Child Outcomes Research Articles

Residential instability, neighborhood deprivation, and outcomes for children

BackgroundResidential instability and neighborhood conditions may shape children’s health and development, but it is unclear whether all residential moves are equally destabilizing, and the extent to which moving to neighborhoods with different conditions can improve children’s outcomes. Most studies estimating causal effects of these factors on children’s health or development use smaller, geographically constrained, urban cohorts.ObjectiveIn a racially/ethnically and socioeconomically diverse statewide cohort including urban and rural communities, we investigate effects of residential instability, neighborhood deprivation, and their intersection on childhood educational outcomes.MethodsWe construct a statewide dataset that links North Carolina birth records (2002–2005) with lead testing data (2003–2015) and 4th grade standardized test scores (2013–2016). A composite census tract-level neighborhood deprivation index (NDI) is linked with individuals based on residence at birth, lead testing, and 4th grade. Outcomes of interest are 4th grade test scores in reading and mathematics. We use multinomial propensity scores to estimate effects of residential instability and neighborhood deprivation on test scores.ResultsChildren who moved between only high deprivation neighborhoods had lower reading test scores (-0.29 [95% CI: -0.59, -0.015]) compared to children who resided in high deprivation neighborhoods but did not move. Children who resided in a high deprivation neighborhood at birth and subsequently moved to a low deprivation neighborhood(s) had higher test scores compared to those who moved between only high deprivation neighborhoods (1.59 [0.90, 2.28]). Additionally, children who move from high to low deprivation neighborhoods earlier had larger improvements.ConclusionBeing residentially stable, even while residing in a high deprivation neighborhood, is associated with improved educational outcomes. However, there is also a larger positive effect of moving from high to low deprivation neighborhoods. Our findings have important implications, particularly given the increasing segregation of neighborhoods by socioeconomic status and the housing affordability crisis in the United States. Partnerships between housing programs, early childhood education and services, and health care providers, which address evictions and broader issues, may help address health inequalities rooted in childhood exposures and experiences.

Vaccination in hemophilic children: Challenges, innovations, and future directions

Introduction: Hemophilia, an inherited disorder primarily affecting blood clotting due to deficiencies in clotting factors VIII or IX, presents complex challenges for vaccination. Children with hemophilia require vaccinations to prevent infections that may exacerbate their bleeding disorder. However, traditional intramuscular vaccination poses bleeding risks, necessitating specialized administration methods and careful post-vaccination care. Purpose: This study examines the efficacy and safety of vaccination in pediatric hemophilia patients, emphasizing the importance of individualized protocols to manage bleeding risks effectively. It explores recent advancements, including needle-free technologies, the potential of gene therapy, and mRNA vaccines. Materials and Methods: The study synthesizes current guidelines from global health organizations, hemophilia management protocols, and clinical studies on vaccine safety in hemophilia. It highlights techniques such as subcutaneous administration, clotting factor prophylaxis, and the use of fine-gauge needles to minimize bleeding complications. Results: Findings indicate that with appropriate management, hemophilic children achieve adequate immune responses to vaccines, with reduced bleeding risks. Emerging technologies, such as microneedle patches, jet injectors, and gene therapy, offer promising safer vaccination alternatives. Additionally, mRNA vaccines demonstrate strong immunogenicity without the need for live-virus vectors, reducing complication risks. Conclusions: Vaccination, when adapted to hemophilia-specific needs, remains essential for infection prevention in this vulnerable population. Newer vaccine technologies and individualized care protocols enhance safety and efficacy, contributing to improved quality of life and long-term health outcomes for hemophilic children.

