Evaluation of hanging deaths in childhood: An autopsy study.

Examining risk factors for the development of dementia, a devastating condition, is of increasing importance in clinical research. Adverse childhood experiences (ACEs) represent one set of potentially modifiable dementia risk factors with known impacts on neurodevelopment and health. Refining approaches used in previous reviews, the authors of this review and meta-analysis sought to answer the question, What is the strength of the association between ACEs and dementia in later life? The authors searched PubMed, EMBASE, and Web of Science, including peer-reviewed studies involving adults exposed to ACEs and a comparison group of unexposed adults. The outcome of interest was dementia of any etiology, and study quality was assessed. Separate meta-analyses were performed with odds ratios and hazard ratios (HRs). The literature search yielded 2,032 articles, of which 13 were included for analysis. ACE exposure (OR=1.54, 95% CI=1.38-1.71, p<0.001; HR=1.51, 95% CI=1.24-1.84, p<0.001) and exposure to parental death in childhood (OR=1.42, 95% CI=1.16-1.74, p<0.001) were associated with increased odds of or risk for developing dementia, respectively. This meta-analytic review is the most extensive examination of the ACE-dementia relationship to date, and its findings suggest that several ACEs are associated with increased dementia odds and risk. Although the number of studies reviewed was small and the studies were mostly of fair quality, necessitating caution in interpretation, nearly all of their results supported the association between ACE and dementia. High-quality prospective cohort studies incorporating biomarkers to measure ACE outcomes will be essential.

This study presents an investment case for reducing unmet need for family planning and improving maternal health outcomes in Gabon between 2025 and 2030. Using the Spectrum software suite and a bottom-up costing approach, four scenarios were modelled to estimate financial requirements, health impacts, and socioeconomic returns from scaling up family planning, periconceptual, and maternal health interventions. Results show that scaling up services generates substantial health and economic gains while reducing overall system costs through lower demand for emergency obstetric care. Under the most ambitious scenario, scale-up could avert more than 15,000 unintended pregnancies, over 340 maternal deaths, and more than 2,100 child deaths, generating USD 793 million in socioeconomic benefits and a benefit-cost ratio of 63:1. Failure to scale up could result in losses of up to USD 780 million. Although short-term financing gaps remain, domestic revenue mobilisation, efficiency gains, and innovative financing mechanisms could support sustainable implementation and strengthen long-term human capital development.

Cryptosporidium is a protozoan that infects epithelial cells of the small intestine and is a cause of diarrhea and death in immunocompromised individuals and malnourished children. Immunity to this parasite is mediated by an intestinal T cell response, which is generated in gut-associated lymphoid tissues and dependent on type 1 conventional dendritic cells (cDC1s). The initial priming of T cells is accompanied by changes in integrin expression and subsequent trafficking to the site of infection. The role of specific integrins in trafficking to the ileum during cryptosporidiosis is largely unknown. The development of a transgenic Cryptosporidium strain that expresses MHCI and MHCII-restricted model antigens provides the ability to track T cell responses to this parasite. Our studies in this system revealed marked changes in the integrin profile of parasite-specific T cells as they are activated and traffic to the gut, and demonstrate that cDC1s contribute to the expression of the integrins ⍺4, β7, β1, and ⍺L. Surprisingly, blockade of the canonical gut-homing integrin ⍺4β7 does not impact the ability of parasite-specific T cells to access the gut. However, blockade of integrin ⍺L decreases the parasite-specific T cell frequency at the site of infection and delays control of parasite burden. These datasets highlight an ⍺4β7-independent mechanism of T cell trafficking to the small intestine and indicate that ⍺L is an integrin required for T cell-mediated resistance to Cryptosporidium .

