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Cureus May 2024The role of vitamin D in the susceptibility to coronavirus disease 2019 (COVID-19) disease has been investigated since the beginning of the pandemic, but there is still... (Review)
Review
The role of vitamin D in the susceptibility to coronavirus disease 2019 (COVID-19) disease has been investigated since the beginning of the pandemic, but there is still scarce data on children. We investigated the impact of vitamin D status and the related genetic variants on COVID-19 vulnerability and severity of the disease in children. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to identify reports on vitamin D status and genetic polymorphisms, their association with the susceptibility of children to COVID-19 and multisystem inflammatory syndrome in children (MIS-C), and the effect of supplementation on the clinical course. Of an initial total of 279 articles, 26 studies, published between September 2020 and May 2023, were finally included in this review according to inclusion criteria. Quantitative data provided by 11 studies revealed that 43.05% of pediatric COVID-19 patients had low vitamin D levels. Mean serum 25(OH)D levels were observed to be significantly low in COVID-19 cases, with an estimated pooled mean value of 17 ng/mL, as provided by 16 studies. Vitamin D deficiency and the vitamin D receptor (VDR) FokI polymorphism may suggest independent risk factors for susceptibility to COVID-19 in the pediatric population. The 25(OH)D level may constitute a significant biomarker associated with the COVID-19 severity and MIS-C. While supplementation of COVID-19 cases with vitamin D showed favorable results, the effect on the outcome of the disease remains uncertain.
PubMed: 38947671
DOI: 10.7759/cureus.61326 -
Frontiers in Nutrition 2024Maternal malnutrition affects the somatic growth of the fetus and subsequent adverse events during infancy and childhood period. Though trials have been conducted on...
Effect of preconception multiple micronutrients vs. iron-folic acid supplementation on maternal and birth outcomes among women from developing countries: a systematic review and meta-analysis.
BACKGROUND
Maternal malnutrition affects the somatic growth of the fetus and subsequent adverse events during infancy and childhood period. Though trials have been conducted on multiple micronutrient (MMN) supplements initiated during the preconception period, there is no collated evidence on this.
MATERIALS AND METHODS
We performed a systematic review of published trials with the application of Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The searches were conducted until 30 September 2023. Meta-analysis was performed using Review Manager 5 software. The primary objective was to compare the effect of preconception MMN vs. iron-folic acid (IFA) supplementation on newborn anthropometric parameters at birth.
RESULTS
Of the 11,832 total citations retrieved, 12 studies with data from 11,391 participants [Intervention = 5,767; Control = 5,624] were included. For the primary outcome, there was no significant difference in the birth weight [MD, 35.61 (95% CI, -7.83 to 79.06), = 0.11], birth length [MD, 0.19 (95% CI, -0.03 to 0.42), = 0.09], and head circumference [MD, -0.25 (95% CI, -0.64 to -0.14), = 0.22] between the MMN and control groups. For all the secondary outcomes [except for small for gestational age (SGA) and low birth weight (LBW)], the difference between the MMN and control groups was not significant. The GRADE evidence generated for all the outcomes varied from "very low to moderate certainty."
CONCLUSION
A "very low certainty" of evidence suggests that MMN supplementation may not be better than routine IFA supplementation in improving newborn anthropometric parameters (weight, length, and head circumference). The adverse events resulting from the supplementation were not significant. We need better quality uniformly designed RCTs before any firm recommendation can be made.: identifier (CRD42019144878: https://www.crd.york.ac.uk/prospero/#searchadvanced).
PubMed: 38946784
DOI: 10.3389/fnut.2024.1390661 -
Contact Dermatitis Jun 2024Fragrance substances are a frequent cause of contact allergy worldwide. Fragrance exposure varies by sex, age and possibly country, influenced by cosmetic availability,...
BACKGROUND
Fragrance substances are a frequent cause of contact allergy worldwide. Fragrance exposure varies by sex, age and possibly country, influenced by cosmetic availability, environmental conditions and cultural practices.
