Changes In Children Research Articles

Functional Brain MRI as a Diagnostic Tool for Detecting Neurological Changes in Children with Wilson’s Disease

Functional Brain MRI as a Diagnostic Tool for Detecting Neurological Changes in Children with Wilson’s Disease

Writing as a Path to the Alphabetic Principle: How Preschoolers Learn that their Own Writing Represents Speech

ABSTRACTThis study explores how preschoolers develop understandings of the symbolic nature of print in the context of their own writing. Using qualitative methods and a cross‐sectional design, this study documents the learning trajectory that begins with children's earliest experiences linking speech and print in writing events and continues as they learn that English print is glottographic and alphabetic. Children's changing approaches to speech‐print linking provide evidence of their developing understanding of how print functions as a representational system. Participants were 134 English‐speaking 2‐ to 5‐year‐olds attending childcare classrooms where preschoolers' writing was frequent and valued. Children completed an open‐ended writing task where they wrote a photo caption and read it to an adult. Open and axial coding identified six core approaches to speech‐print linking during writing: marks not read, conversational speech without pointing, conversational speech with pointing to the graphic array, segmented speech with pointing to the graphic array, segmented speech matched to specific marks, and phoneme‐grapheme matching. A growth curve model provided statistical support for this ordering of the core approaches. Findings show that early writing experiences can be an important context for building foundational literacy skills such as the alphabetic principle. Adult practices that physically materialize speech‐print relations in writing may be especially supportive of this learning. We conclude that young children should be offered frequent opportunities to compose their own texts, and to interact with adults around their writing.

Treatment guesses in the Treatment for Adolescents with Depression Study: Accuracy, unblinding and influence on outcomes.

We evaluated the presence and impact of unblinding during the influential Treatment for Adolescents with Depression Study (ClinicalTrials.gov Identifier: NCT00006286). Our analysis was part of a Restoring Invisible and Abandoned Trials reanalysis. Treatment for Adolescents with Depression Study trialled fluoxetine, placebo, cognitive behaviour therapy or their combination, in treating adolescents with major depressive disorder. We analysed the accuracy of guesses of fluoxetine or placebo allocation, and their effects on change in Children's Depression Rating Scale-Revised at 12 weeks. Of 221 participants allocated to fluoxetine or placebo, 151 adolescents (68%) had their guess about pill-treatment-arm allocation recorded at week 6, and guesses were recorded for 154 independent evaluators, 159 parents and 164 pharmacotherapists. All of these groups guessed treatment allocation more accurately than would be expected by chance (60-66% accuracy; all p-values ⩽ 0.004). Guesses did not become more accurate between 6 and 12 weeks and were not predicted by adverse events, though event documentation was poor. Treatment guess had a substantial and statistically significant effect on outcome (Children's Depression Rating Scale-Revised change mean difference 9.12 [4.69; 13.55], β = 0.334, p < 0.001), but actual treatment arm did not (1.53 [-2.83; 5.89], β = 0.056, p = 0.489). Removing guess from the analysis increased the apparent effect of treatment arm, making it almost statistically significant at the conventional alpha-level of 0.05 (p = 0.06). For Treatment for Adolescents with Depression Study, treatment guesses strongly predicted outcomes and may have led to the exaggeration of drug effectiveness in the absence of actual effects. The integrity of double-blinding in trials should be routinely assessed and reported.

Two-Dimensional Ultrasound Assessment of Long-Term Intra-Abdominal Organ Changes in Children with Sickle Cell Anemia during Steady State: A Comparative Study.

