Introduction The prevalence of childhood overweight and obesity has increased substantially in recent decades. Physical activity is a key component in improving metabolic and overall health in children with obesity. The Swedish Physical Activity on Prescription (PAP) is an established method for promoting physical activity, yet knowledge regarding its applicability and acceptability in paediatric populations is scarce. This study explored children's and parents' experiences of PAP, including perceived barriers, facilitators, and any changes in physical activity behaviour. Methods Twenty-two children and parents were purposively recruited from a previous intervention study at paediatric and rehabilitation clinics in Region Västra Götaland, Sweden. Semi-structured, in-depth interviews were conducted at locations chosen by participants, audio-recorded, and transcribed verbatim. Data were analysed using inductive qualitative content analysis, including coding, categorisation, and development of an overarching theme. Researcher triangulation was applied throughout the analytical process to strengthen credibility. Results The analysis resulted in the main theme Physical activity on prescription spanning healthcare and everyday life, supported by five categories, each with three to five sub-categories. The category The clinical encounter describes the overall experience of PAP as part of a larger whole; Finding "your thing" addresses activity selection as a process with several factors influencing the choice, and Fitting activities into everyday life concerns adoption of activities, engaging the family, and strategies to sustain activities. The category Motivation through monitoring and follow-up describes three different types of follow-up important for motivation: a digital diary, healthcare contacts, and wearing a accelerometer waistband. The last category, Changes beyond physical activity, captures experiences of development in both activity, behaviour, health and emotion. Discussion The findings suggest that children with obesity and their parents experience PAP as a supportive, person-centred, intervention extending across healthcare, everyday life, and organised sports. The intervention was perceived as combining conversational guidance with shared responsibility, with engagement facilitated by fun, tailored activities aligned with family routines, while financial and practical barriers could limit participation. Overall, the findings suggest that individually adapted, family-inclusive PAP is a feasible and acceptable strategy in Swedish paediatric obesity care, with potential broader benefits for children's health and well-being.
Abstract PURPOSE: To report our experience with different craniopharyngioma management strategies done for 246 patients in a single institution during a period of 14 years. METHODS: The medical records of all children with the diagnosis of craniopharyngioma treated at Children's Cancer Hospital Egypt (CCHE-57357) during the period from July 2007 to December 2021 were retrospectively reviewed. RESULTS : our registry included 246 pediatric craniopharyngiomawith median age of 7.4 years old. The main strategies of management after initial surgery were follow up, radiotherapy or administration of intracystic interferone post ommaya insertion. The number of cases in each group were 92, 147,and three respectively. Three patients were not operated upon because of heavily calcified lesions, two of them received radiotherapy while the third was kept under follow up. Overall gross or near total total excision was achieved in 31.2 % , subtotal resection was the case in 42.1% while Ommaya insertion and biopsy was done in 21.1 % of cases. Total number of patients received radiotherapy initially or on progression was 195 patients( 78.9%). The five-year overall survival was 88% (95% CI 82.9 – 93.1) while 5- year progression free survival (PFS) was 49.2% (95% CI 41.2—57.2). The five-year PFS rates for patients in the follow up group versus radiotherapy group were 25.2% and 68.7% respectively (P< 0.0001). Beta catenin was positive in 76.4% of cases that were available for testing (123/161). CONCLUSION: management of craniopharyngioma should be individualized with the main objective is the quality of life. Conservative surgery which entails gross total safe resection whenever possible or lesser extent of resection followed by radiotherapy is the main strategy followed in our institution.
