Background:Medication errors represent a major patient safety concern among hospitalized children due to developmental variability, weight-based dosing, and limited communication capacity. However, the global burden and determinants of pediatric inpatient medication errors remain insufficiently characterized. Objective:This study aims to estimate the worldwide prevalence of medication errors in hospitalized pediatric patients and to identify factors associated with their occurrence. Methods:A systematic review and meta-analysis was conducted using Embase, MEDLINE, Web of Science, PubMed, and the Cochrane Library from database inception to June 2025. Observational studies involving pediatric inpatients younger than 18 years were included. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Data were pooled using a DerSimonian-Laird random-effects model, with subgroup and sensitivity analyses performed to explore heterogeneity. Results:A total of 61 studies from 29 countries or regions were included. The pooled prescribing error rate was 28%, the pooled administration error rate was 32%, and 54% of the hospitalized pediatric patients experienced at least one medication error. Prescribing error rates were higher in lower-middle-income countries (44%), intensive care units (34%), antibiotic prescriptions (30%), and studies conducted between 2013 and 2025 (32%). The proportion of patients experiencing medication errors was the highest in upper-middle-income countries (64%), whereas administration error rates were the highest in low-income countries (71%), although these subgroup findings should be interpreted cautiously because of limited numbers of studies and wide CIs. Factors associated with medication errors included intravenous administration (odds ratio [OR] 6.86, 95% CI 3.17-14.83), hospital stay longer than 5 days (OR 1.94, 95% CI 1.33-2.81), and prescription of 3 or more medications (OR 2.12, 95% CI 1.66-2.70). Conclusions:Medication errors are highly prevalent among hospitalized children worldwide, with substantial variation by region, income level, care setting, and time period. Errors are closely associated with treatment-related factors, underscoring the need for targeted system-level strategies to improve pediatric medication safety.
Background:Technology use by children has implications for their physical, mental, and social health and development. There are many challenges in measuring modern screen use by children. To better understand the potential impact of technology on children, it is crucial to have robust methods to measure technology use. Visual recording data may be particularly well suited to capture modern digital technology use (eg, rapid transitions, multitasking, and device switching). It would be valuable to directly compare the 2 commonly used methods (wearable camera images and room video frames) to determine what is captured best by each and how they compare when both are coded by human annotation. Objective:This study aimed to compare wearable camera images and room video frames to understand what can be captured from each source. Methods:In a laboratory study, children (aged 3-14 years) performed various tasks while wearing a wearable camera and being video recorded by room video cameras. Comparisons between the coding of the wearable camera images and room video frames were performed on a second-by-second basis. Confusion matrices were generated to identify patterns of differences in classifications between wearable camera images and room video frame coding. Percent agreement between the wearable camera image and room video frame coding was calculated based on the confusion matrix. Results:Across 44 participants, 182,451 contemporaneous wearable camera images and room video frames were coded and merged. There were generally low levels of agreement between the codes. The highest agreement was found for "desktop" and "handheld gaming," and the lowest agreement was found for "smartwatch." The wearable camera and room video methods varied in sampling rate, camera movement, and field of view, leading to differences in what was captured. Conclusions:Room video might better capture technology that is within a set space and the context of the technology use, while wearable cameras could better capture active technology use, the content of technology, and different locations. Capturing technology use by children is difficult, with no gold standard and no one ideal method.
BackgroundAvailable information about existing neonatal and pediatric intensive care datasets is scarce. ObjectiveThe objective was to evaluate the feasibility of a monocentric high-frequency dataset of neonatal and pediatric intensive care patients in a cohort study. MethodsThis study included patients treated in the neonatal and pediatric tertiary care intensive care unit at Uniklinik RWTH Aachen, Germany. The dataset comprised high-frequency data on bedside monitoring and ventilation, CO2 monitoring, laboratory results, important diagnoses and interventions, patient characteristics, and manual annotations (including procedures, eg, intubation and X-rays; and states and illnesses, such as episodes of apnea of prematurity and patient-ventilator asynchronies). ResultsIn total, 400 admissions (227 neonatal and 173 pediatric) from 359 patients were included between September 2024 and January 2026. Of these, 28 neonates were extremely preterm, 34 were very preterm, 68 were moderate to late preterm, and 97 were term infants, with an overall median gestational age of 35 (IQR 31-38) weeks and a median birth weight of 1805 (IQR 1446-3251) g. The pediatric population comprised 34 infants aged younger than 1 year, 45 toddlers aged 1 to 5 years, 43 children aged 6 to 12 years, and 51 adolescents aged 13 to 18 years, with a median age of 10.6 (IQR 1.2-13.0) years and a median admission weight of 22 (IQR 11-50) kg. Overall, 77% (400/517) of all eligible patients were enrolled in the study. The dataset comprised 3600 patient days with more than 20,000 manual annotations (approximately 3 TB) and has been used for multiple use cases. ConclusionsThe high temporal resolution allows for detailed characterization of patient states. To our knowledge, there are no published descriptions of comparable European high-frequency neonatal or pediatric intensive care datasets. We share information about our dataset to encourage cross-institutional cooperation. The multicenter pooling of data or federated learning increases possible use cases by enabling new research questions or the development of more robust algorithms.
