Children-Basel最新文献

Background/Objectives: In Japan, the number of elementary and junior high school students who do not attend school is increasing. Sleep problems are considered a contributing factor. Methods: This study utilized self-administered questionnaires about the sleep patterns and backgrounds of 25,257 students from the 3rd-10th grades across 91 elementary schools, 51 junior high schools, and 36 high schools in Japan. Latent class analysis was performed to assess sleep regularity. Logistic regression analysis was conducted to examine the relationship between sleep regularity and school attendance status, as well as the relationship with protective factors against non-attendance. Results: Overall, 19,005 students responded. The response rate was 75.2%. Sleep regularity was categorized into Class 1, Regular; Class 2, Somewhat Irregular; Class 3, Irregular; and Class 4, Schedule-Dependent. Class 1 decreased with grade, from 61.8% in the 3rd grade to 46.2% in the 10th grade. Class 3 comprised 10.0% of students not experiencing school non-attendance, 37.9% among students with persistent school non-attendance, and 17.9% among students who had resumed school attendance after school non-attendance in the previous year. Classes 2, 3, and 4 showed a negative relationship with protective factors against non-attendance such as good relationships with teachers and family, good communication, academic performance, proficiency in athletic activities, and the presence of a place to belong outside school. Conclusions: Sleep irregularity is related to school non-attendance and may serve as a barometer of students' communication and academic difficulties. Additionally, we propose an early intervention for sleep problems to prevent the exacerbation of school non-attendance.

Background: Autism Spectrum Disorder (ASD) necessitates enhanced therapeutic support, especially in rural areas. Individual therapeutic sessions are costly, presenting an economic burden on the family of the child with ASD, as well as on healthcare and educational systems. Therefore, the current investigation aimed to assess the feasibility of a new hybrid therapeutic model involving a combination of remote and in situ interventions, ecologically implemented. Methods: The following outcome measures were used to assess the program's feasibility and preliminary outcomes. The Preschool Language Scales 5th Edition (PLS-5), the Test of Playfulness 4th edition (TOP-4), and individually tailored goals evaluated using the Goal Attainment Scale (GAS) and the Autism Spectrum Rating Scale (ASRS). The evaluated children with ASD (N = 25), age range of 39-76 months (Mean: 53.1 ± 11.9), were treated with the novel Hybrid Ecological Intervention (HEI) method, where each child received bimonthly frontal therapeutic sessions and bi-weekly remote therapeutic sessions by a health care professional (OT or ST), supported by four weekly frontal sessions by a technological support person supervised by healthcare professionals. Results: All qualitative scales presented were associated with improvements in all evaluated areas. Qualitative data mostly supported the HEI and ways to overcome existing challenges, supporting the use of both evaluation methods. Conclusions: The use of quantitative and qualitative data was found to be efficient and complementary to one another. The scales used (ASRS, GAS) were found to be useful tools for this method and for these participants. The HEI model was found to be associated with improvement in play, communication, social abilities, as well as autism severity.

Background/objectives: Varicocele is a common cause of testicular hypotrophy and impaired semen quality in adolescents. Laparoscopic varicocelectomy (LV) and microsurgical varicocelectomy (MV) with internal spermatic vein-superficial epigastric vein bypass are established treatment options. This study aimed to compare clinical outcomes, complication rates, and functional recovery between LV and MV in adolescents.

Methods: A retrospective two-center analysis was conducted on adolescents who underwent LV or MV between 2019 and 2024. Primary outcomes included postoperative complications, recurrence, testicular volume recovery, and semen parameter improvement. Secondary outcomes included operative time, hospital stay, and return to full activity. Statistical significance was set at p < 0.05.

Results: A total of 430 patients met the inclusion criteria (270 LV, 160 MV). LV had a significantly shorter operative time (15 ± 5.1 min vs. 55.5 ± 6.4 min; p < 0.0001). There were no significant differences in hospital stay (p = 0.28), postoperative hematoma (p = 0.06), hydrocele (p = 0.06), or recurrence rates (p = 0.20). Full recovery of testicular volume occurred in 75.0% after LV vs. 70.6% after MV (p = 0.40). Overall semen improvement was 89.5% in LV vs. 100% in MV (p = 0.07). Normalization of oligospermia was significantly higher in the MV group (92.8% vs. 65.3%; p = 0.0048).

