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Proper breakthrough cancer pain (BTcP) management is of pivotal importance. Although rapid-acting, oral and nasal transmucosal, fentanyl formulations (rapid-onset opioids, ROOs) are licensed for BTcP treatment, not all guidelines recommend their use. Presumably, some research gaps need to be bridged to produce solid evidence. We present a bibliometric network analysis on ROOs for BTcP treatment.Documents were retrieved from the Web of Science (WOS) online database. The string was "rapid onset opioids" or "transmucosal fentanyl" and "breakthrough cancer pain". Year of publication, journal metrics (impact factor and quartile), title, document type, topic, and clinical setting (in-patients, outpatients, and palliative care) were extracted. The software tool VOSviewer (version 1.6.17) was used to analyze the semantic network analyzes, bibliographic coupling, journals analysis, and research networks.502 articles were found in WOS. A declining trend in published articles from 2014 to 2021 was observed. Approximately 50% of documents regard top quartile (Q1) journals. Most articles focused on ROOs efficacy, but abuse and misuse issues are poorly addressed. With respect to article type, we calculated 132 clinical investigations. The semantic network analysis found interconnections between the terms "breakthrough cancer pain," "opioids," and "cancers." The top co-cited article was published in 2000 and addressed pain assessment. The largest number of partnerships regarded the United States, Italy, and England.In this research area, most articles are published in top-ranked journals. Nevertheless, paramount topics should be better addressed, and the implementation of research networks is needed.

BACKGROUND Therapeutic stays are a phenomenon of temporary reception of unaccompanied foreign children from contaminated areas in Belarus, Ukraine and Russia. Aim of the study was to analyze the physical and mental health status of children in therapeutic stays in Italy and the possible presence of a state of child abuse and neglect. METHODS The survey was conducted on a total of 55 children, 25 of which belonging to the treatment group composed of 25 Belarusian children in temporary stays in Italy, and the remaining 30 to the control group composed of 30 italian children. Data were collected between July, 2019 and July, 2020. The evaluation included a careful medical history, an accurate physical examination and an interview, focusing on several factors that can be use as indicators of child maltreatment, intended as physical and emotional neglect. RESULTS The survey was conducted on a total of 55 children, 25 of which belonging to the treatment group, and the remaining 30 to the control group. Of the 25 children in the treatment group, 8 (32%) are male and 17 (68%) are female, while of the 30 children in the control group, 14 (47%) are male and 16 are female (53%). For each child, we considered the body-mass index (BMI), the presence of dental caries, and the showing of learning disabilities or hypoacusis. These parameters can be used as indicators of child maltreatment. The analysis of BMI in the two groups shows that the BMI in the treatment group is significantly lower than the BMI in the control group (p=0.004). In the treatment group 7 (28%) children showed some form of caries whereas in the control group no forms of caries were detected. This result itself shows quite a relevant trend, and to have a quantitative measure of its statistical significancy, we performed a permutation test. The results show that the incidence of dental caries in the treatment group is significantly higher than in the control group (p=0.0023). We used the same procedure to analyse data on the presence of learning disabilities or hypoacusis. The p-values we obtained are not significant, but the results still seem to show that there might be a trend of a higher incidence of learning disabilities and hypoacusis in the treatment group, and an extensive study with a larger sample might shed more light on the topic. CONCLUSIONS This study shows that there are indications that suggest a higher risk of child maltreatment in the group of Belarusian children, where maltreatment is understood as physical and emotional neglect to which children are subjected in the institutions and in the group homes where they live. Despite showing only partially significant results, our work could be a starting point for more extensive studies on the topic. These future studies could be extended to other larger samples and other potential maltreatment factors could be evaluated.