Background: Diarrheal disease is still a major public health concern, particularly among children under-five in low-resource areas. It is responsible for high rate of illness and deaths of children mainly in developing countries.  Objectives: To determine the prevalence and associated risk factors of Diarrheal disease among children under five years of age in selected communities in Moro Local Government Area, Kwara State, Nigeria.  Methods: This descriptive cross-sectional study was conducted in three communities in Moro LGA, Kwara State, Nigeria. It included 410 caregivers of children under five years. A multi-stage sampling technique was used to select participants. Data were collected using a pretested, semi-structured, interviewer-administered questionnaire. Analysis was performed with SPSS version 26.0. Descriptive statistics and chi-square tests (p&lt;0.05) were employed.  Results: Two-week prevalence of diarrhea was 22.2% (n = 91). Among affected children, 80.2% had 2–3 episodes, with 66.3% exhibiting fever and 70.0% showing signs of dehydration. Environmental risk factors included the use of untreated well water (44.6%) and uncovered water storage (31.7%). Only 53.7% of households had hand-washing facilities. While 87.8% of caregivers sought medical care, only 34.2% did so immediately. Antibiotic use (56.1%) was more common than the use of oral rehydration solution (ORS) (34.4%) and Zinc tablet (9.4%). Households with more than three under-five children had poorer hygiene and higher diarrhea prevalence due to resource constraints and caregiver fatigue.  Conclusions: Significant associations were found with socio-demographic factors, environmental risks, and poor hygiene practices. Healthcare-seeking behavior was high (87.8%), but gaps existed in ORS use and preparation. Recommendations include improving water safety, sanitation, caregiver education, and adherence to WHO guidelines for diarrheal management.

Traumatic brain injury (TBI) is a leading cause of disability and death in children. More than 30% of children presenting to the emergency department (ED) with head trauma undergo brain computed tomography (CT), the standard neuroimaging modality in acute evaluation of intracranial pathology. Conventional magnetic resonance imaging (MRI) provides a non-ionizing alternative with greater sensitivity for certain intracranial injuries but is infrequently used in acute TBI because of limited scanner access and longer scan duration. Rapid brain MRI protocols reduce scan time and can be completed without sedation, with diagnostic accuracy for TBI comparable to CT, yet real-world availability remains limited. Point-of-care, low-field MRI (POC LF-MRI) systems are a recent radiologic advance that are portable, require less infrastructure, and allow bedside neuroimaging, including in critically injured children who cannot be safely transported. However, critical knowledge gaps exist regarding the diagnostic accuracy and feasibility of POC LF-MRI for pediatric head trauma in emergency and critical care settings. Our research aims to (1) determine the accuracy of POC LF-MRI for neuroradiographic TBI and clinically important TBI compared to current clinical standard of care initial neuroimaging, (2) determine the accuracy of POC LF-MRI for neuroradiographic injury progression on repeat neuroimaging, and (3) determine feasibility metrics and balancing measures of POC LF-MRI, including order-to-scan time, scan duration, proportion of incomplete scans, and ED length-of-stay. We will conduct a prospective, single-center, observational diagnostic accuracy cohort study of children 7-17 years old with blunt head trauma who undergo standard-of-care neuroimaging. Children with MR-unsafe implants or metallic shrapnel and wards of the state will be excluded. POC LF-MRI will be obtained within a reasonable time window of clinical neuroimaging, with a flexible window up to 72 hours, either in the ED, inpatient unit, or intensive care unit (ICU). The primary outcome is neuroradiographic TBI, defined as any traumatic intracranial finding on neuroimaging. Secondary outcomes include clinically important TBI (defined as TBI-related neurosurgical intervention, endotracheal intubation >24 hours, death, or ≥2-night hospitalization) and neuroradiographic injury progression on repeat neuroimaging (yes/no). Feasibility outcomes include order-to-scan time, scan duration, proportion of incomplete scans, and ED length of stay, along with other operational and balancing measures. Accuracy will be determined using imaging-level analyses comparing POC LF-MRI with clinical standard-of-care neuroimaging, reporting sensitivity, specificity, predictive values, and likelihood ratios with 95% confidence intervals for neuroradiographic TBI, clinically important TBI, and neuroradiographic injury progression, including predefined non-inferiority criteria for sensitivity, subgroup analyses, descriptive analyses of feasibility metrics, and exploratory analyses addressing incomplete imaging and missing data. The project was funded in 2024, and enrollment will be completed in July 2026. Data analyses are expected to be completed by December 2026, and the primary study results will be submitted for publication in 2027. This study will evaluate accuracy and feasibility for POC LF-MRI in an important subset of pediatric trauma patients and will provide preliminary data to inform future multicenter studies evaluating POC LF-MRI for children with head trauma.

