Pediatric pre-hospital emergencies in Belgium: a 2-year national descriptive study.

UNLABELLED: This study aims to describe the pediatric physician-staffed EMS missions at a national level and to compare the pediatric and the adult EMS missions. Using a national database, we analyzed 254,812 interventions including 15,294 (6 %) pediatric emergencies. Less children than adults received an intravenous infusion (52.7 versus 77.1 %, p < 0.001), but the intra-osseous access was used more frequently in children (1.3 versus 0.8 %, p < 0.001). More children than adults benefited from a therapeutic immobilization (16.3 versus 13.2 %, p < 0.001). Endotracheal intubation was rare in children (2.1 %) as well as cardiopulmonary resuscitation (1.2 %). Children were more likely than adults to suffer from a neurological problem (32.4 versus 21.3 %, p < 0.001) or from a trauma (27.1 versus 16.8 %, p < 0.001). The prevalence of the pediatric diagnoses showed an age dependency: the respiratory problems were more prevalent in infants (40.3 % of the 0-12-months old), 52.1 % of the 1-4-year-old children suffered from a neurological problem, and the prevalence of trauma raised from 14.8 % of the infants to 47.1 % of the 11-15 year olds. CONCLUSION: Pre-hospital pediatric EMS missions are not frequent and differ from the adult interventions. The pediatric characteristics highlighted in this study should help EMS teams to be better prepared to deal with sick children in the pre-hospital setting. WHAT IS KNOWN: • Pediatric and adult emergencies differ. • Pediatric life-threatening emergencies are not frequent. What is New: • This study is the first to describe a European national cohort of pediatric physician-staffed EMS missions and to compare the pediatric and the adult missions at a national level. • This large cohort study confirms scarce regional data indicating that pediatric pre-hospital emergencies are not frequent and mostly non-life-threatening.

Management of a Trichophyton tonsurans outbreak in a day-care center.

Trichophyton tonsurans is the leading cause of tinea capitis in the United Kingdom (UK) as well as causing tinea corporis. This organism has been linked to several outbreaks in the UK and abroad, and such outbreaks may be prolonged since T. tonsurans can be difficult to control. There remains an incomplete consensus in the literature on the optimal management of such outbreaks of this infection. Following notification that a child with T. tonsurans was identified at a day-care center in the UK, initial investigations identified nine cases of fungal infection involving children and staff over the previous 7 months. We report on the management of an outbreak of T. tonsurans tinea capitis and tinea corporis among children and staff in a day-care center. An outbreak control team with representatives from dermatology, microbiology, day-care center management, and the Health Protection Agency initiated case ascertainment by scalp inspection and brushing of all children and staff at the nursery. Two complete rounds of screening were required before the outbreak was declared over. Infection control measures included antifungal shampoo use, exclusion of identified cases for a short period, removal of shared items from the center, and enhanced decontamination of fomites. The outbreak, which lasted longer than 12 months, involved 12 children and 7 staff members. Of these, 12 cases were confirmed by positive fungal culture. T. tonsurans is difficult to manage, especially in childcare settings, but case ascertainment, appropriate treatment with oral agents, and sustained infection control measures can be effective in controlling such outbreaks.

Genome-wide association study in frontal fibrosing alopecia identifies four susceptibility loci including HLA-B*07:02.

Frontal fibrosing alopecia (FFA) is a recently described inflammatory and scarring type of hair loss affecting almost exclusively women. Despite a dramatic recent increase in incidence the aetiopathogenesis of FFA remains unknown. We undertake genome-wide association studies in females from a UK cohort, comprising 844 cases and 3,760 controls, a Spanish cohort of 172 cases and 385 controls, and perform statistical meta-analysis. We observe genome-wide significant association with FFA at four genomic loci: 2p22.2, 6p21.1, 8q24.22 and 15q2.1. Within the 6p21.1 locus, fine-mapping indicates that the association is driven by the HLA-B*07:02 allele. At 2p22.1, we implicate a putative causal missense variant in CYP1B1, encoding the homonymous xenobiotic- and hormone-processing enzyme. Transcriptomic analysis of affected scalp tissue highlights overrepresentation of transcripts encoding components of innate and adaptive immune response pathways. These findings provide insight into disease pathogenesis and characterise FFA as a genetically predisposed immuno-inflammatory disorder driven by HLA-B*07:02.

All for One: Contributions of Age, Socioeconomic Factors, Executive Functioning, and Social Cognition to Moral Reasoning in Childhood.

Moral reasoning (MR) is a socio-cognitive skill essential to appropriate social functioning in childhood, and evolves in quality and complexity during ontogenetic development. Past research suggests that MR is related to age, socioeconomic factors, as well as some social and cognitive skills, such as executive functioning (EF), theory of mind (ToM), empathy, and affect recognition. However, their contributions have been studied in silos rather than comprehensively, with little integration of the relative and combined contribution of these skills to MR. Furthermore, few studies have addressed the putative links between these factors in childhood, a period during which these skills are in maturation. The aim of this study was to explore what factors predict moral maturity in typically developing children (n = 76, 47.4% males, M = 9.2, SD = 1.67 years), explore the potential moderating and mediating role of executive functions and social cognition in the relationship between age and MR maturity, and identify the specific contributions of age, socioeconomic factors, EF, and social cognition, using an innovative visual MR assessment tool (So-Moral). The results indicate that MR maturity was correlated with age, EF (inhibition, verbal fluency, and attentional control), and social cognition (ToM and affect recognition). Neither EF nor social cognition moderated the effect of age on MR maturity. However, verbal fluency and third-order false beliefs had a moderating role in this link. MR maturity in children was predicted by three variables from each of the three domains: age, verbal fluency, and third-order ToM. These results contribute to a better understanding of the underpinnings of MR during childhood, suggesting that MR is not reducible to general developmental factors such as age, but that higher order skills, such EF and social cognition also contribute to moral maturity. The findings have relevance for both typically developing and clinical populations in which social skills may be reduced, as well as for the identification of potential loci for intervention in children at-risk for socially maladaptive behaviors.