Jornal de pediatria最新文献

{"title":"Mental health issues in adolescent mothers and young adult mothers: the Brazilian context.","authors":"Amanda Ferreira de Carvalho, Daniela Dal Forno Kinalski Guaranha, Bruna Marmett, Júlia Mathias Reis, Carmem Lisiane Escouto de Souza, Bruna Silveira da Rosa, Tiago Chagas Dalcin, Sérgio Luis Amantea","doi":"10.1016/j.jped.2025.03.011","DOIUrl":"10.1016/j.jped.2025.03.011","url":null,"abstract":"<p><strong>Objective: </strong>To analyze anxiety and depression levels in adolescent and young adult mothers.</p><p><strong>Methods: </strong>This multicenter cross-sectional study was conducted across Brazil's five regions. A non-probabilistic sample of 1177 adolescent (10-19 years) and young adult (20-29 years) mothers was selected proportionally based on regional live birth rates. Data collection (August 2022-May 2023) involved a structured questionnaire assessing mental health (DASS-21), family support, and quality of life. Statistical analyses were performed using RStudio©, with p-values < 0.05 considered significant. The study was approved by the Research Ethics Committee (CAAE: 55465822.0.2003.5086).</p><p><strong>Results: </strong>Depression or anxiety was reported by 22.7 % of both adolescent and young adult mothers, with 7.55 % and 7.07 % diagnosed during pregnancy, respectively. Among affected adolescents, 66.67 % did not seek follow-up care, primarily due to limited healthcare access (29.55 %). Adolescent mothers showed a higher prevalence of depression (p < 0.001), anxiety (p < 0.001), and stress (p = 0.027) postpartum. Depression was associated with a lack of emotional support from the child's father (p = 0.096), insufficient family caregiving support (p = 0.014), and low perceived quality of life.</p><p><strong>Conclusion: </strong>Adolescent mothers exhibit greater vulnerability to mental disorders, emphasizing the need for targeted psychological and social support during the perinatal period.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of rapid weight gain in a cohort of children in the first six months of life.","authors":"Maíra Barros Louro Menezes, Cristina Maria Mendes Resende, Danielle Fernandes Durso, Mariane Alves Silva, Jacqueline Isaura Alvarez Leite, Sarah Aparecida Vieira Ribeiro, Juliana Farias de Novaes, Sylvia Do Carmo Castro Franceschini, Maria Tereza Cartaxo Muniz, Gustavo Velasquez-Melendez","doi":"10.1016/j.jped.2025.03.010","DOIUrl":"10.1016/j.jped.2025.03.010","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the influence of genetic, gestational, birth, and socioeconomic factors on Rapid Weight Gain (RWG) in children between birth and six months.</p><p><strong>Methods: </strong>This is a cohort study with 267 children, information on individual and sociodemographics was obtained from the medical record. RWG was identified when the z-score difference in weight-for-age between two child assessments was > +0.67. The rs9939609 was assessed by Real-Time Polymerase Chain Reaction Taqman. The exploratory analysis of the cumulative incidence rate curves of RWG used the Kaplan-Meier, as well as the Log-Rank test to perform comparisons between the groups. To estimate the hazard ratio, the Cox semi-parametric model was used, to verify the quality of the fit of the proposed model the generalized Cox-Snell residuals were used.</p><p><strong>Results: </strong>The RWG between birth and six months was 31.84% and the incidence rate was estimated to be 2.31 cases/1000 person-days. The children who were born with inadequate weight or low weight had 1.88 times the risk of having RWG between birth and six months. In multivariate analysis, a higher risk of RWG in the first six months of life was found for children who were born weighing < 3000 g and whose mothers were overweight/obese in the pregestational phase, adjusted for the variables sex, rs 9939,609 and paternal education, rs9939609 was not associated with RWG.</p><p><strong>Conclusions: </strong>Children with lower birth weight and with mothers overweight/obese before pregnancy presented a higher risk of RWG in the first six months and rs 9939,609 was not associated with RWG.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum hsa-miR-21 expression and its clinical value in pediatric patients with fulminant myocarditis.","authors":"Wenwen Wang, Jingmin Sun, Jing Li","doi":"10.1016/j.jped.2025.04.007","DOIUrl":"10.1016/j.jped.2025.04.007","url":null,"abstract":"<p><strong>Objective: </strong>Fulminant myocarditis (FM) is a distinct and rare form of myocarditis. This study probed hsa-miR-21 expression in FM pediatric patients and its clinical value.</p><p><strong>Methods: </strong>This study enrolled 88 FM pediatric patients and 90 healthy children (normal controls), with serum sample hsa-miR-21 levels measured by RT-qPCR. FM children were categorized into the good and poor prognosis groups. Correlations of hsa-miR-21 expression with myocardial injury markers [cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB)], and independent risk factors and predictive value of hsa-miR-21 expression for FM patients' poor prognoses were analyzed by Pearson's, logistic regression, and receiver operating characteristic (ROC) curve analyses.