The COVID-19 pandemic has exacerbated the global learning crisis, with many learners losing access to their classrooms. Recovery from the pandemic and transition back to regular schooling is slow, and there is a need to catch up. Despite some EdTech having been introduced as a mitigating measure, it is clear that the poorest children, especially, have missed significant learning. The present overview paper seeks to offer inspiration, overarching considerations, and research evidence to highlight opportunities for collaboration to build back better after the COVID-19 crises — globally and particularly among low- and middle-income countries — knowing the urgency under which education policymakers are asked to act.
Abstract Our previous quantitative research studies have revealed that large numbers of older Japanese individuals living in overseas communities either maintain hope of receiving culture-oriented care or harbor aspirations of returning to Japan to live out their final days. Presently, by analyzing a quantitative research study on older Japanese individuals living in Greater New York in 2018, we clarify the characteristics of those individuals who have decided to return to Japan. In the research study, 2,057 questionnaires were distributed, and the overall return rate was 29.7%. Respondents were divided into three groups based on their answers regarding their intentions for the location of their final abode: the United States, Japan, or indecisive. We performed a multinomial logistic regression analysis based on age, gender, immigration status, having children in the United States, and academic background. The following is a summary of the findings: (1) as participants aged, the ratio of selecting either “Japan” or “indecisive” as opposed to “the United States” decreased, (2) compared to those holding citizenship, individuals with permanent residence selected both “Japan” and “indecisive” at greater rates (by approximately 3 times and 8.7 times, respectively); (3) compared to those having children in the United States, individuals without children in the United States selected both “Japan” and “indecisive” at greater rates (by approximately 1.8 times and 2.2 times, respectively); (4) individuals with a graduate career displayed a tendency to select “the United States,” and (5) gender and language proficiency were not critical attributes in determining the likelihood of selecting “Japan.”
Background Suboptimal cardiometabolic health in pregnancy increases risk of perinatal complications and long-term negative health outcomes. Objectives This study aimed to provide updated prevalence estimates of cardiometabolic risk factors among United States pregnant women, and examine associations with food insecurity, diet quality, and United States Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation. Methods This cross-sectional study used National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2023. This analysis included pregnant women aged 20-44 y. From 1999 to 2023, 1538 women had available cardiometabolic data to estimate prevalence, which were examined using survey-weighted descriptive statistics. Associations of cardiometabolic outcomes with food insecurity, diet quality, and WIC participation were examined using survey-weighted multivariable linear regression models. Food insecurity was assessed using the United States Food Security Survey. Diet quality was assessed with Healthy Eating Index-2020 (HEI-2020) scores using the simple ratio method. WIC participation was ascertained from the Food Security Questionnaire. Models were adjusted for age, race/ethnicity, gravidity, income, education, and marital status. Outcomes included prepregnancy body mass index (BMI), fasting plasma glucose, blood pressure, high-density lipoprotein cholesterol (HDL-cholesterol), and C-reactive protein (CRP). Results Prepregnancy overweight/obesity was found in 51.9% of women, elevated fasting glucose in 29.3%, and elevated blood pressure or hypertension in 10.7%. The median HDL-cholesterol in the highest quartile was 84 mg/dL [interquartile range (IQR): 78-93], and for CRP was 14.6 mg/L [IQR: 12.4-16.8]. Food insecurity was associated with lower HDL-cholesterol [β = -4.02, standard error (SE) = 2.03; P = 0.05], but not with CRP, fasting glucose, or blood pressure. Higher HEI-2020 scores were associated with higher HDL-cholesterol levels (β = 1.45; SE = 0.71; P = 0.04), but not with CRP, blood pressure, or fasting glucose. Participation in WIC strengthened the positive association between HEI-2020 scores and systolic blood pressure. Conclusions Prevalence of cardiometabolic risk factors was high among United States pregnant women, with food insecurity and suboptimal diet quality associated with some risk factors.
Chharawalla HM, Nommsen-Rivers LA, Arnold CD et al.
