Pub Date : 2024-12-01Epub Date: 2024-11-05DOI: 10.1016/S2352-4642(24)00297-9
Nicole Salazar-Austin, Lisa Marie Cranmer
{"title":"The underestimated burden of tuberculosis in children.","authors":"Nicole Salazar-Austin, Lisa Marie Cranmer","doi":"10.1016/S2352-4642(24)00297-9","DOIUrl":"10.1016/S2352-4642(24)00297-9","url":null,"abstract":"","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"845-847"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-09-17DOI: 10.1016/S2352-4642(24)00202-5
Fiona Samuels, Suzanne Petroni, Rochelle A Burgess, Olubukola Omobowale, Jean Casey, Emma Sadd
{"title":"Mental health consequences of child marriage.","authors":"Fiona Samuels, Suzanne Petroni, Rochelle A Burgess, Olubukola Omobowale, Jean Casey, Emma Sadd","doi":"10.1016/S2352-4642(24)00202-5","DOIUrl":"10.1016/S2352-4642(24)00202-5","url":null,"abstract":"","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"847-849"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-08-05DOI: 10.1016/S2352-4642(24)00209-8
Katerina Drakos
{"title":"Bridging the gap: a call for inclusive policy making in youth mental health care.","authors":"Katerina Drakos","doi":"10.1016/S2352-4642(24)00209-8","DOIUrl":"10.1016/S2352-4642(24)00209-8","url":null,"abstract":"","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"855-857"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-11-05DOI: 10.1016/S2352-4642(24)00256-6
Fernanda Bruzadelli Paulino da Costa, Mark P Nicol, Maresa Botha, Lesley Workman, Ricardo Alexandre Arcêncio, Heather J Zar, Leonardo Martinez
<p><strong>Background: </strong>Paediatric tuberculosis leads to more than 200 000 deaths annually. We aimed to investigate the incidence of Mycobacterium tuberculosis infection and tuberculosis disease in the first decade of life in the Drakenstein Child Health Study (DCHS), a South African cohort in a community with high tuberculosis and HIV incidence.</p><p><strong>Methods: </strong>In this prospective birth cohort study, we enrolled pregnant women aged 18 years or older who were between 20 and 28 weeks' of gestation in a peri-urban setting outside of Cape Town, South Africa. We followed up their children for tuberculosis until age 10 years. To measure M tuberculosis infection tuberculin skin tests were administered to children at age 6 months, 12 months, and then annually in children with a negative test, and at the time of a lower respiratory tract infection. Tuberculin skin test conversion was defined by an induration reaction of 10 mm or more. To measure tuberculosis disease, active surveillance was done throughout follow-up. Each episode of presumed tuberculosis disease was investigated using sputum induction, tested with Xpert MTB/RIF and liquid culture for M tuberculosis. Survival analyses were performed and multivariable Cox regression was used to measure factors associated with M tuberculosis infection or disease.</p><p><strong>Findings: </strong>Between March 5, 2012, and March 31, 2015, 1137 women and their 1143 children (248 [21·7%] of 1143 children were HIV-exposed, two [0·2%] children with HIV) were included in the analysis. Children were followed up for 8870 person-years (median follow-up 9·1 years [IQR 8·2-10·2]). The annual risk of tuberculin conversion during follow-up was 6·6 infections per 100 person-years (95% CI 5·8-7·3) but ranged from 4-9 infections per 100 person-years over the follow-up period. 98 children developed tuberculosis (1105 cases per 100 000 person-years; 95% CI 906-1347). The cumulative hazard of tuberculin conversion was 36% (95% CI 32-41) at age 8 years and the cumulative hazard of tuberculosis disease was 10% (8-12) at age 10 years. Preventive treatment was associated with a reduction in tuberculosis disease among children who had tuberculin conversion (adjusted hazard ratio 0·23 [95% CI 0·12-0·47]). Most cases of tuberculosis disease (78 [79%; 95% CI 69-86] of 98 children) occurred among children who had tuberculin skin test conversion but were not administered preventive treatment.