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Understanding variation in management of early-onset neonatal sepsis in India: a vignette-based survey. 了解印度早发新生儿败血症管理的差异:一项基于小插曲的调查。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-07 DOI: 10.1136/bmjpo-2024-003095
Samuel McAleese, Tushar B Parikh, Basma Ouddi, Christina M Schumacher, Julia Johnson

Background: Antibiotic use for early-onset neonatal sepsis (EONS) is common, but prolonged exposure can lead to poor outcomes. Laboratory capacity and infection prevention initiatives may impact antibiotic use for EONS in neonatal intensive care units. The objective of this study was to examine the influence of institutional capacity on antibiotic prescribing for EONS in India.

Methods: Between September 2023 and January 2024, we surveyed Indian paediatricians and neonatologists regarding institutional capacity and antibiotic prescribing practices for EONS. Five vignettes with varying maternal and infant risk profiles explored participants' decision to initiate empiric antibiotics at birth and the timing of discontinuation of antibiotics in term and preterm infants at risk for EONS. Variation in reported initiation and discontinuation of empiric antibiotic use by institutional capacity and antimicrobial stewardship initiatives were assessed using logistic regression models.

Results: Of 317 respondents, most (91%) reported antimicrobial stewardship initiatives at their institution and 56% reported receiving blood culture results within 48 hours. Screening tests such as complete blood count and C reactive protein were used in 56%-67% of cases, and abnormal results led to longer courses with fewer than 10% of respondents discontinuing antibiotics by 72 hours. When controlling for infant and maternal characteristics, the adjusted OR of observing infants without empiric antibiotics at birth was 0.38 (95% CI 0.16 to 0.70) for participants without infection prevention initiatives and was 1.57 (95% CI 1.05 to 2.35) for participants with timely (<48 hours) reporting of blood culture results, respectively. Infection prevention initiatives and laboratory capacity were not associated with increased odds of early discontinuation of empiric antibiotics for EONS.

Conclusions: Infection prevention and laboratory capacity may decrease the initiation of empiric antibiotics but are not associated with early discontinuation of empiric antibiotics for EONS. The use of sepsis screening tests remains common in Indian neonates and requires additional study.

背景:早发性新生儿败血症(EONS)使用抗生素是常见的,但长时间使用抗生素可导致不良结果。实验室能力和感染预防措施可能会影响新生儿重症监护病房EONS的抗生素使用。本研究的目的是检查机构能力对印度非营利性医疗机构开具抗生素处方的影响。方法:在2023年9月至2024年1月期间,我们调查了印度儿科医生和新生儿医生关于EONS的机构能力和抗生素处方实践。五个具有不同母婴风险概况的小插曲探讨了参与者在出生时开始使用经验性抗生素的决定,以及有EONS风险的足月和早产儿停用抗生素的时机。使用逻辑回归模型评估了机构能力和抗菌素管理举措在报告开始和停止经验性抗生素使用方面的差异。结果:在317名答复者中,大多数(91%)报告其所在机构采取了抗微生物药物管理措施,56%报告在48小时内接受了血培养结果。56%-67%的病例使用了全血细胞计数和C反应蛋白等筛查试验,结果异常导致疗程延长,只有不到10%的应答者在72小时内停用抗生素。当控制婴儿和母亲的特征时,观察出生时没有使用经验性抗生素的婴儿的调整OR为0.38 (95% CI 0.16至0.70),对于没有感染预防措施的参与者,调整OR为1.57 (95% CI 1.05至2.35)。结论:感染预防和实验室能力可能会减少经验性抗生素的开始使用,但与EONS的早期停用经验性抗生素无关。使用败血症筛查试验在印度新生儿中仍然很常见,需要进一步研究。
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引用次数: 0
Clinical and ultrasound assessment of body composition in preterm infants at discharge: an observational study. 早产儿出院时身体成分的临床和超声评估:一项观察性研究。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-07 DOI: 10.1136/bmjpo-2024-002774
Montserrat Izquierdo Renau, Elsa García González, Carla Balcells-Esponera, Beatriz Del Rey Hurtado de Mendoza, Emilio J Inarejos Clemente, Isabel Iglesias-Platas

Objectives: While the target of growth of very preterm infants (VPIs) during Neonatal Intensive care unit (NICU) admission is still controversial, the most accepted objective is that they should follow their intrauterine trajectory in terms of growth and body composition (BC). BC is difficult to measure in clinical daily routine but proxies like body ratios and skinfolds have been used. Prenatal and postnatal factors can influence the growth and BC of VPIs in the NICU.

