搜索结果：BMC pediatrics

Health information technologies are widely used in hospitals to reduce the risk of medication errors. However, evidence on their impact on medication management and patient safety in pediatric settings remains limited. The aim of this study was to assess safety culture in medication management and medication error reporting in pediatric wards and to identify areas for improvement. A survey was developed and presented on the annual meeting of Medicines for Children Network, Norway, attended by 80 physicians, pharmacists, and nurses. Following adjustments, the questionnaire was piloted with two physicians, three pharmacists, and three nurses. The survey was then distributed by e-mail to all pediatric wards in Norway. We used the SEIPS (Systems Engineering Initiative for Patient Safety) model to guide the analysis. In total 102 nurses, 24 physicians and seven pharmacists responded, representing 19 out of the 22 (86%) pediatric wards. Access to health information technology adapted to pediatrics, including electronic health records, electronic medication administration records, and clinical decision support systems, varied across hospitals and across stages of the medication management process. Respondents generally agreed that a well-established reporting culture promotes learning. A majority also expressed a need for greater involvement in the review of reported medication errors, and more extensive training regarding patient safety and reporting culture. Hospital staff demonstrated generally positive awareness of pediatric patient safety. Medication management seemed to be affected by the ongoing implementation of new health information technology, suggesting opportunities for better health information technologies adapted to pediatric wards. Persistent barriers to medication error reporting may limit opportunities for learning and improvement.

Traditional clinical skills training faces challenges such as limited standardized patient resources, high costs of simulation equipment, and restricted opportunities for repeated practice. Generative artificial intelligence (GAI), particularly large language models, has attracted increasing attention as a potential tool for simulation, feedback, and adaptive learning in medical education. However, the research landscape and thematic development of GAI in clinical skills training remain insufficiently mapped. A bibliometric analysis was conducted using literature retrieved from the Web of Science Core Collection from January 1, 2011 to April 1, 2025. VOSviewer, the Bibliometrix R package, and CiteSpace were used to analyze publication trends, country and institutional contributions, journal distribution, collaboration networks, keyword co-occurrence, co-cited references, and citation bursts. A total of 322 publications were included. Research activity remained limited before 2023 but increased rapidly thereafter. The United States contributed the largest number of publications, followed by China and India. Major contributing institutions included the National University of Singapore, Gazi University, and Nova Southeastern University. Frequently publishing journals included JMIR Medical Education, Medical Teacher, and BMC Medical Education. Keyword and thematic analyses showed that current research attention is mainly concentrated on ChatGPT, large language models, natural language processing, clinical reasoning simulation, personalized learning, virtual patient interaction, and ethical governance. Research on GAI in clinical skills training is in an early but rapidly expanding stage, with growing scholarly attention to language-model-driven educational applications and related ethical issues. The bibliometric findings reflect research activity, knowledge structure, and thematic priorities rather than direct evidence of educational effectiveness. Future studies should adopt rigorous empirical designs and standardized evaluation frameworks to assess the effectiveness, safety, and appropriate boundaries of GAI applications in clinical skills training.

This study aimed to compare rectal, axillary, tympanic, and non-contact forehead temperature measurements in neonates monitored in the neonatal intensive care unit and to evaluate these methods according to gestational age. This prospective observational study was conducted in the Neonatal Intensive Care Unit of Van Yüzüncü Yıl University Dursun Odabaş Medical Center between November 2025 and February 2026. A total of 126 neonates whose clinical condition was suitable for temperature measurement using four different methods were included in the study. Rectal, axillary, tympanic, and non-contact forehead temperatures were measured sequentially by the same researcher. Differences between measurement methods were evaluated using the paired-samples t-test, while comparisons among gestational age groups were analyzed using ANOVA or the Kruskal-Wallis test, as appropriate. Agreement among methods was assessed by Bland-Altman analysis, correlation analysis, and regression analysis. The mean gestational age of the enrolled neonates was 34.2 ± 4.1 weeks. Mean temperature values were 37.25 ± 0.40 °C for rectal measurements, 36.41 ± 0.37 °C for axillary measurements, 37.02 ± 0.37 °C for tympanic measurements, and 36.70 ± 0.10 °C for non-contact forehead measurements. Rectal temperature values were significantly higher than those obtained by all other methods. No significant differences in measurement methods were observed among gestational age groups. The smallest mean difference compared with rectal measurements was observed with tympanic measurements. The correlation and regression performance of non-contact forehead measurements were lower. Tympanic measurement appears to be the closest alternative to rectal temperature measurement; however, none of the non-invasive methods demonstrated a level of agreement sufficient to completely replace rectal measurements.

