Objective The rising prevalence of childhood obesity is closely associated with suboptimal dietary patterns.To address this public health concern,we conducted a comprehensive study to examine the association between c...Objective The rising prevalence of childhood obesity is closely associated with suboptimal dietary patterns.To address this public health concern,we conducted a comprehensive study to examine the association between coarse cereals consumption and body fat percentage(BFP)in Chinese children and adolescents.Methods The study included 48,305 children aged 6–17 years from 28 districts/counties in 14 provinces across seven regions of China(24,152 girls and 24,153 boys).BFP was examined using bioelectrical impedance analysis in the early morning.Coarse cereals consumption was assessed using a Food Frequency Questionnaire and categorized into three groups:0 g/1,000 kcal per day,0–10 g/1,000kcal per day,and>10 g/1,000 kcal per day(daily consumption of coarse cereals×1,000/total energy consumption).Quantile regression model was used to analyze the association between coarse cereals and BFP,adjusting for potential confounders such as age,pubertal development stage,urban/rural and regional factors,total daily dietary energy consumption,sedentary time,moderate-to-high physical activity,household income,parental education,and consumption of other foods.Results Boys aged 6–10,11–14,and 15–17 years had median daily coarse cereals consumptions of6.6 g,7.1 g,and 5.7 g,with BFP of 19.6%,19.5%,and 17.5%(all P<0.05).Girls in the same age groups showed consumption of 7.1 g,8.4 g,and 6.7 g,with BFP of 20.3%,26.4%,and 31.0%(all P<0.05).The quantile regression results for boys showed that daily consumption of coarse cereals was significantly correlated with their BFP in the 0.15,0.25,and 0.50 quartiles,with regression coefficients of-0.257,-0.221,and-0.330,respectively,after adjusting for potential confounders(P<0.05).For girls,there was a significant correlation with PBF at the 0.05,0.15,0.25,0.50,0.75,and 0.85 quartiles,with regression coefficients of-0.258,-0.366,-0.372,-0.431,-0.472,and-0.503(P<0.05 for all).Conclusions Coarse cereals consumption among Chinese children and adolescents remains relatively low.Higher consumption was inversely associated with BFP in children aged 6–17 years.Future interventional studies should assess how increased coarse cereals consumption prevents childhood obesity.展开更多
BACKGROUND There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental...BACKGROUND There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental suicidal ideation among children with CHD and the associated factors.METHODS This was a cross-sectional study among 50 parents of children with CHD who attended the Cardiac Clinic of University of Nigeria Teaching Hospital Ituku-Ozalla.Information was obtained using the Columbia Suicide Severity Rating Scale and the Hospital Anxiety and Depression Scale.RESULTS A greater percentage of parents whose child had a heart defect had anxiety symptoms(50.0%)than did those whose child had no heart defect(24.0%),and the difference in proportions was statistically significant(χ^(2)=7.250,P=0.007).A greater percentage of parents whose child had a heart defect had suicidal ideation(28.0%)than did those whose child had no heart defect(8.0%),and the difference in proportions was statistically significant(χ^(2)=6.775 P=0.009).A positive correlation was elicited between anxiety and suicide ideation,and this correlation was statistically significant(r=0.748,P<0.001).A positive correlation was elicited between depression and suicidal ideation scores,and this was statistically significant(r=0.617,P<0.001).CONCLUSION There is strong interconnectivity between anxiety and depression with suicidal ideation.There is an urgent need to start screening for the mental health of parents of children with CHD to avert the high propensity of complete suicide.In addition,policy makers may introduce a national clinical practice guideline on the importance of psychotherapy and mental health screening and targeted interventions for parents of children with CHD.展开更多
AIM:To evaluate the efficacy and safety of 3%diquafosol sodium eye drops in children wearing orthokeratology lenses and with dry eye disease(DED)or at risk of DED.METHODS:Randomized controlled trials.Children with DED...AIM:To evaluate the efficacy and safety of 3%diquafosol sodium eye drops in children wearing orthokeratology lenses and with dry eye disease(DED)or at risk of DED.METHODS:Randomized controlled trials.Children with DED or at risk of DED were randomly assigned in a 1∶1 ratio to receive either 3%diquafosol sodium eye drops 6 times daily or a blank control at Chongqing Aier Children’s Eye Hospital from November 2023 to November 2024.The primary endpoint was the change in the Dry Eye Questionnaire-5(DEQ-5)score from baseline at 12 wk.Secondary assessments included non-invasive breakup time(NIBUT),tear meniscus height,Schirmer’s test,corneal fluorescein staining score,and axial length.RESULTS:A total of 80 participants(80 eyes)were enrolled(40 in each group),the average age of the participants was 11.11±1.88 years,with 43 females(54%)and 37 males(46%),and all completed the trial.After 12 wk,the DEQ-5 scores for the diquafosol sodium group and the blank control group were 1.88±2.02 and 2.88±2.79,respectively(P=0.079).The diquafosol sodium group demonstrated a significant improvement in DEQ-5 dryness symptom scores(-0.33±0.66 vs.0.05±0.81,P=0.023)and NIBUT(6.18±3.73 vs.-1.09±4.40 s,P<0.001)at 12 wk.Additionally,the diquafosol sodium group showed no axial length elongation,in contrast to the blank control group,which exhibited elongation(0.00±0.08 vs.0.05±0.10 mm,P=0.013).No other significant differences were found in the secondary endpoints.No adverse events occurred during the trial.CONCLUSION:Although no statistically significant improvements were noted in the overall DEQ-5 scores,the 3%diquafosol sodium eye drops significantly improved dryness symptoms and NIBUT when compared to the blank control group.展开更多
Prenatal maternal psychological distress,particularly depression,has been increasingly recognized as a factor that influences fetal growth;however,its impact on early childhood development remains less well understood...Prenatal maternal psychological distress,particularly depression,has been increasingly recognized as a factor that influences fetal growth;however,its impact on early childhood development remains less well understood.The present study investigated the association between prenatal depression and children's growth trajectories,as well as the odds of overweight and obesity from 1 to 36 months,while also accounting for maternal anxiety and stress.We analyzed data from 4710 mother-child dyads in the Jiangsu Birth Cohort,assessing maternal psychological distress across trimesters and categorizing participants into groups with mild,moderate,and severe depressive symptomatology.Children's weight-for-length z-scores(WLZ)were used to assess overweight/obesity prevalence,and growth patterns were identified through trajectory models.The results from the generalized estimating equations analysis showed that greater depressive symptomatology during pregnancy was associated with a 28%to 41%increase in the odds of childhood overweight/obesity across all three trimesters,compared with mild depressive symptomatology.We identified five distinct WLZ growth trajectory patterns,and found that mothers with greater depressive symptomatology were 39%–47%more likely to have children who followed a very-high-stable growth trajectory,compared with mothers with mild depressive symptomatology.These findings highlight the significant impact of prenatal depression on adverse growth patterns and childhood overweight/obesity,underscoring the need for early intervention.展开更多
