Children-Basel最新文献

Background: Food allergy [FA] is a growing public health concern among school-age children, with schools and childcare/daycare settings representing high-risk environments for accidental exposure and anaphylaxis. Objective: To systematically review evidence on digital health interventions supporting FA education, prevention, and management in school settings. Methods: A systematic search of PubMed, Scopus, Web of Science, and CINAHL was conducted to identify studies published between January 2015 and December 2025 [PROSPERO CRD420251185553]. Eligible studies evaluated e-learning, mHealth, or web-based programs targeting school staff, parents, or students. Results: Sixteen studies met inclusion criteria. Digital health emerged as a catalyst for professional development, interprofessional communication, and health equity within school communities. Interventions consistently improved knowledge, preparedness, and self-efficacy in anaphylaxis management among school staff, strengthened parental empowerment and communication with schools, and supported coping and inclusion among allergic children. Evidence on clinical outcomes; however, remains limited. Conclusions: Digital health can meaningfully enhance school preparedness and reduce inequalities in allergy management. Integrating digital tools into national school health frameworks-particularly where school nursing is not yet institutionalized-may represent a pivotal step toward safer, more equitable inclusion of children with food allergy.

Background/Objectives: The optimal timing for inguinal hernia repair in premature infants remains controversial. Most premature patients in our institution undergo repair just before discharge. This study evaluates postoperative complications in premature patients and proposes the optimal timing for hernia repair. Methods: A retrospective single-center review was conducted between January 2020 and November 2023. All infants undergoing hernia repair as inpatients under 50 weeks postmenstrual age (PMA) were included. Data collected included demographic details, perioperative characteristics, and postoperative outcomes. Results: A total of 202 patients were analyzed. Forty-five patients underwent surgery before 38 weeks PMA (early group), and 157 after 38 weeks PMA (late group). The early group had significantly lower gestational age, lower body weight, and more comorbidities. Postoperative respiratory complications were more frequent in the early group. Conclusions: Repair after 38 weeks PMA is associated with fewer respiratory complications while earlier repair increases transient airway support requirements.

Background: Parental loss in childhood is a significant developmental risk factor, underscoring the need for evidence-based knowledge to guide support. Although social responses play a central role in children's adjustment to loss, little is known about how parentally bereaved children in Israel experience social support in school. Methods: This qualitative study examined how parentally bereaved children in elementary and middle school experience social responses in the school context. Thirty-six participants were interviewed: 20 children who participated in dyadic interviews with their 16 surviving parents. Linguistic analysis, combined with Grounded Theory, was used to analyze the data. Results: Peer support was found to lie on a continuum ranging from support, through an unintentional lack of support, to deliberate nonsupport (teasing). These patterns shaped children's experiences of returning to school, their sense of belonging, and their ability to share their grief. Conclusions: The findings, discussed in light of the Dual Process Model of Coping with Bereavement, highlight the crucial role of peers in children's adaptation to parental loss. Developing evidence-based knowledge in this area may inform policy change and tailored school-based training to promote optimal support for parentally bereaved children.

Background/objectives: A neonatal intensive care units (NICU) admission of a premature infant is lifesaving; however, it can also be emotionally devastating experiences for parents. Family-centered care (FCC) interventions are designed to support parents and infants in the NICUs by integrating families into care delivery through partnerships with healthcare professionals. Heterogeneity in outcome reporting across FCC studies limits comparability. Developing a core outcome set (COS) for FCC is essential to address this gap.

Aim: The aim of this study was to explore the views of former neonatal patients, parents, and healthcare professionals who have experiences with FCC in neonatal settings and elucidate outcomes that are important to them.

Methods: This study followed the Core Outcome Measures Effectiveness Trial Handbook, which suggests involving stakeholders in identifying outcomes to reflect what is important to them rather than to researchers. Nine focus group discussions were conducted with 27 international key stakeholders from multiple countries (former neonatal patient n = 1; parents n = 8; healthcare professionals n = 18), reflecting FCC experiences across different neonatal settings. Data were analyzed using a modified framework analysis.

Findings: Five outcome domains were identified including 42 distinct outcomes: (1) Emotional functioning/wellbeing of parents, infants, and healthcare professionals, reflecting emotional responses to a NICU admission of an infant; (2) Role functioning of parents, healthcare professionals, and others, highlighting that FCC strengthens their roles; (3) Delivery of care, highlighting the role of staff attitudes and organizational factors in supporting FCC; (4) Physiological health, reflecting infant physical health; (5) Hospital environment and resource use, reflecting healthcare utilization outcomes.

Conclusions: Participants' experiences provide meaningful insights into outcomes that should be evaluated in neonatal research and practice. These findings will inform the development of a COS for FCC in neonatal settings.