Congenital anomalies of the kidney and urinary tract (CAKUT) encompass a wide spectrum of structural anomalies of the kidney and urinary tract. Evidence from registries in high-income countries suggests that it is a major cause of morbidity in children, with up to 50%-60% of chronic kidney disease (CKD) resulting from CAKUT. The picture is not so clear in medium and low-income countries, mainly due to lack or nonexistence of reliable registries, constraints of skilled personnel, diagnostic capacities, accurate data gathering and poor health-seeking behaviour. Information on children managed from birth to 18 years with CAKUT, from January 2010 to end of December 2022 in the renal unit of the paediatric department, Jos University Teaching Hospital was extracted for review from the general paediatric renal database. One hundred and one children had CAKUT, representing (14.87%) of all children seen in the renal unit during the period. The prevalence of CAKUT among the general paediatric population during the same period was 0.53%. The mean age at diagnosis was 6.35 ± 5.53 years (76 months). There was male preponderance, n = 72(71.29%). The most common kidney anomaly was cystic kidney, n = 17(16.83%), while the most common urologic anomaly was pelvi ureteric junction obstruction (PUJo) n = 26 (25.74%). Recurrent fever and abdominal pain were the commonest symptoms in older children. The antenatal detection rate was very low, only nine (8.9%). Pelvi ureteric junction obstruction was the commonest single anomaly. Antenatal ultrasound detection rate was very low and recurrent fever and abdominal pain were the most frequent symptoms in older children.

Kawasaki disease (KD) is an acute, self-limited vasculitis in children that can lead to significant cardiovascular complications. Gastrointestinal manifestations and related laboratory abnormalities are common in KD, but their association with cardiovascular involvement remains incompletely understood. This study aimed to evaluate the relationship between gastrointestinal-related laboratory and imaging findings and echocardiographic outcomes in pediatric KD. We conducted a retrospective study of 258 children with KD admitted from 2019 to 2024. Demographic, clinical, laboratory, and imaging data, including echocardiography and abdominal ultrasonography, were collected. Univariate and multivariate logistic regression analyses were performed to identify cardiovascular involvement, including coronary artery aneurysm, dilatation, brightness, and valvular abnormalities. Among 258 patients (mean age 3.53 ± 2.69 years; 67.4% male), abnormal echocardiographic findings were observed in 70.7%. Coronary artery aneurysms and dilatation occurred in 9.8% and 9.4%, respectively. Abnormal abdominal sonography was detected in 21.3%. Multivariate analysis identified male sex, anemia, hypoalbuminemia, elevated alkaline phosphatase, elevated C-reactive protein, and prolonged partial thromboplastin time as independent associated factors of cardiovascular involvement in KD patients. Gastrointestinal-related laboratory abnormalities are significantly associated with cardiovascular involvement in children with KD. Early recognition of high-risk patients, particularly males with anemia, hypoalbuminemia, elevated inflammatory markers, and abnormal liver enzymes, may assist in early risk stratification and intensified cardiac surveillance in the acute phase of KD.

Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021-30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). In 2023, there were 50·9 million (95% UI 46·1-56·1) road injury incident cases, 1·34 million (1·04-1·58) deaths, and 75·3 million (59·8-89·2) DALYs globally. Road injuries were the leading global cause of death among males aged 10-39 years. Between 1990 and 2023, age-standardised incidence decreased by 38·3% (95% UI 36·9-39·7) and mortality decreased by 32·3% (6·1-49·0), but progress varied widely by World Bank income group. Mortality in low-income countries (43·8 [95% UI 31·7-56·0] deaths per 100 000 population) was approximately six times higher than in high-income countries (7·5 [7·1-7·9] deaths per 100 000), despite the high-income countries showing the highest age-standardised incidence rates (858·1 [95% UI 781·9-947·1] cases per 100 000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the USA, saw increases. More severe injuries tended to occur in low-income and middle-income countries. Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post-crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential. Gates Foundation.