</p><p><strong>Interpretation: </strong>In this prospective South African birth cohort, M tuberculosis transmission was consistently high throughout the first decade of life leading to approximately 10% of children developing tuberculosis disease. A multipronged approach to decrease paediatric tuberculosis is needed that combines preventive treatment for children at risk, reducing community M tuberculosis transmission, and active case finding.</p><p><strong>Funding: </strong>Bill & Melinda Gates Foundation, Medical Research
背景:小儿结核病每年导致 20 多万人死亡。德拉肯斯坦儿童健康研究(Drakenstein Child Health Study,DCHS)是南非一个结核病和艾滋病高发社区的一个队列,我们的目的是调查该研究中结核分枝杆菌感染和结核病在婴儿出生后头十年的发病率:在这项前瞻性出生队列研究中,我们在南非开普敦郊外的近郊区招募了年龄在 18 岁或 18 岁以上、妊娠期在 20 到 28 周之间的孕妇。我们对她们的孩子进行了结核病跟踪调查,直到他们 10 岁。为了测量 M 型结核病感染情况,我们在儿童 6 个月大和 12 个月大时对其进行了结核菌素皮试,然后每年对皮试呈阴性的儿童以及在下呼吸道感染时进行皮试。结核菌素皮试转阴的定义是压痕反应达到或超过 10 毫米。为了测量结核病,在整个随访过程中都进行了积极的监测。每次推测的结核病发作都要进行痰液诱导检查,并用 Xpert MTB/RIF 和液体培养法检测结核杆菌。研究人员进行了生存分析,并采用多变量考克斯回归法测定了与结核杆菌感染或疾病相关的因素:2012年3月5日至2015年3月31日期间,1137名妇女及其1143名子女(1143名子女中有248名[21-7%]暴露于HIV,2名[0-2%]感染HIV)被纳入分析。对儿童的随访时间为 8870 人年(中位数随访时间为 9-1 年 [IQR 8-2-10-2])。在随访期间,结核菌素转阴的年风险为每 100 人年 6-6 例(95% CI 5-8-7-3),但在随访期间,每 100 人年的感染率为 4-9 例。98 名儿童患上了结核病(每 10 万人年中有 1105 例;95% CI 906-1347)。8 岁时结核菌素转阴的累积风险为 36%(95% CI 32-41),10 岁时结核病的累积风险为 10%(8-12)。在结核菌素转阴的儿童中,预防性治疗与结核病发病率的降低有关(调整后的危险比为 0-23 [95% CI 0-12-0-47])。大多数结核病病例(98 名儿童中的 78 例 [79%;95% CI 69-86])发生在结核菌素皮试转阴但未接受预防性治疗的儿童中:在这一前瞻性南非出生队列中,M 型结核病的传播率在儿童出生后的头十年一直居高不下,导致约 10% 的儿童罹患结核病。需要采取多管齐下的方法来减少小儿结核病的发病率,将对高危儿童的预防性治疗、减少社区间的结核病传播和积极的病例发现结合起来:比尔及梅林达-盖茨基金会、南非医学研究委员会和南非国家研究基金会。
{"title":"Mycobacterium tuberculosis infection and tuberculosis disease in the first decade of life: a South African birth cohort study.","authors":"Fernanda Bruzadelli Paulino da Costa, Mark P Nicol, Maresa Botha, Lesley Workman, Ricardo Alexandre Arcêncio, Heather J Zar, Leonardo Martinez","doi":"10.1016/S2352-4642(24)00256-6","DOIUrl":"10.1016/S2352-4642(24)00256-6","url":null,"abstract":"<p><strong>Background: </strong>Paediatric tuberculosis leads to more than 200 000 deaths annually. We aimed to investigate the incidence of Mycobacterium tuberculosis infection and tuberculosis disease in the first decade of life in the Drakenstein Child Health Study (DCHS), a South African cohort in a community with high tuberculosis and HIV incidence.</p><p><strong>Methods: </strong>In this prospective birth cohort study, we enrolled pregnant women aged 18 years or older who were between 20 and 28 weeks' of gestation in a peri-urban setting outside of Cape Town, South Africa. We followed up their children for tuberculosis until age 10 years. To measure M tuberculosis infection tuberculin skin tests were administered to children at age 6 months, 12 months, and then annually in children with a negative test, and at the time of a lower respiratory tract infection. Tuberculin skin test conversion was defined by an induration reaction of 10 mm or more. To measure tuberculosis disease, active surveillance was done throughout follow-up. Each episode of presumed tuberculosis disease was investigated using sputum induction, tested with Xpert MTB/RIF and liquid culture for M tuberculosis. Survival analyses were performed and multivariable Cox regression was used to measure factors associated with M tuberculosis infection or disease.</p><p><strong>Findings: </strong>Between March 5, 2012, and March 31, 2015, 1137 women and their 1143 children (248 [21·7%] of 1143 children were HIV-exposed, two [0·2%] children with HIV) were included in the analysis. Children were followed up for 8870 person-years (median follow-up 9·1 years [IQR 8·2-10·2]). The annual risk of tuberculin conversion during follow-up was 6·6 infections per 100 person-years (95% CI 5·8-7·3) but ranged from 4-9 infections per 100 person-years over the follow-up period. 