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Evidence That Intervention Dosage Is Associated With Better Outcomes in Autism-Reply. 干预剂量与自闭症患者更好的治疗效果相关的证据--回复。
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-11-04 DOI: 10.1001/jamapediatrics.2024.4707
Micheal Sandbank, James E Pustejovsky
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引用次数: 0
Large Language Model Responses to Adolescent Patient and Proxy Messages. 大语言模型对青少年患者和代理信息的反应。
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-11-04 DOI: 10.1001/jamapediatrics.2024.4438
Gabriel Tse, Aydin Zahedivash, Arash Anoshiravani, Jennifer Carlson, William Haberkorn, Keith E Morse
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引用次数: 0
Errors in Figure. 图中的错误。
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-11-04 DOI: 10.1001/jamapediatrics.2024.5032
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引用次数: 0
Day Care Attendance and Risk of Type 1 Diabetes: A Meta-Analysis and Systematic Review. 参加日托与罹患 1 型糖尿病的风险:元分析和系统回顾
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-11-04 DOI: 10.1001/jamapediatrics.2024.4361
Susanna Tall, Suvi M Virtanen, Mikael Knip

Importance: A meta-analysis published in 2001 suggested that exposure to infections measured by day care attendance may be important in the pathogenesis of type 1 diabetes. Several new studies on the topic have since been published.

Objective: To investigate the association between day care attendance and risk of type 1 diabetes and to include all available literature up to March 10, 2024.

Data sources: Data from PubMed and Web of Science were used and supplemented by bibliographies of the retrieved articles and searched for studies assessing the association between day care attendance and risk of type 1 diabetes.

Study selection: Studies that reported a measure of association between day care attendance and risk of type 1 diabetes were included.

Data extraction and synthesis: Details, including exposure and outcome assessment and adjustment for confounders, were extracted from the included studies. The multivariable association with the highest number of covariates, lowest number of covariates, and unadjusted estimates and corresponding 95% CIs were extracted. DerSimonian and Laird random-effects meta-analyses were performed and yielded conservative confidence intervals around relative risks.

Main outcomes and measures: The principal association measure was day care attendance vs no day care attendance and risk of type 1 diabetes.

Results: Seventeen articles including 22 observational studies of 100 575 participants were included in the meta-analysis. Among the participants, 3693 had type 1 diabetes and 96 882 were controls. An inverse association between day care attendance and risk of type 1 diabetes was found (combined odds ratio, 0.68; 95% CI, 0.58-0.79; P < .001; adjusted for all available confounders). When the 3 cohort studies included were analyzed separately, the risk of type 1 diabetes was 15% lower in the group attending day care; however, the difference was not statistically significant (odds ratio, 0.85; 95% CI, 0.59-1.12; P = .37).

Conclusions and relevance: These results demonstrated that day care attendance appears to be associated with a reduced risk of type 1 diabetes. Increased contacts with microbes in children attending day care compared with children who do not attend day care may explain these findings. However, further prospective cohort studies are needed to confirm the proposed association.

