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Achievement goals and adolescent depression: implications for school-based interventions 成就目标与青少年抑郁症:对校本干预的影响。
IF 36.4 1区 医学 Q1 PEDIATRICS Pub Date : 2024-04-17 DOI: 10.1016/S2352-4642(24)00100-7
Sophie H Li , Aliza Werner-Seidler
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引用次数: 0
Long-term neurocognitive, psychosocial, and physical outcomes after prenatal exposure to radiotherapy: a multicentre cohort study of the International Network on Cancer, Infertility, and Pregnancy 产前接受放射治疗后的长期神经认知、社会心理和身体状况:国际癌症、不孕症和妊娠网络的多中心队列研究
IF 36.4 1区 医学 Q1 PEDIATRICS Pub Date : 2024-04-16 DOI: 10.1016/S2352-4642(24)00075-0
Indra A Van Assche MSc , Kristel Van Calsteren PhD , Jurgen Lemiere PhD , Jana Hohmann MSc , Jeroen Blommaert PhD , Evangeline A Huis in 't Veld MSc , Elyce Cardonick MD , Charlotte LeJeune MD , Nelleke P B Ottevanger PhD , Prof Els P O Witteveen PhD , Martine van Grotel PhD , Prof Marry M van den Heuvel-Eibrink PhD , Prof Lieven Lagae PhD , Maarten Lambrecht PhD , Prof Frédéric Amant PhD
<div><h3>Background</h3><p>The main data available on the safety of radiation during pregnancy originate from animal studies and from studies of survivors of atomic or nuclear disasters. The effect of radiotherapy to treat maternal cancer on fetal development is uncertain. This report presents a unique cohort and aims to determine the long-term neurocognitive, psychosocial and physical outcomes of offspring of mothers treated with radiotherapy during pregnancy.</p></div><div><h3>Methods</h3><p>In this international, multicentre, mixed retrospective–prospective cohort study, we recruited participants between Aug 5, 2006, and Aug 24, 2023, aged between 1·5 and 46 years, at three referral centres in Belgium, the Netherlands, and the USA. Participants were eligible if they were born from mothers treated with radiotherapy during pregnancy. Fetal radiation doses were obtained from medical records and participants were followed up at predefined ages (1·5, 3, 6, 9, 12, 15, and 18 years) and 5-yearly in adulthood, based on age at enrolment, using a neurocognitive test battery (measuring intelligence, attention, and memory), parent-reported executive function and psychosocial questionnaires, and a medical assessment. Results were compared with test-specific normative data. Linear regression models investigated associations between radiotherapy factors (fetal radiation dose, gestational age at the start and end of radiotherapy, and radiotherapy duration) and outcomes.</p></div><div><h3>Findings</h3><p>68 maternal cases of radiotherapy during pregnancy were registered by the three participating centres, of which 61 resulted in a livebirth and were therefore eligible to participate in the child follow-up study. After excluding those who did not give consent, 43 participants born from 42 mothers treated with radiotherapy during pregnancy were included in the study (median age at first assessment 3 years [IQR 2–11]; median age at last assessment 12 years [9–18]; median number of assessments two [1–4]). 