Sickle cell anemia (SCA) is a hereditary blood disorder with global prevalence, including in Nigeria. Despite advancements in SCA care management, understanding the long-term impact on organs during steady state has remained inconclusive. This study aimed to investigate the long-term changes in intra-abdominal organs of SCA children compared with non-SCA children during steady state using two-dimensional ultrasound assessment. A total of 116 children (58 SCA and 58 controls) were enrolled between June 2021 and July 2022. Clinico-demographic data were collected through an interviewer-administered questionnaire. Two-dimensional ultrasound was used to measure the liver, spleen, kidneys, and inferior vena cava in all subjects. Age-matched controls had AA or AS genotypes. Of the 58 patients with SCA, 65.5% were males with an overall mean age of 8.1 ± 3.4 years, while among the non-SCA cohort (n = 58), 48.3% were males with an overall mean age of 8.7 ± 3.9 years. There was no statistically significant difference in the age and gender distribution between the SCA and non-SCA cohorts (P = 0.390 and P = 0.091, respectively). SCA subjects had a larger mean hepatic size than non-SCA subjects (12.09 cm ± 2.23 vs. 11.67 cm ± 1.96; P = 0.276) but smaller mean splenic size (8.01 cm ± 1.89 vs. 8.19 cm ± 1.61; P = 0.577) and inferior vena cava diameter (1.16 cm ± 0.29 vs. 1.25 cm ± 0.33; P = 0.100). Left kidney length and breadth were significantly greater in SCA patients (8.91 ± 1.16 vs. 8.27 ± 1.30; P = 0.006 and 4.15 ± 0.92 vs. 3.79 ± 0.48; P = 0.008, respectively). This study highlights the utility of two-dimensional ultrasound assessment in monitoring intra-abdominal organ changes in SCA children, suggesting its cost-effective benefits in monitoring health outcomes in SCA patients.

Explainable AI-Based Identification of Contributing Factors to the Mood State Change in Children and Adolescents with Pre-Existing Psychiatric Disorders in the Context of COVID-19-Related Lockdowns in Greece

The COVID-19 pandemic and its accompanying restrictions have significantly impacted people’s lives globally. There is an increasing interest in examining the influence of this unprecedented situation on our mental well-being, with less attention towards the impact of the elongation of COVID-19-related measures on youth with a pre-existing psychiatric/developmental disorder. The majority of studies focus on individuals, such as students, adults, and youths, among others, with little attention being given to the elongation of COVID-19-related measures and their impact on a special group of individuals, such as children and adolescents with diagnosed developmental and psychiatric disorders. In addition, most of these studies adopt statistical methodologies to identify pair-wise relationships among factors, an approach that limits the ability to understand and interpret the impact of various factors. In response, this study aims to adopt an explainable machine learning approach to identify factors that explain the deterioration or amelioration of mood state in a youth clinical sample. The purpose of this study is to identify and interpret the impact of the greatest contributing features of mood state changes on the prediction output via an explainable machine learning pipeline. Among all the machine learning classifiers, the Random Forest model achieved the highest effectiveness, with 76% best AUC-ROC Score and 13 features. The explainability analysis showed that stress or positive changes derived from the imposing restrictions and COVID-19 pandemic are the top two factors that could affect mood state.

Changes in Children's Health Care Access and Utilization in the United States in the First 2 Years of the COVID-19 Pandemic.

To compare children's access to and utilization of health care services in the United States during the first 2 years of the pandemic to prepandemic levels. This cross-sectional study used data from the 2017 to 2021 National Survey of Children's Health. Access to care was measured by having a usual place for sick and preventive care, having a personal doctor or nurse, and unmet care needs. Utilization measures included preventive, mental health, specialist, and emergency department (ED) visits, and hospital admissions in the past 12months. Outcomes were reported by parents or other caregivers. Multivariate logistic regressions were employed adjusting for sociodemographic factors and state of residence. The study sample included 163,353 children aged 0 to 17years. Compared to 2019, there were declines in the probability of having a usual place for sick care in 2020 (-1.5 percentage-points) and a usual place for preventive care in 2021 (-2.1 percentage-points), and greater probability of unmet care needs in 2020 (+1.2 percentage-points) and 2021 (+0.8 percentage-points). The probability of having any preventive, specialist, and ED visits and hospitalizations remained lower in 2021 than 2019 (-7.5, 2.2, 5.4 and 0.9percentage-points, respectively). These differences were not explained by prepandemic trends and were observed across a range of sociodemographic subgroups. Children's health care access and utilization declined noticeably over the first 2years of the pandemic. Evaluating these outcomes in subsequent years and addressing barriers to care continue to be critical to reduce unmet needs.