重要性:2001 年发表的一项荟萃分析表明,通过日托机构的出勤率来衡量是否受到感染,可能对 1 型糖尿病的发病机制有重要影响。此后,又有几项新的相关研究发表:调查日间护理出席率与 1 型糖尿病风险之间的关联,并纳入截至 2024 年 3 月 10 日的所有可用文献:数据来源: 我们使用了 PubMed 和 Web of Science 的数据,并对检索到的文章的参考书目进行了补充,以搜索评估日托出席率与 1 型糖尿病风险之间关联的研究:数据提取与综合:从纳入的研究中提取详细信息,包括暴露和结果评估以及混杂因素调整。数据提取:从纳入的研究中提取了包括暴露和结果评估以及混杂因素调整在内的详细信息,并提取了具有最多协变因素、最少协变因素以及未调整估计值和相应 95% CI 的多变量关联。进行了 DerSimonian 和 Laird 随机效应荟萃分析,得出了相对风险的保守置信区间:主要结果和测量方法:主要的关联测量方法是参加日托与不参加日托与 1 型糖尿病风险的关系:荟萃分析纳入了 17 篇文章,包括 22 项观察性研究,共有 100 575 名参与者。其中,3693 人患有 1 型糖尿病,96882 人为对照组。研究发现,参加日托与罹患 1 型糖尿病的风险呈反向关系(综合几率比为 0.68;95% CI 为 0.58-0.79;P 结论及意义:这些结果表明,参加日托似乎与降低罹患 1 型糖尿病的风险有关。与不参加日托的儿童相比,参加日托的儿童与微生物的接触增加,这可能是这些发现的原因。不过,还需要进一步的前瞻性队列研究来证实所提出的关联。
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引用次数: 0
Tracking and Transition Probability of Blood Pressure From Childhood to Midadulthood. 从童年到中年的血压跟踪和过渡概率。
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-11-04 DOI: 10.1001/jamapediatrics.2024.4368
Yaxing Meng, James E Sharman, Fiia Iiskala, Feitong Wu, Markus Juonala, Katja Pahkala, Suvi P Rovio, Brooklyn J Fraser, Rebecca K Kelly, Nina Hutri, Mika Kähönen, Tomi Laitinen, Antti Jula, Jorma S A Viikari, Olli T Raitakari, Costan G Magnussen
<p><strong>Importance: </strong>Despite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remain understudied.</p><p><strong>Objective: </strong>To evaluate BP tracking from childhood to midadulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multiple time points.</p><p><strong>Design, setting, and participants: </strong>The analyses were performed in 2023 using data gathered from September 1980 to August 2018 within the longitudinal Cardiovascular Risk in Young Finns Study. Participants had BP examined 9 times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and midadulthood (39-56 years).</p><p><strong>Exposures: </strong>BP classifications (normal, elevated, hypertension) were based on AAP guidelines for children and adolescents and the 2017 American College of Cardiology/American Heart Association guidelines for adults.</p><p><strong>Main outcomes and measures: </strong>Outcomes were BP classifications at follow-up visits. Tracking coefficients were calculated using generalized estimated equations. Transition probabilities among BP classifications were estimated using multistate Markov models.</p><p><strong>Results: </strong>This study included 2918 participants (mean [SD] baseline age, 10.7 [5.0] years; 1553 female [53.2%]). Over 38 years, the tracking coefficient (odds ratio [OR]) for maintaining elevated BP/hypertension was 2.16 (95% CI, 1.95-2.39). Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP from childhood to midadulthood (transition probability: from normal BP to stage 2 hypertension, 0.20; 95% CI, 0.17-0.22 vs 0.08; 95% CI, 0.07-0.10; maintaining stage 2 BP, 0.32; 95% CI, 0.27-0.39 vs 0.14; 95% CI, 0.09-0.21; from stage 2 hypertension to normal BP, 0.23; 95% CI, 0.19-0.26 vs 0.58; 95% CI, 0.52-0.62. For both sexes, the probability of transitioning from adolescent hypertension to normal BP in midadulthood was lower (transition