Paediatrics & child health最新文献

{"title":"Gene-based drug therapy for children and youth treated with psychoactive medications.","authors":"Ruud H J Verstegen, Iris Cohn, Mark E Feldman, Daniel Gorman, Shinya Ito","doi":"10.1093/pch/pxae029","DOIUrl":"https://doi.org/10.1093/pch/pxae029","url":null,"abstract":"<p><p>Psychoactive medications are increasingly used to treat children and youth with mental health conditions, but individual variations in response highlight the need for precision medicine. Pharmacogenetic (PGx) testing is a key component of precision medicine. The number of commercial pharmacogenetic testing companies promoting PGx, with the promise of achieving individualized and effective treatment of mental health conditions, has grown exponentially in recent years. Scientific evidence supporting the use of PGx to manage mental health conditions is limited, especially for paediatric populations. This practice point outlines steps guiding the use and interpretation of PGx testing for psychoactive medications in clinical settings, along with key supportive resources. Practice guidelines have been developed for variants in pharmacogenes encoding cytochrome P450 drug-metabolizing enzymes (e.g., <i>CYP2C19</i>, <i>CYP2D6</i>, <i>CYP2C9</i>) as one determinant of drug concentrations in blood, which can support both drug choice and dosing strategy for certain anti-psychotics, anti-depressants, and anti-epileptics. Adverse drug reactions to some anti-epileptic drugs (e.g., carbamazepine and phenytoin) have been associated with certain human leukocyte antigen types and variants in DNA polymerase gamma (<i>POLG</i>; valproic acid). Evidence remains limited for genetic variants of drug target proteins, making it challenging to identify patients with altered treatment responses at a therapeutic blood concentration.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving cycling safety for children and youth.","authors":"Daniel Rosenfield, Pamela Fuselli, Suzanne Beno","doi":"10.1093/pch/pxae035","DOIUrl":"https://doi.org/10.1093/pch/pxae035","url":null,"abstract":"<p><p>Cycling remains a popular activity for children and youth around the world, combining the fun of moving at speed with numerous health and societal benefits. However, cycling is also associated with risk for serious injury and death. Over the past decade, research has increasingly shown that improving safety for cyclists depends, in large part, on the environment they are cycling in as well as on individual safety measures such as helmet use. The pandemic provided greater opportunity for many children and youth to engage in cycling, and refocused public attention on safer cycling infrastructure such as protected bike lanes. This statement reviews the evidence supporting safer cycling infrastructure for children and youth along with the physical and mental health benefits of cycling. The advantages of active transportation for young people, and how the built environment influences their cycling safety and uptake, are discussed. An overview of measures individuals can take to improve cycling safety is followed by recommendations for clinicians, the cycling community, parents, and policy-makers.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La pharmacothérapie en fonction des gènes chez les enfants et les adolescents qui prennent des médicaments psychoactifs.","authors":"Ruud H J Verstegen, Iris Cohn, Mark E Feldman, Daniel Gorman, Shinya Ito","doi":"10.1093/pch/pxae028","DOIUrl":"https://doi.org/10.1093/pch/pxae028","url":null,"abstract":"<p><p>Les médicaments psychoactifs sont de plus en plus utilisés pour traiter les enfants et les adolescents ayant des troubles de santé mentale, mais la variabilité des réponses individuelles fait ressortir l'importance d'une médecine personnalisée. Les tests pharmacogénétiques sont un volet important d'un tel type de médecine. Le nombre d'entreprises de tests pharmacogénétiques commerciaux qui font la promotion de tests de ce genre et promettent un traitement efficace et individualisé des troubles de santé mentale se multiplie depuis quelques années. Les preuves scientifiques en appui à l'utilisation de la pharmacogénétique sont limitées, particulièrement dans les populations pédiatriques. Le présent point de pratique souligne les étapes qui orientent le recours à ces tests pour la prise de médicaments psychoactifs en milieu clinique et présente des ressources de soutien importantes. Il existe des