Background Creative music therapy (CMT) in preterm infants has been associated with improved health outcomes in both parents and infants while promoting parent-infant bonding. However, access to CMT is limited. Objective This study aimed to explore the needs and preferences of parents of preterm infants and health care professionals as a first step in developing a CMT-based mobile health (mHealth) intervention. Methods An iterative qualitative study combining multistakeholder online focus groups with mind mapping. Map contributions were analyzed using reflexive thematic analysis. Results A total of 20 participants (7 parents, 1 grandparent, and 12 health care professionals) contributed to creating the mind map, offering insights into the identified five themes: (1) aims of the mHealth intervention, (2) desired functions and design, (3) content, (4) important factors for acceptability, and (5) usability beyond the neonatal intensive care unit. Conclusions The study highlights critical considerations for designing a CMT-based mHealth intervention. The in-depth user insights gathered will inform iterative development and refinement of the intervention, which will be evaluated in future usability, feasibility, and effectiveness studies.
BackgroundNeonatal jaundice is a very common condition in the first week of life requiring timely recognition of the small subset of neonates at risk of developing severe neonatal hyperbilirubinemia (SNH). Total serum bilirubin, as quantified through blood testing, remains the gold standard for diagnosis, whereas screening based on visual inspection has been proven unreliable in identifying which jaundiced neonates require total serum bilirubin. Picterus Jaundice Pro (JP) is a mobile health app developed for use by health care professionals and parents to screen for imminent SNH. However, parental user experiences with Picterus JP remain largely unexplored. ObjectiveThis study aimed to evaluate the usability and user-friendliness of Picterus JP when used and evaluated by parents. MethodsBetween August 2023 and January 2025, we conducted a prospective mixed methods study at 3 maternity care settings: the maternity wards of 2 hospitals in the Netherlands and 1 hospital in Israel. Parents were invited to participate if their infant was near term born (gestational age of ≥35 weeks) and at least 12 hours old but still in the first week of life. Parents used Picterus JP once according to the manufacturer’s instructions. Immediately afterward, usability was evaluated using the validated mHealth App Usability Questionnaire, an instrument measured on a 7-point Likert scale ranging from 1 (“strongly disagree”) to 7 (“strongly agree”), and open-ended questions. A subset of parents and nurses participated in semistructured interviews and focus groups. ResultsIn total, 123 parents completed the questionnaire. The median mHealth App Usability Questionnaire score was 6 (IQR 5-7) out of 7. A total of 87.7% (100/114) of the parents indicated that they would use Picterus JP at home. Parents reported that they found the app easy, quick, and convenient, although 55.8% (67/120) reported a failure on the first try. Some parents struggled to find or interpret the instructions, but most of those who tried again (79/105, 75.2%) obtained a bilirubin estimate. Additionally, 12 nurses from 2 participating maternity wards provided their observations on parents’ use of Picterus JP in 2 focus groups. Thematic analysis of all combined data identified 3 themes that were considered important for the usability of Picterus JP: intention to use Picterus JP, infant well-being, and instruction and guidance. ConclusionsParents rated Picterus JP highly in terms of usability despite encountering difficulties during initial use. Technical improvements and more proactive guidance seem important to support successful parental use. Nonetheless, both parents and nurses were positive about the potential of Picterus JP for home screening for SNH.
