Children-Basel最新文献

Background/Objectives: Caregivers of children with chronic illnesses, including chronic pain, experience high levels of distress, which impacts their own mental and physical health as well as child outcomes. Virtual care solutions offer opportunities to provide accessible support, yet most overlook caregivers' needs. We conducted a scoping review to create an interactive Evidence and Gap Map (EGM) of virtual care solutions across a stepped care continuum (i.e., from self-directed to specialized care) for caregivers of youth with chronic illnesses. Methods: The review methodology was co-designed with four caregivers. Data sources were the peer-reviewed scientific literature and a call for innovations. Records were independently coded and assessed for quality. Results: Overall, 73 studies were included. Most virtual care solutions targeted caregivers of children with cancer, neurological disorders, and complex chronic illnesses. Over half were noted at lower levels of stepped care (i.e., self-guided apps and websites), with psychological strategies being predominant (84%). However, very few addressed caregivers' physical health (15%) or provided family counseling (19%) or practical support (1%). Significant gaps were noted in interventions for managing caregiver chronic pain, despite its high prevalence and impact on child outcomes. Conclusions: Evidence and Gap Maps are innovative visual tools for knowledge synthesis, facilitating rapid, evidence-informed decision-making for patients, families, health professionals, and policymakers. This EGM highlighted high-quality virtual care solutions ready for immediate scaling and identified critical evidence gaps requiring prioritization. To address the complexities of pediatric chronic illnesses, including chronic pain, virtual care initiatives must prioritize family-centered, accessible, and equitable approaches. Engaging caregivers as partners is critical to ensure interventions align with their needs and priorities.

Background: Frontal knee malalignments are hallmarks of Achondroplasia (ACH), along with disproportional short stature. Typically, X-rays are used to assess them, but 3D gait analysis (3DGA) may additionally be used to evaluate dynamic knee function. The research questions were as follows: (1) What is the relationship between X-rays and 3DGA in ACH? (2) Do children with ACH have abnormal frontal knee kinematics and kinetics? (3) Are there aspects of 3DGA that relate to knee symptoms? Methods: A total of 62 knees of 31 children with ACH (age: 11.1 ± 4.3 years, 34 symptomatic knees) underwent 3DGA and X-ray as part of their standard clinical care. X-rays were analyzed for mechanical tibiofemoral angle (mTFA). Relationships between X-rays and 3DGA were determined. Sixty-two knees of 31 age-matched typically developing (TD) children served as references for 3DGA. Frontal knee kinematics (including thrust RoM) and adduction moments (KAMs) were compared. Multiple regression was performed for measurements associated with KAM, and ANOVA was used to compare TD and ACH knees with and without pain. Results: There was a high correlation between static frontal knee angles and mTFA (r = 0.93, p < 0.001, mean difference = -2.9°). ACH knees with a regular mTFA also showed significantly increased KAM. Multiple regression analysis showed that mTFA was the most relevant predictor of KAM (R² = 0.41-0.75). Symptomatic knees (n = 34/62) experienced significantly more knee RoM in early stance than asymptomatic knees. Conclusions: Three-dimensional gait analysis may be an objective screening method for dynamic knee alignment and stability and may complement radiography in monitoring ACH. Symptoms may depend on knee thrust, while the impact of altered KAM needs further study.

Background/objectives: The COVID-19 pandemic created a growing need for insights into the mental health of children and youth and their use of coping mechanisms during this period. We assessed mood symptoms and related factors among children and youth in Saskatchewan. We examined if coping abilities mediated the relationship between risk factors and mood states.

Methods: "See Us, Hear Us 2.0", a cross-sectional study of 563 child-parent dyads, provided the data. The dependent variable, current mood state, was measured by the CoRonavIruS health Impact Survey (CRISIS) scale. Independent variables included sociodemographics, behaviors, household conditions, and coping ability. Multiple linear regression and mediation analyses were conducted, ensuring sample representativeness with sampling weights and addressing missing data through multiple imputations.