OBJECTIVES
To systematically review and gather prevalence of sensitization to fragrance mix I (FM I) and fragrance mix II (FM II) in consecutively patch-tested European dermatitis patients.
METHOD
A total of 4134 publications on patch test results of European dermatitis patients, published from 1981 to 2022, were systematically reviewed according to a previously registered and published PROSPERO protocol.
RESULTS
Eighty-four eligible original articles were analysed. Overall prevalence of sensitization to fragrance mix I (FM I) was 6.81% (95% CI: 6.37-7.28), and FM II was 3.64% (95% CI: 3.3-4.01). Sensitization to FM I was most prevalent in Central and Eastern Europe and to FM II in Western Europe. No clear time trends were observed. Among paediatric dermatitis patients, sensitization prevalence for FM I and FM II was 4.09% (95% CI: 3.37-4.96) and 2.17% (95% CI: 1.53-3.07).
CONCLUSION
The frequency of positive patch test results for both FMI and FMII remains high. Sensitization is also prevalent among children. Enhanced regulation and labelling of cosmetic products play a vital role in averting exposure and sensitization to fragrance allergens.
PubMed: 38945918
DOI: 10.1111/cod.14618 -
Journal of Pediatric Nursing Jun 2024This study presents a systematic review of the obstacles to and enablers of family-centered care (FCC) implementation by nurses. FCC, which has demonstrated beneficial... (Review)
Review
PURPOSE
This study presents a systematic review of the obstacles to and enablers of family-centered care (FCC) implementation by nurses. FCC, which has demonstrated beneficial outcomes, is regarded as a crucial quality measure in certain pediatric units. However, not all nurses incorporate FCC into their practice.
DESIGN AND METHODS
A systematic review was conducted from January to June 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Various medical subject heading keywords and terms were used to search electronic databases, with the aim of synthesizing and evaluating the results.
RESULTS
Twenty-three articles were identified for review. Most of these studies were carried out in Western countries. They revealed several facilitators and obstacles to FCC implementation by nurses when caring for sick children. Some of these factors are linked to the personal attributes of the nurses, while others are associated with the characteristics of the families and the healthcare system itself.
CONCLUSION
Nurses face multi-level barriers that hinder their ability to implement FCC practice. This systematic review identifies the need to leverage nurses' attributes, foster effective nurse-client relationships, and promote organizational changes.
PRACTICE IMPLICATIONS
Nurses need to comprehend and work toward altering the factors that influence the delivery of FCC. The findings of this review can be used by healthcare organization leaders and policymakers to customize interventions and allocate resources to promote FCC practice. Further research in diverse cultural contexts is needed to examine the cause-and-effect relationship concerning the influence of the identified barriers and facilitators on FCC practice. In addition, experimental studies are required to evaluate the effectiveness of evidence-based interventions on FCC practice by nurses.
PubMed: 38944912
DOI: 10.1016/j.pedn.2024.06.008 -
BMC Infectious Diseases Jun 2024An improper host immune response to Mycoplasma pneumoniae generates excessive inflammation, which leads to the impairment of pulmonary ventilation function (PVF).... (Meta-Analysis)
Meta-Analysis
BACKGROUND
An improper host immune response to Mycoplasma pneumoniae generates excessive inflammation, which leads to the impairment of pulmonary ventilation function (PVF). Azithromycin plus inhaled terbutaline has been used in the treatment of Mycoplasma pneumoniae pneumonia (MPP) in children with impaired pulmonary function, but previous randomized controlled trials (RCTs) showed inconsistent efficacy and safety. This study is aimed to firstly provide a systematic review of the combined therapy.
METHODS
This study was registered at the International Prospective Register of Systematic Reviews (PROSPERO CRD42023452139). A PRISMA-compliant systematic review and meta-analysis was performed. Six English and four Chinese databases were comprehensively searched up to June, 2023. RCTs of azithromycin sequential therapy plus inhaled terbutaline were selected. The revised Cochrane risk of bias tool for randomized trials (RoB2) was used to evaluate the methodological quality of all studies, and meta-analysis was performed using Stata 15.0 with planned subgroup and sensitivity analyses. Publication bias was evaluated by a funnel plot and the Harbord' test. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation recommendations.