The Strong Families (SF) Program, developed by the United Nations Office on Drugs and Crime, is an evidence-informed family skills intervention designed to support caregivers and children in low-resourced, high-stress circumstances. Following a pilot phase, we revised the program materials according to the expert trainers’ suggestions to best reflect the needs of the target population. To evaluate the feasibility, effectiveness, and cultural adaptability of the second phase of the Strong Families (SF) program expansion in Northern Thailand. This mixed methods, pre-post feasibility study involved 68 families (caregivers and children as 1:1) from Chiang Mai, Lamphun, and Chiang Rai – three providences in Northern Thailand. The applied intervention consisted of a three-week program with both separate and joint sessions for caregivers and children. Quantitative data were collected using the Parent and Family Adjustment Scale (PAFAS), Strengths and Difficulties Questionnaire (SDQ), and Child and Youth Resilience Measure-Revised (PMK-CYRM-R). Data were analyzed using linear mixed-effects regression. Qualitative data were gathered through semi-structured interviews with 19 families and analyzed using content analysis to identify key themes. Quantitative analysis using linear mixed-effects regression revealed significant improvements in Coercive Parenting (β -0.10, p = 0.003), child Conduct Problems (β -0.04, p = 0.002), and Peer relationship (β -0.04, p = 0.048) for parents, and Emotional behavior (β -0.05, p = 0.011), and Conduct behavior (β -0.04, p = 0.023) for children. However, scores for Positive Encouragement and Parent-Child Relationships significantly declined, a discrepancy that may be due to response shift bias where participants adopted stricter self-evaluation standards post-intervention. Qualitative findings, showed five themes that highlighted improved family atmosphere, better emotional regulation, and successful translation of knowledge into practice to better develop protective factors for young people. Participants viewed the program as feasible and culturally appropriate but recommended extending the duration and increasing paternal involvement for more significant, sustainable outcomes. The SF program is a culturally adaptable and effective intervention for improving family dynamics in low-resource settings.
Background:AI-enabled chatbots and related conversational systems can facilitate human-computer interaction through natural language, personalization, and automated support. In pediatric health promotion, these tools have the potential to provide scalable and flexible approaches to support physical activity (PA) and related lifestyle behavior change within family contexts. However, evidence regarding AI and chatbot-supported interventions for PA and obesity-related lifestyle behaviors among children and adolescents remains limited, and the extent to which these interventions involve parents, caregivers, or families has not been clearly characterized. Objective:This scoping review aimed to provide an up-to-date overview of how AI and chatbot-supported interventions are designed, delivered, and evaluated for PA and obesity-related lifestyle behaviors among children and adolescents, with attention to technology characteristics, family involvement, delivery platforms, outcomes, and research gaps. Methods:In accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guideline, 7 databases (PubMed, Web of Science, APA PsycINFO, Academic Search Complete, CINAHL Ultimate, IEEE Xplore, and Scopus) were searched through February 2026. Two reviewers independently conducted title and abstract screening, followed by full-text screening in Rayyan (Qatar Computing Research Institute). Eligible studies involved children, adolescents, or families; evaluated an AI-enabled chatbot, conversational agent, or related digital system; and addressed PA, exercise, sedentary behavior, screen time, obesity, overweight, or weight management. Diet, sleep, and other lifestyle outcomes were extracted when reported within otherwise eligible studies. Data were extracted and synthesized narratively in accordance with research objectives. Results:Of 2730 records identified, 14 studies met inclusion criteria. Most were published in 2023 or later (n=12, 85.7%) and spanned 10 countries. Mobile app delivery was most common (n=9, 64.3%). AI approaches included rule-based chatbots, hybrid personalization systems, generative AI, and single studies using recommender systems or computer vision. A total of 10 studies (71.4%) included a specific parent, caregiver, or family component. Common intervention features were personalized feedback (n=10, 71.4%), self-monitoring (n=9, 64.3%), and education (n=9, 64.3%). PA was the most common target behavior, often within broader obesity or healthy lifestyle interventions. Among 8 studies reporting direct PA or fitness outcomes, 4 showed significant improvement, 2 found no significant change, and 2 reported mixed or indirect findings. Feasibility, acceptability, usability, and engagement findings were generally favorable across studies, but cultural tailoring was reported in only one study. Conclusions:AI and chatbot-supported interventions for pediatric PA and obesity-related lifestyle behaviors represent a rapidly emerging but still early-stage field. Family involvement varies considerably across interventions and should be more clearly conceptualized and evaluated in future studies.
