Central European Journal of Public Health - Latest articles

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Comparison of occupational diseases development during one decade in the Slovak and Czech RepublicExploring Public Health Sciences: Insights from Slovak and Czech Research

Erik Drabiščák, Erik Dorko, Kvetoslava Rimárová, Jozef Varga

Cent Eur J Public Health 2024, 32(Suppl):S12-17 | DOI: 10.21101/cejph.a7885  

Objectives: An occupational disease (OD) is a disorder or health condition which arises due to work related activities and tasks or is caused by work environment. The impact of ODs on medical and social system may be considered as a very important in relation to mortality, morbidity, and invalidity. The most common ODs in the European Union are musculoskeletal disorders (58% of all ODs in 2015). The aim of the study was to determine the differences in the incidence of occupational diseases between the Slovak Republic (SK) and the Czech Republic (CZ). Methods: Data were obtained from the Health Statistics Yearbooks of the National Health Information...

Birth outcomes of advanced maternal age pregnanciesExploring Public Health Sciences: Insights from Slovak and Czech Research

Jana Diabelková, Erik Dorko, Kvetoslava Rimárová, Peter Urdzík, Zlatana Sulinová, Andrea Houžvičková, Miroslav Kopecký

Cent Eur J Public Health 2024, 32(Suppl):S8-11 | DOI: 10.21101/cejph.a8317  

Objective: Pregnancy at advanced maternal age has become more common over the last decades. Therefore, the study aimed to describe the characteristics and maternal and perinatal outcomes of women giving birth at advanced maternal age and very advanced age. Methods: We conducted a retrospective cohort study of 2,300 singleton births that occurred in 2020-2021 at the Department of Gynaecology and Obstetrics of the Louis Pasteur University Hospital in Košice. The control (age 20-34 years), advanced maternal age (35-39 years), and very advanced maternal age (≥ 40 years) groups included 1,851, 382, and 67 women, respectively. Exclusion criteria were...

Chronic diseases and spondylodiscitisExploring Public Health Sciences: Insights from Slovak and Czech Research

Róbert Čellár, Erik Dorko, Kvetoslava Rimárová, Dávid Sokol, Ahmad Gharaibeh, István Mitró, Rastislav Šepitka, Viliam Knap

Cent Eur J Public Health 2024, 32(Suppl):S4-7 | DOI: 10.21101/cejph.a7886  

Objective: Our research was focused to find a relation between the occurrence of spondylodiscitis and occurrence of chronic diseases. We were trying to discover some new risk factors and relations between chronic disorders in our research group. This analysis was also focused to detect factors that prolong the hospitalization of patients and worsen their prognosis. Methods: A study was carried out involving patients with spondylodiscitis treated between 2013 and 2022. A statistical analysis expressed by several coefficients was calculated in software IBM SPSS 21. Results: The study group comprised 32 (53.3%) females and 28 (46.7%) males. During the...

Sugar-sweetened beverages: taxation evidence from seven European countries and recommendations for implementation in other EU regions

Pavel Semerád, Petra Hospodková, Markéta Lamačová, Vladimír Rogalewicz, Ondřej Babuněk, Marian Dobranschi

Cent Eur J Public Health 2024, 32(4):279-287 | DOI: 10.21101/cejph.a8210  

Objectives: Higher-than-recommended sugar consumption (< 10% of total energy intake; WHO) leads to negative health impacts and the development of serious diseases. Sugar-sweetened beverages (SSBs) proved to be among the leading sources of free sugar intake, as they contain large amounts of added sugar. Our article aims to propose tax measures that will help change consumer behaviour and reduce SSBs consumption. Methods: For a comparison of the forms of taxation, the experience of seven countries (Denmark, France, Hungary, Italy, Poland, Catalonia - Spain, and the UK) were analysed. The evolution of sugar consumption, consumption of sweetened drinks...

Acrylamide content in selected food products collected from Montenegrin market and health risk assessment

Dijana Đurović, Miljan Bigović, Ljubica Ivanović, Maja Blagojević, Amil Orahovac

Cent Eur J Public Health 2024, 32(4):273-278 | DOI: 10.21101/cejph.a8260  

Objectives: This study aimed to investigate the acrylamide exposure of different children and adult population groups (10-14 years, 15-17 years, 18-24 years, 25-44 years, 45-64 years, and 65-74 years) resulting from the consumption of potato chips and wheat-based bread from Montenegrin market and to evaluate it in terms of health risk. Methods: The acrylamide content was monitored in 51 samples of bread and 20 samples of chips. The carcinogenic health risk in different population groups was assessed through the incremental lifetime cancer risk (CR) and total cancer risk (TCR). Results: The average acrylamide content in potato chips and bread was calculated...