</p><p><strong>Results: </strong>Serum hsa-miR-21 levels were elevated in FM children relative to the healthy controls and linked with poor prognoses. hsa-miR-21 levels positively correlated with myoglobin (MYO), B-type natriuretic peptide (BNP), cTnI, and CK-MB levels. Elevated hsa-miR-21, CK-MB, left ventricular ejection fraction, C-reactive protein, lactate dehydrogenase, and lactate were independent risk factors for FM children's poor prognoses. Serum hsa-miR-21 levels yielded an area under the ROC curve of 0.790 in predicting FM pediatric patients' poor prognoses (58.1 % sensitivity, 87.7 % specificity), with positive and negative predictive values of 74.07 % and 81.97 %, respectively, demonstrating that hsa-miR-21 aided in predicting FM pediatric patients' poor prognoses to some extent.</p><p><strong>Conclusion: </strong>Serum hsa-miR-21 was up-regulated in FM pediatric patients, and positively correlated with MYO, BNP, cTnI, and CK-MB. hsa-miR-21 expression was an independent risk factor for FM pediatric patients' poor prognosis, and predicted prognoses to some extent; however, the diagnostic accuracy was limited.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RCPNEOPERU trial: a cluster randomized pilot trial to assess traditional neonatal resuscitation compared to partially virtual training in remote areas.","authors":"Carlos A Delgado, Enrique Gómez Pomar, Pablo Velásquez, Víctor Sánchez, Roberto Shimabuku, Luis Huicho","doi":"10.1016/j.jped.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.jped.2025.04.008","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effects of a neonatal resuscitation training program using traditional training and partial distance learning.</p><p><strong>Method: </strong>Through an open cluster-randomized trial, the authors compared a traditional approach involving face-to-face theory and practice sessions using information and communication technology to offer theory and distance examination, followed by face-to-face practice. Twelve health facilities were allocated by blocked randomization. Comparisons were made adjusting for clustering in qualitative and quantitative data. The primary outcome was the percentage of infants with heart rates ≥100 per minute at the second minute after birth. The authors performed a cluster-level analysis for cluster randomized trials, simplifying the adjustment for individual- and cluster-level covariates.</p><p><strong>Results: </strong>The authors trained 403 health professionals in 2 p.m. in twelve facilities. After six months, the authors assessed 2180 birth deliveries, 966 newborns in the traditional training group (TT), and 1214 in the partial distance learning training group (pDL). The authors found no statistical evidence favoring any of the two trial arms (RR = 0.9859, CI 95 % = 0.9446; 1.0292, p = 0.4819).</p><p><strong>Conclusions: </strong>The authors found no statistical evidence favoring traditional or distance learning methods for neonatal resuscitation training. Further research could assess improved online platforms to enable sustainable virtual reality instructor/provider interaction for theory, practice and testing, addressed to health cadres of rural and remote areas.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in the prophylaxis of severe respiratory syncytial virus infections.","authors":"Dana C Feitosa, Sandra E Vieira","doi":"10.1016/j.jped.2025.04.003","DOIUrl":"10.1016/j.jped.2025.04.003","url":null,"abstract":"<p><strong>Objective: </strong>To analyze palivizumab prophylaxis adherence among newborns and infants, as well as identify its challenges and facilitators.</p><p><strong>Methods: </strong>This retrospective study reviewed medical records of individuals who received palivizumab between 2008 and 2019 at a referral center in a metropolitan city in Brazil. Three adherence criteria were evaluated: an adequate number of doses received, interval between doses ≤ 35 days, and complete adherence (meeting both prior criteria). Associations between these criteria and sociodemographic/clinical variables, as well as post-prophylaxis bronchiolitis-related hospitalizations, were examined.</p><p><strong>Results: </strong>A total of 908 participants (mean age 6.7 months,50.8 % male,57.8 % residing in the city) were analyzed. During the three-season study period, a total of 1,158 doses were prescribed, and complete adherence was observed in 44.5 % of cases. Based on both the adequate number of doses and complete adherence criteria, lower adherence was noted among those living outside the city (52.8 % vs.60.9 %, p = 0.01; and 41.5 %vs.48.5 %, p = 0.03, respectively) and infants born to mothers younger than 20 years (39.7 % vs.60.3 %,p < 0.01; and 31.5 %vs.68.5 %, p = 0.02, respectively). Infants with gestational age < 28 weeks (65.8 % vs.34.2 %, p = 0.03) and birth weight < 1000 g (67.8 % vs.32.2 %, p = 0.03) had higher adherence under the adequate number of doses criterion. No association emerged between adherence and bronchiolitis-related hospitalizations, which were predominantly linked to maternal smoking during pregnancy and chronic lung disease.