Across the world, children and adolescents are exposed daily to toxic levels of violent behaviors, including domestic and family violence. Violence increasingly has permeated and profoundly affected the lives of children, who are the most vulnerable members of society.1 Pediatric societies in Europe and North America have raised great concern over the effect that abusive experiences will have on present and future generations.1, 2, 3, 4 The global spread of coronavirus disease 2019 (COVID-19) during the past year has dramatically worsened the situation, contributing to a further increase in violence and aggression within households. Reports of domestic abuse and family violence have increased around the world with social isolation and quarantine measures, and national health and social care systems worldwide have faced serious challenges posed by the rising rates of domestic and family abuse.5 Children are typically the primary victims of family violence2; however, children who live in homes in which partner abuse occurs are described as secondary victims.6 Minors increasingly are witnessing various forms of unprecedented emotional and physical domestic abuse, often resulting in femicide, and exposed to the emotional, behavioral, physical, social, and cognitive effects.2 There are documented gendered patterns in violence perpetration and victimization.7 This commentary, authored by the working group on social pediatrics of the European Paediatric Association/Union of National European Paediatric Societies and Associations, discusses children witnessing family violence and domestic abuse, including femicide as the most extreme and irreversible expression of domestic violence involving parents or household members. Our aim is to raise awareness regarding this phenomenon, which is rapidly expanding during the COVID-19 pandemic, and on the serious long-term effects on the well-being of children.

More than a year and a half after the first clinical manifestations of coronavirus disease 2019 (COVID-19) were reported in Wuhan, China,1 , 2 the magnitude of the pandemic across the globe and its related clinical and social effects3 remain unclear.4 The pandemic has affected lives and sparked concerns about everything from health to job security. In high–Gross Domestic Product (GDP) countries, despite trillions in coronavirus aid released by governments, many families still struggle to pay for basic necessities like food and rent, and these difficulties worsened during the pandemic.5 , 6 The general social uncertainty caused by the pandemic seems to have also affected family resilience, weakening the ability of individuals to confront challenges, survive difficulties, and thrive in adversities as a group.7 , 8 To reduce community spread of the virus, many countries adopted unprecedented confining measures, including the restriction of populations in their homes and reduction of interpersonal contacts. Confinement, quarantine measures for suspected COVID-19 cases, and social distancing were prolonged, and their effectiveness was debated at social, scientific, and political levels.9 However, although their prevention value in limiting viral spread is generally recognized,6 it is also widely accepted that social isolation measures have upended family lives.4 In particular, they have affected family functioning and parenting, which are significantly associated with the physical and psychosocial functioning of children and adolescents.10 This commentary, authored by the Working Group on Social Pediatrics of the European Paediatric Association/Union of National European Paediatric Societies and Associations, briefly discusses the effects of the confinement measures taken to combat the COVID-19 pandemic on family functioning. Our aim is to raise the awareness of pediatricians, social work professionals, and policy makers, as knowledge of the effects of social restrictions on family functioning may contribute to the efforts of national health systems to be effectively prepared to handle the social effects of future public health crises. Adopting a more mindful and coordinated approach may help overcome divergences across countries, particularly in terms of complex sociopolitical realities.

In response to the global novel coronavirus disease 2019 (COVID-19) pandemic, many countries around the world adopted social isolation measures to contain the spread of the virus.1 For children and adolescents, limitations in faceto-face activities and interactions with their traditional peer groups has been a frustrating experience. After disease containment measures, which included school closures, social distancing, and home quarantine, children and adolescents faced a prolonged state of physical isolation from their peers, teachers, extended family, and community networks that affects their emotional and behavioral health.2 Parents and pediatricians are reporting signs of mental distress in children of all ages within the context of the pandemic.3 In several cases, this unexpected social isolation has paradoxically improved the psychosocial state of fearful children, and the mental health of those who have been victims of bullying.4 School function improved with distance learning and socialization may have increased using virtual connections to create a larger social group.5 However, children and adolescents who experience a prolonged state of physical isolation may look for alternative, somehow attractive or unconventional forms of socialization, available on the internet. Children may be exposed to the risks of unsupervised cyberspace exploration beyond the open web, which may lead them to areas that are usually not available to visitors. They may pass the gates of the “open” and “deep web” sections and enter into the dangerous “dark web” zones, which predominantly host unethical and criminal activities. In those shadowy corners of the worldwide web, there exist dangers ranging from identity theft and the drug trade to suicide chat rooms and child pornography.6 This commentary, authored by European Paediatric Association/Union of National European Paediatric Societies and Associations members of the working group on social pediatrics, briefly discusses the features of the dark web and its implications for children and adolescents. Our aim is to raise awareness of pediatricians and families on the growing risk of child exploitation through the web at a time when vulnerable young people face home lockdowns with potential abusers intruding on their privacy