Project G-SPACE: protocol for exploring the influence of green space on sleep and mental health among children

BackgroundThe prevention of pediatric mental health disorders is a growing health priority in the United States. While exposure to green space, such as outdoor vegetation, has been linked with improved mental health outcomes in children, little is known about the impact of green space on children’s sleep. Sleep has many benefits, but the factors affecting both sleep and mental health as they relate to green space exposure are not well understood in children. This study aims to investigate how green space can affect sleep in children and contribute to the promotion of mental health and wellbeing.MethodsProject Green Space, Sleep, and Mental Health (G-SPACE) aims to recruit 250 elementary school-children from first, second, and third grade in Rhode Island to examine the influence of green space exposure on sleep, physical activity, and mental health over a five-year period. Objective measures of sleep, physical activity, and daily activity space will be assessed using an actigraph and a GPS (Global Positioning System) unit. Subjective measures of sleep duration, sleep quality, and mental health will be assessed using daily sleep diaries from parents, in addition to a range of survey items, including PROMIS® (Patient Reported Outcome Measurement Information System) pediatric scales, and the Children’s Sleep Habits questionnaire, among others. Green space exposure will be based on measures of green space from the normalized difference vegetation index (NDVI) aligned with the daily activity trajectory of children. Additionally, saliva and DNA samples will be collected to examine epigenetic mechanisms linking green space to sleep and mental health. A subset of participants (n = 50) will be followed longitudinally to evaluate the long-term impact of green space on sleep and mental health among children. Multi-level models will be used to assess the association between green space exposure, sleep behaviors, and mental health.DiscussionProject G-SPACE will evaluate whether green space utilization influences sleep and mental health in early elementary school children, and the possible mechanistic pathways through which these associations emerge.

Addressing data needs crucial for improving infant, child and youth mental health and substance-related harms in Aotearoa New Zealand: key design and ethical considerations for future research.

To evaluate the available data on mental health and substance-related harm among infants, children and young people (ICY) in Aotearoa New Zealand. A scoping review was undertaken to take stock of current data and identify gaps. Although there are quality studies, there is a lack of comprehensive, contemporary population-based data to monitor the prevalence and magnitude of mental health conditions and substance use-related harm for children and young people. Existing data are inconsistently measured and are not centrally located or available for all age groups, particularly infants and children. Whānau/family units are seldom considered or prioritised. Aotearoa New Zealand lacks accurate, up-to-date, comprehensive ICY mental health and substance use data to inform investment, service delivery and evidence-based policy. We advocate for enhanced surveillance and monitoring through population-based mental health and addiction studies with Indigenous and other locally designed measures, and propose key design and ethical considerations for future research. Future research must prioritise Māori and other priority groups, with non-stigmatising, strengths-based approaches. Addressing these data gaps presents a critical opportunity to improve outcomes for children, young people and their whānau.

Comparison of Psychiatric Readmission Rates for Child and Adolescent Patients on Long-Acting Injectable Antipsychotics Versus Oral Antipsychotics: A Mirror Study.

Objectives: Current literature shows a benefit in clinical outcomes when long-acting injectable antipsychotics (LAIAs) are utilized in adult patients with psychiatric disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder. Literature regarding LAIA use in pediatric patients is sparse. The objective of this study is to compare the number of acute psychiatric admissions, psychiatric emergency services (PES) visits, and total number of days admitted to an acute psychiatric hospital 1 year prior to and 1-year post-mirror point of index hospitalization and LAIA initiation. Methods: This was a single-site retrospective mirror-image review of patients <18 years of age initiated on an LAIA during an acute psychiatric hospitalization between October 1, 2015, and October 31, 2022. The number of admissions to the acute psychiatric hospital, number of PES visits, and total number of days hospitalized at the acute psychiatric hospital were captured 1-year pre-index hospitalization admission and 1-year post-index hospitalization discharge, with LAIA administration during index hospitalization being the mirror point. Descriptive statistics and a two-tailed paired t-test were utilized to analyze the data. Results: There were 45 unique pediatric patients initiated on an LAIA during the specified timeframe. Across these 45 patients, there were 47 psychiatric admissions 1-year pre-index hospitalization and 38 psychiatric admissions 1-year post-index hospitalization discharge (p = 0.37). Additionally, there were 24 PES visits 1-year pre-index hospitalization admission and 16 PES visits 1-year post-index hospitalization discharge (p = 0.25). Finally, across the 45 patients, there were a total of 1040 days admitted to the acute psychiatric hospital in the 1-year prior to index hospitalization admission compared with 774 days admitted to the acute psychiatric hospital in the 1-year post-index hospitalization discharge (p = 0.48). Conclusions: In this cohort of pediatric patients initiated on an LAIA, there was a positive trend favoring LAIA therapy over oral antipsychotic therapy with LAIA injection as the mirror point; however, there was no statistically significant difference in the number of psychiatric admissions, number of PES visits, or total number of days admitted to an acute psychiatric hospital. Further studies are required to fully understand the impact of LAIA therapy on clinical outcomes for child and adolescent patients with psychiatric disorders.