Abstract This paper explores the critical intersection between Sustainable Development Goal (SDG) 3: Good Health and Well-being and the mental well-being of adolescents residing in Low- and Middle-Income (LMI) families. While SDG 3 "ensure healthy lives and promote well-being for all at all ages including targets for ending preventable deaths of newborns and children, reducing maternal mortality, combating communicable diseases like HIV/AIDS and malaria and promoting mental health and well-being by 2030. Its successful implementation on access to essential healthcare services is pivotal for the psychosocial development of adolescents and youth. SDG 3.4 exclusively aims to reduce by one third premature mortality from non-communicable diseases through prevention, treatment and promote mental health and well-being. Adolescents in LMI families face compounding stressors, including poverty, educational insecurity, mental health challenges and limited access to professional support, which significantly elevate their risk for mental health problems. This study employs a mixed-methods approach, integrating a systematic review of existing quantitative data on mental health service utilization with qualitative interviews exploring the lived experiences and perceived barriers to care among adolescents and their caregivers in selected LMI settings. The findings aim to elucidate the causal pathways through which investment in universal healthcare, educational mental health integration, and community-based support impacts adolescent resilience, coping mechanisms, and prevalence of mental health issues. Policy recommendations advocate for rights-based interventions that ensure accessible and stigma-free mental health services. Keywords: Sustainable Development Goals, Adolescents, Mental Health, Low- and Middle-Income, Good Health and Well-being.

Acute Respiratory Tract Infection (ARI) is an infectious disease that can affect the human respiratory system. ARI is an infection of the upper respiratory tract caused by microorganisms, including the nasal cavity, pharynx, and larynx, which lack gas exchange (Mustafa et al., 2023). An estimated 13 million people die from ARI. The disease burden varies widely, ranging from approximately 4 million of the 13 million people in India (48%), Indonesia (38%), Ethiopia (4.4%), Pakistan (4.3%), China (3.5%), Sudan (1.5%), and Nepal (0.3%). New ARIs occur in almost every region of the world. In 2022, Southeast Asia had the highest number of ARI cases worldwide. Approximately 30 countries contributed to the number of cases. (WHO, 2022) The incidence of acute respiratory infections (ARI) in Indonesia is relatively high, reaching 166,702 in 2022. This figure reaches 53% of the 50% target. Of this 53%, 31.4% of ARTI cases occur in toddlers. ARI is the second leading cause of death in children under five (12-59 months), accounting for 9.4%. This disease is an acute respiratory infection with symptoms of fever, cough lasting less than two weeks, runny nose/nasal congestion, and/or sore throat (Ministry of Health, 2022). In addition to medical treatment, ARTI treatment can also be supported by the use of natural ingredients. The combination of ginger and honey has been shown to have a synergistic effect in relieving ARTI symptoms. Red ginger (Zingiber officinale var. rubrum) is a herbal plant long known and used by Indonesians as a traditional medicine. Red ginger contains active compounds such as gingerol, shogaol, and zingerone, which have anti-inflammatory, antioxidant, and antimicrobial properties. These ingredients are useful in helping relieve symptoms of ARI, such as reducing inflammation in the respiratory tract, relieving coughs, and increasing the body's immune system.

The death of a child is one of the most traumatic life events and can lead to long-term depression in parents. Using data from the 2014 Indonesian Family Life Survey (IFLS-5), this study quantitatively examined the effect of child death on depressive symptoms among 1,735 respondents. Depression was measured using the 10-item CES-D, and analyses were performed with OLS regression. The initial results without control variables revealed that child death was not significantly related to depression (R2 = 0.001). After the control variables were included, child death showed a significant but weak association with depressive symptoms (B = 0.586; p = 0.033). The final model explained 5.6% of the variance in depressive symptoms (F(4.730) = 25.420; p < 0.001). Age and subjective wealth appeared to be protective factors, whereas education did not have a significant effect. These findings indicate that despite the relatively weak association, parents who experience child loss still show psychological vulnerability, necessitating accessible and culturally sensitive bereavement support services.