Design, setting and patients: We conducted a case-control study, including preterm infants born before 32 weeks gestational age at term-corrected age (TCA) and healthy late preterm or term infants as controls and also a retrospective cohort analysis of factors influencing VPI's BC at discharge. Patients had an anthropometric evaluation at discharge including weight, length, head circumference, body circumferences (waist, arm), skinfolds and abdominal ultrasound (US).

Results: 191 VPIs were eligible for discharge visits, but only 83 had a complete evaluation and we collected 26 controls. VPIs at TCA were smaller in weight, length and head circumference but had greater ratios (arm fat-to-circumference and waist-to-length). Abdominal fat assessed by US was smaller in VPIs compared with term infants. Intrauterine growth restriction-VPI remained smaller at TCA but experienced less weight z-score loss. Sex did not seem to influence growth and BC proxies at TCA. Higher nutritional support during the first 2 weeks of life was related to a lower loss of length z-scores, and exclusive human milk feeding correlates with arm fat-to-circumference ratio.

Conclusions: Growth and BC of VPIs can be approached using simpler measures in clinical practice. Arm skinfolds and arm circumferences point to a greater adiposity of VPIs at TCA compared with term infants, while US does not show a greater visceral adiposity. Nutritional factors played a small effect in BC at the time of discharge.

目的:虽然新生儿重症监护病房(NICU)入院时极早产儿(vpi)的生长目标仍有争议,但最被接受的目标是他们应该遵循宫内生长和身体成分(BC)的轨迹。BC在临床日常生活中难以测量,但已使用身体比例和皮肤皱褶等替代指标。产前和产后因素可影响新生儿重症监护室vpi的生长和BC。设计、环境和患者:我们进行了一项病例对照研究,包括在足月矫正年龄(TCA)下32周前出生的早产儿和健康晚期早产儿或足月婴儿作为对照,并对影响VPI出院时BC的因素进行了回顾性队列分析。出院时对患者进行人体测量评估,包括体重、身高、头围、体围(腰、臂)、皮肤褶皱和腹部超声(US)。结果:191名vpi符合出院回访的条件,但只有83名有完整的评估,我们收集了26名对照。TCA的vpi在体重、长度和头围上较小,但具有较大的比率(臂脂肪与围和腰长)。与足月婴儿相比,经US评估的vpi腹部脂肪较少。子宫内生长限制- vpi在TCA时仍然较小,但体重z分数下降较少。性别似乎不影响TCA的生长和BC指标。在生命的前两周内,较高的营养支持与较低的长度z分数损失有关,并且纯母乳喂养与手臂脂肪与围度比相关。结论:在临床实践中,VPIs的生长和BC可以用更简单的方法来观察。手臂皮肤褶皱和手臂周长表明,与足月婴儿相比,TCA时vpi的脂肪含量更高,而US没有显示出更大的内脏脂肪含量。出院时,营养因素对BC的影响较小。
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引用次数: 0
Effect of early establishment of full enteral feeding with exclusive mother's own milk in preterm babies: a retrospective cohort study. 早产儿早期建立纯母乳全肠内喂养的影响:一项回顾性队列研究。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-07 DOI: 10.1136/bmjpo-2024-002931
Urmila Umasekar, Prakash Amboiram, Umamaheswari Balakrishnan, Nalini Sirala Jagadeesh

Background: Human milk, especially the mother's own milk (MOM), is highly recommended for preterm babies considering its numerous benefits. Prioritising the use of exclusive MOM in enteral feeding plans is essential for maximising the health and development of preterm babies. This study evaluated the effect of early establishment of full enteral feed (FEF) with exclusive MOM on feeding rate and neonatal nutritional outcomes at discharge among preterm babies.