Background:Geography and socioeconomic disadvantage impede access to appropriate services for rural and remote-dwelling children with complex developmental and mental health needs. Telehealth offers opportunities to increase access to essential health and well-being services for people with complex needs who live in rural and remote areas, whose experiences of mental ill-health are frequently compounded by social marginalization and economic disadvantage. Objective:This study aimed to describe caregivers' and service providers' perspectives on the challenges and value of telehealth services for rural and remote children by drawing on experiences within a specialist service (Royal Far West; RFW) that provides mental and developmental health services to rural and remote-dwelling children and families in Australia. Methods:Participants included a convenience sample of caregivers of children who use RFW services (n=11) and service providers from RFW (n=21). Deidentified interview transcript data were analyzed thematically using framework analysis. Results:Caregivers were generally enthusiastic about telehealth but acknowledged potential technological limitations and challenges to effectively engaging some children. While acknowledging its value and importance, RFW service providers identified additional challenges with providing telehealth, such as limited capacity for some detailed clinical assessments and potential child and family risk and safety issues. Conclusions:Telehealth remains a vital option within multidisciplinary services to improve access and outcomes for children in rural and remote communities who present with complex mental and developmental health needs. Despite challenges, rural and remote caregivers and RFW service providers identified telehealth as a beneficial, accessible, and effective component of multidisciplinary care for children with complex mental and developmental health needs. These caregiver and service provider perspectives will inform ongoing service development, research, and advocacy.
BackgroundBeing active benefits children and their parents, but there is a lack of co-designed resources that support families to engage in physical activity (PA) together. ObjectiveThis exploratory co-design study aimed to identify ways to optimize guidance resources intended to assist in being active together, and to evaluate the co-design approach it used. MethodsPhysiotherapist-researchers with experience and expertise in family PA drafted 2 evidence-informed prototypes. One prototype informed families about the holistic benefits of being active together, while the other helped families to plan their episode of PA. Twelve parents from 9 rural families and their neurodiverse or developmentally diverse children (n=13) were recruited as co-designers to ensure a wide range of considerations. Family co-designers took part in 2 to 3 workshops. They trialed the prototypes, telling researchers what worked well and how to improve them. Child and adult advisory groups oversaw the co-design approach. Each group met 3 times, with the child advisory group meeting prior to the adult advisory group. A child voice facilitator and advocate was used to support the child advisory groups and facilitate communication between child and adult advisory groups. ResultsSixty-two changes were made to the prototypes in response to feedback from families and researcher observations. Key changes to resources recommended by children, parents, and researchers to increase user acceptability and usability included changing the ordering of the planning resource to reflect the way that most families used it, adding a “hard words” section to improve readability, support to normalize that no-one wins all the time, additional examples to cover each section of the resources, and encourage negotiation among families to ensure that the planned PA was mutually desirable. All families used the resources to successfully complete, or adapt, their planned session of PA together. Overall, co-designers and advisory group members perceived the co-design approach to be appropriate and responsive. However, the researchers identified a possible gap in final communication with the children regarding dissemination of results of the project which were provided to families via parents’ email. ConclusionsThe co-design approach used in this study supported families, including neurodiverse and developmentally diverse children, to trial and provide feedback on PA resources. The large number of changes made to the resources from co-designer suggestions and researcher observations highlights the importance of gaining user feedback for consumer resources. Future research is needed to evaluate how these co-designed resources may impact family PA behavior and identity. The transparent co-design approach and evaluation highlighted limitations for research communication to children, which require careful consideration in future similar studies.
Background:Infants with complex heart disease often have delayed development, learning difficulties, and mental health problems as they grow older. Their parents and other caregivers engage in online health information-seeking behavior to understand and support their children's health and development. Objective:In this study, we analyze the presence, nature, and presentation of information about neurodevelopment on the websites of congenital cardiac surgical programs in the United States. Methods:We used a mixed methods approach, specifically a convergent design. We correlated the presence and presentation of information about neurodevelopment on each program's website with state-level and program-specific factors extracted from multiple publicly available databases. Quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and multivariate logistic regression analysis, all performed using SPSS (IBM Corp). Qualitative methods included both inductive and deductive content analysis. Results:Only 39% (50/129) of programs provided any information about neurodevelopment online. High surgical volume correlated with the presence of online information (P<.001). Websites were written at an average 7th to 10th grade reading level, and fewer than 5% of websites had information in a language other than English. Two semantic clusters of website format, content, and element selection were identified, reflecting distinct approaches to adult learners. Program websites clustered into "sage on the stage" and "guide on the side" formats. Few websites incorporated features caregivers previously identified as useful, with only 6% including the four most helpful features. Conclusions:We highlight the paucity of accessible caregiver-oriented information about neurodevelopment on congenital cardiac surgical programs' websites in the United States and characterize two primary website models. The lack of information may negatively impact caregiver understanding of and engagement with neurodevelopmental services for their child with a congenital heart defect. Future research should explore the impact of each website model on caregiver understanding of and engagement with neurodevelopmental services, as well as the generalizability of these findings to other domains of pediatric subspecialty care.