98 children developed tuberculosis (1105 cases per 100 000 person-years; 95% CI 906-1347). The cumulative hazard of tuberculin conversion was 36% (95% CI 32-41) at age 8 years and the cumulative hazard of tuberculosis disease was 10% (8-12) at age 10 years. Preventive treatment was associated with a reduction in tuberculosis disease among children who had tuberculin conversion (adjusted hazard ratio 0·23 [95% CI 0·12-0·47]). Most cases of tuberculosis disease (78 [79%; 95% CI 69-86] of 98 children) occurred among children who had tuberculin skin test conversion but were not administered preventive treatment.</p><p><strong>Interpretation: </strong>In this prospective South African birth cohort, M tuberculosis transmission was consistently high throughout the first decade of life leading to approximately 10% of children developing tuberculosis disease. A multipronged approach to decrease paediatric tuberculosis is needed that combines preventive treatment for children at risk, reducing community M tuberculosis transmission, and active case finding.</p><p><strong>Funding: </strong>Bill & Melinda Gates Foundation, Medical Research ","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"891-899"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adolescents and the International Conference on Population and Development at 30.","authors":"Satvika Chalasani, Lauren Rumble, Prerna Banati, Sheri Bastien, Jose Roberto Luna, Suzanne Petroni","doi":"10.1016/S2352-4642(24)00235-9","DOIUrl":"10.1016/S2352-4642(24)00235-9","url":null,"abstract":"","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"851-853"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-30DOI: 10.1016/S2352-4642(24)00260-8
Jiali Zhou, Jing Wu, Denan Jiang, Shan Cai, Chenhao Zhang, Jiayao Ying, Jin Cao, Yi Song, Peige Song
<p><strong>Background: </strong>Childhood hypertension is a growing health concern in China. Accurate estimation of prevalence is essential but challenging due to the variability of blood pressure and the need for multiple occasions for confirmation. This study aimed to estimate the national, regional, and provincial prevalence of childhood hypertension in China in 2020.</p><p><strong>Methods: </strong>For this systematic review and modelling study, we did a comprehensive literature search of epidemiological studies reporting the prevalence of elevated blood pressure (EBP) or hypertension among Chinese children (aged 18 years or younger) that were published between Jan 1, 1990 and June 20, 2024 in PubMed, Embase, MEDLINE, China National Knowledge Infrastructure, Wanfang Data, and Chinese Science and Technology Journal Database. EBP was defined as blood pressure greater than or equal to the 95th percentile on a single occasion, and childhood hypertension as blood pressure greater than or equal to the 95th percentile consistently across three occasions. First, we estimated the prevalence of childhood EBP using a multi-level mixed-effects meta-regression and the pooled odds ratios (ORs) for factors associated with childhood EBP through random-effects meta-analysis. Second, the ratio of childhood EBP to childhood hypertension was calculated via random-effects meta-analysis, based on which the national and regional prevalence of childhood hypertension was imputed. Finally, we derived the provincial prevalence of childhood hypertension using an associated factor-based model. The review protocol was registered in PROSPERO (CRD42024537570).