The objective of this editorial is to raise awareness on the burden and risks faced by adolescents developing this emerging form of social withdrawal. The hikikomori phenomenon is part of the group of new morbidities causing children and adolescents to limit their activity owing to a chronic health condition with attendant psychological problems. We further emphasize the importance of including new morbidities involving mental health and social participation in formal pediatric training, to enable new generations of pediatricians to identify and properly manage these disorders.

Background The aim of the present study is to analyse the length-weight growth up to 12 months of age in three groups considering the respective dietary pattern followed from the pregnant mothers and from the infants during the first year of the life. Moreover, the cultural inference of vegetarianism has been studied. Methods Between September 2017 and May 2018, more than 100 mothers have been proposed to participate in this study. As a result of preliminary evaluation, which ensures the presence of inclusion criteria and the absence of exclusion criteria, 55 mothers and their 63 children have been enrolled and assessed with a questionnaire previously created for the study. Results A statistically significant difference has emerged between the omnivorous and the vegan group from the comparison for the weight of children at birth, 6 months and 12 months, both when expressed in grams and when expressed in growth percentiles. Furthermore, between the two children groups just mentioned, a significant difference has emerged from the comparison for the length expressed in growth percentiles at 12 months and for the body mass index at 6 months. No statistically significant differences have emerged between the omnivorous group and the lacto-ovo/lactovegetarian group and between the latter and the vegan one. Conclusions Although differences between the three groups of children have emerged with regard to some anthropometric parameters, their length-weight growth during the first year of life has been harmonic and physiological regardless of the type of planned diet.

Exposure of children and adolescents to violence has significant short and long-term consequences in terms of academic, social, physical, and psychological functioning.1,2 The relationship of exposure to traumatic events, including various forms of violence, with depression, anger, anxiety, dissociation, posttraumatic stress, and total trauma symptoms has been widely debated.1-3 It is largely accepted that adverse early life experiences and abusive events suffered during childhood can cause profound effects on the development and function of the nervous system and increase the risk of neurodevelopmental disorders.4 Studies investigating the relationship between various types of neurodevelopmental disorders and exposure to violence and their consequences have been inconclusive.3 The alarming phenomenon of family and domestic violence has increased significantly during the COVID-19 pandemic.5 Several studies have documented a surge in abuse-related physical and nonphysical trauma in children during this period.6 Similar observations have been made after periods of economic decline or turbulence.7 This commentary, authored by the Working Group on Social Pediatrics of the European Paediatric Association/ Union of National European Paediatric Societies and Associations (EPA/UNEPSA), briefly discusses the important relationship between the occurrence of traumatic events, particularly violence, and neurodevelopmental disorders in children. Our aim is to raise awareness of these circumstances, which may occur during or following periods of social turmoil, as in the case of the 2009 economic crisis8,9 and the COVID-19 pandemic,10 and expose children to the risks of serious immediate and long-term effects on their health and well-being.

