Current opinion in pediatrics最新文献

Purpose of review: Food as Medicine (FAM) and supplemental nutrition programs like supplemental nutrition assistance program (SNAP), women, infants, and children (WIC), and school meals aim to combat rising diet-related chronic diseases and healthcare costs by addressing poor diet and food insecurity. However, their effectiveness is limited by a lack of community integration in planning, implementation, and evaluation. We introduce the Food Access, Justice, and Sovereignty (FAJS) framework, which expands FAM efforts to address acute food disparity through community-based strategies grounded in justice and sovereignty.

Recent findings: FAM interventions on adult populations have demonstrated a positive impact on food insecurity and its related chronic illness and shows promise for pediatric populations. However, community-driven solutions are essential for shifting power toward greater integration of the lived experiences of community, which can enhance positive behavioral changes needed for greater prevention and management of chronic illness.

Summary: Using community driven approaches through the lens of access, justice, and sovereignty address the effects of food insecurity and diet-related chronic diseases for adults and pediatric populations. Through the FAJS Framework, interventionalists can develop sustainable nutrition programs that engender community health, control, and lasting impact.

Purpose of review: The review is aimed at practising paediatricians who want to improve their clinical skills in observational gait analysis. Many paediatric complaints relate to problems of walking or limb alignment, and only a small proportion of these are pathological. With a deeper understanding of normal gait and a framework to conduct an observational analysis, the clinician can feel more confident diagnosing and recognizing those walking patterns that need further investigation.

Recent findings: Advances in instrumented gait analysis over the last two decades have provided deeper insights into the mechanisms of walking, how to interpret gait deviations, and their effect on locomotion. This has helped improve the quality of observational gait analysis and, in many ways, defined its limitations.

Summary: This review explains the components of normal gait and provides a structured approach to observational gait analysis. It also discusses the cause of limps and expands upon the importance of understanding rotational deformities. Finally, some tools to enhance the observational analysis are presented.

Purpose of review: Developmental dysplasia of the hip (DDH) is common and is a source of potentially avoidable morbidity through childhood and adult life. Despite progress over the past century, there is a wide variation in policy, practice and outcomes between countries. This review considers information from a geographically wide range of locations to evaluate the impact of these variations and understand how these variations arise. The aim is to help clinicians and policymakers adopt the best practices for their population.

Recent findings: There is a lack of randomized controlled trials to guide decisions on screening. Given the large numbers to treat and preexisting practices, it is unlikely that such trials of sufficient statistical power will be performed. However, many whole population studies are becoming available from different countries that allow an assessment and comparison of the impact of their strategies.

Summary: Standardizing metrics in studies and defining late diagnosis would improve comparisons across studies. The general trend appears to favour universal screening to reduce the risk of late diagnosis, the need for surgery and the subsequent poorer outcomes. Notably, resource-constrained countries like Mongolia have successfully implemented universal screening, showing that effective strategies can be adopted regardless of resources.

Purpose of review: With growing emphasis on data-driven research in pediatric oncology, particularly in the context of advances in molecular characterization and precision medicine, there is an urgent need for comprehensive data-sharing initiatives. This review explores how the Childhood Cancer Data Initiative (CCDI) addresses this critical need.

Recent findings: CCDI plays a key role in enhancing pediatric cancer research by improving data integration, sharing, and collaboration. Its Molecular Characterization Initiative advances the field by leveraging detailed molecular data to inform clinical trials and therapeutic strategies. For small patient populations, such as those with rhabdomyosarcoma, CCDI's efforts in integrating data across institutions are vital for advancing risk-based treatment strategies to achieve meaningful clinical outcomes.

Summary: CCDI's advancements in data sharing have profound implications for both clinical practice and research. By enabling precise diagnoses, tailoring treatments based on individual genetic profiles, and addressing the challenges associated with small patient populations, CCDI is driving transformative changes in pediatric oncology. Continued support and expansion of such initiatives are crucial to fully realizing their potential in improving outcomes for children with cancer.

Purpose of review: The growth of rich electronic health record (EHR) data and large health databases has introduced new opportunities to link individuals together into households and relational networks. These 'linked relational networks' hold promise for providing family-level care and studying intergenerational epidemiology and clinical outcomes. However, as linked relational networks become more commonly available in EHRs and research databases, it is critical to understand their challenges and limitations.

Recent findings: Matching algorithms are being used to create linked relational networks in EHR and health databases. Clinically, these algorithms have been most useful to provide dyadic maternal-newborn care. In research, studies using these algorithms investigate topics ranging from the pharmacoepidemiology of parental drug exposure on childhood health outcomes, to heritability of chronic conditions, to associations between parental and child healthcare access and service delivery. However, ethical and technical challenges continue to limit use of these algorithms. There is also a critical research gap in the external validity of these matching algorithms.

