There has been a rapid surge of hospitalization due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants globally. The severity of Omicron BA.2 in unexposed, ...unvaccinated, hospitalized children is unknown. We investigated the severity and clinical outcomes of COVID-19 infection during the Omicron wave in uninfected, unvaccinated hospitalized children and in comparison with influenza and parainfluenza viral infections. This population-based study retrieved data from the HK territory-wide CDARS database of hospitalisations in all public hospitals and compared severe outcomes for the Omicron BA.2-dominant fifth wave (5-28 February 2022, n = 1144), and influenza and parainfluenza viruses (1 January 2015-31 December 2019, n = 32212 and n = 16423, respectively) in children 0-11 years old. Two deaths (0.2%) out of 1144 cases during the initial Omicron wave were recorded. Twenty-one (1.8%) required PICU admission, and the relative risk was higher for Omicron than influenza virus (n = 254, 0.8%, adjusted RR = 2.1, 95%CI 1.3-3.3, p = 0.001). The proportion with neurological complications was 15.0% (n = 171) for Omicron, which was higher than influenza and parainfluenza viruses (n = 2707, 8.4%, adjusted RR = 1.6, 95%CI 1.4-1.9 and n = 1258, 7.7%, adjusted RR = 1.9, 95%CI 1.6-2.2, p < 0.001 for both, respectively). Croup occurred for Omicron (n = 61, 5.3%) more than influenza virus (n = 601, 1.9%, adjusted RR = 2.0, 95%CI 1.5-2.6, p < 0.001) but not parainfluenza virus (n = 889, 5.4%). Our findings showed that for hospitalized children who had no past COVID-19 or vaccination, Omicron BA.2 was not mild. Omicron BA.2 appeared to be more neuropathogenic than influenza and parainfluenza viruses. It targeted the upper airways more than influenza virus.
Omicron generally causes milder disease than previous strains of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), especially in fully vaccinated individuals. However, incompletely ...vaccinated children may develop Omicron‐related complications such as those affecting the central nervous system. To characterize the spectrum of clinical manifestations of neuro‐COVID and to identify potential biomarkers associated with clinical outcomes, we recruited 15 children hospitalized for Omicron‐related neurological manifestations in three hospitals in Hong Kong (9 boys and 6 girls aged 1–13 years). All were unvaccinated or incompletely vaccinated. Fourteen (93.3%) were admitted for convulsion, including benign febrile seizure (n = 7), complex febrile seizure (n = 2), seizure with fever (n = 3), and recurrent breakthrough seizure (n = 2), and the remaining nonconvulsive patient developed encephalopathic state with impaired consciousness. None of the seven children with benign febrile seizure and six of eight children with other neurological manifestations had residual deficits at 9‐month follow‐up. SARS‐CoV‐2 RNA was undetectable in the cerebrospinal fluid (CSF) specimens of seven patients who underwent lumbar puncture. Spike‐and‐wave/sharp waves affecting the frontal lobes were detected in four of seven (57.1%) patients who underwent electroencephalogram. Children with Omicron‐related neurological manifestations had significantly higher blood levels of IL‐6 (p < 0.001) and CHI3L1 (p = 0.022) than healthy controls, and higher CSF levels of IL‐6 (p = 0.002) than children with non‐COVID‐19‐related febrile illnesses. Higher CSF‐to‐blood ratios of IL‐8 and CHI3L1 were associated with longer length of stay, whereas higher ratios of IL‐6 and IL‐8 were associated with higher blood tau level. The role of CSF:blood ratio of IL‐6, IL‐8, and CHI3L1 as prognostic markers for neuro–COVID should be further evaluated.
Introduction: The study aimed to assess the level of standard first aid knowledge among Hong Kong undergraduates and identify the associated factors, and to examine their attitudes, training ...preferences and obstacles in first aid training.
Methods: This cross-sectional study employed a structured online questionnaire covering demographic data, first aid knowledge assessment and attitude evaluation. Participants were recruited by convenience sampling from August to October 2020. Inclusion criteria included full-time undergraduates studying for the first degree in Hong Kong and receiving primary and secondary education in Hong Kong. To contrast undergraduates studying medical and non-medical degrees, a set ratio of 1:1 was employed, and estimated proportions were weighted according to the ratio of medical and non-medical undergraduates in the population. Unweighted data were used in logistic regressions.