18 (42%) of the included participants were female and 25 (58%) male, and 37 (86%) were of White ethnicity. Mean neurocognitive outcomes of the entire cohort were within normal ranges. No associations were found with fetal radiation dose or timing of radiotherapy during pregnancy. Six (16%) of 38 participants with neurocognitive outcomes scored lower than one SD on at least one neurocognitive outcome, three (7%) reported chronic medical conditions (spasmophilia, spastic diplegia, and IgG deficiency), and three (7%) were diagnosed with attention-deficit hyperactivity disorder (of whom two scored lower on attention). Of ten (23%) participants with lower neurocognitive score(s), a chronic medical condition, or attention-deficit hyperactivity disorder, eight were born preterm. The remaining 33 (77%) participants showed no neurocognitive, psychosocial, or chronic physical problems.</p></div><div><h3>Interpretation</h3><p>We show on average normal neurocognitive, psycho
关于孕期辐射安全的主要数据来自动物实验和对原子或核灾难幸存者的研究。治疗母体癌症的放射治疗对胎儿发育的影响尚不确定。本报告介绍了一个独特的队列,旨在确定在怀孕期间接受放射治疗的母亲的后代在神经认知、社会心理和身体方面的长期结果。在这项国际性、多中心、回顾性和前瞻性混合队列研究中,我们招募了2006年8月5日至2023年8月24日期间在比利时、荷兰和美国的三个转诊中心接受放疗的1-5岁至46岁的参与者。如果参与者的母亲在怀孕期间接受过放射治疗,那么他们就符合条件。研究人员从医疗记录中获取了胎儿的辐射剂量,并根据入组年龄在预定年龄(1-5岁、3岁、6岁、9岁、12岁、15岁和18岁)和成年后每5年对参与者进行一次随访,随访方法包括神经认知测试(测量智力、注意力和记忆力)、家长报告的执行功能和社会心理问卷以及医疗评估。研究结果与特定测试的常模数据进行了比较。线性回归模型研究了放疗因素(胎儿辐射剂量、放疗开始和结束时的胎龄以及放疗持续时间)与结果之间的关联。三个参与中心共登记了68例孕期接受放射治疗的孕产妇,其中61例为活产,因此有资格参与儿童随访研究。在剔除未表示同意的产妇后,42 名接受过孕期放疗的产妇所生的 43 名婴儿被纳入研究范围(首次评估的中位年龄为 3 岁 [IQR:2-11];最后一次评估的中位年龄为 12 岁 [9-18];评估次数的中位数为 2 次 [1-4])。其中女性 18 人(42%),男性 25 人(58%),白人 37 人(86%)。整个组群的平均神经认知结果均在正常范围内。没有发现胎儿辐射剂量或怀孕期间接受放疗的时间有任何关联。在 38 名有神经认知结果的参与者中,有 6 人(16%)至少有一项神经认知结果的得分低于 1 SD,有 3 人(7%)报告患有慢性疾病(痉挛性肢体瘫痪、痉挛性偏瘫和 IgG 缺乏症),有 3 人(7%)被诊断患有注意力缺陷多动障碍(其中 2 人在注意力方面得分较低)。在 10 名(23%)神经认知评分较低、患有慢性疾病或注意力缺陷多动症的参与者中,有 8 人是早产儿。其余 33 名参与者(77%)没有神经认知、社会心理或慢性身体问题。我们的研究结果表明,产前接受放射治疗后,神经认知、社会心理和身体状况平均正常。孕期接受放疗无法解释结果的差异。这些结果表明,怀孕期间接受腹盆腔外放射治疗一般不会对活产婴儿的预后产生不利影响。有必要对更大样本进行进一步研究,以证实这些发现。Kom Op Tegen Kanker、KWF Kankerbestrijding、Stichting Tegen Kanker、佛兰德斯研究基金会。
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引用次数: 0
Determinants of lung function development from birth to age 5 years: an interrupted time series analysis of a South African birth cohort 从出生到 5 岁肺功能发育的决定因素:对南非出生队列的间断时间序列分析。
IF 36.4 1区 医学 Q1 PEDIATRICS Pub Date : 2024-04-12 DOI: 10.1016/S2352-4642(24)00072-5
Carlyle McCready MSc , Prof Heather J Zar PhD , Shaakira Chaya MD , Carvern Jacobs MSc , Lesley Workman MPH , Prof Zoltan Hantos PhD , Prof Graham L Hall PhD , Prof Peter D Sly PhD , Prof Mark P Nicol PhD , Prof Dan J Stein PhD , Anhar Ullah MSc , Prof Adnan Custovic PhD , Prof Francesca Little PhD , Diane M Gray PhD