Association between polychlorinated biphenyls and circulatory immune markers: results from NHANES 1999–2004

Ma Yuzhu, Li Wei, Liu Ying, Chen Yong, Hu Kesheng

Cent Eur J Public Health 2024, 32(4):263-272 | DOI: 10.21101/cejph.a8056  

Objectives: Polychlorinated biphenyls (PCBs), a family of persistent toxic and organic environmental pollutants, were associated with multiple organ damages in humans once accumulating. However, association between PCBs exposure and circulatory immune markers were not clear. Methods: Data was collected from participants enrolled in the National Health and Nutrition Examination Survey in 1999-2004. PCBs were categorized by latent class analysis (LCA). Weighted quantile sum (WQS) regression was used to investigate effects of PCBs exposure on circulatory immune markers including leukocyte counts, monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte...

Factors affecting smoking cessation success in individuals who applied to a smoking cessation centre

Türkan Günay, Nur Acar, Duygu Lüleci, Fatma Seven, Nurcan Şentürk Durukan, Hakan Baydur, Oğuz Kilinç, Şafak Taner

Cent Eur J Public Health 2024, 32(4):256-262 | DOI: 10.21101/cejph.a8295  

Objectives: This study aims to assess the frequency of smoking cessation and to identify the factors affecting smoking cessation success among individuals seeking assistance at a smoking cessation centre. Methods: This cross-sectional study included 1,570 individuals who applied to the smoking cessation centre in Izmir, Turkey, between 2009 and 2018, and completed three follow-ups. Data were obtained from the centre's records. Factors affecting smoking cessation success were analysed using logistic regression in multivariate analysis. Results: The median age to start smoking was 19 (17-22), and the median number of cigarettes consumed per day was 20...

Influence of smoking on human hearing – literature review

Karol Myszel, Piotr Henryk Skarżyński

Cent Eur J Public Health 2024, 32(4):251-255 | DOI: 10.21101/cejph.a8218  

Objectives: Smoking is a strong addiction, that affects a huge number of people worldwide, including the young ones. Due to composition of cigarette smoke, which contains nicotine and other chemical substances, lots of harmful effects on human health were described. Apart from the influence on other organs smoking is associated with hearing loss. Methods: The literature review was conducted using PubMed and the combination of the following words: smoking, hearing impairment and hearing loss. Results: The total number of 585 articles published in the recent 10 years were analysed. The review results show a strong association of hearing loss with smoking,...

Risk of metabolic syndrome linked to tobacco smoking and caffeine consumption among Palestinian university students

Ahmad Farhoud, Ibrahim Mahamid, Mohab Najjar, Anas Owda, Omar Safarini, Majdeddin MohammedAli, Ammar Thabaleh, Ahmed Mousa, Abdulraziq Zarour, Yazan Alhabil, Lubna Suadi, Zaher Nazzal, Basma Damiri

Cent Eur J Public Health 2024, 32(4):243-250 | DOI: 10.21101/cejph.a7320  

Objectives: The aim of the study was to determine the prevalence of metabolic syndrome (MetS) and its association with the use of tobacco smoking and caffeine consumption among Palestinian university students. Methods: A cross-sectional study was conducted in 2020 among university students at An-Najah National University in the West Bank. MetS was diagnosed according to the National Cholesterol Education Programme. We employed adjusted multiple logistic regression models to address the association between MetS and tobacco smoking and caffeine consumption. Results: The number of participants was 392. The findings revealed that 9.2% of the students met...

