Objective: This prospective study evaluated systolic and diastolic cardiac functions in pediatric cirrhosis using conventional and tissue Doppler imaging (TDI), and explored their correlation with liver severity scores. Methods: Conducted at Inonu University, we enrolled 75 pediatric cirrhotic patients (44 compensated, 31 decompensated) from Pediatric Gastroenterology and 61 controls of similar age and sex without structural/functional heart disease from Pediatric Cardiology outpatients. All underwent clinical, laboratory, and echocardiographic assessments. To address multiple testing, Bonferroni correction was applied. Adjustments for age, sex, and disease severity were integrated into the correlation matrices to control for confounding parameters. Results: The cirrhosis cohort exhibited significantly higher heart rates, ejection fractions, and aortic/pulmonary velocity-time integrals than controls (p < 0.05). Conversely, growth-independent diastolic indices revealed distinct relaxation impairment: transmitral E/A and annular e′/a′ ratios were significantly lower, while Mitral E/e′ was elevated (p < 0.05). Deceleration time, isovolumetric relaxation time, and Myocardial Performance Index (MPI) were significantly prolonged (p < 0.01). Decompensated patients demonstrated significantly higher left ventricular filling pressures (Mitral E/e′) than compensated patients and controls (p = 0.002). After adjusting for age and sex, the Pediatric End-Stage Liver Disease (PELD) score maintained significant positive correlations with heart rate (r = 0.408) and Mitral E/e′ (r = 0.433) (p ≤ 0.002). FIB-4 and APRI scores showed positive correlations with VTI and TAPSE, markers of right ventricular volume overload (p < 0.05). Conclusions: Hyperdynamic circulation appears to mask resting systolic metrics in pediatric cirrhosis. However, prolonged diastolic phases and increased MPI suggest presence of subclinical myocardial dysfunction, especially during clinical decompensation. Routine non-invasive liver staging scores show potential clinical utility as ancillary screening tools for early cardiovascular risk evaluation.
Osteogenesis imperfecta (OI) is the most common heritable bone-fragility disorder, with type I (non-deforming OI) representing its mildest classical phenotype (historically referred to as Lobstein disease). Intramedullary (IM) rodding is essential for managing recurrent long-bone fractures and progressive deformities, with the Fassier–Duval (FD) telescopic rod now being the standard choice. This narrative review, based on a structured search from the seminal 1959 description of IM rodding to 2026, synthesizes the design principles, the minimally invasive technique and the comparative outcomes of FD rodding of the lower limb, with explicit attention to type I disease. Across cohort studies, comparative series and a recent systematic review, telescopic rods consistently achieve lower revision rates and longer implant survival than static or non-telescopic devices, reducing reoperation odds by roughly three-quarters. Overall complication rates nonetheless remain high (commonly 33–55%) and are dominated by implant migration and failure of telescoping. Younger age and eccentric epiphyseal positioning after incomplete deformity correction increase migration risk. Type-I-specific evidence remains limited. A report published under the “Lobstein” designation involved a Sillence type IV patient and therefore does not constitute type-I-specific evidence. Retrospective data nevertheless suggest favorable implant survival with telescopic fixation, but definitive conclusions cannot yet be drawn. Proper technique, adjunctive bisphosphonate therapy and multidisciplinary care remain decisive. Phenotype-stratified prospective data are the principal unmet need.
The Fontan procedure has rewritten the natural history of many children with congenital heart disease and univentricular physiology. However, long-term survival is limited by the development of haemodynamic and multisystem failure, leading to high morbidity and mortality. Absence of a subpulmonary ventricular pump, chronically elevated central venous pressure, and reduced cardiac output, along with lymphatic dysfunction and progressive multiorgan involvement, define the clinical course of many patients with the Fontan procedure, resulting in the heterogeneous clinical entity of Fontan failure. This review provides a comprehensive overview of the pathophysiological mechanisms underlying Fontan failure and a critical analysis of the currently available advanced therapeutic options. Particular attention is paid to the current frontiers of mechanical circulatory support. Although the presence of a total cavopulmonary connection may represent an anatomical limitation, ventricular assist devices have gained attention both as a bridge to transplantation and, in selected cases, as a long-term strategy. Nonetheless, despite the high surgical complexity, heart transplantation currently represents the only definitive option for this patient population. Optimizing clinical outcomes in Fontan failure represents one of the most challenging frontiers in congenital heart disease. Achieving significant advances will require accurate risk stratification, timely transition to advanced therapies, and coordinated multidisciplinary collaboration.