</p><p><strong>Conclusion: </strong>Adherence to palivizumab prophylaxis was low, highlighting the need to address geographic barriers and maternal age factors. Extreme prematurity and very low birth weight facilitated adherence, indicating that more targeted strategies or decentralized administration may improve outcomes in high-risk populations.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental predictors of childhood vaccination adherence in border areas of Southern Vietnam: a first look at minority communities.","authors":"An Dai Tran, Charuai Suwanbamrung, Muhammad Haroon Stanikzai, Nirachon Chutipattana, Shamarina Shohaimin, Patthanasak Khammaneechan, Le Minh Luan, Tran Phu Dien, Truong Thanh Nam, Phan Thanh Tung, Cua Ngoc Le","doi":"10.1016/j.jped.2025.04.005","DOIUrl":"10.1016/j.jped.2025.04.005","url":null,"abstract":"<p><strong>Objectives: </strong>Suboptimal timeliness and coverage of childhood vaccination programs undermined their effectiveness in achieving population-level immunity. This issue is particularly concerning among minority populations, where disparities in vaccination adherence persist. To address this gap, the study assessed the extent of parental adherence to age-appropriate childhood vaccination and its predictors among the minority children under five years of age.</p><p><strong>Methods: </strong>This cross-sectional study was conducted in three districts of Dong Thap Province, Vietnam, and neighboring Cambodia. A total of 449 ethnic minority parents with children under five years old participated. Data were gathered through face-to-face household interviews using a structured questionnaire, complemented by direct observation of the children's vaccination cards to verify adherence. Binary logistic regression was used to identify predictors of vaccination adherence.</p><p><strong>Results: </strong>The adherence rate to childhood vaccination among children in the minority population was 18.9 %. Parental adherence was significantly higher for children under one year of age (aOR = 2.54, 95 % CI: 1.29-5.03) and for firstborn children (aOR = 3.48, 95 % CI: 1.36-9.92). Within the Health Belief Model framework, greater perceived barriers were associated with lower adherence (aOR = 0.32, 95 % CI: 0.21-0.49), while higher parental self-efficacy was linked to increased adherence (aOR = 1.84, 95 % CI: 1.11-3.11).</p><p><strong>Conclusion: </strong>This study revealed a low parental adherence rate (18.9 %) to childhood vaccination. A child's age, birth order, perceived barriers, and parental self-efficacy influenced adherence. These findings emphasize the need to incorporate these factors into targeted policies and interventions for improving immunization rates in minority populations and comparable settings.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining procalcitonin, c-reactive protein, and white blood cell count in predicting infections in pediatric open cardiac surgery with cardiopulmonary bypass.","authors":"Tuan Manh Ha, Man Minh Tran, Tung Viet Le, Nguyen The Nguyen Phung","doi":"10.1016/j.jped.2025.04.006","DOIUrl":"10.1016/j.jped.2025.04.006","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the validity of models using Procalcitonin (PCT) alone and PCT combined with other biomarkers to predict early infection after pediatric open-heart surgery with cardiopulmonary bypass (CPB).</p><p><strong>Methods: </strong>A prospective observational study was conducted on children undergoing open-heart surgery with CPB, without preoperative infection. Procalcitonin, C-reactive protein (CRP), and white blood cell (WBC) count were measured preoperatively and on postoperative days 1 and 3. Postoperative infection was defined according to the Centers for Disease Control and Prevention 2008 criteria.</p><p><strong>Results: </strong>Fifty eligible cases were included, comprising 46 % males with a median age of 7 months (4-17). The AUC (area under the curve) for PCT on postoperative day 3 was 0.67 (0.51-0.82) (p = 0.085). The AUCs for the models combining PCT + CRP and PCT + WBC were 0.71 (0.57-0.86) (p = 0.014) and 0.72 (0.55-0.86) (p = 0.014), respectively. The AUC for the model combining PCT + CRP + WBC was 0.81 (0.69-0.93) (p = 0.002). The combination of PCT > 4.15 ng/ml, CRP > 22.03 mg/l, and WBC > 15.3 × 10³/µl predicted infection with a hazard ratio 9.66 times (2.94-31.72) higher than PCT > 4.15 ng/ml alone (p < 0.05).</p><p><strong>Conclusions: </strong>PCT measurement on the third postoperative day alone cannot predict infection in pediatric open-heart surgery with CPB. The combination of PCT with CRP and WBC may enhance early infection prediction, although further validation in larger, multicenter cohorts is warranted.