Children-Basel最新文献

Background/Objectives: The present study investigated the effects of parental participation in home program intervention on parent-child interactions, parental self-efficacy, and the goal attainment of children with developmental delays in motor skills. Methods: While the interviews consisted of qualitative data, quantitative analyses were applied to the results, making this a mixed-methods study. Participants were 2-6-year-old young children and their families. Twenty-three parent-child dyads were randomly assigned to an intervention group (n = 13) or a comparison group (n = 10). Outcomes were evaluated using the Parent-Child Interaction Questionnaire and Parental Self-Efficacy Questionnaire. Results: Improvements in parental self-efficacy and in the Goal Attainment Scale scores of the children were evident in the posttest, whereas no evidence of differences in improvement was found in parent-child interactions between the intervention and comparison groups on the pretest and posttest. Conclusions: Parent collaboration with therapists has a significant impact on achieving functional goals for young children, and parental involvement in intervention programs effectively enhances parental self-efficacy.

Background/objectives: Pediatric-onset multiple sclerosis (POMS), defined as onset before age 18, is increasingly recognized as a distinct entity, often associated with a more burdensome disease course and earlier disability milestones than adult-onset MS. Although comorbidities may significantly affect disease progression and outcomes, their prevalence, incidence, risk, and characteristics in POMS remain poorly understood. To date, no systematic review has comprehensively evaluated comorbidities in POMS. The primary aim is to systematically identify and synthesize available evidence on the prevalence, incidence, risk, and characteristics of these comorbidities in POMS populations, as well as any reported effects on disease course, treatment outcomes, and overall clinical management.

Methods: We will conduct a systematic review and meta-analysis following a hierarchical and pragmatic analytical strategy tailored to the expected heterogeneity and limited evidence base in POMS. MEDLINE (via PubMed) and Embase (produced by Elsevier) will be searched without date restrictions, combining controlled vocabulary terms (MeSH/Emtree) and relevant keywords for POMS and 15 predefined comorbidity categories. Study selection, abstract and full-text screening, and data extraction will be performed independently by two reviewers using predefined criteria and standardized forms. The primary quantitative outcome will be the pooled prevalence of comorbidities. Where study design and reporting permit, incidence rates will be assessed as secondary outcomes, and risk estimates (e.g., odds ratios) will be evaluated only in studies with appropriate comparator groups. Meta-analyses will be conducted using random-effects models when pooling is feasible. Heterogeneity will be assessed using the I² statistic and Cochran's Q test, with sensitivity and subgroup analyses performed only when sufficient data are available. When quantitative synthesis is not appropriate due to limited data or substantial heterogeneity, findings will be summarized descriptively. Publication bias will be evaluated using funnel plots and, where applicable, Egger's and Begg's tests. This protocol adheres to PRISMA and PRISMA-P guidelines.

Discussion: A systematic quantification of comorbidity prevalence, incidence (where available), and risk, together with POMS-specific characteristics and any reported impact on clinical outcomes, is anticipated to provide a crucial evidence base for guiding screening, refining management strategies, and informing future research directions. Ultimately, these findings may improve clinical outcomes and quality of life for children and adolescents with MS.

Background: Early childhood represents a key stage for the development of movement behaviors (MB), motor skills (MS), and executive functions (EF). Body Mass Index (BMI), defined according to World Health Organization (WHO) references, may influence these domains early in life. In this context, this cross-sectional observational study aimed to examine the associations between BMI and 24-h MB, MS, and EF in Tunisian preschool children aged 4 to 5 years.

