Criterion Validity and Applicability of Motor Screening Instruments in Children Aged 5–6 Years: A Systematic Review

The detection of motor developmental problems, especially developmental coordination disorder, at age 5–6 contributes to early interventions. Here, we summarize evidence on (1) criterion validity of screening instruments for motor developmental problems at age 5–6, and (2) their applicability. We systematically searched seven databases for studies assessing criterion validity of these screening instruments using the M-ABC as reference standard. We applied COSMIN criteria for systematic reviews of screening instruments to describe the correlation between the tests and the M-ABC. We extracted information on correlation coefficients or area under the receiver operating curve, sensitivity and specificity, and applicability in practice. We included eleven studies, assessing eight instruments: three performance-based tests (MAND, MOT 4–6, BFMT) and five questionnaires (DCD-Q, PQ, ASQ-3, MOQ-T-FI, M-ABC-2-C). The quality of seven studies was fair, one was good, and three were excellent. Seven studies reported low correlation coefficients or AUC (<0.70), four did not report these. Sensitivities ranged from 21–87% and specificities from 50–96%, with the MOT4–6 having the highest sensitivity and specificity. The DCD-Q, PQ, ASQ-3, MOQ-T-FI, and M-ABC-2-C scored highest on applicability. In conclusion, none of the instruments were sufficiently valid for motor screening at age 5–6. More research is needed on screening instruments of motor delay at age 5–6.

Tuna Massage Training as An Effort to Improve the Nutritional Status of Toddlers

Difficulty eating in children cause malnutrition, dehydration, underweight, electrolyte imbalance, impaired cognitive development, anxiety disorders, and in more severe cases can be a life-threatening condition. Tuina massage is a massage technique that can overcome eating difficulties in toddlers. The purpose of this activity is to increase the knowledge and skills of health cadres about nutritional health and Tuina massage. The service was carried out in Pasir Lor village, Karanglewas district, which was attended by 23 cadres. Data collection techniques were carried out using questionnaires about toddler nutrition and observation sheets to assess Tuina's massage skills. The results of the activity showed that the knowledge of cadres before training was mostly in the sufficient category, while the knowledge of cadres after attending the training showed that the level of knowledge of cadres was mostly in the good category. Most of the health cadres have good skills in doing Tuina massage. The training activities were effective and able to increase the knowledge and skills of cadres about toddler nutrition and developmental problems and Tuina massage.

Seroprevalence of CMV in Women with Bad Obstetric History in Babil/Iraq

Placental dysfunction and or fetal central nervous system infestation caused by Human cytomegalovirus (HCMV) is the leading cause of congenital non-genetic neuro-developmental problems of the newborn, worldwide. Although the highest rates of congenital infection and CMV seroprevalence occurs in developing countries like Iraq, there remains a paucity of data from that part of the world. This descriptive case control study was undertaken in Babylon/ Iraq to determine the local seroprevalence of CMV in women of child bearing age, and to identify the socio-demographic factors associated with it. This study found a seropositivity peak amongst the 26-35 yr olds which declined in the 36 – 45 yr olds. However, the evidence of current infection was stable at 25% among the 26-35 yr olds and the 36 – 45 yr old women. Overall seropositivity was at 77.32%, a susceptibility rate was at 22.68%, and seropositivity for IgG was highest among the educated, those living in overcrowded settings, and those with poor obstetric histories. Our study concludes that CMV screening of women in the Al Hamza district in Babylon/Iraq and the availability of advice on how to prevent the infection can be beneficial for health outcomes.

Psychosocial Impact of Congenital Heart Diseases on Patients and Their Families: A Parent's Perspective

Background Currently, over 90% of children with congenital heart disease (CHD) survive into adulthood. As a consequence the psychosocial impact on children and their families has become an important outcome measure. Therefore, the goal of this study was to assess the psychosocial impact from a parent's perspective and to identify possible predictors. Methods We included all parents of children who underwent open-heart surgery in the years 2010 and 2011 at the Department of Cardiothoracic Surgery at University Hospital Heidelberg and invited them to complete standardized questionnaires. Psychosocial outcome was measured via parent self- and proxy reporting of family burden (Family Burden Questionnaire, FaBel), health-related quality of life (KidScreen-10), developmental problems (Five-to-Fifteen, FTF), and mental health problems (Strength and Difficulties Questionnaire, SDQ). Results In total, 113 families returned the questionnaires completely (71.5%). The Aristotle Basic Complexity score and the STAT 2020 Score overall did not predict the psychosocial impact, whereas the number of surgical operations did significantly predict psychosocial impact across all domains in this study cohort. Conclusions These data suggest that the number of surgical operations might be a relevant predictor for the long-term psychosocial impact on families suffering from CHD and a potential connecting factor for specialized psychological support. When setting up screening instruments or support programs the entire family must be considered.