BackgroundAttentional functioning in childhood emerges from the interaction between cognitive, behavioral, and emotional processes. Children with these vulnerabilities frequently exhibit executive function deficits, including working memory, inhibitory control, cognitive flexibility, and processing speed, which compromise the ability to regulate attention, plan, and organize tasks, and modulate emotional responses, highlighting the need for screening approaches that integrate multiple dimensions of child functioning. ObjectiveThis study aimed to develop and evaluate an automated, real-time, and simultaneous multimodal screening approach capable of identifying individualized cognitive-emotional-attentional profiles and behavior patterns in children through the integration of oculomotor, emotional, and neuropsychological measures, supporting earlier detection and personalized interventions. MethodsA cross-sectional design was used to assess a sample of 260 children aged 7-15 years through a multimodal approach integrating neuropsychological tests (2- and 3-symbol cancellation tasks from the Coimbra Neuropsychological Assessment Battery; Trail Making Test Parts A and B), eye-tracking metrics, and automated facial emotion recognition during rapid naming and emotion recognition tasks. Oculomotor, emotional, and cognitive data were captured simultaneously and in real time, enabling dynamic characterization of cognitive-emotional interactions at millisecond resolution during task performance. A machine learning pipeline based on a random forest classifier, with a gradient boosting surrogate model used for Shapley additive explanations interpretability analyses, analyzed these data to differentiate children with lower attentional performance from children with normative attentional performance. ResultsThe random forest classifier achieved the best performance in the exploratory 80/20 hold-out evaluation (area under the receiver operating characteristic curve=0.9527; F2-score=0.9055; accuracy=94.2%; sensitivity=88.5%; specificity=100%). To validate the absence of test-set selection bias, a nested 5×5 stratified cross-validation was conducted with model selection based exclusively on inner-fold F2-scores. The negligible difference between nested cross-validated area under the curve (AUC; mean 0.9506, SD 0.0378) and the hold-out AUC (ΔAUC=0.0021) confirmed that the original result was not inflated. Children with lower attentional performance showed increased emotional reactivity, greater gaze instability, fragmented visual exploration patterns, higher variability in fixation behavior, and more frequent impulsive saccadic movements during emotionally salient tasks. Anger and fear stimuli showed stronger discriminative value across attentional performance levels, suggesting that emotional processing modulates attentional allocation. ConclusionsThe simultaneous, real-time capture of eye-tracking, emotion recognition, and neuropsychological data, combined with post hoc analysis within an interpretable machine learning framework, may support the identification of behavioral patterns associated with attentional functioning in children. This multimodal approach provides ecologically grounded and behavior-centered indicators that may support future screening and intervention strategies in educational and clinical contexts.
