搜索结果：Journal of pediatric rehabilitation medicine

BackgroundChildren's media both reflects and shapes societal attitudes toward physical disability. Despite its potential impact on self-concept and stigma, longitudinal, data-driven analysis of these portrayals remains scarce. This study aimed to quantify longitudinal trends in the tone and framing of physical disability representation in children's media and to explore implications for pediatric rehabilitation.MethodsA quantitative content analysis was conducted on 68 children's media productions (1933-2025) sourced from the Vanderbilt Peabody database. Content was filtered to age-appropriate ratings (G, PG, PG-13, TV-14). Three trained reviewers classified depictions of physical disability by clinical category (e.g., spinal cord injury, limb difference) and tone (Positive, Neutral, Negative) and coded for the presence of rehabilitation themes. Inter-rater reliability (&#x3ba;&#x2009;=&#x2009;0.83) was achieved. Statistical testing included Mann-Kendall trend analysis and Fisher's exact tests to compare pre-2000 vs post-2000 portrayals.ResultsPositive portrayals increased significantly from pre-2000 (63%) to post-2000 (90%) (p&#x2009;=&#x2009;0.01). A consistent upward trend across decades was confirmed (Z&#x2009;=&#x2009;3.47, p&#x2009;<&#x2009;0.01). Spinal cord injury was the most frequently depicted disability (40%); rehabilitation themes appeared in 24% of productions, more commonly post-2000. Productions with rehabilitation content were more likely to feature positive portrayals (94% vs 89%).ConclusionsOver nine decades, children's media has shifted toward more affirming representations of physical disability, particularly after 2000. Findings suggest that pediatric rehabilitation providers can use positive media examples to reinforce therapeutic engagement, normalize assistive devices, and address stigma in age-appropriate ways. Stories in children's movies and television can shape how young people see disability. To understand how these portrayals have changed over time, nearly a century of children's media was reviewed. Characters with physical disabilities were identified, including how they were presented and whether rehabilitation or recovery was part of their story. Portrayals of disabilities have become much more positive in more recent decades. Specifically, positive portrayals increased significantly from 63% pre-2000 to 90% post-2000. More recent productions also include more scenes that highlight rehabilitation and recovery. These shifts are important because positive images can help reduce stigma, encourage inclusion, and support the goals of pediatric rehabilitation.

Speech sound disorders are common in children and are associated with an increased risk of academic reading difficulties. The COVID-19 pandemic further highlighted the need for remote and digitalized assessment tools. In South Korea, standardized instruments such as the Urimal Test of Articulation and Phonation and Assessment of Phonology and Articulation for children are widely used but have limitations, including reliance on face-to-face evaluation, and the absence of automated scoring. This study aimed to develop and establish the content validity of an articulation assessment tool that can overcome these limitations and be integrated into digital therapeutics (DTx). A 3-round modified Delphi survey was conducted between July and September 2025 with 92% (23/25) of the invited experts, including 52.2% (12/23) physiatrists and 47.8% (11/23) speech-language pathologists, with a mean professional experience of 10.69 (SD 5.09) years. All participants (23/23, 100%) completed all rounds. Panelists evaluated the appropriateness of word lists, phonological environments, and scoring criteria. Quantitative analyses, including calculations of content validity ratio (CVR), content validity index (CVI), and median and IQR, were performed. Consensus thresholds were set at a CVR of &#x2265;0.39, a CVI of &#x2265;0.78, a median of &#x2265;3.5, and an IQR of &#x2264;1.0. Items were retained only when all 4 criteria were satisfied. While formal qualitative analysis was not performed, the research team internally reviewed and synthesized core keywords and themes from the experts' open-ended responses to guide the refinement of items. These findings were summarized into four key areas: (1) modernization of word stimuli, (2) expansion of phonological coverage, (3) refinement of scoring criteria to reduce ambiguity, and (4) enhancement of result interpretability through visualization. In round 2, a revised 35-word list was evaluated across 25 items, of which 20 (80%) met all consensus criteria. In total, 20% (5/25) of the items failed to meet at least one threshold, including phonological environment adequacy (CVR=0.48; CVI=0.74), scoring redundancy (CVR=0.13; CVI=0.57), usefulness of proportion of whole-word correctness or percentage of word proximity (CVR=0.39; CVI=0.70), contribution of mean phonological length (CVR=0.22; CVI=0.61), and usefulness of feature-based indexes (CVR=0.30; CVI=0.65; IQR 2). Items that reached consensus showed CVR values of 0.57 to 0.91, CVI values of 0.78 to 0.96, a median score of 4, and IQR values of 0 to 1. In round 3, all remaining items achieved consensus. This Delphi study developed a novel articulation assessment tool with robust content validity. This tool includes updated word stimuli, diverse analysis indexes, and visualization features, thereby enhancing its clinical utility and suitability for integration into artificial intelligence-based DTx. By standardizing and digitalizing articulation assessments, this tool has the potential to support personalized and accessible interventions for children with speech sound disorders.

