Better Outcomes For Children Research Articles

Context-Specific Resilience Through a Cultural Lens: Social-Ecological Factors Among Chinese Families of Children with Neurodevelopmental Disabilities.

With the rise in attention towards Neurodevelopmental Disorders in Hong Kong and worldwide, understanding the role of social ecological resilience in reducing parenting stress and enhancing child outcomes is crucial, particularly within the unique cultural context of Chinese families. This study utilized a social ecological model to examine resilience factors at individual and interpersonal levels among Hong Kong parents of children with Neurodevelopmental Disorders. It also compared the stress and resilience conditions and differential functions of social ecological resilience between parents with and without children diagnosed with Neurodevelopmental Disorders. A sample of 447 parents of children with and without Neurodevelopmental Disorders were assessed by a newly developed Social Ecological Resilience Scale, along with measures of parenting stress and the internalizing and externalizing behaviors of their children. Independent sample t-tests showed that Chinese parents of children with Neurodevelopmental Disorders report significantly higher parenting stress and more internalizing and externalizing difficulties in their children compared to those without Neurodevelopmental Disorders. Multiple linear regression analyses indicated that enhanced social ecological resilience among parents predicted improved parenting stress and better outcomes in children's behaviors. Notably, social ecological resilience factors showed varying effects between parents with and without children diagnosed with Neurodevelopmental Disorders. These findings highlight that both individual and interpersonal resilience factors among parents predicted improved parenting stress and better outcomes in children's behaviors and certain resilience factors may be contextually motivated. Policy makers and practitioners should consider developing context-specific strategies and programmes to help the focal target group.

SOCIAL NETWORKS OF CHILDREN AND PARENTS IN SINGLE-PARENT FAMILIES

This paper examines the social networks of children and parents of single-parent households, focusing on the special challenges and resources that characterize these families. Single-parent households face a specific set of challenges like financial stress and social isolation that can powerfully influence the well-being of both children and parents. We explore these questions using a mixed-methods approach that combines in-depth qualitative interviews and surveys to understand the structure and functioning of these networks in terms of emotional, social, and practical support. The great majority of children in single-parent families rely on relationships within peer groups, which are essential for children both as sources of emotional resilience and as reflecting their growing sense of social development. On the other hand, other networks for parents exist, such as extended family, friends, and community organizations, that are significant in reducing their levels of stress and sense of belonging. The study outlines how social support through community resources—the availability of local support groups, educational programs, and the like—can help fortify these social connections and family relationships. Ultimately, the study is looking to inform policymakers and practitioners about specific services single-parent families need, so that these can be leveraged in developing targeted interventions to strengthen familial and community relationships. Because we recognize and foster the social networks that are accessible to these families, we can be contributing to better outcomes for children and their parents.

Recurrent GBS in Children: A Case Report

Background: Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy characterized by rapidly progressing muscle weakness. GBS usually follows a monophasic course, but rarely it can recur after an asymptomatic period of several months to years. Limited cases of recurrent GBS have been reported in the literature. We present two cases of recurrent GBS encountered in a tertiary care hospital. This case report describes the clinical presentation, diagnostic workup, management, and outcomes of two children of GBS who experienced recurrence. By presenting the cases, we aim to increase awareness of this rare presentation of GBS among healthcare professionals and enabletimely recognition and better outcomes for children with recurrent GBS. J Com Med Col Teachers Asso Jan 2024; 28(1): 37-40

The registers of pediatric patients with home artificial nutrition. The Spanish experience

Background: the number of infants and children who receive artificial nutrition at home has been steadily increasing over the last decades, as better outcomes for children with chronic conditions have been achieved. In order to evaluate the need of resources to implement the technique it is necessary to know how many patients benefit from home artificial nutrition. This information can be estimated from the register of patients, when available. Methods: in this paper the characteristics of all registers were reviewed, especially those devoted to pediatric patients. Results: only two pediatric registers are active in 2023: the Canadian register and the Spanish one. NADYA register from the Spanish Society for Clinical Nutrition and Metabolism (SENPE) and the recent REPAFI, form the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition. The most valuable register from the British Society, BANS, stopped providing information in 2018. Conclusion: despite the fact of acknowledging the importance of having gathered information on the prevalence and incidence of home artificial nutrition, to fit resources to necessities, the number of active registers is quite short.