Background

Early life is a key period that determines long-term health. Lung development in childhood predicts lung function attained in adulthood and morbidity and mortality across the life course. We aimed to assess the effect of early-life lower respiratory tract infection (LRTI) and associated risk factors on lung development from birth to school age in a South African birth cohort.

Methods

We prospectively followed children enrolled in a population-based cohort from birth (between March 5, 2012 and March 31, 2015) to age 5 years with annual lung function assessment. Data on multiple early-life exposures, including LRTI, were collected. The effect of early-life risk factors on lung function development from birth to age 5 years was assessed using the Generalised Additive Models for Location, Scale and Shape and Interrupted Time Series approach.

Findings

966 children (475 [49·2%] female, 491 [50·8%] male) had lung function measured with oscillometry, tidal flow volume loops, and multiple breath washout. LRTI occurred in 484 (50·1%) children, with a median of 2·0 LRTI episodes (IQR 1·0–3·0) per child. LRTI was independently associated with altered lung function, as evidenced by lower compliance (0·959 [95% CI 0·941–0·978]), higher resistance (1·028 [1·016–1·041]), and higher respiratory rate (1·018 [1·063–1·029]) over 5 years. Additional impact on lung function parameters occurred with each subsequent LRTI. Respiratory syncytial virus (RSV) LRTI was associated with lower expiratory flow ratio (0·97 [0·95–0·99]) compared with non-RSV LRTI. Maternal factors including allergy, smoking, and HIV infection were also associated with altered lung development, as was preterm birth, low birthweight, female sex, and coming from a less wealthy household.

Interpretation

Public health interventions targeting LRTI prevention, with RSV a priority, are vital, particularly in low-income and middle-income settings.

Funding

UK Medical Research Council Grant, The Wellcome Trust, The Bill & Melinda Gates Foundation, US National Institutes of Health Human Heredity and Health in Africa, South African Medical Research Council, Hungarian Scientific Research Fund, and European Respiratory Society.