The presence of numerous scientific contributions in the program is certainly demonstrative of the fact that research in the field of paleopathology and anthropology has not stopped since the beginning of Covid-19. Furthermore, the same emergency that we are still partially feeling, has pushed our community scientific research to question itself more intensely in connection to the epidemic relationship and measures that repeatedly led to profound transformations in the societies of the past from different points of view: demographic, economic, social and the history buried under the bioarchaeological strata is today more capable than ever to show this connection. It can do this by bringing to light the paleodemographic data that is obtained from the study of human remains. Today we will listen to many paleopathological stories and among these I am very happy to also present ours. Twenty years ago, the University of Insubria started a collaboration with the Archaeological Superintendence of Lombardy for the study of osteological remains found mostly during emergency archaeology recoveries. These experiences led us to reach those bioarchaeological sites again with the aim of extracting all those cemetery layers that remained there because they were not subjected at that time by building reclamation interventions. Returning to those sites that in the past brought to light fragmentary anthropological data means allowing oneself the possibility of obtaining new palaeodemographic and palaeopathological data which are decisive for reconstructing the demographic and epidemiological history of the populations of the past. These new interventions led us to create an operational model that immediately intended to underline the importance of an evident continuity between the archaeological recovery and the anthropological study of the finds through the setting up of physical anthropology and paleopathology laboratories directly on the sites of the finds. All this in harmony with the final design of the projects or the museumization of bioarchaeological sites in their complexity aimed at enhancing cultural tourist routes in the area. In this regard, I would like to thank the community foundation of Varese and the Cariplo foundation for supporting our current initiatives. These include the project financed by the emblematic provincial tender and which has as its final objective the enhancement of three bioarchaeological sites in Valcuvia: the medieval sites of San Biagio in Cittiglio, Sant’Agostino in Caravate, and the modern crypt of the church of the Convent of Azzio. Today, our Research Centre works in Piedmont in different sites in the province of Vercelli and Alessandria. Aware of the importance of a physical anthropological approach in the field, our young Centre goes beyond the continental borders to reach Eritrea, the ancient city of Adulis, because it is in dissecting the taphonomic events and the funeral actions that will make it possible to identify the funerary ritual adopted by the ancient populations. The operational model of paleopathological research, which gradually enriches itself thanks to the multidisciplinary nature of the interventions and thanks to the individual experiences in the field, is thus continuously transferred and adapted to other anthropological contexts that retain potential both in terms of investigative and enhancement of the bioarchaeological heritage. Through the musealization of the sites it is also possible to acquire an attractive force towards all those potentially bioarchaeological areas but which today are in conditions of neglect because they are marginal with respect to the conventionally understood cultural tourist good. And we all know how important it is to transfer the study data even outside the academic context because making this aspect of archaeology, the truly human one, usable too, cannot fail to arouse a strong awareness of our past. We also know how much more we will have to work, following in the footsteps of the professors who started this path, to ensure that the disciplines of paleopathology and physical anthropology arrive within all those degree courses still discovered today by these teachings to heal an important lack: knowing the human past from a physical and pathological point of view allows us to understand the evolutionary path of some pathologies, especially those of infectious nature. If my title of the speech “Paleopathology and osteoarchaeology in the province of Varese” does not respond to what is being said today, it is because my feeling about paleopathology and osteoarchaeology in the province of Varese is understood as that of carrying out research, what I could feel everywhere, through the operational model, the enthusiasm for paleopathological research and of course the people I am lucky enough to work with. Studying the relics of saints and blesseds has sometimes made it possible to discover aspects of their lives that are not documented in historical and literary sources. In some cases, it has also allowed research data to be compared with legends. The authors illustrate the case study of Blessed Egidio da Laurenzana. In 1917, on the occasion of the celebrations marking the 500th anniversary of the death of Blessed Egidio da Laurenzana (1443-1515), the reliquary containing his remains was opened for examination and to allow their state of conservation to be assessed. Bernardino di Bello (this was his secular name) entered the local Franciscan monastery when he was 30 years old. His saintly vocation was immediately clear as he had a marked sense of ascetic and contemplative spirituality, and naturally embraced a life punctuated by ecstasy and prayer. However, according to legend, as well as the accounts of his brothers in the order, he was also plagued by the continuous presence of the devil, who would physically attack him as he prayed at night. The last of these terrible attacks took place in church on Christmas night 1517, when the devil breathed fire on him, burning his left hand, and poured boiling lamp oil over him. He sustained terrible burns, and despite the attentive care of a noblewoman named Donna Lucrezia Trara, a procurator for the friars, who dressed his wounds, he died