Better evaluation of the contribution of the main diseases, injuries, and risk factors for mortality and life expectancy is crucial for more efficient policy making at the national and subnational levels in Iran. The aim of this study is to assess the effect of emerging causes of mortality on health, specifically COVID-19, which can help policy makers implement preventive measures in similar situations. In this systematic analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we present estimates of cause-specific mortality at the national and subnational levels in Iran from 1990 to 2023. New to this iteration of GBD, we present a decomposition analysis of the contribution of specific causes of death to net gain or loss in life expectancy across 31 provinces of Iran. We used an array of data sources including censuses, vital registration, and surveys for national and subnational estimates. The two leading causes of death in Iran were ischaemic heart disease and stroke in both 1990 and 2019. However, in 2020 and 2021, the COVID-19 pandemic displaced the leading causes of death, ranking first with age-standardised mortality rates of 286&#xb7;2 deaths (95% uncertainty interval 267&#xb7;9-310&#xb7;5) per 100&#x2008;000 in 2020 and 250&#xb7;0 deaths (233&#xb7;2-272&#xb7;5) per 100&#x2008;000 in 2021. COVID-19 ranked second and tenth in 2022 and 2023, respectively. Life expectancy at birth for both sexes combined declined from 78&#xb7;0 years (77&#xb7;7-78&#xb7;1) in 2019 to 74&#xb7;3 years (74&#xb7;0-74&#xb7;4) in 2020. It steadily recovered to 78&#xb7;8 years (78&#xb7;5-79&#xb7;2) in 2023. COVID-19 was the main cause of loss in life expectancy, by 4&#xb7;19 years, between 2019 and 2020. There was a net gain of 12&#xb7;4 years in life expectancy in Iran from 1990 to 2023. The net gain at the national level can be mostly attributed to reduced mortality from ischaemic heart disease (2&#xb7;61 years), stroke (1&#xb7;63 years), neonatal disorders (1&#xb7;26 years), transport injuries (0&#xb7;88 years), and neoplasms (0&#xb7;64 years). The decline in mortality rates of major causes continued to 2023 despite the pandemic. An exception was Alzheimer's disease, which showed a 4&#xb7;0% increase in rate between 2019 and 2023 and led to a net loss of 0&#xb7;04 years in life expectancy since 1990. Diabetes led to a net loss of 0&#xb7;09 years since 1990. There were variations between provinces in terms of age-standardised rates and the net change in life expectancy before and after the COVID-19 pandemic. The COVID-19 pandemic disrupted the rising trend of life expectancy in Iran, varying across provinces. Findings show that the health-care infrastructure and policies in Iran were not efficient in controlling the pandemic in 2020 and 2021, mainly due to inadequate vaccination coverage and timeliness, specifically for vulnerable subgroups. Sanctions may have aggravated the effect of COVID-19 on loss in life expectancy of Iranians. Despite the pandemic, the declining trend in age-standardised rates for top causes of mortality has continued to 2023, leading to a full recovery of life expectancy and underscoring the ultimate resilience of Iran's health system. Gates Foundation.

BACKGROUND: The issue of pediatric obesity is becoming increasingly severe, and it has significant implications for a variety of health conditions, such as orthopedic injuries. Obesity has been shown to influence surgical outcomes across various pediatric procedures, and lower extremity long bone fractures (LELBF) are prevalent in adolescents. One of the goals of this research was to look into the effect of obesity on the perioperative findings of pediatric LELBF. METHODS: In the Nationwide Inpatient Sample database, we examined the medical records of 15,896 individuals with LELBF who were less than 18 years old and had operative fixation of fractures from 2010 to 2019. Patients were divided into groups that were obese and non-obese individuals. Length of stay (LOS), total hospital charges, and unfavorable discharge rates were among the outcomes evaluated. RESULTS: Childhood obesity was present in 3.0% of the patients who were included. Obese patients exhibited a substantially prolonged duration of stay (median 3.0 days vs. 2.0 days, p < 0.001) and higher total expenditures ($45,055 vs. $40,561, p = 0.002). The rate of unfavorable discharge (transfer to rehabilitation or skilled-nursing facilities) was considerably higher in the obese group (4.16% vs. 2.0%, p < 0.001). Obesity was independently associated with several adverse outcomes such as extended LOS (odds ratio [OR] 1.566, 95% confidence interval [CI]: 1.281&#x2013;1.914; p < 0.001) and worse discharge outcomes (OR 2.130, 95% CI: 1.482&#x2013;3.060; p < 0.001). Conversely, obese patients had reduced odds of mechanical ventilation (MV) (OR 0.302, 95% CI: 0.118&#x2013;0.776; p = 0.013). CONCLUSIONS: Obesity adversely affects perioperative outcomes in pediatric LELBF surgeries, including longer hospital stays, and increased rates of adverse discharge. These findings underscore the importance of implementing targeted interventions, such as early obesity screening and perioperative risk stratification protocols, to improve outcomes for this vulnerable population.

