Children-Basel最新文献

Background/Objectives: The beliefs about a disease and its treatment determine how patients and caregivers manage and adapt to the illness. The study aimed to explore the QoL and mental health of children with food allergy (FA), and parental illness perception, analyzing influences of sociodemographic and clinical factors and associations between constructs. Methods: This cross-sectional study involved 79 parents of children (3-12 years) with FA, who completed the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ_PF), Strengths and Difficulties Questionnaire (SDQ), and Brief Illness Perception Questionnaire (B-IPQ). Pearson correlation coefficient and multiple linear regressions were performed. Results: FAQLQ score was positively associated (0.28) with SDQ score, particularly internalizing problems (0.33), and with B-IPQ score (0.64), consequences for the child and parents (0.66), timeline (0.43), and emotional representation (0.63). SDQ score was negatively associated with parental control (-0.27) and coherence (-0.24), while internalizing problems were negatively associated with parental control (-0.23) and positively associated with timeline (0.24). A greater number of allergens was associated with a worse QoL (p < 0.05). Previous anaphylaxis was associated with higher illness identity (p < 0.05). An age between 7 and 12 years was associated with lower control and coherence. In the final model, higher scores on internalizing problems, timeline, and emotional representation were associated with poorer child QoL (p < 0.001). Conclusions: It is crucial to understand and explore illness perception, as well as focus on psychosocial-emotional aspects of FA in both children and parents. A multidisciplinary approach addressing medical and psychological aspects of FA should be implemented to ensure optimal QoL.

Purpose: Nurse professionals often practice rectal stimulation in a hospital setting to help premature or full-term babies evacuate or to avoid abdominal pain caused by gas colic. Paediatricians also recommend this technique to newborn caregivers, who can carry it out independently at home. To the best of our knowledge, there are no established national guidelines on how to implement this technique safely or what the clinical/care indications are for its use. Our purpose is to synthesise the evidence on the nursing practice of rectal stimulation in preterm and full-term newborns.

Methods: A narrative literature review was conducted. A search was conducted across six databases in February, followed by a manual review of the included studies' bibliographies, and another search in October 2023. The search strategy identified studies published without date limits. The articles were screened according to the inclusion criteria.

Results: Sixty-two articles were retrieved. Following the screening process, only two articles were selected for inclusion in the final synthesis. Both studies evaluated the effects of enemas and/or rectal stimulation on feeding tolerance and bowel habits in preterm newborns. Even if both studies included information on when rectal stimulation in preterm newborns is indicated and how it is conducted, they are insufficient to provide a clear statement for nursing practice.

Conclusions: Nowadays, nurses perform rectal stimulation and teach it to caregivers of newborns without shared international or national guidelines or procedures focused on patient safety. It is desirable to conduct scientific studies to inform nursing practice and enhance the quality of nursing care delivered. This review also highlights a critical gap in evidence regarding the use of rectal stimulation in full-term newborns and in community settings.

Background: The GRIA3 gene encodes the GluA3 subunit of AMPA-type glutamate receptors, which are crucial for excitatory neurotransmission in the central nervous system. Pathogenic GRIA3 variants cause X-linked neurodevelopmental disorders of varying severity, including developmental delay, behavioral abnormalities, and epilepsy. Case Summary: Here, we present the case of a seven-year-old female patient presenting with developmental delay, spastic gait, and non-convulsive status epilepticus (NCSE), who was found to carry a novel de novo GRIA3 missense variant (c.1969A > G; p.Thr657Ala). The EEG revealed high-amplitude diffuse rhythmic theta/delta activity consistent with NCSE. A brain MRI showed transient cortical and thalamic T2-FLAIR hyperintensities, likely postictal. Metabolic investigations were unremarkable. Following intensive treatment with levetiracetam and midazolam, the patient gradually recovered to her baseline neurological status. Genetic Finding: Whole-exome sequencing (WES) identified a novel de novo variant in GRIA3, c.1969A > G; p.Thr657Ala, involving the replacement of threonine with alanine at position 657 within the coding region. Significance: This case expands the clinical and molecular spectrum of GRIA3-related disorders, demonstrating that females with de novo variants may experience severe epilepsy. This is the first reported case of NCSE in a female patient with a GRIA3 variant.

Emerging research highlights important distinctions in symptomatology between Posttraumatic Stress Disorder (PTSD) resulting from a single, discrete event, complex interpersonal traumas in the past, and the pervasive effects of chronic, ongoing complex trauma. Despite these well-documented differences, much of the existing practice and professional guidelines for PTSD-focused interventions apply a uniform framework across the distinct clinical presentations resulting from different types and timing of trauma exposure. This gap carries significant clinical consequences, as individuals may be treated for PTSD and comorbid diagnoses or behavioral difficulties without recognition of the impact of persistent ongoing exposure to trauma. The present article is a clinical applications paper that directly builds upon a prior published theoretical and empirical literature review study that introduces the construct of persistent trauma. The objectives are to (1) examine the effects of persistent trauma; (2) explore four types of persistent trauma exposure differentiated by the predictability and preventability of past and current trauma; and (3) offer intervention strategies tailored to each type of persistent trauma. Using a composite case study methodology, we present intervention strategies to inform treatment for children and families who continue to experience each form of persistent trauma.

