and boys. Targeted factor analyses and congruence coefficients revealed high cross-language replicability at the domain and at the facet levels. The results showed that the French version of the HiPIC is a reliable and valid instrument for assessing personality with children and has a particularly high cross-language replicability.

Department of Health and Children Corporate Business Plan 2007

Department of Health and Children Corporate Business Plan 2007 This document sets out the broad business and role of the Department of Health and Children, and provides information on the Departmentâ?Ts Key Objectives and corresponding Key Performance Indicators for 2007. Click here to download PDF 223kb

North South Survey of Children's Height, Weight and Body Mass Index, 2002.

North South Survey of Children’s Height, Weight and Body Mass Index, 2002. As part of a North South Survey of Childrenâ?Ts Oral Health conducted in Ireland in 2001/â?T02 [1], the heights and weights of a representative sample of children and adolescents age 4-16 years was measured. Data were collected by 34 teams of trained and calibrated dentists and dental nurses for 17,518 children aged 4-16 in the Republic of Ireland (RoI) and 2,099 in Northern Ireland (NI). Click here to download PDF 379kb

Department of Health and Children Annual Output Statement 2008

The overall aim of this Vote Group is to provide health and personal social services to improve the health and well being of the people of Ireland in a manner that promotes better health for everyone, fair access, responsive and appropriate care delivery and high performance. The money voted goes to the Department of Health and Children (Vote 39), the Health Service Executive (Vote 40), and the Office of the Minister for Children (Vote 41). The Department of Health and Children has responsibility for the overall organisational, legislative, policy and financial accountability framework for the health sector. The Health Service Executive is responsible for the management and delivery of health and personal social services within available resources. The Office of the Minister for Children (OMC) brings together functions relating to children and their well being, along with policy functions on Youth Justice and Early Years Education. Download document here

Fat intake and adiposity in 8 to 11-year-old obese children.

OBJECTIVE: To investigate the relationships between diet composition, body composition, and macronutrient oxidation at rest in obese and non-obese children. DESIGN: Cross-sectional study on fat intake, adiposity and postabsorptive macronutrients oxidation rates. SUBJECTS: 82 prepubertal (age: 9.1 +/- 1.1 y) children, 30 obese (FM = 32.6 +/- 6.1%) and 52 non-obese (FM = 15.6 +/- 5.1%). MEASUREMENTS: Subcutaneous skinfold thickness for body composition, diet history for energy and nutrient intake, indirect calorimetry for resting metabolic rate (RMR) and RQ measurement. RESULTS: Energy intake (EI) was comparable in obese and non-obese children. Adjusted for RMR by ANCOVA, using RMR as the covariate, EI was significantly lower in obese than in non-obese children indicating either a blunted physical activity or a systematic underestimation of EI. Protein and carbohydrate intakes expressed as a percentage of total energy intake (%EI) were not significantly different in the two groups. Lipid intake (%EI) was slightly but significantly higher in the obese than in the non-obese group either unadjusted or adjusted for RMR by ANCOVA. The postabsorptive RQ was significantly lower in obese than in non-obese children. In the total group, %FM was weakly but significantly correlated to lipid intake (%EI). CONCLUSION: Obese prepubertal children have a higher relative fat intake than non-obese children and their FM is associated with this factor. The lower postabsorptive RQ of obese children may indicate a compensatory mechanism to achieve fat equilibrium by enhanced fat oxidation.

North South Survey of Children's Height, Weight and Body Mass Index, 2002

As part of a North South Survey of Childrens Oral Health conducted in Ireland in 2001/’02 [1], the heights and weights of a representative sample of children and adolescents age 4-16 years was measured. Data were collected by 34 teams of trained and calibrated dentists and dental nurses for 17,518 children aged 4-16 in the Republic of Ireland (RoI) and 2,099 in Northern Ireland (NI). This report presents the results of the study which provide a baseline measurement of Childrens height and weight against which future change can be measured. By comparing these data with international norms we can estimate the current prevalence of overweight and obesity among children and adolescents in Ireland.

Reducing unintentional injuries in and around the home among children under 5 Years

Public Health England today launches 2 new resources for local authorities on preventing accidents to children and young people in the home and on the road. The reports show whilst the number of children and young people killed or seriously injured continues to fall in England there are still significant numbers of deaths and emergency admissions from preventable causes. On average each year between 2008 to 2012, 525 children and young people under 25 died and there were more than 53,700 admissions to hospital. The reports highlight actions local partners can take to reduce accidents including improving safety for children travelling to and from school and using existing services like health visitors and children’s centres. The Reducing unintentional injuries in and around the home among children under 5 Years and the Reducing unintentional injuries on the roads among children and young people under 25 reports include an analysis of data between 2008 to 2012. Key findings from the reports include: home injuries (under 5 years of age): an average of 62 children died each year between 2008 and 2012 these injuries result in an estimated 40,000 emergency hospital admissions among children of this age each year 5 injury types should be prioritised for the under-fives: choking; suffocation and strangulation; falls; poisoning; burns and scalds; and drowning hospital admission rate for unintentional injuries among the under-fives is 45% higher for children from the most deprived areas compared with children from the least deprived Road traffic injuries (under 25 years of age) there were 2,316 deaths recorded by the police among road users under the age of 25 years, an average of 463 under 25s each year there were 68,657 admissions to hospital as a result of road traffic injuries, an average of 13,731 each year in total there were 322,613 casualties of all severities recorded by the police, an average of 64,523 each year the rate of fatal and serious injuries for 10to 14 year olds was significantly greater for children from the 20% most deprived areas (37 per 100,000) compared with those from the most affluent areas (10 per 100,000)