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100&#x2008;000 population, and age-standardised rates per 100&#x2008;000 population. We estimated 1&#xb7;17 billion (95% uncertainty interval 1&#xb7;06-1&#xb7;31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14&#x2008;210&#xb7;7 cases (12&#x2008;849&#xb7;5-15&#x2008;940&#xb7;1) per 100&#x2008;000 population. These estimates represented a 95&#xb7;5% (75&#xb7;0-121&#xb7;2) increase in prevalent cases and 24&#xb7;2% (11&#xb7;4-41&#xb7;4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070&#xb7;5 DALYs (1519&#xb7;1-2750&#xb7;5) per 100&#x2008;000 population. Mental disorders contributed to 6&#xb7;1% (4&#xb7;8-7&#xb7;6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17&#xb7;3% (14&#xb7;8-20&#xb7;6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239&#xb7;6 [1643&#xb7;7-3014&#xb7;1] per 100&#x2008;000) than among males (1900&#xb7;2 [1399&#xb7;8-2510&#xb7;8] per 100&#x2008;000), and peaked in the 15-19 years age group (2617&#xb7;3 [1850&#xb7;6-3696&#xb7;8] per 100&#x2008;000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302&#xb7;4 (952&#xb7;7-1683&#xb7;7) per 100&#x2008;000 in Viet Nam to 3555&#xb7;8 (2661&#xb7;9-4715&#xb7;0) per 100&#x2008;000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853&#xb7;0 (1352&#xb7;1-2469&#xb7;3) per 100&#x2008;000 for middle SDI to 2184&#xb7;1 (1606&#xb7;1-2890&#xb7;3) per 100&#x2008;000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

Cyanotic congenital heart diseases, which occur in approximately 0.2% of live births in the United States, have high mortality rates if untreated, but survival to adulthood is common with current surgical interventions. Approximately 80% of all cyanotic congenital heart diseases are caused by tetralogy of Fallot (TOF), D-loop transposition of the great arteries (TGA), and congenital heart disease with single-ventricle circulation. Survivors of cyanotic congenital heart diseases benefit from multidisciplinary care including pediatric and adult cardiologists, congenital cardiac surgeons, and electrophysiologists. Ninety percent of patients with TOF survive more than 30 years after surgery to close the ventricular septal defect and repair the right ventricular outflow tract. Nearly all adults with repaired TOF develop right ventricular volume overload due to pulmonary regurgitation, and atrial tachycardias and atrial fibrillation occur in approximately 20% to 45% of patients by age 45 years. For D-loop TGA, which involves the aorta arising from the right ventricle and the pulmonary artery arising from the left ventricle, arterial switch procedures result in survival rates of 93% to 97% to age 30 years. After atrial switch operation, 30% to 50% of patients develop moderate or severe right ventricle dysfunction by age 25 years; atrial tachycardia occurs in 48% to 63% of patients at 32 to 40 years postsurgery, and sinus node dysfunction is common. Sudden cardiac death occurs at a mean age of 30 to 35 years (SD, 6.4 years) in up to 15% of adults who have undergone an atrial switch operation. Infants born with a single ventricle that supplies both systemic and pulmonary circulation are most often treated with staged open-heart surgical interventions, typically performed during a period from neonatal age to 6 years of age, culminating in the Fontan procedure, which connects the inferior and superior vena cava to the pulmonary arteries, allowing deoxygenated blood to flow to the lungs without a pumping ventricle. Survival rates for children who undergo the Fontan procedure are 50% to 80% at age 40 to 50 years, although these patients may develop New York Heart Association functional class III or IV (0.35% per person-year) and have increased risk of early death or heart transplant requirement (0.36% per person-year). With surgical intervention, survival to adulthood is common among patients with TOF, D-loop TGA, and single ventricle. However, these survivors of cyanotic congenital heart diseases are at risk of valve dysfunction, arrhythmias, heart failure, and premature death. Optimal care involves multidisciplinary management including pediatric and adult cardiologists, congenital cardiac surgeons, and electrophysiologists.

Comprehensive pain management in children requires a specialized skillset, with a limited number of clinicians possessing the level of expertise required to successfully navigate the complexities of holistic care. The emergence of pediatric anesthesia fellowship programs in sub-Saharan Africa presents an opportunity to embed a pediatric pain curriculum for trainees, improving the availability of specialist skill and knowledge in the field. Existing pain curricula fall short in addressing the sociocultural aspects of pediatric pain identified through research as being unique to the African context, and do not include elements of leadership and advocacy training required to navigate the complexities of resource-constrained healthcare settings. A Delphi survey including literature review, iterative rounds of surveys and expert consensus was used to establish a pediatric pain curriculum for pediatric anesthesia fellows undertaking advanced training in sub-Saharan Africa. The 22-member expert panel included anesthetists, nurses, surgeons, pharmacists, pediatricians, a physiotherapist and a patient-caregiver dyad with a lived experience of pain. After completing three rounds of surveys, a steering committee of five members was assembled to resolve outstanding items to achieve the final curriculum. The process yielded a curriculum containing 20 knowledge items and 23 skills items. Attitudes are a key component of the curriculum and were grouped into six themes. A further aspect of the process was the identification of foundational knowledge with which trainees should enter a fellowship training program. This was termed the foundational curriculum. Using a Delphi method, consensus has been achieved on a pediatric pain curriculum for pediatric anesthesia fellows in sub-Saharan Africa with potential to meet the identified need for transformative pain care in this patient population.

