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Using a matched case control design conducted at MRC Gambia in 2015, we measured vitamin D levels in pairs of asymptomatic children with discordant tuberculin skin test status despite the same sleeping proximity to the same adult TB index case. Median ages of groups (infected; 10.0 years, uninfected 8.8 years) were not significantly different (p = 0.13). Mean vitamin D levels were 2.05 ng/mL (95% CI − 0.288 to 4.38) higher in 24 highly TB-exposed uninfected children compared with 24 matched highly TB-exposed infected children (p = 0.08). The findings warrant further investigation in larger studies to understand the implications and significance. Conclusion: Vitamin D levels were higher in TB-uninfected children compared with TB-infected despite equal high exposure to a TB case. What is Known:• Paediatrics TB represents one of the leading causes of child death globally.• Current literature shows an inconsistent relationship between vitamin D deficiency and increased risk of TB disease however a large Phase 3 trial of vitamin D supplementation in (largely vitamin D deficient) Mongolian children did not find any association with TB infection rates. What is New:• This study adds to the literature in a vitamin D sufficient paediatric population whereby children with equal exposure to a household TB case with no evidence of TB infection have higher levels of vitamin D compared with matched children with TB infection.

Using a matched case-control design we measured vitamin D levels in pairs of Gambian children with discordant infection status despite the same sleeping proximity to the same adult TB index case. Vitamin D levels were 2.05ng/mL higher in 24 highly TB-exposed uninfected children compared with 24 matched highly TB-Exposed infected children (p=0.08). The findings warrant further investigation in larger studies to understand the implications and significance. Conclusion: Vitamin D levels were higher in TB-uninfected children compared with TB-infected despite equal high exposure to a TB case.

Using a matched case control design conducted at MRC Gambia in 2015, we measured vitamin D levels in pairs of asymptomatic children with discordant tuberculin skin test status despite the same sleeping proximity to the same adult TB index case. Median ages of groups (infected; 10.0 years, uninfected 8.8 years) were not significantly different (p = 0.13). Mean vitamin D levels were 2.05 ng/mL (95% CI - 0.288 to 4.38) higher in 24 highly TB-exposed uninfected children compared with 24 matched highly TB-exposed infected children (p = 0.08). The findings warrant further investigation in larger studies to understand the implications and significance. Conclusion: Vitamin D levels were higher in TB-uninfected children compared with TB-infected despite equal high exposure to a TB case.

AimsMental health disorders can be a burden on both patients and the National Health Service. With the majority of lifetime mental health problems emerging in childhood and the prevalence of childhood mental illness increasing, the need for effective, standardised mental health education and fostering healthy socio-emotional development is more important than ever before. The aim was to explore if Inside Out provides an accurate representation of depression, and thus, can it be a useful resource for teaching mental health and developing emotional awareness in the classroom?MethodsI explored a novel educational concept: ‘edutainment’, to see if it has use in state mental health education. This project provides a quantitative coding analysis and a qualitative artistic analysis of a contemporary Disney film, Inside Out (2015), for The International Classification of Diseases 10th Edition (ICD-10) depression symptoms. Depression has been chosen as an example of a mental health disorder as it is one of the commonest mental health problems and the leading cause of disability worldwide.ResultsInside Out provides an accurate representation of many of the ICD-10 ‘core’ and ‘cognitive’ symptoms of depression through both coding words and artistic means.ConclusionInside Out, alongside teacher-led discussion, could be useful in teaching children about depression in a relaxed but educational way. Inside Out features themes that can help children develop their emotional intelligence and reduce mental health stigma. I highlight a need for standardised mental health education and suggest that film may be an effective tool for learning about common mental health conditions, such as depression.

To the Editor: Multidrug-resistant tuberculosis (MDR-TB), defined as Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin, is an increasing problem globally [1]. Children are not usually included in global surveys of MDR-TB incidence and prevalence [2] due to the diagnostic challenges of paucibacillary TB [3]. Data on the burden of MDR-TB in children are, therefore, lacking globally [1, 4, 5] and no published data from the UK exist. The current World Health Organization (WHO) [6] and National Institute for Clinical Excellence (NICE) [7] TB guidelines for the management of MDR-TB do not explicitly address paediatric disease. As a consequence, the complex management of this condition is left to individual clinicians' judgment. In general, childhood TB is paucibacillary, most cases are treated on clinical grounds without drug susceptibility testing [2], and correct and timely diagnosis of childhood MDR-TB is therefore challenging. There are limited data on the pharmacokinetics, dosing and safety of the many second-line drugs used to treat MDR-TB in children [5]. Our group is the first to review the management of a paediatric cohort with MDR-TB in the UK, and represents the largest available dataset from children with culture-confirmed MDR-TB from western …