Background/Objectives: Survival of infants born very preterm or with very low birth weight has improved without a comparable reduction in neurodevelopmental morbidity, and the exposures acting during neonatal intensive care are usually studied in isolation. We aimed to identify which prenatal, perinatal and postnatal factors are independently associated, domain by domain, with neurodevelopment at 24 months’ corrected age (CA) and with the composite outcome of neurodevelopment and survival. Methods: Single-centre prospective cohort of 146 infants (135 assessed at 24 months’ CA and 11 who died between day 8 of life and the assessment) with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g admitted to a level III unit (2018–2022). Neurodevelopment was assessed with the Bayley-III; a score < 85, rather than the conventional <70 being taken as pathological, was used, with the third edition yielding systematically higher scores. Eighty-one candidate exposures were screened; for each domain a primary composite outcome (score < 85 or death) and a secondary survivors-only outcome were analysed by exploratory multivariable logistic regression. Results: Twenty-nine of 164 eligible survivors (17.68%) were lost to follow-up and did not differ appreciably from the analysed cohort (all standardised differences ≤ 0.10). Severe intraventricular haemorrhage was associated with language, sepsis and anaemia requiring transfusion with motor, and male sex and sepsis with socio-emotional development, whereas no covariate was associated with cognition. No nutritional, metabolic or postnatal-growth variable was independently associated with any domain, and no association survived Benjamini–Hochberg control of the false discovery rate (optimism-corrected c-statistics 0.598–0.739). Conclusions: These findings are associations rather than evidence of causality; they are hypothesis-generating and warrant multicentre external validation and longer follow-up.
The evidence consistently indicates that parenting and family environments are important determinants of child and adolescent health [...]
Background: The development of motor skills in childhood contributes to overall well-being throughout life. However, delays in these skills without intervention may negatively affect both physical and psychological health. Objective: This study aimed to evaluate the effect of an intervention program on gross motor skills in Peruvian preschool children. Methods: A quasi-experimental study was conducted with a sample of 45 five-year-old children assigned to a control group (n = 24) and an experimental group (n = 21). The intervention consisted of an eight-session program of 45 min physical activities delivered over six weeks. The TGMD-3 was administered before and after the intervention in both groups. The data were analyzed through comparisons of pre–post group differences with p < 0.05. In addition, a repeated-measures mixed-model analysis was conducted, reporting β coefficients, standard errors, and 95% confidence intervals, with adjustment for confounding variables. Results: The experimental group showed a significant average increase of 10.67 points in overall motor skills and 6.67 points in locomotor skills compared to the control group. Moreover, the mixed models confirmed significant Time × Group interactions for both overall motor skills (β = 10.8, SE = 4.6, 95% CI [1.7, 19.8]) and locomotor skills (β = 6.2, SE = 2.3, 95% CI [1.7, 10.7]). Conclusions: The intervention program significantly improved fundamental motor skills in five-year-old children. In this regard, motor circuit-based programs represent an effective strategy to support early childhood development.
Background/Objectives: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood and may involve the temporomandibular joint (TMJ), sometimes with limited clinical manifestations. This report combines a narrative review of TMJ involvement in JIA with a 15-year follow-up of a patient with JIA-associated TMJ disease. The objectives were to summarize current evidence regarding the clinical assessment and management of TMJ involvement in JIA and to describe the relationship between long-term clinical and structural findings in an individual patient. Case Report: A 12-year-old girl with newly diagnosed oligoarticular JIA was referred by the pediatric rheumatologist to the Clinic of Orofacial Pain Management, National and Kapodistrian University of Athens. At referral, TMJ involvement was identified despite systemic antirheumatic treatment. The patient presented with orofacial pain, restricted mouth opening, mandibular deviation, multiple painful orofacial sites, maximum interincisal opening of 26 mm, reduced mandibular excursions, marked masticatory muscle tenderness, and an anterior open bite. Contrast-enhanced magnetic resonance imaging (MRI) demonstrated bilateral active TMJ synovitis, early condylar erosions, and anterior disc displacement, with reduction on the right and without reduction on the left. Management comprised systemic antirheumatic therapy together with a structured physiotherapy program and a maxillary stabilization splint. Results: At one-year follow-up, maximum mouth opening had increased to 50 mm, with substantial improvement in mandibular function and symptoms. Fifteen years after the initial TMJ assessment, the patient remained pain-free with satisfactory mandibular function and a maximum mouth opening of 46 mm. Panoramic radiography at long-term follow-up demonstrated bilateral condylar abnormalities, including flattening, osteophyte formation, and intraosseous cystic changes. Because the initial and long-term assessments were performed using different imaging modalities, these findings cannot be directly compared to establish longitudinal structural progression. Conclusions: This case illustrates dissociation between favorable long-term clinical and functional status and substantial structural abnormalities identified at follow-up in a patient with JIA-associated TMJ involvement. It also highlights the limitations of relying on clinical symptoms and function alone to characterize TMJ structural status. The literature supports multidisciplinary management and individualized clinical and imaging assessment of TMJ involvement in JIA; however, prospective studies with standardized serial imaging are needed to better define the relationship between clinical outcomes and structural changes over time.