BackgroundHospitalization poses significant psychosocial challenges for children, including anxiety, emotional distress, and disruption of daily routines. While animal-assisted therapy has shown benefits, practical barriers such as infection control concerns and inconsistent availability limit its implementation in pediatric wards. Social robots have emerged as a promising alternative, but evidence on their psychosocial impact in pediatric settings remains limited. LOVOT is a companion robot designed for emotional engagement through warmth, softness, and nonverbal interaction; however, no studies have examined its effects in pediatric health care. ObjectiveThis exploratory study aimed to assess the perceived impact of LOVOT on hospitalized children, their caregivers, and health care staff in a pediatric ward. MethodsThis prospective observational study was conducted in a pediatric ward at Hyogo Prefectural Amagasaki General Medical Center, Japan, from May 2024 to March 2025. Two LOVOT units were permanently installed in the playroom for free interaction. Caregivers (n=110) and health care staff (n=32) completed postintroduction questionnaires with retrospective ratings of perceived change using 5-point Likert scales (1=“much worse” to 5=“much better,” with 3=“no change” as the baseline). Free-text responses (n=91) were analyzed using automated emotion classification. One-sample 2-tailed t tests or Wilcoxon signed-rank tests compared ratings against the baseline, with false discovery rate (FDR) correction for multiple comparisons. ResultsAll 10 caregiver-rated and 11 of 12 staff-rated outcomes showed significant perceived improvement (all caregiver items FDR P<.001; staff items FDR P≤.02; the workload item was not significant, P=.37). Mean ratings ranged from 3.28 to 4.62 on the 5-point scale (baseline: 3=“no change”). The largest perceived improvements were reported for children’s enjoyment of hospital life (mean 4.47, SD 0.62), adaptation to hospital life (mean 4.10, SD 0.70 to mean 4.28, SD 0.63), and stress and anxiety reduction (mean 4.17, SD 0.76 to mean 4.19, SD 0.64). One-sample effect sizes ranged from medium to very large (Cohen d=0.53-2.67); however, because these were calculated against a fixed neutral baseline rather than a control group, they should be interpreted cautiously. Ratings from caregivers and staff showed strong agreement on 4 of 5 matched items. Notably, no detectable increase in staff workload was observed (mean 3.09, SD 0.53; P=.37), supporting implementation feasibility. Qualitative analysis revealed predominantly positive responses, with joy as the dominant emotion (mean probability 88.7%, 95% CI 86.8%-90.6%). ConclusionsThis study provides preliminary evidence that a companion robot (LOVOT) may positively impact hospitalized children, caregivers, and health care staff across multiple psychosocial outcomes without a detectable increase in staff workload. The low response rate and reliance on retrospective self-report limit generalizability and causal inference; however, convergent findings across stakeholder perspectives justify further investigation through controlled trials. Companion robots represent a feasible, low-burden adjunct to psychosocial care in pediatric settings.
BackgroundScreen-based media use among children has been increasing, particularly in lower socioeconomic groups. As this behavior is linked to obesogenic habits, it is crucial to examine the associations between screen-based media use and adiposity in primary schoolchildren, particularly those from socially vulnerable contexts, such as children from the Educational Territories of Priority Intervention program. ObjectiveThis study aimed to examine the associations between screen-based media use and adiposity in primary schoolchildren from socially vulnerable contexts. MethodsThis study, part of the BeE-school Project, included 735 children (mean age 7.7, SD 1.2 years; n=380, 51.7% boys and n=355, 48.3% girls) from 10 primary schools located in vulnerable contexts in northern Portugal. Researchers recorded weight, height, and waist circumference and calculated BMI z scores and the waist-to-height ratio (WHtR). Screen-based media use was reported by parents using the ScreenQ tool, which includes 4 domains (screen access, frequency of use, media content, and caregiver-child coviewing). Sociodemographic and anthropometric data of parents were obtained via a questionnaire. Generalized linear models were applied. ResultsA higher screen-based media use score was associated with higher BMI z scores and WHtR (b=0.064, 95% CI 0.034-0.094 and b=0.002, 95% CI 0.001-0.003, respectively) even after adjusting for children’s sex and age and parents’ education and BMI. Significant associations (P<.05) were also observed for the domains of screen access, frequency of use, and media content. ConclusionsScreen-based media use is linked to higher BMI and WHtR in vulnerable children. Reducing screen access, limiting use frequency, and curating media content could improve health outcomes. Interventions for obesity prevention should consider these factors. Trial RegistrationClinicalTrials.gov NCT05395364; https://clinicaltrials.gov/study/NCT05395364
BACKGROUND:Collaboration between speech-language pathologists (SLPs) and parents is central to pediatric speech sound disorder (SSD) intervention. Prior research has emphasized the relational and home-practice components of collaboration; however, little is known about the enactment, organization, and maintenance of collaborative processes across SLP sessions and home practice in relation to speech sound generalization. OBJECTIVE:This study examined the enactment and organization of collaboration between SLPs and parents in pediatric SSD intervention, with attention to children's participation. Using a grounded theory approach, it aimed to develop an empirically grounded conceptual account of how collaboration is organized in relation to speech sound generalization. METHODS:This qualitative study adopted a Strauss and Corbin-oriented grounded theory approach. Semistructured interviews were conducted with 12 SLPs and 10 parents of children aged 4 to 7 years receiving SSD intervention in South Korea. Data collection and analysis proceeded iteratively using open, axial, and selective coding with constant comparison. A paradigm model explicated relationships among categories, and selective coding integrated categories around a core category. RESULTS:The central phenomenon was conceptualized as striving for triadic collaboration, reflecting SLPs' and parents' efforts to coordinate roles, expectations, and practice while supporting children's participation across SLP sessions and home practice. Three interrelated action/interaction strategies were identified: SLP-led monitoring strategies, parent-led home-based intervention strategies, and gradual motivation strategies. These collaborative processes were shaped by background and practice-level constraints. A category integration diagram was developed to represent how the core category, action/interaction strategies, and contextual concerns were organized around triadic collaboration. CONCLUSIONS:The findings suggest that collaboration in pediatric SSD intervention is a contextually embedded process in which SLPs and parents coordinate roles and practices across SLP sessions and home practice while supporting children's participation. The category integration diagram represents how collaborative processes were organized across settings in relation to the gap between structured target sound production and everyday speech use. These findings highlight the relevance of coordinated collaboration for supporting practice across settings in relation to speech sound generalization.