Protocol to Refine and Test Limited Efficacy of Tailored Messaging and Goal Setting on Short-term Dietary and Oral Health Behavior Change in Children

Protocol to Refine and Test Limited Efficacy of Tailored Messaging and Goal Setting on Short-term Dietary and Oral Health Behavior Change in Children

“Excess” Doubling Up During COVID: Changes in Children's Shared Living Arrangements

The proportion of U.S. children living in doubled-up households, in which a child lives with a parent plus adult kin or nonkin, has increased in the last 40 years. Although shared living arrangements are often understood as a strategy to cope with crises, no research to date has examined changes in children's living arrangements during the first year of the COVID-19 pandemic. We use the American Community Survey and the Current Population Survey to examine children's doubled-up living arrangements during 2020 and the extent to which children may have experienced “excess” doubling up relative to earlier years. We consider trends by household type (multigenerational, extended with other relatives, and nonrelative households) and differences by demographic characteristics (marital status, race and ethnicity, work status, education, age, and number of coresident children). We find evidence that more than half a million (509,600) children experienced “excess” doubling up in 2020. Greater than expected increases in doubled-up arrangements were driven by increases in multigenerational households, in particular among Black and Hispanic children, young children (under age six), those whose mothers never married, and those whose mothers were not working. Correlates of coresidence remained largely unchanged over time, although having a mother who had never married became a stronger correlate in 2020. Our findings suggest that both economic and instrumental needs likely explained the rise in multigenerational coresidence in 2020.

Longitudinal Assessment of Macular Thickness and Microvascular Changes in Children with Sickle Cell Disease

To longitudinally assess macular thickness and microvascular changes in children with sickle cell disease (SCD). A retrospective consecutive series. Children with SCD aged ≤ 18 years who had an ophthalmic examination at Boston Children's Hospital between January 1998 and August2022. Qualitative and quantitative analyses of both OCT and OCT angiography (OCTA) images were performed. Total retinal thickness measured on macular OCT, superficial capillary plexus and deep capillary plexus (DCP) vessel density (VD), and foveal avascular zone (FAZ) area measured on 6-× 6-mm OCTA scans. International Classification of Diseases, 10th Revision, code search identified 303 pediatric SCD patients who underwent ophthalmic examination during the study period. OCT and OCTA images were acquired on 104 (17.2%) and 60 (9.9%) eyes at presentation and on 159 (26.2%) and 100 (16.5%) eyes at final visit, respectively. Overall, temporal retinal thinning was noted qualitatively in 35.6% of SCD patients at presentation and 39.6% at final visit. Of those patients with macular thinning, 94.6% and 90.5% had peripheral sickle cell retinopathy (SCR) at presentation and final visit. On quantitative OCT analysis, HbSS eyes had a lower retinal thickness in the fovea and temporal parafovea compared with HbSC (P < 0.05). Eyes with peripheral SCR had a larger FAZ at presentation compared with eyes without peripheral SCR (P= 0.004), a lower DCP VD at final visit in the inferior temporal macula (P= 0.03), and a higher DCP VD at final visit in the superior nasal macula (P= 0.01). Eighty eyes of 40 patients had OCT, and 34 eyes of 20 patients had both OCT and OCTA images acquired at both initial and final visits. At final visit, retinal thickness decreased at the fovea, inferior perifovea, and temporal perifovea compared with presentation (P < 0.05). In parallel, VD DCP in the superonasal quadrant increased at final visit (P= 0.03). Macular retinal thinning was progressive and observed in eyes with and without peripheral SCR. Over time, there was a compensatory increase in DCP VD in the nasal macula on OCTA. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Elasticity and Lipids Changes in Children with Type I Diabetes Mellitus Compared with Controls and the Effect of Lipids on Elasticity in Diabetic Children