Background: Physical activity and breakfast consumption are commonly clustered adolescent health behaviors, but Saudi evidence on their association is limited to a single city, and whether this relationship varies by sex or age remains untested. Objective: We aimed to examine the association between physical activity frequency and breakfast skipping among Saudi adolescents and determine whether it differs by sex and age. Methods: This cross-sectional study used 2019 Global School-based Student Health Survey (GSHS) data from adolescents in five Saudi cities (Riyadh, Jeddah, Dammam, Khamis Mushait, Tabuk; N = 5900). Cases with missing data on any analysis variable were excluded listwise (final N = 5431). Physical activity frequency and breakfast skipping were both assessed using self-reported GSHS questionnaire items. Logistic regression via generalized estimating equations (clustered on school) estimated adjusted odds ratios, adjusting for sex, age (years), grade, nationality, and city; moderation by sex and age was tested with interaction terms and a joint Wald test, and robustness was assessed with three sensitivity analyses. Results: The final analytic sample (N = 5431) had a mean age of 13.71 years (standard deviation (SD) 1.13) and was 54.6% female. Breakfast-skipping prevalence was 18.7%. Each additional physically active day was associated with 10% lower odds of breakfast skipping (adjusted odds ratio [AOR] = 0.90, 95% confidence interval [CI] 0.86–0.93, p < 0.001), a finding robust across all sensitivity analyses, including multiple imputation (OR = 0.89, 95% CI 0.87–0.92). Female sex, non-Saudi nationality, older age, and city of residence (higher odds in Jeddah and Dammam relative to Riyadh) were independently associated with greater odds of skipping. Neither sex nor age moderated the physical activity–breakfast association (joint Wald χ2(2) = 2.70, p = 0.259). Conclusions: Physical activity frequency was independently and robustly associated with lower breakfast skipping among Saudi adolescents, irrespective of sex or age, extending single-city evidence to a larger and more diverse population. School-based strategies that jointly promote physical activity and breakfast consumption may not require tailoring by sex or age, although this study did not evaluate intervention effectiveness, and this inference should be confirmed prospectively; city-level variation suggests monitoring and resource allocation may benefit from geographic disaggregation.
Background: Rare diseases collectively affect millions of children worldwide and are a major cause of pediatric morbidity, mortality, and lifelong disability. Although most have a genetic basis, obtaining a timely molecular diagnosis remains challenging because of substantial clinical and genetic heterogeneity. Advances in genomic medicine are transforming rare disease diagnosis and establishing genomics as the center of precision medicine. Methods: This review summarizes current evidence on genomic approaches for pediatric rare diseases, including established and emerging sequencing technologies, their clinical applications, implementation challenges, and future directions. Results: Whole-genome sequencing is increasingly being adopted as a first-line genomic test for suspected rare genetic disorders, particularly when the phenotype is heterogeneous or does not point to a specific diagnosis. Conventional cytogenetic and targeted molecular techniques remain important complementary approaches for selected phenotypes, variant classes, and orthogonal confirmation. Gene panels are effective for well-defined phenotypes, whereas whole-exome sequencing remains a high-yield approach for genetically heterogeneous disorders, particularly when whole-genome sequencing is not available or is not clinically indicated. Long-read whole-genome sequencing expands diagnostic capacity by detecting structural variants, repeat expansions, complex rearrangements, and non-coding pathogenic variants that frequently escape short-read technologies. Emerging multi-omics approaches further improve variant interpretation and help resolve previously unsolved cases. Beyond diagnosis, molecular findings guide personalized clinical management, genetic counselling, reproductive planning, and access to targeted therapies and genotype-driven clinical trials. However, broad implementation is constrained by challenges in variant interpretation, ethical and legal considerations, data governance, workforce capacity, cost, and inequitable access to genomic services. Artificial intelligence, international data-sharing initiatives, and coordinated healthcare networks are helping overcome these barriers and improve diagnostic equity. Conclusions: Whole-genome sequencing is increasingly emerging as a first-line genomic strategy for pediatric rare diseases, while complementary technologies, expert phenotyping, and iterative data interpretation remain essential for comprehensive and accurate diagnosis and equitable access to genomic medicine.