Methods: A retrospective cohort study was conducted using medical records of single preterm babies born between 27 and 33+6 weeks of gestational age and admitted to a single tertiary care hospital in South India between June 2019 and May 2022. The primary exposure was the establishment of FEF with exclusive MOM. The outcomes assessed were the exclusive MOM feeding rate and neonatal nutritional outcomes at discharge.

Results: A total of 160 preterm babies met the inclusion criteria. Among these 104 (65%) achieved FEF with exclusive MOM. The exclusive MOM feeding rate at discharge was significantly higher among preterm babies who achieved FEF with exclusive MOM, 91.3% vs 62.5% (RR: 1.46 (95% CI: 1.18 to 1.81)). Preterm babies who achieved FEF with exclusive MOM were five times more likely to continue exclusive MOM feeding at discharge (aOR: 5.37, 95% CI: 2.04 to 14.16). The median time taken to achieve exclusive MOM among the exposure group was 6 days (95% CI: 5.6 to 6.3) compared with 12 days (95% CI: 10.2 to 13.8) for the unexposed group (HR: 0.26 (95% CI: 0.17 to 0.38; p<0.001)). There was no significant difference in growth and neonatal complications between the groups. Availability of MOM within 48 hours was strongly associated with achieving FEF with exclusive MOM, with an adjusted OR of 6.12 (95% CI: 2.81 to 13.30).

Conclusions: Early establishment of FEF with exclusive MOM increases the exclusive MOM feeding rate at discharge. Early access to MOM within 48 hours significantly enhances the likelihood of achieving FEF with exclusive MOM.

背景:考虑到母乳的诸多益处,强烈建议早产婴儿使用母乳,尤其是母乳。在肠内喂养计划中优先使用纯母乳喂养对于最大限度地促进早产儿的健康和发育至关重要。本研究评估了早期建立全肠内喂养(FEF)和纯母乳喂养(MOM)对早产儿喂养率和出院时新生儿营养结局的影响。方法:对2019年6月至2022年5月在印度南部一家三级医院住院的27至33+6周胎龄的单胎早产儿的医疗记录进行回顾性队列研究。主要暴露是建立了FEF与独家MOM。评估的结果是出院时的纯妈妈喂养率和新生儿营养状况。结果:160例早产儿符合纳入标准。其中104例(65%)达到了单独MOM的FEF。获得FEF的早产儿中,出院时纯妈妈喂养率显著高于纯妈妈喂养率,91.3% vs 62.5% (RR: 1.46 (95% CI: 1.18 ~ 1.81))。获得FEF和纯妈妈的早产儿在出院时继续纯妈妈喂养的可能性高出5倍(aOR: 5.37, 95% CI: 2.04至14.16)。暴露组达到完全MOM所需的中位时间为6天(95% CI: 5.6至6.3),而未暴露组为12天(95% CI: 10.2至13.8)(HR: 0.26 (95% CI: 0.17至0.38;结论:早期建立专属MOM的FEF可提高出院时专属MOM的喂养率。在48小时内尽早获得MOM可显著提高通过独家MOM实现FEF的可能性。
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引用次数: 0
Climate change will impact childhood cancer risks, care and outcomes. 气候变化将影响儿童癌症风险、护理和结果。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-07 DOI: 10.1136/bmjpo-2024-003123
Hannah M Thompson, Perry Sheffield, Omar Shakeel, Nicole M Wood, Mark D Miller
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引用次数: 0
Influence of SARS-CoV-2 variants of concern and maternal vaccination status on neonatal outcome. 关注SARS-CoV-2变异体和孕产妇疫苗接种状况对新生儿结局的影响
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-07 DOI: 10.1136/bmjpo-2024-003109
Nadine Mand, Ulrich Pecks, Matthias Hutten, Rolf Felix Maier, Mario Rüdiger

SARS-CoV-2 infection during pregnancy can adversely affect maternal and neonatal health, although risks vary depending on the variant of concern (VOC). Omicron, although highly infectious, causes fewer maternal and neonatal complications than earlier VOC, so vaccination may be considered unnecessary in planned pregnancy. Using data from the CRONOS registry, we compared pregnancy outcomes according to VOC and vaccination status. We found that vaccination during pregnancy reduced preterm birth rates compared with unvaccinated or vaccinated women with Omicron infection, without increasing severe neonatal outcomes. Given the risks associated with preterm birth, the study consistently supports vaccination recommendations for women planning pregnancy.