Results: The participants reported mood symptoms ("moderate" to "extreme") ranging from 23% to 38% on the CRISIS scale. Factors such as older children, hybrid learning, disrupted activities, and increased screen time worsened moods. The ethnic minority groups (BIPOC) living in mid-sized cities/towns experienced more negative moods compared to Whites residing in cities. Coping ability mediated the relationship between extracurricular activities and mood states.

Conclusions: Our results underscore the importance of tailored interventions, recognizing the diverse needs of specific age groups, gender identities, and ethnicities and addressing the adverse effects of the pandemic-related disruptions on the mental health and well-being of school children in Saskatchewan. Our study also suggests prioritizing the diverse needs of children and youth during the planning and implementation of mental health services in the province.

Background/objectives: This cohort study aimed to establish a correlation between salivary cytokines and retinopathy of prematurity (ROP) in premature neonates. Additionally, we sought to identify a minimally invasive method for cytokine detection in this population.

Methods: We recruited premature neonates born at less than 34 weeks gestational age (GA), with no history of maternal or neonatal infections. Salivary samples were collected on their first (D1) and seventh (D7) days of life, and cytokine levels were measured using the MILLPLEXMAP Human multiplex assay.

Results: A total of 125 neonates were included in the study, categorized into two groups based on the severity of ROP: None to Mild and Moderate to Severe. The salivary levels of interleukin (IL)-6, IL-8, vascular endothelial growth factor (VEGF), and tumor necrosis factor (TNF)-α on D1 and D7 were significantly higher in the Moderate to Severe ROP group compared to the None to Mild ROP group (p = 0.005, 0.004, 0.026, 0.018, 0.001, 0.007, 0.025, and 0.002, respectively). After adjusting for GA, the levels of IL-6 and VEGF on D7 were significantly elevated in the Moderate to Severe ROP group compared to the None to Mild ROP group (p = 0.024 and 0.016, respectively).

Conclusions: This study establishes a novel, non-invasive method for the early prediction of ROP in premature neonates by correlating salivary cytokine levels in early life with the subsequent development of ROP.

Background/objectives: Childhood obesity is a multifactorial chronic disease that represents one of the main preventable causes of morbidity and mortality. This study analyzes how nutritional beliefs influence eating habits and the prevalence of overweight and obesity in Spanish children and adolescents.

Methods: A cross-sectional study was conducted in 35 educational centers in 12 Spanish provinces, with a sample of 1131 children and adolescents aged 6 to 14 years. Anthropometric and sociodemographic data were collected, and dietary habits were assessed by means of questionnaires. Statistical analyses were used to identify associations between dietary beliefs and body mass index.

Results: In total, 29.5% of participants were overweight or obese. Two groups of beliefs were identified: healthier beliefs and less healthy beliefs. Children with less healthy dietary beliefs had a significantly higher BMI (22.16 kg/m²) compared to those with healthier beliefs (17.2 kg/m²). False nutritional beliefs, influenced by advertising and the family environment, contribute to overweight and obesity.

Discussion: Dietary beliefs play a crucial role in determining eating habits and, therefore, the health of children. Nutrition education and public policies that promote healthy eating habits are essential to prevent childhood obesity. It is important to involve the family, the school, and the media in these efforts.

Conclusions: Despite efforts, many children continue to hold erroneous nutritional beliefs that contribute to the rise in overweight and obesity. This study highlights the importance of addressing dietary beliefs and promoting appropriate nutrition education to prevent childhood obesity. It is recommended to implement educational strategies and public policies that regulate the advertising of unhealthy foods and promote healthy eating habits.

Purpose: Currently, there is no clinical data reported on the therapy of dual biological agents in pediatric-onset inflammatory bowel disease (PIBD) patients in China. The purpose of this study was to evaluate the efficacy and safety of dual biologic therapy or biologics combined with small molecule drugs in refractory PIBD patients in China.