RESULTS
A total of 1,938 pediatric patients from 20 RCTs were eventually included. The results of meta-analysis showed that combined therapy was able to significantly increase total effectiveness rate (RR = 1.20, 95%CI 1.15 to 1.25), forced expiratory volume in one second (SMD = 1.14, 95%CIs, 0.98 to 1.29), the ratio of forced expiratory volume in one second/forced vital capacity (SMD = 2.16, 95%CIs, 1.46 to 2.86), peak expiratory flow (SMD = 1.17, 95%CIs, 0.91 to 1.43). The combined therapy was associated with a 23% increased risk of adverse reactions compared to azithromycin therapy alone, but no significant differences were found. Harbord regression showed no publication bias (P = 0.148). The overall quality of the evidence ranged from moderate to very low.
CONCLUSIONS
This first systematic review and meta-analysis suggested that azithromycin sequential therapy plus inhaled terbutaline was safe and beneficial for children with MPP. In addition, the combined therapy represented significant improvement of PVF. Due to lack of high-quality evidence, our results should be confirmed by adequately powered RCTs in the future.
Topics: Humans; Azithromycin; Terbutaline; Pneumonia, Mycoplasma; Child; Anti-Bacterial Agents; Mycoplasma pneumoniae; Drug Therapy, Combination; Administration, Inhalation; Treatment Outcome; Randomized Controlled Trials as Topic; Child, Preschool
PubMed: 38944667
DOI: 10.1186/s12879-024-09564-x -
Impact of spiritual interventions in individuals with cancer: A systematic review and meta-analysis.European Journal of Oncology Nursing :... Jun 2024This meta-analysis aimed to determine how spiritual interventions affect cancer patients' physical, emotional, and spiritual outcomes and quality of life.
PURPOSE
This meta-analysis aimed to determine how spiritual interventions affect cancer patients' physical, emotional, and spiritual outcomes and quality of life.
METHODS
Between 2012 and May 2024, the Cochrane Library, Scopus, PubMed, and Web of Science were searched considering the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Twenty-six randomized controlled trials were included, and 16 were synthesized in the meta-analysis. Bias risk was evaluated using the Cochrane risk-of-bias methodology for randomized studies. The Grading of Recommendations, Assessment, Development, and Evaluations tool was employed for evidence certainty. Heterogeneity was expressed through I and Q statistics. Hedge's g was calculated for effect sizes. Egger's and Kendall's Tau were used for publication bias.
RESULTS
Spiritual interventions yielded beneficial effects on fatigue (Hedges's g = 0.900, p < 0.001) and pain (Hedges's g = 0.670, p < 0.001) but not for overall symptom burden (Hedges's g = 0.208, p = 0.176). Significant effects were found for anxiety (Hedges's g = 0.301, p < 0.001), depression (Hedges's g = 0.175, p = 0.016), and psychological distress (Hedges's g = 0.178, p = 0.024), except for hopelessness (Hedges's g = 0.144, p = 0.091). Spiritual interventions enhanced faith (Hedges's g = 0.232, p = 0.035), the meaning of life (Hedges's g = 0.259, p = 0.002), spiritual well-being (Hedges's g = 0.268, p < 0.001), and quality of life (Hedges's g = 245, p < 0.001). Moderator analysis pointed out that cancer stage, total duration, delivery format, providers' qualification, content, and conceptual base of spiritual interventions significantly affect physical, emotional, and spiritual outcomes and quality of life.
CONCLUSION
This meta-analysis highlighted the benefits of spiritual interventions with varying effect sizes on patients' outcomes, as well as quality of life in cancer, and shed on how to incorporate these approaches into clinical practice.
PubMed: 38943773
DOI: 10.1016/j.ejon.2024.102646 -
Genetics in Medicine : Official Journal... Jun 2024Germline testing in pediatric cancer presents opportunities and challenges. Understanding family perspectives, experiences, and preferences will optimize integration... (Review)
Review
PURPOSE
Germline testing in pediatric cancer presents opportunities and challenges. Understanding family perspectives, experiences, and preferences will optimize integration into routine care.