怀孕期间感染SARS-CoV-2会对孕产妇和新生儿健康产生不利影响,尽管风险因关注的挥发性有机化合物(VOC)的变化而异。Omicron虽然传染性很强,但与早期VOC相比,它引起的孕产妇和新生儿并发症较少,因此在计划妊娠中可能被认为没有必要接种疫苗。使用CRONOS登记处的数据,我们根据VOC和疫苗接种状况比较妊娠结局。我们发现,与未接种疫苗或接种了欧米克隆感染疫苗的妇女相比,怀孕期间接种疫苗可降低早产率,但不会增加严重的新生儿结局。考虑到与早产相关的风险,该研究始终支持对计划怀孕的妇女接种疫苗的建议。
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引用次数: 0
Neonatal outcomes in offspring of mothers with pregestational diabetes: a hospital-based multicentre prospective cohort study protocol. 妊娠期糖尿病母亲的后代新生儿结局:一项基于医院的多中心前瞻性队列研究方案
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-07 DOI: 10.1136/bmjpo-2024-003002
Anju Philip Thurkkada, Radhamany Kunjukutty, Manu Raj, Sobha S Nair, Annie Soman, Sethulakshmi Ramachandran, Renjitha Bhaskaran, Vishnu Renjith

Introduction: Pregestational diabetes mellitus (PGDM) occurs when a woman becomes pregnant after having diabetes mellitus. The presence of diabetes during the entire pregnancy can have an adverse impact on fetal and neonatal outcomes. The objective of this study is to examine the association between PGDM and neonatal outcomes at birth.

Methods and analysis: This prospective hospital-based cohort study is ongoing at three tertiary-level hospitals in Kerala, India. The study targets to recruit 1260 pregnant women. All pregnant women above the age of eighteen who had confirmed pregnancy in an early pregnancy scan and in the first trimester of pregnancy visiting the three study sites for antenatal care will be included in the study. Those who will have a miscarriage, an abortion or twin pregnancies will be excluded from the study. All pregnant women will be evaluated for diabetic state via RBS, HbA1c and FBS based on the International Association of Diabetes and Pregnancy Study Groups criteria during their initial visit to the study sites. PGDM will be diagnosed by the following criteria-FBS ≥126 mg% OR HbA1c ≥6.5 mg% OR Random blood glucose ≥200 mg% on the initial visit or documented prior to the index pregnancy. Neonatal outcomes among the newborn babies will be assessed on the day of birth. We will report adjusted ORs with 95% CI for significant associations derived from multivariable logistic regression analysis.

Ethics and dissemination: The present study received ethical approval from the three study sites. Informed consent will be obtained from the study participants before data collection.

Trial registration number: CTRI/2024/06/068978.

Conclusion: Early identification and management of PGDM among mothers will probably help to prevent adverse neonatal outcomes at birth.