The quality of dying and death (QODD) of children on the PICU is essential for them, their families, and carers at the end-of-life. Currently, there are no standard instruments for measuring QODD in PICUs in Japan (J). We have developed a Japanese version of PICU-QODD (PICU-QODD-J) instrument, which has been culturally adapted to the Japanese context, and evaluated its psychometric validity. The study comprised two phases: 1) development of the PICU-QODD-J instrument, conducted with input from experts, clinicians, and bereaved families and 2) a multicenter, prospective, cross-sectional validation involving PICU clinicians. Data for the validation phase were collected between May 2023 and June 2024. Eight PICUs in Japan. We recruited 231 clinicians (112 physicians, 119 nurses) who provided end-of-life care for 65 children in the PICU and their families. None. The PICU-QODD-J instrument was developed through forward-backward translation, reviewed by a panel of five experts, and evaluated by 12 clinicians and seven bereaved family members. The PICU-QODD-J instrument comprises 21 items and demonstrated acceptable internal consistency (Cronbach's α = 0.92) and good test-retest reliability with intraclass correlation coefficient of 0.77 (95% CI, 0.64-0.85). The inter-rater reliability (IRR) was low (0.09 [95% CI, 0.06-0.13]). Standardized PICU-QODD-J instrument scores showed moderate positive correlations ( r = 0.42-0.57; p < 0.001) with evaluations of overall quality of end-of-life care, quality of the moment of death, and fulfillment of family needs, supporting good construct validity. The PICU-QODD-J instrument demonstrated good reliability and validity and can be used to assess and improve end-of-life care in PICUs in Japan. However, given the low IRR, evaluations should be interpreted from multiple perspectives rather than a single assessment.

26-CCC-14971-ACC MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MIS-C): HOW EARLY IDENTIFICATION CAN PREVENT PROGRESSION OF CARDIOVASCULAR SYSTEM HYPERINFLAMMATION AND DEATH IN CHILDREN AND ADOLESCENTS

Fathers' grief in action.

An epidemiological analysis of extracorporeal membrane oxygenation use in trauma.

Preventable unintentional injuries are a leading cause of death, disability and hospitalisation for children worldwide. Researchers work with parents to understand their perspectives on children's safety and to mitigate the likelihood of children being injured. While recent evidence suggests that exposure to injuries can heighten parents' awareness for child safety threats, little is known on how occupational exposure to severe injuries and death, such as those witnessed in emergency departments by physicians and nurses, may shape parents' emotional well-being and child safety perspectives. To address this gap in knowledge, we conducted semi-structured interviews with physicians (n=40) and nurses (n=16) across Canada with emergency room experience. Our approach was informed by tenets of narrative inquiry and we conducted a thematic narrative analysis. We identified two themes: (1) 'Moments you carry with you forever': Exposure to severe child injuries and death results in declines in emotional well-being; and (2) 'Where was the supervising parent?': Exposure heightens awareness for preventable injuries. Exposure can result in physicians and nurses exercising more caution towards activities and environments that could result in their children experiencing similar injuries to their patients. As a result of witnessing injuries and death, physicians and nurses can have declines in well-being, more awareness for safety threats, and they can feel frustration towards children experiencing injuries they perceive as preventable.