Aim To describe the epidemiological aspects of nocturnal enuresis (NE). In this study we identify the prevalence and the familial conditions in a large, representative sample of children with monosymptomatic NE (MNE) and nonmonosyptomatic NE (NMNE). Material and methods In this descriptive-analytic study the Italian Society of Pediatrics (SIP) promoted a prevalence study of NE using a questionnaire involved 320 primary care Pediatricians from Northern, Central and Southern Italy, from January 2019 to July 2019, with a total of 130,000 children analyzed by questionnaire related to epidemiology and type of NE, familiarity, quality of sleep, eating and drinking habits, pharmacological and psychological/behavioural interventions and family involvement. Results 270/320 (84.4%) Paediatrician replied to our questionnaire. We enrolled a total of 9307/130,000 (7.2%) children with NE, aged between 5 and 14 years: 2141 diagnosed with MNE and 7176 qualified as NMNE. Poor quality of sleep were reported in 7064 patients; 90% of children did not consider a dietary and drinking recommendation. Pediatrician reported a total of 54.1% of parents who declared to have a negative reaction to their children because of the bedwetting. A percentage of 71.4% of parents declared to use or to have used alternative therapies and not to prefer, at first, a pharmacological intervention. Conclusion The choice of treatment should include psychological/behavioural interventions in all cases to improve the therapeutic outcome. All primary care Pediatricians should be aware of the all aspects of NE to choose the best way to treat every patient.

To assess side effects of MELT monotherapy and MELT in association with oxybutynin in children suffering from nocturnal enuresis (NE). We enrolled 340 enuretic children admitted to our Pediatric Service, Campus Bio-Medico University of Rome, from April 2014 to April 2018; 23 children were excluded. The research was structured in 2 steps. During step 1, a patient’s medical history was carefully collected and physical assessment was performed. During step 2, after 3-month treatment period with MELT (Minirin/dDAVP®) at the dose of 120 mcg a day or MELT plus oxybutynin (Ditropan®), voiding calendar, adherence to treatment and any side effects were examined. The study was conducted in accordance with the Helsinki Declaration. Among 317 patients enrolled in the study, 18 male and 8 female (n=26; 26/317: 8.2%) children, with a mean age 10.86 ± 2.42 years, referred side effects: 13 cases (n=13, 13/26: 50%) treated with MELT monotherapy, 11 cases (n=11, 11/26: 42.3%) treated with MELT plus oxybutynin, 2 cases (n=2, 2/26: 7.7%) who received only oxybutynin. In our research, higher bioavailability of MELT guaranteed lower frequency of adverse effects with a spontaneous and rapid resolution. Several studies demonstrate that dDAVP is an effective and safe drug for NE and MELT formulation is actually considered for first-line therapy of NE, although further research is needed to endorse the observations of the authors.

The evidence to date suggests that vaping is not a safe alternative to smoking tobacco. This, coupled with the worrying trend of young nonsmokers being attracted to vaping, raises fears of yet another generation suffering from chronic lung disease and other acute and chronic health conditions. Finally, due to the insufficient regulations in several countries, up-to-date data on the prevalence of e-cigarette use and studies on the health's implications of their use are urgently needed to inform policy at a national and international level (ie, European Union). Pediatricians are typically on the front line for identifying emerging risks for children and adolescents ; therefore, they may effectively help increase awareness about the potential danger of vaping on health. Information on the use of vaping devices should be implemented worldwide and included in public health information and prevention programs.