Objective:This review aimed to evaluate existing evidence of educational interventions targeted at parents and caregivers of children with type 1 diabetes(T1D)to improve diabetes management outcomes.Methods:A general ...Objective:This review aimed to evaluate existing evidence of educational interventions targeted at parents and caregivers of children with type 1 diabetes(T1D)to improve diabetes management outcomes.Methods:A general review was conducted with primary caregivers of children younger than 18 with T1D as the population of interest.Journal searches were performed using the CINAHL,EBSCO,Pub Med,Scopus,Science Direct,and Google Scholar,databases for publications between 2017 and 2024,with full text in English.Results:A total of 26 studies were included in the review.Nine of these studies focused on various educational interventions,both technology-based and non-technology-based.By contrast,17 studies examined the impact of these interventions on caregiver outcomes,such as treatment adherence and glycemic control in children with T1D.So,the following research questions guided this review:(1)What is the effectiveness of diabetes education interventions on glycemic control in children with T1D?(2)How do caregiver knowledge and self-efficacy affect diabetes management outcomes?Conclusions:Diabetes interventions highlight the vital role of empowering caregivers of children with T1D with knowledge,skills,and support to improve and enhance their adherence to treatment,knowledge,and self-efficacy that ultimately contribute to better glycemic control of children as reflected by their Hb A1c levels.This review highlights the importance of diabetes education interventions for caregivers of children with T1D.The evidence indicates that such interventions can improve caregiver knowledge,self-efficacy,and glycemic control in children.However,variability in outcomes suggests that fur ther research is needed to identify the most effective educational strategies.展开更多
AIM:To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies.METHODS:A cross-sectional...AIM:To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies.METHODS:A cross-sectional survey of ocular symptoms and clinical eye examinations were performed in a sample of 35 rural primary schools in the semi-arid region of Kajiado West sub-county in S.W.Kenya,amongst a seminomadic tribe(Maasai).Students in Grades 1-8 were included.Visual acuity was measured using the Snellen“tumbling E”chart at 6 m.Children with symptoms of refractive error underwent non-cycloplegic refraction.RESULTS:A total of 2036 children(1084 males)between the ages of 4-20y were examined.Conjunctival actinic changes were present in 22%(442/2036).Nine cases were seen with a potential squamous carcinoma.No overt classical ocular signs of vitamin A deficiency were noted,although 181(8.9%)children complained of nyctalopia.Three hundred thirty-six(16.5%)children had a visual acuity worse than 6/12 in either eye,were unable to read N10 near text at 40 cm or had symptoms suggestive of refractive error.Refractive data led to an estimate of hyperopia of+1.00 D or more in 3.9%and of myopia of-0.50 D or more in either eye in 3.0%of the study population.CONCLUSION:Solar exposure-and dust-related conjunctival pathology is common.As this may develop into potentially sight-or even life-threatening conditions,it warrants further study,and preventive strategies may be needed.Complaints of nyctalopia were common and could suggest vitamin A deficiency.The prevalence of refractive errors is low in this rural African population.展开更多
This study investigated the effects of parental involvement,parenting stress,and social support on the social skills of school-aged children(6-18 years old)with intellectual disabilities(ID).Data were collected from 2...This study investigated the effects of parental involvement,parenting stress,and social support on the social skills of school-aged children(6-18 years old)with intellectual disabilities(ID).Data were collected from 280 Chinese parents(mothers=70.0%,fathers=30.0%)of children with ID through purposive sampling and analyzed using partial least squares structural equation modeling(PLS-SEM).The results indicated that parental involvement not only directly enhanced children’s social skills but also indirectly improved them by alleviating parenting stress,which acted as a partial mediator.Contrary to the stress-buffering hypothesis,social support did not moderate the negative impact of parenting stress on social skills.Theoretically,this study contributes by validating ecological systems theory through a shift in focus from individual deficits to family systems,while also challenging the conventional view of stress-buffering theory.Accordingly,parent-support programs should integrate practical involvement training with systematic stress reduction and provide tailored assistance such as behavior-management training and respite care.展开更多
1.Background The United Nations(UN)2030 Agenda for Sustainable Development,adopted in 2015,established the Sustainable Development Goals(SDGs)as a comprehensive framework to address global challenges through interconn...1.Background The United Nations(UN)2030 Agenda for Sustainable Development,adopted in 2015,established the Sustainable Development Goals(SDGs)as a comprehensive framework to address global challenges through interconnected social,economic,and environmental targets.展开更多
Background:Childhood leukemia,a malignant proliferative disorder of the hematopoietic system and the most common childhood cancer,poses a significant threat to the lives and health of affected children.For parents,a l...Background:Childhood leukemia,a malignant proliferative disorder of the hematopoietic system and the most common childhood cancer,poses a significant threat to the lives and health of affected children.For parents,a leukemia diagnosis in their child is a profoundly traumatic event.As primary caregivers,they endure immense psychological distress and caregiving stress throughout the prolonged and demanding treatment process,which can adversely affect their own well-being and caregiving capacity.However,the psychological mechanisms,such as the role of mindfulness,linking caregiver stress to parental coping strategies remain underexplored,and evidence-based interventions to support these parents are needed.Methods:In Study 1,we administered a cross-sectional survey to 242 parents of children with leukemia who were hospitalized at the Affiliated Hospital of Qingdao University between January and August 2024.Participants completed measures assessing caregiver burden,mindful attention awareness,and parental coping style.In Study 2,we further evaluated the effects of a Mindfulness-Based Stress Reduction(MBSR)intervention.Results:The results of Study 1 revealed:(1)The caregiving stress significantly and negatively predicted coping style(β=−1.18,95%CI[−2.18,−0.18],p<0.01).(2)Caregiving stress also significantly and negatively predicted mindfulness(β=−1.90,95%CI[−2.43,−1.38],p<0.01).(3)Conversely,mindfulness significantly and positively predicted coping style(β=0.85,95%CI[0.62,1.07],p<0.01).These findings suggest that mindfulness mediates the relationship between caregiver burden and coping style.In Study 2,the experimental group showed a significant decrease in caregiver stress post-intervention(t=2.24,p<0.05),a significant increase in mindfulness(t=−4.61,p<0.001),and a significant improvement in coping style(t=−2.36,p<0.01).No significant changes were observed in the control group.Conclusion:MBSR can effectively enhance mindfulness and promote adaptive coping strategies,while reducing caregiver burden among parents of children with leukemia.展开更多
