Aim This study examined age- and sex-specific prevalence and trends in underweight among Norwegian children and adolescents during the pre-pandemic period from 2010 to 2019 and COVID-19 pandemic period from 2020 to 2022. Methods Height and weight data from 78 024 children aged 2 to 13 years in Bergen from 2010 to 2022 were obtained from public health clinic and school health service records. Underweight grades 1 to 3 were defined using the International Obesity Task Force cut-offs. Age- and sex-specific prevalence was analysed longitudinally, and trends were assessed for boys and girls across age groups using regression analyses. Results Underweight was most prevalent among 2-year-olds and declined with increasing age, more in girls than boys. Among girls, the prevalence decreased from 19.3% at age 2 years to 6.2% at age 13 years, and among boys from 13.3% to 8.6%. The interaction between sex and age was statistically significant. During the pre-pandemic period, prevalence decreased significantly among 2-year-olds. During the pandemic period, increased prevalence of underweight was observed among 8-year-old girls. Conclusion Underweight remains a relevant public health concern, with clear age- and sex-specific patterns. These findings highlight the need for continued monitoring and targeted follow-up in early childhood.
The prevalence of ultra-processed food (UPF) consumption in pediatric diets has raised significant concerns regarding long-term health. This review examines evidence for a proposed 'pro-inflammatory imprint' involving the gut microbiome-inflammation axis. Using a structured narrative synthesis of pediatric observational evidence, adult intervention studies, preclinical research, multi-omics data, and public health evaluations, we examine associations between UPF exposure and metabolic, inflammatory, cognitive, and neurodevelopmental outcomes while distinguishing direct from indirect evidence. We propose the Pediatric-Specific Integrated Dietary Inflammatory Index (cP-IDII) as an unvalidated, hypothesis-generating research framework for integrating reproducible nutrient- and processing-related dietary exposures; downstream microbial, intestinal-barrier, inflammatory, metabolic, and immune measures are reserved for external validation. Furthermore, we discuss the role of commercial determinants and environmental factors in shaping child health. The synthesis identifies measurement gaps and complementary policy entry points across product composition, food environments, affordability, and marketing. Empirical development and external validation are required before the cP-IDII can be used for clinical, epidemiological, or public health decision-making.
Background Childhood trauma often leads to maladaptive emotional schemas that affect social adjustment and self-compassion. This study aimed to investigate the correlation of childhood trauma with social adjustment and self-compassion, based on the moderating role of emotional schemas in adolescents with risky behaviors. Methods The present study employed a descriptive correlational design. The statistical population comprised all adolescents with risky behaviors who were referred to psychological counseling centers in Tehran, Iran, during 2024-2025. A total of 324 individuals were selected using convenience sampling based on the minimum sample size calculation for structural equation modeling. For data collection, we used the Childhood Trauma Questionnaire (CTQ), Sense of Coherence Scale (SOC-13), Adjustment Inventory (AI), Emotional Schema Scale (ESS-P), and Iranian Adolescent Risk-Taking Scale (IARS). Data analysis was conducted using descriptive statistics (demographic and variable descriptions) and inferential statistics (structural equation modeling) in SPSS version 27 and Smart PLS version 4. Results A sense of coherence showed a significant negative correlation with childhood trauma (β= -0.771, P<0.001) and a significant positive correlation with emotional schemas (β=0.119, P=0.009). However, a sense of coherence associated with social adjustment was not statistically significant (β=0.064, P=0.158). Additionally, emotional schemas had a significant role as a moderating variable in the correlation between childhood trauma and sense of coherence. Conclusions Emotional schemas mitigated the negative impact of childhood trauma on the sense of coherence in at-risk adolescents. Early adversity can diminish an adolescent's belief in life's comprehensibility, manageability, and meaningfulness; emotional schemas are crucial in this context. Therefore, assessing the sense of coherence in high-risk adolescents necessitates considering both psychological vulnerabilities and protective factors.
