Child Outcomes Research Articles

Mapping and comparing the quality of life outcomes in childhood and adolescent and young adult cancer survivors: an umbrella review and future directions.

A cancer diagnosis early in life can leave a legacy in terms of compromised Quality of Life (QoL). There is a lack of clarity regarding the impact on QoL according to age at diagnosis, with childhood cancer survivors (CCS) and adolescents and young adult cancer survivors (AYACS) often combined. As part of an EORTC Quality of Life Group study, this umbrella review aims to (1) identify the QoL outcomes reported in the literature for both CCS and AYACS, and (2) investigate the similarities and differences in QoL challenges between both groups. A systematic literature search of systematic reviews and meta-analyses was conducted in December 2023 using PubMed, PsychInfo, and CINAHL. Methodological quality was evaluated using the AMSTAR tool. Overall, 1457 articles were assessed, and 39 systematic reviews and meta-analyses met the inclusion criteria. QoL outcomes were categorized into eight QoL domains, all of which were reported in both groups of young survivors. However, reviews on CCS often focused on outcomes relating to emotional functioning, cognitive difficulties, social challenges, school functioning, body image and overall happiness, whereas AYACS reviews had a greater focus on depressive symptoms, outcomes related to sexual health and reproductive health, employment, financial difficulties, self-image and identity and the impact of cancer. This umbrella review comprehensively explores QoL outcomes among CCS and AYACS, revealing both shared and distinct challenges. Future research should focus on developing tailored questionnaires, emphasizing transition periods and incorporating a life perspective to capture unique developmental tasks of young survivors.

One is Good, but are Two Really Better? Outcomes for Dual versus Individual Attendees in a Behavioral Parent-Training Program for Caregivers of Young Children

ABSTRACT Background The Helping Our Toddlers, Developing Our Children’s Skills (HOT DOCS) BPMT program utilizes positive behavior support principles to help caregivers of children birth-5 years address early childhood disruptive behaviors and common developmental challenges experienced by many young children. Objective The present study examined whether there were differences in child outcomes, attendance rates, homework completion rates, levels of caregiver stress, and treatment satisfaction for individual versus dual caregiver participation in the HOT DOCS BPMT. Method Using a quasi-experimental design, caregivers of children ages 0–5 years were assigned to two non-equivalent groups: individual attendee (n = 141) and dual attendee (n = 123). Independent samples t-tests were utilized to compare means between individual and dual attendee groups for number of sessions attended and homework completion. Paired samples t-tests were calculated to compare means between individual and dual attendee groups on HOT DOCS program outcomes, including child behavior, parenting stress, and treatment satisfaction. Results There were no significant differences in outcomes between individual and dual attendee groups. Child behavior outcomes, parenting stress, treatment satisfaction, attendance, and homework completion were similar across both groups. Conclusions Individual caregiver engagement in the HOT DOCS BPMT program might be sufficiently potent to result in desirable outcomes. Future directions should include examining family structure and treatment modality on BPMT outcomes, maintenance of intervention gains, and perceived child behavior outcomes of BPMT non-attending caregivers.

The Impact of Medicaid Expansion on Congenital Heart Surgery Outcomes: Data From the Society of Thoracic Surgeons Database

BACKGROUND: The Affordable Care Act expanded Medicaid eligibility and increased public insurance coverage for children across the United States. As only a subset of states adopted expansion of coverage, disparities in insurance coverage between expansion and nonexpansion states emerged. We examined the association between Medicaid expansion and cardiac surgery outcomes to understand the impact of Medicaid expansion in a medically complex pediatric population. We hypothesized that expansion of Medicaid eligibility would be associated with greater improvement in surgical outcomes. METHODS: The Society of Thoracic Surgeons Congenital Heart Surgery Database was used to evaluate perioperative outcomes for children 0 to 18 years undergoing cardiac surgery between January 2010 and December 2019. We used a difference-in-differences (DiD) design to estimate the impact of Medicaid expansion on surgical outcomes by comparing changes in outcomes between individuals in expansion states and those in nonexpansion states, both before and after the expansion. Outcomes included operative mortality, major complications and postoperative length of stay (PLOS). RESULTS: The interaction between Medicaid expansion and time period post- vs preexpansion was not significant for any of the outcome variables. The odds ratio (OR) for mortality related to the Medicaid expansion was 1.12 (confidence interval [CI], 0.95–1.32, P = .161). For major complications, the OR was 0.99 (CI, 0.90–1.09, P = .770). For PLOS, the incidence rate ratio was 1.02 (CI, 0.99–1.05, P = .141). CONCLUSIONS: There was an overall decline in congenital heart surgery mortality over time; however, states that expanded Medicaid eligibility did not experience a greater improvement in mortality relative to states that did not expand eligibility. Similarly, there was no significant difference in major complications or PLOS related to Medicaid expansion. Further studies are needed to examine long-term outcomes and the larger spectrum of accessibility to congenital cardiac care which may benefit from insurance coverage.