MDB-107. MINNELIDE, A PROMISING COMPOUND FOR THE TREATMENT OF HIGH-RISK MEDULLOBLASTOMA

Abstract Despite the overall good outcome of children with medulloblastoma (MB), a subset faces the challenge of highly aggressive metastatic tumors. The poor prognosis for these patients underscores the urgent need for advancing therapeutic approaches. Minnelide, an analog of the natural product triptolide, exhibits potent antitumor activity in preclinical and early clinical settings. Despite its efficacy and tolerable toxicity, Minnelide has not been assessed against MB. Using a bioinformatic dataset integrating cellular drug response and gene expression, we predicted sensitivity of Group 3 (G3) MB, characterized by a poor five-year survival, to triptolide/Minnelide. Subsequent experiments confirmed the ability of both triptolide and Minnelide to reduce the viability of G3 MB cells ex vivo. Transcriptomic analyses identified MYC signaling, a crucial driver of G3 MB, as a downstream target of these drugs. We validated the MYC dependency and demonstrated that triptolide affects both MYC transcription and protein stability. Notably, Minnelide acted in vivo on MYC, leading to reduced tumor growth and metastatic spread, resulting in improved survival in mouse and patient-derived G3 MB models. Furthermore, Minnelide enhanced the efficacy of adjuvant chemotherapy, suggesting its potential repurposing for treating MYC-driven G3 MB patients.

Targeting Peer Contagion Dynamics in Children with ADHD: Effects from a Two-Site Randomized Controlled Trial

ABSTRACT Objective Parental Friendship Coaching (PFC) teaches parents to coach their children in friendship skills. This paper examines whether PFC fosters positive peer contagion processes (i.e. dyadic mutuality) and reduces negative peer contagion processes (i.e. coercive joining) within the friendships of children with attention-deficit/hyperactivity disorder (ADHD). Method Participants were 134 families of children with ADHD and peer problems (age 6–11 years; 69% male; 72% white) at two Canadian sites, randomized to PFC or CARE (an active comparison intervention). Children were observed in the lab at baseline, post-treatment, and at 8-month follow-up during cooperation and competition tasks with a real-life friend. Amount and reciprocity of dyadic mutuality indicators (i.e. positive affect and positive behaviors) and coercive joining indicators (i.e. aggressive, controlling, and rule-breaking behaviors) between friends were coded. Results Across treatment conditions, children showed an increase in the amount of dyadic mutuality during cooperation and a decrease in the amount of coercive joining during competition over time. Relative to CARE, PFC induced a reduced amount of coercive joining behaviors during cooperation at post-treatment and follow-up. However, PFC led to decreases in the reciprocity of positive affect during cooperation at post-treatment and to increases in the reciprocity of coercive joining during competition at follow-up relative to CARE. Moderation analyses suggest PFC was associated with better outcomes for children with externalizing comorbidity, and for those with a stable or a best friend. Conclusions Findings highlight the importance of transactional processes, contextual differences, externalizing comorbidities, and friendship status when assessing the efficacy of PFC.