BACKGROUND Emotional reactions,such as anxiety,irritability,and aggressive behavior,have attracted clinical attention as behavioral and emotional problems in preschool-age children.AIM To investigate the current statu...BACKGROUND Emotional reactions,such as anxiety,irritability,and aggressive behavior,have attracted clinical attention as behavioral and emotional problems in preschool-age children.AIM To investigate the current status of family rearing,parental stress,and behavioral and emotional problems of preschool children and to analyze the mediating effect of the current status of family rearing on parental stress and behavioral/emo-tional problems.METHODS We use convenience sampling to select 258 preschool children in the physical examination center of our hospital from October 2021 to September 2023.The children and their parents were evaluated using a questionnaire survey.Pearson's correlation was used to analyze the correlation between child behavioral and emotional problems and parental stress and family rearing,and the structural equation model was constructed to test the mediating effect.RESULTS The score for behavioral/emotional problems of 258 preschool children was(27.54±3.63),the score for parental stress was(87.64±11.34),and the score for parental family rearing was(31.54±5.24).There was a positive correlation between the behavioral and emotional problems of the children and the“hostile/mandatory”parenting style;meanwhile,showed a negative correlation with the“support/participation”parenting style(all P<0.05).The intermediary effect value between the family upbringing of parents in parental stress and children's behavior problems was 29.89%.CONCLUSION Parental family upbringing has a mediating effect between parental stress and behavioral and emotional problems of children.Despite paying attention to the behavioral and emotional problems of preschool-age children,clinical medical staff should provide correct and reasonable parenting advice to their parents to promote the mental health of preschool-age children.展开更多
Mycotoxins are the toxic metabolites produced by the fungi that grow in food crops;however,the modified mycotoxins are the undetectable metabolites during testing for the parent mycotoxin.Although more than 300 mycoto...Mycotoxins are the toxic metabolites produced by the fungi that grow in food crops;however,the modified mycotoxins are the undetectable metabolites during testing for the parent mycotoxin.Although more than 300 mycotoxins were discovered and identified,little is known about the effects of most of them or their modified forms on child health.Aflatoxins are well known to induce liver cancer and play a significant role in the impairment of child growth.Fumonisin also are known to induce esophageal cancer and neural tube defects.However,deoxynivalenol and the other trichothecenes are well known as immunotoxic and induce gastroenteritis.In this review,the adverse health hazards in children associated with the major mycotoxins as well as the modified forms of fusarium mycotoxins were described.Additionally,the global burden of the health ghazards resulted from the exposure of children to dietary mycotoxin.The risk assessment,risk characterization and the challenges in risk characterization of multiple mycotoxins in children food were discussed.展开更多
Purpose:This study aimed to provide comparative evidence on the effectiveness of various lifestyle interventions on body composition management for preschool and school-aged children.Methods:PubMed(MEDLINE),Embase,CIN...Purpose:This study aimed to provide comparative evidence on the effectiveness of various lifestyle interventions on body composition management for preschool and school-aged children.Methods:PubMed(MEDLINE),Embase,CINAHL,and Web of Science were systematically searched for this network meta-analysis.Randomized controlled studies(RCTs)that included children aged 4-12 years with no physical or mental conditions;performed at least 1 type of lifestyle intervention;reported change in body mass index(BMI),BMI z-score,or body fat percentage(BFP);and were published between January2010 and August 2023 were included.Results:The final analysis included 91 RCTs with aggregate data for 58,649 children.All interventions were categorized into single-arm approaches(physical activity,diet,and behavioral and informational support)and combined arms approaches(bicomponent and multicomponent treatment).Multicomponent treatment showed significant effectiveness on the reduction of BMI(mean deviation(MD)-0.49,95%confidence interval(95%CI):-0.88 to-0.12),BMI z-score(MD=-0.11,95%CI:-0.18 to-0.04),and BFP(MD=-1.69,95%CI:-2.97 to-0.42)compared to the usual care condition.Bicomponent treatment also significantly reduced BMI(MD=-0.28,95%CI:-0.54 to-0.04)and BMI z-score(MD=-0.07,95%CI:-0.12 to-0.02)compared to usual care.Conclusion:Interventions targeting multiple lifestyle components achieved greater reductions in children's BMI and BFP.Among single-component approaches,physical activity engagement emerged as the most effective.These findings should guide practitioners in recommending comprehensive lifestyle modifications for children.Moreover,children with higher initial BMI and body fat levels tend to exhibit more positive responses to lifestyle interventions aimed at managing obesity.展开更多
Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractor...Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases.Complications may occur,such as necrotizing pneumonia and respiratory failure.Extrapulmonary complications,including encephalitis,myocarditis,nephritis,hepatitis,or even multiple organ failure,can also arise.In this editorial,we dis-cuss the clinical implications of the significant findings from the article"Serum inflammatory markers in children with M.pneumoniae pneumonia and their predictive value for mycoplasma severity"published by Wang et al.They reported that measuring lactic dehydrogenase,interleukin-6 levels,and D-dimer effectively predicts refractory M.pneumoniae pneumonia cases.展开更多
BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,pa...BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,particularly in children.This report describes a DPB case resolved with long-term azithromycin therapy,em-phasizing the need for a timely and accurate diagnosis.CASE SUMMARY A 12-year-old girl,diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists,developed a history of chronic productive cough and chronic sinusitis for a year.On examination,she exhibited wheezing and coarse crackles.Despite receiving treatment for an asthma exacer-bation,her symptoms did not improve.A chest X-ray revealed reticulonodular infiltration in both lower lungs,prompting further evaluation with high-resolu-tion computed tomography(HRCT).The HRCT confirmed centrilobular nodule opacities,a'tree-in-bud'pattern,and non-tapering bronchi,suggesting DPB.Elevated cold hemagglutinin titers at 128 further supported the diagnosis.Her cough and sinusitis resolved within a month after starting azithromycin therapy,chosen for its anti-inflammatory and immunomodulatory effects.Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.CONCLUSION This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.展开更多