Background/Objectives: Indigenous children in Canada face higher rates of overweight and obesity compared to non-Indigenous children. Parents’ perceptions of their child’s body weight are shaped by broader systemic influences, including historical trauma and limited access to healthy food. This study aimed to evaluate the association between children’s actual body weight (measured by BMI) and parental perceptions among First Nations children. Methods: Participants were children from two Saskatchewan First Nations communities involved in the First Nations Lung Health Project (2013 and 2017). Self-administered questionnaires were distributed through schools to parents of children in Grades 1–12. The questionnaire collected data on health, environment, physical activity, and diet. Parents assessed their child’s weight as underweight, about the right weight, or overweight. BMI was calculated using clinically measured height and weight. Logistic regression was used to identify predictors of BMI misclassification. Results: Among 472 children with both survey and clinical data, 42.6% were boys. Clinically measured overweight prevalence was 52.3%, compared to 15.9% based on parental perception. Overall, 58% of parents accurately perceived their child’s weight status. Misclassification was more likely among children who engaged in at least 60 min of daily physical activity on more days per week. Conclusions: Parents underestimated their children’s overweight status compared to clinical measures. Questionnaire-based assessments significantly underestimated true weight status among school-aged First Nations children. These findings highlight the need to consider systemic and environmental factors when addressing childhood obesity in First Nations communities.
Background/Objectives: Exercise-induced bronchoconstriction (EIB) may persist despite apparently adequate asthma control and may remain unrecognized in children without prominent exercise-related symptoms. This study aimed to determine the prevalence of objectively confirmed EIB in children with controlled asthma who did not report prominent exercise-related respiratory symptoms and to identify factors associated with EIB. Methods: This cross-sectional study included 67 children with controlled asthma who underwent standardized exercise challenge testing with serial spirometry. Demographic, environmental, allergic, laboratory, aeroallergen sensitization, and baseline pulmonary function characteristics were evaluated. Children were classified as EIB-positive or EIB-negative according to their post-exercise FEV1 response. Factors associated with EIB were assessed using univariate analyses and multivariable logistic regression. Results: EIB was identified in 24 of 67 children (35.8%). Baseline pulmonary function was generally preserved and did not differ significantly between EIB-positive and EIB-negative children. A history of atopic eczema was more frequent in the EIB-positive group (37.5% vs. 14.0%; p = 0.035). Allergic rhinitis, food allergy, total IgE, eosinophil percentage, and aeroallergen sensitization were not significantly associated with EIB. In multivariable logistic regression, a history of atopic eczema remained associated with EIB (adjusted odds ratio, 3.95; 95% CI, 1.08–14.41; p = 0.038), although the wide confidence interval indicates substantial uncertainty in the effect estimate. Conclusions: EIB was objectively detected in more than one-third of children with controlled asthma without prominent exercise-related symptoms despite preserved baseline pulmonary function. A history of atopic eczema may help identify children with persistent susceptibility to exercise-induced airway narrowing who might otherwise remain unrecognized.
Parents play an important role in adolescent substance use prevention, yet the competencies underlying their protective role remain inconsistently conceptualized and measured. This scoping review aimed to map parental competencies as modifiable family-level protective factors for adolescent substance use prevention. Following Joanna Briggs Institute methodology and PRISMA-ScR guidance, nine electronic databases were searched from inception to 20 July 2026. Peer-reviewed original studies addressing parental competencies relevant to substance use prevention among adolescents aged 9–19 years were included. Competencies were mapped according to their conceptual domains and evidence roles. Thirty-two publications were included, identifying 11 parental competency domains. Relational bonding and family involvement (90.6%), prevention communication (87.5%), monitoring and supervision (62.5%), and rules, boundaries, and expectations (53.1%) were most frequently represented. Competencies were more often targeted in interventions than directly measured or examined in relation to adolescent substance-use outcomes, and measurement approaches varied considerably across studies. Parental competencies relevant to adolescent substance use prevention encompass multiple relational, communicative, supervisory, and behavioral capacities. The findings highlight important gaps between intervention content, competency measurement, and outcome-related evidence and provide a foundation for developing competency-based prevention interventions and measurement tools.