Child Well-Being, Family Functioning, and Contextual Strain: A Study of Multi-Assisted Low-Income Families

Objectives: This study aimed to examine the effects of poverty on child well-being and family functioning among low-income families. Specifically, it explored the role of parental stress, family dynamics, and contextual strain on children’s behavioral and emotional outcomes. Using a sample of families receiving welfare support, the research sought to assess the impact of conditional cash transfer programs and the involvement of Child Protective Services on child development and family well-being. Methods: This cross-sectional study involved 99 children aged 8–12 from low-income, welfare-assisted families recruited from the Porto Metropolitan Area. Parental stress, parenting attitudes, family functioning, and child outcomes were assessed using standardized questionnaires. Families with and without Child Protective Services involvement were compared, and a cumulative index of contextual strain was developed to measure the multidimensional impact of stressors on child outcomes. Results: The results revealed that 53% of children exhibited clinical or borderline internalizing behaviors, 47% showed externalizing behaviors, and 39% experienced low psychological well-being. High levels of parental stress, low parenting competence, and significant contextual strain were associated with poorer child outcomes. Families involved with Child Protective Services showed no significant differences in parent or family characteristics, but children from these families exhibited fewer behavioral problems. Conclusions: The study highlights the pervasive impact of poverty and contextual strain on child development, emphasizing the need for more comprehensive interventions. Family functioning and parental stress are critical factors influencing child well-being, pointing to the importance of addressing these areas through targeted welfare and support programs to reduce the intergenerational transmission of poverty and improve child outcomes.

Patient-reported outcomes of Children with an Anorectal Malformation.

We aimed to study the impact of anorectal malformation (ARM) type and sacral ratio on continence outcomes in children. We secondarily aimed to compare continence outcomes by age group and determine quality of life (QoL) with different bowel regimens. Children with ARM experience dysfunctional stooling into adulthood. Little is known about how ARM type, sacral ratio, age, and bowel regimen affect continence and QoL. We administered five validated survey measures on stooling habits and QoL to children aged 2-19 with ARM at two tertiary hospitals. Sacral ratio as a determinant of sacral hypodevelopment was defined as normal (≥0.7), moderate (0.4-0.0.69), or severe (≤0.39). Children not on an enema program were compared to those on an enema program to identify factors associated with achieving voluntary bowel movements defined as continence. All children were compared to identify factors associated with QoL. Of 910 patients, half (52.8%) had mild sacral hypodevelopment. In patients not receiving enemas managed solely at study hospitals, most were continent (69.2%). There were no differences in continence demonstrated by sacral ratio; 79.4% of those who were continent had normal/moderate sacral hypodevelopment and mild ARM.Continence improved with age (50% ≤6y old, 69.8% 6-12y old, 82.1% >12y old; P<0.001). Those on enemas and soiling had a QoL 19.6 points lower than those soiling on laxatives, and 20.7 points lower than those who were clean on enemas or continent with voluntary bowel movements without the need for enemas. In patients on laxatives the type of malformation, but not sacral ratio, is associated with continence in patients with ARM. Continence improves with age; those on enemas with soiling have a worse QoL.

Outcome Analysis of Parathyroid Gland Auto-transplantation in Pediatric Patients: A Retrospective Review.

Parathyroid gland (PG) auto-transplantation is performed to preserve the function of de-vascularized or unintentionally removed PGs, however, little has been published about the technique and outcomes in children. In our study, we aimed to present the results of PG auto-transplantation in children undergoing thyroidectomy or parathyroidectomy at a tertiary single institution. A retrospective review identified 14 patients (<18 years of age) who underwent PG auto-transplantation from January 2000 to December 2022. 57.1% (8/14) had transient postoperative hypocalcemia and 14.3% (2/14) had permanent postoperative hypocalcemia. Eight patients had transient hypoparathyroidism, correlating with the rate of transient hypocalcemia. The most common reimplantation site was the sternocleidomastoid (11/14) and it was significantly associated with normalized calcium levels 6 months after auto-transplantation (p=0.033). Bilateral central neck dissection and surgical indication of cancer had a statistically significant association with transient hypocalcemia (p=0.03 and p=0.005, respectively). Our study provides valuable insights into the outcomes of PG auto-transplantation in pediatric patients, highlighting the potential for successful engraftment and factors associated with hypocalcemia.