</p><p><strong>Findings: </strong>We identified 8872 records, of which 134 articles covering 22 431 861 children were included. In 2020, the overall prevalence of hypertension among Chinese children aged 6-18 years was 3·11% (95% CI 2·35-4·04), equivalent to 6·80 million (5·13-8·83) affected children. The prevalence of childhood hypertension ranged from 2·25% (1·54-2·75) for children aged 6 years to 2·01% (1·36-3·37) for those aged 18 years, peaking at 3·84% (2·97-4·94) for those aged 14 years. The overall prevalence was higher in boys (3·34% [2·53-4·35]) than in girls (2·85% [2·13-3·69]). Associations between four factors (overweight, obesity, salted food intake, and family history of hypertension) and childhood EBP were graded as highly suggestive evidence.</p><p><strong>Interpretation: </strong>This study reveals substantial regional and provincial variations in the prevalence of childhood hypertension in China. Our findings could inform targeted public health initiatives and optimise resource allocation to address this public health concern.</p><p><strong>Funding: </strong>This study was supported by the National Natural Science Foundation of China (72104211 and 82273654) and the Chao Kuang Piu High-tech Development Fund (2022RC019).</p><p><strong>Translation: </strong>For the Chinese translation of the abstract se
{"title":"National, regional and provincial prevalence of childhood hypertension in China in 2020: a systematic review and modelling study.","authors":"Jiali Zhou, Jing Wu, Denan Jiang, Shan Cai, Chenhao Zhang, Jiayao Ying, Jin Cao, Yi Song, Peige Song","doi":"10.1016/S2352-4642(24)00260-8","DOIUrl":"10.1016/S2352-4642(24)00260-8","url":null,"abstract":"<p><strong>Background: </strong>Childhood hypertension is a growing health concern in China. Accurate estimation of prevalence is essential but challenging due to the variability of blood pressure and the need for multiple occasions for confirmation. This study aimed to estimate the national, regional, and provincial prevalence of childhood hypertension in China in 2020.</p><p><strong>Methods: </strong>For this systematic review and modelling study, we did a comprehensive literature search of epidemiological studies reporting the prevalence of elevated blood pressure (EBP) or hypertension among Chinese children (aged 18 years or younger) that were published between Jan 1, 1990 and June 20, 2024 in PubMed, Embase, MEDLINE, China National Knowledge Infrastructure, Wanfang Data, and Chinese Science and Technology Journal Database. EBP was defined as blood pressure greater than or equal to the 95th percentile on a single occasion, and childhood hypertension as blood pressure greater than or equal to the 95th percentile consistently across three occasions. First, we estimated the prevalence of childhood EBP using a multi-level mixed-effects meta-regression and the pooled odds ratios (ORs) for factors associated with childhood EBP through random-effects meta-analysis. Second, the ratio of childhood EBP to childhood hypertension was calculated via random-effects meta-analysis, based on which the national and regional prevalence of childhood hypertension was imputed. Finally, we derived the provincial prevalence of childhood hypertension using an associated factor-based model. The review protocol was registered in PROSPERO (CRD42024537570).</p><p><strong>Findings: </strong>We identified 8872 records, of which 134 articles covering 22 431 861 children were included. In 2020, the overall prevalence of hypertension among Chinese children aged 6-18 years was 3·11% (95% CI 2·35-4·04), equivalent to 6·80 million (5·13-8·83) affected children. The prevalence of childhood hypertension ranged from 2·25% (1·54-2·75) for children aged 6 years to 2·01% (1·36-3·37) for those aged 18 years, peaking at 3·84% (2·97-4·94) for those aged 14 years. The overall prevalence was higher in boys (3·34% [2·53-4·35]) than in girls (2·85% [2·13-3·69]). Associations between four factors (overweight, obesity, salted food intake, and family history of hypertension) and childhood EBP were graded as highly suggestive evidence.