Macrolide resistance is common in pediatric Mycoplasma pneumoniae pneumonia (MPP), but its relationship with clinical phenotype, short-term in-hospital course, and radiographic severity remains uncertain. We aimed to characterize macrolide resistance-associated sites and their clinical correlates in hospitalized children with MPP, focusing on A2063G and pulmonary consolidation. This retrospective study included children aged&#x2009;<&#x2009;14 years hospitalized with MPP at Shantou Central Hospital, China, from January 1 to December 31, 2024. All patients had undergone throat-swab targeted next-generation sequencing within 24&#xa0;h of admission as part of routine clinical diagnostic work-up. This retrospective study used secondary data extracted from clinical diagnostic reports and electronic medical records. Four macrolide resistance-associated sites were interrogated: A2063G, A2064G, A2067G, and C2617G. Clinical, laboratory, radiographic, and short-term in-hospital outcome variables were compared by A2063G resistance-site status and by pulmonary consolidation. Multivariable logistic regression was performed for A2063G resistance-site status and pulmonary consolidation. Firth penalized logistic regression was used as a sensitivity analysis for the A2063G model. Among 402 hospitalized children with MPP, A2063G was detected in 362 (90.0%), whereas A2064G, A2067G, and C2617G were not detected. Monthly case counts peaked during June-August, while the proportion of A2063G remained consistently high throughout the year. Pulmonary consolidation was present in 103 patients (25.6%) and was less frequent in A2063G-positive than in wild-type cases (23.2% vs. 47.5%, P&#x2009;=&#x2009;0.002). In multivariable analysis, pulmonary consolidation was independently associated with lower odds of A2063G positivity (OR 0.370, 95% CI 0.187-0.732; P&#x2009;=&#x2009;0.004). For pulmonary consolidation, A2063G positivity remained independently associated with lower odds after adjustment for age, Tmax_24h, and CRP (OR 0.378, 95% CI 0.190-0.752; P&#x2009;=&#x2009;0.006). No clear differences were observed by resistance-site status in systemic inflammatory profile, overall clinical course, or in-hospital resource use. Overall, short-term in-hospital outcomes were favorable, with no deaths. In hospitalized children with MPP from the Chaoshan region of southern China in 2024, A2063G was the dominant macrolide resistance-associated site. In this cohort, A2063G positivity was not accompanied by more frequent pulmonary consolidation, a more severe clinical phenotype based on the available indicators, or worse short-term in-hospital outcomes. These findings suggest that, in pediatric MPP, predominance of a resistance-associated site, radiographic severity, and short-term clinical course may not necessarily vary in parallel.

Maintaining a balanced immunity between pathogen defense and tolerance to environmental antigens in neonates is essential for survival and the establishment of life-long immune homeostasis. Instructed by environmental signals, type 1 conventional dendritic cells (cDC1) contribute to both processes but how the balance may be achieved is unclear. Here, we uncover an interferon (IFN)&#x3b3;-driven regulatory circuit in early life that relays dietary cues to spleen cDC1. IFN&#x3b3;-mediated STAT1-signaling induces an immunogenic maturation program in spleen cDC1 that enables them to shape the effector differentiation of antigen-experienced effector memory CD8&#x207a; T cells. This cDC1 program emerges during the transition from breastfeeding to solid food at weaning, occurs in germ-free mice, and remains operative to dietary intervention in adult mice. At weaning, this IFN&#x3b3; signal enables spleen cDC1 to shape the effector phenotype of food-antigen-specific CD8+ T cells in a feedforward manner, thereby recalibrating the developing T cell pool. Our findings identify diet as a modifiable cue that can tune systemic cDC1-mediated immunity, opening new opportunities to steer immune responses during early life and beyond.