Maternal health and child socio-emotional development: findings from the growing up in New Zealand study

AbstractWe study the influence of maternal chronic illness and disability on the socio-emotional development of children across early to mid-childhood using the Growing Up in New Zealand study. Controlling for a host of relevant maternal, household and child characteristics, our results show a negative link between maternal chronic illness and disability and child socio-emotional outcomes at eight years of age. At earlier ages, the evidence of a relationship between maternal health and child socio-emotional outcomes is weaker. We also find that maternal parenting style and depression mediate the relationship between maternal chronic illness and disability and child socio-emotional outcomes. Specifically, parenting style mediates the relationship between maternal chronic illness and disability and child socio-emotional outcomes in early childhood, at age 2, but not at age 5, and for boys after commencement of formal education, at age 8. In contrast, maternal depression consistently mediates the relationship between maternal chronic illness and disability and child socio-emotional outcomes from early to mid-childhood, and for both boys and girls. Our findings stress the need to better understand both direct and indirect effects of maternal health on the formation of skills in childhood that influence future life chances.

Early motor developmental milestones and health outcomes in preadolescent children

IntroductionThe prevalence of depression and anxiety in children has risen in recent years, while childhood obesity and sedentary behavior continue to be a major public health concern. Existing evidence suggests early motor development and locomotor experiences contribute to psychosocial and physical development. By further understanding the far-reaching effects of early motor development, early life interventions aimed at preventing physical and mental health adversity may benefit from investigating early motor developmental milestones (MDM) attainment. The current study is the first to assess the longitudinal association between parent-reported gross MDM timing with objective measures of mental health, cardiorespiratory fitness (CRF), subcutaneous abdominal (SAAT), and visceral adipose tissue (VAT) outcomes later in childhood.MethodIn total, 131 children aged 8–11 years (46% female) were recruited. The parents of these children reported the age of attainment for five MDMs: holding their head unsupported, rolling over, sitting unsupported, standing, and walking independently. The study encompassed a comprehensive assessment, including measures of mental health, CRF (VO2 max), body–mass index (BMI), SAAT, and VAT. Data were analyzed using multiple stepwise linear regressions, adjusting for demographic and parental factors in Step 1 and including each MDM individually in Step 2.ResultsOur findings indicated earlier rolling over and walking were associated with higher CRF during preadolescence. Earlier rolling over was also linked to healthier BMI and lower levels of VAT, lower levels of trait anxiety, and fewer symptoms of depression.ConclusionThis study provides further evidence with potential clinical implications that parent-reported MDM age of attainment is related to later preadolescent physical and mental health. The age at which a child first rolls over emerges as a particularly predictive factor for various preadolescent health outcomes, highlighting the multi-finality of MDM timing in understanding developmental trajectories.

Neuromonitoring modalities predicting neurological impairment in pediatric congenital heart disease: a systematic review

The increased risk of neurodevelopmental impairment in children with congenital heart disease (CHD) has been established, but the search for targeted neurological predictors of adverse outcome is ongoing. This systematic review reports on the utility of three functional neuromonitoring modalities, Near-infrared Spectroscopy (NIRS), electroencephalography (EEG) and biochemical biomarkers, in predicting either clinical neurodevelopmental outcome or structural brain abnormalities after pediatric CHD surgery. Medline, Embase, CENTRAL, Web of Science, clinicaltrials.gov and ICTRP were systematically searched for eligible articles. Original research articles, written in English, published before November 2023 and reporting on perioperative NIRS, EEG or biomarkers and their association with clinical neurodevelopmental outcome or neuroimaging in children &amp;lt;17 years undergoing surgery for CHD were included. The search yielded 11,367 citations, of which 40 papers were included in the final review: sixteen articles (n = 908 cases) reported on NIRS, twelve (n = 1,163) on EEG and fifteen (n = 903) on biochemical biomarkers. Three papers reported on a combination of modalities. Median age at time of surgery was 9 (IQR 7–57) days. Postoperative MRI was performed before discharge at varying timepoints. Median age at clinical outcome assessment was 15 (IQR 12–24) months. Limited evidence supports an association of cerebral oxygen extraction, cerebral desaturation and cerebral autoregulation with outcome, but there was significant heterogeneity in results. Perioperative electroencephalographic ictal discharges and abnormal background were associated with impaired neurological outcome and abnormal neuroimaging. Numerous biochemical biomarkers have been reported but showed no consistent relationship with outcome, except for lactate, which could serve as a predictor of poor outcome. There is a need for larger homogeneous cohorts of children with CHD to determine which perioperative modalities might serve as predictors of neurodevelopmental outcome or neuroimaging abnormalities.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO, CRD42023479344