Undernutrition significantly increases the risk of severe infections and mortality in children under five, particularly in low- and middle-income countries. Pneumonia, a leading cause of childhood death, is especially dangerous in undernourished children, yet prognostic measures to identify those at highest risk are lacking. To identify algorithms of poor prognosis in undernourished children with clinical pneumonia for early identification of children at risk for poor outcomes. This study analyzed a subset of children enrolled in a cohort designed to identify biomarkers of bacterial pneumonia. Children aged 2–59 months with clinical pneumonia were recruited from two rural Gambian hospitals. Clinical and anthropometric data were collected at baseline, during hospitalization, and at 30-day follow-up. Nutritional status was classified using WHO definitions for stunting (height-for-age Z-scores) and wasting (weight-for-height Z-scores) as severe (Z-scores ≤ -3), moderate (-2 ≥ Z-scores > -3), and mild (-1 ≥ Z-scores > -2). Prognostic outcomes were classified into good and poor. Poor prognosis included death, prolonged hospital stay (≥ 7 days), post-discharge care-seeking, and difficult to feed during admission. Good prognosis was based on a hospital stay < 3 days, with good outcomes within 30 days of the initial visit. Classification tree models and penalized logistic regression models (fit through elastic net) were used to identify combinations of predictors of poor prognosis (prognostic signatures). A total of 246 children with clinical pneumonia and undernutrition (wasting or stunting) were included. Children with poor prognosis presented more frequently with respiratory distress, hypoxemia, reduced capacity oforal feeding difficulty, and anemia. As expected, undernutrition was associated with adverse outcomes. The final prognostic algorithms were accurate to identify undernourished children at risk of poor prognosis: with sensitivity and specificity > 80% and area under the receiver operating characteristic curve ≥ 0.80. Furthermore, we identified accurate prognostic signatures among children with both wasting and stunting. Measures collected at admission in undernourished children with clinical pneumonia can identify those at risk of poor outcomes. The prognostic signatures developed in this study may inform early risk stratification and guide timely intervention, particularly in resource-limited settings.

Abstract Pediatric gliomas are the most common form of malignant brain tumors in children, representing ∼50% of all pediatric brain tumor cases and being the leading cause of cancer-related deaths in children under the age of 15. Aggressive standard treatments offer limited benefit in high-grade gliomas, with low survival rates (25%; 5-year survival rate) and significant long-term cognitive consequences diminishing life quality due to the harsh impact of these interventions on the developing brain. These limitations underscore the urgent necessity of novel therapeutic approaches and a more comprehensive understanding of the disease’s molecular drivers and tumor behavior. To explore the molecular underpinnings of pediatric gliomagenesis, we utilized an advanced non-invasive postnatal electroporation approach (MADR) to create an inducible mouse model and derived organoids in combination with extensive genomic, transcriptomic, and proteomic analyses. Through this platform, we identified several ETS transcription factors as key contributors to tumor development. These factors, including the Pea3 subfamily (ETV1, ETV4, ETV5) and ETV6 (also known as Tel), are known for regulating key cellular functions such as proliferation and cell differentiation which could shape the tumor heterogeneity. We observed significant and overexpression of ETV5 and other ETS factors in pediatric gliomas and in a cell-population dependent manner, where they interact directly and dynamically with glial-specific transcriptional regulators (e.g.: OLIG2) to drive tumor formation. Furthermore, our single-cell analyses of Ets inducible MADR-derived organoids were further unraveling the common and different roles of ETV1, ETV4, ETV5, and ETV6 in determining the different tumor progression, cell identity, and how they regulate transcriptional programs during gliomagenesis showing they importance of its regulations in the heterogeneity shaping for the tumor success. Interestingly, among them, ETV4 showed an exclusive potential to force the glioma cell phenotype to fate them to a unique cell cluster. In addition, our data reveal the central role of ETV5 in glial fate decisions by promoting the differentiation of neural precursor cells toward an oligodendrocyte progenitor cell (OPC)-like phenotype. OPCs are highly proliferative and migratory cells considered potential origins of glioma. Thus, targeted in vivo suppression of ETV5 resulted in substantial reductions in tumor growth, delayed disease progression, and improved survival outcomes, affirming its functional importance in the tumor behaviour. These findings emphasize the central involvement of ETS transcription factors in promoting glioma diversity and illustrate how the distinct activation of individual Ets family members can differentially direct the lineage and functional state of tumor subpopulations. Altogether, this study position ETS factors as key regulators of tumor biology and promising therapeutic targets in high-grade pediatric gliomas. Citation Format: Antonio C. Fuentes-Fayos, Hannah Park, Naomi Kobritz, Moise Danielpour, Joshua J. Breunig. ETS transcription factors as key modulators of heterogeneity in pediatric high-grade gliomas [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Brain Cancer; 2026 Mar 23-25; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2026;86(6_Suppl):Abstract nr B046.