Gut colonization with multidrug-resistant (MDR) Klebsiella pneumoniae is commonly associated with an increased risk of extraintestinal infections among hospitalized patients. Extensive antibiotic exposure during the COVID-19 pandemic, is a critical contributing factor for the emergence of resistant strains. This investigation sought to elucidate the phenotypic and molecular resistance traits of carbapenem-resistant K. pneumoniae (CRKP) and extended-spectrum &#x3b2;-lactamase-producing K. pneumoniae (ESBL-KP) colonizing the gut of pediatric patients with confirmed COVID-19. A cross-sectional study was conducted from October 2020 to March 2022 at a tertiary pediatric hospital in Fayoum, Egypt. Fecal samples were collected from hospitalized pediatric COVID-19 patients. K. pneumoniae isolates were identified using standard microbiological methods. Antimicrobial susceptibility testing was carried out in accordance with the CLSI guidelines. ESBL and carbapenemase production were assessed phenotypically, while resistance genes were detected by multiplex and uniplex PCR. Microtiter plate method was used to assess biofilm formation. K. pneumoniae was detected in 36 of 71 patients (50.7%) using antibiotic-supplemented selective culture. The isolated strains were exclusively resistant, including 22 CRKP and 14 ESBL-KP. Colistin susceptibility was maintained in all isolates. CRKP strains showed significantly increased rate of resistance to fluoroquinolones and amikacin compared with ESBL-KP. BlaNDM gene (54.5%) and blaKPC (45.5%) were detected among CRKP isolates. ESBL-associated genes blaCTX-M, blaTEM, and blaSHV were prevalent in both groups. Biofilm formation was common and comparable between CRKP and ESBL-KP isolates. A high prevalence of fecal carriage of MDR K. pneumoniae, driven by carbapenemase-producing strains, was observed among hospitalized pediatric COVID-19 patients. These outcomes highlight the necessity for routine colonization surveillance, optimized antimicrobial stewardship, and strengthened infection control strategies in pediatric settings.

Thermal stress has been associated with gestational diabetes mellitus (GDM), but ambient temperature alone inadequately captures integrated thermal stress. The Universal Thermal Climate Index (UTCI) is comprehensive, while residential greenness's role remains unclear. This study aimed to investigate the nonlinear and lagged associations between maternal thermal stress, assessed using the UTCI, and GDM risk, and to examine whether residential greenness modified these associations. This hospital-based prospective birth cohort included 2,984 pregnant women recruited in Fuzhou, China, between January 2020 and October 2024. GDM was defined by a 75-g oral glucose tolerance test (OGTT) or a documented clinical diagnosis during pregnancy. Maternal thermal exposure during the 12-week preconception period and the first 24 weeks of pregnancy was assessed using UTCI based on spatiotemporally matched reanalysis data. Residential greenness was characterized using the annual mean Enhanced Vegetation Index (EVI). Distributed lag nonlinear models were applied to examine the nonlinear and lagged associations between UTCI and GDM and to evaluate whether residential greenness modified these associations. Compared with the median UTCI, lower UTCI during the 12-week preconception period was associated with a lower GDM risk (RR&#x2009;=&#x2009;0.67, 95% CI: 0.53-0.84), whereas it was associated with an increased risk during the first trimester (RR&#x2009;=&#x2009;1.15, 95% CI: 1.02-1.28). Higher UTCI showed delayed associations with GDM, with the strongest risk observed during the second trimester (RR&#x2009;=&#x2009;1.17, 95% CI: 1.01-1.36). Women with junior college or undergraduate education were more susceptible to thermal stress. Residential greenness modified the UTCI-GDM association during the preconception period, with lower risks observed under combinations of lower UTCI with moderate-to-low EVI and higher UTCI with extremely high EVI. The association between thermal stress and GDM varied across exposure windows. Preconception cold exposure was associated with a lower GDM risk, whereas early-pregnancy cold exposure was associated with a higher risk. The second trimester appeared to be a critical susceptibility window for heat-related GDM risk. Residential greenness modified the UTCI-GDM association during the preconception period. These findings support time-specific thermal exposure interventions and urban greening strategies to reduce maternal thermal vulnerability and improve GDM prevention.