Abstract 1087: Synergistic mechanisms against pediatric bone sarcoma models: Trabectedin enhances oncolytic virotherapy intratumoral spread and antitumor immune activation

Abstract Osteosarcoma and Ewing sarcoma are the most common pediatric bone malignancies and, despite decades of research, efforts to treat patients with advanced disease remain dismal. To address this inadequacy, we leverage oncolytic herpes simplex virotherapy as a double-edged attack against tumors through 1) tumor cell-specific lysis and 2) antitumor immune stimulation. However, previous trials of oncolytic herpes simplex virotherapy in pediatric sarcomas displayed limited responses, likely due to the observed presence of immunosuppressive monocytes and macrophages. To improve efficacy, we combined oncolytic herpes simplex virotherapy with trabectedin, an FDA-approved DNA-binding agent known to disrupt gene expression and deplete monocytes and macrophages. Surprisingly, we found that the efficacy of this combination far surpassed our predictions, inducing complete and partial regressions in multiple models of Ewing sarcoma and osteosarcoma. To explore potential mechanisms driving this high degree of synergy, we performed single cell RNA sequencing on tumors of mice treated with monotherapy or combination therapy. Interestingly, trabectedin synergized with the oncolytic virotherapy through two unexpected mechanisms. Our analysis revealed that trabectedin increased intratumoral oncolytic virus spread by disrupting expression of the intrinsic antiviral response in human Ewing sarcoma cells. Additionally, trabectedin not only reduced immunosuppressive macrophages but also stimulated cytotoxic granzyme expression in infiltrating T and NK cells in immunocompetent osteosarcoma models. These effector NK and T cells were necessary for the regressions of osteosarcoma allografts treated with trabectedin and oncolytic virotherapy. Thus, trabectedin enhanced both the oncolytic effect of herpes simplex virotherapy and the effector function of cytotoxic lymphocytes that become activated in response to the virus. The combination of trabectedin and oncolytic herpes simplex virotherapy offers the potential to unite these mechanisms against bone tumors to achieve better outcomes for children. Citation Format: Emily Ringwalt, Mark Currier, Andrea Glaspell, Matthew V. Cannon, Chun-Yu Chen, Amy C. Gross, Maren Cam, Pin-Yi Wang, Ryan D. Roberts, Timothy P. Cripe. Synergistic mechanisms against pediatric bone sarcoma models: Trabectedin enhances oncolytic virotherapy intratumoral spread and antitumor immune activation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1087.

Evaluation of robot-assisted laparoscopic versus conventional laparoscopic hiatal hernia repair in children.

Laparoscopic approach is the gold standard for repairing hiatal hernia (HH). Robotic technology is now widely accepted, but it is rarely used in children with HH. Our aim was to evaluate the clinical effect of robot-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (CLS) in the treatment of HH in children. A retrospective study was carried out in patients undergoing elective robot-assisted laparoscopic or conventional laparoscopic HH repair at a tertiary academic hospital from January 2020 to December 2022, and patients who met the inclusion criteria were included in this study. We compared the characteristics and clinical results of patients to understand the effects of the two surgical methods. Forty-six patients (CLS, group 1, n = 25; RALS, group 2, n = 21) met the inclusion criteria. All operations were performed by one experienced pediatric surgeon. In this study, no significant differences were found in terms of gender, age, weight, size of HH, total operation times, the effective operation time (excluding setup time) and complications between group 1 and group 2. (P = 0.979, P = 0.438, P = 0.265, P = 0.800, P = 0.122, P = 0.427 and P = 0.478, respectively). However, the intraoperative bleeding, the intensive care unit (ICU) admission, postoperative hospital length of stay (LOS) and postoperative fasting time were significantly less for RALS (P = 0.016, P = 0.040, P = 0.035 and P = 0.025, respectively). Meanwhile, the overall charges were significantly higher in group 2 (P < 0.01). Despite higher charges for robotic-assisted HH repair, it is a safe and reliable alternative to CLS and was associated with better outcomes in children.