Background The rising prevalence of obesity among preschool children has become a critical public health concern in Suzhou, China. Nevertheless, evidence-based, personalized, and multicomponent intervention strategies tailored to children with overweight or obesity remain inadequately established in current practice. Objective This study aims to investigate the prevalence and pathogenic factors of obesity among preschool children in Suzhou and to develop a comprehensive and multifaceted integrated intervention program. Through systematic assessment of its short-term effectiveness and long-term sustainability in improving obesity-related indicators and preventing overweight, it provides a scientific basis for obesity prevention and control. Methods This cluster randomized controlled trial is being conducted among children aged 3 to 6 years in Suzhou City, Jiangsu Province. Children from 3 kindergartens were randomly assigned to the intervention group and children from 3 other kindergartens were assigned to the control group. The 1-year intervention includes health education, dietary guidance, and increased physical activity, adopting a multilevel approach that engages children, families, schools, communities, and society. Children participate in health education and physical activity courses in the kindergarten, while parents receive educational materials online. Parental education and regular assessment of knowledge, attitudes, and practices are key components of the family-based intervention. Body measurements will be taken at baseline, 6 months, 12 months, and thereafter, alongside questionnaires for both parents and children to evaluate their own health behaviors. The primary outcome will be the difference in BMI, BMI z scores, and body fat percentage between the 2 groups of children at the end of the intervention. Results The study received ethical approval in March 2025. Baseline assessments were conducted from March to June 2025, followed by the initiation of the intervention, which will be completed by June 2026. Participants will then enter a noninterventional long-term follow-up until June 2032, with annual surveys conducted during this period. Conclusions This program will test the effectiveness of comprehensive multifaceted interventions on children. The results of this study will provide scientific evidence for formulating effective intervention strategies for childhood overweight and obesity and are also expected to offer crucial practical references for the formulation and improvement of treatment guidelines for childhood obesity in China.
Introduction Childhood allergic diseases constitute a substantial global health burden, with children aged 0-6 years representing a highly vulnerable population during early immunological transition. Evidence regarding the associations of lifestyle, household environments, and prenatal exposures with these conditions remains inconsistent and heterogeneous, and epidemiological data for this critical age group are still limited. This study aimed to develop and validate a standardized screening instrument and to evaluate these potential associations. Methods This study utilized a two-phase design: Phase I (Clinical Validation) evaluated the psychometric properties of a newly developed, culturally localized 24-item Childhood Allergy and Asthma Comprehensive Screening Questionnaire (CACSQ) against clinical gold-standard physician diagnoses in a hospital-based case-control study comprising 98 cases and 98 matched controls. Phase II (Epidemiological Survey) applied the validated CACSQ in a district-wide cross-sectional investigation. Using multi-stage stratified random cluster sampling, 3,064 children aged 0-6 years were enrolled in Minhang District, Shanghai, China. Multivariable logistic regression models were employed to identify independent perinatal, residential-environmental, and familial factors associated with childhood allergies. Results The CACSQ demonstrated high accuracy, with an AUC of 0.88 (P<0.001), sensitivity of 92%, specificity of 76%, and Kappa coefficient of 0.698. Among 3,064 children aged 0-6 years, the overall CACSQ-identified prevalence of food allergy, asthma, atopic dermatitis, and allergic rhinitis was 14.7%, 8.4%, 18.9%, and 20.0%, respectively. Male sex, higher socioeconomic status, only-child status, history of antibiotic use and pneumonia, and family history of allergy were associated with elevated risk of allergic diseases. In contrast, sleep duration ≥ 12 h/day and window-opening ventilation were associated with lower odds of allergic diseases. Age effects varied by condition; the odds of atopic dermatitis decreased with age, whereas the odds of allergic rhinitis increased. Conclusion Genetic predisposition and modifiable environmental/lifestyle factors significantly associated with early childhood allergies. The validated CACSQ offers a reliable, low-cost screening tool for early detection and future longitudinal cohort studies.