Methods: Clinical, laboratory, endoscopic, and ultrasound data of PIBD patients from the Department of Gastroenterology of Beijing Children's Hospital between January 2021 and October 2024 were retrospectively analyzed. PIBD patients who received dual biologic treatment or a combination of biologic and small molecule therapy were included in this study. Steroid-free clinical remission and adverse events were recorded.

Results: In this retrospective study, out of 520 children with IBD, twelve children (2.3%) were diagnosed with refractory PIBD and met the criteria for dual biotherapy, including four with UC (33%) and eight with CD (67%). The median age of patients was 13.64 (range, 1.2-17.1) years at eligibility for dual biologic therapy. There are eight (67%) patients treated with infliximab/ustekinumab (IFX + UST), three (25%) patients with upadacitinib/ustekinumab (UPA + UST), one (8%) patient with infliximab/vedolizumab (IFX + VDZ). At 3, 6, and 12 months of dual biological treatment, 91.2% (11/12), 100% (12/12), and 100% (12/12) patients showed steroid-free clinical remission, respectively. The median fecal calprotectin decreased significantly from 1852.5 µg/g (IQR, 762.5-1988.25) at baseline to 359.0 (IQR, 217.5-730.25) μg/g at 3 months, 113 (IQR, 73.7-256) μg/g at 6 months, and 82.5 (IQR, 40.25-122.25) μg/g at 12 months. Only one CD patient with IFX + UST reported mild elevation of aminotransferase, who recovered after symptomatic treatment.

Conclusions: Dual biologic or small molecule therapy may be effective and safe for children with refractory PIBD in China.

Background: Takayasu's arteritis (TA) is a systemic vasculitis that primarily affects the aorta and major arteries. Despite aggressive treatment with glucocorticoids (GCs) and non-biological disease-modifying antirheumatic drugs (nbDMARDs), about 30% of patients experience resistance to therapy or relapse. This study aimed to identify risk factors associated with refractory and relapse TA in pediatric patients. Methods: A retrospective, open-label, case-control study was conducted with 56 pediatric patients with TA diagnosed between February 2011 and October 2022. Fourteen patients were excluded due to insufficient data in their medical records, leaving 42 for further analysis. The patients were divided into two groups: Group 1 (18 patients) with no evidence of relapse and Group 2 (24 patients) with relapse despite first-line treatment at the end of the follow-up period. Clinical, laboratory, and instrumental data were collected and analyzed using R v4.2 and Python v3.10. Results: The median time to relapse was 18 [IQR: 13; -] months according to the Kaplan-Meier curve. Patients with ITAS.A with a diagnosis of TA ≥ 12 had a higher probability of relapse, according to the log-rank criterion (p = 0.006). Symptoms of critical ischemia, such as limb claudication, were more common in Group 2 at diagnosis (p = 0.047), and a trend toward a longer diagnostic delay was observed (p = 0.067). Conclusions: Pediatric patients with an initial ITAS.A score above 12 have a higher risk of relapse when treated with a combination of GCs and nbDMARDs as first-line treatment. Further research is needed to identify high-risk patients more accurately and optimize therapeutic strategies.

Background/objectives: We aim to describe the changing inpatient epidemiology of NAFLD in the U.S. and identify major risk factors associated with mortality in the disease among hospitalized pediatric patients.

Methods: Hospitalization data from the 1998-2020 National Inpatient Sample were utilized. ICD-9 and ICD-10 codes were used to identify pediatric patients (age less than 18 years old) with NAFLD, and risk factors for mortality were analyzed by logistic regression.