Scrub Typhus Associated Secondary Hemophagocytic Lymphohistiocytosis in Pediatric Intensive Care Unit

Background: Scrub Typhus is febrile illness caused by orientia tsutsugamusi and presents with multiorgan involvement. It can cause multiorgan failure resulting in acute respiratory distress syndrome, acute kidney Injury and hemophagocytic lymphohistiocytosis. Secondary hemophagocytic lymphohistiocytosis is rare but life threatening clinical condition caused by uncontrolled activation of inflammatory cytokines and accumulation of activated macrophages and lymphocytes.&#x0D; Materials and Methods: This study is a prospective observational study conducted on children with Scrub Typhus being admitted to Pediatric Intensive care Unit of Nobel Medical College during 12 months period from July 2022 to June 2023. Basic demographic features, clinical presentation, severity and outcome were analyzed. Categorical variables were reported as frequencies, and continuous as mean ± SD. Independent sample t-test and chi square test was used for comparison of means and categorical variables.&#x0D; Results: A total of 32 children with scrub typhus were included. Common age group was &gt;10 years. Fever, hepatosplenomegaly, rash and respiratory distress were common clinical features. Among 32 cases, 7 (21.87%) had Encephalitis, 10 (31.25%) developed acute respiratory distress syndrome, 13 (40.62%) had Shock, and 9 (28.12%) developed secondary hemophagocytic lymphohistiocytosis. Among 9 children with scrub typhus associated secondary hemophagocytic lymphohistiocytosis, all of them had Hyperferritenemia, Hypofibrinogenemia, and Hypertriglyceridemia. Hemophagocytosis was identified in (55.55%) in bone marrow biopsies. 1 patient succumbed to multiorgan failure.&#x0D; Conclusion: Secondary hemophagocytic lymphohistiocytosis should be considered in children with Scrub typhus requiring Intensive care support. Early recognition and prompt treatment can result in good outcome in children with Scrub typhus associated secondary hemophagocytic lymphohistiocytosis.

Macronutrient and Micronutrient Intake in Children with Lung Disease.

This review article aims to summarize the literature findings regarding the role of micronutrients in children with lung disease. The nutritional and respiratory statuses of critically ill children are interrelated, and malnutrition is commonly associated with respiratory failure. The most recent nutrition support guidelines for critically ill children have recommended an adequate macronutrient intake in the first week of admission due to its association with good outcomes. In children with lung disease, it is important not to exceed the proportion of carbohydrates in the diet to avoid increased carbon dioxide production and increased work of breathing, which potentially could delay the weaning of the ventilator. Indirect calorimetry can guide the process of estimating adequate caloric intake and adjusting the proportion of carbohydrates in the diet based on the results of the respiratory quotient. Micronutrients, including vitamins, trace elements, and others, have been shown to play a role in the structure and function of the immune system, antioxidant properties, and the production of antimicrobial proteins supporting the defense mechanisms against infections. Sufficient levels of micronutrients and adequate supplementation have been associated with better outcomes in children with lung diseases, including pneumonia, cystic fibrosis, asthma, bronchiolitis, and acute respiratory failure.

Impact of the COVID-19 pandemic on diabetic ketoacidosis management in the pediatric intensive care unit.

Diabetic ketoacidosis (DKA) is a common endocrine emergency in pediatric patients. Early presentation to health facilities, diagnosis, and good management in the pediatric intensive care unit (PICU) are crucial for better outcomes in children with DKA. This was a single-center, retrospective cohort study conducted between February 2015 and January 2022. Patients with DKA were divided into two groups according to pandemic status and diabetes diagnosis. The study enrolled 59 patients, and their mean age was 11±5 years. Forty (68%) had newly diagnosed type 1 diabetes mellitus (T1DM), and 61% received follow-up in the pre-pandemic period. Blood glucose, blood ketone, potassium, phosphorus, and creatinine levels were significantly higher in the new-onset T1DM group compared with the previously diagnosed group (P=0.01, P=0.02, P<0.001, P=0.01, and P=0.08, respectively). In patients with newly diagnosed T1DM, length of PICU stays were longer than in those with previously diagnosed T1DM (28.5±8.9 vs. 17.3±6.7 hours, P<0.001). The pandemic group was compared with pre-pandemic group, there was a statistically significant difference in laboratory parameters of pH, HCO3, and lactate and also Pediatric Risk of Mortality (PRISM) III score. All patients survived, and there were no neurologic sequelae. Patients admitted during the pandemic period were admitted with more severe DKA and had higher PRISM III scores. During the pandemic period, there was an increase in the incidence of DKA in the participating center compared to that before the pandemic.