Methods: This cross-sectional observational study included 112 Tunisian children aged 4 to 5 years (50 boys, 62 girls), recruited from kindergartens in urban and rural areas. Anthropometric measurements were used to calculate age-specific BMI z-scores and classify children into three BMI categories: below normal, normal, and above normal. Twenty-four-hour MB physical activity (PA), sedentary behavior (SB), and sleep were objectively assessed using accelerometry over five consecutive days. EF (inhibition and working memory) were assessed using standardized cognitive tests, gross MS were evaluated using the Supine Timed Up and Go test (functional mobility), One-Leg Standing Balance test (postural steadiness), Hand Grip Dynamometer (upper body strength), and Standing Long Jump (lower body strength), and fine MS were assessed using the 9-Hole Pegboard Test (dexterity). All tools are validated and standardized for children.

Results: Significant differences between BMI categories were observed for anthropometric variables (p < 0.05). In contrast, no significant differences were found for 24-h MB, adherence to recommendations, EF, and MS (p > 0.05). Only Sleep duration showed a difference significantly between BMI < normal and BMI > normal (p = 0.022).

Conclusions: In Tunisian preschool children, weight status is primarily associated with differences in physical growth, with no marked relationship to MB, EF, or MS. These findings highlight the importance of universal preventive interventions, particularly focusing on growth monitoring, starting in early childhood. These results should be interpreted with caution and highlight the need for further studies on larger populations to better understand the relationships between BMI, PA, and development in young children.

Objective: Kangaroo care (KC) is underutilized in preterm infants on ventilator support due to perceived physiologic instability. The objective of our study is to demonstrate the feasibility of safe KC provision on high-frequency jet ventilation (HFJV) in micro preemies weighing less than 750 g.

Study design: Our neonatal intensive care unit has a multidisciplinary clinical standard for KC while preterm infants are on HFJV (HFJV-KC). Bedside staff documented cardiorespiratory and physiologic parameters pre, during, and post HFJV-KC. We performed a retrospective assessment of the feasibility of HFJV-KC in the micro preemie population.

Results: A total of 96 HFJV-KC occurrences from 13 neonates with median gestational age 24 1/7 weeks and birth weight of 670 g were included. There were no significant differences in heart rate and temperature pre, during, and post-HFJV-KC. There were statistically significant improvements in oxygen saturation and fraction of inspired oxygen post HFJV-KC. Secondary analyses of prolonged HFJV-KC beyond 1 h (mean 2.3 h) compared to the standard 1 h duration also showed no differences in outcome measures.

Conclusions: This study demonstrates that KC may be performed in the smallest micro preemie infants (<750 g) on HFJV. Our study also presents processes to overcome perceived barriers of HFJV-KC implementation in a vulnerable population.

Background: Deaf and hard-of-hearing (DHH) adolescents in mainstream schools may face communication barriers and social challenges that can affect their well-being and health. However, population-based knowledge based on adolescents' own reports-particularly including those with additional disabilities-remains limited. The aim of this study was to assess self-reported well-being, mental health complaints, somatic complaints, and perceived teacher support among DHH adolescents in Swedish mainstream schools and to compare these outcomes with those of hearing adolescents and DHH adolescents with additional disabilities.

Methods: This cross-sectional study was based on data from the Swedish school survey Liv och Hälsa Ung (Life and Health of Young People). The sample comprised 5923 adolescents aged 13-18 years attending grades 7 and 9 in compulsory school and year 2 in upper-secondary school. Outcomes included well-being (WHO-5 or a single-item measure for grade 7), mental health complaints, somatic complaints, and perceived teacher support. Group differences by hearing status, additional disability, gender, and school level were examined using analysis of variance (ANOVA).

Results: Hearing adolescents reported higher well-being, fewer somatic complaints, fewer mental health complaints, and higher perceived teacher support compared with DHH adolescents. DHH adolescents with additional disabilities consistently reported the poorest outcomes across all domains. For example, perceived teacher support was significantly lower among DHH adolescents with additional disabilities (M = 3.66, 95% CI [3.54-3.78]) compared with hearing adolescents (M = 4.01, 95% CI [3.99-4.03]). Across all groups, girls, particularly those with disabilities, reported poorer well-being and higher levels of somatic and mental health complaints than boys.