Violence against individuals during their developmental years (

Objective To evaluate the characteristics of patients with NE. Design It is a cross-sectional study. Setting During the physical examination, we sought signs and symptoms of voiding disorders and comorbidities with precise questions posed to the patients and their parents. Further, we assessed family history and behavioral characteristics of patients. Analyses were conducted using the Microsoft Excel 2016 program. We used descriptive statistics to describe patients’ information. Patients We recruited 403 children with Noctunal Enuresis (NE) at the Services of Pediatrics, Campus Bio-Medico University Hospital of Rome between June 2013 and July 2018. We rejected 2 children respectively with a renal agenesis and a chromosomopathy and we enrolled 401 patients, 101 girls (25.2%) and 300 boys (74.8%), aged 5–16 years; mean age at first visit 8.8±2.44 years. Of the 401 eligible patients, we counted 327 (81.5%) patients with monosymptomatic NE (MNE) and 74 (18.5%) patients with non-monosymptomatic MNE (N-MNE). In the group of MNE children, 242 (74%) children were boys with mean age at first examination 9.1 years and 85 (26%) were girls with mean age at first examination 7.8 years. In the group of N-MNE children, 58 (78.4%) children were boys with mean age at first examination 9 years and 16 (21.6%) were girls with mean age at first examination 8.4 years. Among the children with MNE, 322 (98.5%) had PMNE and 5 (1.5%) were diagnosed with SMNE. Interventions Not applicable Main outcome measures Signs and symptoms of voiding disorders, comorbidities, family history of NE, behavioral characteristics and school achievement. Results We noticed that heredity, parasomnias, urogenital abnormalities, constipation and innocence heart murmur are correlated to NE. Notably, 53.6% (67/125 children) had paternal heredity, 46.4% (58/125) had maternal heredity; 11.2% (14/125) had both paternal and maternal inheritance. 12/401 (3%) had sleep apnea, 95/401 (23.7%) had somniloquy and 59/401 (14.7%) had bruxism. Children suffered from headaches were 21/401 (5.2%): 112 (27.3%) had family history of headache. 47/300 boys (15.7%) had urogenital-abnormalities: 28/47 (59.6%) children had balanopreputial adhesions. Cutaneous manifestations of spinal dysraphism such as pilonidal dimple, single and deflected intergluteal cleft or double intergluteal cleft were found in 21/401 (5.2%) patients. Encopresis was found in 12/401 (3%) children and 58/401 (14.5%) suffered from constipation. Lastly, a significant percentage of children presented innocent heart murmur (86/401 – 21.4%). Conclusions Our experience demonstrate that there are many comorbidities that influence the prognosis and the response to the therapy in these children.

Objective To evaluate health status of a group of children placed in a residential care in the city of Rome. Design It is a cross-sectional study. Setting We drawn up a questionnaire, which was filled out anonymously by each educator with the data of the child of which each was responsible. Analyses were conducted using the Microsoft Excel 2016 program. We used descriptive statistics to describe patients’ information. Patients We selected the residential care Il Girotondo, located in Rome. In April 2018 it hosted 17 children, 8 boys (47%) and 9 girls (52%), with a mean age of 23.9 ± 14.6 months. 35% (6/17) of children was from Romania, 29% (5/17) of children was from Italy, 18% (3/17) was from Nigeria, 6% (1/17) of children was of Rom ethnicity. One child had the father from Nigeria and the mother from Russia and one children had the father from Bulgaria and the mother from Algeria. The children were admitted to the residential care at a mean age of 15.7 ± 15.1 months. The mean length of stay was 8.4 ± 5.2 months. Interventions Not applicable. Main Outcome Measures Respiratory, urinary, intestinal, neurological, motor and psychological diseases, allergies to pollens or food, the state of vaccination, the re-lationship of the child with other children, the school attended and the academic achievement reported by their teachers. Results Respiratory diseases were the most frequent (37.5%), expecially in the fe-male group (55.6%) than in the male group (14.3%), followed by tendency to isola-tion (18.2%), neurological diseases (17.8%), not being at ease with other children (16.7%), intestinal diseases (11.8%), lack of acceptance by the others children (8.3%), motor diseases (6.3%) and psychological pathologies (5.9%). About respira-tory diseases, asthmatic pathologies affected 12.5% of the sample and the 22.2% of the girls. No one had any urinary diseases or pollen and food allergies. All children were vaccinated. Lastly, 80% of the sample (100% of males and 62.5% of females) did not attend any school. Two girls attended the day care and one girl attended the kindergarten. Conclusions Beyond the psychological pathologies, the children hosted in the alternative care suffer from physical and development disease more than the general pediatric popu-lation. It is needful to perform a systematic analysis of the data to define the real needs for this special paediatric population in order to start them on an appropriate medical path.