Orthoptic findings in trigonocephaly patients after completed visual development.

Trigonocephaly is associated with suboptimal visual outcomes in young children. However, the presence of orthoptic abnormalities after completed visual development remains unknown. The purpose of this study is to assess the prevalence of orthoptic abnormalities in trigonocephaly patients, after completed visual development. A retrospective study among non-syndromic trigonocephaly patients aged 8 years and older was conducted at the Dutch Craniofacial center. Ophthalmologic records were reviewed for refractive errors and a history of strabismus and amblyopia. Refractive errors were classified as follows: myopia: spherical equivalent (SE) ≤ -0.50 diopters (D), emmetropia: SE -0.50 D to + 0.50 D, hyperopia: ≥ + 0.50 D, astigmatism: cylinder error ≥ 1.00 D. The history of strabismus and amblyopia was assessed retrospectively. Prevalence and cumulative incidence of these abnormalities in healthy age-matched populations were retrieved from literature. We included 78 trigonocephaly patients with a median (interquartile range) age of 10.0 (9.0-12.0) years. Thirty-four (43.6%) of these patients presented with a refractive error after the age of 8 years. Specific findings in these 78 patients versus controls were hyperopia in 35.9% vs 8.4%; myopia in 6.4% vs 11.4%; astigmatism in 20.5% vs 11.9%; strabismus in 14.1% vs 2.65%; amblyopia in 6.4% vs 3.4%. Trigonocephaly patients have a two-to-threefold higher risk of hyperopia, astigmatism, amblyopia, and strabismus, as compared to healthy populations. We recommend screening and, in case of abnormalities, regular follow-up before completed visual development. In addition, we recommend long-term surveillance of visual functioning by a pediatric ophthalmologist and/or orthoptist.

The effect of retrieval-induced forgetting for pain-related memories on child pain-related outcomes: A randomized experimental study.

Children's inability to forget the negative aspects of a painful event is associated with more anticipatory anxiety at an upcoming pain task and lower pain thresholds; however, the impact of forgetting on children's pain outcomes has not been examined. Retrieval-Induced Forgetting (RIF) was experimentally induced to investigate whether children would (1) forget more negative details of a previous painful autobiographic event and; (2) report better pain-related outcomes for an unrelated pain task (i.e., cold pressor task; CPT). Additionally, it was investigated whether the success of RIF was dependent on child characteristics known to influence children's memories for pain (i.e., attention bias to pain, attention switching ability and pain catastrophizing). Healthy school children (N = 128; 9-16 years old) recalled and rehearsed memory details of two painful autobiographical events, while only children in the randomized RIF group rehearsed positive details. All children underwent two CPTs (before and after RIF) and reported pain-related outcomes. Two weeks later, children recalled CPT pain and reported on future pain expectancies. Children in the RIF group remembered less negative details of their past autobiographical pain events, but also reported a greater reduction in pain-related fear from the CPT 2 compared to their ratings for CPT 1, than children in the control group. They furthermore expected less pain-related fear 2 weeks later for a future pain task. Findings suggest that RIF is a promising avenue in pediatric pain management that could be harnessed to foster more positive memories and better future pain experiences. Retrieval-induced forgetting (RIF) makes children forget negative details of a past autobiographical pain experience, decreases experienced pain-related fear for experimental pain and lowers future pain-related fear expectancies. Results show a promising role for RIF- based memory interventions in the context of paediatric pain care.