妊娠期糖尿病(PGDM)发生在女性糖尿病患者怀孕后。糖尿病在整个妊娠期间的存在会对胎儿和新生儿的结局产生不利影响。本研究的目的是探讨妊娠期糖尿病与新生儿出生结局之间的关系。方法和分析:这项基于医院的前瞻性队列研究正在印度喀拉拉邦的三家三级医院进行。这项研究的目标是招募1260名孕妇。所有18岁以上的孕妇,在妊娠早期扫描中确认怀孕,并在怀孕的前三个月到三个研究地点进行产前护理,将被纳入研究。那些将会流产、流产或双胎妊娠的人将被排除在研究之外。所有孕妇将根据国际糖尿病和妊娠研究小组协会的标准,在首次访问研究地点时通过RBS、HbA1c和FBS评估糖尿病状态。PGDM将通过以下标准诊断-首次就诊时fbs≥126 mg%或HbA1c≥6.5 mg%或随机血糖≥200 mg%或在指数妊娠前记录。新生儿的新生儿结局将在出生当天进行评估。我们将报告由多变量logistic回归分析得出的显著关联的调整后or, 95% CI。伦理和传播:本研究得到了三个研究地点的伦理批准。在收集数据之前,将获得研究参与者的知情同意。试验注册号:CTRI/2024/06/068978。结论:早期识别和处理妊娠期糖尿病可能有助于预防新生儿不良结局的发生。
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引用次数: 0
Mobile health van as an intervention to provide clinical support and health promotion to street children and marginalised populations in the National Capital Region of Delhi: a mixed-methods evaluation. 移动保健车作为一种干预措施,向德里国家首都地区的街头儿童和边缘化人口提供临床支持和健康促进:一项混合方法评价。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-07 DOI: 10.1136/bmjpo-2024-002988
Rajeev Seth, Tanu Girotra Girotra, Id Mohammad, Yawar Qaiyum, Indra Taneja, Shanti Raman

Background: Urban health challenges, particularly for street and slum-dwelling children and families, have emerged as one of the most significant health concerns in India. While there is little published on effective healthcare delivery to these populations, mobile health vans (MHV) have been proposed as a proactive pathway to providing outreach healthcare. Our aims were to evaluate the impact of Bal Umang Drishya Sanstha (BUDS) MHV in providing health and support services to the urban slum populations in Delhi National Capital Region (NCR), focusing on benefits to children.

Methods: This was a mixed-methods evaluation, using routinely collected data. We collated and reviewed available data recorded by the BUDS staff in their health record system from June 2017 to December 2023. Qualitative data were provided by two recent focus group discussions carried out in the community; one with 18 mothers and another with a mixed group of 12 adults-all had used MHV clinics for children in their families. We chose two typical case studies that were reported to the funding bodies.

Results: Between 2017 and 2023, there were a total of 41 062 clinic visits for children<18 years, with visits increasing steadily and peaking at 8864 in 2023. Just under 10% of encounters were referred to specialist services, 122 children were diagnosed with disability. Health education sessions were provided mainly in group settings, to over 70 000 children. Themes extracted from focus group discussions were enhanced access to healthcare, quality of care, value adds from MHV and suggestions for improvement. Families expressed overwhelming appreciation of BUDS MHV. Case studies illustrated the benefits of facilitated access to tertiary healthcare.

Conclusions: MHV can serve as a valuable source of primary healthcare for street and slum-dwelling children and their families. Other benefits are empowering communities with health literacy and negotiating pathways to tertiary care.