Postpartum depression in Ukrainian refugee women who gave birth abroad after beginning of large-scale war

Olena Kostiuk, Yelyzaveta Shunko, Roma Jusiene, Rima Breidokiene, Violeta Drejeriene, Sigita Lesinkiene, Arunas Valiulis

Cent Eur J Public Health 2024, 32(4):236-242 | DOI: 10.21101/cejph.a8003  

Objectives: The Russian military aggression against Ukraine in February 2022 became the cause of the biggest humanitarian crisis. Postpartum depression (PPD) is a type of mood disorder of pregnant and postpartum women. It was earlier reported that depression of pregnant women is increased in a combat zone, while effects of war on pregnant refugee and displaced women are less studied. The aim of the study was to determine the features of emotional state of temporarily displaced Ukrainian women who gave birth in Lithuania in spring-autumn 2022, and compare it with the state of Lithuanian women who were not directly affected by war. Methods: The study...

Post-pandemic health literacy: COVID-19 knowledge among future teachers in the Czech Republic

Tereza Sofková, Michaela Hřivnová

Cent Eur J Public Health 2024, 32(4):231-235 | DOI: 10.21101/cejph.a8091  

Objectives: The global situation concerning the incidence of infectious diseases emphasises the need for increased health literacy, particularly after the COVID-19 pandemic. A large part of this need relates to the area of education. The aim of this study was to analyse health literacy in relation to the cognitive dimension in the field of knowledge about the COVID-19 disease in the post-pandemic period among future teachers. Methods: The research sample comprised 286 female students in the first year of Bachelor's teacher training courses at the Faculty of Education in the Czech Republic. The research study was conducted during the academic year 2022/2023....

Attitudes of pregnant women toward vaccination against COVID-19 – a study conducted in Poland in the first quarter of 2022

Magdalena Konieczny, Dariusz Sobieraj, Aleksandra Niezgoda, Izabela Gąska, Aneta Mielnik, Mateusz Niemiec, Elżbieta Cipora

Cent Eur J Public Health 2024, 32(4):225-230 | DOI: 10.21101/cejph.a8177  

Objectives: The study aimed to assess the attitudes of pregnant women toward vaccination against COVID-19. Methods: The research was conducted using a diagnostic survey with our original questionnaire among 283 pregnant women. The survey was carried out in Poland in the first quarter of 2022. Statistical analyses were performed using IBM SPSS 26.0 (p < 0.05). Results: It was shown that 140 (49.5%) pregnant women were vaccinated against COVID-19, of which 90 (64.3%) received vaccination during pregnancy. In the group of 143 (50%) unvaccinated people, only 11.9% of respondents expressed willingness to be vaccinated against COVID-19. The most frequently...

Long-term consequences of COVID-19 on mental and physical health in young adults

Darina Falbová, Viktória Kovalčíková, Radoslav Beňuš, Lenka Vorobeľová

Cent Eur J Public Health 2024, 32(4):219-224 | DOI: 10.21101/cejph.a8118  

Objectives: This study investigates the impact of COVID-19 on various long-term psychological and physical symptoms in young adults from Slovakia. Methods: We assessed 229 Slovak young adults aged 18 to 30 years. Probands were interviewed using standardised questionnaires. The relationship between COVID-19 and long-term health symptoms was determined using Pearson's chi-square test. The McNemar test was used to determine the differences in health symptoms before and after COVID-19 recovery. Results: The statistically significant effect of COVID-19 after recovery on adverse cognitive health was only documented in women in the following symptoms: memory...

Socio-demographic and other factors contributing to excessive leisure screen time in preadolescent children

Kateřina Lukavská, Michal Božík, Niko Männikkö, Ondřej Hrabec, Michaela Slussareff, Jaroslav Vacek, Martina Píšová, Roman Gabrhelík

Cent Eur J Public Health 2024, 32(3):205-214 | DOI: 10.21101/cejph.a7941  

Objectives: Excessive screen use in early school age is associated with worsened health habits and negative child development in later age. We aimed to assess the time spent on modern and traditional screen-based devices and examine its associations with socio-demographic characteristics. Methods: This population-based cross-sectional observation study was conducted in Czechia, Slovakia and Finland between April and June 2021. Participants (N = 1,915) were parents/caregivers of children attending elementary school grades 1 to 3, selected by stratified random sampling. Children's daily leisure screen time (LST) based on parental reports was the main...