Pediatric neurology training must evolve to meet increasing clinical complexity and rapid advances in neuroscience while maintaining high standards of family-centered care. In Saudi Arabia, structured residency programs have expanded under national accreditation frameworks; however, systematic evaluations of curriculum adequacy from the faculty perspective remain limited. This study aimed to comprehensively evaluate the pediatric neurology training curriculum within the Saudi Commission for Health Specialties (SCFHS)-accredited training system (including programs in Saudi Arabia and the United Arab Emirates [UAE]) from the faculty perspective, identifying strengths, gaps, and differences between program directors (PDs) and non-director faculty. We conducted a multi-institutional cross-sectional study between September and December 2025 targeting pediatric neurology faculty, including PDs, deputy directors, core faculty, and clinical staff involved in resident education. A validated 47-item questionnaire assessed satisfaction across six core curriculum components (educational resources, graduate autonomy and safety, clinical knowledge, clinical-academic balance, research opportunities, and professionalism), identified priority training gaps, and collected qualitative recommendations. Quantitative data were analyzed using descriptive statistics, non-parametric comparisons, correlation analysis, and exploratory multivariable linear regression. Open-ended responses underwent inductive thematic analysis. Forty-three consultants participated, including nine PDs. Overall satisfaction was moderate, with the highest ratings for resident professionalism (mean 3.8/5) and the lowest for clinical-academic balance (2.8/5) and research opportunities (2.9/5). Genetics and hereditary diseases (74%), neuroimmunology (70%), and neurodevelopmental disorders (63%) were the most frequently cited domains requiring greater emphasis. PDs reported significantly lower overall satisfaction than non-directors (&#x3b2; = -0.37, p&#x2009;=&#x2009;0.02), particularly regarding academic time and research infrastructure. Satisfaction with educational resources strongly correlated with perceived research opportunities (&#x3c1;&#x2009;=&#x2009;0.58, p&#x2009;<&#x2009;0.001). Qualitative themes highlighted excessive service demands, insufficient protected academic time, limited research mentorship, and the need for structured training in rapidly evolving subspecialties. Pediatric neurology training in the region demonstrates strong clinical and professional foundations but is constrained by systemic challenges in academic balance, research support, and subspecialty preparedness. These perception-based findings suggest that PDs' heightened concerns may inform future curriculum development. Potential areas for consideration include protected academic time, enhanced research infrastructure, and nationally coordinated curricula in high-priority domains. However, these are exploratory implications requiring further evaluation before implementation.

Pregnant women's emotional well-being is a major determinant of maternal and pregnancy outcomes. This study aimed to estimate the prevalence of pregnant women's perceived unhappiness with their current pregnancy, and to examine the reasons and factors associated with such feelings in Quelimane district, Central Mozambique. A population-based pregnancy surveillance study was conducted during 2023-2024. Data included pregnant women's perceived status of unhappiness with their current pregnancy at realization, reasons for such feelings, and perceived reactions of their sexual partners. Variables associated with women's unhappiness were investigated within a couple-centered conceptual framework that views pregnancy-related unhappiness as the result of interacting socio-demographic, reproductive, and partner-level factors; using descriptive statistics and multivariate logistic regression (three sequentially adjusted models). Among the 1546 participating women, 24.5% referred being unhappy with their pregnancy, and this was higher among adolescents (42.2%), in daughters/grand-daughters/daughters-sisters-in-law (33.5%), residing in larger households (29.7%), un-married women (36.6%), first trimester of gestation (37.7%), without couple's communication about childbirth (48.9%), and with unhappy partner (74.5%). The leading reasons for unhappiness were unplanned pregnancy (30.2%), unwanted/undesired pregnancy (26.5%), and fear of consequences (17.7%). In the multivariate logistic regression analysis, the associations of socio-demographic (first model) and reproductive (second model) variables with unhappiness were progressively attenuated as the models were being fitted. In the fully adjusted model (third model), women's age and gestational age maintained strong association with unhappiness, with adolescents and older women showing higher odds of unhappiness compared to middle-aged adults (OR&#x2009;=&#x2009;2.18, 95% CI:1.43-3.32) and (OR&#x2009;=&#x2009;2.21, 95% CI:1.25-3.93), respectively; and women interviewed in the first and third trimester being more likely to be unhappy than those in the second trimester (OR&#x2009;=&#x2009;2.19, 95% CI:1.10-4.37) and (OR&#x2009;=&#x2009;1.51, 95% CI:1.08-2.11), respectively. However, partner-related variables emerged as strongly associated with maternal unhappiness, with partner's unhappiness with pregnancy showing ORs of 8.23 (95% CI:5.04-13.43), lack of couple's communication (OR&#x2009;=&#x2009;2.23, 95% CI:1.34-3.74), and partner's pregnancy intendedness showing ORs of 1.73 (95% CI:1.12-2.65). Nearly one in four women in Quelimane reported being unhappy with their pregnancy, and unhappiness was particularly frequent among adolescents, non-married, women in first gestational age, those without couple's communication, and with unhappy partners. While women's socio-demographic and reproductive factors contributed to unhappiness, partner's emotional response and couple communication were the most influential factors. These findings highlight the importance of couple-centered approaches in maternal health research and interventions, particularly for adolescents and other vulnerable groups.