ObjectivePediatric head trauma is common, but computed tomography exposes children to ionizing radiation. This systematic review and meta-analysis evaluated the diagnostic accuracy of point-of-care ultrasound for pediatric skull fractures and clarified its role as an adjunct to clinical assessment rather than a replacement for computed tomography when intracranial injury is suspected.MethodsWe conducted a systematic review and bivariate random-effects diagnostic test meta-analysis guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and registered in the International Prospective Register of Systematic Reviews (Registration Number: CRD420251139217). PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception through 3 September 2025. Two reviewers independently screened studies, extracted 2&#x2009;&#xd7;&#x2009;2 diagnostic data, and assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsNine studies conducted in emergency department settings met the inclusion criteria. Point-of-care ultrasound demonstrated a pooled sensitivity of 0.90 (95% confidence interval: 0.84-0.94), specificity of 0.98 (95% confidence interval: 0.94-0.99), and an area under the summary receiver operating characteristic curve of 0.96 (95% confidence interval: 0.94-0.97). The summary positive likelihood ratio was 41.73 (95% confidence interval: 15.85-109.87), and the negative likelihood ratio was 0.10 (95% confidence interval: 0.07-0.17). Deeks' funnel plot showed no evidence of small-study effects (P&#x2009;=&#x2009;0.80).ConclusionsPoint-of-care ultrasound shows high diagnostic accuracy for detecting pediatric skull fractures and may support bedside risk stratification in selected children with low- or intermediate-risk mild head trauma. However, most isolated linear skull fractures are managed conservatively, and point-of-care ultrasound does not evaluate intracranial injury. Computed tomography decisions should therefore remain anchored in neurological status, injury mechanism, validated pediatric head injury decision rules, and clinician judgment.

Over 50% of patients participating in cardiac rehabilitation (CR) experience poor sleep and/or, closely related, psychological stress. Although stress management interventions are generally available, they are typically underutilised in CR, and sleep remains an underaddressed component within CR. This is concerning, as poor sleep and stress not only reinforce each other but are also associated with poorer cardiovascular health and lower quality of life. Therefore, the primary aim of the OPtimising CArdiac REhabilitation by REfining Sleep and STress (RESST) study is to investigate the (cost-)effectiveness of adding a behavioural intervention targeted at improving sleep and managing stress during CR (RESST intervention) on sleep and psychological stress. Furthermore, the study aims to explore the (bidirectional) associations between sleep, stress and lifestyle behaviours. This parallel-arm multicentre randomised controlled trial will include 200 CR patients across 3 major CR centres in the Netherlands who experience poor sleep and/or stress. Patients will be randomised in a 1:1 ratio to standard CR or standard CR with the RESST intervention. Standard CR is a structured programme combining exercise, lifestyle guidance and risk management. On top of standard CR, the RESST intervention consists of 5 in-person group sessions targeting sleep and stress and is based on Acceptance and Commitment Therapy and Cognitive Behavioural Therapy. Primary outcomes are accelerometer-assessed and self-reported sleep and perceived stress. Secondary outcomes include quality of life, psychosocial well-being, chronic stress biomarkers (hair cortisol and cortisone), momentary fatigue, momentary stress and physical activity. Linear mixed models will be used to assess changes in outcomes at 3-month (after intervention and/or CR completed) and 6-month follow-up. The momentary data collected with ecological momentary assessment and accelerometry will be analysed using multilevel linear mixed models to explore the (bidirectional) relationship between sleep, stress and other lifestyle components such as physical activity. This study was approved by the ethics committee of Erasmus MC, Erasmus University Medical Centre, Rotterdam, the Netherlands (MEC-2024-0238). The findings will be disseminated through publications in peer-reviewed journals, presentations at academic conferences and professional and patient publications. NCT06505109.

Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality in the United States, but little is known about long-term neurorecovery. We investigated the association between coma duration, ischemic injury, and seizure activity on post-TBI functional outcomes among pediatric patients admitted to inpatient rehabilitation (IPR). A retrospective review of pediatric and adolescent trauma patients (<18 y) admitted to an accredited pediatric IPR unit after TBI was performed. Patients were classified into short (&#x2264;7 d) and long (>7 d) coma duration. Outcomes were measured through the pediatric Functional Independence Measure scores measured at IPR admission and discharge, comparing subdomains of self-care, mobility, and cognition. A total of 111 patients met the inclusion criteria, with 57% experiencing short coma and 43% long coma. Most injuries were blunt with intracranial hemorrhage. Ischemic injury occurred in 23% and post-traumatic seizures in 31% of patients. Ischemic injury was associated with lower cognitive Functional Independence Measure scores at both admission (8.46 &#xb1; 6.03 versus 11.95 &#xb1; 7.83, P = 0.0195) and discharge (13.46 &#xb1; 9.73 versus 18.76 &#xb1; 8.92, P = 0.0054). Long coma was independently associated with lower self-care (relative rate: 0.80; 95% confidence interval: 0.66-0.96) and mobility outcomes (relative rate: 0.82; 95% confidence interval: 0.68-0.98). Coma duration, injury mechanism, ischemic injury, and seizure activity emerged as factors associated with functional recovery after TBI. Long coma duration was associated with increased hospital and rehabilitation resource utilization and lower likelihood of return to baseline function. Patients with ischemic injury demonstrated lower cognitive recovery scores, consistent with prior literature. Early recognition of these factors can guide therapy, family counseling, and discharge planning. These findings highlight the importance of targeted and individualized rehabilitation strategies for pediatric TBI patients.

Developmental dysplasia of the hip remains a preventable yet underdiagnosed condition. Conventional screening strategies that rely on physical examination demonstrate limited sensitivity and fail to achieve comprehensive population coverage. Although universal ultrasound screening has shown promise, evidence supporting scalable, sustainable, and nurse-led community-based implementation models within real-world public health systems remains limited. To evaluate a nurse-led community-based ultrasound hip screening program integrated into routine maternal and child health services in Japan using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. A prospective cohort study with a mixed-methods design. Three rural Japanese municipalities (February 2024 to August 2025). Public health nurses, midwives, infants, and their caregivers who underwent routine newborn home visits or child-rearing consultations in the participating municipalities. The existing maternal and child health services evaluated across the following dimensions: Reach (coverage rate); Effectiveness (the proportion and mean age of infants referred early to medical institutions, and caregiver-reported outcomes following referral); Adoption (nurse adoption rate); Implementation (the proportion of ultrasound images meeting Graf's criteria, examination time, operational challenges, and cost); and Maintenance (continuation and policy integration). Ultrasound images were uploaded to a secure encrypted cloud server and interpreted remotely by Graf-certified pediatric orthopedic surgeons, with structured feedback provided to nurses throughout the implementation process. A total of 818 examinations were performed in 349 infants. The estimated coverage rate was 95.6%, indicating a near-universal range. Standard-plane images meeting Graf's criteria were obtained in 85.8% of examinations. Non-Type I hips accounted for 8.7% of cases, and 7.0% of infants were referred for further evaluation. Of these referred infants, 97.6% visited medical institutions, 54.8% required continued follow-up, and 4.8% required treatment. Adoption was high, with 95.5% of trained nurses conducting screenings. Implementation challenges included infant positioning, data-upload errors, and limited digital integration; however, interprofessional feedback from orthopedic surgeons improved technical performance. Ultrasound visualization enhanced caregiver understanding and facilitated timely adherence to referral recommendations. All municipalities continued screening, demonstrating strong maintenance. Nurse-led ultrasound hip screening can be feasibly integrated into routine maternal and child healthcare systems. This model enables early identification of suspected developmental dysplasia of the hip without clinical signs, and offers an equitable approach in resource-limited settings from a precision public health nursing perspective. University Hospital Medical Information Network Clinical Trial Registry; UMIN000051929 (https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000059248). Registration date: September 16, 2023. Start of recruitment: November 01, 2023. Nurse-led community ultrasound hip screening achieved 95.6% coverage, and 8.7% of the screened infants had a suspected dislocation or hip dysplasia.