Role of diet in development of non-communicable diseases: focus on gut microbiome

Andrea Fričová, Anna Zavaďáková, Monika Bludovská

Cent Eur J Public Health 2024, 32(3):200-204 | DOI: 10.21101/cejph.a8138  

Objectives: The dietary composition is able to rapidly and significantly influence the diversity of the gut microbiome. This article focuses on how various types of diet affect the composition of the gut microbiome and how dietary changes are able to prevent or slow down the development of non-communicable diseases including obesity, type 2 diabetes mellitus, cardiovascular diseases, and low-grade inflammation. Methods: A review in PubMed and a hand search using references in identified articles were performed. Studies published in English from 2000 to 2024 were included. Results: The studies showed the significant effect of diet on the development...

A post-pandemic trend in the consumption of dietary supplements among residents of Lithuania

Rokas Arlauskas, Donatas Austys, Rimantas Stukas

Cent Eur J Public Health 2024, 32(3):189-199 | DOI: 10.21101/cejph.a8092  

Objectives: The consumption of dietary supplements might prevent the deficiency of necessary nutrients. On the other hand, in cases of overconsumption, adverse effects might occur. In Lithuania, the COVID-19 pandemic provoked an increase in the consumption of dietary supplements. The aim of this study was to reveal the post-pandemic trend of the consumption of dietary supplements among the working-age residents of Lithuania with respect to social and demographic factors and food selection criteria. Methods: A cross-sectional observational study was performed. In total, using the same methods, 3,200 residents were surveyed: 1,600 in 2021 and 1,600 in...

Mediterranean diet adherence in 9-years old children: a cross-sectional study in the part of the Split-Dalmatia County, Croatia

Katarina Tomelić Ercegović, Petar Đolonga, Zvonimir Družianić, Vladimir Ercegović, Željka Karin

Cent Eur J Public Health 2024, 32(3):183-188 | DOI: 10.21101/cejph.a8094  

Objectives: Childhood obesity is a growing global problem that can be prevented by improving diet quality. Mediterranean diet (MedDiet), historically present in Mediterranean countries, is considered one of the healthiest dietary patterns. This cross-sectional study aimed to determine the MedDiet adherence and anthropometric parameters in 9-year-old children from the central geographic locations of Split-Dalmatia County, Croatia. Methods: The study analysed data obtained from 158 children aged nine years from central parts of Dalmatia: Split and Hvar. To assess the MedDiet adherence, the parents of the children filled out the Mediterranean Diet Index...

Impact of climate on varicella distribution in Bulgaria (2009-2018)

Tatina Todorova

Cent Eur J Public Health 2024, 32(3):178-182 | DOI: 10.21101/cejph.a7792  

Objectives: Temperature is the most important environmental variable associated with the varicella frequency across the world. The present study compares the incidence of varicella in the districts of Bulgaria against some climatic factors and tries to find environmental variables which account for the differences in the varicella distribution observed among the Bulgarian districts. Methods: The 28 Bulgarian districts were used as units of observation and their average 10-year varicella incidence (2009-2018) was tested for correlation with the standard bioclimatic variables of WorldClim, version 2. Results: The WorldClim estimates for the annual mean...

Not bitten by Ixodes ticks or bitten without symptoms, why still to worry?

Mykhaylo Andreychyn, Maria Shkilna, Oleksandr Tokarskyy, Oleh Ivakhiv, Zoriana Smahlii, Mykhaylo Korda

Cent Eur J Public Health 2024, 32(3):173-177 | DOI: 10.21101/cejph.a8114  

Objectives: The purpose of the current study was to analyse the risks of Lyme borreliosis (LB) among 1,070 forestry workers, the influence of responsible behaviour (use of repellents, skin self-inspection) on Borrelia screening result status, and the occurrence of immediate and mid-term symptoms after tick bites and LB positive serological screening test. Methods: The questionnaire was conducted as well as blood tests for LB disease by one-stage serological screening procedure using ELISA for specific B. burgdorferi IgM and IgG antibodies (EuroImmun AG company, Germany). Results: While 39.6% of foresters were LB positive among bitten foresters,...