背景:城市卫生挑战,特别是街头和贫民窟儿童和家庭的卫生挑战,已成为印度最重大的卫生问题之一。虽然很少有关于向这些人群提供有效医疗保健服务的出版物,但已提出移动卫生货车(MHV)作为提供外展医疗保健的主动途径。我们的目标是评估“全民健康计划”在向德里国家首都区(NCR)的城市贫民窟人口提供保健和支助服务方面的影响,重点是儿童的福利。方法:这是一个混合方法的评价,使用常规收集的数据。我们整理和审查了2017年6月至2023年12月期间由BUDS工作人员在其健康记录系统中记录的可用数据。最近在社区进行的两次焦点小组讨论提供了定性数据;其中一组有18名母亲,另一组有12名成年人,他们都曾在自己家庭的儿童中使用过MHV诊所。我们选择了两个向资助机构报告的典型案例研究。结果:2017年至2023年期间,共有41 062名儿童就诊。结论:MHV可作为街头和贫民窟儿童及其家庭的宝贵初级卫生保健来源。其他好处包括增强社区卫生知识的能力,并就三级保健途径进行谈判。
{"title":"Mobile health van as an intervention to provide clinical support and health promotion to street children and marginalised populations in the National Capital Region of Delhi: a mixed-methods evaluation.","authors":"Rajeev Seth, Tanu Girotra Girotra, Id Mohammad, Yawar Qaiyum, Indra Taneja, Shanti Raman","doi":"10.1136/bmjpo-2024-002988","DOIUrl":"10.1136/bmjpo-2024-002988","url":null,"abstract":"<p><strong>Background: </strong>Urban health challenges, particularly for street and slum-dwelling children and families, have emerged as one of the most significant health concerns in India. While there is little published on effective healthcare delivery to these populations, mobile health vans (MHV) have been proposed as a proactive pathway to providing outreach healthcare. Our aims were to evaluate the impact of Bal Umang Drishya Sanstha (BUDS) MHV in providing health and support services to the urban slum populations in Delhi National Capital Region (NCR), focusing on benefits to children.</p><p><strong>Methods: </strong>This was a mixed-methods evaluation, using routinely collected data. We collated and reviewed available data recorded by the BUDS staff in their health record system from June 2017 to December 2023. Qualitative data were provided by two recent focus group discussions carried out in the community; one with 18 mothers and another with a mixed group of 12 adults-all had used MHV clinics for children in their families. We chose two typical case studies that were reported to the funding bodies.</p><p><strong>Results: </strong>Between 2017 and 2023, there were a total of 41 062 clinic visits for children<18 years, with visits increasing steadily and peaking at 8864 in 2023. Just under 10% of encounters were referred to specialist services, 122 children were diagnosed with disability. Health education sessions were provided mainly in group settings, to over 70 000 children. Themes extracted from focus group discussions were enhanced access to healthcare, quality of care, value adds from MHV and suggestions for improvement. Families expressed overwhelming appreciation of BUDS MHV. Case studies illustrated the benefits of facilitated access to tertiary healthcare.</p><p><strong>Conclusions: </strong>MHV can serve as a valuable source of primary healthcare for street and slum-dwelling children and their families. Other benefits are empowering communities with health literacy and negotiating pathways to tertiary care.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Parental separation following preterm delivery in Canada: a population-based cohort study. 加拿大早产后父母分离:一项基于人群的队列研究。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-31 DOI: 10.1136/bmjpo-2023-002408
Deepak Louis, Ava Nykiforuk, Aaron Chiu, Sapna Oberoi, Chelsea Ruth, Lisa Flaten, James Bolton, Hamman Akil, Fabiana Bacchini, Karen Netzel, Kristene Cheung, Lisa M Lix, Allan Garland

Objective: To examine the association between preterm delivery and parental separation and identify associated risk factors.

Methods: All opposite sex, married or common-law parents whose relationship status was available at index delivery and for the next 5 years were eligible in this retrospective population-based cohort study in Manitoba, Canada. Parents of children born preterm were matched 1:5 to parents of children born full-term. Parental separation within 5 years of childbirth was the primary outcome. Secondary outcome was the time to separation. Multivariable Poisson regression model was created to estimate the 5-year incidence rate ratios (IRR) of the primary outcome.

Results: Parents of 6367 children born preterm (n=164 for <28 weeks, n=1196 for 28-33 weeks, n=5007 for 34-36 weeks) and parents of 30 663 children born full-term were included. Compared with parents of children born term (4.2%), only parents of children born at 34-36 weeks had a higher incidence rate of separation (5.5%, IRR: 1.26; 1.09-1.45, p=0.002), although parents of children born at 28-33 weeks (5.4%, IRR: 1.20; 0.93-1.55, p=0.16), and at<28 weeks (5.5%, IRR: 1.27; 0.66-2.45, p=0.48) had similar IRRs. Time to separation was similar between all groups.

Conclusions: Parents of children born at 34-36 weeks had higher separation rates than parents of children born full-term. The risk factors identified can be used to identify and provide supports to at-risk parents.

目的:探讨早产与父母分离的关系及相关危险因素。方法:在加拿大马尼托巴省进行的这项基于人群的回顾性队列研究中,所有异性、已婚或同居父母的关系状况在分娩时和未来5年内均可获得。早产儿童的父母与足月儿童的父母的比例为1:5。分娩后5年内父母分居是主要结果。次要结果是分离的时间。建立多变量泊松回归模型来估计主要结局的5年发病率比(IRR)。结果:早产儿父母6367例(n=164例)结论:34 ~ 36周新生儿父母的分离率高于足月新生儿父母。确定的风险因素可用于确定并为处于风险中的父母提供支持。
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引用次数: 0
Comparison of the performance of myopia control in European children and adolescents with defocus incorporated multiple segments (DIMS) and highly aspherical lenslets (HAL) spectacles. 欧洲儿童和青少年离焦合并多段(DIMS)和高度非球面透镜(HAL)眼镜近视控制效果的比较
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-31 DOI: 10.1136/bmjpo-2024-003187
Andrea Lembo, Irene Schiavetti, Massimiliano Serafino, Roberto Caputo, Paolo Nucci