Abstract INTRODUCTION: Due to recent advancements in surgical techniques, imaging and adjuvant therapies, survival rates for children with central nervous system (CNS) tumours have improved. Research priorities have now shifted to focus on late-effects and quality of survivorship amongst childhood CNS tumour survivors. Our study aimed to assess levels of cardiorespiratory fitness and health-related quality of life (HRQoL) amongst survivors of childhood CNS tumours. A secondary aim was to investigate potential relationships between cardiorespiratory fitness and HRQoL. METHODS: Participants were recruited from the National Children’s Cancer Service in CHI Crumlin. Inclusion criteria included: diagnosis of a primary CNS tumour, aged between 6-17 years, between 3 months and 5 years post completion of oncology treatment, independent mobility, deemed clinically appropriate to participate by treating oncologist. Cardiorespiratory fitness was assessed using the six-minute walk test. HRQoL was assessed with the PedsQL Generic Core Scales, Version 4.0, both self-report and parent proxy report forms were used. RESULTS: 20 participants (n=9 male) were recruited with a mean age of 12.34 (SD = 3.46) years. Mean time since completion of oncology treatment was 2.31 (SD = 1.38) years. Mean 6-minute walk distance (6MWD) was 482.75 (SD = 50.04) metres, equating to the 5.55th (SD = 6.83th) percentile overall. 6MWD was significantly reduced compared to predicted 6MWD (t = -12.52, p <.001, 95% CI [-163.52, -116.68]). Parent proxy-reported HRQoL was significantly reduced compared to healthy population norms (t = -5.82, p <0.001, 95% CI [-25.76, -12.17]). A strong positive correlation exists between 6MWD and both parent-proxy (Pearson’s r = 0.533, p = 0.015) and child-reported HRQoL (r = 0.580, p = 0.007). CONCLUSION: Survivors of childhood CNS tumours present with impaired levels of cardiorespiratory fitness and HRQoL compared to healthy population norms. Higher levels of cardiorespiratory fitness are associated with higher levels of HRQoL.
Background Child study satisfaction has rarely been assessed in longitudinal pediatric research. This study examined child and maternal study satisfaction among 10-15-year-old participants in The Environmental Determinants of Diabetes in the Young (TEDDY) study, an observational multinational (US, Finland, Germany, and Sweden) study of children at increased genetic risk for type 1 diabetes enrolled at birth. Methods Child and maternal study satisfaction was measured by a 3-item annual questionnaire from child-age 10 years until the last visit at child-age 15. Generalized estimating equations identified sociodemographic and study-related variables associated with study satisfaction. Results Children and mothers exhibited high study satisfaction across all ages although their study satisfaction scores were weakly correlated (r ≥ 0.20, p < 0.001). Factors associated with higher study satisfaction were similar for children and mothers: living in the US compared to Finland (Finnish children: -0.78 95%CI -0.86, -0.69; Finnish mothers: -1.48 95%CI -1.61, -1.35; p < 0.001), older child age (15-year-old vs 10-year-old child: 0.09 95%CI 0.03,0.14; mother: 0.42 95%CI 0.37, 0.47; p < 0.001), and accurate perception about the child's type 1 diabetes risk (child: 0.20 95%CI 0.15,0.25; mothers: 0.20 95%CI 0.13, 0.22; p < 0.001). Additional factors associated with greater child study satisfaction included female sex (-0.29 95%CI -0.35, -0.24; p < 0.001), being multiple islet autoantibody positive (0.21 95%CI 0.11, 0.32; p < 0.001), lower child anxiety about type 1 diabetes risk (-0.01 95%CI -0.02, -0.01; p < 0.001), having a mother with higher study satisfaction (0.13 95%CI 0.12, 0.15; p < 0.001), and having read an age-appropriate book about the study, its purpose, and type 1 diabetes (0.19 95%CI 0.12, 0.25; p < 0.001). Conclusions Study satisfaction was high among 10-15-year-old children at increased genetic risk for type 1 diabetes, and their mothers, who had participated in a longitudinal observational study since the child's birth. Factors associated with satisfaction were similar for children and their mothers. Potentially modifiable factors that could be targeted to improve study satisfaction include mother and child accuracy about the child's type 1 diabetes risk and for child study satisfaction in particular - the child's own anxiety about type 1 diabetes, the child's mother's satisfaction and having the child read high quality age-appropriate materials about the study. Trial registration NCT00279318, 06/09/2004.
Abstract INTRODUCTION: Diffuse midline glioma (DMG) is a fatal childhood CNS tumor. Magnetic resonance imaging (MRI) is the gold standard for DMG diagnosis and monitoring of response to therapy. Leveraging novel MRI analytical approaches, including volumetric and machine learning based analyses, may aid in the prediction of patient overall survival (OS) and help to identify high-risk cases. METHODS: T1- and T2-weighted MR images were retrospectively collected from children and young adults diagnosed with DMG (n=43). MRI features, including manually determined 3D tumor volume (T2), T1 contrast-enhancing tumor volume, T1 relative to T2 volume (T1/T2), tumor relative to whole brain volume, tumor average intensity, and tumor heterogeneity (i.e., intensity skewness and kurtosis), were evaluated at upfront diagnosis. MRI features were analyzed to identify significant predictors of OS outcome, which was defined as OS shorter, or longer, than one year from diagnosis. A support vector machine was used to predict OS outcomes using combinations of these features. RESULTS: The presence of T1 contrast-enhancing tumor at diagnosis (p=0.01), and a high T1/T2 ratio (>25%, p=0.009), predicted significantly shorter median OS. Moreover, feature selection identified T2 mean intensity (p<0.001), T2 image intensity skew (p=0.006), T1/T2 ratio (p=0.02), and T1 volume relative to whole brain (p=0.03) as significant predictors of OS outcome (short versus long). Combining T2 mean intensity, T2 image skew, T1 segment kurtosis and patient gender resulted in OS outcome prediction accuracy of 83.3% (sensitivity=85%, specificity=81.8%, n=42 cases).CONCLUSION: We have identified MRI volume and imaging features that significantly predict OS outcome in children diagnosed with DMG. Our findings provide a framework for incorporating MRI volumetric and machine learning analyses into the clinical setting, allowing for the customization of treatment based on tumor risk characteristics.