Comparison of splinting immobilization and K-wire fixation in children with type II phalange neck fracture.

To compare outcomes of type II phalangeal neck fractures in children who received closed reduction followed by splinting immobilization or by K-wire fixation. Furthermore, we analyzed the remodeling potential of residual deformities and the relationship between age and outcomes. Patients in Children's Hospital of Fudan University, Xiamen Hospital were included in the study from October 2015 to October 2018. We compared outcomes between the conservation group and operation group. Remodeling of residual deformities was calculated on a series of anteroposterior and lateral radiography. The correlation between age and outcomes was analyzed using Spearman's rank correlation coefficient. Forty patients (25 males) were enrolled. Nineteen patients had subtype IIa, 19 subtype IIb, and two subtype IIc fractures. Left hands were affected more than right hands, and small finger and proximal phalanx were more frequently involved. There were no significant differences between conservation group and operation group among excellent, good, and fair outcomes. And the outcomes were not significantly different between the IIa and IIb subtypes. An average sagittal remodeling rate was 88.5%, and coronal remodeling rate was 56.71%, respectively, in 13 patients with residual deformities. There was a significant correlation between age and final outcomes. Closed reduction and stable splint fixation may be an effective and economical initial treatment option. Fracture subtype does not seem to be a key factor for choosing treatment options. The fractured phalangeal neck had remodeling potential whether on sagittal or coronal plane. Younger age might be a predictor of better outcomes in children with type II phalanx neck fractures.

Mutation in Methionyl-tRNA Synthetase 1 Causing Pulmonary Alveolar Proteinosis

Background: A chronic history of exertional dyspnea, dry cough, and fatigue, associated with reticulonodular ground-glass opacity indicates an underlying interstitial lung disease (ILD). Pulmonary alveolar proteinosis (PAP) is a rare cause of ILD, in which there is abnormal accumulation of surfactant material in alveoli, thereby impairing gaseous exchange. In children, PAP is usually due to genetic mutations. We report a child with PAP due to mutation in methionyl-transfer RNA synthetase 1 (MARS) gene. Clinical Description: An 8-year-old boy presented with persistent dry cough, and exercise-induced breathlessness for 2 years of age, associated with failure to gain weight. He had multiple exacerbations in the past, requiring common symptomatic treatment, but with minimal improvement. On presentation to us, the child had tachypnea, hypoxia (oxygen saturation [SpO2]: 85%), and Grade 2 clubbing, with bilateral fine crepitation in bilateral lung fields. Management and Outcome: The child was stabilized by providing oxygen via high-flow nasal cannula. Blood investigations were largely normal. His chest X-ray and computerized tomography (CT) of the chest were suggestive of childhood ILD. A lung biopsy revealed periodic acid–Schiff-positive eosinophilic granular material in the alveolar spaces without any fibrosis, suggesting a diagnosis of PAP. Next-generation sequencing revealed a compound heterozygous mutation of the MARS1 gene resulting in PAP. Parental segregation analysis showed each one to be a carrier of one of the genes. Therapeutic whole-lung lavage (WLL) was carried out, following which symptoms improved markedly. SpO2 increased and the child was able to be weaned off oxygen and discharged. Three years, postdischarge, the child is asymptomatic and thriving well. Conclusions: PAP may be a cause of ILD in a child. Although the etiology can be ascertained by high-resolution CT of the chest and bronchoalveolar lavage, further genetic analysis should also be undertaken in children to identify the exact defect. WLL can provide a good outcome in children with PAP due to MARS mutation.

