Objective To evaluate the safety of valproate (VPA) on bone mineral density and bone metabolism in children with epilepsy. Methods Retrieve relevant research from online databases (January 1, 1980-March 1, 2018) as PubMed, EBMASE/SCOPUS and Cochrane Library with key words: epilepsy, bone, child. Selection of studies was performed according to pre-designed inclusion and exclusion criteria. Quality of studies was evaluated by using Newcastle-Ottawa Scale (NOS). All data were pooled by RevMan 5.2 software for Meta?analysis. Results The research enrolled 1455 articles, from which 13 studies with NOS score ≥ 6 were chosen after excluding duplicates and those not meeting the inclusion criteria. A total of 683 children with epilepsy using VPA and 436 children in control group were included. Meta-analysis showed that comparing with control group, bone mineral density of lumbar (BMDL) in children treated with VPA has no significant difference (MD = -0.019, 95% CI: -0.044-0.006; P = 0.140), but there was a significant decrease in bone mineral density of femur (BMDF; MD = - 0.037, 95%CI: -0.069- -0.005, P = 0.020). There was no significant change in serum calcium (SMD = -0.284, 95% CI: -0.951-0.382; P = 0.400), phosphorus (SMD = - 0.164, 95%CI: -0.457-0.129; P = 0.270), alkaline phosphatase (ALP; SMD = 0.363, 95%CI: -0.294-1.020, P = 0.280), parathyroid hormone (PTH; SMD = 0.102, 95%CI: -0.291-0.495, P = 0.610) and 25-hydroxy vitamin D [25(OH)D; SMD = -0.104, 95%CI：-0.620-0.413, P = 0.690] in bone metabolic markers. Sensitivity analysis showed Meta-anlaysis of BMDF, serum phosphorus and 25(OH)D was unstable, therefore, it should be cautious when explaining the results. Conclusions VPA has less effect on bone mineral density and bone metabolism, but for children with epilepsy using VPA, their BMDF should be monitored. DOI: 10.3969/j.issn.1672-6731.2018.06.005
The disclosure of cases of pedophiles online on social media in Indonesia certainly dangers that lurk children from perpetrators of sexual crimes. End Child Prostitution in Asian Tourism (ECPAT) Indonesia and the Criminal Crime Reform Institute (ICJR) regard this case of online child pornography as the largest ever disclosed by police without casualties. Online pedophile actors operating on social media Facebook use Official Candy Group accounts. Online pedophile prostitution has involved international networks. Departing from this background, the purpose of writing this scientific paper is to find out about the protection of children in Indonesia in terms of online pedophiles that refer to international child protection instruments that have been ratified. The research method used in this study is a normative legal research method. Seeing the situation in the territory of Indonesia become a place of practice that deviates until the involvement of international syndicates and modes is more sophisticated. Conditions further strengthen the assumption that Indonesia is indeed in an emergency of sexual violence. Harmonizing national laws to protect children online with international standards is key to providing the right tools for law enforcement in dealing with child sex crimes. In the child protection survey in the digital era in ASEAN member countries, it appears that Indonesia still needs improvement in terms of legal instruments related to child protection in the context of regulations and policies in making child protection mechanisms in the virtual realm in accordance with global commitments in which Indonesia is member of several international organizations.
Background: Vaccination has emerged as a promising strategy for dengue prevention, with several vaccines undergoing clinical evaluation. This systematic review is aimed to synthesize the current literature on the efficacy, immunogenicity, and safety of dengue vaccines, particularly CYD-TDV (Dengvaxia®) and TAK-003 (Qdenga®) in children. Methods: PRISMA guidelines were used to guide standard processes for data extraction during a systematic literature search. To find pertinent research published, electronic databases such as PubMed, Medline, Embase, and the Cochrane Library were searched up to 2024. Observational studies, randomized controlled trials, meta-analyses and systematic reviews, focused on children (<18 years of age) were considered eligible for inclusion. The CYD-TDV vaccination and TAK-003 were evaluated for their overall and serotype-specific effectiveness. Results: Key findings regarding vaccine efficacy, immunogenicity, and safety in children are summarized in this review. CYD-TDV, despite its efficacy in dengue-experienced individuals, long term safety data demonstrated that this vaccine increased the risk of more severe symptoms upon dengue infection in individuals who were dengue-naive and in children <9 years of age. TAK-003 has shown promising results, with an overall efficacy in preventing symptomatic dengue in children and adolescents. Conclusion: Dengue vaccines represent a promising tool for dengue prevention in children. While vaccine efficacy and safety issues remain, ongoing research and innovation hold promise for the safer and more effective dengue vaccines development.