Helicobacter pylori infection is a major cause of gastric cancer, and eradication before advanced precancerous gastric changes develop provides a biologically plausible opportunity for primary prevention. Adolescence represents a strategically favorable, although not universally established, window for intervention in Japan because persistent childhood-acquired infection can be identified before extensive mucosal damage while school-based programs provide organized access to defined birth cohorts. This narrative review evaluates the evidence supporting population-based adolescent H. pylori screening, its potential harms and uncertainties, and the lessons derived from Japanese implementation. Representative programs demonstrate that organized screening is feasible but show substantial heterogeneity in participation, diagnostic pathways, antimicrobial resistance, eradication outcomes, and retention across the care cascade. Direct evidence that adolescent screening reduces future gastric cancer incidence or mortality is not yet available. As H. pylori prevalence declines, the balance among screening yield, diagnostic performance, antimicrobial exposure, cost, and equity will continue to change. International experience further indicates that prevention strategies should be matched to local epidemiology and healthcare systems. Adolescent screening should therefore be viewed as an adaptive prevention strategy whose target population, diagnostic pathway, and treatment approach require periodic reassessment.
Purpose: Hypernatremia is a common electrolyte disorder in pediatric intensive care units (PICU) and is associated with considerable morbidity and mortality. We aimed to evaluate underlying etiologies, clinical characteristics, and factors associated with outcomes in critically ill children with hypernatremia, while accounting for illness severity. Methods: We retrospectively analyzed pediatric patients with at least one serum sodium measurement > 145 mEq/L during their stay in a tertiary Level 3 PICU. Demographic, clinical, laboratory, Glasgow Coma Scale (GCS), and Pediatric Risk of Mortality (PRISM) data were collected. Factors associated with in-hospital mortality were evaluated using univariate and multivariable analyses. Results: A total of 113 children were included (mean age 4.8 ± 5.3 years; 57.5% male). Neurological disorders were the most common underlying disease category, while free water deficit was the most frequently identified etiology of hypernatremia. Overall in-hospital mortality was 15.9%. Mortality rates were 21.5% among patients with PICU-associated hypernatremia and 8.3% among those with hypernatremia within the first 24 h of admission; the difference was not statistically significant (p = 0.058). PRISM score remained independently associated with mortality (OR 1.124, 95% CI 1.059–1.193; p < 0.001), whereas serum sodium concentration was not significantly different between survivors and non-survivors. Conclusions: Among critically ill children with hypernatremia, mortality was higher than the overall PICU mortality rate but was primarily associated with overall illness severity rather than with the degree of hypernatremia itself. PRISM score, rather than serum sodium concentration, was independently associated with mortality, suggesting that hypernatremia may represent a marker of severe underlying illness rather than an independent determinant of outcome.
Background: Endotracheal intubation is a painful and stressful procedure for neonates, and premedication is recommended for non-emergent settings. However, there is no consensus on the optimal pharmacological regimen. In recent years, several drugs have emerged as treatment options to improve comfort and safety of neonates undergoing endotracheal intubation. Worldwide, a range of agents are used. Remifentanil is a short-acting opioid with rapid onset and recovery characteristics that may be useful for neonatal intubation. Methods: A structured search of PubMed/MEDLINE, Embase, and Cochrane Library databases (1990–December 2024) identified publications evaluating remifentanil for neonatal intubation. Clinical studies, pharmacokinetic investigations, reviews and guidelines were qualitatively synthesized with an emphasis on dosing, efficacy, safety, dosing, administration technique, and clinical context. Results: The literature search retrieved 45 publications, but only a small subset were randomized clinical studies. Findings generally support feasibility and short-term efficacy, while results vary across studies, particularly for intubation conditions and respiratory adverse events. Chest wall rigidity, apnea, and desaturation appear to be influenced by dose, administration rate, patient characteristics, and co-medication, although the available studies are too small and heterogeneous to define an optimal regimen. Conclusions: Remifentanil can be considered for selected non-emergent neonatal intubation and INSURE procedures when administered by experienced teams under appropriate monitoring conditions. Particular caution is warranted in clinically unstable infants, during LISA procedures where preservation of spontaneous breathing is desirable, and in settings where immediate airway rescue capabilities are unavailable. The study did not demonstrate clear superiority of remifentanil. Current evidence is limited and heterogeneous, and larger comparative studies with standardized dosing, administration, and outcome definitions are needed.