Objective This study aimed to analyse the trend of the mental disorder spectrum in children and adolescents from 2014 to 2022 in one city in Central China and to provide actionable recommendations for the prevention a...Objective This study aimed to analyse the trend of the mental disorder spectrum in children and adolescents from 2014 to 2022 in one city in Central China and to provide actionable recommendations for the prevention and management of mental disorders.Methods In this hospital-based retrospective study,we utilized child and adolescent medical records data from the Wuhan Mental Health Center from January 2014 to December 2022 and examined the top 5 mental disorders(schizophrenia,depressive episode,bipolar disorder,pervasive developmental disorder,and unspecified mood disorder)that accounted for the overall proportion of patients admitted.The rank and proportion of these mental disorders,demographic characteristics and disease indicators were analysed.Results There was a significant upwards trend in the number of children and adolescents diagnosed with mental disorders over the past 9 years,with a sharp decline in 2020 due to the COVID-19 pandemic,followed by a rebound in 2021 and a sustained level above prepandemic figures by 2022.The average age of hospitalization decreased significantly from 20.7 to 16.2 years,with a marked increase in the 12-17-year-old age group.The proportion of female hospitalizations increased from 39.2%to 55.2%,with a corresponding decrease in male hospitalizations.There was a notable decrease in the proportion of schizophrenia cases and an ascent of depressive episode to the most prevalent position.Conclusion This study emphasizes the critical need for targeted interventions and resources for severe mental disorders in children and adolescents and the importance of early detection and management of mental disorders to mitigate long-term effects on well-being and development.展开更多
Hepatoblastoma(HB)is the most common primary malignant liver tumor in children,representing approximately 50%to 60%of pediatric liver cancers.It predominantly affects children under the age of 3 years,with a slightly ...Hepatoblastoma(HB)is the most common primary malignant liver tumor in children,representing approximately 50%to 60%of pediatric liver cancers.It predominantly affects children under the age of 3 years,with a slightly higher incidence in boys compared to girls.The main pathological subtypes of HB are epithelial and mixed types.The etiology and pathogenesis are unclear and may be related to factors such as genetics and gene mutations.The diagnosis primarily relies on imaging examinations(including abdominal ultrasound,computed tomography,and magnetic resonance imaging)and serum alpha-fetoprotein testing.Treatment approaches include surgical resection,chemotherapy,and liver transplantation.Surgical resection is currently the only curative option,especially effective for early-stage localized tumors;chemotherapy can be used to shrink tumors before surgery or to manage their progression;liver transplantation is recommended for cases that cannot be surgically removed or for instances where the disease recurs after surgery.Recent advancements have encouraged a mul-tidisciplinary approach to treatment,with ongoing research into new chemothera-peutic and targeted agents.Despite these developments,challenges remain,such as the need for more precise and individualized therapies,chemotherapy resistance that can lead to poor outcomes in some patients,and a shortage of organ donors,along with the risk of immune rejection after transplantation.A thorough synthesis of current therapeutic strategies will establish an evidence-based foundation to enhance the management of HB in children,ultimately improving prognosis and quality of life.展开更多
BACKGROUND The incidence of type 2 diabetes mellitus(T2DM)in children and adolescents is increasing,yet there is limited information on the available pharmacological interventions to combat T2DM and prevent associated...BACKGROUND The incidence of type 2 diabetes mellitus(T2DM)in children and adolescents is increasing,yet there is limited information on the available pharmacological interventions to combat T2DM and prevent associated comorbidities.AIM To assess the effectiveness of current pharmacological treatments in managing T2DM in children and adolescents.The protocol of the study was registered in PROSPERO(CRD42022382165).METHODS Searches were performed in PubMed,EMBASE,Scopus,and ClinicalTrials.gov for publications between 1990 to September 2024 without language restrictions.Randomized control trials(RCTs)of pharmacotherapy in children and adolescents with T2DM(aged<19 years)were included.The primary outcome was a change in glycated hemoglobin(HbA1c)from baseline to follow-up.Secondary outcomes were changes in body weight,body mass index(BMI),total cholesterol,triglycerides,high density lipoprotein,and low-density lipoprotein from baseline,and incidence of adverse events during study periods.Screening,full-text review,data extraction,and assessments of risk of bias were done by two reviewers.Conflicts on each step were resolved by a third reviewer.Data analysis was performed using Review Manager Version 6.5(RevMan 6.5)and‘R’software via RStudio,‘meta’and‘netmeta’.RESULTS A total of 12 studies having low to moderate risk of bias with 1658 participants,and follow-up duration 12-52 weeks were included.In our network meta-analysis,compared to control(s),the reduction of HbA1c was sig-nificantly larger for dulaglutide[mean difference(MD),95%confidence interval:-1.20,-2.12 to-0.28],followed by dapagliflozin(-0.94,-1.44 to-0.44),liraglutide(-0.91,-1.37 to-0.45),empagliflozin(-0.87,-1.40 to-0.34),exenatide(-0.59,-1.07 to-0.11)and linagliptin(-0.45,-0.87 to-0.02)while other drugs had little or no effect.While liraglutide was associated with a change in body weight[MD-2.41(-4.68,-0.14)kg],no other drug treatment was associated with significant changes in body weight,BMI,and lipids.Apart from level 1 hypoglycemia with liraglutide[risk difference(RD):0.20,0.04-0.37]and minor adverse events with dulaglutide(RD:0.24,0.08-0.40),no other treatment was associated with excess risk of hypoglycemia or minor or major adverse events.CONCLUSION Pharmacotherapy of T2DM with dulaglutide,dapagliflozin,liraglutide,empagliflozin,exenatide,and linagliptin in children is associated with modest reduction of HbA1c.Larger RCTs with longer follow-up durations are needed to guide better therapeutic decision making.展开更多
