Pokémon Go and augmented virtual reality games: a cautionary commentary for parents and pediatricians.

PURPOSE OF REVIEW: The recent release of Pokémon Go has ushered in a new set of challenges for parents and pediatricians, highlighting the importance of parents setting guidelines for video game use with their children. Within 1 week of its launch, the game attracted over 65 million users, many of whom are young children. Despite the potential benefits of the game described in our article, this location-based game format poses specific threats to the safety and physical wellbeing of children. RECENT FINDINGS: Reports have discussed both the benefits and adverse effects of this extremely popular video game. Benefits include increased exercise, socialization, and outdoor activity. Negative effects include increased risk of injury, abduction, trespassing, violence, and cost. SUMMARY: Pediatricians play a key role in counseling parents and children about safety precautions and setting appropriate limits for impressionable youth. Parents and pediatricians should be aware of this new and remarkably popular game that appeals to a wide variety of individuals. To protect children from injury, predators, and inappropriate situations, parents and pediatricians must regulate children's participation in this game and maintain vigilance for potentially dangerous circumstances.

Abnormal Cardiac Magnetic Resonance-Derived Ascending Aortic Area Strain Demonstrates Altered Ventriculo-Vascular Function in Marfan Syndrome.

PURPOSE: There remains a need for improved imaging markers for risk stratification and treatment guidance in Marfan syndrome (MFS). After aortic root replacement (ARR), vascular remodeling and progressive aneurysm formation can occur due to alterations in up- and downstream wall biomechanics and hemodynamics. We aim to compare the ventriculo-vascular properties of patients with MFS with controls, and investigate the correlation between ascending aortic area strain and descending aortic area strain (DAAS) with other clinical variables. PATIENTS AND METHODS: Nineteen patients with MFS (47% males), including 6 with ARR were studied. In 26 studies, aortic area strain was measured using cross-sectional cardiac magnetic resonance images at the ascending and proximal descending aortic levels. Left atrial, left ventricular longitudinal, and left ventricle circumferential strain (left atrial longitudinal strain, left ventricular longitudinal strain, and left ventricular circumferential strain, respectively) were measured using cardiac magnetic resonance-feature tracking. RESULTS: Compared with healthy controls, patients with MFS had significantly impaired left ventricular longitudinal strain and left ventricular circumferential strain (-15.8 ± 4.7 vs -19.7 ± 4.8, P = 0.005, and -17.7 ± 4.0 vs -27.0 ± 4.1, P < 0.001). Left atrial longitudinal strain was comparable between patients with MFS and controls. AAAS was significantly reduced (19.0 [11.9, 23.7] vs 46.1 ± 11.3, P < 0.001), whereas DAAS was not significantly decreased. AAAS and DAAS were negatively correlated with age, whereas no significant associations were identified with left ventricle function indices. No significant differences were observed between the ventriculo-vascular properties of patients with MFS who underwent ARR and those who did not. CONCLUSION: Patients with MFS demonstrated impaired ventricular and vascular function compared with healthy controls. Further investigations are warranted to determine clinical utility of aortic stiffness indices for predicting primary and repeat aortic events.

Time course of hypertension and myocardial dysfunction following anthracycline chemotherapy in pediatric patients.

Background: Anthracyclines are associated with cardiac dysfunction. Little is known about the interplay of pre-existing hypertension and treatment response. We aimed to investigate the relationship between hypertension and the development of cancer therapy-related cardiac dysfunction (CTRCD) in pediatric patients treated with anthracycline chemotherapy. Methods: Pediatric patients with cancer who received anthracycline chemotherapy from 2013 to 2021 were retrospectively included. Serial cardiac assessments were conducted during and after chemotherapy. The primary outcome was the development of CTRCD, classified as mild, moderate, or severe according to contemporary definitions. Results: Among 190 patients undergoing anthracycline chemotherapy, 34 patients (17.9 %) had hypertension (24 patients Stage 1, and 10 patients Stage 2) at baseline evaluation. Patients underwent chemotherapy for a median of 234.4 days (interquartile range 127.8-690.3 days) and were subsequently followed up. Hypertension was frequent during follow-up 31.3 % (0-3 months), 15.8 % (3-6 months), 21.9 % (0.5-1 years), 24.7 % (1-2 years), 31.1 % (2-4 years) and 35.8 % (beyond 4 years) (P for trend < 0.001). Freedom from mild CTRCD at 5 years was 45.0 %, freedom from moderate CTRCD was 87.8 % at 5 years. Baseline hypertension did not increase the risk of mild (HR 0.77, 95 % CI: 0.41-1.42, P = 0.385) or moderate CTRCD (HR 0.62, 95 % CI: 0.14-2.72, P = 0.504). Patients with baseline hypertension showed different global longitudinal strain (P < 0.001) and LVEF (P < 0.001) patterns during follow-up. Conclusions: Pediatric patients often develop CTRCD post-anthracycline chemotherapy. Those with pre-existing hypertension show a unique treatment response, despite no increased CTRCD risk, warranting further investigation.

Deterioration in myocardial work indices precedes changes in global longitudinal strain following anthracycline chemotherapy.