Results: We identified 68,869 pediatric hospitalizations involving NAFLD. Among those, 970 (1.4%) died during hospitalization. Hospitalization rates have been rapidly increasing from 1998 to 2020 (incidence rate ratio (IRR): 1.07; 95% CI: 1.06-1.07; p < 0.001). There was a significant difference in mortality based on the type of hospital (rural, non-teaching urban, or teaching urban) in pediatric patients with NAFLD (p < 0.05). Coagulopathy was significantly associated with increased odds of mortality, while age ≥ 12 years, diabetes and obesity were associated with decreased odds of mortality (p < 0.05). Sex, race/ethnicity, hepatitis B, hepatitis C, HIV, and IV drug use were not significantly associated with mortality.

Conclusions: Our study has shown ever increasing hospitalization rates for NAFLD in pediatric populations and well as significant risk factors associated with mortality. Further studies should be performed as more data on this patient population are collected.

Background: Argonautes (AGOs) are a type of protein that degrade specific messenger RNAs, consequently reducing the expression of a specific gene. These proteins consist of small, single-stranded RNA or DNA and may provide a route for detecting and silencing complementary mobile genetic elements. In this research, we investigated which AGO(s) were involved in Kawasaki disease (KD).

Methods and materials: We obtained mRNA-level gene expression profiles from leukocyte samples that had previously been gathered in another study and uploaded to the NCBI GEO database. The Human Transcriptome Array (HTA 2.0) analysis included 50 children with KD prior to IVIG (KD1), 18 children with KD three weeks post-IVIG (KD3), 18 non-febrile controls (HC), and 18 febrile controls (FC), which were arranged in the quoted publications for all materials and methods in order to collect data. We used the default value of the commercialized microarray tool Partek to perform an analysis of variance and determine any significant fold changes (KD1, KD3, HC, and FC individually).

Results: The data revealed that the AGO2 and AGO4 genes displayed significant within-group differences with p = 0.034 and 0.007, respectively. In AGO2, significant differences were observed between KD1 vs. HC + FC with p = 0.034. KD1 appears higher than the other specimens in AGO4, with significant differences between KD1 and HC (p = 0.033), KD1 and FC (p = 0.033), KD1 and KD3 (p = 0.013), and KD1 and HC + FC (p = 0.007). We observed no substantial differences in AGO1 or AGO3 (p > 0.05). There were no significant differences between AGO(s) and coronary artery lesions or intravenous immunoglobulin resistance. (p > 0.05) Conclusion: Endothelial cell inflammation and injury, two basic pathological mechanisms, are thought to be involved in coronary endothelial dysfunction in KD. AGO2 and AGO4 are likely to participate in the endothelial dysfunction of children with KD, with AGO4 potentially playing a key role, while AGO1 and AGO3 appear not to participate.

Background/Objectives: Oral breathing is a common condition, particularly in children, and it is associated with significant changes in craniofacial development, dentomaxillary anomalies, and overall health. Despite extensive research, the role of oral breathing in the development of malocclusion remains controversial, with debates on whether it is a causative factor or a secondary adaptation to existing craniofacial issues. Methods: This narrative review synthesizes studies published in the last 15 years, focusing on the impact of oral breathing on dentofacial development and mandibular posture. A comprehensive search was conducted on four electronic databases (Embase, Medline, ProQUEST, Scopus) using keywords related to oral breathing, malocclusion, mandibular posture, and craniofacial development. Studies were included if they focused on the effects of oral breathing on craniofacial morphology, malocclusion, and postural changes in children and adolescents aged 6-18 years. Results: Results indicate a strong link between oral breathing and dentofacial changes such as adenoid facies, Class II malocclusion, posterior crossbite, and anterior open bite. It causes cranial posture changes, particularly increased craniocervical extension, as a compensatory mechanism to maintain airway patency. Conclusions: Oral breathing is a risk factor for malocclusion prognosis, especially in growing children. Dentofacial changes in oral breathers include adenoid facies, convex facial profile, and increased lower facial height. Oral breathing also leads to significant changes in cranial posture, often accompanied by mandibular, lingual, and palatal alterations.