Exploring Brazilian Immigrant Mothers’ Beliefs and Practices Regarding Their Preschool Children’s Oral Health: A Qualitative Study Conducted in the United States

Parents’ beliefs and practices significantly shape young children’s oral health (OH), particularly during preschool years when these habits are being established. Immigrant parents often face challenges in promoting OH due to cultural, financial, and logistical barriers. This qualitative study explored OH beliefs, practices, and barriers among Brazilian immigrant mothers in the United States (U.S.). Semi-structured interviews, guided by the Health Belief Model (HBM), were conducted with mothers of children aged 2–5 years. Thematic analysis, also guided by the HBM, revealed four key themes: (1) beliefs about children’s OH; (2) awareness of the parent’s role in fostering early OH behaviors; (3) identification of risk and protective factors affecting children’s OH; and (4) perceived barriers to maintaining children’s optimal OH. Mothers emphasized the importance of proper oral hygiene, regular dental check-ups, and balanced diets for promoting children’s OH. Despite recognizing their role in supporting oral hygiene routines and care, mothers noted barriers such as limited access to care, linguistic barriers, and difficulty adopting and maintaining healthy OH practices due to work and family demands. Notably, 96.6% (n = 28) of the mothers scored low on the SASH scale (SASH &lt; 2.99), reflecting low acculturation levels, which may further contribute to these challenges. Study findings highlight the critical role of parental beliefs and practices in shaping early OH behaviors and the unique challenges faced by Brazilian immigrant mothers. Culturally relevant public health interventions, including tailored education and improved access to affordable dental care, are essential for enhancing OH outcomes in young children from these families.

Developmental and Functional Outcomes Amongst Culturally and Linguistically Diverse Autistic Children.

Children typically learn by attending to other people. Autism traits may impact access to social stimuli fundamental to early learning, increasing children's likelihood of a learning disability. Recent reports have highlighted that Autistic children from minority backgrounds have a higher likelihood of co-occurring intellectual disability. This study aimed to firstly confirm that early autism traits are concurrently and prospectively associated with lower developmental quotients, and secondly to examine the developmental and functional gains in Culturally and Linguistically Diverse (CALD) and non-CALD Autistic children following one year of Group-based Early Start Denver Model (G-ESDM). Secondary data on 114 non-CALD and 91 CALD Autistic preschoolers receiving the G-ESDM was utilised to address the study aims. Children were administered the Autism Diagnostic Observation Schedule (ADOS) at entry into the service. The Mullen Scales of Early Learning and the Vineland Adaptive Behaviour Scales-II were administered at both entry (Time 1) and 12 months later (Time 2). While no concurrent associations were found between autism traits and Developmental Quotient (DQ), significant associations were found prospectively with ADOS scores at Time 1 and DQ at Time 2, holding for both groups after controlling for DQ at Time 1. Autistic children made significant gains in cognition and functional behaviour following one year of early therapy, with no differences between the two groups. The results indicate that young Autistic children make significant gains in early development and add to the sparse research on the developmental and functional outcomes of Autistic children from CALD communities.

Evaluating neuronal damage biomarkers at birth for predicting neurodevelopmental risks in foetal growth restriction.

This study was based on the need to predict neurodevelopmental outcomes of children with foetal growth restriction. The aim was to systematically review the correlation between biomarkers of neural injury in children with foetal growth restriction and their neurodevelopment. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the review included studies on growth-restricted foetuses that measured biomarkers of postpartum brain injury and assessed neurodevelopment in childhood. Studies published between 1 January 2014 and 31 March 2024 were identified through PubMed and Embase, with the study protocol registered in PROSPERO (CRD42024520254). Only five met the inclusion criteria. Results showed that urinary S100B levels were significantly elevated in foetal growth restriction, negatively correlating with neurological development at 7 days of life. Neuron-specific enolase negatively correlated with cognitive, motor and socio-emotional development. Urinary nerve growth factor levels were significantly lower in neonates with foetal growth restriction, correlating with poor neurodevelopment. No alterations in BDNF levels were observed. Tau protein levels were lower in children with foetal growth restriction and adverse outcomes. The study emphasised the need for further research on biomarkers and predictive models of neurodevelopment in children with foetal growth restriction.