The hidden impact of GLP-1 receptor agonists on endometrial receptivity and implantation.

Increasing infertility rates represent a growing medical challenge in modern societies resulting from a complex interplay of sociocultural trends, lifestyle factors, exposure to environmental toxins, and underlying health problems. Women's fertility is particularly vulnerable to these shifts. The obesogenic lifestyle not only accelerates weight gain, but also disrupts ovulation driving the rise in infertility. Among several medications used for treating obesity and type 2 diabetes, glucagon-like peptide-1 receptor agonists (GLP-1RAs) show promising improvement in female fertility most likely by stimulating ovulation. However, the effects of GLP-1RAs on the endometrium remain unclear. Further studies are needed to investigate the impact of GLP-1RAs on endometrial receptivity and embryo implantation and early development. The aim of this study is to address the knowledge gap regarding the effects of GLP-1RAs on human reproduction, with special focus on the endometrium. Understanding these mechanisms may help to develop new strategies for improving fertility treatment, reduce implantation failureand address potential safety concerns regarding teratogenicity and adverse developmental outcomes for children born to women conceiving during or soon after GLP-1RA treatment.

Barriers and facilitators of school-based obesity prevention interventions: a qualitative study from the perspectives of primary school headteachers

BackgroundChildhood obesity is a growing global health issue. The World Health Organization identifies obesity as a significant risk factor for Non-Communicable Diseases and considers it a pandemic. This study aimed to investigate headteachers' perspectives and practices concerning childhood obesity prevention interventions in primary schools highlighting the barriers and facilitators for those interventions.MethodsThis qualitative study used a phenomenological approach and semi-structured interviews with headteachers of primary schools in the West Yorkshire area, UK. The collected data was transcribed and analysed using inductive thematic analysis.ResultsA total of 32 interviews with headteachers were conducted. The data indicated that interventions meant to prevent childhood obesity in schools are influenced by a range of barriers and facilitators that are organized under the following seven key themes: (1) staff perception of obesity prevention at school; (2) school policies on eating at schools; (3) School curriculum on healthy diets and physical activities; (4) role models at school; (5) partnership with parents; (6) extra-curricular activities on healthy diets and physical activities; (7) School capacity and resources.ConclusionsChildhood obesity prevention interventions vary across UK schools depending on staff and head teachers' beliefs, awareness, commitments, school resources, parents' involvement and parents’ awareness, income, and culture. The study suggests raising awareness of childhood obesity among parents and staff, involving external partners like school nurses for training, making all primary pupils eligible for free meals, and providing schools with guidance on securing government funding. It provides a foundation for improving school-based strategies that indirectly contribute to better health outcomes for children.

Improving the learning skills of autistic students using social robotics technologies

Teachers are instrumental in advancing the cognitive and motor skills of children with autism. Despite their importance, the incorporation of both educators and robotic aids in the educational frameworks of specialized schools and centers is infrequent. Extensive research has been conducted to evaluate the impact of robotic assistance on the learning outcomes for children with autism. This study investigates the effects of the Furhat robot on the educational experiences of autistic children in schools, analyzing its utility both with and without the presence of teachers. Interviews with educators were carried out to gauge the effectiveness of implementing Furhat robots in these settings. Data collected from sessions with autistic children were analyzed using ANOVA tests, offering insights into the Furhat Social Robot’s potential as a significant tool for fostering engagement and interaction. The findings highlight the robot’s effectiveness in enhancing social interaction and engagement, thereby contributing to the ongoing discussion on how social robots can improve the developmental progress and well-being of children with autism. Moreover, this paper underlines the innovative aspects of our proposed model and its wider implications. By presenting specific quantitative outcomes, our aim is to extend the reach of our findings to a broader audience. Ultimately, this research delineates significant contributions to the understanding of social robots, such as Furhat, in improving the overall well-being and developmental trajectories of children with autism.