</p><p><strong>Interpretation: </strong>This study reveals substantial regional and provincial variations in the prevalence of childhood hypertension in China. Our findings could inform targeted public health initiatives and optimise resource allocation to address this public health concern.</p><p><strong>Funding: </strong>This study was supported by the National Natural Science Foundation of China (72104211 and 82273654) and the Chao Kuang Piu High-tech Development Fund (2022RC019).</p><p><strong>Translation: </strong>For the Chinese translation of the abstract se","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"872-881"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-11DOI: 10.1016/S2352-4642(24)00233-5
Peter B Sporns, Kartik Bhatia, Todd Abruzzo, Lisa Pabst, Stuart Fraser, Melissa G Chung, Warren Lo, Ahmed Othman, Sebastian Steinmetz, Ulf Jensen-Kondering, Stefan Schob, Daniel P O Kaiser, Wolfgang Marik, Christina Wendl, Ilka Kleffner, Hans Henkes, Hermann Kraehling, Thi Dan Linh Nguyen-Kim, René Chapot, Umut Yilmaz, Furene Wang, Muhammad Ubaid Hafeez, Flavio Requejo, Nicola Limbucci, Birgit Kauffmann, Markus Möhlenbruch, Omid Nikoubashman, Peter D Schellinger, Patricia Musolino, Ali Alawieh, Jenny Wilson, Dominik Grieb, Alexandra S Gersing, Thomas Liebig, Martin Olivieri, Jaroslava Paulasova Schwabova, Ales Tomek, Panagiotis Papanagiotou, Grégoire Boulouis, Olivier Naggara, Christine K Fox, Kirill Orlov, Alexandra Kuznetsova, Carmen Parra-Farinas, Prakash Muthusami, Robert W Regenhardt, Adam A Dmytriw, Tanja Burkard, Mesha Martinez, Daniel Brechbühl, Maja Steinlin, Lisa R Sun, Ameer E Hassan, André Kemmling, Sarah Lee, Heather J Fullerton, Jens Fiehler, Marios-Nikos Psychogios, Moritz Wildgruber
<p><strong>Background: </strong>Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke.</p><p><strong>Methods: </strong>In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone. Intravenous thrombolysis was considered part of best medical treatment and therefore permitted in both groups. The primary outcome was the difference in median modified Rankin Scale (mRS) score between baseline (pre-stroke) and 90 days (±10 days) post-stroke, assessed by the Wilcoxon rank test (α=0·05). Efficacy outcomes in the endovascular thrombectomy and best medical treatment groups were compared in sensitivity analyses using propensity score matching. The Save ChildS Pro study is registered at the German Clinical Trials Registry, DRKS00018960.</p><p><strong>Findings: </strong>Between Jan 1, 2020, and Aug 31, 2023, of the 241 patients in the Save ChildS Pro registry, 208 were included in the analysis (115 [55%] boys and 93 [45%] girls). 117 patients underwent endovascular thrombectomy (median age 11 years [IQR 6-14]), and 91 patients received best medical treatment (6 years [3-12]; p<0·0001). The median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score on admission was 14 (IQR 10-19) in the endovascular thrombectomy group and 9 (5-13) in the best medical treatment group (p<0·0001). Both treatment groups had a median pre-stroke mRS score of 0 (IQR 0-0) at baseline. The change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0·020). One (1%) patient developed a symptomatic intracranial haemorrhage (this patient was in the endovascular thrombectomy group). Six (5%) patients in the endovascular thrombectomy group and four (5%) patients in the best medical treatment group had died by day 90 (p=0·89). After propensity score matching for age, sex, and PedNIHSS score at hospital admission (n=79 from each group), the change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0·029). Regarding the primary outcome for patients with suspected focal cerebral arteriopathy, endovascular thrombectomy (n=18) and best medical treatment (n=33) showed no difference in 90-day median mRS scores