A Comparative Analysis of Language Skills and Parent–Child Interactions in Monolingual and Bilingual Children Born Preterm

Children born preterm are at an elevated risk of language delays compared to children born full-term. However, there is a dearth of research investigating language outcomes in premature children exposed to more than one language. There is also limited empirical evidence linking the quantity and quality of parent input and language outcomes in premature children and the strength of these relationships in bilingual contexts remains unknown. Therefore, the current study examined language skills, parent input, conversational turns, and their associations at 16 months to 36 months in monolingual and bilingual children born preterm. Nine English-speaking monolingual parent–child dyads, and nine Spanish–English bilingual parent–child dyads participated in parent–child interactions that occurred over time in play-based contexts. Results revealed that preterm monolingual and bilingual children exhibited similar language abilities at all time points assessed. While both monolingual and bilingual dyads engaged in a comparable number of conversational turns at 16 m, monolingual mothers produced more words than bilingual mothers during play. Significant associations were observed between children’s vocabulary skills and their ability to combine words within and across most time points. Notably, relationships between parental input, conversational turns, and language skills were limited to a significant association between conversational turns at 16 m and vocabulary skills at 24 m. Together, findings indicate that bilingual children born preterm acquire language on the same timeline as monolingual children born preterm. While it is crucial that the current work be replicated in larger samples of children born preterm, the current work is the first to compare relationships between children’s language outcomes and the quantity and quality of parental input in monolingual and bilingual contexts.

C3 glomerulopathy in children: a European longitudinal study evaluating outcome.

C3 glomerulopathy is a rare clinical entity characterized by dysregulation of the alternative complement pathway in glomerular disease. Studies defining the natural history of C3G in the pediatric population are scarce. Patients included in this retrospective study were diagnosed between 2011 and 2020 in 12 European pediatric nephrology units. Data were collected from baseline, 6months, 12months and at the last follow-up. Complete remission (CR) was defined as a urinary protein creatinine ratio (UPCR) < 0.3mg/mg with normal estimated glomerular filtration rate (eGFR). Partial remission was defined as a decrease in UPCR to 0.3 and 3mg/mg with normal eGFR. Lack of remission was defined as non-response. A total of 108 pediatric patients were included. Complete remission was achieved in 71/108 patients (65.7%), with probability of CR of 50% at 1.8years and of 78% at 7years. At presentation by univariate analysis the predictive factors at presentation associated with CR included eGFR (p = 0.028), UPCR (p = 0.004), serum C3 levels (p = 0.018), elevated plasma sC5b9 levels, defined as > 400ng/ml, (p = 0.037), the presence of endocapillary proliferation (p = 0.017), and the absence of dense deposits on electron microscopy (p = 0.032). By multivariate analysis a low UPCR at presentation (p < 0.001) and the presence of endocapillary proliferation (p < 0.01) remained positively associated with CR. Our data confirm that C3G has a more benign outcome in children compared to previous reports in adults, and suggest that endocapillary proliferation and the degree of proteinuria at onset are the most relevant prognostic factors.

Effect of a playful parenting programme on early childhood development and care outcomes of young children in vulnerable communities: findings from a quasi-experimental study

BackgroundWorld Vision launched the Inclusive Playful Parenting for a Brighter Childhood (IPP4BC) project in identified vulnerable communities in Nepal and Uganda to mitigate risk for children at risk of poor development due to COVD 19. The intervention, based on the nurturing care framework, offered a customized parenting curriculum for young children, emphasizing holistic development through behavior change approaches tailored to local contexts.ObjectiveTo evaluate the effect of the IPP4BC project, on early childhood development (ECD) and care outcomes of children under 6 years in vulnerable communities in Nepal and Uganda, particularly those affected by the COVID-19 pandemic.MethodsThe intervention was delivered by trained facilitators over a 7-month period in different arms defined by the dosage: high (10 group sessions, 4 home visits) medium (5 group sessions, 2 home visits) or low (delivery of key messages through media) dose. An endline evaluation designed as quasi-experimental non-equivalent control groups post-test only study, assessed the effect of the project utilizing the Malawi Development Assessment Tool (MDAT) for child outcomes and the Multiple Indicator Cluster Survey (MICS) for caregiver outcomes. Additionally, an implementation survey was conducted to assess program fidelity and participant engagement.FindingsIn Nepal, higher intervention doses were associated with significantly better child development outcomes (High dose M = 1.20, SD = 2.22, Medium dose M = 1.01, SD = 1.99; Low dose M = 0.43, SD = 2.32, p < 0.001) whereas in Uganda, only medium dose (M = -0.03, SD = 1.28) showed significant improvement (High dose M = -0.30, SD = 1.30; Low dose M = -0.28, SD = 1.51, p = 0.015). A higher proportion of caregivers in both high and medium dose reported engagement with early learning practices compared to low dose. With respect to uptake, in Nepal, a higher number of families received home visits compared to group sessions, while in Uganda, more families reported attending group sessions than receiving home visits.ConclusionThe study demonstrated that higher intervention doses were associated with better child development outcomes in Nepal and only with medium dose in Uganda, emphasizing the importance of implementation factors like dosage, quality and delivery modality in community-based interventions for improving ECD outcomes in vulnerable populations.