Background/Objectives: Neonates with hypoxic–ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) frequently develop coagulation abnormalities and bleeding complications, yet data on transfusion burden and its clinical correlates in this population remain limited. Materials and Methods: We performed a secondary analysis of a retrospective single-center cohort of neonates with HIE treated with TH between 2014 and 2022. Transfusion burden was defined as receipt of at least one blood component and coagulation/plasma products during hospitalization and the total number of transfusion episodes. Demographic, perinatal, biochemical, and clinical severity variables were collected. Univariable and multivariable logistic regression analyses were used to identify factors independently associated with transfusion exposure. Brain magnetic resonance imaging (MRI) findings were compared between transfused and non-transfused infants. Results: Among 142 included neonates, 74 (52.1%) received at least one blood product. The median number of transfusion episodes among transfused infants was 2 (IQR 1–3). Fresh frozen plasma and prothrombin complex concentrate were the most frequently administered products. Transfused infants showed higher markers of illness severity. In multivariable analysis, clinically visible bleeding (adjusted odds ratio [aOR] 12.95, 95% CI 1.34–124.97) and need for respiratory support (aOR 2.98, 95% CI 1.19–7.45) remained independently associated with transfusion exposure. Pathological brain MRI findings, including intracranial bleeding and hypoxic–ischemic injury, were more frequent among transfused infants. Conclusions: blood components and coagulation/plasma-derived products transfusions are common in neonates with HIE undergoing TH and appear to primarily reflect underlying disease severity. These findings highlight the need for optimized, evidence-based transfusion strategies in this vulnerable population.
Background/Objectives: While screening, brief intervention, and referral to treatment (SBIRT) is a widely recommended evidence-based approach for early detection and intervention for alcohol and other drug (AOD) use, limited guidance exists for implementing SBIRT among hospitalized adolescents with chronic medical conditions (A-CMCs). This exploratory qualitative study examined A-CMC and caregiver perspectives on factors that may shape the acceptability, feasibility, and equitable implementation of a proposed inpatient SBIRT approach for A-CMCs. Methods: Two separate focus groups were conducted in an urban pediatric hospital in 2023 with A-CMCs aged 13–18 (n = 7), who had a history of hospitalization for their medical condition, and their caregivers (n = 6). Data were coded using thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR) and the Health Equity Implementation Framework (HEIF), which captured implementation and equity-relevant determinants, respectively. Results: Although A-CMCs and caregivers recognized the importance of SBIRT within hospital settings, its acceptability hinged on the conditions of its delivery. The timing, relevance to current health needs, and modality of screening shaped an A-CMC’s willingness to disclose AOD use. Clinician communication style, including the use of a nonjudgmental tone and clear parameters for confidentiality, were also indicated as crucial for SBIRT delivery. Broadly, participants noted the significant impact that the sociopolitical context (e.g., stigma) and structural factors (e.g., financial burden) had on a family’s ability to benefit from SBIRT. Conclusions: In this exploratory qualitative study, participants identified confidentiality-forward, patient-centered workflows, and accessible follow-up supports as potentially important considerations for inpatient SBIRT among A-CMCs. These findings generate hypotheses for future co-design and implementation research across diverse pediatric inpatient settings.