on January 10th, 1518 after experiencing great suffering. Egidio immediately became a figure of worship in Laurenzana, a small Italian town in the Province of Potenza. His beatification was confirmed in 1880. The examination of the mummy, by the Anthropology Unit of the G. d’Annunzio di Chieti University of Pescara, revealed that its condition had deteriorated since its previous inspection in 1940. Therefore, before the restoration work could begin, various procedures, including microscopic, microanalytical and radiological studies, had to be carried out. These analyses provided some interesting clues about the blessed’s general state of health (stones, arthritis, cleft lip), but above all regarding the causes of his death. Macroscopically, burn marks were found on the bones of the left shoulder girdle, the base of the skull and the anterior aspect of the bodies of the first thoracic vertebrae. The radiological studies revealed signs of bone necrosis on the left scapula, in the form of hypodense subcircular-shaped areas at whose periphery there were found micro-areas of thickening around areas of necrosis. Finally, scanning electron microscopy and microanalytical analyses of ectopic lamellar bone present on the scapula revealed the presence, on one of its surfaces, of tightly woven textile fibres containing traces of aluminum and copper; the appearance of the other surface was similar to that of skin. The micromorphological characteristics support the hypothesis that these fibers may be the remains of a dressing. Overall, the results of the analyses indicate that he suffered very serious burns, compatible with third degree lesions, which were treated with bandages impregnated with a therapeutic ointment. The extent and severity of the lesions were such that Blessed Egidio died two weeks after sustaining them. The medieval deserted village of Geridu, near Sorso, in the North of Sardinia, is mentioned in historical sources since the XIIth century and reached its maximum development during the XIVth century, when its population was about 1500 people. The village had been deserted before 1427, as the sources suggest, for several reasons, such as fiscal pressure, wars and pestilence. The village’s cemetery, near the church of Saint Andrews, was excavated in 1997-1998. The archaeologists dug 26 burials and discovered an hypogeic structure, most ancient, used in XIVth century as an ossuary. More than 90 cm of human remains were found, including some portions of skeletons in anatomical connection in the most ancient part of the ossuary. Therefore, archaeologists hypothesized the use of the structure also as a primary burial place for some individuals, especially for non-adults. In fact, the high presence of all subadult bones, found in the most ancient part of the ossuary, can suggest that some children were buried directly in the ossuary. Based on pottery found in ossuary’s obliteration the structure was closed definitively in the XVth century. The aim of the anthropological study was to determine the bioarchaeology of Geridu from the commingled bones from the ossuary. The osteological study focused on adults remains from the most recent part of the ossuary, separated from the first period of use by a layer of lime, and on several portion in connection found in the US 2812, the most ancient stratigraphical unit. Therefore, 180 commingled bones and 36 parts of individuals in connection has been analyzed. The paleopathological aspect seems to be very interesting; it confirms the results of individuals’ study from the cemetery burials, in addition to providing new data. The sample contained two cases of DISH, Diffuse Idiopatic Skeletal Hyperostosis, already found in Geridu, several bones affected by infectious diseases, such as a femur with pathological traces of osteomyelitis and a tibia with a probable case of Sclerosing osteomyelitis of Garré. Furthermore, a probable case of Osteosarcoma has been found, is an adult femur with extensive lithic lesions that have completely altered the proximal bone profile. For a better diagnosis the bones with traces of pathological lesions were analyzed with XR and Spiral CT scan by a team of Radiology from the University Hospital (A.O.U.) of Sassari. Despite the impossibility to complete a differential analysis, due to the absence of the rest of the skeleton, the hypotheses advanced seem to be confirmed by a CT scan. The study, even if incomplete, shows that important information can also be obtained from contexts such as ossuaries, which give a general picture on the state of health of past populations.
Background Developmental delay refers to children who experience significant variation in the achievement of expected milestones for their actual or adjusted age. Delays may occur in the areas of motor function, speech and language, cognitive, play, and social skills. Caregivers of these children feel stressed and limit their participation in society. This study was designed to assess the parental stress experienced by caregivers, their social participation, and the coping strategies they adopt. Methodology An observational study was carried out on 100 caregivers of children with developmental delay who were enrolled in a rural rehabilitation center. Caregivers were interviewed and assessed for stress, coping strategies, and social participation using specific questionnaires. Results and conclusions The mean age of the caregivers was 32.9 ± 7.76 years, and mainly women (64%). The age of the children ranged from 8 months to 18 years, and most were boys (57%). The proportion of total parental stress was 34%, with the "dysfunctional interaction" subscale at 63%, "parental distress" at 49%, and the "difficult child" subscale at 4%. Only 35% of the participants had no participation restriction, and a significant association between parental distress and social participation was noted (P = 0.004). Though the caregivers used all forms of coping strategies, caregivers with stress used the "avoidant emotional" strategy more compared to those without stress (mean score: 2 ± 0.41 vs 1.65 ± 0.34; P < 0.0001). Caregivers without stress mainly adopted the "problem-focused" coping strategy (mean score: 3.19 ± 0.54 vs 2.86 ± 0.62; P < 0.0001).