The role of prenatal perceived stress and hair cortisol as they relate to toddler socioemotional outcomes over the first three years

Prenatal maternal psychological distress and physiological stress (hypothalamic-pituitary-adrenal [HPA] activity) can negative impact early child development. Research rarely examines the combined or interactive role of prenatal perceived stress and HPA activity on child outcomes. The current longitudinal study examined how prenatal distress and HPA activity impacted child socioemotional functioning from age 1–3. This sample (n=148) was followed from pregnancy, 15-, 24- and 35-months postpartum. During pregnancy, mothers reported their levels of perceived stress and hair samples were collected, reflecting cortisol secretion in the past 3 months. At each postpartum timepoint, mothers reported toddler socioemotional functioning using the Brief Infant–Toddler Social and Emotional Assessment. Multivariate regression results indicated that higher maternal perceived stress interacted with higher hair cortisol levels in association with greater socioemotional problems at 15 and 24 months. In addition, there was a main effect of higher prenatal perceived stress in relation to greater socioemotional problems at 36 months. Exploratory sex-specific moderation analyses indicated that sex interacted with hair cortisol, such that higher levels of prenatal cortisol were associated greater behaviour problems and lower socioemotional competence for females compared to males at 24-months. Findings indicated the importance of examining both physiological stress and psychological stress in pregnancy, as they interact to impact child socioemotional development. Findings also highlight sex-specific prenatal effects.

The relationship between classroom interaction and performance of children in Science in pre-primary schools in Tharaka Nithi County, Kenya

The purpose of this study was to establish if classroom interaction has any relationship with preschool learners’ performance in science activity areas. A solid science foundation at an early age of children can predict their performance in sciences at a later stage of primary and secondary levels of education. From the preschool level, children's interests, attitudes, and learning outcomes are, to a large extent, determined by the teaching methods teachers apply. A descriptive research design was applied as the researcher collected data. The target population for this study was 240 preschools, 505 teachers and 5326 learners in the early childhood Classes (PP2) in the three sub-counties (Meru South, Maara and Tharaka) of Tharaka Nithi County. Data was collected using questionnaires for teachers, documentary analysis and an observation checklist for preschool children. Descriptive analysis was applied to the data from the questionnaires. The study established that the classroom interaction used by preschool teachers had an influence on the learners' performance in science activities. The ability of the teachers to identify the learners' learning needs and the teaching methods that can best handle the topic were found to be crucial in science instruction. The study recommends that the Ministry of Education, through the Kenya Institute of Curriculum Development, should review the current classroom interaction for preschools and modify them to fit specific topics. The methods should then be taught to teachers through in-service training to keep them versed in the current classroom interaction.

Real-world glycaemic outcomes in children and young people on advanced hybrid closed-loop therapy: A population-based study in Western Australia.