背景早年是决定长期健康的关键时期。儿童时期的肺发育可预测成年后的肺功能以及整个生命过程中的发病率和死亡率。我们旨在评估南非出生队列中早期下呼吸道感染(LRTI)及相关风险因素对出生至学龄期肺发育的影响。我们收集了包括 LRTI 在内的多种早期生活暴露数据。研究结果966名儿童(475名[49-2%]女性,491名[50-8%]男性)接受了肺功能测量,测量方法包括振荡测量法、潮气量环流法和多次呼吸冲洗法。484名儿童(50-1%)发生了LRTI,每名儿童的LRTI发作次数中位数为2-0次(IQR为1-0-3-0)。LRTI 与肺功能的改变密切相关,5 年内顺应性降低(0-959 [95% CI 0-941-0-978])、阻力增加(1-028 [1-016-1-041])、呼吸频率增加(1-018 [1-063-1-029])就是证明。随后的每一次 LRTI 都会对肺功能参数产生额外的影响。与非 RSV LRTI 相比,呼吸道合胞病毒(RSV)LRTI 与较低的呼气流量比(0-97 [0-95-0-99])相关。包括过敏、吸烟和艾滋病病毒感染在内的母体因素也与肺部发育的改变有关,早产、低出生体重、女性性别和来自不富裕家庭也与肺部发育的改变有关。资助英国医学研究委员会拨款、惠康基金会、比尔-盖茨基金会、美国国立卫生研究院、非洲人类遗传与健康、南非医学研究委员会、匈牙利科学研究基金和欧洲呼吸学会。
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引用次数: 0
Lung function trajectories and determinants in early life 生命早期的肺功能轨迹和决定因素。
IF 36.4 1区 医学 Q1 PEDIATRICS Pub Date : 2024-04-12 DOI: 10.1016/S2352-4642(24)00081-6
Sophie Yammine , Philipp Latzin
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引用次数: 0
Re-integrating Africa's street children 让非洲街头儿童重新融入社会。
IF 36.4 1区 医学 Q1 PEDIATRICS Pub Date : 2024-04-11 DOI: 10.1016/S2352-4642(24)00103-2
John Agaba
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引用次数: 0
PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study 对急诊科就诊的腹部钝伤或轻微头部创伤儿童进行 CT 成像检查的 PECARN 预测规则:一项多中心前瞻性验证研究
IF 36.4 1区 医学 Q1 PEDIATRICS Pub Date : 2024-04-10 DOI: 10.1016/S2352-4642(24)00029-4
Prof James F Holmes MD , Prof Kenneth Yen MD , Irma T Ugalde MD , Prof Paul Ishimine MD , Pradip P Chaudhari MD , Nisa Atigapramoj MD , Prof Mohamed Badawy MD , Prof Kevan A McCarten-Gibbs MD , Donovan Nielsen BA , Allyson C Sage MPH , Grant Tatro MD , Prof Jeffrey S Upperman MD , Prof P David Adelson MD , Prof Daniel J Tancredi PhD , Prof Nathan Kuppermann MD
<div><h3>Background</h3><p>The intra-abdominal injury and traumatic brain injury prediction rules derived by the Pediatric Emergency Care Applied Research Network (PECARN) were designed to reduce inappropriate use of CT in children with abdominal and head trauma, respectively. We aimed to validate these prediction rules for children presenting to emergency departments with blunt abdominal or minor head trauma.</p></div><div><h3>Methods</h3><p>For this prospective validation study, we enrolled children and adolescents younger than 18 years presenting to six emergency departments in Sacramento (CA), Dallas (TX), Houston (TX), San Diego (CA), Los Angeles (CA), and Oakland (CA), USA between Dec 27, 2016, and Sept 1, 2021. We excluded patients who were pregnant or had pre-existing neurological disorders preventing examination, penetrating trauma, injuries more than 24 h before arrival, CT or MRI before transfer, or high suspicion of non-accidental trauma. Children presenting with blunt abdominal trauma were enrolled into an abdominal trauma cohort, and children with minor head trauma were enrolled into one of two age-segregated minor head trauma cohorts (younger than 2 years <em>vs</em> aged 2 years and older). Enrolled children were clinically examined in the emergency department, and CT scans were obtained at the attending clinician's discretion. All enrolled children were evaluated against the variables of the pertinent PECARN prediction rule before CT results were seen. The primary outcome of interest in the abdominal trauma cohort was intra-abdominal injury undergoing acute intervention (therapeutic laparotomy, angiographic embolisation, blood transfusion, intravenous fluid for ≥2 days for pancreatic or gastrointestinal injuries, or death from intra-abdominal injury). In the age-segregated minor head trauma cohorts, the primary outcome of interest was clinically important traumatic brain injury (neurosurgery, intubation for >24 h for traumatic brain injury, or hospital admission ≥2 nights for ongoing symptoms and CT-confirmed traumatic brain injury; or death from traumatic brain injury).