Background/Objectives: We examined discharge-level associations between an administrative NQI03 numerator-code-positive bloodstream infection construct and hospital outcomes in very low birth weight (VLBW) discharges and whether the NQI03 short-stay criterion altered mortality estimates. Methods: Using the 2022 HCUP Kids’ Inpatient Database, we constructed an independent 500–1499 g cohort from ICD-10-CM birth-weight codes. Mortality, procedure-defined mechanical ventilation, and prolonged hospitalization (≥108 days, cohort P90) were modeled with adjustment for birth weight, completed gestational age, patient/discharge characteristics, and hospital characteristics. Missing baseline covariates were addressed with 50 multiple imputations; survey-design, transfer/inborn, short-stay, and model-specification sensitivities were examined. Results: Among 39,630 discharges from 1750 hospitals, 1655 (4.18%) were NQI03 numerator-code-positive. Multiple-imputation aORs were 1.20 (95% CI 1.005–1.432) for mortality, 2.50 (2.14–2.93) for mechanical ventilation, and 2.02 (1.75–2.33) for prolonged hospitalization; corresponding adjusted risk ratios were 1.17, 1.29, and 1.60. Secondary complete-case record-level standardized probabilities were 7.5% versus 6.5%, 58.6% versus 42.6%, and 15.4% versus 9.5%, respectively; uncertainty for these estimates is reported using hospital-cluster bootstrap confidence intervals. Of 3041 deaths, 1528 (50.25%) occurred during stays <3 days; imposing LOS ≥ 3 days increased the mortality aOR to 1.96. Conclusions: NQI03 numerator-code-positive bloodstream infection showed a modest, imprecise association with mortality and more pronounced associations with mechanical ventilation and prolonged hospitalization. Mortality estimates were sensitive to short-stay eligibility. Because infection timing is unavailable, findings are non-causal discharge-level associations.
Objectives: Mental health problems and post-traumatic stress symptoms are prevalent among adolescent refugees, yet little is known about the role of resilience in relation to these difficulties among Syrian adolescents. This study examined the unique contribution of resilience to mental health problems and post-traumatic stress symptoms after controlling for age and gender. Methods: Participants were 501 Syrian refugee adolescents residing in Ankara, Türkiye (63.67% male; aged 12–18 years, M = 15.72, SD = 1.61), recruited through multistage cluster sampling in 15 schools. They completed the Brief Resilience Scale, the Children’s Revised Impact of Event Scale (CRIES), the Depression, Anxiety, and Stress Scale, and a socio-demographic questionnaire. Five hierarchical multiple regressions were conducted, entering age and gender at Step 1 and resilience at Step 2. Results: After controlling for age and gender, resilience was significantly and negatively associated with depression (β = −0.11, p < 0.05), anxiety (β = −0.19, p < 0.01), stress (β = −0.15, p < 0.01), intrusion (β = −0.14, p < 0.01), and avoidance (β = −0.15, p < 0.01), explaining a modest but consistent proportion of unique variance (1–3%). Conclusions: These findings suggest that resilience is a modest but consistent correlate of mental health and post-traumatic stress symptoms among Syrian refugee adolescents in Türkiye. Longitudinal studies incorporating trauma exposure and multi-level resilience resources are needed before causal or intervention-related conclusions can be drawn.
Background/Objectives: School closures and social restrictions during the COVID-19 pandemic substantially disrupted adolescents’ everyday lives. However, much of the existing evidence relies on standardized measures or retrospective accounts, providing less insight into how adolescents themselves described the psychosocial meaning of this disruption while it was still unfolding. This study aimed to explore Hungarian secondary school students’ real-time written reflections on their experiences during COVID-19-related school closures, online education, and social restrictions, with a focus on adolescent mental health, peer connectedness, school belonging, and developmental disruption. Methods: A retrospective qualitative study was conducted using 111 anonymized open-ended student reflections written in 2021 during the active period of online education and social restrictions. The texts were originally produced in a pedagogical-reflective context, not as research interviews or questionnaire responses. The material was analysed using structured qualitative content analysis. Two researchers independently coded the texts; disagreements were resolved through discussion, and a third researcher was involved when consensus was required. Descriptive frequency summaries were used to contextualize the qualitative findings. Results: In the descriptive frequency summaries, negative appraisals were most common in relation to the general pandemic situation, online schooling, and peer relationships. Thematic analysis identified recurring patterns of confinement, loss of normality, reduced peer contact, weakened school routines, academic overload, uncertainty about graduation and the future, and the loss of age-specific adolescent experiences and transition rituals. Family appeared as both a stabilizing resource and, in some cases, a source of conflict or additional burden. A central interpretive theme was that adolescents experienced the pandemic not merely as educational disruption but as an interruption of adolescence itself. Conclusions: The findings highlight that adolescent mental health support during large-scale crises should extend beyond maintaining educational continuity. Early prevention and intervention strategies should preserve peer connectedness, school belonging, daily structure, emotional validation, and developmentally sensitive support during future pandemics or comparable periods of prolonged social restriction.