A Systematic Review of Implicit Versus Explicit Social Skills Group Programs in Different Settings for School-Aged Autistic Children and Adolescents.

This systematic review and meta-analysis aimed to identify and evaluate the quality of randomised controlled trials (RCTs), assessing the efficacy of Social Skills Group Programs (SSGPs) for primary and secondary school aged autistic children and adolescents exploring the influence of informant, setting characteristics and teaching strategies as moderating factors for social outcomes. A search of the electronic databases of Medline, ProQuest, CINAHL, Scopus, and Web of Sciences electronic databases was conducted for the period January 1, 2013 until December 31, 2023 for peer-reviewed RCT studies published in English, evaluating the efficacy of SSGPs for school-aged autistic children and adolescents (6-18years). Included studies were assessed for methodological quality and efficacy using random effect meta-analysis. Informant analysis and moderator analyses were also conducted investigating the influence of informant, setting characteristics and teaching strategy utilised in the SSGPs on the participants social outcomes. Sixty-five studies were included in the systematic review with 49 studies included in the meta-analysis. Although most studies had strong or good methodological quality, a high possibility of publication bias was detected in the meta-analysis. After statistical adjustments for publication bias were made, findings revealed that SSGPs had no effect on the overall outcomes assessed by included studies on school-aged autistic children and adolescents. However, informant analysis revealed small effects reported by self-report, parent-proxy and researchers. Teaching strategies and setting characteristics were not significant moderators for the efficacy of SSGPs on the social outcomes of autistic children and adolescents. This review highlights the need for improvements in measurement frameworks for assessing social skills in autistic children and adolescents.

Exploring the Role of Early Diagnosis of Hearing Loss in Children and Its Impact on Educational Outcomes, Language Development, and Social Integration in Special Education Settings

The study explores the impact of early diagnosis of hearing loss on children's educational outcomes, language development, and social integration in special education settings. The research involved 150 children with early hearing loss, comparing the differences between early diagnosis (0-2 years) and late diagnosis (more than 2 years after birth). A quantitative research design was employed, using standardized test scores, teacher assessments, speech development tests, and social interaction surveys for data collection. The findings show that early diagnosis positively influences academic performance, language development, and peer interactions. Children diagnosed early demonstrated better academic outcomes (p &lt; 0.05), more advanced language skills (p &lt; 0.05), and improved social interactions (p &lt; 0.05) compared to those diagnosed later. A strong positive correlation was found between early diagnosis and the effectiveness of support services (r = 0.65, p &lt; 0.05). These results emphasize the importance of early intervention and robust support systems for children with hearing loss, highlighting the need for expanded newborn hearing screening programs and improvements in educational practices. Further research is recommended on long-term outcomes, the role of assistive technologies, and the influence of family involvement on improving outcomes following early diagnosis.

Factors associated with accelerated parenteral weaning in children with intestinal failure: A descriptive cohort study.

The goal of intestinal rehabilitation in children is to wean from parenteral nutrition (PN). The aim of this study was to identify factors associated with accelerated weaning and to evaluate long-term outcomes of children receiving long-term PN. This was a retrospective study of children managed by the Intestinal Rehabilitation Center at Cincinnati Children's Hospital. Medical history data were retrieved. The outcomes of children receiving long-term chronic PN (>2 years) were compared with those of children receiving short-term chronic PN regimen (<2 years). The cohort consisted of 112 children (58% boys, median [IQR] age of 6.0 [3.7-9.5] years). The group treated with a long-term PN regimen had significantly shorter residual small bowel and large bowel compared with the group treated with a short-term PN regimen (20% vs 60% and 75% vs 100%, respectively; P < 0.05). The lapse of time between PN and enteral feed initiation was longer in the group undergoing long-term PN regimen than in the short-term group (71 vs 32.5 days; P = 0.012). More episodes of central line-associated bloodstream infection (CLABSI) and a higher percentage of feeding aversion was demonstrated in the long-term PN group (2 [1-3] vs 1 [0-2] episodes and 36% vs 0%, respectively). Small bowel, colon length, enteral feed initiation, and frequency of CLABSI are factors associated with duration of PN regimen. A long-term chronic PN regimen is associated with a higher risk of food aversion.