Comparison of cervical cancer screening models based on Pap and HPV tests in Tbilisi, Georgia

Eter Kiguradze, Tamar Skhirtladze, Nikoloz Chkhartishvili, Tamuna Gogoladze, Nino Chikhladze, Tamar Alibegashvili

Cent Eur J Public Health 2024, 32(3):166-172 | DOI: 10.21101/cejph.a8014  

Objective: The objective of this study was to evaluate the effectiveness of human papillomavirus HPV test with HPV16/18 genotyping and liquid-based cytology (LBC) triage as a primary screening method for cervical cancer compared to conventional Pap test in women undergoing routine cervical cancer screening in Tbilisi. Methods: Cross-sectional, prospective study was conducted, where 1,000 enrolled women aged 30-60 years during one visit underwent conventional Pap smear and Hr-HPV testing (Roche Cobas system). Women with any positive screening results were referred for further evaluation and remaining cells from the Cell Collection Medium vial were used...

Occupational respiratory disease in Eastern Slovakia between 1990-2021: a shift from agriculture to industrial manufacturing

Ľubomír Legáth, Ivan Tkáč, Petra Dittrichová, Ivan Perečinský, Miroslava Matejová, Slavomír Perečinský

Cent Eur J Public Health 2024, 32(3):160-165 | DOI: 10.21101/cejph.a8111  

Objectives: Occupational allergic respiratory diseases frequently occur in individuals working in the agricultural and food production sectors, textile manufacturing, and industries involving exposure to isocyanates. The study aimed to describe trends surrounding the prevalence of occupational asthma (OA), occupational rhinitis (OR), and occupational hypersensitivity pneumonitis (OHP) in Eastern Slovakia between 1990-2021. Methods: All cases of OA, OR, and OHP registered in a database at the Louis Pasteur University Hospital in Košice, Slovakia, between 1990 and 2021, were divided into categories based on economic sector (agricultural, food production...

Course and complications of influenza A in seniors over 65 years of age

Dalibor Sedláček, Robin Šín, Patrik Christian Cmorej, Miroslav Kubiska

Cent Eur J Public Health 2024, 32(3):155-159 | DOI: 10.21101/cejph.a7877  

Objectives: Influenza A and B viruses cause epidemics every year, with approximately 3-5 million serious cases and about 290,000 to 650,000 deaths worldwide. Most patients die from bacterial complications of influenza. The aim of our study was to describe the clinical pictures of influenza and the development of the complications in seniors over 65 years of age, who were treated in University Hospital Pilsen. The course of the disease and changes in laboratory parameters were evaluated with regard to the method of treatment performed. Methods: A descriptive retrospective study was performed. Clinical and laboratory data of seniors with the diagnosis...

Occurrence of adverse events following vaccination in patients with allergies: a prospective study

Petra Macounová, Hana Tomášková, Rastislav Maďar

Cent Eur J Public Health 2024, 32(3):147-154 | DOI: 10.21101/cejph.a8170  

Objectives: Allergic patients may be concerned about more frequent and/or more severe adverse events following vaccination, which may lead to the refusal of vaccines among these patients. The aim of this study is to assess whether allergic patients have more frequent adverse events (AEs) after vaccination than healthy individuals. Methods: Study participants (N = 591) underwent vaccination of their choice at a selected Vaccination and Travel Medicine Centre. At a 10 to 14-day interval, they were contacted for a telephone questionnaire survey on the occurrence of AEs after vaccination. A group of allergic patients (n = 188) and healthy controls (n =...

Organization of PhD studies at the Faculty of Public Health of the Slovak Medical University in the context of practiceShort communication

Eva Horváthová, Juraj Tihányi

Cent Eur J Public Health 2024, 32(2):137-142 | DOI: 10.21101/cejph.a7944  

Objectives: The Slovak Medical University (SMU) holds a unique position in the health education system in Slovakia. It has a direct connection to the health sector, allowing health education to reflect the actual needs in this field. Because of increasing importance of public health in the last decades, more attention must be given to disease prevention and the promotion of healthy lifestyles. We aim to highlight the main characteristics of health higher education at one of the specialized health universities in Slovakia, with a particular focus on public health and its practical impacts. Methods: We analysed the available legal regulations for postgraduate...

Some issues of compulsory vaccination of adults

Vít Vlček

Cent Eur J Public Health 2024, 32(2):132-136 | DOI: 10.21101/cejph.a8088  

Legal regulation, whether we want it or not, plays a role in protecting and promoting individual and public health. This also applies to legislation involving vaccination, especially compulsory vaccination. It is appropriate that legislation should not create barriers to the provision of health care. Where there is legal ambiguity, problems can arise that make the provision of health care more difficult, as we have seen, for example, in the context of the COVID pandemic. Furthermore, in the case of compulsory vaccination, there is a conflict between fundamental rights and freedoms. On the one hand, the right to the protection of personal freedom and...