Results: Among 385 respondents, the weighted proportion of good knowledge of standard first aid was 15.2% (95% confidence interval (CI): 11.6%-18.8%) and that of good attitudes towards standard first aid was 71.3% (95% CI: 66.8%-75.8%). Holding valid or expired standard first aid certificates (valid: odds ratio (OR) = 9.897, p < 0.001; expired: OR = 4.816, p < 0.001) and studying medical-related degrees (OR = 3.693, p < 0.001) were shown by multiple logistic regression to be associated with good knowledge of standard first aid. Only being a current or past member of first aid cadet teams was associated with a greater likelihood of having good attitudes towards first aid (OR = 2.336, p = 0.047). Respondents proposed standard first aid training should take form of credit-bearing or non-credit-bearing courses in university curriculum, and academic workload should be taken into account when designing training schemes.
Conclusion: The proportion of undergraduates in Hong Kong with good first aid knowledge was unsatisfactory, but the counterpart with a good attitude was encouraging. Standard first aid training should be proactively provided to all the local undergraduates, regardless of their enrollment in medical- or non-medical-related degrees.
Childhood intracranial germ cell tumor (GCT) survivors are prone to radiotherapy-related neurotoxicity, which can lead to neurocognitive dysfunctions. Diffusion kurtosis imaging (DKI) is a diffusion ...MRI technique that is sensitive to brain microstructural changes. This study aimed to investigate the association between DKI metrics versus cognitive and functional outcomes of childhood intracranial GCT survivors.
DKI was performed on childhood intracranial GCT survivors (n = 20) who had received cranial radiotherapy, and age and gender-matched healthy control subjects (n = 14). Neurocognitive assessment was performed using the Hong Kong Wechsler Intelligence Scales, and functional assessment was performed using the Lansky/Karnofsky performance scales (KPS). Survivors and healthy controls were compared using mixed effects model. Multiple regression analyses were performed to determine the effects of microstructural brain changes of the whole brain as well as the association between IQ and Karnofsky scores and the thereof.
The mean Intelligence Quotient (IQ) of GCT survivors was 91.7 (95% CI 84.5 - 98.8), which was below the age-specific normative expected mean IQ (
= 0.013). The mean KPS score of GCT survivors was 85.5, which was significantly lower than that of controls (
< 0.001). Cognitive impairments were significantly associated with the presence of microstructural changes in white and grey matter, whereas functional impairments were mostly associated with microstructural changes in white matter. There were significant correlations between IQ versus the mean diffusivity (MD) and mean kurtosis (MK) of specific white matter regions. The IQ scores were negatively correlated with the MD of extensive grey matter regions.
Our study identified vulnerable brain regions whose microstructural changes in white and grey matter were significantly associated with impaired cognitive and physical functioning in survivors of pediatric intracranial GCT.
Purpose: The neurocognitive outcomes of pediatric brain tumor survivors have been extensively studied but the risk and predictors for neurobehavioral impairment are less clearly defined. We ...systematically analyzed the rates of emotional, psychosocial, and attention problems in pediatric brain tumor survivors. Methods: PubMed, Web of Science, Embase, Scopus, and Cochrane were searched for articles published between January 2012 to April 2022. Eligible studies reported neurobehavioral outcomes for PBTS aged 2 to <23 years with a brain tumor diagnosis before 18 years of age. A random-effect meta-analysis was performed in R. Results: The search yielded 1187 unique publications, of which 50 were included in the quantitative analysis. The estimated risk of having emotional, psychosocial, and attention problems were 15% (95%CI 10−20%), 12% (95%CI 9−16%), and 12% (95%CI 9−16%), respectively. PBTS were more likely to have emotional difficulties (Hedge’s g = 0.43 95%CI 0.34−0.52), psychosocial problems (Hedge’s g = 0.46 95%CI 0.33−0.58), and attention problems (Hedge’s g = 0.48 95%CI 0.34−0.63) compared to normal/healthy control subjects. There was no significant difference in the rates of neurobehavioral impairment between children with and without history of cranial radiotherapy. Conclusions: PBTS are at elevated risk of neurobehavioral impairment. Neurobehavioral monitoring should be considered as the standard of care for PBTS.
Digital competence can help children and adolescents engage with technology for acquiring new knowledge and for broadening social contact and support, while reducing the risk of inappropriate media ...use. This study investigated the effects of digital competence on the risk of gaming addiction among children and adolescents. We explored whether students with good digital competence were protected from the adverse effects of media use and the risk of gaming addiction.