To evaluate real-world glycaemic outcomes in children with type 1 diabetes (T1D) commencing advanced hybrid closed loop therapy (AHCL) and to explore these outcomes based on the cohort's clinical and socioeconomic characteristics. A single-centre, population-based retrospective study in children commencing AHCL (Smart Guard, Control IQ, CamAPS) with minimum 70% data from two-weeks CGM pre-AHCL was conducted between December 2021 and June 2023 in Western Australia. CGM metrics (time in range (TIR) 3.9-10 mmol/L, time below range (TBR) < 3.9 mmol/L, glucose management indicator (GMI)) were analysed at baseline, monthly and 6 months. HbA1c at baseline and 6 months were also collected. The proportion meeting glycaemic targets of TIR > 70%, TBR < 4% and GMI < 7.0% were determined. Change in TIR from baseline to 6 months was examined by the following characteristics: %TIR, age group and Index of Relative Socioeconomic Disadvantage (IRSD) of residential postcode. CGM data of 309 children, mean (SD) age 12.4 (3.2) years were analysed. Glycaemia improved from baseline to 6 months with (mean) TIR +8% (95% CI 7, 9; P ≤ 0.001), GMI -0.3% (95% CI -0.3, -0.2; P < 0.001) and (median) TBR -0.3% (95% CI -0.4, -0.1; P < 0.001). Proportion meeting glycaemic targets increased from 13.3% at baseline to 30.6% at 6 months. Improvement in TIR did not differ based on age group or IRSD Quintile. Greater increase in TIR was seen in those with lowest TIR at baseline (+20.9%, -0.2%; P < 0.001 for baseline TIR < 40%, >70%). There was a 0.27% reduction in HbA1c in 6 months (n = 116) (P < 0.001). AHCL improves glycaemia, irrespective of age and socioeconomic characteristics, with greatest changes seen in those with lowest baseline TIR.

Association between nighttime/weekend visits and patient outcomes in children with blunt liver and spleen injuries.

The "out-of-hours effect," which indicates hospital admittance during weekends or nighttime, has poorer outcomes for patients than for those admitted on weekdays and is widely documented in various medical conditions. However, this effect remains understudied in pediatric trauma cases, including blunt liver and spleen injuries (BLSIs). This was a secondary analysis of a nationwide multicenter retrospective study, focusing on pediatric patients with trauma (≤ 16years old) with BLSI admitted from 2008 to 2019. This study evaluated the association between out-of-hour admissions and outcomes. The primary outcome was the intervention rate and secondary outcomes were 30-day mortality and time from hospital arrival to the first intervention. This study identified 1414 pediatric patients with BLSI. In total, 681 events occurred during the daytime and 733 during the nighttime, with 927 weekday and 487 weekend events. Out-of-hour admissions did not significantly associate with a higher rate of intervention. This association remained after adjusting for five potential confounders and patient clustering within the hospital. In addition, Out-of-hour admissions did not significantly associated with 30-day mortality, or time from hospital arrival to the first intervention. The current study showed no significant difference in treatment strategy and outcomes between weekday and out-of-hour among children with BLSI.

The efficacy of behavioral sleep intervention on sleep problems among children with attention-deficit hyperactivity disorder: A randomized controlled trial.

Attention-deficit hyperactivity disorder (ADHD), affecting 5% of global children, presents inattention, hyperactivity, and impulsivity. Sleep problems, prevalent in 70% of cases, exacerbate long-term psychosocial challenges. This study aimed to assess the efficacy of behavioral sleep intervention in alleviating sleep problems, enhancing quality of life (QoL), and reducing ADHD symptom severity among children diagnosed with ADHD. A randomized controlled trial was conducted from June 2022 to April 2023. The intervention group (n = 47) engaged in a hybrid approach, participating in both face-to-face and Zoom sessions, while the control group (n = 45) received standard care. Data collection involved administering the Children's Sleep Habits Questionnaire (CSHQ), Pediatric Quality of Life Inventory (PedsQL), and ADHD Rating Scale IV (ADHD-RS-IV). Significant enhancements were observed in CSHQ (p ≤ 0.001, effect size = 1.913), PedsQL (p ≤ 0.001, effect size = 1.862), and a notable reduction in ADHD-RS-IV (p ≤ 0.001, effect size = 1.548). These findings highlight the intervention's efficacy in improving sleep quality, QoL, and reducing ADHD symptomatology. This trial contributes substantially to understanding behavioral sleep interventions' impact on ADHD-affected children, enhancing quality of life and ADHD symptomatology. The study highlights the importance of individualized care for optimal outcomes in children with ADHD. The study's findings underscore the potential for integrating behavioral sleep interventions into routine nursing practices, offering a valuable approach to address sleep-related challenges in children with ADHD. By focusing on sleep improvement, nurses can contribute to enhancing overall well-being and emotional regulation in these children within the context of comprehensive healthcare.

The composition of commercially available human embryo culture media.