Increase in measles cases in a City hospital, Istanbul, Turkey

Mehmet Karabey, Nuran Karabulut, Sema Alaçam, Alper Gündüz, Canan Caymaz, Özlem Altuntaş Aydin

Cent Eur J Public Health 2024, 32(2):125-131 | DOI: 10.21101/cejph.a7981  

Objectives: Measles cases are increasing remarkably in our country as well as all over the world. In this study, it was aimed to examine the epidemiological and clinical characteristics of measles cases detected in our hospital, as well as the measles seroprevalence in our region. Methods: A total of 7,452 individuals whose measles IgG and/or IgM antibodies were studied between December 2021 and March 2023 in the Medical Virology Laboratory in Başakşehir Çam and Sakura City Hospital were included in this retrospective study. Measles IgG and IgM antibodies were analysed by enzyme-linked immunosorbent assay. Demographic information, clinical symptoms...

A case-control epidemiological survey on potential risk factors for celiac disease

Matúš Bielik, Martin Selvek, Magda Suchánková, Ivana Shawkatová

Cent Eur J Public Health 2024, 32(2):119-124 | DOI: 10.21101/cejph.a8010  

Objectives: Celiac disease (CD) is a chronic autoimmune disorder caused by a complex interplay between genetic and environmental factors. The main goal of our case-control study was to analyse the association of environmental factors with the odds of CD development in a sample of the Slovak population. Methods: Data were collected from 1,226 respondents (534 CD patients and 692 controls) by a questionnaire. The impact of analysed parameters on the chance of disease development was assessed by multiple regression analysis and expressed as odds ratios (OR). Values of p < 0.05 were considered statistically significant. Results: In the patient group,...

Return to work after ischaemic stroke in young adults: a scoping review

Daniela Bartoníčková, Elena Gurková, Renáta Zeleníková, Soňa Kalafutová

Cent Eur J Public Health 2024, 32(2):108-118 | DOI: 10.21101/cejph.a7936  

Objectives: The aim of the study was to synthesize the body of knowledge on the factors that are important to the process of returning to work after ischaemic stroke in young adults under 55 years of age. Methods: Guidelines regarding the scoping review methodology developed by the Joanna Briggs Institute, and the PRISMA checklist for scoping reviews were used. A total of 2,249 studies were identified through a bibliographic search in six databases. Results: A total of ten studies were finally selected to respond to the research questions. Eight studies were quantitative observational studies, and two studies had a case study design. The rate of returning...

Dietary intake of plant polyphenols: Exploring trend in the Czech population

Pavel Sedláček, Monika Bludovská, Iveta Plavinová, Anna Zavaďáková, Luděk Müller, Dana Müllerová

Cent Eur J Public Health 2024, 32(2):101-107 | DOI: 10.21101/cejph.a7994  

Objectives: This study aimed to determine trend in polyphenol consumption in the Czech Republic during the last three decades. Additionally, it provides a brief overview of the beneficial effects of polyphenols in several body systems. Methods: Data from the Phenol-Explorer 3.6, a specialized database of polyphenolic substances, were assigned to the resources of the Czech Statistical Office on the consumption of food and beverages in the Czech Republic for the years 1989-2022. The average daily intake of polyphenols was determined by multiplying the average annual consumption of each type of food by the polyphenol content obtained from the database;...

Predictors of children's headaches during the second COVID-19 pandemic wave in the country with long-lasting lockdown

Roma Jusienė, Lina Lisauskienė, Edita Baukienė, Ilona Laurinaitytė, Rūta Praninskienė, Vaidotas Urbonas

Cent Eur J Public Health 2024, 32(2):95-100 | DOI: 10.21101/cejph.a8007  

Objectives: The current study examined the links and interactions among headaches, screen-based media use, physical activity, sleep, and the family environment in Lithuanian school-aged children during the second COVID-19 lockdown. Methods: The study comprised data of 541 children aged 7-14 years from different Lithuania regions, and without chronic health conditions or developmental disorders. Information about the child was provided by their parents or caregivers who filled questionnaire on child's screen time, sleep duration and quality, physical activity, parental distress, parent-child relationship, history of child's headaches and infectious...