Pregnancy in Inflammatory Bowel Disease: Data from a Real-World Cohort in Germany

Background: Inflammatory bowel disease (IBD) frequently manifests at a young age, during the peak fertility years. Understanding the risks of negative pregnancy outcomes associated with IBD is crucial for effective pregnancy management and support. Additionally, it is essential to provide patients with the necessary knowledge to make informed choices and foster their confidence in navigating pregnancy while maintaining effective disease management. Although IBD frequently appears during the peak fertility years, knowledge about managing pregnancy in the context of IBD remains limited and often inaccurate among both physicians and patients. Our study aims to assess the complications occurring during pregnancy in patients with IBD, considering the level of disease activity, and to evaluate the standard of care provided to patients with chronic inflammatory conditions through a cohort analysis. Methods: Patients with IBD who had children were included in this single-center mixed-method (retrospective and prospective) study. Clinical data, disease progression, course of pregnancy, and complications were examined in women. Outcomes for children of men with IBD were also analyzed. To supplement the data, a survey addressing various pregnancy-related topics, including all patients from the university outpatient clinic for IBD, was conducted over a period of six months. Results: A total of 410 patients were screened retrospectively between 2010 and 2021. In total, 134 patients who had children were included in the study: 51.4% (n = 69) had Crohn’s disease, 44% (n = 59) had ulcerative colitis, and 4.6% (n = 6) had unclassified inflammatory bowel disease. Of the women, 85% (n = 34) were in remission for at least three months before pregnancy, 14.6% (n = 6) experienced an acute flare-up during pregnancy, and 10.3% (n = 4) and 7.7% (n = 3) had active disease at the time of delivery and during breastfeeding, respectively. Patients with IBD who were in remission before pregnancy did not experience a higher risk of pregnancy complications (no cases of pre-eclampsia or placental abruption were reported in this group). However, the rates of gestational diabetes and fever during pregnancy were 10% for those in remission, compared to 25% for those with active disease. Conclusions: Patients with IBD in remission did not present an increased risk of pregnancy complications. However, our survey indicates that those with active disease at conception were more likely to experience complications such as gestational diabetes and fever. These findings underscore the importance of adequate patient education regarding the safety of various IBD medications during pregnancy in order to avoid pregnancy-related complications.

Project Initiate: A Clinical Feasibility Trial of Equitable Access to Early Neurodevelopmental Therapy

Background/Objectives: Despite evidence of the effectiveness of early intervention (EI) programs, eligible infants often experience delays in initiation of services or fail to receive services entirely. Disparities have been documented, including lower enrollment rates for infants with public insurance. The objective of this pilot study was to evaluate the feasibility of initiating home physical therapy (PT) services promptly after neonatal or cardiac intensive care unit (NICU/CICU) discharge for infants with public insurance and to assess early motor outcomes for children who received study therapy compared with a standard of care group. Methods: Infants were recruited if discharged from a study NICU/CICU, had public insurance, and were eligible for Illinois EI services. Infants living in Chicago (n = 46) received weekly home-based PT from a study therapist until 3–4 months corrected age (CA). Infants living outside Chicago received standard of care services and served as a control group (n = 14). At discharge, infants were referred to EI and underwent the Test of Infant Motor Performance (TIMP). Outcomes at 3–4 months CA included initiation rates for study PT and EI and follow-up TIMP testing. Results: By 3–4 months CA, 78% of the intervention group had received ≥1 PT session. In contrast, just 13% of the entire cohort had received any EI therapy. Infants who had 8–10 PT sessions in the first 3–4 months after discharge were more likely to have a change in the TIMP Z-score of &gt;0.5 SD. Conclusions: Prompt transition to home therapy was feasible for infants with public insurance in an urban setting who may benefit most due to the potential for neuroplastic change. Addressing barriers identified in this study may assist in improving access to EI for young infants.

