BMJ Paediatrics Open最新文献

Background: Ocular disorders can arise in the advanced stages of chronic kidney disease (CKD) for various reasons, including uraemia, biochemical abnormalities, hypertension and inadequate haemodialysis treatment.

Methods: We conducted a cross-sectional study at the Pediatric Nephrology Department, both inpatient and outpatient, of from January 2020 to July 2021. The study aimed to identify and compare ophthalmological changes among children at different stages of CKD to assess potential visual threats. A total of 92 children with advanced-stage CKD, aged 5-18 years, meeting the inclusion and exclusion criteria, were included in the study. Comprehensive assessments, including medical history, physical examinations, relevant tests and detailed ophthalmological examinations, were conducted.

Results: The mean age of the participants was 12.1±3.68 years. Most of the children were boys (66%). Twenty-nine patients exhibited impaired visual acuity, children with (6/60-6/24) scores in Snellen's chart Lid oedema and conjunctival pallor were observed in 20.7% and 60.9% of cases, respectively, which were found to statistically significant with advancing CKD stages (p<0.001). Dry eyes were found in 9.8% of CKD stage V patients receiving dialysis (VD) (p=0.003). One patient had a posterior subcapsular cataract, and 7.6% had conjunctival congestion. Patients with conjunctival congestion and hypertensive retinopathy had significantly higher levels of serum phosphate and calcium phosphate product (p<0.001). Hypertensive retinopathy was present in 16.3% of cases, with a significantly higher proportion in the haemodialysis group (93%). Haemodialysis patients exhibited higher blood pressure, lower haemoglobin levels, and a more severe reduction in estimated glomerular filtration rate (p<0.001).

Conclusion: This study highlights the significant ocular complications associated with CKD, underscoring the need for regular ophthalmological screenings.

Objectives: To evaluate changes in anxiety, care experiences and condition impact among adolescents with chronic health conditions in two countries as they transfer to adult healthcare and to assess factors influencing anxiety levels.

Design: A longitudinal international study. Data was collected by questionnaires before (2017-2021) and a year after (2018-2022) transfer of care.

Setting: Two specialist hospitals in Finland and Australia.

Participants: 440 adolescents with chronic health conditions were recruited from Finland (FIN n=237; mean age 17.2) and Australia (AUS n=203; mean age 18.3) with the answering percentage FIN 68.8% and AUS 55.2% of the first time point.

Main outcome measures: The validated State-Trait Anxiety Inventory short form (STAI) was used to measure care-related anxiety. Care experiences were measured using eight questions from the Adolescent-Friendly Hospital Survey. Self-reported condition impact was measured by a Visual Analogue Scale. Care experiences, condition impact, country and age were included in regression analyses as predictors of care-related anxiety.

Results: At baseline, there were few clinically meaningful differences between participants at the two sites. Adolescents reported positive care experiences both before and after the transfer of care. In regression analyses after the transfer of care, adolescents with lower condition impact experienced lower anxiety levels than adolescents with higher condition impact (beta -9.00, 95% CI -13.85 to 4.16, p<0.001). After the transfer of care, adolescents who reported negative care experiences also reported higher anxiety (median STAI score 40.0 (IQR 30.0-50.0) versus 33.3 (IQR 23.3-41.6), p<0.001).

Conclusion: Across two different healthcare systems, most adolescents with chronic health conditions reported low anxiety and positive care experiences before and after transfer to adult healthcare. Beyond efforts to generally enhance positive care experiences, focusing on adolescents with higher-impact chronic conditions may reduce disease-related anxiety.

Trial registration number: ClinicalTrials.org NCT04631965, submitted 21 October 2020.

Objectives: Research has shown that children with epilepsy often experience mental health disorders but face barriers to effective care. One solution is to train healthcare professionals within paediatric epilepsy services to deliver psychological interventions. The aim of this paper was to examine aspects of treatment integrity of the 'Mental Health Interventions for Children with Epilepsy' (MICE) treatment, a modular cognitive behavioural therapy intervention for anxiety, depression and behavioural difficulties in childhood epilepsy.