Abstract Diffuse midline glioma with H3 K27 alterations (DMG) is the most aggressive primary malignant brain tumor in the pediatric population. Radiation therapy (RT) is the standard-of-care; however, it has not demonstrated a significant improvement in overall survival or stalled disease progression, and children usually succumb to disease within 12-15 months of diagnosis. Consequently, finding efficient treatments for DMG remains one of the most critical unmet needs in modern neuro-oncology. Interleukin 13 receptor subunit alpha 2 (IL-13Rα2) is a cell-surface receptor upregulated in ~80% of DMG versus normal brain, posing a potentially promising therapeutic target. Immunotherapies harnessing IL-13Rα2 to selectively delivery cytotoxic payloads, such as pseudomonas exotoxin A (PE), to tumor cells have been previously demonstrated to be safe in DMG patients and efficacious in preclinical models of DMG with high IL-13Rα2 expression using convection-enhanced delivery (CED). Furthermore, there is evidence that PE-based therapies can sensitize cells to RT. In this study, we utilized in vitro and in vivo models of DMG to evaluate clinically-relevant combination treatments of RT and the IL-13/PE immunotoxin GB-13 (IL13.E13K-PE4E). GB-13 improved the effectiveness of low-dose RT in multiple DMG cell lines by promoting caspase activation, which boosted apoptotic cell death. Intratumoral administration of GB-13 via chronic CED decreased tumor burden and prolonged survival in both DMG patient-derived orthotopic xenograft and genetically engineered mouse models. When GB-13 and RT were administered concurrently, this impact became even more prominent, informing future preclinical and clinical investigation of a potentially efficacious therapeutic approach in a subset of DMG.
Background Child abuse remains a significant public health challenge. Healthcare workers serve as critical frontline responders, yet gaps persist between legislative frameworks and implementation. Objective The objective of this study is to assess knowledge, attitudes, and practices of healthcare workers in Al Dhahira regarding child abuse identification and reporting, identify barriers to consistent implementation, and examine factors associated with reporting behavior. Methods A descriptive cross-sectional study of 150 healthcare workers at 18 primary healthcare centers in Al Dhahira was conducted in 2023 (sample size calculated as 148 for a population of 600, 95% confidence level). Data were analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States) with descriptive statistics and chi-square tests (p<0.05). Results The sample comprised 102 (68.0%) physicians, 38 (25.3%) nurses, and 10 (6.7%) allied health professionals. While 140 (93.3%) were aware of the Omani Child Law and 128 (85.3%) knew a child protection hotline exists, only 110 (73.3%) knew the correct hotline number; 91 of 128 (71.1%) among those aware. Although 138 (92.0%) believed suspected abuse should always be reported, only 110 (73.3%) consistently reported cases, revealing an 18.7-percentage-point attitude-practice gap. Major barriers included fear of legal consequences (44; 29.3%), clinical identification challenges (42; 28.0%), and lack of feedback (39; 26.0%). Previous child protection training was significantly associated with consistent reporting behavior: 73 of 89 (82.0%) trained workers consistently reported versus 37 of 61 (60.7%) untrained workers (p=0.001). Conclusions Healthcare workers demonstrate good theoretical knowledge of child protection frameworks but face significant practical barriers to consistent implementation. Evidence-based interventions including professional development programs, clear legal protection communications, feedback mechanisms, and multi-professional reporting capacity warrant prospective evaluation to bridge the attitude-practice gap and ensure effective child protection implementation.