BackgroundHeadache following traumatic brain injury (TBI) is a common, yet disabling, disorder with diverse mechanisms and treatment needs that remain poorly defined. Pharmacological regimens are the primary source of remedies for individuals with post-traumatic headaches (PTH). The main objective of this review is to describe the efficacy of pharmacological medications for the treatment of PTH with a specific focus on the effect of these medications on headache characteristics and headache-related quality of life (QoL).MethodsThis systematic review (CRD42024537719) followed PRISMA and SWiM guidelines. PubMed, CINAHL, Scopus, PsycINFO and the Cochrane Library were searched in April 2024 for peer-reviewed articles published in English between 2009 and 2024. Eligible studies included randomized controlled trials, controlled cohort studies, and systematic reviews or meta-analyses evaluating pharmacological treatments for PTH in adults. Studies were excluded if they did not assess outcomes related to PTH pain, only included pediatric populations, used animal models, investigated only non-pharmacological interventions, were case reports, narrative reviews, editorials or conference abstracts, or did not involve human participants with TBI-related headache. Risk of bias was assessed using RoB-2 for Randomized controlled trials (RCTs) and ROBINS-I for the non-randomized studies of the effects of interventions.ResultsSixteen studies were included in the final review, comprising retrospective observational (n&#x2009;=&#x2009;7), non-randomized prospective (n&#x2009;=&#x2009;4) and randomized controlled trials (n&#x2009;=&#x2009;5). Most studies reported some improvements in headache frequency and intensity following pharmacological treatment, although findings for headache-related QoL were inconsistent. Erenumab showed potential benefits for persistent PTH in small, uncontrolled studies of civilian samples. However, findings on its impact on headache-related QoL should be interpreted with caution, given the high discontinuation rate observed. Prazosin demonstrated similar benefits in military populations, with minimal side effects. In the acute care setting, metoclopramide, co-administered with diphenhydramine to minimize side effects, was associated with short-term relief of headache symptoms. Of the RCTs, only two had a low risk of bias, of which only one specifically focused on PTH.ConclusionsPharmacological treatments for PTH may provide improvements in headache frequency and intensity; however, evidence for their efficacy is limited and inconsistent. Given the limited high-quality evidence overall, no specific clinical recommendations can be made at this time. Future research should prioritize rigorous, controlled studies, particularly comparative effectiveness trials, and explore holistic, personalized approaches that incorporate treatment of psychiatric comorbidities and consider patient context.

For youth living with neurodisabilities and rare conditions, transitioning from pediatric to adult care results in significant loss of services and supports. This article examines transition-related health systems, policies and provider roles in the context of Duchenne muscular dystrophy (DMD). DMD is a multi-systemic X-linked disorder mainly characterized by progressive muscle degeneration, with about 30% of patients presenting with neurodevelopmental comorbidities. Due to advances in respiratory and cardiac care, life expectancy has increased significantly, creating a new population of adults living with DMD. This demographic shift has exposed critical gaps in the transition from pediatric to adult health care. To date, there is no systematic review covering existing transition policies and programs. This article utilizes integrated care and continuity of care frameworks to examine transition-related health systems, policies, and provider roles. We conducted a PRISMA-compliant systematic review searching OVID Medline, Embase, PsycINFO, CINAHL, Web of Science, and SCOPUS from January 1, 2000, to August 31, 2025. Studies were included if they reported on health systems, programs, policies or health care providers' roles in DMD. For synthesizing evidence, we utilized Popay's Narrative Synthesis framework to analyze health systems, policies, and provider roles across included studies, allowing for an aggregation of a body of heterogenous data (quantitative, qualitative and mixed-methods). This methodological approach ensured that the review moved beyond a simple aggregation of findings to generate new insights into the structural gaps. 42 studies met the inclusion criteria. The programs described in these studies varied from residential life-skills training to respiratory-focused transition protocols. A significant disconnect was identified between international care guidelines and implementation; most initiatives are project-based rather than policy-driven. While neurology is central in pediatric care, respiratory and sleep medicine often become the de facto "medical home" for adults. Crucially, support for patients with neurodiverse development was only discussed in 4 of the 42 studies. This review underlines a lack of comprehensive care models for DMD transition, specifically within the high-resource settings that dominate the literature. Future policies must bridge the gap between project-based funding and sustainable health systems, specifically addressing neurodiversity and caregiver burden.

Paediatric severe pneumonia is a major cause of Paediatric Intensive Care Unit admissions. This review evaluates the extent that integrated nursing care, a comprehensive strategy that combines family-centred, psychosocial and routine interventions, benefits children with severe pneumonia. Integrated nursing care may enhance recovery by reducing fever, cough and hospital stay while improving lung function and quality of life. To evaluate the effectiveness of integrated nursing interventions in improving rehabilitation outcomes in paediatric severe pneumonia patients admitted to paediatric intensive care units. Systematic searches of PubMed, Scopus and Web of Science were used to find relevant research studies, which were then evaluated based on predetermined inclusion criteria. Then, meta-analysis assessing nursing interventions for paediatric severe pneumonia was conducted. Key outcomes included fever reduction, cough alleviation, shorter hospital stays and improvements in lung function and quality of life. The impact of interdisciplinary collaboration and family-centred care was also examined. Six studies involving paediatric patients with severe pneumonia were included. With a pooled mean difference of -1.764 (95% CI: -2.126 to -1.402; p&#x2009;<&#x2009;0.001), a meta-analysis revealed that integrated nursing care significantly improved clinical outcomes and expedited symptom resolution. When compared to standard care, integrated nursing interventions considerably reduced hospital stays, cough relief times and fever duration. Integrated nursing care improves recovery in paediatric severe pneumonia patients in PICUs. However, further research is needed to standardise nursing intervention protocols and optimise implementation across diverse healthcare settings. This review highlights the importance of structured nursing interventions, interdisciplinary teamwork and family-centred care in paediatric severe pneumonia management. Continuous nursing education is crucial for sustaining high-quality care and improving patient outcomes.