Purpose: A performance comparison of two myopia control spectacle lens designs, defocus incorporated multiple segments (DIMS) and highly aspherical lenslets (HAL), at slowing myopia progression in a European child/adolescent population. Previous research directly comparing these designs has been limited to Chinese participants and 1-year follow-up. The prevalence of myopia in European child/adolescent has been estimated at 22.60%.

Methods: Retrospective cohort study of individuals (6-17 years) with myopia progression. Participants wore DIMS (Hoya MiyoSmart) or HAL (Essilor Stellest) spectacles for a minimum of 2 years. Axial length (AL) and cycloplegic autorefraction (spherical equivalent refraction (SER)) were measured at baseline and 1 and 2 years.

Results: Mean 1-year SER changes for DIMS were -0.34D (±0.46 SD) and HAL -0.30D (±0.30); 2-year changes for DIMS were -0.50D (±0.64 SD) and HAL -0.63D (±0.56). Mean 1-year AL increases for DIMS were 0.19 mm (±0.56) and HAL 0.15 mm (±0.47); 2-year increases for DIMS were 0.29 mm (±0.63) and HAL 0.32 mm (±0.72). For equivalence margins of 0.25D and 0.50D for SER at 1 and 2 years, respectively, and similarly 0.20 mm and 0.30 mm margins for AL, DIMS and HAL lenses were equivalent apart from AL at 1 year where the 0.21 mm 95% CI upper limit just exceeded 0.20 mm. At both 1 and 2 years, none of the differences in mean SERs or ALs between DIMS and HAL were clinically or statistically significant (p≥0.05 Mann-Whitney U test). Using linear mixed model analysis, the interaction between lens type and time did not significantly affect SER or AL at 1- or 2-year follow-up (p≥0.05). 38.4% of children/adolescents with DIMS had no SER progression at 2 years, compared with 21.9% with HAL (p=0.047).

Conclusion: In a European population, DIMS and HAL lenses are essentially equivalent in their ability to reduce myopia progression and AL elongation over a 2-year follow-up period.

目的:比较两种控制近视的镜片设计,离焦合并多段(DIMS)和高度非球面镜片(HAL),在减缓欧洲儿童/青少年近视进展方面的性能。先前直接比较这些设计的研究仅限于中国参与者和1年的随访。欧洲儿童/青少年的近视患病率估计为22.60%。方法:回顾性队列研究近视进展个体(6-17岁)。参与者佩戴DIMS (Hoya MiyoSmart)或HAL (Essilor Stellest)眼镜至少2年。在基线和1年和2年测量轴长(AL)和睫状体麻痹自折射(球等效折射(SER))。结果:DIMS患者1年平均SER变化为-0.34D(±0.46 SD), HAL为-0.30D(±0.30);2年DIMS变化为-0.50D(±0.64 SD), HAL变化为-0.63 3d(±0.56)。DIMS患者1年平均AL升高0.19 mm(±0.56),HAL患者平均AL升高0.15 mm(±0.47);2年DIMS增加0.29 mm(±0.63),HAL增加0.32 mm(±0.72)。对于1年和2年SER的等效边缘分别为0.25D和0.50D, AL的等效边缘同样为0.20 mm和0.30 mm,除了AL, DIMS和HAL透镜在1年的等效边缘是相等的,其中0.21 mm 95% CI上限刚刚超过0.20 mm。在1年和2年,DIMS和HAL的平均SERs或ALs均无临床或统计学差异(p≥0.05 Mann-Whitney U检验)。采用线性混合模型分析,1年或2年随访时,晶状体类型和时间的相互作用对SER或AL无显著影响(p≥0.05)。38.4%患有DIMS的儿童/青少年在2年时没有SER进展,而患有HAL的儿童/青少年为21.9% (p=0.047)。结论:在欧洲人群中,在2年的随访期内,DIMS和HAL镜片在减少近视进展和AL伸长方面的能力基本相同。
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引用次数: 0
Prevalence and correlates of child labour in five low-income countries: a descriptive study based on UNICEF Multiple Indicator Cluster Surveys 6 (MICS6). 五个低收入国家童工的流行情况及其相关关系:基于儿童基金会多指标类集调查6的描述性研究。
IF 2 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-31 DOI: 10.1136/bmjpo-2024-002871
Nick Spencer, Geir Gunnlaugsson, Shanti Raman