</p></div><div><h3>Findings</h3><p>7542 children with blunt abdominal trauma and 19 999 children with minor head trauma were enrolled. The intra-abdominal injury rule had a sensitivity of 100·0% (95% CI 98·0–100·0; correct test for 145 of 145 patients with intra-abdominal injury undergoing acute intervention) and a negative predictive value (NPV) of 100·0% (95% CI 99·9–100·0; correct test for 3488 of 3488 patients without intra-abdominal injuries undergoing acute intervention). The traumatic brain injury rule for children younger than 2 years had a sensitivity of 100·0% (93·1–100·0; 42 of 42) for clinically important traumatic brain injuries and an NPV of 100·0%; 99·9–100·0; 2940 of 2940), whereas the traumatic brain injury rule for children aged 2 years and older had a sensitivity of 98·8% (95·8–99·9; 168 of 170) and an NPV of 100·0% (99·9–100·0; 6015 of 6017)
背景儿科急诊护理应用研究网络(PECARN)制定的腹腔内损伤和创伤性脑损伤预测规则旨在分别减少腹部和头部创伤患儿对 CT 的不当使用。在这项前瞻性验证研究中,我们招募了在 2016 年 12 月 27 日至 2021 年 9 月 1 日期间前往美国萨克拉门托(加利福尼亚州)、达拉斯(德克萨斯州)、休斯顿(德克萨斯州)、圣迭戈(加利福尼亚州)、洛杉矶(加利福尼亚州)和奥克兰(加利福尼亚州)的六个急诊科就诊的 18 岁以下儿童和青少年。我们排除了以下患者:怀孕或已有神经系统疾病而无法进行检查、穿透性创伤、到达前受伤超过 24 小时、转院前已进行 CT 或 MRI 检查或高度怀疑非意外创伤。腹部钝性外伤患儿被纳入腹部外伤队列,轻微头部外伤患儿被纳入两个按年龄划分的轻微头部外伤队列(2岁以下 vs 2岁及以上)。入组儿童在急诊科接受临床检查,并由主治临床医生决定是否进行 CT 扫描。在看到 CT 结果之前,所有入选儿童都根据相关的 PECARN 预测规则的变量进行了评估。腹部创伤队列的主要研究结果是接受急性干预的腹部内伤(治疗性开腹手术、血管栓塞、输血、胰腺或胃肠道损伤静脉输液≥2 天或腹部内伤致死)。在按年龄划分的轻微头部创伤队列中,主要研究结果是临床上重要的脑外伤(神经外科手术、脑外伤插管 24 小时,或因持续症状和 CT 证实脑外伤住院≥2 晚;或因脑外伤死亡)。腹部内伤规则的灵敏度为 100-0%(95% CI 98-0-100-0;对 145 名接受急性干预的腹部内伤患者中的 145 名进行了正确检测),阴性预测值 (NPV) 为 100-0%(95% CI 99-9-100-0;对 3488 名未接受急性干预的腹部内伤患者中的 3488 名进行了正确检测)。2岁以下儿童创伤性脑损伤规则对临床重要创伤性脑损伤的灵敏度为100-0%(93-1-100-0;42例中的42例),NPV为100-0%;99-9-100-0;2940例中的2940例),而2岁及以上儿童创伤性脑损伤规则的灵敏度为98-8%(95-8-99-9;170例中的168例),NPV为100-0%(99-9-100-0;6017例中的6015例)。两名被脑外伤规则误诊的患儿入院观察,但无需进行神经外科手术。因此,在儿科急诊部门实施这些规则可被视为一种安全的策略,可最大限度地减少因腹部或头部创伤而需要高质量护理的儿童不适当使用 CT 的情况。
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引用次数: 0
A renewed commitment to intersectoral action for child and adolescent health 重新承诺为儿童和青少年健康采取跨部门行动
IF 36.4 1区 医学 Q1 PEDIATRICS Pub Date : 2024-04-10 DOI: 10.1016/S2352-4642(24)00082-8
Jennifer Thorley
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引用次数: 0
Limiting radiation exposure when evaluating injured children 评估受伤儿童时限制辐射照射
IF 36.4 1区 医学 Q1 PEDIATRICS Pub Date : 2024-04-10 DOI: 10.1016/S2352-4642(24)00085-3
Shannon N Acker , Katrina Weaver
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引用次数: 0
Death by accident: the curse of mobility 意外死亡:流动性的诅咒
IF 36.4 1区 医学 Q1 PEDIATRICS Pub Date : 2024-04-10 DOI: 10.1016/S2352-4642(24)00083-X
Dominik Mautner
{"title":"Death by accident: the curse of mobility","authors":"Dominik Mautner","doi":"10.1016/S2352-4642(24)00083-X","DOIUrl":"https://doi.org/10.1016/S2352-4642(24)00083-X","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 5","pages":"Pages 323-324"},"PeriodicalIF":36.4,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140544013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Extreme or pathological demand avoidance: prioritising research to understand the prevalence and cause 极端或病态的需求回避:优先开展研究以了解其普遍性和原因。
IF 36.4 1区 医学 Q1 PEDIATRICS Pub Date : 2024-04-01 DOI: 10.1016/S2352-4642(24)00057-9
Christopher Gillberg , Ylva Larsson , Eva Billstedt
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引用次数: 0
期刊
Lancet Child & Adolescent Health
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