METHODS
Following PRISMA guidelines, we searched four databases for studies exploring perspectives, experiences, and preferences of parents/caregivers and/or patients regarding germline testing of children with cancer. Qualitative and quantitative data was extracted, organized, and summarized by research question and themes.
RESULTS
We identified 2286 unique articles, of which 24 were included. Interest in and uptake of testing was high. Families were motivated by altruism and a desire for inheritance/causation information. Testing barriers included psychological concerns, timing of the testing approach if offered at diagnosis or in a high-risk cancer setting and privacy/discrimination. Testing experiences highlighted challenges yet also positive impacts, with results providing psychological relief and informing proactive decision-making. Timing preferences varied, however allowing time to adjust to a new diagnosis was a common theme. Most wanted to receive as many germline sequencing-related results as possible.
CONCLUSION
Findings underscore the importance of integrating germline analyses into pediatric cancer care with flexibility and support for families facing challenges. Where possible, consent should be provided at a time that suits each family's situation with access to information aligning with their needs and preferences.
PROSPERO
CRD42023444890.
PubMed: 38943478
DOI: 10.1016/j.gim.2024.101197 -
Journal of Neuromuscular Diseases Jun 2024Respiratory and bulbar dysfunctions (including swallowing, feeding, and speech functions) are key symptoms of spinal muscular atrophy (SMA), especially in its most...
BACKGROUND
Respiratory and bulbar dysfunctions (including swallowing, feeding, and speech functions) are key symptoms of spinal muscular atrophy (SMA), especially in its most severe forms. Demonstrating the long-term efficacy of disease-modifying therapies (DMTs) necessitates an understanding of SMA natural history.
OBJECTIVE
This study summarizes published natural history data on respiratory, swallowing, feeding, and speech functions in patients with SMA not receiving DMTs.
METHODS
Electronic databases (Embase, MEDLINE, and Evidence-Based Medicine Reviews) were searched from database inception to June 27, 2022, for studies reporting data on respiratory and/or bulbar function outcomes in Types 1-3 SMA. Data were extracted into a predefined template and a descriptive summary of these data was provided.
RESULTS
Ninety-one publications were included: 43 reported data on respiratory, swallowing, feeding, and/or speech function outcomes. Data highlighted early loss of respiratory function for patients with Type 1 SMA, with ventilatory support typically required by 12 months of age. Patients with Type 2 or 3 SMA were at risk of losing respiratory function over time, with ventilatory support initiated between the first and fifth decades of life. Swallowing and feeding difficulties, including choking, chewing problems, and aspiration, were reported in patients across the SMA spectrum. Swallowing and feeding difficulties, and a need for non-oral nutritional support, were reported before 1 year of age in Type 1 SMA, and before 10 years of age in Type 2 SMA. Limited data relating to other bulbar functions were collated.
CONCLUSIONS
Natural history data demonstrate that untreated patients with SMA experience respiratory and bulbar function deterioration, with a more rapid decline associated with greater disease severity. This study provides a comprehensive repository of natural history data on bulbar function in SMA, and it highlights that consistent assessment of outcomes in this area is necessary to benefit understanding and approval of new treatments.
PubMed: 38943396
DOI: 10.3233/JND-230248 -
International Breastfeeding Journal Jun 2024Despite global public health organizations endorsing breastfeeding or human milk (HM) as the optimal source of nutrition for infants, detailed knowledge of how HM...
BACKGROUND
Despite global public health organizations endorsing breastfeeding or human milk (HM) as the optimal source of nutrition for infants, detailed knowledge of how HM composition influences infant growth is lacking. In this commentary we summarize and interpret the key findings of a large systematic review on HM components and child growth (N = 141 articles included). We highlight the most consistent associations, discuss study quality issues, explore socio-economic and time trends in this body of research, and identify gaps and future research directions.