Conclusions: Both LV and MV are safe and effective techniques for adolescent varicocele repair, with comparable complication and recurrence rates. LV offers significantly shorter operative time, whereas MV provides a superior improvement in semen parameters, suggesting a potential advantage of microsurgical repair in adolescents presenting with abnormal semen analysis.

Postural alignment can be influenced by intrinsic and extrinsic factors; failure to control these confounding factors and the use of invalid tools increase the risk of bias and may distort the results. Objective: The first objective is to identify the confounding factors that may influence the evaluation of body posture in children. The second objective is to determine which methods or tools are used to analyze postural alignment and to review the evidence regarding their validity and reliability, in order to strengthen the credibility of the results obtained. Methods: A systematic review was performed following the PRISMA 2020 criteria. Eligible studies were searched in the Virtual Health Library, Scopus, Medline, Web of Science, PEDro, and the Cochrane Library throughout the entire month of December 2024. Observational studies written in English, Portuguese, or Spanish that analyzed body posture (as the dependent variable) in children under 12 years of age were included. Articles not available in full text or those that assessed only a single body region were excluded. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale, while the ROBINS-E tool was used to assess risk of bias. The synthesis of results was presented as a narrative review. Results: A total of 42 observational articles were included. No meta-analysis was conducted, and the findings are synthesized through a narrative review. The ROBINS-E tool showed a generalized result of high risk of bias, while the Newcastle-Ottawa scale reported moderate quality for longitudinal and case-control studies, with worse scores for cross-sectional studies. Methodological limitations: The differences found in the designs, population, and outcome measures generate high methodological variability that limits the possibility of quantitative synthesis. Likewise, the available evidence on the reliability of the tools is insufficient, which conditions the interpretation of the reported results. Conclusions: The findings with the strongest scientific support suggest that anthropometric variables or those related to body composition may be associated with body alignment. By contrast, there is still controversy regarding the influence of sex and age on postural variables. Sport modality or the weight of the school backpack could also play a role in posture; however, more high-quality studies are needed to contrast the results. The quality of the evidence is limited by heterogeneity in study designs, insufficient control of confounding factors, and the use of tools with inadequate validity and reliability. Other: The study was registered in PROSPERO under the number CRD42024618753. This research received no external funding.

Background: Children can be removed from their home if allegations of abuse or neglect are substantiated. The preference is to place them with family members. In the most extreme cases, a child may be placed in a congregate care setting. A child with diabetes should only be placed in such a facility if the staff have been appropriately trained. Otherwise, the consequences can be devastating. In 2022 and 2024, two children were placed into congregate care facilities in Arizona and died of diabetic ketoacidosis due to a lack of appropriate employee training.

Study objective: We aim to inform providers of the legal processes and laws that can result in a child being placed into a congregate care setting. We analyze what went wrong in the care of these two children. We present alternative pathways that might ensure the safety of children before they are placed in such facilities.

Methodology: We reviewed public information for cases of morbidity and mortality in children with diabetes in congregate care. We reviewed the California Welfare and Institution legal codes and applicable laws in the Federal Register. We obtained information regarding children with diabetes mellitus who were in the care of child welfare on PubMed.

Results and conclusions: While there are legal safeguards for children with diabetes who are placed in congregate care, these safeguards are ineffective if staff are inappropriately trained. We present programs and recommendations to prevent a child who is placed in a congregate care facility from suffering medical complications or death.

Background: As the overall prevalence of dietary supplements (DS) use in pediatric populations is high, these products should be strictly regulated. However, regulatory frameworks for DS in the European Union and Serbia share inconsistencies and ambiguities which may compromise pediatric DS safety.

Objective: To identify and critically assess the regulatory and practical issues in defining, labeling, advertising, and use of pediatric dietary supplements in the EU and Serbia.

Methods: This review focused on identifying and assessing inconsistencies, gaps, and other regulatory challenges, as well as marketing practices affecting consumer safety through the assessment of legal and policy frameworks of the European Union and Serbia, and peer-reviewed articles, pertaining to the definition, labeling, and advertising of pediatric dietary supplements, that were assessed for contextual evidence on related, evidence-based, and practice-based information.