Abstract Background Increased atrial elasticity is a marker of cardiovascular events. This study aimed to compare the parameters of elasticity and lipids in children with type 1 diabetes mellitus (TIDM) compared with controls and the effect of lipids on elasticity in children with diabetes. Method This case-control study was performed in 186 children aged 6 to 18 years. The aortic diameter was obtained from 3 cm above the aortic valve using M mode and was calculated as the distance between the medial edge of the anterior and posterior walls of the aorta at systole and diastole. AoS and AoD were recorded when the aortic wall was fully open. The parameters of aortic elasticity, aortic stiffness beta index, aortic tension, and elastic modulus of pressure were measured. Cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein were measured. For data analysis, SPSS 20 considers the applicable error to be 0.05. Results The participants were matched by sex and age. The right CHO, LDL, HDL, and MPI lipids, systolic, diastolic, and aortic systolic blood pressure were different among patients. The analysis also showed that ASβI (MWU = 1582.50, p &lt; 0.001) and PSEM (MWU = 1381.00 and p &lt; 0.001) were higher when AS (MWU = 1204 and p &lt; 0.001) and AoD (MWU = 1672.00 and p &lt; 0.001) and AoD (MWU = 1672.00 and p &lt; 0.001) were lower in patients than in controls. No lipid profiles were significantly correlated with stiffness parameters before and after controlling for age. Conclusion It was concluded that lipid profiles were different, and ASβI and PSEM were lower when AoS and AoD were higher in children with diabetes. None of the lipid profiles were significantly correlated with stiffness parameters before and after controlling for age.

Changes in Children and Youth's Mental Health Presentations during COVID-19: A Study of Primary Care Practices in Northern Ontario, Canada.

Recent research suggests that children and youth are at increased risk of anxiety and depression due to the indirect effects of the COVID-19 pandemic. In Canada, children and youths may face additional hurdles in accessing mental health services in rural areas due to socioeconomic disadvantages and healthcare provider shortages worsened by the pandemic. Our study aimed to assess changes in primary healthcare utilization related to depression and anxiety among children and youth aged 10-25 years in Northern Ontario, Canada. We analyzed de-identified electronic medical record data to assess primary healthcare visits and prescriptions for depression and anxiety among children and youth aged 10-25 years. We used provider billing data and reasons for visits and antidepressant/antianxiety prescriptions compared with 21 months pre-pandemic (1 June 2018 to 28 February 2020) and 21 months during the pandemic (1 April 2020 to 31 December 2021). Our interrupted time series analysis showed an average increase in visits by 2.52 per 10,000 person-months and in prescriptions by 6.69 per 10,000 person-months across all ages and sexes. Females aged 10 to 14 years were found to have the greatest relative change in visits across all age-sex groups. The greatest relative increases in antianxiety and antidepression prescriptions occurred among females and males aged 10 to 14 years, respectively. These findings indicate that there were increased anxiety and depression presentations in primary healthcare among children and youths living in northern and rural settings during the COVID-19 pandemic. The increased primary healthcare presentations of anxiety and depression by children and youths suggest that additional mental health resources should be allocated to northern rural primary healthcare to support the increased demand. Adequate mental health professionals, accessible services, and clinical recommendations tailored to northern rural populations and care settings are crucial.

(NEW) Electrocardiographic Changes In Children With Idiopathic Epilepsy And Epilepsy Secondary To Structural Brain Lesions

(NEW) Electrocardiographic Changes In Children With Idiopathic Epilepsy And Epilepsy Secondary To Structural Brain Lesions

Measures of Connectivity and Dorsolateral Prefrontal Cortex Volumes and Depressive Symptoms Following Treatment With Selective Serotonin Reuptake Inhibitors in Adolescents