INTRODUCTION: Systemic juvenile idiopathic arthritis (sJIA) is a distinct disease subset, with a poorer prognosis compared with other JIA subsets. Tocilizumab has an important role in the management of sJIA refractory to standard initial therapy. However, no specific guidelines exist for the tapering of tocilizumab therapy in sJIA, which could have implications on the overall cost and side effects of treatment. METHODS: This was an observational study which included 21 children with refractory sJIA, who were initially put on injection tocilizumab every 2 weekly, with subsequent dosing tapered to 4 weekly and 6 weekly intervals based on JIA ACR 70 responses at 12 and 24 weeks, respectively. The primary outcome at week 36 included JIA ACR 30, 50, 70, and 90 response rates with other efficacy and safety measures as secondary outcomes. RESULTS: At 36 weeks, JIA ACR 30, 50, 70, and 90 responses were observed in 90.5%, 90.5%, 71.4%, and 52.4% patients respectively along with significant improvement in hematological and inflammatory parameters. The mean prednisolone dose could be reduced from 0.54 to 0.13 mg/kg/day and around 29% patients were able to discontinue steroids altogether. No serious adverse events were recorded. With drug tapering, we could curtail on 26% of the total tocilizumab dose that would have been otherwise required on the continuous 2 weekly protocol. CONCLUSIONS: Tocilizumab, used in an early response-based tapering regimen, was both safe and efficacious in children with sJIA refractory to standard therapy. Larger and longer duration studies are required to further validate our observations.
Soumya Dey, Debaditya Roy, Pradyot Sinhamahapatra et al.
Study background AACCI - Association of Adolescent and Child Care in India conducts multicentric youth behaviour studies in India. The results are shared with the school and intervention programs are held. This paper analyses the pattern of internet use knowledge and practices in school children Abbreviations AACCI - _Association of Adolescent and Child Care in India Methods Cross sectional study. All children studying in class 6th to 10th (n=377) age range 11-16 yrs. -coed, elite, english medium school in North Delhi. Due permissions from parents and assent from participants taken. Ethical clearance was given by AACCI ethics committee Results n= 377 – Boys 66% (249) , girls 34% (128) . Majority i.e. 86.20% (325)) used internet and 29.2% (95) used for more than two hours a day. The favourite activities in 37.23% (121) were Internet games. 80% (259) had personal facebook account ;63.32% (164) have more than 100 facebook friends. Safety precautions analysis showed -a) majority i.e. 95% (246) believed that it is not right to post embarrassing personal information about self or friends. b) 21% (62) had facebook friends- not met in real life. c) Only 81% (239) students discuss internet experience with their parents; d) 47% (122) were not aware that information uploaded by them is tracked and stored and can be used by companies to make profits. e) Only 69% (203) used privacy settings and had detailed knowledge about cyber bullying. Conclusions Majority are not taking basic precautions like using privacy settings on the facebook. Since 34% (100) do not inform parents about their online activities, they are vulnerable to exploitation on the net and can also be tempted to go on inappropriate sites. We conducted a workshop in this school for students, parents and teachers on cyber safety and monitoring teen internet use. This is the need of the hour
Purpose: Cycling is a popular activity for children aged 5–14 years and has a notable risk of head injuries. Extensive evidence shows that bicycle helmets can reduce the severity of head injuries and prevent fatalities. The current study examines the prevalence of bicycle helmet use among children (aged 5–17 years) in Saudi Arabia, parents’ attitudes and safety perceptions toward children’s bicycle helmets, and factors that influence parents’ decisions regarding their children’s bicycle helmets. Methods: This study used an analytical cross-sectional design via a validated questionnaire to examine parents’ attitudes toward helmet use for their children (aged 5–17 years) in Saudi Arabia. The study, which was carried out from September 2023 to September 2024, involved 492 participants (69.5% mothers and 30.5% fathers), and they were recruited from all regions of Saudi Arabia. A validated and translated questionnaire was used to assess helmet usage attitudes, considering demographic factors and potential confounders. Results: Approximately 60% of children wear helmets while cycling, despite a high mean attitude score of 5.49 (SD = 0.91), with 93.3% of respondents expressing strong support for mandatory helmet laws. While belief (mean (M) = 5.45) and knowledge (M = 4.63) scores were also high, they did not correlate with actual helmet use. Strong helmet regulations significantly increased usage rates (>80%). Helmet ownership and parental helmet-wearing habits were associated with higher usage among children, with mothers showing greater usage rates for younger children than fathers. Regression analyses indicated that parents who wore helmets as children were 5.85 times more likely to have their children wear helmets and parents who wore helmets themselves were 7.98 times more likely to ensure that their oldest child did so. Conclusions: While parents have positive attitudes toward helmet safety, actual helmet usage among children measures at approximately 60%. Sustainable helmet regulations and parental modeling, especially for parents who wear helmets, are crucial for improving safety.
Leena Rashad Baghdadi, Razan A. Alotaibi, Layan A. Aldoukhi et al.
