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Caregiver mental health promotion and early parenting programmes 促进照顾者心理健康和早期养育计划
IF 19.9 1区 医学 Q1 PEDIATRICS Pub Date : 2024-08-12 DOI: 10.1016/S2352-4642(24)00190-1
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引用次数: 0
Luregn Schlapbach: advocating for children with sepsis Luregn Schlapbach:为患败血症的儿童代言
IF 19.9 1区 医学 Q1 PEDIATRICS Pub Date : 2024-08-12 DOI: 10.1016/S2352-4642(24)00206-2
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引用次数: 0
Effects of multi-component parenting and parental mental health interventions on early childhood development and parent outcomes: a systematic review and meta-analysis 多成分育儿和父母心理健康干预对幼儿发展和父母成果的影响:系统回顾和荟萃分析
IF 19.9 1区 医学 Q1 PEDIATRICS Pub Date : 2024-08-12 DOI: 10.1016/S2352-4642(24)00134-2

Background

Interventions supporting parents of young children often target parenting or parental mental health separately. Multi-component parenting and parental mental health interventions have the potential to improve parenting practices, mental health, and early childhood development. We aimed to examine their impact on child and parent outcomes.

Methods

In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science Core Collection, APA PsycINFO, CINAHL Complete, the Cochrane Central Register of Controlled Trials, and the Global Health Database from inception to Jan 23, 2024. Eligible studies were randomised controlled trials of interventions explicitly targeting parenting behaviours and parental mental health antenatally or in children's first 3 years of life. Screening, extraction, and quality assessment were done independently by two authors. Primary outcomes were cognitive and social–emotional functioning in children and depressive symptoms in parents, meta-analysed as standardised mean differences (SMDs), relative to control. This study is registered with PROSPERO, CRD42022302848.

Findings

We found 5843 records. After screening 2636 (45·1%) titles and abstracts, we manually identified and screened three additional articles and excluded 2177 records. After screening 462 full-length articles, 25 articles, representing a sample size of 8520 children and caregivers, were included. At baseline, mean caregiver age was 27·7 years (SD 5·9) and mean child age (excluding those enrolled during pregnancy) was 14·4 months (8·0). Interventions lasted a mean of 14 months (SD 11) and used a mean of 3·7 behaviour change techniques (2·0). Most interventions dedicated more time to parenting behaviours than to parental mental health. We found significant intervention effects on children's cognitive (SMD 0·19 [95% CI 0·04 to 0·34]; I2=69%) and social–emotional (0·26 [0·17 to 0·34]; I2=47%) outcomes but not on depressive symptoms in female caregivers (–0·18 [–0·36 to 0·002]; I2=86%) relative to control conditions. Risk of bias across studies was moderate, and we found heterogeneity across results.

Interpretation

Multi-component parenting and mental health interventions had a positive effect on child cognitive and social–emotional outcomes, but not on depressive symptoms in parents, suggesting that other factors might contribute to positive ECD outcomes. Interventions might lack adequate focus on mental health to make a discernible impact, highlighting a need for future studies to differentiate and assess contributions of parenting and mental health components to understand independent and collective effects on family outcomes.

Funding

Canadian Institutes of Health Research.