Background:Parenting exerts a profound influence on children’s mental health and behavioral development.Despite the high prevalence of children’s emotional and behavioral problems(CEBP)in China,evidence-based parent...Background:Parenting exerts a profound influence on children’s mental health and behavioral development.Despite the high prevalence of children’s emotional and behavioral problems(CEBP)in China,evidence-based parenting interventions remain scarcely investigated as preventive public health strategies.This pilot study evaluated a school-based intervention for preventing CEBP.Methods:We employed a quasi-experimental design with propensity score matching(PSM)to select 28 families(intervention:n=13;control:n=15)from two matched urban primary schools.Quantitative data from seven validated scales were analyzed using t-tests and ANCOVA.Qualitative insights were derived from 10 semi-structured interviews via thematic analysis.Results:Compared to the control group,the intervention group demonstrated significantly greater improvements in CEBP(p=0.020,Cohen’s d=0.92),parental adjustment(p=0.031,Cohen’s d=0.80),parenting confidence(p=0.003,Cohen’s d=1.04),and parentchild relationships(p=0.001,Cohen’s d=1.46).Non-significant effects were observed for parenting style,parental relationship,and parenting conflict(p>0.05).Qualitative analysis corroborated these findings and further identified contributing factors for non-significant outcomes,including challengeswithmeasurement adaptability and inconsistent co-parenting practices.Conclusions:This pilot study suggests that an authoritative parenting style may be effective and culturally adaptable in China.Positive parenting interventions appear to mitigate CEBP by reducing risk factors and enhancing protective factors.However,improving parental relationships and parenting conflict may require targeted strategies.Given the pilot nature of this PSM-matched study(n=28),the findings should be interpreted as exploratory and used primarily for intervention refinement.展开更多
·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case gro...·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.展开更多
基金supported by the Special Project of National Science and Technology Basic Resources Survey(Grant No.2017FY101100)。
文摘Objective The rising prevalence of childhood obesity is closely associated with suboptimal dietary patterns.To address this public health concern,we conducted a comprehensive study to examine the association between coarse cereals consumption and body fat percentage(BFP)in Chinese children and adolescents.Methods The study included 48,305 children aged 6–17 years from 28 districts/counties in 14 provinces across seven regions of China(24,152 girls and 24,153 boys).BFP was examined using bioelectrical impedance analysis in the early morning.Coarse cereals consumption was assessed using a Food Frequency Questionnaire and categorized into three groups:0 g/1,000 kcal per day,0–10 g/1,000kcal per day,and>10 g/1,000 kcal per day(daily consumption of coarse cereals×1,000/total energy consumption).Quantile regression model was used to analyze the association between coarse cereals and BFP,adjusting for potential confounders such as age,pubertal development stage,urban/rural and regional factors,total daily dietary energy consumption,sedentary time,moderate-to-high physical activity,household income,parental education,and consumption of other foods.Results Boys aged 6–10,11–14,and 15–17 years had median daily coarse cereals consumptions of6.6 g,7.1 g,and 5.7 g,with BFP of 19.6%,19.5%,and 17.5%(all P<0.05).Girls in the same age groups showed consumption of 7.1 g,8.4 g,and 6.7 g,with BFP of 20.3%,26.4%,and 31.0%(all P<0.05).The quantile regression results for boys showed that daily consumption of coarse cereals was significantly correlated with their BFP in the 0.15,0.25,and 0.50 quartiles,with regression coefficients of-0.257,-0.221,and-0.330,respectively,after adjusting for potential confounders(P<0.05).For girls,there was a significant correlation with PBF at the 0.05,0.15,0.25,0.50,0.75,and 0.85 quartiles,with regression coefficients of-0.258,-0.366,-0.372,-0.431,-0.472,and-0.503(P<0.05 for all).Conclusions Coarse cereals consumption among Chinese children and adolescents remains relatively low.Higher consumption was inversely associated with BFP in children aged 6–17 years.Future interventional studies should assess how increased coarse cereals consumption prevents childhood obesity.
文摘BACKGROUND There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental suicidal ideation among children with CHD and the associated factors.METHODS This was a cross-sectional study among 50 parents of children with CHD who attended the Cardiac Clinic of University of Nigeria Teaching Hospital Ituku-Ozalla.Information was obtained using the Columbia Suicide Severity Rating Scale and the Hospital Anxiety and Depression Scale.RESULTS A greater percentage of parents whose child had a heart defect had anxiety symptoms(50.0%)than did those whose child had no heart defect(24.0%),and the difference in proportions was statistically significant(χ^(2)=7.250,P=0.007).A greater percentage of parents whose child had a heart defect had suicidal ideation(28.0%)than did those whose child had no heart defect(8.0%),and the difference in proportions was statistically significant(χ^(2)=6.775 P=0.009).A positive correlation was elicited between anxiety and suicide ideation,and this correlation was statistically significant(r=0.748,P<0.001).A positive correlation was elicited between depression and suicidal ideation scores,and this was statistically significant(r=0.617,P<0.001).CONCLUSION There is strong interconnectivity between anxiety and depression with suicidal ideation.There is an urgent need to start screening for the mental health of parents of children with CHD to avert the high propensity of complete suicide.In addition,policy makers may introduce a national clinical practice guideline on the importance of psychotherapy and mental health screening and targeted interventions for parents of children with CHD.
文摘AIM:To evaluate the efficacy and safety of 3%diquafosol sodium eye drops in children wearing orthokeratology lenses and with dry eye disease(DED)or at risk of DED.METHODS:Randomized controlled trials.Children with DED or at risk of DED were randomly assigned in a 1∶1 ratio to receive either 3%diquafosol sodium eye drops 6 times daily or a blank control at Chongqing Aier Children’s Eye Hospital from November 2023 to November 2024.The primary endpoint was the change in the Dry Eye Questionnaire-5(DEQ-5)score from baseline at 12 wk.Secondary assessments included non-invasive breakup time(NIBUT),tear meniscus height,Schirmer’s test,corneal fluorescein staining score,and axial length.RESULTS:A total of 80 participants(80 eyes)were enrolled(40 in each group),the average age of the participants was 11.11±1.88 years,with 43 females(54%)and 37 males(46%),and all completed the trial.After 12 wk,the DEQ-5 scores for the diquafosol sodium group and the blank control group were 1.88±2.02 and 2.88±2.79,respectively(P=0.079).The diquafosol sodium group demonstrated a significant improvement in DEQ-5 dryness symptom scores(-0.33±0.66 vs.0.05±0.81,P=0.023)and NIBUT(6.18±3.73 vs.-1.09±4.40 s,P<0.001)at 12 wk.Additionally,the diquafosol sodium group showed no axial length elongation,in contrast to the blank control group,which exhibited elongation(0.00±0.08 vs.0.05±0.10 mm,P=0.013).No other significant differences were found in the secondary endpoints.No adverse events occurred during the trial.CONCLUSION:Although no statistically significant improvements were noted in the overall DEQ-5 scores,the 3%diquafosol sodium eye drops significantly improved dryness symptoms and NIBUT when compared to the blank control group.
基金supported by the National Natural Science Foundation of China(Grant No.82373581 to Yuan Lin).