Background: The Convention on the Rights of the Child states that children need to be protected from 'any work that is likely to be hazardous or to interfere with the child's education, or to be harmful to the child's health or physical, mental, spiritual, moral or social development'. We aimed to determine the prevalence and correlates of child labour in five low-income African countries using the sixth wave of UNICEF Multiple Indicator Cluster Surveys (MICS6).

Methods: Data on child labour, reported by the household respondent for a randomly selected child (5-17 years), were extracted from MICS6 reports from Chad, Guinea Bissau, Malawi, Sierra Leone and Togo. Prevalence rates were extracted from three categories of child labour (household chores, economic activity and hazardous work) stratified by gender, age, wealth and residence.

Results: 140 598 children aged 5-17 years (61.2% 5-11; 22.0% 12-14; 16.8% 15-17) were included in the reports; 59 090 (42%) were engaged in child labour. The highest proportion of child labourers by age was 12-14 years old (61.1%) followed by 15-17 years old (51.1%) and 5-11 years old (36.1%). There were differences between countries, with Chad having the highest proportion of working children. Gender differences in working were limited (43.9% boys vs 40.3% girls); rural children were almost twice as likely to be working compared with urban children (47.5% rural vs 25.6% urban) as were children in the poorest quintile compared with those in the wealthiest quintile (46.9% vs 23.7%). Over a third (35.3%) of working children were exposed to hazardous conditions. Older, male, rural or poor children were over-represented among those in hazardous work.

Conclusions: Almost half of all children in these five sub-Saharan African countries are engaged in labour, of which one-third are in hazardous work. MICS6 surveys do not report on working children's health; however, working puts their health and development at risk.

背景:《儿童权利公约》指出,需要保护儿童不从事“可能有害或妨碍儿童教育,或有害儿童健康或身心、精神、道德或社会发展的任何工作”。我们的目的是利用联合国儿童基金会第六次多指标类集调查(MICS6)确定五个低收入非洲国家童工的流行程度及其相关因素。方法:从乍得、几内亚比绍、马拉维、塞拉利昂和多哥的中等收入国家调查报告中提取由家庭调查对象报告的随机抽取的5-17岁儿童的童工数据。患病率是从按性别、年龄、财富和居住地分层的三类童工(家务劳动、经济活动和危险工作)中提取出来的。结果:5-17岁儿童140 598例(5-11岁占61.2%;12 - 14 22.0%;16.8%(15-17)被纳入报告;59090人(42%)从事童工劳动。按年龄划分,童工比例最高的是12-14岁(61.1%),其次是15-17岁(51.1%)和5-11岁(36.1%)。各国之间存在差异,乍得的童工比例最高。工作的性别差异有限(男孩43.9%,女孩40.3%);农村儿童参加工作的可能性几乎是城市儿童的两倍(农村儿童47.5%比城市儿童25.6%),最贫穷五分之一家庭的儿童比最富裕五分之一家庭的儿童(46.9%比23.7%)。超过三分之一(35.3%)的童工暴露在危险条件下。在从事危险工作的人中,年龄较大、男性、农村儿童或贫困儿童的比例过高。结论:在这五个撒哈拉以南非洲国家,几乎一半的儿童从事劳动,其中三分之一从事危险工作。多指标类集调查未报告工作儿童的健康状况;然而,工作使他们的健康和发展处于危险之中。
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BMJ Paediatrics Open
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