Background:The gut microbiota plays a crucial role in infant nutrition through its effects on energy metabolism, nutrient absorption, and immune regulation. However, evidence from Indonesian infants remains limited. Objective:This study aimed to examine the association between genus-level gut microbiota abundance and weight-for-age z scores (WAZ) among 6-month-old infants in coastal Banggai District, Central Sulawesi, Indonesia. Methods:We conducted a nested follow-up cross-sectional observational analysis of 88 six-month-old infants, including 42 (47.7%) who were born to mothers who were assigned to receive Moringa oleifera enriched with royal jelly group and 46 (52.3%) who were assigned to receive a multiple micronutrient supplement in a previous maternal supplementation trial. Maternal and infant characteristics were collected via structured interviews and standardized anthropometric measurements. WAZ was calculated using the World Health Organization Child Growth Standards, and underweight (WAZ <-2 SD) was reported as a secondary indicator. Stool samples were analyzed using genus-specific quantitative polymerase chain reaction to quantify Bifidobacterium, Lactobacillus, Bacteroides, Clostridium, and Escherichia coli (log10 colony-forming unit/mL). Associations between bacterial abundance and WAZ were assessed using multivariable linear regression adjusted for maternal supplementation allocation and relevant maternal, environmental, and infant covariates. Results:The pooled mean WAZ was -0.47 (SD 1.09), and 8% (7/88) of the infants were underweight. The combined abundance of beneficial genera was higher than that of opportunistic bacteria (E coli and Clostridium; Wilcoxon signed-rank test; P=.002). Higher Clostridium abundance was inversely associated with WAZ (unadjusted β=-.094, 95% CI -0.173 to -0.015; P=.02; adjusted β=-.091, 95% CI -0.172 to -0.010; P=.03). No statistically significant associations were observed for Bifidobacterium (P=.13), Lactobacillus (P=.19), Bacteroides (P=.70), or E coli (P=.18) in adjusted models. Conclusions:Among 6-month-old infants in coastal Central Sulawesi, higher genus-level Clostridium abundance was independently associated with lower WAZ. Given the cross-sectional design and genus-level quantitative polymerase chain reaction assessment, temporality and species-level mechanisms cannot be established. Longitudinal studies using more comprehensive microbiome profiling are warranted to clarify potential pathways linking gut microbiota and early-life growth.