Methods: The MICE treatment was delivered in paediatric epilepsy clinics by 21 healthcare professionals with limited mental health experience, supported by a comprehensive training and supervision package. Data from 2269 treatment sessions with 166 young people were analysed to examine adherence to the MICE protocol. Audio recordings from a randomly selected sample of 251 sessions were rated for therapist competence, of which 30 were independently rated by a second expert.

Results: Therapists administered the MICE intervention with integrity and closely adhered to the established protocol. Any adaptations made were related to the sequence of delivery rather than changes to the content.

Conclusions: The overall findings indicate that professionals in paediatric epilepsy clinics can be effectively trained and supported to administer evidence-based mental health interventions. Additional research is required to explore the link between integrity and clinical outcomes, as well as to determine the most effective methods for training and supervision. This is crucial for ensuring the successful implementation of mental health interventions for children with epilepsy and concurrent mental health needs.

Background: A child health-friendly neighbourhood is defined as a neighbourhood where the child's health is provided, protected and promoted. Designing and validation of an assessment tool is required to identify the deficits and strengths of neighbourhoods within the context of each country. This study aimed to design and validate a child health-friendly neighbourhood assessment tool in Tehran.

Methods: A mixed-methods approach using semistructured interviews with 31 participants (15 mothers of children under 6 years old and 16 experts) conducted in Tehran between 2021 and 2022. Face validity, content validity and reliability of the checklist were calculated. Highly influenced by the Child Friendly City framework, designing and validation of the checklist was carried out through three phases: (a) identifying the child health-friendly neighbourhood domains and subdomains, (b) drafting the Iranian Child Health-Friendly Neighbourhood checklist and (c) validation of the designed checklist.

Results: Following three phases of study, the final version of the checklist consisted of six dimensions, namely green space and park, recreational centre, passage and street, healthcare centre, cultural centre and kindergarten. Each dimension encompassed five domains of facilities and services, accessibility, security, safety and aesthetics and view, with 42 indicators, 77 subindicators and 273 items.

Conclusions: The child health-friendly neighbourhood checklist has a more health focus on neighbourhood level and is more contextually specific, relevant and appropriate compared with UNICEF's Child Friendly City framework. It also showed acceptable validity and reliability; therefore, the checklist could be a feasible tool to assess child health-friendly neighbourhoods.

Objective: To investigate awareness and implementation of the Spare Pens (ie, adrenaline auto-injectors (AAIs)) scheme in primary and secondary schools in two regions in Wales.

Design: A cross-sectional pilot study employing a mixed research methods approach was carried out.

Setting and participants: State primary and secondary schools within Swansea and Pembrokeshire regional authorities were invited to take part. For geographical context, Swansea is the second largest city in Wales and is situated in the southwest of the country. Pembrokeshire is located in West Wales, with a large rural population outside of its main towns.

Main outcome measures: Awareness and implementation of the Spare Pens in Schools scheme. Additionally, compliance with national guidance was measured by administering a questionnaire capturing data on registers, procedures, storage and training in the use of AAIs.

Results: 35 schools (30 primary, 5 secondary) participated, with 11% and 6% reporting awareness and implementation of the scheme, respectively. No significant differences in awareness or implementation of the scheme were revealed for school type or region. Secondary schools reportedly stored more AAI devices compared with primary schools. The location of stored AAIs varied by school type, with 46.7% of primary schools storing AAIs in the classroom while 80% of secondary schools stored AAIs in the school office. Procedures for accessing AAI training differed, with 83% of primary schools receiving training by school nurses and 60% of secondary schools accessing training via an allergy team.

Conclusions: The overall poor awareness of the Spare Pens in Schools scheme has resulted in a worrying lack of implementation of generic AAI devices. An urgent review of information dissemination regarding the scheme is required.