Selective serotonin reuptake inhibitors (SSRIs) are considered a first-line pharmacological treatment for adolescent depression with moderate or higher levels of symptom severity. Thus, it is important to understand neurobiological changes related to SSRIs during the course of treatment for adolescents with depression. To examine neurobiological changes associated with SSRI treatment in adolescents with major depressive disorder (MDD) by measuring longitudinal changes in volume and resting-state functional connectivity (rsFC) in the dorsolateral prefrontal cortex (DLPFC), a core region of cognitive control. This cohort study was conducted with an open-label design. Adolescents with MDD and healthy controls were recruited at the Seoul National University Hospital (Seoul, South Korea). Adolescents with MDD were treated with escitalopram for 8 weeks. Data analysis was conducted between April 2021 and February 2022. Depressive symptoms were assessed using the Children's Depression Rating Scale-Revised. The outcome measure was defined as the change in Children's Depression Rating Scale-Revised scores from week 0 (before treatment) to week 8 (after treatment) or upon termination. Participants completed structural and resting-state functional magnetic resonance imaging (rsfMRI) assessments before (week 0) and after (week 8) SSRI treatment. Repeated measures analysis of variance and liner mixed model analyses were used to examine the longitudinal associations of SSRI treatment with DLPFC volume and rsFC between responders who showed at least a 40% decrease in depressive symptoms and nonresponders who did not. Ninety-five adolescents with MDD and 57 healthy controls were initially recruited. The final analyses of volume included 36 responders (mean [SD] age, 15.0 [1.6] years; 25 girls [69.4%]) and 26 nonresponders (mean [SD] age, 15.3 [1.5] years; 19 girls [73.1%]). Analyses of rsFC included 33 responders (mean [SD] age, 15.2 [1.5] years; 21 girls [63.6%]) and 26 nonresponders (mean [SD] age, 15.3 [1.5] years; 19 girls [73.1%]). The longitudinal associations of SSRI treatment were more evident in responders than in nonresponders. Responders showed significantly increased right DLPFC volume, decreased bilateral DLPFC rsFC with the superior frontal gyri, and decreased left DLPFC rsFC with the ventromedial PFC after treatment compared with before treatment. Furthermore, increased right DLPFC volume was correlated with decreased rsFC between the right DLPFC and superior frontal gyri after SSRI treatment. The preliminary results of this cohort study suggest that the DLPFC volumetric and rsFC changes may serve as potential neurobiological treatment markers that are associated with symptom improvement in adolescents with MDD.

Neural Changes in Children With Residual Speech Sound Disorder After Ultrasound Biofeedback Speech Therapy.

Children with residual speech sound disorders (RSSD) have shown differences in neural function for speech production, as compared to their typical peers; however, information about how these differences may change over time and relative to speech therapy is needed. To address this gap, we used functional magnetic resonance imaging (fMRI) to examine functional activation and connectivity on adaptations of the syllable repetition task (SRT-Early Sounds and SRT-Late Sounds) in children with RSSD before and after a speech therapy program. Sixteen children with RSSD completed an fMRI experiment before (Time 1) and after (Time 2) a speech therapy program with ultrasound visual feedback for /ɹ/ misarticulation. Progress in therapy was measured via perceptual ratings of productions of untreated /ɹ/ word probes. To control for practice effects and developmental change in patterns of activation and connectivity, 17 children with typical speech development (TD) completed the fMRI at Time 1 and Time 2. Functional activation was analyzed using a region-of-interest approach and functional connectivity was analyzed using a seed-to-voxel approach. Children with RSSD showed a range of responses to therapy. After correcting for multiple comparisons, we did not observe any statistically significant cross-sectional differences or longitudinal changes in functional activation. A negative relationship between therapy effect size and functional activation in the left visual association cortex was on the SRT-Late Sounds after therapy, but it did not survive correction for multiple comparisons. Significant longitudinal changes in functional connectivity were observed for the RSSD group on SRT-Early Sounds and SRT-Late Sounds, as well as for the TD group on the SRT-Early Sounds. RSSD and TD groups showed connectivity differences near the left insula on the SRT-Late Sounds at Time 2. RSSD and treatment with ultrasound visual feedback may thus be associated with neural differences in speech motor and visual association processes recruited for speech production.

Parenting, Gender, and Perception of Changes in Children's Behavior during the COVID-19 Pandemic.

In a previous Argentine study, we found that, in the critical context of social isolation during the COVID-19 pandemic, there were changes in maternal practices that influenced the relationship with their children. We also found that the impact of mandatory isolation was moderated positively by protective factors such as positive parenting and maternal school support or negatively by risk factors such as maternal stress. Although this study only analyzed maternal behavior, we were interested in studying the behavior of both parents, comparing the parenting (positive parenting, parental stress, and school support) of the father and mother and the perceived behavioral changes in their children. A quantitative ex post facto study was carried out. The sample consisted of 120 Argentinean parents (70 mothers and 50 fathers) aged between 27 and 56 (M = 38.84; SD = 5.03). Questionnaires were administered on sociodemographic and behavioral data of the children, as well as a brief scale to assess parenting. Mann-Whitney U and MANOVA were used to analyze the influence of gender on perceived changes in children's behavior and perceived parenting, respectively. Mothers perceived more significant changes than fathers in their children's behavior. In addition, women reported more parental stress, greater child school support, and greater perceived positive parenting compared to men. These findings support the hypothesis that parenting developed differently in fathers and mothers. These results imply the need for psycho-educational intervention programs aimed at promoting greater involvement of fathers in parenting and better management of parental stress in mothers' and family psychological well-being.