Plasma Phthalate Levels In Children With Speech Delay

Speech delay is one of the most common developmental problems. One of the risk factors may be the exposure to environmental chemicals. There is increased environmental exposure to phthalates, an endocrine-disrupting chemical. In this study, we aimed to determine the relationship of phthalates with speech delay. We included 50 children with isolated speech delay and 40 healthy children of similar age. Children were surveyed for risk factors for speech delay and phthalate exposure. Plasma di-(2-ethylhexyl) phthalate (DEHP), mono-(2-ethylhexyl) phthalate (MEHP) and dibutyl phthalate (DBP) levels were measured by high pressure liquid chromatography. The DEHP, MEHP and DBP levels in study and control groups were 0.377 [0.003 - 1.224] µg/ml, 0.212 [0.007 - 1.112] µg/ml (p = 0.033), 0.523 [0.031 - 2.477] µg/ml, 0.152 [0.239 - 2.129] µg/ml (p <0.001), and 0.395 [0.062 - 1.996] µg/ml, 0.270 [0.006 - 0.528] µg/ml (p = 0.004), respectively. Multiple linear regression analysis was used to adjust the association between the phthalate levels and factors differing between the two groups in terms of delayed speech risk factors. While there was no significant difference between the study and control groups in terms of DEHP level (p=0.233), the MEHP and DBP levels were found significantly higher in the study group (p<0,001). Conclusion: The statistically significant higher phthalate levels in those with speech delay indicate that these children are more exposed to phthalates and more epidemiological studies are needed to evaluate the association between phthalates and speech delay.

Current state of infection and prevalence of giardiasis in Malaysia: a review of 20 years of research

Background Giardiasis is a neglected parasitic zoonotic disease caused by Giardia duodenalis that is often overlooked despite the damage inflicted upon humans and domestic/wild animals. Lack of surveillance studies, low sensitivity of diagnostic tools, and resistance to giardiasis treatment add to the challenge in managing giardiasis, leaving a gap that continues to render giardiasis a silent threat to public health worldwide. This situation is not much different in Malaysia, where giardiasis remains a public health problem, especially in the indigenous communities. Realizing the existence of gaps in the literature and information on giardiasis in Malaysia, this review aims to revisit and update the situation of giardiasis in Malaysia based on articles published in 20 years from 2000 to 2020, providing estimates on the incidence of giardiasis in humans, animals, and the environment, which may inform efforts to prevent and control the impact of giardiasis in the country. Methodology We searched PubMed, Science Direct, and Scopus using MeSH terms and text keywords “Giardia duodenalis OR Giardia intestinalis OR Giardia lamblia OR intestinal protozoa AND Malaysia”. Information was collected from all giardiasis reports published between 2000 and 2020. Results Giardiasis in Malaysia is more prevalent among the poorest segments of the population, namely the indigenous communities and people living in densely populated areas such as slums and prisons, due to low standard of personal hygiene, unsafe water resources, and improper sanitation. While the prevalence data is hugely dependent on microscopic fecal examination in epidemiological studies of giardiasis, current studies mostly focused on species identification and genotype distribution by multilocus genotyping. Thus far, the outbreak of giardiasis has not been reported in the country, but the disease was found to be significantly associated with stunting, wasting, and malnutrition among children of the indigenous communities. Surveillance studies also discovered the simultaneous presence of Giardia in the animal-environments, including wild animals, ruminants, and treated and untreated water. The data collected here will be a useful addition to the literature body on giardiasis in Malaysia, which can be exploited in efforts to prevent and control the impact of giardiasis in the country. Conclusions The last 10 years have shown that the overall mean rate of giardiasis in Malaysia is quite encouraging at 13.7%. While this figure appears to be declining, there has been a slight increase in the prevalence of underweight, stunting, and wasting among rural children in 2019. The fact that giardiasis is linked to long-term childhood developmental problems, indicates that addressing and providing better disease control against giardiasis should be a priority in supporting the national agenda to achieve Malaysia Global Nutrition Targets by 2025.