文摘Prenatal maternal psychological distress,particularly depression,has been increasingly recognized as a factor that influences fetal growth;however,its impact on early childhood development remains less well understood.The present study investigated the association between prenatal depression and children's growth trajectories,as well as the odds of overweight and obesity from 1 to 36 months,while also accounting for maternal anxiety and stress.We analyzed data from 4710 mother-child dyads in the Jiangsu Birth Cohort,assessing maternal psychological distress across trimesters and categorizing participants into groups with mild,moderate,and severe depressive symptomatology.Children's weight-for-length z-scores(WLZ)were used to assess overweight/obesity prevalence,and growth patterns were identified through trajectory models.The results from the generalized estimating equations analysis showed that greater depressive symptomatology during pregnancy was associated with a 28%to 41%increase in the odds of childhood overweight/obesity across all three trimesters,compared with mild depressive symptomatology.We identified five distinct WLZ growth trajectory patterns,and found that mothers with greater depressive symptomatology were 39%–47%more likely to have children who followed a very-high-stable growth trajectory,compared with mothers with mild depressive symptomatology.These findings highlight the significant impact of prenatal depression on adverse growth patterns and childhood overweight/obesity,underscoring the need for early intervention.
文摘Objective:This review aimed to evaluate existing evidence of educational interventions targeted at parents and caregivers of children with type 1 diabetes(T1D)to improve diabetes management outcomes.Methods:A general review was conducted with primary caregivers of children younger than 18 with T1D as the population of interest.Journal searches were performed using the CINAHL,EBSCO,Pub Med,Scopus,Science Direct,and Google Scholar,databases for publications between 2017 and 2024,with full text in English.Results:A total of 26 studies were included in the review.Nine of these studies focused on various educational interventions,both technology-based and non-technology-based.By contrast,17 studies examined the impact of these interventions on caregiver outcomes,such as treatment adherence and glycemic control in children with T1D.So,the following research questions guided this review:(1)What is the effectiveness of diabetes education interventions on glycemic control in children with T1D?(2)How do caregiver knowledge and self-efficacy affect diabetes management outcomes?Conclusions:Diabetes interventions highlight the vital role of empowering caregivers of children with T1D with knowledge,skills,and support to improve and enhance their adherence to treatment,knowledge,and self-efficacy that ultimately contribute to better glycemic control of children as reflected by their Hb A1c levels.This review highlights the importance of diabetes education interventions for caregivers of children with T1D.The evidence indicates that such interventions can improve caregiver knowledge,self-efficacy,and glycemic control in children.However,variability in outcomes suggests that fur ther research is needed to identify the most effective educational strategies.
基金Supported by Vision International Eye Missions-USA,“One Drop for All”,Italy,and Private Donors in the Netherlands.
文摘AIM:To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies.METHODS:A cross-sectional survey of ocular symptoms and clinical eye examinations were performed in a sample of 35 rural primary schools in the semi-arid region of Kajiado West sub-county in S.W.Kenya,amongst a seminomadic tribe(Maasai).Students in Grades 1-8 were included.Visual acuity was measured using the Snellen“tumbling E”chart at 6 m.Children with symptoms of refractive error underwent non-cycloplegic refraction.RESULTS:A total of 2036 children(1084 males)between the ages of 4-20y were examined.Conjunctival actinic changes were present in 22%(442/2036).Nine cases were seen with a potential squamous carcinoma.No overt classical ocular signs of vitamin A deficiency were noted,although 181(8.9%)children complained of nyctalopia.Three hundred thirty-six(16.5%)children had a visual acuity worse than 6/12 in either eye,were unable to read N10 near text at 40 cm or had symptoms suggestive of refractive error.Refractive data led to an estimate of hyperopia of+1.00 D or more in 3.9%and of myopia of-0.50 D or more in either eye in 3.0%of the study population.CONCLUSION:Solar exposure-and dust-related conjunctival pathology is common.As this may develop into potentially sight-or even life-threatening conditions,it warrants further study,and preventive strategies may be needed.Complaints of nyctalopia were common and could suggest vitamin A deficiency.The prevalence of refractive errors is low in this rural African population.
文摘This study investigated the effects of parental involvement,parenting stress,and social support on the social skills of school-aged children(6-18 years old)with intellectual disabilities(ID).Data were collected from 280 Chinese parents(mothers=70.0%,fathers=30.0%)of children with ID through purposive sampling and analyzed using partial least squares structural equation modeling(PLS-SEM).The results indicated that parental involvement not only directly enhanced children’s social skills but also indirectly improved them by alleviating parenting stress,which acted as a partial mediator.Contrary to the stress-buffering hypothesis,social support did not moderate the negative impact of parenting stress on social skills.Theoretically,this study contributes by validating ecological systems theory through a shift in focus from individual deficits to family systems,while also challenging the conventional view of stress-buffering theory.Accordingly,parent-support programs should integrate practical involvement training with systematic stress reduction and provide tailored assistance such as behavior-management training and respite care.
文摘1.Background The United Nations(UN)2030 Agenda for Sustainable Development,adopted in 2015,established the Sustainable Development Goals(SDGs)as a comprehensive framework to address global challenges through interconnected social,economic,and environmental targets.
基金approved by the Ethics Review Committee of Northwest Normal University(Approval No.:[2023028]).All participants signed the informed consent in this study.
文摘Background:Childhood leukemia,a malignant proliferative disorder of the hematopoietic system and the most common childhood cancer,poses a significant threat to the lives and health of affected children.For parents,a leukemia diagnosis in their child is a profoundly traumatic event.As primary caregivers,they endure immense psychological distress and caregiving stress throughout the prolonged and demanding treatment process,which can adversely affect their own well-being and caregiving capacity.However,the psychological mechanisms,such as the role of mindfulness,linking caregiver stress to parental coping strategies remain underexplored,and evidence-based interventions to support these parents are needed.Methods:In Study 1,we administered a cross-sectional survey to 242 parents of children with leukemia who were hospitalized at the Affiliated Hospital of Qingdao University between January and August 2024.Participants completed measures assessing caregiver burden,mindful attention awareness,and parental coping style.In Study 2,we further evaluated the effects of a Mindfulness-Based Stress Reduction(MBSR)intervention.Results:The results of Study 1 revealed:(1)The caregiving stress significantly and negatively predicted coping style(β=−1.18,95%CI[−2.18,−0.18],p<0.01).(2)Caregiving stress also significantly and negatively predicted mindfulness(β=−1.90,95%CI[−2.43,−1.38],p<0.01).(3)Conversely,mindfulness significantly and positively predicted coping style(β=0.85,95%CI[0.62,1.07],p<0.01).These findings suggest that mindfulness mediates the relationship between caregiver burden and coping style.In Study 2,the experimental group showed a significant decrease in caregiver stress post-intervention(t=2.24,p<0.05),a significant increase in mindfulness(t=−4.61,p<0.001),and a significant improvement in coping style(t=−2.36,p<0.01).No significant changes were observed in the control group.Conclusion:MBSR can effectively enhance mindfulness and promote adaptive coping strategies,while reducing caregiver burden among parents of children with leukemia.