BACKGROUND: Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) have conventionally been used for surveillance of cardiac function after cancer therapy, but indices of myocardial work (MW) are potentially superior for this purpose because they take into account both myocardial deformation and loading conditions. OBJECTIVES: We aimed to investigate the usefulness of MW in the follow-up of children and young adults following anthracycline chemotherapy. METHODS: Conventional markers of LV function (LV fractional shortening [LVFS], LVEF, GLS) and MW indices (global work index [GWI], global constructive work [GCW], global wasted work [GWW], and global work efficiency [GWE]) were obtained from 2342 echocardiographic examinations in 598 patients (354 male, 12.2 [4.7-17.3] years at initiation of chemotherapy). RESULTS: GWI, GCW, GLS, LVFS, and LVEF all deteriorated significantly during and after anthracycline chemotherapy, while GWW decreased and GWE was preserved. On multivariable analysis, MW indices were correlated with conventional markers of LV function and with clinical information relating to underlying malignancy and chemotherapy. Cox regression analysis revealed that similar levels of deterioration in GWW, GWI, and GCW preceded those in GLS, LFS, and LVEF. CONCLUSIONS: Non-invasive MW indices correlate well with conventional markers of LV function. Indices of MW appear to provide an earlier and more sensitive marker of progression towards chemotherapy-related cardiac dysfunction. Future studies are warranted to validate whether the incorporation of non-invasive MW into the routine clinical surveillance in patients after chemotherapy would improve outcomes.

The Internet's Effect on Parental Trust in Pediatrician Diagnosis of Autism and Likelihood of Seeking a Second Opinion.

This study assessed how web-based information affects parental trust in physician's diagnosis of autism (PDA) and likelihood of seeking a second opinion. Participants of an online survey were randomly allocated to one of three hypothetical scenarios, all were given a vignette of a non-verbal 18-month-old child followed by (1) not viewing Internet results, (2) viewing results suggesting autism, or (3) viewing results suggesting language delay and rated their trust and likelihood of seeking a second opinion. When Internet results contradicted PDA, parents reported less trust in PDA and greater likelihood of seeking a second opinion. Due to the Internet's influence on parents' response to PDA, clinicians should discuss their differential diagnosis with parents, address Internet-related concerns, and recommend trustworthy sources.

Paging Dr. Google: The Effect of Online Health Information on Trust in Pediatricians' Diagnoses.

This study investigates how parental trust in physician diagnoses and likelihood of seeking a second opinion (SO) are affected by Internet sources. In an anonymous survey, 1374 parents of minors viewed a vignette describing their child's symptoms followed by Internet results that either supported or contradicted the pediatrician's diagnosis (Dx). A control group did not view any Internet results. After learning the Dx, participants rated trust in the Dx and likelihood of seeking a SO on a 7-point Likert-type scale. Participants who viewed contradicting results were less likely to trust the Dx ( P < .001) and more likely to seek a SO than the control ( P < .001). Participants who viewed supporting results were more likely to trust the Dx ( P < .001) and less likely to seek a SO than the control ( P < .001). Physicians must be aware of the influence the Internet may have on patients' trust.

Pediatric Resident Education and Preparedness Regarding Vaccine-Preventable Diseases.

This study assessed pediatric residents' reported knowledge of and self-confidence in identifying/treating 8 vaccine-preventable diseases. Pediatric residents nationwide (n = 385) reported (1) if they had previously diagnosed measles, mumps, rubella, diphtheria, tetanus, pertussis, varicella, and/or polio; (2) their comfort level in treating these diseases; (3) the likelihood of identifying symptoms; and (4) 16 disease-related statements as true/false. More than 25% of residents were not comfortable treating 5 of the 8 diseases. More than 25% reported themselves as unlikely/extremely unlikely to identify symptoms of 3 of these diseases. Third- or fourth-year residents did not feel more confident in identifying disease symptoms than first-year residents, except for pertussis ( P ≤ .01). True/false statement accuracy ranged from 56.8% correct (polio) to 94.6% correct (pertussis). Most residents (73.3%) were "extremely concerned" regarding parental vaccine refusal, and 96.0% felt that they would benefit from receiving more information. Increased emphasis on this subject in residency education is essential for the management of potential disease outbreaks.

Adolescent Consumption of Sports Drinks.

BACKGROUND: Sports drinks are aggressively marketed to teenagers to replenish fluids and/or electrolytes. According to the American Academy of Pediatrics, typical adolescent physical activity does not require sports drink rehydration. Given US obesity rates and that sugar-sweetened sports drinks add superfluous calories to the diet, it is important to assess adolescent sports drink consumption and changes over time. METHODS: Researchers in the 2015 Youth Risk Behavior Survey and 2010 National Youth Physical Activity and Nutrition Survey collected nationally representative samples of US high school students about sports drink consumption. Respondent characteristics and health behaviors were examined relative to sports drink consumption by using multivariable survey logistic regression. χ2 tests were used to compare the 2 samples and examine changes over time. RESULTS: The 2015 Youth Risk Behavior Survey and 2010 National Youth Physical Activity and Nutrition Survey had national samples of 15 624 and 11 458 respondents, respectively. Sports drink consumption in the previous week increased from 56% (2010) to 57.6% (2015; P = .0002). However, comparisons of daily sports drink consumption revealed reductions for all age groups, sexes, race and/or ethnicity categories, and levels of physical activity. The greatest reductions were for non-Hispanic African Americans and for children with overweight. Daily sports drink consumption did not decrease for children with obesity and increased for children who watched >2 hours per day of television. In 2015, boys, non-Hispanic African Americans, Hispanics, and tobacco users exhibited higher odds of consuming sports drinks daily. CONCLUSIONS: Although daily consumption of sports drinks has decreased overall, sugar-sweetened sports drinks remain popular, with the majority of high school students drinking them at least weekly. Of concern, daily consumption increased among teenagers watching television >2 hours per day. Pediatricians should counsel adolescents about the American Academy of Pediatrics' recommendations regarding sports drinks.