暂无摘要（点击查看详情）

Tonsillectomy ranks among the most frequently performed surgical procedures in the pediatric population. Post-tonsillectomy hemorrhage (PTH) represents one of its most severe complications, potentially resulting in anemia, hemodynamic instability, reoperation, and even mortality. Nevertheless, the incidence of and risk factors for PTH are not well defined. Consequently, we performed a systematic review and meta-analysis to examine and identify risk factors for this postoperative complication. An extensive literature search was executed across six electronic databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Ovid MEDLINE) from their inception until June 1, 2025. We included observational studies (case-control, cohort, cross-sectional) that enrolled pediatric patients (aged 0-18&#xa0;years) undergoing tonsillectomy. Data analysis was performed using Stata 16.0 and Review Manager 5.4.1. A total of 18 studies, encompassing 844,123 children, were included in the analysis. The pooled incidence of PTH was 3% (95% CI 3%-4%; I2&#x2009;=&#x2009;98.61%). The following factors were identified as significant risk factors: increasing age (OR&#x2009;=&#x2009;1.12, 95% CI 1.10-1.13), age&#x2009;&#x2265;&#x2009;9&#xa0;years (OR&#x2009;=&#x2009;2.47, 95% CI 2.05-2.99), age&#x2009;&#x2265;&#x2009;12&#xa0;years (OR&#x2009;=&#x2009;2.40, 95% CI 1.83-3.03), male sex (OR&#x2009;=&#x2009;1.19, 95% CI 1.08-1.31), abnormal coagulation parameters (OR&#x2009;=&#x2009;3.14, 95% CI 1.15-8.56), a history of chronic tonsillitis (OR&#x2009;=&#x2009;1.55, 95% CI 1.10-2.19), severe tonsillar embedment (OR&#x2009;=&#x2009;2.74, 95% CI 1.66-4.50), surgery performed by a junior surgeon (OR&#x2009;=&#x2009;1.74, 95% CI 1.36-2.22), use of cold steel dissection techniques (OR&#x2009;=&#x2009;1.87, 95% CI 1.41-2.48), use of postoperative analgesics (OR&#x2009;=&#x2009;4.82, 95% CI 1.25-18.58), and poor postoperative diet (OR&#x2009;=&#x2009;4.60, 95% CI 2.22-9.52). This meta-analysis quantified a pooled PTH incidence of 3% in the pediatric population and identified multiple perioperative factors associated with increased odds of PTH. The findings may guide the risk stratification of patients and inform tailored preventive strategies and perioperative optimization, ultimately enhancing surgical safety and improving postoperative outcomes. PROSPERO CRD420251066627.