基金Supported by the Shijiazhuang Science and Technology Research and Development Program,No.221460383.
文摘BACKGROUND Emotional reactions,such as anxiety,irritability,and aggressive behavior,have attracted clinical attention as behavioral and emotional problems in preschool-age children.AIM To investigate the current status of family rearing,parental stress,and behavioral and emotional problems of preschool children and to analyze the mediating effect of the current status of family rearing on parental stress and behavioral/emo-tional problems.METHODS We use convenience sampling to select 258 preschool children in the physical examination center of our hospital from October 2021 to September 2023.The children and their parents were evaluated using a questionnaire survey.Pearson's correlation was used to analyze the correlation between child behavioral and emotional problems and parental stress and family rearing,and the structural equation model was constructed to test the mediating effect.RESULTS The score for behavioral/emotional problems of 258 preschool children was(27.54±3.63),the score for parental stress was(87.64±11.34),and the score for parental family rearing was(31.54±5.24).There was a positive correlation between the behavioral and emotional problems of the children and the“hostile/mandatory”parenting style;meanwhile,showed a negative correlation with the“support/participation”parenting style(all P<0.05).The intermediary effect value between the family upbringing of parents in parental stress and children's behavior problems was 29.89%.CONCLUSION Parental family upbringing has a mediating effect between parental stress and behavioral and emotional problems of children.Despite paying attention to the behavioral and emotional problems of preschool-age children,clinical medical staff should provide correct and reasonable parenting advice to their parents to promote the mental health of preschool-age children.
文摘Mycotoxins are the toxic metabolites produced by the fungi that grow in food crops;however,the modified mycotoxins are the undetectable metabolites during testing for the parent mycotoxin.Although more than 300 mycotoxins were discovered and identified,little is known about the effects of most of them or their modified forms on child health.Aflatoxins are well known to induce liver cancer and play a significant role in the impairment of child growth.Fumonisin also are known to induce esophageal cancer and neural tube defects.However,deoxynivalenol and the other trichothecenes are well known as immunotoxic and induce gastroenteritis.In this review,the adverse health hazards in children associated with the major mycotoxins as well as the modified forms of fusarium mycotoxins were described.Additionally,the global burden of the health ghazards resulted from the exposure of children to dietary mycotoxin.The risk assessment,risk characterization and the challenges in risk characterization of multiple mycotoxins in children food were discussed.
文摘Purpose:This study aimed to provide comparative evidence on the effectiveness of various lifestyle interventions on body composition management for preschool and school-aged children.Methods:PubMed(MEDLINE),Embase,CINAHL,and Web of Science were systematically searched for this network meta-analysis.Randomized controlled studies(RCTs)that included children aged 4-12 years with no physical or mental conditions;performed at least 1 type of lifestyle intervention;reported change in body mass index(BMI),BMI z-score,or body fat percentage(BFP);and were published between January2010 and August 2023 were included.Results:The final analysis included 91 RCTs with aggregate data for 58,649 children.All interventions were categorized into single-arm approaches(physical activity,diet,and behavioral and informational support)and combined arms approaches(bicomponent and multicomponent treatment).Multicomponent treatment showed significant effectiveness on the reduction of BMI(mean deviation(MD)-0.49,95%confidence interval(95%CI):-0.88 to-0.12),BMI z-score(MD=-0.11,95%CI:-0.18 to-0.04),and BFP(MD=-1.69,95%CI:-2.97 to-0.42)compared to the usual care condition.Bicomponent treatment also significantly reduced BMI(MD=-0.28,95%CI:-0.54 to-0.04)and BMI z-score(MD=-0.07,95%CI:-0.12 to-0.02)compared to usual care.Conclusion:Interventions targeting multiple lifestyle components achieved greater reductions in children's BMI and BFP.Among single-component approaches,physical activity engagement emerged as the most effective.These findings should guide practitioners in recommending comprehensive lifestyle modifications for children.Moreover,children with higher initial BMI and body fat levels tend to exhibit more positive responses to lifestyle interventions aimed at managing obesity.
文摘Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases.Complications may occur,such as necrotizing pneumonia and respiratory failure.Extrapulmonary complications,including encephalitis,myocarditis,nephritis,hepatitis,or even multiple organ failure,can also arise.In this editorial,we dis-cuss the clinical implications of the significant findings from the article"Serum inflammatory markers in children with M.pneumoniae pneumonia and their predictive value for mycoplasma severity"published by Wang et al.They reported that measuring lactic dehydrogenase,interleukin-6 levels,and D-dimer effectively predicts refractory M.pneumoniae pneumonia cases.
文摘BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,particularly in children.This report describes a DPB case resolved with long-term azithromycin therapy,em-phasizing the need for a timely and accurate diagnosis.CASE SUMMARY A 12-year-old girl,diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists,developed a history of chronic productive cough and chronic sinusitis for a year.On examination,she exhibited wheezing and coarse crackles.Despite receiving treatment for an asthma exacer-bation,her symptoms did not improve.A chest X-ray revealed reticulonodular infiltration in both lower lungs,prompting further evaluation with high-resolu-tion computed tomography(HRCT).The HRCT confirmed centrilobular nodule opacities,a'tree-in-bud'pattern,and non-tapering bronchi,suggesting DPB.Elevated cold hemagglutinin titers at 128 further supported the diagnosis.Her cough and sinusitis resolved within a month after starting azithromycin therapy,chosen for its anti-inflammatory and immunomodulatory effects.Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.CONCLUSION This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.
