Background: Orofacial dysfunction may co-occur with speech and language disorders. This study compared orofacial function in children with and without speech disorders using the Nordic Orofacial Test-Screening (NOT-S) and examined whether Kotlow tongue-tie severity is associated with orofacial function. Methods: This cross-sectional study included 77 children aged 5–13 years (37 with speech and language disorders [SD]; 40 without [N]). Orofacial function was screened with the NOT-S, and free tongue length was classified according to Kotlow. Nonparametric and exact tests, Poisson regression adjusted for age, sex, and systemic conditions, and sensitivity analyses were used. Results: The SD group had higher NOT-S total (median 3 vs. 1; p < 0.001; r = 0.50) and examination scores (p < 0.001; r = 0.76) than the N group, whereas interview scores did not differ. After Holm correction, facial expression, oral motor function, and speech remained more frequently impaired. The difference persisted after adjustment (incidence rate ratio 2.21, 95% CI 1.53–3.19), in children without systemic conditions, and after exclusion of the speech domain. Tongue-tie prevalence and free tongue length did not differ between groups, and no severity-related association with NOT-S scores emerged. Conclusions: Children with speech disorders had higher NOT-S scores, which persisted after adjustment for age, sex, and systemic conditions, whereas no statistically significant association between tongue-tie severity and orofacial function was demonstrated in this small sample, which does not rule out an effect. Anatomical frenulum assessment alone may be insufficient and should be complemented by functional and speech and language evaluation.
Background/Objectives: Bronchopulmonary dysplasia (BPD) remains a major complication of prematurity, particularly among infants requiring prolonged respiratory support. Despite its clinical relevance, data on BPD epidemiology and risk factors in Kazakhstan are limited. This study aimed to assess the incidence of BPD and identify significant antenatal, intranatal, and neonatal risk factors associated with its development among preterm infants in Almaty. Methods: A retrospective analysis was conducted using medical records of preterm infants born at the City Perinatal Center in Almaty between 2013 and 2017. Clinical, obstetric, and neonatal data were collected for 111 infants diagnosed with BPD and 109 matched controls without BPD. Statistical analyses included χ2 tests, Student’s t-tests, and multiple logistic regression to determine independent predictors of BPD. Results: Among 39,255 live births over a five-year period, 6271 were preterm, and bronchopulmonary dysplasia (BPD) was diagnosed in 111 preterm infants (1.8%). Mortality among BPD infants was 31.9%, with a declining trend over time. Significant maternal factors associated with BPD included edema during pregnancy, polyhydramnios, acute respiratory viral infection (ARVI) during the second trimester, low placentation, vaginal bleeding, chronic bronchitis, and a history of preterm birth. Logistic regression identified edema (p = 0.009) and antenatal steroid prophylaxis (p < 0.001). Neonatal risk factors significantly associated with BPD included neonatal respiratory distress syndrome (p = 0.002), reintubation (p = 0.046), high FiO2 requirements, prolonged mechanical ventilation, and HFOV use. Regression analysis confirmed neonatal RDS (p = 0.006) and higher FiO2 (p < 0.001). Conclusions: BPD in Almaty is driven by a combination of maternal complications and severe neonatal respiratory pathology. Early identification and targeted perinatal management of these parameters may help reduce BPD incidence and improve outcomes for preterm infants.