directives cliniques sur les variants des pharmacogènes qui encodent les enzymes de métabolisation du cytochrome P450 (p. ex., <i>CYP2C19</i>, <i>CYP2D6</i>, <i>CYP2C9</i>), lesquels sont l'un des déterminants des concentrations pharmacologiques dans le sang et peuvent appuyer à la fois le choix du médicament et la stratégie posologique de certains antipsychotiques, antidépresseurs et antiépileptiques. Les effets indésirables de certains médicaments antiépileptiques (p. ex., la carbamazépine et la phénytoïne) sont associés à certains types d'antigènes d'histocompatibilité humaine et à des variants de l'ADN polymérase gamma (<i>POLG</i>; acide valproïque). Les données probantes sont limitées à l'égard des variants génétiques des protéines qui ciblent les médicaments, et c'est pourquoi il est difficile de déterminer quels patients présenteraient une réponse altérée au traitement à une concentration sanguine thérapeutique.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Améliorer la sécurité à vélo chez les enfants et les adolescents.","authors":"Daniel Rosenfield, Pamela Fuselli, Suzanne Beno","doi":"10.1093/pch/pxae036","DOIUrl":"https://doi.org/10.1093/pch/pxae036","url":null,"abstract":"<p><p>Le vélo demeure une activité populaire pour les enfants et les adolescents du monde entier; elle combine le plaisir de se déplacer rapidement et de nombreux avantages pour la santé et la société. Cependant, le vélo est également associé à un risque de blessures graves et de décès. Depuis dix ans, les recherches démontrent de plus en plus que l'amélioration de la sécurité des cyclistes dépend en grande partie de l'environnement dans lequel ils se déplacent et de mesures de sécurité individuelles comme le port du casque. Pour de nombreux enfants et adolescents, la pandémie a accru les possibilités de faire du vélo et, et elle ramené l'attention du public vers des infrastructures cyclables sécuritaires, telles que des voies cyclables réservées. Le présent document de principes passe en revue les données probantes en appui à des infrastructures cyclables plus sécuritaires pour les enfants et les adolescents, de même que les bienfaits du vélo pour la santé physique et mentale. Les avantages du transport actif chez les jeunes et l'influence de l'environnement bâti sur la sécurité et l'adoption du vélo sont exposés. Un aperçu des mesures que chacun peut prendre pour améliorer la sécurité à vélo est suivi de recommandations pour les cliniciens, la communauté des cyclistes, les parents et les décideurs.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unintended consequences of a night float system in Paediatric Residency","authors":"Ali Al Maawali, Allan Puran, Susanna Talarico, Zia Bismilla","doi":"10.1093/pch/pxae046","DOIUrl":"https://doi.org/10.1093/pch/pxae046","url":null,"abstract":"Objectives Many residency programs implement ‘night float’ (NF) systems as alternatives to a traditional 24-h call model in an attempt to comply with duty-hour regulations. Research evaluating NF systems has focused primarily on the perspective of the resident with respect to fatigue and quality of life. Understanding the broader consequences of NF models from both trainee and faculty points of view is essential to creating effective and sustainable systems to comply with duty-hour regulations while maximizing patient care, education, and quality of life (QoL). Methods This study used qualitative thematic analysis situated in a constructivist paradigm to explore the experience of an NF system by residents and faculty. Semi-structured interviews were conducted with 15 trainees and 3 faculty members at a large academic pediatric hospital to understand their perceptions of an NF call structure compared to the traditional 24-h call schedule. Results Three themes were identified: (i) Implications for resident; (ii) Implications for patient and family; and (iii) Implications for curriculum. Eight sub-themes were identified, highlighting both intended and unintended consequences of the NF system. Conclusions The NF system resulted in the intended outcomes of decreased fatigue and improved continuity of patient care. Unintended outcomes also occurred, however, including negative effects on assessment and feedback, lack of integration of competencies, and mixed results on resident quality of life. These areas require special attention when designing and implementing NF systems.