Objective Despite growing global recognition that nutrition literacy in childhood is a cornerstone of healthy eating and long-term wellbeing, evidence from Chinese primary school settings-particularly from inland, rapidly urbanizing regions-remains scarce. This study aimed to assess the nutrition literacy level of 4th-5th graders in chongqing, china, and to identify its key influencing factors, thereby sounding a wake-up call for school-based health promotion that holds relevance beyond the local context. Methods A multistage stratified cluster sampling method was used to conduct a cross-sectional online survey of 1,420 elementary school students in grades 4 and 5 in Chongqing, China. The questionnaire consisted of three sections: demographic characteristics, dietary behaviors, and nutrition literacy levels (Cronbach's α = 0.752). Participants were divided into high- and low-scoring groups based on the median nutritional literacy (NL) score. Multiple linear regression analysis was used to identify factors associated with nutrition literacy scores. Results The mean nutrition literacy score was 65.47 ± 9.79. In multivariable analysis, older age, female sex, minority ethnicity, urban residence, and higher caregiver educational attainment were independently associated with higher nutrition literacy scores (all P < 0.05). Keeping meal records (β = 4.18, 95% CI: 2.84-5.51) and participating in meal preparation (β = 2.07, 95% CI: 1.03-3.12) were also positively associated with nutrition literacy, whereas a meal duration of 31-45 min was negatively associated with nutrition literacy compared with <15 min (β = -3.39, 95% CI: -5.36 to -1.42). Conclusion Nutrition literacy among 4th-5th grade students in Chongqing was generally low and was associated with both sociodemographic characteristics and dietary behaviors. The findings highlight the importance of strengthening nutrition education and promoting practical food-related activities among school-aged children, with particular attention to children from socioeconomically disadvantaged backgrounds.
Introduction This cross-sectional study examined the relationships among English learning beliefs (ELBs), English learning self-efficacy (ELSE), English classroom enjoyment (ECE), and English autonomous learning ability (EALA) among secondary school students. Methods A convenience sample of 1,939 secondary school students was recruited from 11 provincial-level regions in China. Mediation and moderated mediation analyses were conducted using Hayes' PROCESS macro (Models 4 and 8) with 5,000 bootstrap samples, controlling for age, school stage, family residence, only-child status, and monthly family income. Results After controlling for covariates, ELBs were positively associated with EALA (B = 0.731, 95% CI [0.701, 0.761]). A significant indirect association between ELBs and EALA via ELSE was observed (indirect association = 0.377; 95% bootstrap CI: [0.340, 0.414]). ECE significantly moderated the association between ELBs and ELSE (B = 0.036, 95% CI [0.017, 0.054]), such that the positive association was stronger at higher ECE levels. The index of moderated mediation was significant (index = 0.016, 95% bootstrap CI [0.007, 0.024]), indicating that the indirect association between ELBs and EALA through ELSE was stronger at higher levels of ECE. Discussion These findings highlight the relevance of learning beliefs, self-efficacy, and classroom enjoyment to secondary school students' autonomous English learning.
Background Augmentative and Alternative Communication (AAC) refers to a range of communication methods used by children or adults to enhance or replace oral communication. Studies show many children with communication needs who require AAC do not have access to appropriate supports, and that embedding AAC interventions in the classroom is challenging. This means many children who use AAC face barriers to meaningful participation, engagement, and independence. Understanding the experiences and perspectives of AAC users and those who support the use of AAC in the classroom can provide actionable knowledge to guide service improvement such that AAC users can be empowered to achieve and participate in school. Methods A comprehensive literature search of the following electronic databases will be completed: PubMed, CINAHL Complete, EMBASE, EBSCO and Scopus. A manual search of the grey literature will also be carried out. Qualitative studies and mixed-methods designs that include qualitative data on the perspectives and experiences of AAC users, their families, and educators and healthcare professionals who support AAC users in school settings for children 3-18 years will be analysed. Methodological quality of included papers will be appraised using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research by two independent reviewers. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) - Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach will be employed to assess how much confidence to place in the findings of the qualitative evidence synthesis. Qualitative content analysis will be undertaken using constructs from Normalisation Process Theory. Conclusion This qualitative evidence synthesis will summarise findings from the empirical international literature to provide a deeper understanding of the experiences of AAC use from a range of stakeholder perspectives. Findings will inform the development of pathways to support implementation of AAC for children with communication needs within schools. Prospero Registration No. CRD420251229480.