Background Idiopathic scoliosis is a common 3D spinal deformity with a global prevalence of 2% to 3% in adolescents. Early detection is crucial for timely intervention and preventing curve progression. Although standing full-spine radiography with Cobb angle measurement remains the diagnostic gold standard, its time-consuming nature limits its utility for large-scale screening. Safe, rapid, and noninvasive screening methods are urgently needed to identify high-risk individuals while reserving x-rays for definitive diagnosis. Objective This study aimed to evaluate the diagnostic accuracy of a custom-developed millimeter-wave imaging system in patients with suspected scoliosis, with radiographic Cobb angle measurement serving as the reference standard, and explore its potential as a first-line screening tool. Methods This prospective diagnostic accuracy study enrolled consecutive outpatients with suspected scoliosis. All participants underwent rapid millimeter-wave imaging scanning (Ka band, 29-40 GHz with no undressing required) followed by standard standing full-spine radiography. Scoliosis was defined as a Cobb angle of 10° or higher. Millimeter-wave images were evaluated using four morphological indicators: (1) shoulder height asymmetry (≥2 cm), (2) trunk lateral shift (≥2 cm), (3) waistline contour asymmetry (≥5°), and (4) lower-limb height difference (≥1 cm). A multiparameter integration strategy classified screening as positive if more than 2 indicators exceeded threshold values. Cobb angle measurements were performed independently by 2 experienced orthopedic surgeons blinded to millimeter-wave image results and each other’s assessments. Diagnostic performance metrics (sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy) were calculated according to the STARD (Standards for Reporting of Diagnostic Accuracy Studies) guidelines. A multivariate logistic regression model incorporating the 4 morphological parameters was constructed for receiver operating characteristic curve analysis. Results Ultimately, 132 participants were included. Radiographic evaluation confirmed 98 (74.2%) cases with scoliosis (Cobb angle≥10°) and 34 (25.8%) negative cases. Millimeter-wave imaging achieved an overall accuracy of 86.4% (114/132; 95% CI 76.5%-94.7%), sensitivity of 85.7% (84/98; 95% CI 75.1%-96.5%), specificity of 88.2% (30/34; 95% CI 70.7%-97.6%), positive predictive value of 95.5%, and negative predictive value of 68.2%. Receiver operating characteristic curve analysis of the multivariate logistic regression model exhibited an area under the curve of 0.862 (95% CI 0.802-0.922), with a sensitivity of 92.9% (91/98) and specificity of 38.2% (13/34). Notably, sensitivity was lower for mild curves (Cobb angle=10°-20°) than for moderate or severe curves (≥20°). Conclusions Millimeter-wave imaging represents a feasible, rapid, and non-ionizing radiation screening method for scoliosis with good diagnostic accuracy (accuracy=114/132, 86.4%; sensitivity=84/98, 85.7%; specificity=30/34, 88.2%). Its capability to penetrate clothing and rapid scanning time (approximately 2 seconds) make it suitable for large-scale screening applications. As a first-line screening tool, this method identifies high-risk individuals for targeted referral and definitive radiography. It follows the “as low as reasonably achievable” principle, optimizing scoliosis screening and reducing unnecessary radiation exposure.
Unlabelled:Given growing concern about maternal loneliness in Japan, this secondary analysis of municipal evaluation data suggests that the nationwide Universal Home Visit Program for Families with Infants ("Hello Baby") may serve as an initial point of contact and an entry point for expanding parenting support networks, with most mothers receiving a visit and reporting encouragement to talk with someone afterward.
BackgroundAdolescents and young adults (AYAs) with type 1 diabetes (T1D) face a heightened risk of care gaps and preventable complications during the transition from pediatric to adult care. AYAs from low-income families are more likely to experience poor outcomes. Care guidelines for T1D now recommend a transition program beginning several years prior to anticipated independence. However, existing transition programs often require substantial resources, limiting their scalability and accessibility. ObjectiveWe used a human-centered design approach to develop and refine a low-cost, virtual intervention to support T1D transitions among publicly insured AYAs. MethodsGuided by the “3I” model (inspiration, ideation, implementation) of IDEO, we conducted semistructured interviews with 26 providers and staff across 4 University of California medical centers to identify challenges and opportunities for improving transition care. We then completed customer discovery interviews with 36 adopters and influencers, including AYAs, endocrinologists, and diabetes educators, to identify priorities and needs and create value propositions. The resulting intervention was tested with 3 cohorts (n=25) of publicly insured AYAs aged 17 to 21 years receiving pediatric diabetes care at an academic medical center. The intervention consisted of two 75-minute virtual group sessions led by a diabetes educator and peer mentors with lived experience. Feasibility, acceptability, and appropriateness were assessed via validated surveys and qualitative interviews. ResultsCore functions of the intervention included education and discussion on “adulting with diabetes” and navigating the health care system, interactive creation of a transition plan, mentors sharing their experiences with diabetes, open discussion among peers, opportunities to ask questions, and provision of resources based on individual needs. Facilitators and mentors reported high feasibility (mean 4.25, SD 0.52) and appropriateness (mean 4.43, SD 0.53). Qualitative interviews highlighted peer support and lived-experience mentorship as core drivers of engagement. Attendance was highest among participants enrolled closer to session dates. Participant feedback informed ongoing adaptations to content and delivery across cohorts, including timing of the intervention, use of the chat function, multiple text reminders before intervention sessions, and specific topics of interest. ConclusionsThis human-centered virtual transition intervention addressed priorities identified by AYAs, peer mentors, and clinicians, including peer support, judgment-free discussion, and self-advocacy. While engagement and attendance varied across cohorts, findings support further refinement and evaluation of the intervention in diverse settings.