KEY FINDINGS OF SYSTEMATIC REVIEW
We grouped HM components into three categories: micronutrients (28 articles), macronutrients (57 articles), and bioactives (75 articles). Overall, we struggled to find consistent associations between HM components and infant growth. The majority of studies (85%) were of moderate or low-quality, with inconsistent HM collection and analysis strategies being identified as the most substantial quality concerns. Additional quality issues included failing to account for potential confounding by factors such as breastfeeding exclusivity and maternal body mass index.
CONSIDERATIONS FOR FUTURE HUMAN MILK RESEARCH
Many opportunities exist for the future of HM research. Using untargeted metabolomics will expand our understanding of HM components beyond previously defined and well-understood components. Machine learning will allow researchers to investigate HM as an integrated system, rather than a collection of individual components. Future research on HM composition should incorporate evidence-based HM sampling strategies to encompass circadian variation as well as infant consumption. Additionally, researchers need to focus on developing high quality growth data using consistent growth metrics and definitions. Building multidisciplinary research teams will help to ensure that outcomes are meaningful and clinically relevant.
CONCLUSION
Despite a large body of literature, there is limited quality evidence on the relationship between HM composition and infant growth. Future research should engage in more accurate collection of breastfeeding data, use standardized HM collection strategies and employ assays that are validated for HM. By systematically evaluating the existing literature and identifying gaps in existing research methods and practice, we hope to inspire standardized methods and reporting guidelines to support robust strategies for examining relationships between HM composition and child growth.
Topics: Humans; Milk, Human; Infant; Breast Feeding; Infant, Newborn; Infant Nutritional Physiological Phenomena; Anthropometry; Female; Child Development
PubMed: 38943170
DOI: 10.1186/s13006-024-00652-x -
BMC Oral Health Jun 2024There are more than one million children and adolescents living with type 1 diabetes mellitus, and their number is steadily increasing. Diabetes affects oral health... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
There are more than one million children and adolescents living with type 1 diabetes mellitus, and their number is steadily increasing. Diabetes affects oral health through numerous channels, including hyposalivation, immune suppression, and the inflammatory effect of glycation end-products. However, patients with type 1 diabetes must follow a strict sugar free diet that is proven to be carioprotective. Therefore, the aim of this systematic review and meta-analysis is to investigate whether children with type 1 diabetes have a difference in Decayed, Missing, Filled Teeth index (DMFT), salivary function, and periodontal status than children without diabetes, with an emphasis on glycemic control.
MATERIALS AND METHODS
PubMed, Embase and Cochrane libraries were screened for articles, using predefined search keys without any language or date restrictions. Two independent authors performed the selection procedure, extracted data from the eligible articles, carried out a manual search of the reference lists, and assessed the risk of bias using the Newcastle-Ottawa scale. Meta-analysis was performed in R using the random-effects model. Effect sizes were mean differences; subgroup analysis was performed on glycemic control.
RESULTS
33 studies satisfied the eligibility criteria. 22 studies did not show a significant difference regarding the DMFT index between the diabetes and non-diabetes groups; six studies found that children living with diabetes had higher DMFT scores, compared to five studies that found significantly lower scores. Meta-analysis found no statistically significant differences in plaque, gingival, and calculus indexes, however it found significant differences in pooled DMFT indexes, and salivary flow rate. Subgroup analysis on glycemic control using DMFT values found significant differences in children with good and poor glycemic control with results of 0.26 (CI95%=-0.50; 1.03) and 1.46 (CI95%=0.57; 2.35), respectively.
CONCLUSIONS
Children with poor glycemic control face higher risk of developing caries compared to good control and non-diabetes children. Regular dental check-ups and strict control of glycemic levels are highly advised for children living with type 1 diabetes, further emphasizing the importance of cooperation between dentists and diabetologists.
Topics: Humans; Diabetes Mellitus, Type 1; Child; Oral Health; Glycemic Control; Adolescent; DMF Index
PubMed: 38943074
DOI: 10.1186/s12903-024-04516-y