Background/Objectives: Cerebral palsy (CP) is the most common cause of physical disability in childhood. While gait improvements are often observed during childhood, it remains unclear whether these gains are sustained into adulthood. This study aimed to evaluate the long-term evolution of gait outcomes from childhood to adulthood in individuals with CP who received orthopedic care early in life. Methods: This retrospective study included 83 adults with cerebral palsy (44 unilateral/uCP, 39 bilateral/bCP; GMFCS I-III) who underwent clinical gait analysis in childhood and again as adults (minimum 4 years between visits, n = 249 CGA). Gait was assessed using the modified Gait Profile Score (mGPS) and normalized walking speed (NWS). The effects of life stage (childhood, adolescence, early adulthood, and adulthood) were analyzed using Kruskal-Wallis tests with post hoc comparisons. Individual clinical transitions were quantified from early adulthood to adulthood, with a minimal clinically important difference (MCID) change in mGPS (1.6°) and NWS (0.20 s^-1) for improvement or decline. Results: Longitudinal analysis revealed that while group-average mGPS improved from childhood to adulthood, NWS declined significantly for all patients (p < 0.01). However, individual trajectories from early adulthood to adulthood diverged by CP type. Those with bCP GMFCS II and III had a more frequent clinical decline in mGPS (4/14, 29%), with minimal potential for improvement (1/14, 17%). In contrast, individuals with uCP had less frequent decline (1/17, 6%) and a greater improvement (3/17, 18%). Conclusions: While significant improvements in gait quality are achieved by early adulthood, substantial clinical decline occurs during adulthood in bCP (GMFCS II-III) patients. These findings highlight the need for lifelong monitoring, with re-evaluation regarding the need for surgical interventions from early adulthood to adulthood in bCP patients with greater motor impairments.

Background/Objectives: Although numerous studies have examined associations between screen time and early language development, less is known about how screen exposure interacts with developmental stage, digital content quality, and parental mediation across childhood and adolescence, particularly with respect to pragmatic communication. This study aimed to address these gaps by examining the joint associations of screen time, content composition, and parental mediation with multiple linguistic and pragmatic domains across a broad age range. Methods: A cross-sectional study was conducted with 286 Romanian participants aged 5-19 years, grouped into four developmental stages. Measures included daily screen time, proportion of educational versus recreational content, parental mediation practices, and standardized assessments of vocabulary, verbal fluency, grammatical competence, and pragmatic communication. Analyses included descriptive statistics, Pearson correlations, 4 × 3 factorial ANOVAs (age group × screen-time category), and multiple linear regression. Results: Higher levels of screen exposure were consistently associated with lower performance across all linguistic and pragmatic domains (r = -0.19 to -0.28, all p < 0.01). Participants viewing >2 h/day showed significantly weaker outcomes than those with ≤1 h/day, particularly in semantic and phonemic fluency and pragmatic communication (p < 0.001). Educational content correlated positively with linguistic scores, whereas recreational content showed negative associations. Parental mediation emerged as a significant positive predictor. In the regression model (R² = 0.42), age (β = 0.47), parental mediation (β = 0.21), and educational content (β = 0.18) predicted better linguistic performance, while screen time (β = -0.29) predicted lower performance. Conclusions: The findings indicate that associations between digital media use and linguistic and pragmatic performance vary across developmental stages and contextual factors. Rather than screen time alone, digital content quality and parental mediation are associated with differences in communicative performance. These results highlight the value of a nuanced, developmentally informed perspective when considering children's digital media environments.

Background/Objectives: Children in paediatric palliative care often face school attendance barriers due to complex health needs. This study describes post-training perceptions of a training program by a pediatric hospice team to prepare school care assistants to safely include children with complex conditions, focusing on procedural skills, knowledge of the child, and family partnership. Methods: Care assistants who completed a structured course at the Paediatric Palliative Care Centre, University Hospital of Padua (2023-2024), were surveyed immediately after training. The program combined classroom instruction with hands-on simulation using high-fidelity mannequins and standard devices, including suction, pulse oximetry, ventilation, enteral feeding, and tracheostomy care. It also covered modules on urgent and emergency management, as well as family communication. An anonymous online questionnaire gathered socio-demographic data, prior training, clinical tasks performed, self-efficacy levels, and open-ended feedback. Quantitative results were analyzed descriptively, while qualitative comments were subjected to thematic analysis. Results: Of 130 invited assistants, 105 participated (81%). Participants reported strong perceived confidence: 85% selected the upper end of the 5-point scale ("very" or "extremely") for routine-management ability, and 60% selected these same response options for emergency-management ability. In the most severe events recalled, 60.5% of incidents were resolved autonomously, 7.6% involved contacting emergency services, and 3.8% involved community or hospice nurses. Seventy-five percent judged the course comprehensive; thematic analysis of 102 comments identified satisfaction, requests for regular refreshers, stronger practical components, and requests for targeted topics. Conclusions: Immediately after the session, participants tended to select the upper end of the self-assurance item for both routine and emergency tasks. Combining core emergency procedures with personalized, child-specific modules and family-partnership training may support safety, trust, and inclusion. Regular refreshers and skills checks are advised.