文摘Objective This study aimed to analyse the trend of the mental disorder spectrum in children and adolescents from 2014 to 2022 in one city in Central China and to provide actionable recommendations for the prevention and management of mental disorders.Methods In this hospital-based retrospective study,we utilized child and adolescent medical records data from the Wuhan Mental Health Center from January 2014 to December 2022 and examined the top 5 mental disorders(schizophrenia,depressive episode,bipolar disorder,pervasive developmental disorder,and unspecified mood disorder)that accounted for the overall proportion of patients admitted.The rank and proportion of these mental disorders,demographic characteristics and disease indicators were analysed.Results There was a significant upwards trend in the number of children and adolescents diagnosed with mental disorders over the past 9 years,with a sharp decline in 2020 due to the COVID-19 pandemic,followed by a rebound in 2021 and a sustained level above prepandemic figures by 2022.The average age of hospitalization decreased significantly from 20.7 to 16.2 years,with a marked increase in the 12-17-year-old age group.The proportion of female hospitalizations increased from 39.2%to 55.2%,with a corresponding decrease in male hospitalizations.There was a notable decrease in the proportion of schizophrenia cases and an ascent of depressive episode to the most prevalent position.Conclusion This study emphasizes the critical need for targeted interventions and resources for severe mental disorders in children and adolescents and the importance of early detection and management of mental disorders to mitigate long-term effects on well-being and development.
文摘Hepatoblastoma(HB)is the most common primary malignant liver tumor in children,representing approximately 50%to 60%of pediatric liver cancers.It predominantly affects children under the age of 3 years,with a slightly higher incidence in boys compared to girls.The main pathological subtypes of HB are epithelial and mixed types.The etiology and pathogenesis are unclear and may be related to factors such as genetics and gene mutations.The diagnosis primarily relies on imaging examinations(including abdominal ultrasound,computed tomography,and magnetic resonance imaging)and serum alpha-fetoprotein testing.Treatment approaches include surgical resection,chemotherapy,and liver transplantation.Surgical resection is currently the only curative option,especially effective for early-stage localized tumors;chemotherapy can be used to shrink tumors before surgery or to manage their progression;liver transplantation is recommended for cases that cannot be surgically removed or for instances where the disease recurs after surgery.Recent advancements have encouraged a mul-tidisciplinary approach to treatment,with ongoing research into new chemothera-peutic and targeted agents.Despite these developments,challenges remain,such as the need for more precise and individualized therapies,chemotherapy resistance that can lead to poor outcomes in some patients,and a shortage of organ donors,along with the risk of immune rejection after transplantation.A thorough synthesis of current therapeutic strategies will establish an evidence-based foundation to enhance the management of HB in children,ultimately improving prognosis and quality of life.
文摘BACKGROUND The incidence of type 2 diabetes mellitus(T2DM)in children and adolescents is increasing,yet there is limited information on the available pharmacological interventions to combat T2DM and prevent associated comorbidities.AIM To assess the effectiveness of current pharmacological treatments in managing T2DM in children and adolescents.The protocol of the study was registered in PROSPERO(CRD42022382165).METHODS Searches were performed in PubMed,EMBASE,Scopus,and ClinicalTrials.gov for publications between 1990 to September 2024 without language restrictions.Randomized control trials(RCTs)of pharmacotherapy in children and adolescents with T2DM(aged<19 years)were included.The primary outcome was a change in glycated hemoglobin(HbA1c)from baseline to follow-up.Secondary outcomes were changes in body weight,body mass index(BMI),total cholesterol,triglycerides,high density lipoprotein,and low-density lipoprotein from baseline,and incidence of adverse events during study periods.Screening,full-text review,data extraction,and assessments of risk of bias were done by two reviewers.Conflicts on each step were resolved by a third reviewer.Data analysis was performed using Review Manager Version 6.5(RevMan 6.5)and‘R’software via RStudio,‘meta’and‘netmeta’.RESULTS A total of 12 studies having low to moderate risk of bias with 1658 participants,and follow-up duration 12-52 weeks were included.In our network meta-analysis,compared to control(s),the reduction of HbA1c was sig-nificantly larger for dulaglutide[mean difference(MD),95%confidence interval:-1.20,-2.12 to-0.28],followed by dapagliflozin(-0.94,-1.44 to-0.44),liraglutide(-0.91,-1.37 to-0.45),empagliflozin(-0.87,-1.40 to-0.34),exenatide(-0.59,-1.07 to-0.11)and linagliptin(-0.45,-0.87 to-0.02)while other drugs had little or no effect.While liraglutide was associated with a change in body weight[MD-2.41(-4.68,-0.14)kg],no other drug treatment was associated with significant changes in body weight,BMI,and lipids.Apart from level 1 hypoglycemia with liraglutide[risk difference(RD):0.20,0.04-0.37]and minor adverse events with dulaglutide(RD:0.24,0.08-0.40),no other treatment was associated with excess risk of hypoglycemia or minor or major adverse events.CONCLUSION Pharmacotherapy of T2DM with dulaglutide,dapagliflozin,liraglutide,empagliflozin,exenatide,and linagliptin in children is associated with modest reduction of HbA1c.Larger RCTs with longer follow-up durations are needed to guide better therapeutic decision making.
基金supported by the National Social Science Fund of China[18BSH146].
文摘Background:Parenting exerts a profound influence on children’s mental health and behavioral development.Despite the high prevalence of children’s emotional and behavioral problems(CEBP)in China,evidence-based parenting interventions remain scarcely investigated as preventive public health strategies.This pilot study evaluated a school-based intervention for preventing CEBP.Methods:We employed a quasi-experimental design with propensity score matching(PSM)to select 28 families(intervention:n=13;control:n=15)from two matched urban primary schools.Quantitative data from seven validated scales were analyzed using t-tests and ANCOVA.Qualitative insights were derived from 10 semi-structured interviews via thematic analysis.Results:Compared to the control group,the intervention group demonstrated significantly greater improvements in CEBP(p=0.020,Cohen’s d=0.92),parental adjustment(p=0.031,Cohen’s d=0.80),parenting confidence(p=0.003,Cohen’s d=1.04),and parentchild relationships(p=0.001,Cohen’s d=1.46).Non-significant effects were observed for parenting style,parental relationship,and parenting conflict(p>0.05).Qualitative analysis corroborated these findings and further identified contributing factors for non-significant outcomes,including challengeswithmeasurement adaptability and inconsistent co-parenting practices.Conclusions:This pilot study suggests that an authoritative parenting style may be effective and culturally adaptable in China.Positive parenting interventions appear to mitigate CEBP by reducing risk factors and enhancing protective factors.However,improving parental relationships and parenting conflict may require targeted strategies.Given the pilot nature of this PSM-matched study(n=28),the findings should be interpreted as exploratory and used primarily for intervention refinement.
文摘·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.