Objectives During the nineteenth century, the health and living conditions of many working-class European peoples declined in association with growing industrialization and urbanization. Emigration to British colonies grew as people sought to escape such hardships. This research presents the first direct comparison of dental markers of stress in a case study of migrants to a British colony (Otago, New Zealand) alongside a contemporaneous assemblage representing an origin population (London, United Kingdom). Materials and methods Dental markers of childhood stress, accentuated lines, were observed in thin-sections of archeological teeth from adults (n = 9) and children (n = 16) interred in London, United Kingdom (UK), and adult European migrants interred in Otago, New Zealand (NZ) (n = 24) using standard histological techniques. Results All individuals interred in London, and 92% (22/24) of those in New Zealand exhibited evidence of accentuated line formation within the first 2.5 years of life. There was no difference in median accentuated line occurrence between adults and children interred in the UK. However, NZ adults had a lower median occurrence of accentuated lines over the first 2.5 years since birth (5 ALs/individual) than UK adults (13 ALs/individual). Accentuated lines most frequently occurred in infancy for all three groups examined. However, temporal trends in accentuated line occurrence differed between groups in association with age. Discussion These results highlight the impact of childhood stresses on working-class people growing up during the nineteenth century, underlining potential differences in the childhood experiences of hardship in individuals that remained in Britain and those that departed for foreign soils.
Kavale-Henderson LA, Buckberry J, Buckley H et al.
Background The RTS,S/AS01E malaria vaccine (RTS,S) was introduced by national immunisation programmes in Ghana, Kenya, and Malawi in 2019 in large-scale pilot schemes. We aimed to address questions about feasibility and impact, and to assess safety signals that had been observed in the phase 3 trial that included an excess of meningitis and cerebral malaria cases in RTS,S recipients, and the possibility of an excess of deaths among girls who received RTS,S than in controls, to inform decisions about wider use. Methods In this prospective evaluation, 158 geographical clusters (66 districts in Ghana; 46 sub-counties in Kenya; and 46 groups of immunisation clinic catchment areas in Malawi) were randomly assigned to early or delayed introduction of RTS,S, with three doses to be administered between the ages of 5 months and 9 months and a fourth dose at the age of approximately 2 years. Primary outcomes of the evaluation, planned over 4 years, were mortality from all causes except injury (impact), hospital admission with severe malaria (impact), hospital admission with meningitis or cerebral malaria (safety), deaths in girls compared with boys (safety), and vaccination coverage (feasibility). Mortality was monitored in children aged 1-59 months throughout the pilot areas. Surveillance for meningitis and severe malaria was established in eight sentinel hospitals in Ghana, six in Kenya, and four in Malawi. Vaccine uptake was measured in surveys of children aged 12-23 months about 18 months after vaccine introduction. We estimated that sufficient data would have accrued after 24 months to evaluate each of the safety signals and the impact on severe malaria in a pooled analysis of the data from the three countries. We estimated incidence rate ratios (IRRs) by comparing the ratio of the number of events in children age-eligible to have received at least one dose of the vaccine (for safety outcomes), or age-eligible to have received three doses (for impact outcomes), to that in non-eligible age groups in implementation areas with the equivalent ratio in comparison areas. To establish whether there was evidence of a difference between girls and boys in the vaccine's impact on mortality, the female-to-male mortality ratio in age groups eligible to receive the vaccine (relative to the ratio in non-eligible children) was compared between implementation and comparison areas. Preliminary findings contributed to WHO's recommendation in 2021 for widespread use of RTS,S in areas of moderate-to-high malaria transmission. Findings By April 30, 2021, 652 673 children had received at least one dose of RTS,S and 494 745 children had received three doses. Coverage of the first dose was 76% in Ghana, 79% in Kenya, and 73% in Malawi, and coverage of the third dose was 66% in Ghana, 62% in Kenya, and 62% in Malawi. 26 285 children aged 1-59 months were admitted to sentinel hospitals and 13 198 deaths were reported through mortality surveillance. Among children eligible to have received at least one dose of RTS,S, there was no evidence of an excess of meningitis or cerebral malaria cases in implementation areas compared with comparison areas (hospital admission with meningitis: IRR 0·63 [95% CI 0·22-1·79]; hospital admission with cerebral malaria: IRR 1·03 [95% CI 0·61-1·74]). The impact of RTS,S introduction on mortality was similar for girls and boys (relative mortality ratio 1·03 [95% CI 0·88-1·21]). Among children eligible for three vaccine doses, RTS,S introduction was associated with a 32% reduction (95% CI 5-51%) in hospital admission with severe malaria, and a 9% reduction (95% CI 0-18%) in all-cause mortality (excluding injury). Interpretation In the first 2 years of implementation of RTS,S, the three primary doses were effectively deployed through national immunisation programmes. There was no evidence of the safety signals that had been observed in the phase 3 trial, and introduction of the vaccine was associated with substantial reductions in hospital admission with severe malaria. Evaluation continues to assess the impact of four doses of RTS,S. Funding Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid.