Background/Objectives: In light of the concerning research data on students' mental health, it is essential to provide high-quality programs that support children and young people in strengthening their psychological well-being. To address this need, the three-year Erasmus+ KA3 international project PROMEHS: Promoting Mental Health at Schools was developed. The project involved universities and education policy representatives from seven European countries, Italy (project leader), Greece, Croatia, Latvia, Malta, Portugal, and Romania. Its core activities included the development of the PROMEHS curriculum, grounded in three key components: social and emotional learning, resilience, and the prevention of behavioral problems, alongside a rigorous evaluation of its implementation. The main research aim was to test the effect of PROMEHS on students' and teachers' mental health. Methods: In Croatia, the curriculum was introduced following the training of teachers (N = 76). It was implemented in kindergartens, and primary and secondary schools (N = 32), involving a total of 790 children. Using a quasi-experimental design, data were collected at two measurement points in both experimental and control groups by teachers, parents, and students. Results: The findings revealed significant improvements in children's social and emotional competencies and resilience, accompanied by reductions in behavioural difficulties. These effects were most evident in teachers' assessments, compared to parents' ratings and student self-reports. Furthermore, teachers reported a significantly higher level of psychological well-being following implementation. Conclusions: Bearing in mind some study limitations, it can be concluded that this study provides evidence of the positive effects of PROMEHS in Croatian educational settings. Building on these outcomes and PROMEHS as an evidence-based program, a micro-qualification education was created to ensure the sustainability and systematic integration of the PROMEHS curriculum into Croatian kindergartens and schools.

Background: Although surfactant replacement therapy has been a cornerstone of respiratory distress syndrome (RDS) management for decades, traditional delivery via endotracheal intubation and mechanical ventilation is associated with procedure-related complications and increased risk of bronchopulmonary dysplasia (BPD). These concerns have driven the development of less invasive surfactant administration strategies.

Objective: This review aims to summarize and evaluate the current literature on less invasive surfactant delivery techniques used in preterm infants with RDS, with a focus on their feasibility, efficacy, and short- and long-term neonatal outcomes.

Methods: We reviewed the available literature evaluating less invasive surfactant administration methods, including InSurE, Less Invasive Surfactant Therapy/Minimally Invasive Surfactant Therapy (LISA/MIST), surfactant administration via laryngeal mask airway (SALSA/LMA), pharyngeal administration, and nebulized surfactant. We compared major outcomes, namely the need for mechanical ventilation, incidence of BPD, procedural complications and long-term neurodevelopmental outcomes.

Results: Non-invasive surfactant administration techniques have been associated with reduced exposure to mechanical ventilation and lower rates of BPD compared with conventional approaches. Studies on LISA/MIST demonstrate the most consistent evidence in reducing the need for mechanical ventilation and BPD, while other techniques such as LMA-assisted delivery and nebulization show promise but remain limited by device constraints, gestational age applicability, and heterogeneous study designs. Long-term neurodevelopmental outcome data remain sparse across all techniques.

Conclusions: Non-invasive surfactant administration represents an important advancement in the management of RDS. While several techniques offer potential advantages over traditional intubation-based delivery, further high-quality studies are required to optimize patient selection, standardize techniques, develop safe and effective delivery devices, and evaluate long-term neurodevelopmental outcomes.

Objectives: The Impostor Phenomenon (IP), defined as persistent self-doubt despite objective success, has been extensively researched in adults. In contrast, empirical research on children and adolescents remains limited. Methods: The present study examines the prevalence, correlates, and potential risk as well as protective factors of the IP in a sample of 286 participants (56.6% female, 42.7% male, and 0.7% diverse) aged 8-18 years (M = 11.75, SD = 2.50). Participants were recruited from four distinct German subsamples between 2022 and 2024, including a clinically vulnerable group. The study employed a cross-sectional survey design administered to children and adolescents. Results: The results of the study indicate the presence of the IP as early as primary school age, with increasing intensity during adolescence. The study identified robust correlations between the IP and neuroticism, extraversion, conscientiousness, and self-esteem. In the present study, children and adolescents exhibiting depressive-anxious symptomatology demonstrated significantly elevated impostor scores in comparison to those manifesting other disorders. Furthermore, the study yielded negative associations between impostorism and various personal resources (e.g., optimism, self-efficacy) and family resources (e.g., parental support, authoritative parenting style). Conclusions: The present findings underline the importance of early intervention in addressing impostor feelings among younger age groups. In conclusion, the present findings contribute to our understanding of the IP etiology and underscore the importance of understanding the IP during formative years to inform prevention and intervention strategies.