Summary: Linked relational networks are in widespread use in pediatric clinical care and research. More research is needed to understand the scope, limitations, and biases inherent in existing matching strategies.

Purpose of review: To summarize the impact of financial hardship on children whose parents have been incarcerated, describe both existing cash transfer and guaranteed income programs, and highlight their impact on child and family well being.

Recent findings: Emerging data on guaranteed income programs for formerly incarcerated adults indicates that the funds improve recipient health and legal system outcomes and allow participants to spend funds on stabilizing themselves and their families. Guaranteed income programs in the broader population similarly highlight the use of funds to support families' basic needs and improved parent-child relationships, but more data are needed to understand the impact on child health and well being among families impacted by the criminal legal system.

Summary: Over 5 million children experience parental incarceration, which directly contributes to financial hardship and subsequent negative health outcomes. Cash transfers may assist these families, but policies and administrative burdens limit the ability of existing programs to fully address financial hardship. Guaranteed income programs may therefore serve a unique role in supporting the financial needs of families impacted by incarceration. More longitudinal data focusing on child health outcomes are necessary to fully understand the impact of guaranteed income of children and families impacted by parental incarceration.

Purpose of review: Patella alta, which describes an abnormally proximally positioned patella, has become of particular interest as it has been identified as a potential factor in patellofemoral instability (PFI) and other common pediatric orthopedic conditions. The purpose of this review is to describe the condition, measuring techniques, and its association with pediatric orthopedic conditions, and to evaluate methods of correction of patella alta.

Recent findings: Recent literature has explored the etiology of patella alta by investigating patellar height as age increases, with inconclusive findings as to whether the condition is congenital or acquired over time. Additionally, patella alta has been identified to be associated with several pediatric orthopedic conditions, including PFI, anterior knee pain, and cerebral palsy. As such, methods of correction for patella alta, including medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle distalization, and patella tendon imbrication, have been studied.

Summary: Patella alta, defined by an abnormally high patellar height, is associated with patellofemoral instability, anterior knee pain, and cerebral palsy. Various indices have been developed to measure and define patellar height, including the Caton-Deschamps Index and Koshino-Sugimoto Index which are applicable to a pediatric population. Treatments include isolated or concomitant MPFLR, distalizing tibial tubercle osteotomy, and patella tendon imbrication, which have shown success in reducing patellar height and improving patella alta, though risks for complications do exist.

Purpose of review: The purpose of this review is to describe the current trends in the treatment of Cozen's phenomenon and evaluate if there are changes in the treatment paradigm due to the advent of implant-mediated guided growth.

Recent findings: Current literature emphasizes the need for early recognition of Cozen's phenomenon (tibia valgus), with a high incidence associated with proximal tibia fractures. There are cases with late onset progression of the valgus deformity, which can be easily treated with implant-mediated guided growth.

Summary: Clinical observation continues to be the current standard of treatment for this phenomenon. An average surveillance time of 2 years postfracture is recommended to observe for valgus deformity of the tibia. During this period, implant-mediated guided growth may be utilized to correct tibial deformity, which is an easier and safer solution than tibial osteotomy.

Purpose of review: We provide an overview of the etiology of childhood cancer, the state of the literature, and highlight some opportunities for future research, including technological advancements that could be applied to etiologic studies of childhood cancer to accelerate our understanding.

Recent findings: Risk factors of childhood cancer were summarized based on demographics and perinatal factors, environmental risk factors, and genetic risk factors. Overall, demographics and perinatal factors are the most well studied in relation to childhood cancer. While environmental risk factors have been implicated, more work is needed to pinpoint specific exposures, identify window(s) of susceptibility, and understand mechanisms. With genome-wide association studies (GWAS), genetic risk factors of eight childhood cancers have emerged, and opportunities remain to conduct GWAS for other cancer types and determine whether risk variants are inherited or de novo. Technological advancements that can shed light into the susceptibility of childhood cancer include metabolomics, using primary teeth as an exposure matrix, and long-read sequencing.

Summary: The development of childhood cancer remains largely not well understood. Collaboration to increase sample size to conduct analyses by histology and/or molecular subtype and application of novel technologies will accelerate our understanding of childhood cancer.

Purpose of review: Primary mitochondrial disease (PMD) is diverse both genetically and phenotypically. Neurologic manifestations are present at a high rate and often pose complications for providers. The review will discuss common manifestations and how advances in genetic testing have broadened understanding of PMDs.

Recent findings: Across all areas of PMD research, genetic advancements are notable both for mitochondrial and nuclear DNA.

Summary: Global understanding of PMDs is driving deeper and broader research. Neurologic manifestations primarily include neuromuscular disease, epilepsy, stroke-like episodes and neurodegeneration, and advances in all areas have benefitted from global reporting of genetic studies.