Introduction: Hypoxic ischaemic encephalopathy (HIE), a condition where the brain does not receive enough oxygen and/or blood flow around the time of birth, is associated with significant morbidity and mortality. Systemic circulation may be affected due to poor myocardial function. The cochlear hair cells are vulnerable to changes in microcirculation, which may occur in HIE predisposing to hearing loss. Therefore, all infants with HIE undergo neurodevelopmental surveillance after discharge to monitor for adverse neurodevelopment including speech and hearing problems. This study will examine the incidence of confirmed hearing loss in newborn infants with any stage of HIE (cases) and compare them with controls.

Methods and analysis: All infants diagnosed with any stage of HIE (cases) over a 12-year period (January 2010 to December 2021) will be examined. Controls were newborn infants without HIE who were admitted to the neonatal unit and received intensive care including antibiotics (control group 1) and stable infants in the postnatal ward who received antibiotics (eg, gentamicin) (control group 2). Controls matched for gestation, gender and birth weight will be selected from a similar time period. Infant details and hearing screening data will be gathered from prospectively entered BadgerNet and S4H system databases, respectively. Categorical data will be analysed using the χ² test. Predictors for hearing loss will be performed using binary logistic regression analysis.

Ethics and dissemination: The study is approved by the Health and Care Research Wales (HCRW) Research Ethics Committee and the Health Research Authority (HRA) (reference 21/HRA/4506). The study findings will be presented at national/international conferences and published in peer-reviewed scientific journals.

Background: Public health measures during the COVID-19 pandemic had dramatic consequences for children and adolescents. However, policy-makers and healthcare researchers did not give sufficient weight to children's perspectives. One common public health measure was mandatory SARS-CoV-2 tests in schools. This study examines the evaluation of such mandatory testing.

Methods: We investigated the effects of test type (pooled PCR tests vs antigen rapid tests) and demographic and psychological factors on evaluations of the experience of being tested. A total of 569 children (8-17 years) in two major German cities completed online questionnaires between October and December 2021. Participants answered questions addressing test evaluation, vaccination status, pandemic-related stress, mental health difficulties and health-related quality of life.

Results: Our results showed that overall test ratings were better for pooled PCR tests (p<0.001). Vaccine-willing students evaluated SARS-CoV-2 tests more positively than vaccine-unwilling students, regardless of test type (p<0.001). Children with mental health difficulties (abnormal/borderline Strength and Difficulties Questionnaire (SDQ) scores) evaluated SARS-CoV-2 tests more negatively than children with normal SDQ scores (p<0.001). Additionally, children who reported better health-related quality of life and children with less pandemic-related stress rated the tests more positively.

Conclusions: Our results suggest that there are differences in the appraisal of the test types and that specific subgroups' experiences of regular testing vary. Our study provides insights for policy-makers in future pandemics and raises questions regarding parallels between testing and vaccination hesitancy. Moreover, our study demonstrates the feasibility and value of collecting data directly from a large cohort of children in order to understand their experiences.

Background: Early childhood development is essential for lifelong health and well-being. This study aims to assess the proportion of children aged 24-59 months in Thailand who are developmentally on track using the Early Childhood Development Index 2030 (ECDI2030) and to explore associations with household socioeconomic characteristics and environments.

Methods: A cross-sectional analysis was conducted using data from the 2022 Multiple Indicator Cluster Survey by the Thailand National Statistical Office. The developmental progress of 6557 children was evaluated across health, learning and psychosocial domains using ECDI2030 criteria. Multivariable logistic regression was used to assess associations between developmental status and household and participant characteristics.

Results: The study found that 81.3% of children were developmentally on track. Factors positively associated with being on track included being female (adjusted OR (AOR)=1.49), higher maternal education (AOR=2.02 for above secondary education), more books at home (AOR=1.59 for 3-9 books; AOR=2.40 for 10+ books) and increased screen time (AOR=1.68). Living in the Northern (AOR=0.45) and Northeastern (AOR=0.56) regions decreased the likelihood of being on track.

Conclusion: Around 20% of children did not meet ECDI2030 milestones, highlighting the need for targeted policy interventions. Gender, region, maternal education, access to books and screen time were significant factors for developmental outcomes. Policies should prioritise support for parents, nurturing care and educational resources, particularly for socioeconomically disadvantaged groups.