Objectives The aim of the present study is to compare the length-weight growth up to 12 months of age of three groups of children according to the dietary pattern followed by the pregnant mothers and by the infants during the first year of the life. Design This is a retrospective study Setting A questionnaire of 26 multiple-choise questions was drafted and electronically sent to the participants. From the questionnaire the following anthropometric data of the children were obtained: weight, length and head circumference, at birth, at 6 months and at 12 months; the corresponding BMI were calculated from them. Then, the percentiles of growth of all the parameters were calculated. Data were expressed as the arithmetic mean, standard deviation, median and interquartile range and a statistical analysis through ANOVA was conducted, with analysis post-hoc in accordance with the Bonferroni method. Values of P less than 0,05 were considered significant. This study was conducted in accordance with the regulatory standards of Good Clinical Practice and the Declaration of Helsinki. Patients 55 mothers and their 63 children were enrolled from the Pediatric Service of the Campus Bio-Medico University Hospital of Rome, between September 2017 and May 2018. The participants were divided into three groups based on the food patterns followed: 21 mothers and 21 children vegan, 19 mothers and 21 children lacto-ovo-/lacto-vegetarian, and 15 mothers and 21 children omnivore. Main outcome measures Comparison of the anthropometric parameters of three groups of children according to the dietary pattern followed by the pregnant mothers and by the infants during the first year of the life. Results From the statistical analysis, statistically significant differences emerged between the vegan group (lower values) and the omnivorous one regarding the children weight at birth, at 6 months and at 12 months, both when expressed in grams and when expressed as percentile of growth, the children length at 12 months expressed in percentile of growth and the children BMI at 6 months. No statistically significant differences emerged for the other parameters analysed between the omnivorous group and the vegan one and for no parameter between the vegan group and the lacto-ovo-/lacto-vegetarian one and between the latter and the omnivorous group. Conclusion The limited number of participants does not allow us to draw unequivocal conclusions, but, despite the differences between the groups examined, we found during the first year of life a physiological and harmonic growth of all children.

Objective The aim of this study is to evaluate the prevalence of innocent heart murmurs in children affected by nocturnal enuresis (NE). Specifically, for this purpose, a possible pathogenic relationship linking both conditions. Design This study is an observational study. Setting The study was characterized by a careful examination of patient’s medical history and performing of physical examination, including the weight and height measurement. Mostly, it was a cardiological examination including monitoring patient’s blood pressure and abnormal heart sounds: patent’s foramen ovale, slight systolic impurity, mitral insufficiency, muffled heart sound, heart murmur, and impurity. The study was carried out in compliance with the Helsinki Declaration. Analyses were conducted using the Microsoft Excel 2011 (version 14.0.0) program. We used descriptive statistics to describe patients’ information (age, gender, familiarity). Data were expressed as the mean±standard deviation and percentage. The χ2 test was used for categorical variables. The significance level was set at p Patients We are enrolling about 400 children (G1), 300 males and 100 females aged between 5 and 15 years, affected from NE referred to the Service of Pediatrics, ‘Campus Bio-Medico’ University Hospital of Rome, from September 2013 to January 2019 in the study. The control group is composed of about 400 children without NE (G2). Main outcome measures Prevalence of innocent heart murmurs in children with MNE or N-MNE. There isn’t any study investigating the association of NE with innocent murmur in the literature. Results The prevalence of heart innocent cardiac murmur appears to be significantly higher in children who suffer from NE. The results obtained are not definitive, because the study is ongoing. Conclusions These findings made us acquaintance of the presence of possible underlying mechanisms which explain the association between higher prevalence of innocent heart murmur and enuresis, further studies are needed. A possible explanation of this relationship could be provided by heart increased secretion of atrial natriuretic peptide (ANP) and B-type natriuretic peptide (B-BNP). In particular, the murmur could be accentuated by hypervolemia, which in turn determines atrial and ventricular distention. This stimulates cardiomyocytes into producing ANP and B-BNP. ANP shares with B-BNP a high degree of structural homology and a profile of diuretic, natriuretic and vasodilator activities and inhibition of the renin-angiotensin-aldosterone system.