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of excessive screen time in hospitalized pediatric patients.","authors":"Guilherme Hoff Affeldt, Gleice Medeiros, Vanessa Vieira, Bruna Ziegler","doi":"10.1016/j.jped.2025.02.005","DOIUrl":"10.1016/j.jped.2025.02.005","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to understand the prevalence of screen time in hospitalized children and identify factors predicting excessive screen use during hospitalization.</p><p><strong>Methods: </strong>This cross-sectional quantitative study was conducted with patients from the Pediatric Inpatient Unit of a Brazilian hospital, from March 2022 to April 2023. A total of 260 children were included. Family members completed questionnaires about screen time during hospitalization and at home, as well as providing information on physical activity and functionality. Socioeconomic and demographic details were obtained from electronic records.</p><p><strong>Results: </strong>During hospitalization, children spent a median of 270 min per day on screens, significantly more than at home. Excessive screen time at home, better patient functionality, and lower caregiver education levels were significant predictors of excessive screen use during hospitalization.</p><p><strong>Conclusion: </strong>Excessive use of screen devices among hospitalized children, with only a minority adhering to the World Health Organization's screen time recommendations. Key predictors of excessive screen use included high screen time at home, lower caregiver education levels, and preserved child functionality.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with developmental delay in late preterm infants: the BRISA cohort.","authors":"Paulo Ricardo Higassiaraguti Rocha, Gabriela Pap da Silva, Otávio Augusto Gratão, Marco Antonio Barbieri, Viviane Cunha Cardoso, Maria da Conceição Pereira Saraiva, Heloisa Bettiol","doi":"10.1016/j.jped.2025.04.002","DOIUrl":"10.1016/j.jped.2025.04.002","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association of sociodemographic characteristics, gestational factors, and birth outcomes with developmental delay from the second year of life in late preterm (LPT) infants.</p><p><strong>Method: </strong>This study included 327 LPT infants from a cohort started in 2010. Developmental performance was assessed using the Bayley-III screening test. The covariates were obtained with questionnaires and from the maternity records. Hierarchical multiple logistic regression was used for analysis.</p><p><strong>Results: </strong>Smoking during pregnancy was associated with fine motor and cognitive delays (OR = 2.27, 95 %CI 1.05-4.93 and OR = 2.22, 95 %CI 1.05-4.68, respectively). Living without a partner (OR = 2.98, 95 %CI 1.36-6.52) and intrauterine growth restriction of the child (OR = 2.63, 95 %CI 1.32-5.24) were associated with fine motor delay and neonatal intensive care unit admission with cognitive delay (OR = 2.11, 95 %CI 1.01-4.44).</p><p><strong>Conclusions: </strong>These factors must be considered when implementing strategies for the diagnosis of possible developmental delays and when designing interventions for LPT children.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health mediates the association between cardiorespiratory fitness and academic performance in European schoolchildren.","authors":"Adrià Muntaner-Mas, Pedro L Valenzuela, Tania Pinto-Escalona, Kirk I Erickson, Óscar Martínez-de-Quel","doi":"10.1016/j.jped.2024.10.013","DOIUrl":"10.1016/j.jped.2024.10.013","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to assess the potential mediating role of mental health in the association between cardiorespiratory fitness (CRF) and academic performance in European schoolchildren.</p><p><strong>Method: </strong>The study followed a cross-sectional design. 507 schoolchildren (51.5 % girls, 7.4 ± 0.4 years) from 20 schools in five European countries were included in the analyses. Academic performance was assessed using school grades, mental health was assessed through the Strengths and Difficulties Questionnaire (SDQ) for parents, and CRF was estimated through the multistage 20-m shuttle run test. Linear regression and mediation analyses were conducted to test these hypotheses.</p><p><strong>Results: </strong>Mental health difficulties were associated with worse performance on academic indicators (β ranging from -0.121 to -0.324, p < 0.05). Further, mental health difficulties were associated with lower CRF (β ranging from -0.121 to -0.189, p < 0.05). Mediation analyses revealed that the association between CRF and academic performance indicators was partially mediated (from 8 % to 25 %) by mental health [except for conduct and peer problems (β ranging from -0.025 to -0.080, p > 0.05).</p><p><strong>Conclusion: </strong>The present results highlight that mental health is a possible mediator in the association between CRF and academic performance. These findings might support the importance of improving CRF levels to reduce mental health difficulties with subsequent potential benefits on academic performance.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}