背景为幼儿父母提供支持的干预措施通常分别针对养育子女或父母的心理健康。多成分育儿和父母心理健康干预措施有可能改善育儿实践、心理健康和幼儿发展。在这项系统性回顾和荟萃分析中,我们检索了从开始到 2024 年 1 月 23 日的 MEDLINE、Embase、Web of Science Core Collection、APA PsycINFO、CINAHL Complete、Cochrane Central Register of Controlled Trials 和 Global Health Database。符合条件的研究均为随机对照试验,这些试验明确针对产前或儿童出生后头三年的养育行为和父母心理健康进行干预。筛选、提取和质量评估由两位作者独立完成。主要结果是儿童的认知和社会情感功能以及父母的抑郁症状,相对于对照组,以标准化均值差异(SMDs)进行元分析。本研究已在 PROSPERO 注册,注册号为 CRD42022302848。在筛选了 2636 篇(45-1%)标题和摘要后,我们又人工识别并筛选了另外三篇文章,排除了 2177 条记录。在筛选了 462 篇长篇文章后,纳入了 25 篇文章,样本量为 8520 名儿童和照顾者。基线时,照顾者的平均年龄为 27-7 岁(SD 5-9),儿童的平均年龄为 14-4 个月(8-0)(不包括怀孕期间的儿童)。干预平均持续 14 个月(标准差 11),平均使用 3-7 种行为改变技术(2-0)。大多数干预措施在养育行为方面投入的时间多于在父母心理健康方面投入的时间。我们发现,相对于对照组,干预对儿童认知(SMD 0-19 [95% CI 0-04 to 0-34];I2=69%)和社会情感(0-26 [0-17 to 0-34];I2=47%)结果有明显影响,但对女性照顾者的抑郁症状(-0-18 [-0-36 to 0-002];I2=86%)没有影响。各研究之间的偏倚风险为中等,我们发现了各研究结果之间的异质性。解释:多成分养育和心理健康干预对儿童的认知和社会情感结果有积极影响,但对父母的抑郁症状没有影响,这表明其他因素可能有助于取得积极的幼儿发展结果。干预措施可能对心理健康缺乏足够的关注,因而无法产生明显的影响,这就强调了今后的研究需要区分和评估养育和心理健康因素的贡献,以了解其对家庭结果的独立和集体影响。
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引用次数: 0
Starting with empirical oral antibiotics for paediatric bone and joint infections 针对儿科骨与关节感染,从经验性口服抗生素开始
IF 19.9 1区 医学 Q1 PEDIATRICS Pub Date : 2024-08-12 DOI: 10.1016/S2352-4642(24)00191-3
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引用次数: 0
Achievement goals and adolescent mental health in individualist versus collectivist cultures 个人主义文化与集体主义文化中的成就目标和青少年心理健康
IF 19.9 1区 医学 Q1 PEDIATRICS Pub Date : 2024-08-12 DOI: 10.1016/S2352-4642(24)00170-6
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引用次数: 0
The burden and contemporary epidemiology of sepsis in children 儿童败血症的负担和当代流行病学
IF 19.9 1区 医学 Q1 PEDIATRICS Pub Date : 2024-08-12 DOI: 10.1016/S2352-4642(24)00140-8

Sepsis is a dysregulated host response to infection that leads to life-threatening organ dysfunction. Half of the 50 million people affected by sepsis globally every year are neonates and children younger than 19 years. This burden on the paediatric population translates into a disproportionate impact on global child health in terms of years of life lost, morbidity, and lost opportunities for children to reach their developmental potential. This Series on paediatric sepsis presents the current state of diagnosis and treatment of sepsis in children, and maps the challenges in alleviating the burden on children, their families, and society. Drawing on diverse experience and multidisciplinary expertise, we offer a roadmap to improving outcomes for children with sepsis. This first paper of the Series is a narrative review of the burden of paediatric sepsis from low-income to high-income settings. Advances towards improved operationalisation of paediatric sepsis across all age groups have facilitated more standardised assessment of the Global Burden of Disease estimates of the impact of sepsis on child health, and these estimates are expected to gain further precision with the roll out of the new Phoenix criteria for sepsis. Sepsis remains one of the leading causes of childhood morbidity and mortality, with immense direct and indirect societal costs. Although substantial regional differences persist in relation to incidence, microbiological epidemiology, and outcomes, these cannot be explained by differences in income level alone. Recent insights into post-discharge sequelae after paediatric sepsis, ranging from late mortality and persistent neurodevelopmental impairment to reduced health-related quality of life, show how common post-sepsis syndrome is in children. Targeting sepsis as a key contributor to poor health outcomes in children is therefore an essential component of efforts to meet the Sustainable Development Goals.