{"title":"Endovascular thrombectomy for childhood stroke (Save ChildS Pro): an international, multicentre, prospective registry study.","authors":"Peter B Sporns, Kartik Bhatia, Todd Abruzzo, Lisa Pabst, Stuart Fraser, Melissa G Chung, Warren Lo, Ahmed Othman, Sebastian Steinmetz, Ulf Jensen-Kondering, Stefan Schob, Daniel P O Kaiser, Wolfgang Marik, Christina Wendl, Ilka Kleffner, Hans Henkes, Hermann Kraehling, Thi Dan Linh Nguyen-Kim, René Chapot, Umut Yilmaz, Furene Wang, Muhammad Ubaid Hafeez, Flavio Requejo, Nicola Limbucci, Birgit Kauffmann, Markus Möhlenbruch, Omid Nikoubashman, Peter D Schellinger, Patricia Musolino, Ali Alawieh, Jenny Wilson, Dominik Grieb, Alexandra S Gersing, Thomas Liebig, Martin Olivieri, Jaroslava Paulasova Schwabova, Ales Tomek, Panagiotis Papanagiotou, Grégoire Boulouis, Olivier Naggara, Christine K Fox, Kirill Orlov, Alexandra Kuznetsova, Carmen Parra-Farinas, Prakash Muthusami, Robert W Regenhardt, Adam A Dmytriw, Tanja Burkard, Mesha Martinez, Daniel Brechbühl, Maja Steinlin, Lisa R Sun, Ameer E Hassan, André Kemmling, Sarah Lee, Heather J Fullerton, Jens Fiehler, Marios-Nikos Psychogios, Moritz Wildgruber","doi":"10.1016/S2352-4642(24)00233-5","DOIUrl":"10.1016/S2352-4642(24)00233-5","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke.</p><p><strong>Methods: </strong>In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone. Intravenous thrombolysis was considered part of best medical treatment and therefore permitted in both groups. The primary outcome was the difference in median modified Rankin Scale (mRS) score between baseline (pre-stroke) and 90 days (±10 days) post-stroke, assessed by the Wilcoxon rank test (α=0·05). Efficacy outcomes in the endovascular thrombectomy and best medical treatment groups were compared in sensitivity analyses using propensity score matching. The Save ChildS Pro study is registered at the German Clinical Trials Registry, DRKS00018960.</p><p><strong>Findings: </strong>Between Jan 1, 2020, and Aug 31, 2023, of the 241 patients in the Save ChildS Pro registry, 208 were included in the analysis (115 [55%] boys and 93 [45%] girls). 117 patients underwent endovascular thrombectomy (median age 11 years [IQR 6-14]), and 91 patients received best medical treatment (6 years [3-12]; p<0·0001). The median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score on admission was 14 (IQR 10-19) in the endovascular thrombectomy group and 9 (5-13) in the best medical treatment group (p<0·0001). Both treatment groups had a median pre-stroke mRS score of 0 (IQR 0-0) at baseline. The change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0·020). One (1%) patient developed a symptomatic intracranial haemorrhage (this patient was in the endovascular thrombectomy group). Six (5%) patients in the endovascular thrombectomy group and four (5%) patients in the best medical treatment group had died by day 90 (p=0·89). After propensity score matching for age, sex, and PedNIHSS score at hospital admission (n=79 from each group), the change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0·029). Regarding the primary outcome for patients with suspected focal cerebral arteriopathy, endovascular thrombectomy (n=18) and best medical treatment (n=33) showed no difference in 90-day median mRS scores ","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"882-890"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-21DOI: 10.1016/S2352-4642(24)00232-3