Background/Objectives: Parental involvement is currently recommended by Italian national guidelines on autism spectrum disorder (ASD) intervention. However, research on the impact of parent-mediated interventions on parental skills and children's outcomes in Italy is limited. This study evaluated the feasibility of delivering Parent-ESDM (Parent-mediated Early Start Denver Model), a well-supported Naturalistic Developmental Behavioral Intervention (NDBI) known to benefit parents' well-being and children's development, within an Italian healthcare service. Methods: Twenty parent-child dyads participated in weekly 1 h Parent-ESDM sessions for 6 months. Spontaneous parent-child interactions were assessed at baseline, mid-intervention, and post-intervention to examine parents' use of NDBI strategies and changes in children's core ASD behaviors. Results: Throughout the intervention, parents acquired a good level of fidelity in the use of NDBI strategies and children obtained significant improvements in core ASD behaviors. Conclusions: These preliminary findings support the feasibility of delivering a parent-mediated intervention within an Italian healthcare service. The positive trends observed provide a strong rationale for conducting controlled trials to more definitively evaluate this model and its potential adoption as a future standard practice.

Background/Objectives: Both benign and malignant thyroid lesions present as nodules. While thyroid nodules are less common in the pediatric population than in adults, their malignancy rates are considerably higher. Although the 10 mm cut-off for fine-needle aspiration cytology (FNAC) is commonly used for both adults and children, there is limited information regarding subcentimeter thyroid nodules in the pediatric population. The majority of published studies have focused on nodules measuring 1 cm or greater. This study aimed to compare the cytological diagnosis, ultrasonographic features, and histopathological outcomes of thyroid nodules in pediatric patients (under 21 years old), stratified by size (≤10 mm vs. >10 mm). Methods: We conducted a retrospective, single-center cohort study, evaluating 108 thyroid nodules from 98 patients. Nodule sizes were categorized into two groups, and their features were correlated with findings from FNAC using the Bethesda System for Reporting Thyroid Cytopathology and subsequent surgical histopathology. The risk of malignancy (ROM) was calculated for each Bethesda category. Results: A total of 108 nodules were evaluated, with 35 (32.4%) measuring ≤ 10 mm. The overall malignancy rate was 12%, with 14.3% in the ≤10 mm group and 11% in the >10 mm group. The difference was not statistically significant, and this finding indicates that small nodules can also harbor malignancy. Notably, all cases categorized as suspicious for malignancy or malignant by FNAC were confirmed to be malignant on histopathology (ROM = 100%). The Atypia of Undetermined Significance (AUS) category exhibited a malignancy rate of 60%, which is significantly higher than the rates reported in previous studies. Ultrasonographic features such as hypoechogenicity and microcalcifications were more prevalent in malignant nodules but lacked statistical significance. Conclusions: Our findings demonstrate that pediatric thyroid nodules, including those ≤10 mm, have a notable risk of malignancy. The high rate of malignancy in the AUS category suggests that the current Bethesda criteria, primarily designed for adults, may require re-evaluation for pediatric cases due to known differences in genetic profiles and disease behavior. Consequently, these pathological findings clearly demonstrate that FNAC indications in children should not be based solely on nodule size, and that a multidisciplinary approach guided by pediatric-specific guidelines should inform clinical management.

Background/objectives: To assess whether laparoscopic adjustable gastric banding (LAGB) and combined lifestyle intervention (CLI) reduce hepatic steatosis more effectively than CLI alone in adolescents with severe obesity.

Methods: Adolescents aged 14-16 with a BMI ≥ 40 kg/m² (or ≥35 kg/m² with comorbidity) were randomized to receive LAGB + combined lifestyle intervention (CLI, n = 30) or CLI alone (n = 30). Hepatic fat was assessed at baseline and one year via ultrasound-based Hepatorenal Index (HRI), liver span, and ALAT levels.

Results: Of 59 participants (mean age 15.7, 80% female, BMI 44.3 kg/m²), 58.9% had steatosis at baseline (HRI ≥ 1.40). After one year, BMI decreased by 5.6 kg/m² in the LAGB group but remained stable in controls. Steatosis resolution (HRI < 1.05) occurred in 21.4% of LAGB versus 4.4% of CLI patients (p = 0.078). Liver span declined by 1.09 cm post-LAGB (95% CI -2.05 to -0.13) and correlated with HRI improvement. ALAT levels were unchanged.

Conclusions: LAGB led to greater reductions in hepatic fat and size than lifestyle changes alone. Though steatosis resolution was not statistically significant, findings suggest bariatric surgery may be a promising strategy for mitigating early hepatic changes in severe adolescent obesity.

What is already known: Severe obesity in adolescents is frequently accompanied by hepatic steatosis, which can progress to metabolic dysfunction-associated steatotic liver disease (MASLD). Bariatric procedures-such as laparoscopic adjustable gastric banding (LAGB)-are proven to induce substantial weight loss and improve obesity-related comorbidities in youth.

What this study adds: This is the first randomized controlled trial to evaluate the effect of LAGB on hepatic steatosis specifically in adolescents. At one year, 21.4% of LAGB-treated patients no longer met the sensitive HRI cut-off for steatosis (<1.05) versus 4.4% of controls. Moderate weight loss after LAGB corresponded with significant improvements in the Hepatorenal Index and liver span, suggesting a reduction in hepatic fat content.

The global disruption caused by COVID-19 has drawn renewed attention to an already pressing reality: child and adolescent mental health requires sustained, system-level investment and high-quality evidence to guide practice [...].