Changes in Children's Self-Confidence Level after Participating in Confident Child School Program 2018 - 2022

This study aims to determine the level of self-confidence of the beneficiaries of the Sekolah Anak Percaya Diri program. The sample in this study were students of the Sekolah Anak Percaya Diri program as many as 57 children or all participants who actively participated in the program. The results of the analysis show that every year the self-confidence of children who take part in the Sekolah Anak Percaya Diri program has increased with the final results as many as 45 children in the good category, 11 children in the medium category and 1 child for the less category.

A Qualitative Study Exploring Parents’ Experiences of Caring for an Adolescent Child with Conduct Problems during the Covid-19 Lockdowns

Young people with conduct problems (CPs) have been detrimentally impacted by Covid-19 restrictions, with increased behaviour problems and internalising symptoms. Parents experienced increased strain, managing their child’s behaviours through lockdowns, while support services have been reduced. The present qualitative study aims to explore the deeper parental experience of caring for an adolescent child with CPs during the Covid-19 period. Participants were purposively recruited through a social media support forum. Semi-structured online interviews were conducted with 14 parents of children with CPs (13 mothers and one father) between June-December 2021. Interviews were analysed through reflexive thematic analysis. Analysis revealed four main themes; Experiencing Positive Changes in Children, Navigating Practicalities of Home Confinement, Parents at “Breaking Point”, and Methods of Survival. Parents observed increased behavioural problems in their children, and expressed great strain and fatigue in relation to their child’s expression. Overall, parents felt isolated, confused, and burnt out, feeling they have no support to turn to. These issues appear to expand beyond the pandemic, highlighting an imperative need to provide more social, practical, and psychoeducational support for these parents whose voices are currently going unheard. These should be more robust and tailored to this unique population, with suggested services including peer social networks or parental hubs, more proficient and targeted psychoeducation, crisis interventions, and a greater capacity for parental respite.

Comparative Evaluation of Oral Health and Behavior Changes in Children after Motivational Interviewing and Traditional Method of Oral Health Education among Mothers: A Systematic Review and Meta-analysis.

To analyze the effectiveness of motivational interviewing (MI) compared to traditional health education among mothers in improving children's oral health and behavioral changes. The search strategy was framed using relevant MeSH terms and free text terms in PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Directory of Open Access Journals (DOAJ), Cochrane Library, and Google Scholar for the articles published in the English language between 1st January 2000 and 31st December 2020. Only randomized controlled trials, non-randomized controlled trials, and clinical trials comparing MI with traditional health education were included. Cochrane risk of bias (ROB) tool was used for the quality assessment of the included studies, and Review Manager 5.3 software was used for computing results. A total of 9 studies were included for qualitative synthesis and 5 for quantitative synthesis from an initial search of 3,708 articles. The cumulative mean difference for dental caries was -1.03 [95% confidence interval (CI)-1.37-0.70] p < 0.00001, for frequency of toothbrushing Pooled odds ratio was 1.69 (95% CI-0.68-4.25) p = 0.26 and for in-between snacking was 0.83 with (95% CI-0.48-1.44) p = 0.51. A significant difference was present in dental caries among children with mothers in the MI group, while no difference was present in in-between snacking and frequency of toothbrushing between both the groups. Motivational interviewing (MI) prove to be significantly effective in reducing newer dental caries for shorter duration; however, long-term effectiveness could not be assessed. Motivational interviewing (MI) can be considered an effective and feasible method for oral health education to mothers, which will, in turn, improve the oral health of their children. International prospective register of systematic reviews (PROSPERO) under registration code. CRD42021224278. Karande PH, Shetty VB, Vinay V, et al. Comparative Evaluation of Oral Health and Behavior Changes in Children after Motivational Interviewing and Traditional Method of Oral Health Education among Mothers: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2023;16(3):464-473.