Results: The analysis identified five critical areas of concern within the current regulations for pediatric DS: (i) the absence of universal and clear product definition, (ii) the lack of uniform, age-appropriate composition standards, (iii) potential safety risks related to ambiguous composition standards, arbitrary age cut-offs, and lack of age-appropriate reference values specific to DS, (iv) misuse of labels and unfair advertising practices, and (v) practical aspects of pediatric DS use and the limited role of healthcare providers in it.

Conclusions: Regulating pediatric DS is a complex task due to the diversity of the pediatric population. Regulatory systems must be ready to swiftly resolve all inconsistencies and adjust to new scientific developments and market changes in order to ensure our primary goal-children's health and safety.

The Special Issue, "Children and Adolescents with Neurodevelopmental Disabilities: Ecological Assessment Tools and Cognitive Analysis," brings together a diverse collection of articles that highlight the rapidly evolving landscape of assessment, participation, and cognitive analysis in children and adolescents with neurodevelopmental disabilities (NDDs) [...].

Background/Objectives: Hydrocephalus is primarily treated with open ventriculoperitoneal shunt (VPS) insertion, but laparoscopy-assisted VPS insertion has emerged as an alternative. This study compared outcomes and complications of laparoscopic versus open VPS insertion without a peel-away sheath in pediatric patients. Methods: A retrospective review was conducted on 121 VPS insertions (2012-2025) at a tertiary pediatric center in Korea. Patients were categorized into laparoscopic (n = 42) and open (n = 79) groups. The laparoscopic technique utilized only standard reusable instruments, without a peel-away sheath. Demographics, surgical parameters, postoperative recovery, and unplanned revision rates were analyzed. A Cox proportional hazards regression model was used to evaluate catheter survival, adjusting for baseline characteristics that differed significantly between the groups. Five-year shunt survival was assessed using Kaplan-Meier survival analysis. Results: The laparoscopic group had more revision cases and previous abdominal surgeries; additionally, intra-abdominal adhesions were more common (52.4% vs. 3.8%), and adhesiolysis was more often performed (9.5% vs. 1.3%). However, no differences were found in total operative time, distal catheter insertion time, or perioperative complications. After adjusting for demographic differences between the groups, Cox regression analysis demonstrated no significant difference in catheter survival. Both short-term (12 months) and long-term (5 years) shunt survival rates were comparable between the groups. Conclusions: Laparoscopic VPS insertion without a peel-away sheath is feasible and safe in pediatric patients, including those with complex surgical histories. It offers favorable recovery and adhesion management outcomes without compromising shunt durability, supporting its use as a practical alternative in resource-limited settings.

Background/Objectives: Fever and pain are among the most common symptoms in pediatric infections and chronic diseases, causing significant discomfort for children and concern for caregivers. Effective management is essential to relieve distress while avoiding overtreatment or undertreatment. Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen, are the primary antipyretic and analgesic agents in pediatric care, but their use in children with chronic conditions might be challenging. Methods: A narrative review and clinical expert judgment were used to synthesize current evidence on the use of paracetamol and NSAIDs (especially ibuprofen) in children with some common chronic diseases. Results: Paracetamol is often considered a first-line option in several chronic conditions. Caution is warranted in children with pre-existing malnutrition, obesity, and neuromuscular disorders as these factors might increase the risk of hepatotoxicity. NSAIDs provide additional anti-inflammatory effects and comparable analgesic efficacy but should be used cautiously in some high-risk populations due to potential gastrointestinal, renal, and bleeding complications. Their use is contraindicated in children with dehydration, renal impairment, nephrotic syndrome relapses, while careful risk-benefit assessment is required in small and vulnerable neonates. Some data also suggests NSAIDs may worsen outcomes in certain acute bacterial and viral infections. Data on chronic infections such as tuberculosis, HIV, and viral hepatitis are limited, highlighting the need for further research. Combination therapy with paracetamol and ibuprofen may enhance analgesia in postoperative settings without significantly increasing adverse events. Overall, available evidence is limited and largely observational. Conclusions: This narrative review synthesizes current evidence and clinical expertise to provide practical guidance on the rational use of paracetamol and NSAIDs in children, emphasizing individualized therapy according to comorbidities, risk factors, and clinical context, particularly in vulnerable populations. A risk-adapted, evidence-based approach ensures optimal symptom control while minimizing harm, supporting safer, more effective, and family-centered care for children with fever and pain.