Violence against children includes all forms of violence against people under 18 years old whether perpetrated by parents or other caregivers, peers, partners, teacher or strangers. This is a public health, human rights, and social problem: levels of violence against children are frightfully high and it is estimated that up to 1 billion children aged 2–17 years, have experienced a type of violence. Very few studies provided physical violence perpetrated at school but it can have a physical impact, causing psychological distress, permanent physical disability and long-term physical or mental ill-health. Children who experienced any type of violence at school may develop reactive attachment disorder, modest physical inactivity, overweight or obesity, diabetes, smoking habits, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease and other negative outcomes. Evidence from international studies clearly shows that nonviolent, positive discipline delivers better results, while any type of violence is associated with many negative one.

The data in the literature on the appropriateness of vegetarian diets during pregnancy and the impact on the birth anthropometric parameters of the newborn are divergent and conflicting. The aim of the present study is to compare the birth anthropometric parameters of three groups of children distinguished according to the dietary pattern followed by their mothers during pregnancy. Moreover, the second aim is to study the cultural inference of vegetarianism.Between September 2017 and May 2018, from the Pediatric Service of the Campus Bio-Medico University Hospital of Rome and vegetarian-oriented societies, detailed information have been provided to all mothers who showed interest in participating in the study. More than 100 mothers gave their consent, but in consideration of the criteria of inclusion and exclusion only 55 with the respective children (for a total of 63 kids) have been enlisted in the study. Based on the dietary pattern followed by women during pregnancy, the participants have been divided into three groups: vegan group, lacto-ovo-/lacto-vegetarian group, and omnivorous group. The data necessary for the study have been collected through a questionnaire previously created and sent electronically to 55 enrolled mothers.From our statistical analysis, it has emerged that birth weight, both when expressed in grams and when expressed in growth percentiles, of the vegan mothers' children is lower than that of the omnivorous mothers' children. No significant difference has emerged from the comparison for the length, cranial circumference and BMI at birth between the three groups.Although from our study statistically significant differences in birth weight between the vegan group and the omnivorous one has emerged, the values of this anthropometric parameter were all included within the physiological range decided by the experts in the field. From this, it emerges that the planning of any type of diet with experts in the field is indispensable to ensure a physiological development of the fetus, but given the limited number of participants we cannot draw unequivocal and certain conclusions on this subject.

Objective The aim of this study was to evaluate adverse effects of oral desmopressin lyophilisate (MELT) in enuretic children. Material and methods We enrolled 260 children with nocturnal enuresis (NE) referred to the Pediatric Service, 'Campus Bio-Medico' University of Rome, from April 2014 to April 2017 in the study, of these 23 were excluded. The study was characterized by 2 phases. During Phase 1 a careful patient's medical history was obtained and physical examination was performed. After 3 months of treatment with MELT (Minirin/DDAVP®) at the dose of 120 mcg a day, a micturition diary was kept, adherence to therapy and any possible adverse effects were checked during the Phase 2. The study was carried out in compliance with the Helsinki Declaration. Results Among 237 patients included in the study 11 male and 6 female (n=17; 7.2%) patients with a mean age 10.06±2.49 years, reported 22 adverse effects, with an absolute risk of 7.17%. In particular, 5 neurological symptoms, 3 gastrointestinal effects, 4 sleep disturbances, 8 psycho-behavioral disorders, 2 symptoms of fatigue were reported. Conclusion In our study MELT with its higher bioavailability guaranteed lower frequency of adverse effects which resolved spontaneously and rapidly. The MELT formulation actually represents the first line and safe treatment for the NE.