Background: Post-concussion sequelae in adolescents include physical, cognitive, and psychosocial effects that may result in reduced quality of life (QOL) and academic challenges when returning to school. The COVID-19 pandemic resulted in altered teaching and learning models outside the traditional in-person classroom, and elevated psychosocial stress and isolation among adolescents. It is unknown whether these changes affected QOL or academic challenges post-concussion. Hypothesis/Purpose: To compare self-reported QOL and academic challenges among concussed adolescents prior to and during the COVID-19 pandemic. Methods: Concussed adolescents were enrolled from secondary schools and children’s medical centers across seven sites into the Sport Concussion Outcomes in Pediatrics (SCOPE) study (PRiSM Concussion RIG). Participants completed demographics, medical history, symptom report, the Concussion Learning Assessment and School Survey (CLASS) and QOL via PROMIS Pediatric Global 25 during their first evaluation visit. Participants were grouped by date ranges: September 2018-January 2020 (Pre-COVID-19) and September 2020-May 2021 (COVID-19). No participants were enrolled between February-August 2020 (cessation of clinical research activities during this time.). Results: A total of 141 patients were enrolled. Mean age=14.9±2.4 years, 61% self-reported as male, 82% white and 85% not Hispanic or Latino, 5.2+3.1 days post-injury (range=1-14 days). Seventy-four patients were enrolled prior to COVID, and 67 were enrolled during COVID (Table 1). No significant differences were found between the ‘Pre-COVID-19’ group versus ‘During COVID-19’ group in symptom resolution, symptom severity score, QOL, or academic concerns (Table 2). The only difference was the ‘person at school who is best to coordinate support.’ A significantly lower proportion of participants who sustained their concussion during COVID-19 reported their principal/assistant principal would be the best person to coordinate support compared to those who sustained their concussion before the COVID-19 pandemic. In contrast, a significantly higher proportion of those who sustained their concussion during the COVID-19 pandemic reported their coach would be the best person to coordinate support. Conclusion: In this convenience yet nationally representative sample, students who sustained a concussion during the pandemic did not report increased academic concerns or reduced QOL compared to those whose injury was prior to the pandemic. Median symptom severity was lower during the pandemic, though not statistically significant. These findings could represent shifted priorities of the principal/assistant principal but still adequate support from medical and school-based staff; less academic stress and greater flexibility during the COVID-19 pandemic; or may represent limitations in the CLASS instrument to detect differences that occurred during the pandemic.Table 1 Participant characteristics by group. Data are presented as mean (standard deviation) or n (% within group).Table 2 Clinical and Quality of Life characteristics (via PROMIS Pediatric Global 25) between groups, assessed at the initial post-concussion assessment. Data are presented as median [interquartile range] and compared using Mann Whitney U tests.
Objective This study examined the relationship between adolescent sports participation and school adjustment and analyzed the serial mediating effects of peer relationships and depressive symptoms. Methods The study sample comprised 8,096 adolescent participants. Assessments were conducted using the Physical Activity Questionnaire for Children (PAQ-C), the School Social Behavior Scale (SSBS), the Quality of Life Scale for Children and Adolescents (QLSCA), and the Symptom Checklist-90 (SCL-90). The hypothesized mediation effects were tested using the SPSS 26.0 macro PROCESS 4.5 with bias-corrected bootstrapping (5,000 resamples) to assess the significance of the indirect effects. Results Group comparisons showed that boys scored higher than girls on sports participation, school adjustment and reported lower depressive symptoms scores (p < 0.001), while no significant gender difference emerged for peer relationships. No significant age differences were observed for sports participation, school adjustment, or peer relationships (all p > 0.05), but depressive symptoms increased significantly with age (p < 0.01), with the highest levels at age 19. Only children scored higher on sports participation and school adjustment and lower on depressive symptoms, but lower on peer relationships, than non-only children (p < 0.001). Students in remote areas showed lower school adjustment and higher depressive symptoms scores than those in several non-remote groups (p < 0.001). Sports participation was positively correlated with school adjustment (r = 0.260, p < 0.001) and peer relationships (r = 0.201, p < 0.001) and negatively correlated with depressive symptoms (r = -0.166, p < 0.001). Peer relationships were positively correlated with school adjustment (r = 0.344, p < 0.001) and negatively correlated with depressive symptoms (r = -0.362, p < 0.001). Depressive symptoms were negatively correlated with school adjustment (r = -0.226, p < 0.001). Peer relationships (effect = 1.76, 95% CI [1.50, 2.03]) and depressive symptoms (effect = 0.23, 95% CI [0.14, 0.33]) each mediated the association between sports participation and school adjustment. They also formed a small but statistically significant serial mediation effect pathway (effect = 0.20, 95% CI [0.14, 0.28]). Conclusion This study further clarifies the relationship between adolescent sports participation and school adjustment, and emphasizes the chain mediating role of peer relationships and depressive symptoms. These findings provide empirical evidence for the educational value of adolescent sports participation and offer practical implications for optimizing school physical education to enhance school adjustment and promote mental health.