probability, ranging from 0.16; 95% CI, 0.14-0.19 to 0.44; 95% CI, 0.39-0.48) compared with childhood hypertension (transition probability, ranging from 0.23; 95% CI, 0.19-0.26 to 0.63; 95% CI, 0.61-0.66). The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter. Children with normal BP generally maintained this status into adolescence (male: transition probability, 0.64; 95% CI, 0.60-0.67; female: transition probability, 0.81; 95% CI, 0.79-0.84) but decreased by young adulthood (male: transition probability, 0.41; 95% CI, 0.39-0.44; female: transition probability, 0.69; 95% CI, 0.67-0.71).</p><p><strong>Conclusion and relevance: </strong>Results of this cohort study reveal an e
重要性:尽管小儿血压(BP)筛查与此相关,但小儿血压分类的长期预测效用和自然进展仍未得到充分研究:目的:使用美国儿科学会(AAP)阈值评估从儿童到成年中期的血压跟踪,并考虑多个时间点,估算血压分类随时间推移的过渡概率:分析于 2023 年进行,使用的是 "芬兰年轻人心血管风险纵向研究 "从 1980 年 9 月至 2018 年 8 月期间收集的数据。参与者在 38 年中接受了 9 次血压检查,从童年(6-12 岁)或青春期(15-18 岁)到青年期(21-27 岁)、青年晚期(30-37 岁)和中年期(39-56 岁):血压分类(正常、升高、高血压)基于美国儿童和青少年协会指南以及 2017 年美国心脏病学会/美国心脏协会成人指南:结果为随访时的血压分类。采用广义估计方程计算追踪系数。使用多态马尔可夫模型估算血压分类之间的转换概率:本研究共纳入 2918 名参与者(平均 [SD] 基线年龄为 10.7 [5.0] 岁;1553 名女性 [53.2%])。在 38 年的时间里,血压/高血压持续升高的追踪系数(几率比 [OR])为 2.16(95% CI,1.95-2.39)。与女性相比,男性从儿童期到中年期发展为高血压并维持高血压的概率更高,而恢复正常血压的概率更低(过渡概率:从正常血压到 2 期高血压,0.20;95% CI,0.17-0.22 vs 0.08;95% CI,0.07-0.10;维持 2 期血压,0.32;95% CI,0.27-0.39 vs 0.14;95% CI,0.09-0.21;从 2 期高血压到正常血压,0.23;95% CI,0.19-0.26 vs 0.58;95% CI,0.52-0.62。与儿童期高血压(过渡概率从 0.23;95% CI,0.19-0.26 到 0.63;95% CI,0.61-0.66)相比,中年期男女从青春期高血压过渡到正常血压的概率较低(过渡概率从 0.16;95% CI,0.14-0.19 到 0.44;95% CI,0.39-0.48)。血压保持正常的概率在最初的 5 到 10 年间急剧下降,之后趋于稳定。血压正常的儿童一般会在青春期保持这种状态(男性:过渡概率,0.64;95% CI,0.60-0.67;女性:过渡概率,0.81;95% CI,0.79-0.84),但到了青年期,这种状态会有所下降(男性:过渡概率,0.41;95% CI,0.39-0.44;女性:过渡概率,0.69;95% CI,0.67-0.71):这项队列研究的结果表明,儿童和青少年时期的血压(AAP 阈值)与日后的血压有持久的联系。虽然儿童期正常血压往往会维持到青春期,但从青春期到青年期,恢复和维持正常血压的概率会明显下降。这项研究结果强调了从儿童时期开始预防以维持正常血压的重要性,并指出青春期是一个潜在的关键时期。研究结果表明,对于最初血压正常的儿童,可以减少筛查的频率。
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引用次数: 0
Low-Dose Iron and Early Development in Breastfed Infants. 低剂量铁与母乳喂养婴儿的早期发育。
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-11-01 DOI: 10.1001/jamapediatrics.2024.3297
Pin-Yen Chen, Chung-Ming Chen
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引用次数: 0
Low-Dose Iron and Early Development in Breastfed Infants. 低剂量铁与母乳喂养婴儿的早期发育。
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-11-01 DOI: 10.1001/jamapediatrics.2024.3300
Hong-Kun Jiang, Wan-Lin Cui
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引用次数: 0
Prevalence of Obesity Is Higher Than Published Estimates Suggest. 肥胖症的发病率高于已公布的估计值。
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-11-01 DOI: 10.1001/jamapediatrics.2024.3618
John J Reilly
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引用次数: 0
Mild Traumatic Brain Injury and Criminal Charges and Convictions in Mid and Late Adolescence. 轻度脑外伤与青春期中后期的刑事指控和定罪。
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-11-01 DOI: 10.1001/jamapediatrics.2024.3452
Ea Hoppe Blaabæk, Daniel Juhász Vigild, Felix Elwert, Peter Fallesen, Lars H Andersen