Conclusions: The findings highlight substantial health disparities among adolescents with hearing loss in mainstream schools, especially among those with additional disabilities. Perceived teacher support emerged as an important contextual factor and may represent a key target for school-based interventions aimed at promoting well-being and mental health among DHH adolescents.

Callous-unemotional (CU) traits are characterised by reduced empathy, guilt, and emotional responsiveness, and are strongly linked to atypical socioemotional processing. Eye-tracking research provides a valuable window into these processes by capturing early developing patterns of attention to emotionally salient social cues, particularly facial expressions. This narrative review examines how alterations in gaze behaviour contribute to the emergence of CU traits across neurodevelopmental disorders (NDs), with a focus on autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and conduct disorder (CD). Across studies, elevated CU traits are associated with reduced fixations on the eye region, most consistently in response to fearful faces. ASD is associated with robust eye avoidance, ADHD with inhibitory and attentional control difficulties during face processing, and CD with atypical gaze allocation to negative emotional expressions such as fear and anger. These patterns appear amplified when CU traits co-occur with NDs. Competing explanatory accounts, including aberrant amygdala functioning, oculomotor disinhibition, and hostile attribution biases, each capture aspects of these patterns but fail to provide a unified explanation. Integrating developmental, neurobiological, and environmental perspectives, we propose that CU traits reflect a transdiagnostic developmental construct shaped by early attentional-emotional mechanisms, rather than a disorder-specific identity.

Background: Effective self-management is essential for optimizing asthma control. Although peak flow meters (PFMs) and spacers are recommended to support self-management, the associations between device use patterns and asthma outcomes remain unclear. This study aims to examine the ownership and use of devices among adolescents with asthma and their associations with asthma exacerbations in the past 12 months and asthma control.

Methods: Cross-sectional data from 373 inner-city adolescents with asthma were analyzed. Participants reported PFM or spacer ownership and their frequency of use. Exacerbation history was determined based on oral corticosteroid use, hospitalizations, and emergency department visits in the past 12 months. Asthma control was assessed using the Asthma Control Questionnaire. Chi-square tests and independent t-tests were used to examine associations among device ownership, use frequency, asthma control, and exacerbations.

Results: Ownership rates were 36% for PFMs and 61.6% for spacers. Ownership of both devices was negatively associated with asthma exacerbations in the past year (all p < 0.001). Regular use was reported by only 15.2% of PFM owners and 40.2% of spacer owners. Regular users did not differ from infrequent users in exacerbation history but reported significantly poorer asthma control (PFM: p = 0.007; spacer: p < 0.001).

Conclusions: Adolescents' ownership of peak flow meters and spacers remains suboptimal, and the routine adoption of these devices is limited. Adolescents with exacerbations in the past year were more likely to own devices but use them infrequently. Regular use was associated with poorer asthma control, suggesting reactive rather than preventive use. Findings highlight the need for improved education on preventive device use, enhanced training in proper use, and proactive integration of devices into adolescent asthma self-management.