Issues in the identification, assessment and treatment of children and adolescents with ADHD

Many studies into Attention-Deficit/hyperactivity Disorder (ADHD) have documented that this neurodevelopment disorder may be under-identified. Early diagnosis of children and adolescents with ADHD is important, and consequently school-based interventions represent an essential tool for work in this area. To identify issues in the diagnosis, assessment and treatment of children and adolescents with ADHD, is reviewed here research findings which could lead to significantly better outcomes for children and adolescents with ADHD. Accordingly, we briefly review studies retrieved in a MEDLINE search, using the terms “ADHD”, “identification”, prevalence”, “assessment”, “treatment”, “learning disabilities” and “ADHD” and “comorbidity” combined, as these pinpoint diagnosis, for the years 2009 to 2022. In this respect, the literature reviewed suggests that multiple aspects associated with psychometric features, as well as clinical and/or pharmacological factors should be considered of highly clinical significance in identifying, assessing and treating individuals diagnosed with ADHD. For this reason, it is important to investigate about difficulties immersed in identifying, assessing and treating to children and adolescents with ADHD in different settings.

Exploring current and future therapies for childhood astrocytoma

Exploring current and future therapies for childhood astrocytoma Here, Doctor Peter J Houghton explains current therapies for childhood brain cancer what needs to change to ensure better outcomes for children diagnosed with astrocytoma in the future. Cancer in children is rare, representing less than 1% of all cancers in the U.S. Yet, despite major advances in treating childhood cancer, it remains the major cause of disease-related death in children up to 19 years of age in the U.S. It is estimated that 1 in 285 children will be diagnosed with cancer.

A question of omission of care or social reciprocity? Low-income families’ perception of child neglect in Ghana

Child neglect is the most contested type of child maltreatment as its definition and measurement are more subjective, however, the less researched area of concern is the basis of its construction. Therefore, the purpose of this study was to explore what low-income families deem as child neglect to inform more acceptable interventions for both Social Workers and families to ensure better outcomes for children. This paper presents the findings of a pilot study in Assin Assempanaye, a low-income community in the Central Region of Ghana. Adopting an interpretative phenomenological analysis approach with an in-depth interview guide, 18 parents from different households’ views were explored using thematic analysis. The findings of the study revealed that age and expected social behaviour were the basis for neglect. Where omission of care for a child below 10 years was deemed as parental failure, for those, 10-17 years, the incidence of neglect was linked to the child’s failure to conform to the reciprocal social relationship between a parent and a child. It is suggested that Social Workers have to address adolescent neglect differently in programme interventions by also focusing on social role expectations.

Commentary on Kempe, the Next 50 Years

This paper provides a reflection on the evolution of child maltreatment systems and research across the globe during the time since the establishment of the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect (Kempe Center) over 50 years ago. While research has demonstrated that children who are victims of maltreatment have poorer outcomes than their peers, it is also clear that the child welfare workforce faces workforce challenges, and the system established 50 years ago is not the same as it is today. Efforts to move this field of study forward in a changing world rely upon the understanding of child abuse and neglect in the broader culture of our world, including disentangling poverty and social structures from neglect, supporting underrepresented people and communities, and identifying how best to balance the role of child welfare with community services. The Kempe Center’s continued commitment to a multidisciplinary approach to understanding, preventing, and treating child maltreatment, while challenging professional and social reticence to address complex contributing issues and the impact of historical actions, is at the core of its work looking forward to the next 50 years. The continued focus of centering research as a critical component in moving the field forward in just and equitable ways is demonstrated in this sampling of current efforts to support better outcomes for children and families.

How Can Critical Reflection Improve Social Work Practice with Children and Families?