Background: The first-line drug therapy for patients with nocturnal enuresis (NE) associated with nocturnal polyuria and normal bladder function is desmopressin (dDAVP). Objective: To evaluate if increasing dose of oral desmopressin lyophilisate (MELT) can improve response rates to dDAVP and is useful in enuretic children. Materials and methods: We enrolled a total of 260 children all diagnosed with NE. Enuretic children were treated with increasing MELT at a dose of 120, 180 and 240 mcg a day.Results. We included in our study a total of 237 children, 164 males (69.2%) and 73 females (30.8%) aged between 5 and 18 years (mean age 10.32 ± 2.52 years). Of the 237 patients enrolled in the study and treated with MELT 120 mcg, a full response was achieved in 135 (56.9%). A partial response was achieved in 21 (8.9%) patients, therefore the dose was increased up to 180 mcg, with further improving symptoms (14.3%) or full response (9.5%), and up to 240 mcg, without usefulness. Conclusions: MELT at the dose of 120 mcg resulted efficacy and safety; the increased dose up to 180 mcg resulted poorly efficacy; finally, the further increase up to 240 mcg did not improve the symptoms with the increased risk of side effects.

Femicide, defined as the killing of females by males because they are females, is be-coming recognized worldwide as an im-portant ongoing manifestation of gender inequality. Actual or imminent separation, abuser’s access to firearms, prior threats with a weapon, prior threats to kill the victim, a stepchild in the household, prob-lematic alcohol and illicit drug use, as well as mental health problems, are associated with a substantially higher risk of femi-cide. Little is known about the number of orphaned children who have instantane-ously lost both parents. Sparse attention has been focused on children whose moth-er was murdered: these are difficult cases for child psychiatry teams. Decisions about protection could be made by judges, the police, social workers or officers that at-tend victims, on the basis of empirical data and not merely by using intuitive criteria.

This study explored the effects of implicit gender–math stereotyping on women's math self-efficacy and mathematics performance under stereotype threat and stereotype lift conditions. It was conducted with a sample of female undergraduate students enrolled in an introductory statistics course. Results showed that girls with implicit gender–math stereotype were sensitive to a stereotype threat-lift manipulation, whereas girls with weak implicit stereotype were not. Data suggest that implicit gender–math stereotyping acts as a critical variable in determining women's math self-efficacy and performance. These findings give some suggestions about the improvement of the teaching of math and related disciplines to female students.

The authors of this commentary, many of whom are part of a working group on social pediatrics supported by some of the European national pediatric societies member of EPA-UNEPSA, conclude that more studies are needed to cross the boundaries between disciplines, for example, looking at the inter-relationship of family life and child health and how parental loss is affecting the micro and macro level of child healthcare service systems. Therefore, this article aims to alert pediatricians to the impact of parental loss on child health and wellbeing. It emphasizes the importance of implementing preventive and social support programs for achieving health promotion and health-protective effects.

Slow, large deformations of human brain tissue—accompanying cranial vault deformation induced by positional plagiocephaly, occurring during hydrocephalus, and in the convolutional development—has surprisingly received scarce mechanical investigation. Since the effects of these deformations may be important, we performed a systematic series of in vitro experiments on human brain tissue, revealing the following features. (i) Under uniaxial (quasi-static), cyclic loading, brain tissue exhibits a peculiar nonlinear mechanical behaviour, exhibiting hysteresis, Mullins effect and residual strain, qualitatively similar to that observed in filled elastomers. As a consequence, the loading and unloading uniaxial curves have been found to follow the Ogden nonlinear elastic theory of rubber (and its variants to include Mullins effect and permanent strain). (ii) Loaded up to failure, the “shape” of the stress/strain curve qualitatively changes, evidencing softening related to local failure. (iii) Uniaxial (quasi-static) strain experiments under controlled drainage conditions provide the first direct evidence that the tissue obeys consolidation theory involving fluid migration, with properties similar to fine soils, but having much smaller volumetric compressibility. (iv) Our experimental findings also support the existence of a viscous component of the solid phase deformation. Brain tissue should, therefore, be modelled as a porous, fluid-saturated, nonlinear solid with very small volumetric (drained) compressibility.