Young patients with acquired brain injury (ABI) often report diminished health-related quality of life (HRQoL) compared to healthy peers. Yet, this has not been investigated in a large multicenter outpatient-rehabilitation based cohort. Furthermore, a clear way to categorize HRQoL to better interpret scores is lacking, though this could be valuable for clinical use (i.e., for comparison with other populations). This cross-sectional study used the PedsQL&#x2122; Generic Core Scales 4.0 questionnaire with 23 items to assess patients' HRQoL, where lower scores mean a more diminished HRQoL. Children (8-12 years), adolescents (13-17 years), and young adults (18-25 years) with ABI, referred to a Dutch rehabilitation center, were included. Patient characteristics were analyzed using descriptive statistics and mean (standard deviation [SD]). HRQoL scores were calculated per age group and subsequently categorized using reference data(means, SDs) from healthy peers. HRQoL was categorized as 1 ('better HRQoL than healthy peers', >&#x2009;+&#x2009;1SD), 2 ('comparable HRQoL', -1SD to +1SD), 3 ('moderately diminished HRQoL', -1SD to -2SD), or 4 ('severely diminished HRQoL', < -2SD). Four hundred twenty-six young patients (aged 8-25 years) with ABI participated in the study; 233 were female (54.7%), and 334 had a diagnosis of traumatic brain injury (78.4%). Children, adolescents, and young adults had mean (SD) HRQoL total scores below age-specific Dutch healthy peer normative means (62.98 [14.39], 62.86 [16.82], and 59.34 [18.46], respectively). Based on the SD-based categorization using healthy peer reference data, 59% of children (55/93), 52% of adolescents (147/282), and 61% of young adults (31/51) were categorized in Category 4 ('severely diminished HRQoL'&#x2009;<&#x2009;-2SD relative to age-specific Dutch healthy peer norms). Measuring and categorizing HRQoL in outpatient rehabilitation may facilitate clinically meaningful interpretation of PedsQL scores by benchmarking to healthy peers, supporting shared decision-making at referral in young patients with ABI.

Classic lissencephaly is a malformation of cortical development that includes agyria and pachygyria. The major clinical symptoms are developmental impairment, muscular hypotonia, and drug-resistant epilepsy. The severity of the clinical phenotype depends on the associated gene and mutation. This study aimed to systematically investigate the genotype-specific course of the disease including neurodevelopmental outcome, medical complications, use of non-pharmacological supportive therapies, and its impact on the quality of life of the affected families. 47 patients with genetically and radiologically confirmed lissencephaly were included with mutation in LIS1/PAFAH1B1 (n&#x2009;=&#x2009;38), DCX (n&#x2009;=&#x2009;5 males), DYNC1H1 (n&#x2009;=&#x2009;2), TUBA1A (n&#x2009;=&#x2009;1) and TUBG1 (n&#x2009;=&#x2009;1) genes. Standardized questionnaires were completed by families and treating pediatricians. Quality of life was assessed with the PedsQL&#x2122; Family Impact Module. Prenatal abnormalities, most commonly microcephaly, were observed in 14/37 (38%) of LIS1/PAFAH1B1 patients and 2/5 (40%) of DCX patients. Early symptoms included microcephaly, developmental delay, muscular hypotonia, and epileptic seizures. The median age at suspected diagnosis was 5 months for LIS1/PAFAH1B1 patients and 9 months for DCX patients. Compared to LIS1/PAFAH1B1, DCX-related lissencephaly patients showed significantly better neurodevelopmental outcome in reaching more advanced milestones such as walking unassisted (z=-2.23, p&#x2009;=&#x2009;0.026) and speaking sentences (z=-2.53, p&#x2009;=&#x2009;0.011). Frequent medical complications included recurrent respiratory infections (14/38 (37%) of LIS1/PAFAH1B1 patients; 1/4 (25%) of DCX patients) and dysphagia/ vomiting (23/37 (62%); 2/4 (50%)), which may require tube feeding (15/38 (40%); 1/5 (20%)). A median of eight different supportive therapies was used per patient (range 1-17), with physiotherapy and respiratory therapy considered the most effective. The scores obtained for health-related quality of life (HRQL) were low (parental HRQL mean 61.23; SD 16.79). Our study confirms the severely impaired developmental potential and frequent neurological and medical complications in lissencephaly patients from an early age. The psychomotor prognosis in LIS1/PAFAH1B1-related lissencephaly is significantly worse compared to DCX-related lissencephaly. Supportive therapies are used intensively and are considered to be very effective. The disease puts a high burden on caregivers and the entire family. This emphasizes the need for appropriate epilepsy treatment, personalized care for patients and professional support for their families.

