IntroductionThe diagnosis of childhood cancer disrupts family dynamics and routine, potentially causing increased family stress and difficulties in maintaining academic commitments for the healthy sibling. Research evaluating siblings’ academic performance following a child’s cancer diagnosis is scarce. Thus, this study aimed to examine the impact of childhood cancer on academic performance in their cancer-free siblings.MethodsBy accessing nationwide registers and data on school grades, this study included 2,148 cancer-free siblings (born 1972–2002) to cancer-affected children (diagnosed 1997–2016) and 7,571 matched comparisons, matched on type of sibling (full/half sibling), country of birth (Sweden/abroad), siblings’ sex, siblings’ birth year and birth month, cancer-affected child’s birth year and birth month, maternal and paternal highest education. “Poor academic performance” was defined as the lowest 25th percentile of grades per year and the grades were set between 1989 and 2018. Odds ratios and 95% confidence intervals were calculated using conditional logistic regression.ResultsCompared to individuals whose siblings did not have cancer, individuals having a sibling with childhood cancer did not affect their academic performance with an OR of 1.04 (95% CI = 0.92–1.17). However, in an exploratory subgroup analysis, individuals who had their academic grades assessed in the same year as their sibling’s cancer diagnosis had a numerically higher, but not statistically significant, odds ratio for poor academic performance (OR 1.32, 95% CI 0.97–1.80).ConclusionWe found no significant association between childhood diagnosis and academic achievement in their healthy siblings. However, the impact needs to be addressed in further studies with larger sample sizes. Our exploratory finding of a numerically higher estimate for siblings graded in the same year as the diagnosis is hypothesis-generating and should be examined in larger studies.
BackgroundExisting studies of sunlight exposure and health have mainly focused on specific organs, particularly the skin and eyes, while associations with other organs and systems remain largely unexplored. We aimed to comprehensively examine the associations between outdoor sunlight exposure duration and 134 diseases.MethodsUsing UK Biobank data, summer and winter outdoor durations were collected by questionnaire, and average daily exposure was calculated as their arithmetic mean. Incident diseases were defined using 525 three-character ICD-10 codes. Cox proportional hazards models estimated associations, and restricted cubic splines assessed potential nonlinearity.ResultsAmong 281,282 participants [mean (SD) age, 55.81 (8.07) years; 55.79% female], 1,115,346 incident cases occurred during a median follow-up of more than 13.4 years. After false discovery rate correction, sunlight exposure was associated with 36 diseases, with hazard ratios ranging from 0.914 to 1.086. For example, each additional hour of average exposure was associated with higher risks of malignant melanoma of the skin (HR = 1.052, 95% CI 1.012–1.094), obesity (1.039, 1.027–1.052), cerebrovascular diseases (1.028, 1.011–1.046), and osteoarthritis (1.042, 1.033–1.052), and lower risks of osteoporosis (0.975, 0.957–0.994), disorders of mineral metabolism (0.968, 0.944–0.992), and pressure ulcers (0.947, 0.916–0.979). Thirty diseases, including depression, anxiety, sleep disorders, arrhythmias, iron deficiency anemia, and kidney failure, showed U-shaped associations.ConclusionOutdoor sunlight exposure duration showed positive, inverse, and nonlinear associations with a broad range of diseases. These findings highlight the potential importance of moderate exposure and appropriate sun protection but require validation in other populations.
IntroductionMyopia and reduced vision among children and adolescents place a substantial burden on public health, particularly where eye-care resources are limited. We evaluated an interpretable questionnaire-based framework for modelling self-reported reduced uncorrected visual acuity.MethodsThe analysis included the first eligible record for each of 7,118 students from seven schools across three survey rounds. Sixteen demographic, familial and behavioural predictors were used to model an affirmative response to a question about uncorrected visual acuity below 5.0 in at least one eye. Internal-external cross-validation (IECV) comprised seven outer folds, each holding out one school. Preprocessing, model selection, probability calibration and Youden threshold estimation were confined to the training schools.ResultsThe selected workflow achieved an area under the receiver operating characteristic curve (AUC) of 0.706 [95% confidence interval (CI) 0.694-0.718], a Brier score of 0.212, sensitivity of 0.730 and specificity of 0.575. The academic-year-only benchmark achieved an AUC of 0.611 and a Brier score of 0.233. Stage-specific AUCs ranged from 0.633 to 0.680, with substantial variation in sensitivity and specificity. Applying the same development procedure to the full cohort selected CatBoost. SHapley Additive exPlanations (SHAP) identified academic year, parental myopia and desk-chair adjustment as leading contributors to its predictions.DiscussionQuestionnaire responses provided predictive information about self-reported visual status beyond academic year, with moderate overall discrimination and variation across educational stages. These findings provide a basis for further evaluation of the framework in school eye-health research.