Importance: Childhood exposure to mild traumatic brain injury (mTBI) is common. Individuals with a childhood history of mTBI experience more frequent criminal justice involvement in mid to late adolescence and adulthood. No study had been conducted to examine whether the link is causal or spurious.

Objective: To determine whether mTBI in childhood causes criminal justice involvement in mid to late adolescence.

Design, setting, and participants: This cohort study used population-based data for all children born between 1995 and 2000 in Denmark, with data linked to emergency department (ED) visits and hospitalizations before age 10 years and all criminal charges and convictions from ages 15 to 20 years. The exposure group contained all individuals diagnosed with mTBI before age 10 years without other intracranial or extracranial injuries; the comparison group was individuals not diagnosed with mTBI or intracranial or extracranial injuries. Sibling and twin fixed-effects models were used to evaluate the association after controlling for family-level confounding. Data were analyzed from May 2021 to July 2024.

Exposures: Mild TBI before age 10 years without other intracranial or extracranial injuries before or at the time of diagnosis.

Main outcomes and measures: Associations between mTBI before age 10 years and criminal charges and convictions from ages 15 to 20 for the entire study population and separately by sex at birth, controlling for additional covariates.

Results: The final analytic sample consisted of 343 027 individuals, 13 514 in the exposure group and 329 513 in the comparison group. Of the total sample, 166 455 (49%) were female and 176 572 were male (51%). A total of 326 191 participants (95%) had at least 1 parent with Danish citizenship, and 79 386 mothers (23%) held a college degree. There was a positive association between mTBI and criminal charges (odds ratio [OR], 1.26; 95% CI, 1.19-1.34) and convictions (OR, 1.24; 95% CI, 1.16-1.33). When controlling for family-level confounding, the associations became statistically insignificant and, in most models, greatly reduced. Results were robust across multiple model specifications.

Conclusions and relevance: This study found that although mTBI in childhood was predictive of adolescent criminal justice involvement, there was no evidence that mTBI caused criminal charges or convictions.

重要性:童年时期受到轻微创伤性脑损伤 (mTBI) 是一种常见现象。有轻微脑损伤童年史的人在青春期中后期和成年后会更频繁地卷入刑事司法程序。目前还没有研究探讨这种联系是因果关系还是虚假关系:目的:确定童年时期的创伤性脑损伤是否会导致青春期中后期的刑事司法参与:这项队列研究使用了丹麦 1995 年至 2000 年间出生的所有儿童的人口数据,这些数据与 10 岁前的急诊室就诊和住院以及 15 至 20 岁期间的所有刑事指控和定罪相关联。暴露组包括所有在10岁前被诊断为mTBI且无其他颅内或颅外损伤的个体;对比组为未被诊断为mTBI或颅内或颅外损伤的个体。在控制了家庭层面的混杂因素后,使用同胞和双胞胎固定效应模型来评估相关性。数据分析时间为2021年5月至2024年7月:10岁前轻度创伤性脑损伤,诊断前或诊断时无其他颅内或颅外损伤:在控制其他协变量的情况下,整个研究人群10岁前的轻度创伤性脑损伤与15至20岁期间的刑事指控和定罪之间的关系,并按出生时的性别分别进行分析:最终分析样本包括 343 027 人,其中暴露组 13 514 人,对比组 329 513 人。在所有样本中,女性 166 455 人(占 49%),男性 176 572 人(占 51%)。共有 326 191 名参与者(95%)的父母中至少有一人拥有丹麦国籍,79 386 名母亲(23%)拥有大学学位。mTBI 与刑事指控(几率比 [OR],1.26;95% CI,1.19-1.34)和定罪(OR,1.24;95% CI,1.16-1.33)之间存在正相关。在控制了家庭层面的混杂因素后,这些关联在统计上变得不显著,而且在大多数模型中大大降低。在多个模型规格中,结果都是稳健的:本研究发现,虽然儿童期的创伤性脑损伤可预测青少年刑事司法参与,但没有证据表明创伤性脑损伤会导致刑事指控或定罪。
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引用次数: 0
Pooled Analysis of Physical Activity, Sedentary Behavior, and Sleep Among Children From 33 Countries. 对 33 个国家儿童的体育活动、久坐行为和睡眠情况进行汇总分析。
IF 24.7 1区 医学 Q1 PEDIATRICS Pub Date : 2024-11-01 DOI: 10.1001/jamapediatrics.2024.3330
Kar Hau Chong, Thomas Suesse, Penny L Cross, Sarah T Ryan, Eivind Aadland, Oluwayomi Aoko, Ankhmaa Byambaa, Valerie Carson, Jean-Philippe Chaput, Hayley Christian, Dylan P Cliff, Marieke De Craemer, Clarice Maria de Lucena Martins, Christine Delisle Nyström, Catherine E Draper, Asmaa El Hamdouchi, Alex Antonio Florindo, Hongyan Guan, Amy S Ha, Najmeh Hamzavi Zarghani, Kylie D Hesketh, Mohammad Sorowar Hossain, Jajat Jajat, Thanh Kim, Denise Koh, Anna V Kontsevaya, Nicholas Kuzik, Marja H Leppänen, Marie Löf, Himangi Lubree, Kim Meredith-Jones, Tawonga W Mwase-Vuma, Johan Y Y Ng, Rachel Novotny, Jackline Jema Nusurupia, Bang N Pham, Bee Koon Poh, John J Reilly, Amanda E Staiano, Kuston Sultoni, Chiaki Tanaka, Hong K Tang, Rachael W Taylor, Simone A Tomaz, Mark S Tremblay, Stewart G Trost, Ali Turab, Susana Vale, V Pujitha Wickramasinghe, Anthony D Okely

Importance: The prevalence estimates of physical activity, sedentary behavior, and sleep (collectively known as movement behaviors) in 3- and 4-year-old children worldwide remains uncertain.