Mifepristone Directly Disrupts Mouse Embryonic Development in Terms of Cellular Proliferation and Maturation In Vitro

Mifepristone (RU-486), a synthetic steroid with potent antiprogestogen and anti-glucocorticoid properties, has been widely used in clinical practice. Its effect on the endometrium, ovary, and fallopian tube has been well reported in many human and animal studies. However, its direct impact on post-implantation embryos remains underexplored. Additionally, some women choose to keep their pregnancy after mifepristone treatment fails. Thus, the potential risk remains controversial. Hence, this study investigated the direct effects of mifepristone on the development of mice blastocysts in vitro in terms of implantation and post-implantation. We detected the level of progesterone (P4) associated with ovulation in vivo. The presence of progesterone receptors (PRs) in blastocysts and post-implantation embryos was also evaluated. Cultured embryos were treated directly with mifepristone. We further examined embryonic implantation and post-implantation of blastocysts in vitro to evaluate the direct effects of mifepristone on embryos by the assessment of embryonic outgrowth and differential cell staining. In the oviduct lumen, the P4 level dramatically increased at 48 h and slightly decreased at 72 and 96 h following ovulation. PR was expressed in blastocysts not only in the preimplantation stage but also in the early post-implantation period. In the evaluation of developmental stages, mifepristone significantly reduced the successful ratio of developing into the late egg cylinder and the early somite stage. In addition, it further decreased the cell number of the embryos’ inner cell mass and trophectoderm. We herein provide evidence that mifepristone affects blastocyst viability directly and inhibits post-implantation embryo development in vitro. Furthermore, our data reveal a potential risk of fetus fatality and developmental problems when pregnancies are continued after mifepristone treatment fails.

Patient engagement in the design of clinical research in Noonan syndrome spectrum disorders: a scoping review

Background Noonan syndrome spectrum disorders are a group of disorders caused by mutations in several genes of the RAS/MAPK pathway. Because of a highly heterogeneity and variable phenotypical manifestations of the disorders, these children and adults have a variable number of symptoms. Inclusion of their perceived experience of their health and developmental problems in research (design) could contribute to increased relevance of the research process and outcomes. The aim of this study is to get insight in what way patients with a Noonan syndrome spectrum disorder have been involved in the research process in order to learn for future engagement practices. Methods and results To that end, the degree of engagement was measured by the eight levels of the participation ladder of Arnstein. Using a scoping review approach, 18 articles were selected in which patient engagement in the design of studies in patients with Noonan syndrome spectrum disorders was described over the past twenty years. Six of these articles reported engagement on the level of informing (level 3), 8 on the level of consultation (level 4), 2 on the level of placation (level 5)and 2 on the level of partnership (level 6). Conclusions The current results do show a positive albeit still modest development of patient engagement over the last few years. A promising way to stimulate engagement is aiming to yield insights in the most important patients’ needs by developing a patient guided research agenda. However, this is not automatically followed by patient engagement at higher levels of participation in subsequent research steps. For this reason, in the Netherlands for example, a Dutch Noonan syndrome spectrum disorders research agenda is being developed, in a collaboration between the Dutch Noonan Syndrome Foundation and national scientific and clinical professionals.

Caregivers Perspective Towards Use of Enteral Lactoferrin Supplementation In Newborn Infants; Formative Research Findings

Background: Infection is the second most leading cause of neonatal deaths in Pakistan. Lactoferrin is a naturally occurring protein found in human milk which can prevent neonatal infections and improve the survival of high-risk, low birth weight newborns. Bovine lactoferrin (bLF) has been recognized as a safe nutrient with no adverse effects. The aim of this study was to explore routine newborn care practices, care seeking attitudes, and assess the acceptability and the optimal method of administering bLF at the household level.Method: Exploratory qualitative research design was adopted. Thirty in-depth interviews with mothers, grandmothers and fathers of low birthweight (LBW) infants were conducted at postnatal wards and the neonatal intensive care unit (NICU) of the Aga Khan University Hospital. Eleven of these families were also recruited for a trial of improved practices (TIPs) to assess the feasibility and the method of administration of bLF prior to the main trial. Interviews were recorded and analyzed using thematic analysis.Result: Most study participants consider birthweight as a predictor of neonatal health outcomes. Caring of LBW newborns was identified as a physically and emotionally overwhelming experience. Majority of mothers believed that LBW babies are prone to infections, gastrointestinal, respiratory and developmental problems. Fathers and grandmothers were major decision makers in the family and supported the use of bLF in LBW newborns. Parents, who used bLF were satisfied with feeding method and frequency of bLF. Conclusion: Our formative study found that participants were willing to use bLF for feeding LBW babies. However, educating mothers, fathers and grandmothers is crucial for successful uptake of the intervention. Bovine lactoferrin is a safe and easy to administer according caregivers of LBWs babies. It also has potential to be translated into a safe and effective intervention for LBW babies to prevent sepsis.Trial registration: ClinicalTrials.gov identifier: NCT03431558.