Archives of Disease in Childhood最新文献

Objective: This study aimed to examine profiles of co-occurrence of developmental disorders and their association with birth before full term.

Design: Latent class analysis of cohort data with linked health data.

Setting: Bradford, England.

Patients: 13 172 children were included in the analysis.

Outcome measures: Developmental disorder in medical records.

Methods: Data were censored at each child's 12th birthday. The latent class analysis identified patterns of developmental disorders. Multinomial logistic regression explored the association with gestational age while adjusting for clinical and socio-factors.

Results: The majority (12,536) had a low risk of developmental disorders; this group was named 'typical development'. The remaining children were classified into three groups: 'educational difficulties' (347 children); 'social, emotional, behavioural and communication difficulties' (189 children) and 'early developmental impairment, with physical and intellectual disabilities' (100 children).Compared with 'typical development', very preterm birth was associated with an increased likelihood of being in the 'early developmental impairment, with physical and intellectual disabilities' group, adjusted relative risk ratio (aRRR): 9.22 (95% CI 4.58 to 18.55). Birth before full term was associated with increased likelihood of being in the 'educational difficulties' group; risk was highest <34 weeks (aRRR: 2.64 (95% CI 1.44 to 4.83)) but persisted up to 37-38 weeks: aRRR: 1.41 (95% CI 1.10 to 1.81). There was no association between gestational age and the 'social, emotional, behavioural and communication difficulties'' group.

Conclusion: Four distinct profiles of developmental disorders were identified; gestational age was associated with two of these. Understanding which disorders children are most at risk of and how these co-occur can help provide accurate information to families and contribute to prompt diagnosis.

Background: Cognitive ability and socioemotional behaviour during childhood have independently been shown to impact educational outcomes. The extent to which their co-development predicts these outcomes remains unclear. This study aimed to assess associations between concurrent cognitive and socioemotional development trajectories in childhood and exam results at age 16 years.

Data and method: We analysed longitudinal data on 9084 children from the UK Millennium Cohort Study. Exposure trajectories of cognitive and socioemotional development from age 3 to 14 years were characterised using group-based multi-trajectory models. We used logistic regression to assess associations between these development trajectories and exam attainment, measured by passing five or more GCSE subjects at age 16, adjusting for confounders. Population-attributable fractions were calculated to quantify the contribution of cognitive and socioemotional problems to poor educational outcomes.

Results: Compared with the 'no problem' trajectory group, the odds of not achieving a standard pass in GCSE was 2.5 times higher for the 'late socioemotional problems' trajectory group (adjusted OR 2.5, 95% CI 2.1 to 3.1) and four times higher for the 'early cognitive and socioemotional problems' trajectory group (adjusted OR 4.2, 95% CI 3.4 to 5.3). The OR was highest for the trajectory group with persistent cognitive and socioemotional problems (adjusted OR 4.4, 95% CI 3.3 to 5.8). Approximately 17% of poor exam results in adolescence were attributable to cognitive and socioemotional behaviour problems in childhood (adjusted population-attributable fraction 17%, 95% CI 15% to 19%).

Conclusion: In a representative UK cohort, adverse development of cognitive and socioemotional behaviour in childhood was associated with a negative impact on exam results in adolescence, more so when the adverse development co-occurs or clusters early or persistently. Cross sector health and education policy that invests in reducing cognitive and socioemotional behaviour problems in children has the potential to improve educational outcomes in adolescence.

Chimeric antigen receptor (CAR) T cell therapy is a promising form of adoptive cell therapy. This process re-engineers patient-derived T cells to express a hybrid receptor targeting a selected tumour-expressed antigen. CAR T cell therapy directed against the CD19 antigen has been highly successful in haematological malignancies that have failed other therapies, particularly relapsed B-cell acute lymphoblastic leukaemia (B-ALL). This review focuses on the numerous real-world aspects of treating children with B-ALL with CD19-targeted CAR T cell therapy. We discuss some of the considerations for clinicians including manufacturing time, administration and care of the patient receiving this novel therapy, toxicities and outcomes. We also discuss the therapeutic uncertainty many physicians now face of when to use CAR T cell therapy in the patient journey, especially when haematopoietic stem cell transplant is being considered.

Objective: To examine the views of adolescents with excess weight and parents of adolescents with excess weight towards weight and weight management.

Design: A qualitative study design using semi-structured phone interviews. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis to interpret the data.

Settings: Parents and adolescents based in the UK and recruited through schools, social media and youth centres.

Participants: Ten parents and 16 adolescents, including four linked parent-child dyads.

Results: Both parents and adolescents reported that adolescents felt societal pressure to achieve an 'ideal body' and that this pressure was the primary motivator for weight loss. All interviewed parents perceived themselves as overweight; however, those who had minimal weight-based shame were more likely to normalise weight discussions, reducing weight shame in their children. Adolescents preferred parents to display healthy behaviours rather than initiate weight-based discussions; however, they wanted to feel supported if the conversations were self-initiated.