BACKGROUND: Off-label intranasal administration of injectable dexmedetomidine has been widely applied in the pediatric sedation setting. However, the development of an improved drug delivery system that is easy to use is needed. We developed a novel dexmedetomidine nasal spray that can be administered directly without dilution or configuration for pediatric pre-anesthetic sedation. This nasal spray has a fixed dose and is stable during storage. To the best of our knowledge, this is the first licensed nasal spray preparation of dexmedetomidine worldwide. OBJECTIVE: To evaluate the pre-anesthetic sedation efficacy and safety of the novel dexmedetomidine nasal spray in children. METHODS: The study was conducted at 11 sites in China between 24 November 2021 and 20 May 2022 and was registered in ClinicalTrials.gov (NCT05111431, first registration date: 20/10/2021). Subjects (n = 159) between 2 and 6 years old who were to undergo elective surgery were randomized to the dexmedetomidine group (n = 107) or the placebo group (n = 52) in a 2:1 ratio. The dosage was 30 µg or 50 µg based on the stratified body weight. The primary outcome measure was the proportion of subjects who achieved the desired child-parent separation and Ramsay scale ≥ 3 within 45 min of administration. Safety was monitored via the assessments of adverse events, blood pressure, heart rate, respiratory rate and blood oxygen saturation. RESULTS: The proportion of subjects achieving desired parental separation and Ramsay scale ≥ 3 within 45 min was significantly higher in the dexmedetomidine group (94.4%) vs the placebo group (32.0%) (P < 0.0001). As compared with placebo, dexmedetomidine treatment led to more subjects achieving Ramsay scale ≥ 3 or UMSS ≥ 2, and shorter time to reach desired parental separation, Ramsay scale ≥ 3 and UMSS ≥ 2 (all P < 0.0001). Adverse events were reported in 90.7% and 84.0% of subjects in the dexmedetomidine and placebo groups, respectively, and all the events were mild or moderate in severity. CONCLUSIONS: This novel dexmedetomidine nasal spray presented effective pre-anesthetic sedation in children with a tolerable safety profile.
Objective: The aim of this study was to examine the use of Eye Movement Desensitization and Reprocessing (EMDR) in online counseling for children with single-incident trauma. Method: A qualitative case study method was employed. The research was conducted with two volunteering children and their parents. The sessions were transcribed by the authors, and code names (Ipek and Eylül) were assigned to protect the participants' identities. İpek's traumatic memory was explored through drawing pictures with tactile bilateral stimuli and Eylül's traumatic experience was addressed using tactile bilateral stimuli during the EMDR therapeutic story technique. The Child Revised Impact of Events Scale (CRIES-8) was used for pre-test, post-test, and follow-up testing to support the session descriptions. Results: The results indicated that post-traumatic symptoms were reduced and remained at a low level for an extended period in both clients. Conclusions: It is suggested that future studies should explore various bilateral stimulation methods in online EMDR, conduct larger-scale studies with children who have experienced different types of traumatic events, and investigate the impact of various EMDR protocols on children.
Canan Çitil Akyol, Mustafa Kutlu, Ümran Korkmazlar
Extended Reality (XR), encompassing Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR), is transforming digital interaction by providing immersive and interactive experiences. However, the proliferation of XR technologies introduces significant cybersecurity concerns, particularly the heightened risk of online exploitation and abuse targeting vulnerable populations, including children and women. This research paper critically examines the unique cybersecurity threats posed by XR environments, focusing on the protection of these at-risk groups. The study explores current trends in XR technology and analyzes the specific nature of cyber threats within these virtual spaces, such as cyberbullying, harassment, and exploitation. It assesses existing legal and technological frameworks designed to mitigate these threats and identifies significant gaps that need addressing. Furthermore, the paper highlights the psychological and social impacts of XR-related abuse, emphasizing the need for comprehensive protective measures. By proposing a multifaceted approach that combines legal, technological, and educational strategies, this research aims to enhance online safety for children and women in XR environments. The findings underscore the necessity for proactive and interdisciplinary efforts to develop robust cybersecurity measures that keep pace with the evolving digital landscape. This study contributes to the broader discourse on cybersecurity, advocating for innovative solutions to protect vulnerable populations from the complex challenges presented by XR technologies.
Prof. Namita Vyas Joshi, Ms. Ravina Parihar, Gurdeep Kaur Pandher
Cyberspace, given its unique capabilities, can have both positive and negative impacts. However, if individuals engage with this space naively and without adequate knowledge, they may become vulnerable to its negative effects. Children are among the most significant and sensitive groups exposed to the potential harms of cyberspace. Within this context, the central research question is: What are the religious and ethical risks of cyberspace for children, and what strategies can mitigate these risks? To address this question, the hypothesis posits that a lack of awareness, insufficient parental supervision, and the absence of appropriate frameworks for safe and effective use of cyberspace expose children to the weakening of Islamic beliefs, moral deviations, and ethical exploitation. This study employs a library-based method for data collection and an analytical approach for data processing. The findings indicate that while cyberspace holds immense potential for learning, creativity, and innovation, it should not be simplistically regarded as a safe environment for children's engagement. Thus, precaution, heightened awareness, supervision, and the enforcement of restrictions are critical strategies to prevent religious and ethical harms in cyberspace for children.