What is the composition of currently available commercial human embryo culture media provided by seven suppliers, for each stage of human preimplantation embryo development? While common trends existed across brands, distinct differences in composition underlined the absence of a clear standard for human embryo culture medium formulation. The reluctance of manufacturers to fully disclose the composition of their human embryo culture media generates uncertainty regarding the culture conditions that are used for human preimplantation embryo culture. The critical role of the embryo culture environment is well-recognized, with proven effects on IVF success rates and child outcomes, such as birth weight. The lack of comprehensive composition details restricts research efforts crucial for enhancing our understanding of its impacts on these outcomes. The ongoing demand for greater transparency remains unmet, highlighting a significant barrier in embryo culture medium optimization. For this study, 47 different human embryo culture media and protein supplements were purchased between December 2019 and June 2020; they comprise complete media (n = 23), unsupplemented media (n = 14), and supplements (n = 10). Unsupplemented media were supplemented with each available supplement from the same brand (n = 33 combinations). All samples were directly frozen in liquid nitrogen and stored at -80°C until composition analysis. We determined the concentrations of 40 components in all samples collected (n = 80). Seven electrolytes (calcium, chloride, iron, magnesium, phosphate, potassium, sodium), glucose, immunoglobulins A, G, and M (IgA, IgG, IgM), uric acid, alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), and albumin, as well as the total protein concentration, were determined in each sample using a Cobas 8000 Analyser (Roche Diagnostics). Analysis of pyruvate, lactate, carnitine, and 21 amino acids was achieved with Ultra-High Performance Liquid Chromatography-Mass Spectrometry (UPLC-MS/MS). Our analysis showed that generally, the concentrations of components of ready-to-use human embryo culture media align with established assumptions about the changing needs of an embryo during early development. For instance, glucose concentrations displayed a high-low-high pattern in sequential media systems from all brands: 2.5-3 mM in most fertilization media, 0.5 mM or below in all cleavage stage media, and 2.5-3.3 mM in most blastocyst stage media. Continuous media generally resembled glucose concentrations of cleavage stage media. However, for other components, such as lactate, glycine, and potassium, we observed clear differences in medium composition across different brands. No two embryo culture media compositions were the same. Remarkably, even embryo culture media from brands that belong to the same parent company differed in composition. Additionally, the scientific backing for the specific concentrations used and the differences in the composition of sequential media is quite limited and often based on minimal in vivo studies of limited sample size or studies using animal models. N/A. We used a targeted approach and performed a selection of tests which limit the composition analysis to this set of analytes. Comprehensive disclosure and complete transparency concerning the composition of human embryo culture media, including the exact concentration of each component, are crucial for evidence-based improvements of culture media for human preimplantation embryos. This research was supported by ZonMw (https://www.zonmw.nl/en), Programme Translational Research 2 (project number 446002003). M.G. declares an unrestricted research grant from Ferring not related to the presented work, paid to the institution VU Medical Center. The remaining authors have no conflicts of interest to declare. N/A.

Translating and validating the modified checklist for autism in toddlers (M-CHAT-R/F) into Malayalam for effective utilization of it in the clinical setting

Background: Early intervention strategies significantly improve developmental outcomes for children with autism spectrum disorders. In this background, this study was conducted to translate and validate Malayalam version of Modified Checklist for Autism in Toddlers (M-CHAT-R/F). Methods: This cross-sectional study was conducted in four steps. The original version of MCHAT-R/F was translated into Malayalam, and back translated by bilingual experts followed by pilot testing. Finally, the translated tool was administered to 100 children for evaluation of psychometric properties which included reliability and validity assessment. The statistical analysis was conducted using IBM SPSS version 25. Results: The internal consistency of the items as per parent confirmed stage of screening and flow chart interview stage of screening was 0.539 and 0.731 respectively. The level of agreement in categorizing the children according to the risk of ASD by two raters during first and second screening stage was 0.647 and 0.432 respectively. The test-retest reliability analysis showed that all the items had a moderate level of agreement between test and retest. All the items had an I-CVI more than 0.90. There was strong positive correlation between the score obtained during first stage (r: 0.562) and second stage (r: 0.529) with CARS score which indicates high convergent validity. Conclusions: The newly translated tool with high reliability and validity could enable in screening symptoms of autism among children belonging to lower age group, which would facilitate in providing appropriate intervention as early as possible.