Treatment of Pediatric Acute Lymphoblastic Leukemia in India as per modified BFM 95 protocol with Minimal Residual Disease monitoring

ABSTRACT Background: Survival outcomes of Pediatric Acute Lymphoblastic Leukemia (ALL) in the developing world have lagged. Here we report improved outcomes of pediatric ALL from India. Methods: We analyzed outcomes of children with ALL treated at our center between 2016 and 2021. They were treated as per the modified BFM 95 protocol with Minimal Residual Disease (MRD) monitoring by flow cytometry (FCM). Results: We diagnosed and managed 68 patients, 57 being Precursor B (Pre B) cell ALL and the rest of T cell ALL. With BFM 95 protocol-based risk stratification, 19/68, 44/68 and 3/68 patients were Standard risk (SR), Medium risk (MR) and High risk (HR), respectively and 2/68 were not stratified due to Induction mortality. With MRD-based risk stratification, 52/68, 11/68 and 2/68 patients fell in the SR, MR and HR category, respectively and 3/68 patients were not classifiable by MRD (2 Induction deaths and 1 refractory disease) and 65/68 patients achieved morphological complete remission (CR) at the end of Induction. Five out of 68 ALL patients underwent allogeneic hematopoietic stem cell transplant (HSCT) in CR1. Ten out of 68 patients had a relapse, 6 of whom are alive and in CR2 till the last follow-up. The mean duration of follow-up was 1150 days (median 1219 days). Treatment-related mortality was 4.4% in our cohort. The Event Free Survival (EFS) of our cohort was 79.4% and Overall Survival (OS) was 88.2% at a median follow-up of 1219 days. Conclusion: Survival outcomes have improved for children with ALL with modifications in BFM 95 protocol and incorporation of MRD assessment.

Early Childhood Intervention in North Macedonia – Parents’ Perspective

Early childhood intervention (ECI) should focus on building strong relationships with families, as this family-centered approach leads to improved developmental outcomes for children. This study examines ECI and support systems in the Republic of North Macedonia from the perspective of families of children with developmental delays or disabilities. A descriptive method was used, suitable for describing individuals, processes or situations as they unfold in nature, with no manipulation of variables. The research included a sample of 78 parents of children with developmental delays or disabilities. The findings indicate that when at-risk factors or disabilities are identified shortly after birth, ECI tends to be quick and efficient. Most services (71.4%) are provided in ECI centers, while 28.6% of families receive services at home. Some 53.8% of families reported covering the costs of all ECI services. By the age of three, 43.7% of children had been detected, diagnosed, and received some form of stimulation services or early rehabilitation treatment. The insights gained from this study may also be applicable in other countries with similar ECI systems.

Association Between Parental Adverse Childhood Experiences and Offspring's Risk of Suboptimal Health: A Systematic Review and Meta-Analysis.

Previous reviews and meta-analysis have not adequately explored the impact of specific parental adverse childhood experiences (ACEs) subtypes on offspring's health. This updated systematic review and meta-analysis aimed to investigate the association between parental ACE subtypes and various offspring health outcomes. A comprehensive search was conducted in electronic databases including PubMed, Web of Science, the Cochrane Library, WANFANG, and China National Knowledge Infrastructure for studies published in English and Chinese from January 1, 1998, until July 18, 2023. Two independent reviewers screened studies, extracted data, and assessed study quality using the Newcastle-Ottawa Scale. A random-effects model was applied to generate pooled odds ratios (ORs) and 95% confidence interval (95% CI). A total of 47 eligible studies were included in the final analysis. Overall, parental ACEs were significantly associated with several offspring's health outcomes, including preterm birth (PTB), low birth weight (LBW), total developmental delay, social-emotional problems, and behavioral problems (total, externalizing and internalizing behaviors), with ORs ranging from 1.06 to 3.02. Specific subtypes of parental ACEs, such as household dysfunction, sexual abuse, and physical abuse (but not emotional abuse) were significantly associated with PTB. Household dysfunction was notably linked to delayed cognition ability in offspring. Parental sexual abuse, physical abuse, emotional abuse, and emotional neglect were significantly correlated with social-emotion problems, with the expception of household dysfunction. Regarding total behavioral problems, parental household dysfunction, physical abuse, emotional abuse, physical neglect, and peer bullying were all significantly associated with children's behavioral issues, except for emotional neglect. There is a positive correlation between parental household dysfunction, sexual abuse, physical abuse, emotional abuse, emotional neglect, physical neglect, peer bullying, and neighborhood-related adversity and their children's externalizing behavior problems. These findings underscore the significant impacts of parental ACEs on multiple adverse health outcomes in children, with specific parental ACEs subtypes exerting unique effects. This highlight the significance of comprehending the intergenerational effects of different ACE subtypes, and emphasizes the urgency of interventions to address these issues.