Children and youth with physical disabilities face significant psychosocial challenges compared to their able-bodied peers. Medical specialty camps provide space where children can enjoy a typical camp experience alongside peers with similar conditions, offering programming and support tailored toward various levels of ability. This paper aimed to assess the impact of such camps on the psychosocial well-being of children with physical disabilities. A literature search performed in PubMed and Science Direct uncovered n&#x2009;=&#x2009;33 research articles meeting the inclusion criteria. The existing literature consists of a mixture of qualitative and quantitative studies, collectively suggesting that medical specialty camps can lead to measurable improvements in children's quality of life, self-esteem, and self-perception, while also fostering positive social connections, enjoyment, belonging, and empowerment. However, questions remain about the long-term benefits of these camps, with extinguishing effects potentially being offset by follow-up programming. The absence of control data limits the strength of the conclusions that can be drawn. This review builds on the body of literature suggesting that medical specialty camps offer positive improvements to the lives of children and youth with illnesses and disabilities. Also, it suggests key components of effective research in this field, as well as avenues for future study.

Pediatric-onset multiple sclerosis (POMS) affects children's health-related quality of life (HRQOL). This study aimed to examine the role of parents' and children's perspectives on HRQOL. Since identification of predictors for HRQOL is crucial to intervention and patients' QOL, this study focused on identifying cognitive and emotional predictors of POMS patients' HRQOL. A cross-sectional study assessing HRQOL predictors from child and parent reports in 30 children with POMS (mean age = 15.76 years, 63% female). Children were assessed for HRQOL, psychological, and cognitive functioning. HRQOL was measured using self- and parent-reports on the Pediatric Quality of Life Inventory, evaluating physical health, psychological, social, and school functioning. Predictors included cognitive functioning (processing speed, attention, memory), psychological functioning (depression, anxiety), and disease severity (Expanded Disability Status Scale). Multiple regressions identified predictors of child- and parent-reported HRQOL, and correlations examined relationships between significant predictors and HRQOL subdomains. School functioning was the most affected HRQOL domain, followed by physical health, emotional, and social functioning. Self-reported HRQOL was predicted solely by psychological functioning: anxiety and depression significantly predicted child-reported HRQOL, with anxiety having the strongest impact. Parent-reported HRQOL was predicted by processing speed, attention, and depression, with cognitive functioning relating to school, physical, and social domains, while depression was linked to psychological HRQOL. Children's HRQOL perceptions were strongly shaped by anxiety and depressive symptoms, whereas parents emphasized mainly cognitive functioning. Integrating both perspectives in clinical assessments is essential. Addressing anxiety and depression in children, alongside cognitive rehabilitation and parental education, may enhance HRQOL in POMS.

In this cohort, we explored the DNA methylation changes of 3 genes of the canonical Wnt/&#x3b2;-catenin and RANKL/OPG pathways related to bone homeostasis in cord blood at birth. Those mothers with poor sleep quality in the first trimester of pregnancy had 5.9 times higher odds of complete OPG methylation compared to those with good sleep (adjusted OR&#x2009;=&#x2009;5.9; 95% CI 1.04-33.0; p&#x2009;=&#x2009;0.045). Maternal lifestyle factors during pregnancy can influence fetal development through epigenetic mechanisms, potentially affecting neonatal skeletal programming and long-term bone health. Sleep quality is an important, modifiable maternal factor, but its role in shaping epigenetic regulation of bone development remains unclear. We aimed to investigate the association between maternal sleep quality during pregnancy and DNA methylation of key genes of the canonical Wnt/&#x3b2;-catenin signaling pathway, Wnt Family Member 10B (WNT10B), &#x3b2;-catenin (CTNNB1), and osteoprotegerin (OPG or TNFRSF11B) in the offspring's cord blood samples at birth. A total of 300 pregnant women were recruited as a sub-study of the PERSIAN Birth Cohort-Isfahan. Maternal sleep patterns were assessed using the Pittsburgh Sleep Quality Index (PSQI). Methylation at cytosine-guanine (CpG) dinucleotide sites within the promoters of WNT10B, &#x3b2;-catenin, and OPG was quantified in offspring's cord blood at birth, and associations with maternal sleep quality across all trimesters were assessed. Poor sleep quality in the first trimester was significantly associated with increased OPG methylation (adjusted OR&#x2009;=&#x2009;1.40, 95% CI 1.05-1.8, p&#x2009;=&#x2009;0.023). Mothers with poor sleep quality (PSQI&#x2009;&#x2265;&#x2009;5) in the first trimester had 5.9 times higher odds of complete OPG methylation compared to those with good sleep quality (adjusted OR&#x2009;=&#x2009;5.9, 95% CI 1.04-33.0, p&#x2009;=&#x2009;0.045). However, associations with WNT10B and &#x3b2;-catenin were not statistically significant. Maternal sleep quality during early gestation may influence the DNA methylation and epigenetic programming of bone-related genes in neonatal cord blood, emphasizing the importance of maternal lifestyle as a modifiable factor shaping early-life bone health.