Due to the COVID-19 pandemic, many children missed their routine vaccinations globally. There is insufficient evidence on the trends in vaccination coverage in the private healthcare sector in South Africa. This study explored the changes in childhood vaccination patterns (non-COVID vaccines) in the private healthcare sector in South Africa using medicine claim data. Using the information on medication claims from a South African pharmaceutical benefit management (PBM) company, we performed a quantitative cross-sectional analysis comparing the period before (2018-2019) and during the COVID-19 pandemic (2020-2021). All patients who made claims within the study period were included. This study included 67,830 children aged two years and younger. In particular, from 2018 to 2021, boys (52%) outnumbered girls (48%). Pharmacists consistently held the predominant prescriber role before and during the COVID-19 pandemic. The proportion of children receiving non-COVID-19 vaccines was higher before the pandemic (60%) than during the pandemic (55%). Furthermore, there was a notable decline of 5% in measles vaccination rates during the children's first year of life, while a notable increase was observed for measles (5%), hepatitis A (7.7%), and the pentavalent vaccine (5%) during the second year of life. Governments and private healthcare providers must take action to enhance vaccination coverage rates for children in their first year of life to prevent a resurgence of vaccine-preventable diseases. The results obtained in this study underscore the significance of implementing vaccine catch-up campaigns to address missed vaccination opportunities arising from the impact of the COVID-19 pandemic. Moreover, pharmacists emerged as the predominant healthcare providers responsible for administering vaccinations within the private healthcare sector in South Africa, both prior and during the COVID-19 pandemic. Their pivotal role in the vaccination process warrants due recognition and should not be underestimated.
We report on an ongoing measles outbreak in the Federation of Bosnia and Herzegovina with 141 cases notified between week 52 2023 and week 6 2024. Among those with known vaccination status, 97% were unvaccinated and the most affected group is children under the age of 5 years (n = 87) who were not vaccinated during the pandemic years. Sixty-eight cases were hospitalised, the most common complications were measles-related pneumonia and diarrhoea. The sequenced measles viruses from four cases belonged to genotype D8.
Introduction During the pre-pandemic era, negative vaccine sentiments did not feature in South African publications reporting on infant vaccination uptake. In contrast, vaccine hesitancy is an established driver of suboptimal COVID-19 vaccine uptake in South Africa, suggesting that the COVID-19 pandemic increased vaccine hesitancy in South Africa. This study used data from a social media tracking project to investigate vaccine sentiment expressed on South African social media platforms in the pre-pandemic era. Methods This mixed-methods study analysed South African social media [Twitter (now X); online news forums; microblogs] posts mentioning vaccine-related words from 1 December 2016-31 May 2017. Content analysis was used to assign vaccine sentiment, and thereafter a step-wise thematic content analysis of negative sentiment posts was conducted using NVivo12®. Results Of 10,997 posts about human vaccines, 16.2% expressed negative vaccine sentiments. Specific vaccines were discussed in 35.9% of posts, with human papillomavirus (HPV) vaccines attracting the most negative sentiments (31.9% of all negative posts). The majority of negative posts included links to articles emanating from other countries, predominantly the USA. Five themes were identified: Vaccine safety; autism; vaccine effectiveness; conspiracy theories; and philosophical/religious objections. Discussion Relatively high levels of pre-existing negative sentiments toward vaccines were expressed in the pre-pandemic era, with HPV vaccines attracting the most negative comments. These results provide a baseline for comparison to post-pandemic social media studies and may prove useful for measuring the impact in South Africa of global policies introduced to limit the spread of vaccine mis- and disinformation.