Victoria O Oyenuga, Gioia Mosler, Emmanuel Addo-Yobo, Olayinka O Adeyeye, Bernard Arhin, Farida Fortune, Christopher J Griffiths, Marian Kasekete, Elizabeth Mkutumula, Reratilwe Mphahlele, Hilda A Mujuru, Sofia Muyemayema, Rebecca Nantanda, Lovemore M Nkhalamba, Oluwafemi T Ojo, Sandra Kwarteng Owusu, Ismail Ticklay, Peter O Ubuane, Rafiuk C Yakubu, Lindsay Zurba, Refiloe Masekela, Jonathan Grigg
<p><strong>Background: </strong>Rapid urbanisation and population growth in sub-Saharan Africa has increased the incidence of asthma in children and adolescents. One major barrier to achieving good asthma control in these adolescents is obtaining a clinical diagnosis. To date, there are scant data on prevalence and severity of asthma in undiagnosed yet symptomatic adolescents. We therefore aimed to assess symptom prevalence and severity, the effect of symptoms on daily life, and objective evidence of asthma in young adolescents from sub-Saharan Africa with and without a clinical diagnosis of asthma by spirometry and fractional exhaled nitric oxide (FeNO).</p><p><strong>Methods: </strong>We designed a two-phase, multi-country, school-based, cross-sectional study to assess symptom prevalence and severity in sub-Saharan African adolescents. In phase 1 we surveyed young adolescents aged 12-14 years who were attending selected primary and secondary schools in Blantyre in Malawi, Durban in South Africa, Harare in Zimbabwe, Kampala in Uganda, Kumasi in Ghana, and Lagos in Nigeria. The adolescents were screened for asthma symptoms using the International Study of Asthma and Allergies in Children (ISAAC) questionnaire. Then, after opt-in consent, symptomatic adolescents were invited to complete a detailed survey on asthma severity, treatment, and exposure to environmental risk factors for phase 2. Adolescents performed the European Respiratory Society's diagnostic tests for childhood asthma. A positive asthma test was classified as a forced expiratory volume in 1 sec (FEV<sub>1</sub>) predicted under 80%, a FEV<sub>1</sub> under the lower limits of normal, or FEV<sub>1</sub> divided by forced vital capacity (FEV<sub>1</sub>/FVC) under the lower limits of normal; positive bronchodilator responsiveness or reversibility was defined as either an increase in absolute FEV<sub>1</sub> of 12% or more, or an increase of 200 mL or more, or both, after 400 μg of salbutamol (shortacting β2 agonist) administered via a metered-dose inhaler and spacer, or FeNO of 25 parts per billion or higher, or any combination of these. The study was registered with ClinicalTrials.gov (NCT03990402) and is complete.</p><p><strong>Findings: </strong>Between Nov 1, 2018, and Nov 1, 2021, we recruited 149 schools from six regions in six sub-Saharan countries to participate in the study. We administered phase 1 asthma questionnaires from Jan 20, 2019 to Nov 11, 2021, and from 27 407 adolescents who were screened, we obtained data for 27 272 (99·5%). Overall, 14 918 (54·7%) adolescents were female and 12 354 (45·3%) adolescents were male, and the mean age was 13 years (IQR 12-13); nearly all recruited adolescents were of black African ethnicity (26 821 [98·3%] of 27 272). In phase 1, a total of 3236 (11·9% [95% CI 11·5-12·3]) reported wheeze in the past 12 months, and 644 (19·9%) of 3236 had a formal clinical diagnosis of asthma. The prevalence of adolescents with asthma symptoms ranged fr