IntroductionChronic child malnutrition (CCM) remains a major public health challenge, particularly in socially vulnerable settings, given its association with adverse developmental outcomes. Preventing CCM requires integrated approaches that combine nutritional support, healthcare, and the strengthening of family caregiving capacities.ObjectiveTo describe pre-to-post changes over 6 months in parental knowledge (primary outcome) and in practices and perceived competencies (secondary outcomes) related to the prevention and management of CCM among 208 pregnant women or mothers of children under 3 years of age participating in a family-support process guided by the principles of Family-Centered Practices (FCP) in a rural community in Santa Elena, Ecuador.MethodsAn uncontrolled longitudinal pre-post study with an embedded exploratory qualitative component was conducted within a community program involving biweekly home visits and monthly food kits. No concurrent comparison group was used. A 34-item, study-specific scale assessing knowledge, practices, and perceived competencies related to CCM prevention and management was administered before and after the intervention. In addition, 25 purposively selected mothers provided written responses to open-ended questions, which were analyzed deductively using four a priori categories.ResultsThe total scale score increased significantly from pre- to post-assessment (mean difference = 8.03, 95% CI [4.53, 11.53], p < 0.001, dz = 0.31). The largest and only statistically significant domain-level change was observed in Knowledge (dz = 0.66), whereas changes in Practices (p = 0.425) and Competencies (p = 0.080) were smaller and not statistically significant. Sixteen of 34 item-level comparisons remained significant after Holm-Bonferroni correction. Differences according to baseline nutritional status were descriptive and were not confirmed by the group-by-time interaction test. Qualitative responses illustrated perceived learning related to safe water, dietary practices, and greater confidence in food-related decision-making.ConclusionParticipation in an integrated home-visiting and food-support program was associated with higher self-reported knowledge related to CCM prevention and management, whereas aggregate changes in practices and perceived competencies were not statistically significant. Given the uncontrolled design, concurrent food support, and use of a study-specific outcome measure, the findings should be considered preliminary. Controlled studies using validated measures and objective nutritional outcomes are needed to evaluate the contribution of family-centered support to CCM prevention.
ObjectiveUsing an integrated analytical pipeline that combines regression and machine learning, with nonlinear dose–response modeling, this cross-sectional study sought to examine dietary amino acid composition in relation to elevated fasting glucose (EFG) in children and adolescents.MethodsData from 12,567 children and adolescents (6–18 years) from four provinces in a national nutrition and health surveillance program were analyzed. Feature selection was performed using the Boruta algorithm, and propensity score matching (PSM) was utilized to address confounding. Conditional logistic regression was used to assess the relationships between EFG risk and 20 amino acids expressed as percentages of total protein intake; odds ratios (ORs) were reported per 1-percentage-point increment in the proportion of total protein intake. Predictive models were built with six machine learning algorithms (LightGBM, XGBoost, SVM, KNN, CatBoost, and NB) and the SHAP method was used to measure feature contributions and determine the most important amino acids. Further stratified analyses and a generalized additive model (GAM) were conducted to assess association strength and investigate possible nonlinear dose–response relationships.Results6,960 participants were included in the final analysis. The best-performing model was LightGBM (AUC = 0.831), which included this model included 20 amino acids plus 12 confounding factors (including fat intake, protein intake, hypertension, and general/central obesity). Conditional logistic regression combined with SHAP-based feature importance ranking identified methionine (OR = 2.03, 95% CI: 1.61–2.57) and threonine (OR = 1.59, 95% CI: 1.32–1.92) as positively associated with EFG, whereas arginine (OR = 0.82, 95% CI: 0.74–0.92) and tyrosine (OR = 0.71, 95% CI: 0.59–0.86) were inversely associated (all p < 0.01). Stratified analyses showed generally consistent directions of association. The GAM showed that methionine, arginine, and tyrosine had significant nonlinear relationships with EFG risk (P for nonlinearity < 0.05).ConclusionThe dietary amino acid intake is strongly associated with EFG levels in children and adolescents. Methionine and threonine are positively associated, and arginine and tyrosine are inversely associated. Collectively, these four amino acids may be important dietary correlates associated with abnormal glucose metabolism in this study population.