Acute intussusception is a common abdominal emergency in children. Although air enema reduction is an established effective treatment, the use of intravenous phloroglucinol alone for this condition has rarely been reported. This study aimed to evaluate the efficacy of phloroglucinol compared with air enema for pediatric acute intussusception and to develop and validate a predictive model for phloroglucinol treatment failure, aiding clinicians in early identification of high-risk children for timely management adjustment and prevention of severe complications. We retrospectively analyzed clinical data from 1149 children with acute intussusception admitted to our hospital between January 2014 and December 2023. Baseline characteristics, clinical presentations, and ultrasound findings were collected. We used chi-square test to compare treatment outcomes between the phloroglucinol group (n&#x2009;=&#x2009;757) and the air enema group (n&#x2009;=&#x2009;392). Children in the phloroglucinol group were randomly divided into training and validation sets at a 7:3 ratio. Independent risk factors for phloroglucinol treatment failure were identified using univariate and multivariate logistic regression analyses, and a predictive model was constructed accordingly. Model performance was assessed using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). (1) No statistically significant difference was observed in treatment success rates between the phloroglucinol and air enema groups (93.7% vs. 95.4%, P&#x2009;=&#x2009;0.227). (2) Multivariate logistic regression analysis identified duration of symptoms, vomiting, and intussusception depth as independent risk factors for phloroglucinol treatment failure (all P&#x2009;<&#x2009;0.05). A nomogram incorporating these factors achieved an area under the ROC curve (AUC) of 0.96 (95%CI: 0.94-0.99) in the training set and 0.93 (95%CI: 0.81-1.00) in the validation set. Calibration curves demonstrated excellent agreement between predicted probabilities and observed outcomes. DCA indicated a significant clinical net benefit of the model. Phloroglucinol appears to be an effective treatment option for pediatric acute intussusception. The developed nomogram, based on duration of symptoms, vomiting, and intussusception depth, exhibits robust predictive performance and may serve as a convenient and reliable tool for the early identification of children at high risk for phloroglucinol treatment failure, facilitating timely clinical decision-making.

Mental disorders impose a disproportionate burden on populations in low- to middle-income countries (LMICs) and low-income countries (LICs), yet longitudinal assessments across these settings remain limited. Using the Global Burden of Disease Study 2023, we investigated prevalence and disability-adjusted life years (DALYs) for 10 mental disorder subcategories across 76 LMICs and LICs from 1990 to 2023 and projected trends through 2050 via a generalized ensemble modeling approach. Age-standardized prevalence rose markedly between 1990 and 2023, from 10,759.9 (95% uncertainty interval, 9,560.1-12,088.6) to 13,929.3 (12,512.5-15,829.0) per 100,000 in LMICs and from 11,723.6 (10,577.7-12,987.5) to 14,979.1 (13,512.9-16,770.7) in LICs, accompanied by corresponding increases in age-standardized DALY rates. The most pronounced increases in both age-standardized prevalence and DALYs were observed during the COVID-19 pandemic. Anxiety disorders (total percentage change: 102.3% in LMICs; 67.3% in LICs), eating disorders (40.7% in LMICs; 4.8% in LICs), depressive disorders (28.6% in LMICs; 29.8% in LICs), and autism spectrum disorders (14.9% in LMICs; 22.5% in LICs) showed the largest increases in prevalence. Under a reference scenario where past trends persist, age-standardized prevalence is projected to reach 17,155.8 (14,449.5-20,212.5) per 100,000 in LMICs and 17,968.4 (15,109.8-21,090.9) in LICs by 2050. These findings reveal persistent and widening disparities in mental health burden across resource-limited settings, substantially exacerbated by the pandemic. Without targeted, scalable, and sustained policy interventions, the burden in LMICs and LICs will continue to worsen, underscoring the critical need for context-specific public health action. This study was funded by the Gates Foundation.

We evaluated the impact of the COVID-19 pandemic on adolescents born preterm versus at term. This prospective cohort study included participants aged 13-21&#xa0;years in the Environmental influences on Child Health Outcomes (ECHO) Cohort. Participants completed questionnaires from April 2020 to June 2022 about their behaviors during the pandemic and the impact of the pandemic on their social connectedness and overall well-being. Analyses compared adolescents born extremely preterm (before 28&#xa0;weeks of gestation; n&#x2009;=&#x2009;419) and those born moderate or late preterm (&#x2265;&#x2009;28&#xa0;weeks and&#x2009;<&#x2009;37&#xa0;week; n&#x2009;=&#x2009;118) with those born at term (n&#x2009;=&#x2009;1,598). Associations were expressed as adjusted prevalence ratios (PRadj) and 95% confidence intervals (CIs). Adolescents in both preterm groups were less likely than those born at term to participate in unhealthy behaviors, such as drinking alcohol and using marijuana (moderate preterm: PRadj 0.78 [95% CI 0.61, 0.99]; extremely preterm: PRadj 0.74 [95% CI 0.58, 0.94]). Girls born extremely preterm were more likely to report health-promoting/prosocial behaviors (PRadj 1.15 [95% CI 1.06, 1.25]). Participants born moderate or late preterm reported feeling more socially connected during the pandemic compared with pre-pandemic (PRadj 1.29 [95% CI 1.09, 1.52]); nonetheless, this group was more likely to report a negative overall impact of the pandemic on their lives (PRadj 0.84 [95% CI 0.76, 0.92]). During the COVID-19 pandemic, adolescent behaviors and self-reported impact differed for participants born preterm compared with those born at term. These findings can inform counseling for parents and adolescents during future national crises.