1956 students (690 primary and 1266 secondary) completed a digital competence assessment and a self-report questionnaire on their mental health status, use of digital devices, and experiences of cyberbullying. Multiple regression analyses with further mediation and moderation analyses were performed to investigate the association of digital competence with gaming addiction and mental health in children and adolescents.
Regression analyses showed that children and adolescents with better digital competence were less likely to develop gaming addiction (β = -0.144, p < 0.0001) and experienced less cyberbullying behaviour as perpetrators (β = -0.169, p < 0.0001) and as victims (β = -0.121, p < 0.0001). Digital competence was found to mediate the relationship between digital device usage time and gaming addiction.
Digital competence is associated with less gaming addiction and could potentially lead to better mental wellbeing by reducing the risks of gaming addiction and cyberbullying. Education that promotes digital competence is essential to maximize the benefits of media use, while reducing the potential adverse effects from the inappropriate use of digital devices.
This study was supported by a grant from the Research Grants Council of the HKSAR Government (#T44-707/16N) under the Theme-based Research Scheme
Sex differences in the pathogenesis of hypertension exist. While gut microbiota (GM) has been associated with hypertension, it is unclear whether there are sex-linked differences in the association ...between GM and hypertension.
We conducted a cross-sectional study to investigate the sex differences in associations between GM characterized by shotgun sequencing, GM-derived short-chain fatty acids, and 24-hour ambulatory blood pressure in 241 Hong Kong Chinese (113 men and 128 women; mean age, 54±6 years).
The hypertensive group was associated with GM alterations; however, significant differences in β-diversity and GM composition in hypertensive versus normotensive groups were only observed in women and not in men under various statistical models adjusting for the following covariates: age, sex, body mass index, sodium intake estimated by spot urine analysis, blood glucose, triglycerides, low- and high-density lipoprotein cholesterol, smoking, menopause, and fatty liver status. Specifically,
,
, and
were significantly more abundant in the hypertensive women, whereas
was more abundant in the normotensive women. No bacterial species were found to be significantly associated with hypertension in men. Furthermore, total plasma short-chain fatty acids and propionic acid were independent predictors of systolic and diastolic blood pressure in women but not men.
GM dysregulation was strongly associated with 24-hour ambulatory blood pressure in women but not men, which may be mediated through propionic acid. Our work suggests that sex differences may be an important consideration while assessing the role of GM in the development and treatment of hypertension.
Abstract only Background: Sex differences in the pathogenesis of hypertension exist. Whilst gut microbiota (GM) dysregulation is a novel risk factor of hypertension, studies using shotgun ...metagenomics sequencing and ambulatory 24-hour blood pressure (BP) monitoring to study the potential sex differences in the associations between the GM and BP are lacking. Methods: We recruited 241 asymptomatic Hong Kong Chinese (113 male, 128 female, mean age 54±6), who were not on anti-hypertensive agents, and studied their GM composition using shotgun sequencing. 24-hour ambulatory BP was recorded. GM-mediated short chain fatty acids (SCFAs) were quantified in stool and plasma by GC-MS. Statistical analysis was performed under covariate-adjusted models including age, sex, BMI, smoking, sodium-intake, fatty liver and menopause status. Results: Based on 24-hour BP, 36% (87 of 241) of the study population was hypertensive. Males had a higher mean BP than females (127±13/81±10mmHg vs. 117±12/71±8mmHg, p<0.001). GM β-diversity was significantly different in hypertensive vs. normotensive individuals, driven by females. A significant enrichment of Ruminococcus gnavus was observed in the hypertensive group whilst Oscillibacter sp. CAG:241 and Gemmiger formicilis was enriched in the normotensive group. These differences remained significant in females with no significant differential species found in males. Additionally, Dorea formicigenerans was negatively associated whilst Clostridium bolteae and Bacteroides ovatus were positively associated in female-specific hypertension. Repeated cross-validation machine-learning demonstrated microbial features were more predictive of hypertension in females than males, and the addition of microbial features to clinical features (age, BMI) improved the model’s prediction accuracy from 0.69 to 0.84 in females. Total plasma SCFAs and propionic acid were independent predictors of systolic and diastolic BP in females but not males. GM β-diversity was also significantly associated with total SCFAs and propionic acid levels. Conclusion: GM dysregulation appears to be more strongly associated with hypertension in females, which may be mediated through circulating plasma SCFAs.
There is limited evidence on whether the quality of life and behavior of children with special educational needs (SEN) have improved or worsened since schools reopened after COVID-19-related school ...closures.