Background/Objectives: The 24 h movement behavior (24HMB) framework integrates moderate-to-vigorous physical activity (MVPA), recreational screen time, and sleep. Sociodemographic correlates of simultaneous guideline adherence among European adolescents remain poorly understood. We aimed to estimate 24HMB compliance with each guideline and their combination, identify sociodemographic correlates, and compare accelerometry- and questionnaire-based sleep models. Methods: Cross-sectional data from 444 Spanish adolescents aged 12–17 years in the Eating Healthy and Daily Life Activities (EHDLA) study, conducted in a single semi-rural municipality in the Region of Murcia, were analyzed. MVPA and sleep were measured by ActiGraph wGT3X-BT accelerometry (valid days ranged from 1 to 6); sleep and screen time were also self-reported. Firth’s penalized logistic regression was applied uniformly across binary outcomes to provide a consistent estimation framework, with primary inference based on uncorrected p-values and Benjamini–Hochberg false discovery rate (FDR) correction reported for transparency. Results: In the subsample with complete screen-time data (n = 403; 51.6% female; median age 14 years), compliance was 26.1% (MVPA), 20.3% (screen time), and 36.7%/40.2% (accelerometry-derived sleep period time/questionnaire self-reported time in bed); only 3.5–4.0% met all three guidelines simultaneously. Female sex was associated with lower MVPA (odds ratio, OR = 0.51) and screen time (OR = 0.44) compliance (both FDR-corroborated). Caucasian ethnicity was unexpectedly associated with lower MVPA compliance (OR = 0.29) in the primary complete-case analysis. Older age was associated with lower screen-time compliance (OR = 0.45; both FDR-corroborated). No predictor was significant for accelerometry-derived sleep period time compliance, and questionnaire self-reported time in bed associations did not survive FDR correction. Conclusions: Concurrent adherence to 24HMB guidelines is critically low and socially patterned. Female sex was an FDR-corroborated correlate of lower MVPA and screen-time compliance. The Caucasian ethnicity association with MVPA was specific to the primary complete-case analysis and attenuated under stricter wear-time criteria. Sleep compliance estimates and their sociodemographic correlates differed by assessment method. Future 24HMB surveillance should use validated, standardized, and clearly reported protocols, and cross-study comparisons should account for methodological differences in sleep assessment.
Background/Objectives: Pediatric flexible flatfoot is a common developmental variation, and treatment is generally considered when pain or functional limitations are present. This systematic review evaluated clinical and biomechanical evidence for sensorimotor insoles in children with flexible flatfoot and contextualized these findings alongside evidence for conventional foot orthoses and exercise-based rehabilitation; head-to-head comparative evidence was not assumed when unavailable. Methods: Following PRISMA 2020 guidelines, comprehensive searches were performed across PubMed/MEDLINE, the Cochrane Library, and PubMed Central up to August 2026. Eligible primary studies comprised randomized controlled trials, randomized comparative or sequence trials, prospective comparative or pre-post studies, and longitudinal cohort studies evaluating pain, function, gait, balance, posture, or neuromuscular outcomes. Risk of bias was assessed using RoB 2 and ROBINS-I, and the certainty of the evidence was summarized qualitatively using GRADE. Results: Ten main clinical studies met inclusion criteria, including 5 RCTs and 5 non-randomized studies, with follow-up periods ranging from 6 weeks to 2 years. Both customized supportive orthoses and intrinsic muscle exercises consistently reduced pain and improved function in symptomatic children in the short- to medium-term. Direct randomized evidence for sensorimotor insoles suggests potential functional and neuromuscular effects; however, the limited evidence base does not support firm conclusions about comparative effectiveness or superiority over supportive orthoses. Evidence for permanent structural arch correction was not established. Conclusions: In symptomatic pediatric flexible flatfoot, conservative treatment should prioritize pain and function. Conventional supportive orthoses and targeted exercise have a broader evidence base, whereas current evidence is insufficient to establish the superiority of sensorimotor insoles.
Background/Objectives: This study aimed to investigate the factors affecting triage reclassification, including down-triage and up-triage, associated with the use of a new triage tool for assessing patient urgency in pediatric emergency departments (PEDs). Methods: This was a retrospective observational study based on the national registry data of patients aged < 15 years who visited PEDs between January 2016 and December 2019. Patients were classified into no reclassification, down-triage, and up-triage groups, and the incidence and risk factors of triage reclassification and its characteristics according to hospital size were analyzed. Results: Overall, 5,462,950 patients were included, and triage reclassification occurred in 129,903 (2.4%). Down-triage and up-triage occurred in 35,897 (0.7%) and 94,006 (1.7%) patients, respectively. Among patients initially classified as PedKTAS levels 1–3, 1.87% were down-triaged, whereas 2.66% of patients initially classified as levels 4–5 were up-triaged. The down-triage-associated factors were age 1–4, 5–9, and 10–14 years, trauma group, self-referrals, and presentation to regional EMIs. The up-triage-associated factors were age of <1 year, male sex, daytime visits, visits for diseases, referral from an outpatient department or clinic, and presentation to district EMCs. There were also differences in reclassification patterns according to hospital size. Conclusions: This study identified factors related to triage reclassification in patients in PEDs. Accurate triage that considers these factors is essential for providing appropriate treatment and efficient use of PED resources.