{"title":"Asthma symptoms, severity, and control with and without a clinical diagnosis of asthma in early adolescence in sub-Saharan Africa: a multi-country, school-based, cross-sectional study.","authors":"Victoria O Oyenuga, Gioia Mosler, Emmanuel Addo-Yobo, Olayinka O Adeyeye, Bernard Arhin, Farida Fortune, Christopher J Griffiths, Marian Kasekete, Elizabeth Mkutumula, Reratilwe Mphahlele, Hilda A Mujuru, Sofia Muyemayema, Rebecca Nantanda, Lovemore M Nkhalamba, Oluwafemi T Ojo, Sandra Kwarteng Owusu, Ismail Ticklay, Peter O Ubuane, Rafiuk C Yakubu, Lindsay Zurba, Refiloe Masekela, Jonathan Grigg","doi":"10.1016/S2352-4642(24)00232-3","DOIUrl":"10.1016/S2352-4642(24)00232-3","url":null,"abstract":"<p><strong>Background: </strong>Rapid urbanisation and population growth in sub-Saharan Africa has increased the incidence of asthma in children and adolescents. One major barrier to achieving good asthma control in these adolescents is obtaining a clinical diagnosis. To date, there are scant data on prevalence and severity of asthma in undiagnosed yet symptomatic adolescents. We therefore aimed to assess symptom prevalence and severity, the effect of symptoms on daily life, and objective evidence of asthma in young adolescents from sub-Saharan Africa with and without a clinical diagnosis of asthma by spirometry and fractional exhaled nitric oxide (FeNO).</p><p><strong>Methods: </strong>We designed a two-phase, multi-country, school-based, cross-sectional study to assess symptom prevalence and severity in sub-Saharan African adolescents. In phase 1 we surveyed young adolescents aged 12-14 years who were attending selected primary and secondary schools in Blantyre in Malawi, Durban in South Africa, Harare in Zimbabwe, Kampala in Uganda, Kumasi in Ghana, and Lagos in Nigeria. The adolescents were screened for asthma symptoms using the International Study of Asthma and Allergies in Children (ISAAC) questionnaire. Then, after opt-in consent, symptomatic adolescents were invited to complete a detailed survey on asthma severity, treatment, and exposure to environmental risk factors for phase 2. Adolescents performed the European Respiratory Society's diagnostic tests for childhood asthma. A positive asthma test was classified as a forced expiratory volume in 1 sec (FEV<sub>1</sub>) predicted under 80%, a FEV<sub>1</sub> under the lower limits of normal, or FEV<sub>1</sub> divided by forced vital capacity (FEV<sub>1</sub>/FVC) under the lower limits of normal; positive bronchodilator responsiveness or reversibility was defined as either an increase in absolute FEV<sub>1</sub> of 12% or more, or an increase of 200 mL or more, or both, after 400 μg of salbutamol (shortacting β2 agonist) administered via a metered-dose inhaler and spacer, or FeNO of 25 parts per billion or higher, or any combination of these. The study was registered with ClinicalTrials.gov (NCT03990402) and is complete.</p><p><strong>Findings: </strong>Between Nov 1, 2018, and Nov 1, 2021, we recruited 149 schools from six regions in six sub-Saharan countries to participate in the study. We administered phase 1 asthma questionnaires from Jan 20, 2019 to Nov 11, 2021, and from 27 407 adolescents who were screened, we obtained data for 27 272 (99·5%). Overall, 14 918 (54·7%) adolescents were female and 12 354 (45·3%) adolescents were male, and the mean age was 13 years (IQR 12-13); nearly all recruited adolescents were of black African ethnicity (26 821 [98·3%] of 27 272). In phase 1, a total of 3236 (11·9% [95% CI 11·5-12·3]) reported wheeze in the past 12 months, and 644 (19·9%) of 3236 had a formal clinical diagnosis of asthma. The prevalence of adolescents with asthma symptoms ranged fr","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"859-871"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-29DOI: 10.1016/S2352-4642(24)00298-0
Nuria Sanchez Clemente, Kirsty Le Doare, Ezekiel Mupere, Jean B Nachega, Stephen Rulisa, Boghuma Titanji
{"title":"Hidden in plain sight: the threat of mpox to children and adolescents.","authors":"Nuria Sanchez Clemente, Kirsty Le Doare, Ezekiel Mupere, Jean B Nachega, Stephen Rulisa, Boghuma Titanji","doi":"10.1016/S2352-4642(24)00298-0","DOIUrl":"10.1016/S2352-4642(24)00298-0","url":null,"abstract":"","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"849-851"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}