Background: Ipsilateral concomitant ureteropelvic junction (UPJ) and ureterovesical junction (UVJ) obstruction is an uncommon but clinically important pediatric condition. Because standard imaging often detects only one level of obstruction, the coexistence of both lesions is frequently overlooked. Delayed diagnosis may result in persistent hydronephrosis, recurrent urinary tract infections, and progressive renal injury. This systematic review synthesizes current evidence regarding diagnostic challenges, management strategies, and outcomes in children with dual UPJ-UVJ obstruction. Methods: A systematic review following PRISMA 2020 guidelines was conducted and prospectively registered in PROSPERO. Major databases were searched for studies describing pediatric patients with confirmed ipsilateral UPJ + UVJ obstruction. Extracted data included clinical presentation, diagnostic pathways, imaging modalities, timing of diagnosis, surgical sequencing, and postoperative outcomes. Results: Across the 8 included studies, preoperative recognition of dual obstruction was uncommon. Most cases were diagnosed intraoperatively when retrograde stent passage failed or postoperatively when hydronephrosis persisted after an apparently adequate first procedure. Retrograde or antegrade pyelography consistently outperformed ultrasonography and diuretic renography in identifying distal pathology. Staged repair-typically beginning with pyeloplasty-emerged as the most reliable approach, as correction of the proximal obstruction alone frequently improved distal drainage. UVJ-first strategies were less effective and often required secondary pyeloplasty. Endoscopic and minimally invasive techniques showed promise in selected patients but were reported in limited numbers with short follow-up. Functional renal outcomes generally stabilized or improved following complete correction, particularly when intervention occurred early in life. Conclusions: Dual UPJ-UVJ obstruction remains a diagnostic challenge in pediatric urology. Complementing standard imaging with contrast pyelography and maintaining vigilance during intraoperative stent placement can improve detection. Available reports suggest that a staged proximal-first surgical strategy can optimize drainage and reduce the risk of unnecessary distal reconstruction. Early intervention appears beneficial for renal recovery, though long-term outcomes remain insufficiently studied. Ongoing follow-up is essential, particularly in children with recurrent urinary tract infections or persistent hydronephrosis.

Background/objectives: Early Childhood Intervention (ECI) services are critical for supporting children with developmental needs and their families. Despite an established legislative framework, challenges related to accessibility, equity, resources, and standardization of practices persist. This study aimed to describe the perspectives of early intervention professionals in Portugal regarding current barriers, facilitators, and priority areas for improvement within the system.

Methods: A descriptive study was conducted involving 82 professionals working in early intervention in Portugal. Data were collected using a survey specifically developed by the research team, grounded in a comprehensive literature review and professional expertise. The instrument was validated through a Delphi Panel with two rounds involving six experts in ECI. Data from open-ended questions were analyzed using content analysis, identifying categories and sub-categories to describe the responses, and descriptive statistics for the closed-ended questions.

Results: Professionals highlighted the need to update the National ECI System (SNIPI), improve accessibility, and ensure equitable access to early intervention services. Participants reported limited resources, a lack of standardization in practices, and emphasized the importance of professional training and continuous professional development. The findings also pointed to the urgent need for investment and functional and structural restructuring of early intervention services. Various barriers and facilitators were identified.

Conclusions: The study provides valuable insights into the perspectives of early intervention professionals, identifying critical areas for policy improvement, resource allocation, and practice standardization.

Background: This study assessed the long-term stability of dental arch changes achieved through clear aligner treatment in growing patients during the early mixed dentition stage.

Methods: This retrospective study included 20 patients (mean age 8.3 ± 0.4 years) treated with clear aligners according to a standardized sequential expansion protocol. No additional auxiliaries, interproximal reductions, or retentions were used. Dental casts were collected at baseline (T0), end of treatment (T1), and two years post-treatment without retention (T2). Linear and angular measurements (arch width, molar and incisor torque, Henry's angle, overjet, overbite, and Little's index) were assessed on digital models. Friedman ANOVA and Wilcoxon signed-rank tests were applied (α = 0.05).

Results: At T1-T0, significant transversal expansion was achieved in both arches (U6-6 mesial +2.1 mm; L6-6 mesial +2.4 mm; p < 0.05), with favorable torque changes and a reduction in overjet (-1.5 mm). From T1 to T2, only minimal, non-significant relapse was detected, except for a slight reduction in lower left molar torque (-1.1°). The T2-T0 comparison confirmed stable improvements in mesial intermolar widths (upper +2.0 mm; lower +1.6 mm), molar derotations, and overjets (-1.9 mm), with no significant loss of expansion or sagittal correction.

Conclusions: Clear aligners in early mixed dentition achieved significant and stable dental arch modifications over a 2-year follow-up without the use of retention appliances. This therapeutic approach may represent a reliable interceptive option in growing patients.