Abstract AIMS: We report a cohort of YCMB cases homogeneously treated with HDCT in two Italian institutions, and the prognostic impact of histology and genetics retrospectively evaluated. METHODS: All YCMB (aged≤3 years) treated with upfront HDCT in the period 1998-2019 were included, reclassified according to the WHO2021 classification of CNS tumours. Mutational status ofPTCH1, SUFU, and TP53 was analysed in selected cases. Histology and genetics were correlated with survival, secondary tumours(STs), and cancer predisposition syndromes(CPSs). RESULTS: Fifty-three patients were enrolled (62.3% male), median age 2.2 years. 21 had classic(CMB), 15 desmoplastic/nodular(DMB), 11 MBEN and 6 large-cell/anaplastic(AMB/LCMB) medulloblastoma. Metastases were present in 18. Genomic pattern showed SHH-TP53wt in 29 cases, non-WNT/non-SHH in 22; 2 were SHH-TP53mut. Induction chemotherapy (VCR/HDMTX, HDVP16, VCR/HDCTX and HDCARBO) was followed by 2-3 HDCT courses; irradiation reserved to cases with metastatic disease and/or residual tumours. 22 patients never received irradiation. SHH-TP53wt cases had significantly less metastasis (p=0.002), while non-WNT/non-SHH received more often irradiation (p<0.0001). OS at 5, 10, and 20 yrs was 0.73, 0.70 and 0.57 respectively in the entire cohort; stable at 0.85 (at 5, 10, and 20 yrs) in SHH-TP53wt patients while 0.58, 0.51 and 0.17 in the non-WNT/non-SHH. PFS at 5, 10, 20 yrs was stable at 0.89 in SHH-TP53wt and remained 0.35 in non-WNT/non-SHH. 13/53 patients presented Gorlin Syndrome; 1 had familial MB. 16 STs were reported in 14 cases; life-threatening, irradiation-related STs mainly in non-WNT/non-SHH cases. In SHH-TP53wt benign tumours or related to CPS were reported. CONCLUSIONS: This is one of the first series of YCMB treated with HDCT without stratification for stage and histology. The long follow-up highlights the frequency/types of associated CPS and STs; the latter, in non-WNT/non-SHH, were treatment-related and life-threatening.
Background We evaluated the impact of the COVID-19 pandemic on adolescents born preterm versus at term. Methods This prospective cohort study included participants aged 13-21 years in the Environmental influences on Child Health Outcomes (ECHO) Cohort. Participants completed questionnaires from April 2020 to June 2022 about their behaviors during the pandemic and the impact of the pandemic on their social connectedness and overall well-being. Analyses compared adolescents born extremely preterm (before 28 weeks of gestation; n = 419) and those born moderate or late preterm (≥ 28 weeks and < 37 week; n = 118) with those born at term (n = 1,598). Associations were expressed as adjusted prevalence ratios (PRadj) and 95% confidence intervals (CIs). Results Adolescents in both preterm groups were less likely than those born at term to participate in unhealthy behaviors, such as drinking alcohol and using marijuana (moderate preterm: PRadj 0.78 [95% CI 0.61, 0.99]; extremely preterm: PRadj 0.74 [95% CI 0.58, 0.94]). Girls born extremely preterm were more likely to report health-promoting/prosocial behaviors (PRadj 1.15 [95% CI 1.06, 1.25]). Participants born moderate or late preterm reported feeling more socially connected during the pandemic compared with pre-pandemic (PRadj 1.29 [95% CI 1.09, 1.52]); nonetheless, this group was more likely to report a negative overall impact of the pandemic on their lives (PRadj 0.84 [95% CI 0.76, 0.92]). Conclusion During the COVID-19 pandemic, adolescent behaviors and self-reported impact differed for participants born preterm compared with those born at term. These findings can inform counseling for parents and adolescents during future national crises.
Abstract Many pediatric oncology patients report medical marijuana (MMJ) and hemp-based CBD use. Eleven states and Washington, DC have legalized marijuana for recreational use for adults greater than 21. Medical marijuana is legalized in 33 states. Additionally, due to the bipartisan Farm Bill passed in December of 2018, hemp is federally legal. Marijuana has medical legalization in 23 countries worldwide. Clinical trials in adults have examined MMJ for cancer-related symptoms. New research is emerging on MMJ in anticancer therapy, MMJ receptors on tumor cells, and the potential role for MMJ as an immunomodulator. Few pediatric oncology studies have evaluated MMJ. We describe the initial findings of a prospective observational study of MMJ on the quality of life (QOL) in pediatric brain tumor patients. Specific aims included (1) MMJ’s association with symptoms (nausea, anxiety, pain, fatigue, and cognitive problems) and (2) MMJ’s impact on family dynamics. The legality of hemp plus the increasing use of MMJ raises concerns with pharmacological interactions with CBD and the medications routinely administered to children with cancer. Nurses are the frontline for discussions with patients about MMJ and must be aware of the emerging field of MMJ in pediatric cancer. Additionally, nurses can influence patient care protocols and processes for alternative therapy administration enabling an open dialogue between providers, parents, and patients regarding treatments, symptoms, adverse effects, and drug interactions. Education about how to have conversations about important facets to cover and consider is crucial to patient safety and increased quality of life.