Leg-Length and Alignment Changes in Children and Adolescents After Transphyseal Anterior Cruciate Ligament Reconstruction With Soft Tissue Graft: Results at 1-Year Follow-up.

Growth disturbance to leg length or coronal plane alignment are important considerations in pediatric anterior cruciate ligament (ACL) reconstruction (ACLR). The purpose of this study was to investigate the lower limb alignment and leg length of pediatric patients preoperatively and at approximately 1 year after transphyseal ACLR. Our hypothesis was that there would be no significant change in leg-length discrepancy (LLD) or operated-side alignment at follow-up. Case series; Level of evidence, 4. Data were extracted from the prospective Queensland Children's Hospital Pediatric ACL Injury Registry. Long-leg alignment radiographs were captured preoperatively and at an approximately 12-month postoperative follow-up. Radiographic measures included leg length, LLD (injured minus uninjured leg length), mechanical axis deviation (MAD), mechanical and anatomical lateral distal femoral angle (mLDFA and aLDFA, respectively), and medial proximal tibial angle. We evaluated the effect of time (annual vs baseline) on imaging measurements with analysis of covariance, using the covariates of age, sex, and body mass index. Data were available for 104 patients, of whom 34 (33%) had >12 months of skeletal growth remaining based on skeletal age. At an average follow-up time of 14.5 months after ACLR, there were no significant differences in mean lower limb alignment or longitudinal growth compared with baseline. However, seven patients demonstrated clinically significant changes to their mechanical axis or LLD (>10 mm change). A subgroup analysis of patients with >12 months of growth remaining (n = 34) demonstrated no statistically significant changes in mean alignment or LLD. Before surgery, LLD was -1.39 mm and the injured limb was in significantly more valgus compared with the uninjured lower limb (mean difference: MAD, 4.79 mm [95% CI, 2.64 to 6.94 mm]; mLDFA, -0.93° [95% CI, -1.29° to -0.57°], and aLDFA, -0.91° [95% CI, -1.31° to -0.50°]). After ACLR, there were no statistically significant changes in mean alignment or longitudinal growth; however, 7 out of 104 patients (6.7%) demonstrated clinically significant changes in alignment or LLD. Preoperatively, the injured limb was statistically significantly in more valgus compared with the uninjured limb with lateralized MAD.

Analisis Yuridis Pembinaan Residivis Anak Pada Lembaga Pemasyarakatan Khusus Anak

The development of prisoners in Indonesia is implemented in the correctional system. Various forms of guidance for correctional students at Special Child Development Institutions cannot be separated from a change in the correctional system, which aims to provide provisions for correctional students to face life after completing their sentence. The problems that will be examined in this article include how to foster child recidivism in Special Child Development Institutions and what are the inhibiting factors in the implementation of child recidivism guidance in Special Child Development Institutions.&#x0D; The method used in this research is Normative Juridical and Empirical Juridical Research Methods, using primary data and secondary data.&#x0D; Research Results: The Bandar Lampung Special Children's Development Institute has generally attempted to provide rights to children by implementing and providing guidance in accordance with what is mandated by law. The implementation of coaching for correctional students who are recidivists has so far been the same as other correctional students who are not recidivists, this is because the program and coaching patterns that have existed so far have regulated this. In its implementation, Special Child Development Institutions find it quite difficult to run a coaching program, several inhibiting factors in the implementation of recidivist coaching for correctional students include: low level of education, children's skill abilities, lack of community participation and children's changing thinking patterns. Suggestions that can be given by the author regarding the problems that arise include: for Special Child Development Institutions, it is necessary to differentiate between the training of ordinary correctional students and recidivist correctional students which can have a deterrent effect on children so that they do not commit crimes again, for example by developing their mental health. children and put more emphasis on spiritual development and for officers at Special Education Institutions for Children to be able to encourage correctional students not to commit criminal acts again.