Objective: To report the proportion of 3- and 4-year-old children who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep across 33 countries.

Design, setting, and participants: Pooled analysis of data from 14 cross-sectional studies (July 2008 to September 2022) identified through systematic reviews and personal networks. Thirty-three countries of varying income levels across 6 geographical regions. Each study site needed to have at least 40 children aged 3.0 to 4.9 years with valid accelerometry and parent-/caregiver-reported screen time and sleep duration data. Data were analyzed from October 2022 to February 2023.

Exposures: Time spent in physical activity was assessed by reanalyzing accelerometry data using a harmonized data-processing protocol. Screen time and sleep duration were proxy reported by parents or caregivers.

Main outcomes and measures: The proportion of children who met the World Health Organization guidelines for physical activity (≥180 min/d of total physical activity and ≥60 min/d of moderate- to vigorous-intensity physical activity), screen time (≤1 h/d), and sleep duration (10-13 h/d) was estimated across countries and by World Bank income group and geographical region using meta-analysis.

Results: Of the 7017 children (mean [SD] age, 4.1 [0.5] years; 3585 [51.1%] boys and 3432 [48.9%] girls) in this pooled analysis, 14.3% (95% CI, 9.7-20.7) met the overall guidelines for physical activity, screen time, and sleep duration. There was no clear pattern according to income group: the proportion meeting the guidelines was 16.6% (95% CI, 10.4-25.3) in low- and lower-middle-income countries, 11.9% (95% CI, 5.9-22.5) in upper-middle-income countries, and 14.4% (95% CI, 9.6-21.1) in high-income countries. The region with the highest proportion meeting the guidelines was Africa (23.9%; 95% CI, 11.6-43.0), while the lowest proportion was in North and South America (7.7%; 95% CI, 3.6-15.8).

Conclusions and relevance: Most 3- and 4-year-old children in this pooled analysis did not meet the current World Health Organization guidelines for physical activity, sedentary behavior, and sleep. Priority must be given to understanding factors that influence these behaviors in this age group and to implementing contextually appropriate programs and policies proven to be effective in promoting healthy levels of movement behaviors.

重要性:全球 3-4 岁儿童的体力活动、久坐行为和睡眠(统称为运动行为)的流行率估计值仍不确定:目的:报告 33 个国家中符合世界卫生组织体育锻炼、久坐不动和睡眠指导原则的 3-4 岁儿童的比例:对通过系统回顾和个人网络确定的 14 项横断面研究(2008 年 7 月至 2022 年 9 月)的数据进行汇总分析。横跨 6 个地理区域的 33 个不同收入水平的国家。每个研究地点至少需要有 40 名年龄在 3.0 至 4.9 岁之间的儿童,并提供有效的加速度测量和家长/护理人员报告的屏幕时间和睡眠时间数据。数据分析时间为 2022 年 10 月至 2023 年 2 月:暴露:通过使用统一的数据处理协议重新分析加速度计数据来评估体育活动时间。屏幕时间和睡眠时间由父母或看护人代理报告:主要结果和测量方法:采用荟萃分析法,按世界银行收入组别和地理区域估算了不同国家符合世界卫生组织体力活动指南(总体力活动时间≥180 分钟/天,中高强度体力活动时间≥60 分钟/天)、屏幕时间(≤1 小时/天)和睡眠时间(10-13 小时/天)的儿童比例:在本次汇总分析的 7017 名儿童(平均 [SD] 年龄为 4.1 [0.5]岁;3585 [51.1%] 名男孩和 3432 [48.9%] 名女孩)中,14.3%(95% CI,9.7-20.7)的儿童符合体育活动、屏幕时间和睡眠时间的总体指导方针。收入组别没有明显的模式:低收入和中低收入国家中符合指导方针的比例为 16.6%(95% CI,10.4-25.3),中上收入国家为 11.9%(95% CI,5.9-22.5),高收入国家为 14.4%(95% CI,9.6-21.1)。符合指南要求比例最高的地区是非洲(23.9%;95% CI,11.6-43.0),而比例最低的地区是北美和南美(7.7%;95% CI,3.6-15.8):在这项汇总分析中,大多数 3-4 岁儿童的体力活动、久坐行为和睡眠都不符合世界卫生组织的现行指导方针。我们必须优先了解影响该年龄组儿童这些行为的因素,并根据具体情况实施经证实能有效促进健康运动行为的计划和政策。
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引用次数: 0
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JAMA Pediatrics
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