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183315","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":"Patient-reported outcome measures for paediatric gender-affirming care: A systematic review","authors":"Liam Jackman, Cynthia Chan, Chloë Jacklin, Eve Deck, Ann C Lee, Melissa Stepney, Conrad Harrison, Abhilash Jain, Jeremy Rodrigues, Rakhshan Kamran","doi":"10.1093/pch/pxae019","DOIUrl":"https://doi.org/10.1093/pch/pxae019","url":null,"abstract":"Objectives Patient needs must be comprehensively measured to offer paediatric gender-affirming care in line with clinical standards. Patient-reported outcome measures (PROMs) are self-report tools that measure outcomes deemed to be of importance to patients. PROMs may assess a single outcome or multiple outcomes simultaneously, such as symptoms, functional ability, and quality of life. This study aims to identify PROMs for paediatric gender-affirming care. Methods This systematic review is PRISMA-compliant and was prospectively registered on PROSPERO (CRD42023461959). Six databases were searched: PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science from inception to December 16, 2022. Articles meeting the following criteria were included: 1) Original article; 2) Administers a formally-developed PROM; 3) Focuses on gender-affirming care; and 4) Focuses on paediatric populations. Screening and data extraction occurred independently and in duplicate. Data extracted include study/demographic information, and details of PROM used. Results In total, 20 articles were included, representing a total of 5793 paediatric patients undergoing gender-affirming care. Most studies (13, 65%) focused on hormonal gender-affirming care. A total of 38 different PROMs for paediatric gender-affirming care were identified, ranging from 4 to 120 items each (mean 23 items; median 14 items). Most PROMs (n = 22) measured psychological functioning, with eight PROMs measuring quality of life, and three PROMs measuring gender-related concepts (i.e., gender dysphoria/euphoria). Commonly used PROMs include the Utrecht Gender Dysphoria Scale (n = 4; 20%), Body Image Scale (n = 5;25%), and Youth Self-Report (n = 8; 40%). Conclusions A total of 38 PROMs were identified measuring a range of concepts for paediatric gender-affirming care.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141778031","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":"Research capacity and limitations in Canadian paediatric emergency departments: An observational study on biomarker discovery","authors":"Elena Mitevska, Beata Mickiewicz, Leslie Boisvert, Christine Bon, Redjana Carciumaru, Ramona Cook, Tyrus Crawford, Joan Dietz, Melanie Doyle, Angela Y Hui, Karly Stillwell, Adriana Trajtman, Darcy Beer, Maala Bhatt, William Craig, Eleanor Fitzpatrick, Jocelyn Gravel, April Kam, Ahmed Mater, Anne Moffat, Naveen Poonai, Vikram Sabhaney, Graham C Thompson","doi":"10.1093/pch/pxae023","DOIUrl":"https://doi.org/10.1093/pch/pxae023","url":null,"abstract":"Background Paediatric research is essential to acquire effective diagnoses and treatment for children, but it has historically been under-prioritized. The PRIMED study aimed to characterize the bio-profiles of children with appendicitis and investigate their use as a clinical prediction tool. We evaluated the clinical research capacity of several Canadian paediatric emergency departments (EDs) and described both the challenges experienced in the implementation of the PRIMED study and the strategies which were used to improve local research capacity. Methods Eleven paediatric EDs across Canada provided basic demographic and administrative data along with laboratory- and human-resource availability during the PRIMED study enrollment. Data were summarized using descriptive statistics. Results Fewer than half of the study sites (5/11, 45%) had access to a laboratory that would process research samples 24 hours per day. Four study sites (36%) only enrolled patients during business hours (8:00–17:00). There was no nighttime coverage for patient enrollment and sample collection. Only three study sites (27%) had enrollment hours that captured over 75% of the potential study participants. Over half of the study sites (6/11, 55%) developed novel processes to enable study success, for example, creating graduate student on-call schedules and hiring bioscience-trained site coordinators to process samples. Interpretation Despite site-specific efforts to overcome resource barriers, the gap in clinical research capacity at academic paediatric EDs remains a significant concern. University research institutes and paediatric hospitals should invest in infrastructure and human resources to increase after-hours research capacity to optimize child health and wellness outcomes.