This study aimed to assess the diagnostic capability of a YOLOv7 deep learning algorithm for the computerized detection of periapical lesions from pediatric panoramic radiographs. Its potential utility as a supportive diagnostic tool and accurate diagnosis in mixed dentition cases was further assessed by comparing the algorithm's performance with the diagnoses made by dental students. In this study, a total of 408 panoramic radiographs were used, consisting of 333 original images and 75 images generated through feature-based preprocessing expansion. The YOLOv7 model was trained on 302 images, which included 227 original radiographs and 75 images specifically enhanced via grayscale conversion, noise reduction, and edge detection filters to emphasize structural pathological features. A relatively larger set was allocated for testing in order to enhance robustness despite the small sample size. The diagnostic capability of the algorithm and trainees was compared using accuracy, sensitivity, specificity, precision, F1 score, and error rate. YOLOv7 achieved higher diagnostic performance compared with the student group. Its sensitivity (76.1%) was also higher than that of the students (55.2%). The algorithm further demonstrated superior specificity (99.8% vs. 97.3%), precision (99.8% vs. 95.3%), and F1 score (86.4% vs. 69.9%). The findings suggest promising potential in the YOLOv7 algorithm's performance for detecting periapical lesions in deciduous teeth on panoramic radiographs, compared with the diagnostic accuracy of the students.

Dental caries remains the most prevalent chronic disease of childhood, with substantial consequences for children's health, development, and educational outcomes. Schools provide a strategic platform for oral health promotion, particularly through structured curricula aligned with the World Health Organization's Health Promoting Schools framework. However, clarity regarding the nature, scope, and implementation of oral health curricula within school settings remains limited. This scoping review aimed to map global evidence on school-based oral health curricula, examining their characteristics, delivery methods, stakeholder involvement, and assessment approaches. This review followed JBI Methodology for scoping reviews and PRISMA-ScR guidelines. Databases searched were Medline (Ovid), Cochrane Library, SCOPUS, CINAHL (Ovid), Dental & Oral Sciences source (Ovid), Web of Science, grey literature (like ProQuest, Google Scholar), ERIC, Epistemonikos, and government and professional dental associations' websites. Covidence software facilitated identification and screening of documents containing information about oral health in school curriculum. From 5,035 records identified, 42 documents met the inclusion criteria. The included evidence was heterogeneous comprising peer-reviewed studies, curriculum documents, websites, dissertations, conference proceedings, and media reports, with most published after 2000. The United States (n&#x2009;=&#x2009;15) contributed the largest share of evidence, followed by India (n&#x2009;=&#x2009;7) and United Kingdom (n&#x2009;=&#x2009;6). Oral health curricula predominantly targeted primary school children focusing mainly on preventive topics such as oral hygiene practices, diet, and regular dental check-ups. Integrated curricula (n&#x2009;=&#x2009;11)were reported more than stand-alone models (n&#x2009;=&#x2009;1). Teachers were primary curriculum facilitators(n&#x2009;=&#x2009;13). Only a minority of documents reported formal assessment methods, most commonly measuring changes in oral health knowledge and attitudes. Despite the high global burden of childhood oral diseases, evidence on structured school-based oral health curricula remains sparse and heterogeneous. Variability in terminology, curriculum design, delivery, and assessment highlights the need for standardized frameworks and clearer conceptualization of oral health curricula within school health programs. Strengthening and systematically integrating oral health into school curricula has the potential to support sustainable improvements in children's oral health and overall well-being.