Abstract The impacts of neoliberal managerialism mean that practitioners working in child protection programmes are often challenged to balance social work values, with formal compliance activities to reduce risk. Within this context, what are the possibilities for practitioners to creatively navigate complex practice environments to achieve better outcomes for children and families? And how might transformative research empower practitioners to improve practice by reconnecting their work with the emancipatory values of the profession? This article seeks to address these questions by showcasing key findings of a state-wide study focused on empowering children’s voices, through the presentation and analysis of a case study. The research used a pre-test/post-test design with critical reflection as a methodology to transform the practice of front line workers and managers who work with children and families in an Australian-based non-government organisation. The case study illustrates the conceptual and practical processes involved in achieving change in a way that can be replicated by others and transferred to other contexts. The findings of the research suggest that critical reflection can be effective to enable practitioners to improve practice with children and families. The article concludes by highlighting implications for organisations in supporting critically reflective practitioners.

Autism Spectrum Disorder Screening Practices in the United States and Mexico

Purpose: The purpose of this study was to explore screening practices for autism spectrum disorder (ASD) in Mexico and the United States (U.S.).&#x0D; Methods: Data from a larger study exploring the knowledge, screening, and diagnostic practices of healthcare practitioners from Mexico and the U.S. was used for the current study. The original survey was created by experts in ASD and consisted of 63 questions: 15 demographic questions, 20 questions relating to knowledge of ASD, 11 questions relating to screening practices, and 17 questions relating to diagnostic practices. All surveys were completed by professionals engaging in the screening and diagnosis of ASD. For this study, a total of thirty- five survey responses for the screening portion of the survey (30 from the U.S. and 5 from Mexico) were explored. Qualitative data and descriptive statistics were utilized.&#x0D; Results: Many of the responses relating to screening practices from professionals practicing in Mexico and the U.S. were consistent with best practice guidelines from the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and the Mexican Public Health Guide. Furthermore, many similarities were found in the screening practices of professionals from both countries. Differences in screening practices reported by professionals from Mexico and the U.S. were found in the type of professional involved in the screening process and professional referrals after a failed ASD screening. Additionally, some professionals from both the U.S. and Mexico reported the use of inappropriate screening tools, and the average age reportedly screened was much higher than the current recommendations of the American Academy of Pediatrics (Hyman et al., 2020).&#x0D; Conclusion: An understanding of the screening practices currently being used in Mexico and the U.S. provides both researchers and clinicians with a better understanding of what is being implemented by different professionals. This study identified areas of strength and areas of weaknesses in the screening process for ASD in both countries. These results can now be used in future studies and programs targeting improved screening processes in Mexico in the U.S. Improved screening processes are important because of the potential to result in an earlier age of diagnosis of ASD and provision of services at a younger age. The latter of which is associated with better outcomes for children with ASD.&#x0D; Keywords: autism spectrum disorder, screening, Mexico, United States.

Recent updates in enthesitis-related arthritis.

Enthesitis-related arthritis (ERA) is a category of juvenile idiopathic arthritis which belongs to the spectrum of diseases that are included in juvenile spondyloarthropathy. In recent years, there have been significant advances in understanding pathogenesis, tools to assess disease activity, early recognition of the axial disease, and targeted therapy using IL-17 inhibitors and small molecule inhibitors. The current narrative review highlights these new advances. Among many hypotheses linking HLA B27 to ERA, one of them is the effect of HLA B27 on gut dysbiosis. However, recent data suggest that gut dysbiosis is probably not determined by HLA B27. Though children present with arthritis and enthesitis, axial disease is present in 50-60% on MRI. Using data-driven approach, discriminative MRI finding for active and chronic diseases has been defined for children. This will help in the early recognition of disease. An abridged version of juvenile spondyloarthropathy disease activity (JSpADA) score without the need for acute phase reactants and Schober test performed as well as the original score may increase its acceptance in routine practice. Secukinumab (anti-IL-17 antibody) has shown a more than 75% response rate in children with ERA and may be a good alternative to anti-TNF therapy. Initial data with tofacitinib also look promising. All these will translate into better outcomes for children with ERA.