To describe the changes in the mental well-being of children and adolescents with SEN during the initial 6 months of resuming in-person learning after COVID-19-related school closures.
This repeated cross-sectional study reported data from surveys completed by parents and caregivers of children and adolescents aged 3 to 18 years with SEN studying at special schools in Hong Kong. The first cohort was obtained during COVID-19-related school closure in April 2020 (wave 1) and the second cohort was obtained 6 months after school resumption with data collection between July and October 2021 (wave 2). Data analysis occurred from January to June 2022.
Diagnosis of a disability or disorder that required school-based special educational programming.
Children's emotional and behavioral difficulties (measured with the Strengths and Difficulties Questionnaire SDQ), quality of life (measured with the Pediatric Quality of Life Inventory PedsQL), lifestyle habits, parental stress, and parental well-being (measured with the PedsQL Family Impact Module) were assessed. Cross-sectional comparisons of well-being between the 2 waves were conducted using analysis of covariance, and multiple regression analysis was performed to identify factors associated with mental health outcomes in wave 2.
In wave 1, a total of 456 parents and caregivers of children with SEN (mean SD age, 7.44 3.98 years; 315 boys 69.1%; 141 girls 30.9%) responded to the surveys. In wave 2, 519 parents and caregivers of children with SEN (mean SD age, 8.16 4.47 years; 365 boys 70.3%; 154 girls 29.7%) responded. After school resumption, preschoolers aged 3 to 5 years with SEN had significantly fewer emotional difficulties (mean SD SDQ score, 3.26 2.39 vs 2.68 2.03; standardized mean difference SMD = 0.26; 95% CI, 0.07-0.46; Bonferroni-corrected P = .04) and conduct difficulties (mean SD SDQ score, 2.88 1.89 vs 2.41 1.91; SMD = 0.25; 95% CI, 0.05-0.44; Bonferroni-corrected P = .01), whereas adolescents had more conduct difficulties (mean SD SDQ score, 1.62 1.50 vs 2.37 3.02; SMD = 0.41; 95% CI, 0.13-0.70; Bonferroni-corrected P = .049). The overall quality of life of school-aged children with SEN aged 6 to 11 years worsened after school resumption (mean SD PedsQL score, 67.52 17.45 vs 60.57 16.52; SMD = 0.41; 95% CI, 0.19-0.62; Bonferroni-corrected P = .002).
The findings of this repeated cross-sectional study suggest that preschoolers with SEN had improved emotional and behavioral functioning when school resumed after COVID-19-related closures. School-aged children with SEN, adolescents with SEN, and children with intellectual disabilities were at risk of reduced quality of life, indicating that additional support should be offered to vulnerable groups as they return to schools.
Age-specific incidence of acute myocarditis/pericarditis in adolescents following Comirnaty vaccination in Asia is lacking. This study aimed to study the clinical characteristics and incidence of ...acute myocarditis/pericarditis among Hong Kong adolescents following Comirnaty vaccination.
This is a population cohort study in Hong Kong that monitored adverse events following immunization through a pharmacovigilance system for coronavirus disease 2019 (COVID-19) vaccines. All adolescents aged between 12 and 17 years following Comirnaty vaccination were monitored under the COVID-19 vaccine adverse event response and evaluation program. The clinical characteristics and overall incidence of acute myocarditis/pericarditis in adolescents following Comirnaty vaccination were analyzed.
Between 14 June 2021 and 4 September 2021, 33 Chinese adolescents who developed acute myocarditis/pericarditis following Comirnaty vaccination were identified. In total, 29 (87.88%) were male and 4 (12.12%) were female, with a median age of 15.25 years. And 27 (81.82%) and 6 (18.18%) cases developed acute myocarditis/pericarditis after receiving the second and first dose, respectively. All cases are mild and required only conservative management. The overall incidence of acute myocarditis/pericarditis was 18.52 (95% confidence interval CI, 11.67-29.01) per 100 000 persons vaccinated. The incidence after the first and second doses were 3.37 (95% CI, 1.12-9.51) and 21.22 (95% CI, 13.78-32.28 per 100 000 persons vaccinated, respectively. Among male adolescents, the incidence after the first and second doses were 5.57 (95% CI, 2.38-12.53) and 37.32 (95% CI, 26.98-51.25) per 100 000 persons vaccinated.
There is a significant increase in the risk of acute myocarditis/pericarditis following Comirnaty vaccination among Chinese male adolescents, especially after the second dose.
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