Conclusion: Weight is a sensitive issue in intergenerational relationships, primarily driven by feelings of shame. Adolescents feel supported by a 'show not tell' approach from parents, which is more likely in families with less shame. While guidelines encourage clinicians to initiate weight-related conversations, this may not be welcomed by adolescents, although they do want confidence that they could access weight management support if they choose to seek help.

Background: Children and young people (CYP) with bone tumours often experience lengthy intervals prior to diagnosis that can lead to increased morbidity and mortality. Early diagnosis is key to optimising treatment options and long-term outcomes. This review aims to describe symptomatology at diagnosis, in order to develop interventions to accelerate diagnosis.

Methods: A literature search of MEDLINE and EMBASE was conducted for studies published between January 2008 and May 2023, reporting signs and symptoms in CYP with bone tumours. Pooled proportions of symptoms and signs were calculated.

Results: 16 studies (1452 patients; 492 osteosarcoma and 932 Ewing's sarcoma) were included in the analysis. The most prevalent symptoms were pain (64%, 95% CI 52% to 75%) and swelling (22%, 95% CI 6% to 42%). Other symptoms included fever, pain and swelling, history of trauma, pathological fracture, palpable mass, functional limitation, increased volume and limp. Subanalysis identified differences in symptom clusters: osteosarcoma more frequently presented with a history of trauma, pathological fracture, pain on weight-bearing, pain worse at night, pain at rest and weight loss. Ewing's sarcoma was associated with fever, functional limitation and a palpable mass.

Conclusions: These data highlight the differences in presentations between osteosarcoma and Ewing sarcoma, which may account for differences in survival and outcome. This will be used to inform professional and public health interventions through the Child Cancer Smart campaign to accelerate diagnosis for all. This review also highlights the need for a renewed research focus to identify patients earlier in the disease development as a strategy to improve the current static outcomes.

Objective: A process evaluation of the Children and Young People's Health Partnership (CYPHP) model of integrated care for the interpretation of trial findings and building evidence on the implementation of integrated care for children.

Design: A mixed-methods process evaluation.

Setting: CYPHP was implemented at scale across two inner-city London boroughs in South London, England, as a pragmatic cluster-randomised controlled trial involving nearly 98 000 children, with a nested process evaluation.

Participants: Linked data were available from 73 000 participants. Qualitative data collection was through 102 interviews (group and 1:1) and observations.

Interventions: Local child health clinics delivered by paediatricians and general practitioners and a nurse-led early intervention service for children with tracer conditions (asthma, eczema and constipation), decision support, a primary care hotline, self-management support and health promotion.

Main outcome measures: Five domains of the RE-AIM implementation framework: Reach, Effectiveness, Adoption, Implementation and Maintenance.

Results: Implementation varied depending on resource availability, competing priorities and natural changes over time. Successful implementation drivers included cohesive interprofessional and partnership collaboration.

Conclusions: Integrated care for children can be implemented at scale, but variability, particularly low reach, may limit measurable impact at the population level. Significant health system strengthening, implementation plasticity and contextual tailoring are crucial for ensuring the efficacy and sustainability of impactful integrated care for children.

Trial registration number: NCT03461848.

Objective: To examine trends in diagnosis of gender dysphoria and related conditions in children and young people attending primary care practices in England.

Design: Longitudinal analysis of electronic primary care records from the Clinical Practice Research Datalink (CPRD) Aurum database linked to hospital and Index of Multiple Deprivation data.

Setting: Primary care practices in England between 2011 and 2021.

Participants: 3782 patients aged 0-18 years with a recorded history of gender dysphoria/incongruence and matched comparators with autism spectrum conditions or eating disorder.

Main outcome measures: Incidence rates and prevalence of gender dysphoria/incongruence; prescribing rates for medical treatments; co-occurrence of anxiety, depression and self-harm.

Results: Between 2011 and 2021, incidence rates of recorded gender dysphoria/incongruence increased from 0.14 (95% CI 0.08 to 0.20) to 4.4 (95% CI 4.1 to 4.7) per 10 000 person years, and from 2014 the rate increased more rapidly in recorded females than males. There was no significant association between gender dysphoria/incongruence and area level deprivation. Of the 3782 children and young people with a record of gender dysphoria/incongruence, 176 (4.7%) were prescribed puberty suppressing hormones; 302 (8.0%) were prescribed masculinising/feminising hormones; and 1994 (52.7%) had a record of anxiety, depression or self-harm. Compared with matched comparators, those experiencing gender dysphoria/incongruence had similar recorded rates of anxiety and higher rates of depression and self-harm.

Conclusions: Recorded prevalence of gender dysphoria/incongruence increased substantially in children and young people between 2011 and 2021, particularly in recorded females. Levels of anxiety, depression and self-harm were high, indicating an urgent need for better prevention and treatment of mental health difficulties in these patients.