The Society of Critical Care Medicine Pediatric Sepsis Definition Task Force recommends the use of the Phoenix Sepsis Score (PSS) to diagnose pediatric sepsis among children with suspected infection. However, the performance of the PSS in different healthcare settings remains unclear. The present study aimed to validate and modify the ability of the PSS to predict in-hospital death in children with suspected infection admitted to the intensive care unit (ICU) in China. This multicenter retrospective cohort study included children aged ≤18 years with suspected infection admitted to the ICU from five hospitals in China between January 2012 and December 2023. Two children's specialized hospitals and three tertiary general hospitals participated. The primary evaluation of PSS prediction performance was based on in-hospital mortality discrimination through the area under the receiver operating characteristic curve (AUROC). The secondary evaluation was conducted using the area under the precision-recall curve (AUPRC). Given the moderate discriminative performance of the PSS in this cohort, we employed extreme gradient boosting (XGBoost) with SHapley Additive exPlanations (SHAP) to identify key predictors of in-hospital mortality. Predictors selected through this process were incorporated into the original PSS framework while prioritizing clinical feasibility, resulting in a modified score, PSS+, for mortality prediction. Among 9221 ICU admissions for children with suspected infections (13.4% mortality), the PSS showed moderate discrimination, with an AUROC of 0.60 (95% CI: 0.59-0.62). The modified PSS (PSS+), which selectively incorporated comorbidities, vital signs, and demographic variables identified through model development, outperformed the original PSS-4, PSS-8, and pediatric sequential organ failure assessment (pSOFA) in terms of both internal validation (AUROC of 0.75, 95% confidence interval [CI]: 0.70-0.78) and external validation (AUROC of 0.71, 95% CI: 0.69-0.73). The PSS demonstrated only moderate ability to predict in-hospital mortality among pediatric ICU patients in the present cohort, indicating that its application in other healthcare settings should be approached with caution. The modified PSS+ scoring system significantly improved mortality prediction performance and may serve as a more reliable and clinically applicable tool for risk assessment in critically ill children.

A Dried Platelet-Derived Biologic for Blood-Brain Barrier Repair and Hemorrhage Control Following TBI in Mice.

Background: Acute respiratory infections (ARI) are a significant cause of illness and death in infants and children under five. Infants' nutritional status and feeding patterns are factors that affect their vulnerability to ARI. This literature review aimed to summarize the incidence of ARI, the risk factors, and the evaluation of nutritional strategies. Methods: The literature review was conducted using articles published between January 2020 and December 2025. A search was conducted in PubMed and Scopus using keywords related to ARI. Results: ARI is very common among children under 5 years old. Malnutrition and low birth weight correlate with heightened risk and severity of ARI. Insufficient exclusive breastfeeding practices are associated with an increased risk of ARI, while exclusive breastfeeding has a protective effect. Environmental factors affect the likelihood of ARI. Evidence on micronutrient supplementation is varied and not ideal. Conclusion: Interventions for ARI in children require an integrated strategy that focuses on exclusive breastfeeding, improved nutritional status, and a healthier household environment.

Despite extensive literature on suicide prevention and experiences of bereaved individuals in the context of adult suicide, a significant gap remains in research examining the impact of suicidal deaths of children and adolescents. This systematic review aims to understand the experiences and impact among parents and mental health professionals (MHPs) following the loss of a child/adolescent to suicide and identify ways in which insights from bereaved individuals can inform strengthening systemic responses. The meta-synthesis included qualitative, quantitative and mixed-methods studies. The coding principles were based on thematic synthesis and interpretative phenomenological analysis to allow the participants' voices to emerge. The findings from quantitative studies were interpreted qualitatively and incorporated into higher-order themes. The final conceptual framework was developed through triangulation across diverse study methodologies and participant groups. Twenty-five studies were included. Superordinate themes illuminating experiences of parents include-'pervasive experiences of bereaved parents', 'making sense of the child and the suicide', 'moving on vs moving forward' and 'when support falls short'. Experiences of MHPs were captured through the following preliminary superordinate themes-'navigating grief as therapists', 'client suicide-is realistic estimate a fallacy', 'surviving client's suicide' and 'holding space for healers'. This review uniquely speaks of the shared grief experiences of parents and MHPs on a continuum while also highlighting the distinct contexts and meanings that shape their experiences. Integrated postvention support should prioritize systemic continuity of care for bereaved parents and families while simultaneously ensuring individualized support for bereaved MHPs through sensitive institutional structures.