败血症是宿主对感染的一种失调反应,会导致危及生命的器官功能障碍。在全球每年 5000 万败血症患者中,有一半是新生儿和 19 岁以下的儿童。儿科患者所承受的这一负担对全球儿童健康造成了不成比例的影响,包括生命损失年数、发病率以及儿童失去发挥其发展潜力的机会。本系列丛书介绍了儿童败血症的诊断和治疗现状,并描绘了减轻儿童、其家庭和社会负担所面临的挑战。我们利用不同的经验和多学科专业知识,为改善败血症患儿的治疗效果提供了路线图。本系列的第一篇论文是对从低收入到高收入环境中儿童败血症负担的叙述性回顾。在改进各年龄组儿科败血症的可操作性方面取得的进展促进了全球疾病负担估算中有关败血症对儿童健康影响的评估更加标准化,预计随着新的凤凰城败血症标准的推出,这些估算将进一步精确。败血症仍是儿童发病和死亡的主要原因之一,其直接和间接社会成本巨大。虽然各地区在发病率、微生物流行病学和治疗效果方面仍存在巨大差异,但这些差异不能仅用收入水平的差异来解释。最近对小儿败血症出院后后遗症的研究表明,败血症后综合征在儿童中非常普遍,这些后遗症包括晚期死亡、持续的神经发育障碍以及与健康相关的生活质量下降等。因此,把败血症作为导致儿童健康状况不良的一个主要因素,是实现可持续发展目标工作的一个重要组成部分。
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引用次数: 0
Rare and severe adverse events in children with inflammatory bowel disease - Authors' reply 炎症性肠病患儿罕见的严重不良事件 - 作者的回复
IF 19.9 1区 医学 Q1 PEDIATRICS Pub Date : 2024-08-12 DOI: 10.1016/S2352-4642(24)00197-4
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引用次数: 0
Quality improvement programmes in paediatric sepsis from a global perspective 从全球视角看儿科败血症质量改进计划
IF 19.9 1区 医学 Q1 PEDIATRICS Pub Date : 2024-08-12 DOI: 10.1016/S2352-4642(24)00142-1

Sepsis is a major contributor to poor child health outcomes around the world. The high morbidity, mortality, and societal cost associated with paediatric sepsis render it a global health priority, as summarised in Paper 1 of this Series. Sepsis is characterised by a dysregulated host response to infection that manifests as organ failure, and children are uniquely susceptible to sepsis, as discussed in Paper 2. The focus of this third Series paper is quality improvement in paediatric sepsis. The 2017 WHO resolution on sepsis outlined key aims to reduce the burden of sepsis. As of 2024, only a small number of countries have implemented systematic, paediatric-focused quality improvement programmes to raise sepsis awareness, enhance recognition of sepsis, promote timely treatment, and provide long-term support for paediatric sepsis survivors. We examine programme successes and systematic barriers to quality improvement targeting paediatric sepsis. We highlight the need for programme design to consider the entire patient journey, starting with prevention, caregiver awareness, recognition at home, education of the health-care workforce, development of health-care systems, and establishment of long-term family and survivor support extending beyond the intensive care unit. Building on lessons learnt from existing quality improvement programmes, we outline implementation strategies and measures to enable benchmarking. Ultimately, quality improvement on a global scale can only be accelerated through a global learning platform focusing on paediatric sepsis.

败血症是导致全球儿童健康状况不良的一个主要因素。正如本丛书论文 1 所概述的那样,儿科败血症的高发病率、高死亡率和高社会成本使其成为全球健康的优先事项。败血症的特点是宿主对感染的反应失调,表现为器官衰竭,而儿童是败血症的特殊易感人群,这一点在论文 2 中有所讨论。第三篇系列论文的重点是儿科败血症的质量改进。2017 年世卫组织关于败血症的决议概述了减少败血症负担的主要目标。截至 2024 年,只有少数国家实施了系统的、以儿科为重点的质量改进计划,以提高对败血症的认识、加强对败血症的识别、促进及时治疗,并为儿科败血症幸存者提供长期支持。我们研究了针对儿科败血症的质量改进计划的成功之处和系统性障碍。我们强调,计划的设计需要考虑患者的整个生命历程,从预防、护理人员的意识、家庭识别、医护人员的教育、医护系统的发展,以及建立超越重症监护室的长期家庭和幸存者支持开始。基于从现有质量改进计划中吸取的经验教训,我们概述了实施策略和措施,以便制定基准。最终,只有通过以儿科败血症为重点的全球学习平台,才能加快全球范围内的质量改进。
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引用次数: 0
Advancing neonatal phototherapy after 70 years of global impact 新生儿光疗在全球产生影响 70 年后取得进展。
IF 19.9 1区 医学 Q1 PEDIATRICS Pub Date : 2024-08-09 DOI: 10.1016/S2352-4642(24)00195-0
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引用次数: 0
Responsive caregiving: conceptual clarity and the need for indicators 响应式护理:概念的明确性和指标的必要性。
IF 19.9 1区 医学 Q1 PEDIATRICS Pub Date : 2024-08-06 DOI: 10.1016/S2352-4642(24)00194-9
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引用次数: 0
期刊
Lancet Child & Adolescent Health
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