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141778094","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":"Les soins peau-à-peau chez les nourrissons à terme et prématurés.","authors":"Gabriel Altit, Danica Hamilton, Karel O'Brien","doi":"10.1093/pch/pxae014","DOIUrl":"10.1093/pch/pxae014","url":null,"abstract":"<p><p>Les soins peau-à-peau (SPP) sont un aspect important des soins au parent et au nourrisson pendant la période néonatale et la première enfance. Ils doivent être entrepris immédiatement après la naissance et faire partie des soins standards dans tous les milieux, y compris à la maison. Selon de solides données probantes, les SPP ont un effet positif sur l'allaitement et l'alimentation par du lait humain, tant chez les nourrissons à terme que prématurés, de même que sur la mortalité, la stabilité cardiorespiratoire et la thermorégulation. Les SPP réduisent la douleur et le stress chez les nourrissons, accroissent l'attachement entre le parent et son nourrisson et ont des effets bénéfiques sur le neurodéveloppement de l'enfant ainsi que sur la santé mentale des parents. Le caractère sécuritaire et la faisabilité des SPP sont établis chez les nourrissons à terme et prématurés, et ces soins sont recommandés dans le cadre d'une pratique exemplaire auprès de tous les nourrissons. Les avantages des SPP sont supérieurs aux risques dans la plupart des situations, et malgré les défis qui y sont associés, les dispensateurs de soins devraient adopter des protocoles et prévoir des adaptations pour s'assurer que les SPP soient une expérience positive et sécuritaire pour le parent, la famille, le nourrisson et l'équipe soignante. Le présent document de principes s'adresse à toutes les familles, telles qu'elles se définissent et se déterminent elles-mêmes, et tiennent compte de l'importance de personnaliser la communication, le langage et la terminologie en matière de santé pour que l'équipe soignante réponde aux besoins particuliers de la famille.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11261829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Le développement sain de l'enfant par le jeu risqué extérieur : un équilibre à trouver avec la prévention des blessures.","authors":"Emilie Beaulieu, Suzanne Beno","doi":"10.1093/pch/pxae017","DOIUrl":"10.1093/pch/pxae017","url":null,"abstract":"<p><p>Le jeu libre est essentiel pour le développement de l'enfant, de même que pour sa santé physique, mentale et sociale. Les occasions de se livrer au jeu libre extérieur, et au jeu risqué en particulier, ont considérablement diminué ces dernières années, en partie parce que les mesures de sécurité ont visé à prévenir toutes les blessures liées aux jeux plutôt que seulement les blessures graves et fatales. Le jeu risqué désigne des formes passionnantes et stimulantes de jeu libre dont l'issue est incertaine et qui comportent une possibilité de blessure physique. Les promoteurs du jeu risqué distinguent le « risque » du « danger » et aspirent à recadrer la perception du risque pour qu'il devienne une occasion d'évaluer une situation et de favoriser le développement personnel. Dans le présent document de principes, les auteures soupèsent le fardeau des blessures liées au jeu par rapport aux données probantes en appui au jeu risqué, notamment les avantages, les risques et les nuances, qui peuvent varier en fonction de l'étape de développement de l'enfant, de ses aptitudes et du contexte social et médical. Elles proposent des approches pour promouvoir des échanges ouverts et constructifs avec les familles et les organisations. Les pédiatres sont invités à percevoir le jeu risqué extérieur comme un moyen de contribuer à prévenir et à gérer des problèmes de santé courants tels que l'obésité, l'anxiété et les problèmes de comportement.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11261840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthy childhood development through outdoor risky play: Navigating the balance with injury prevention.","authors":"Emilie Beaulieu, Suzanne Beno","doi":"10.1093/pch/pxae016","DOIUrl":"10.1093/pch/pxae016","url":null,"abstract":"<p><p>Free play is essential for children's development and for their physical, mental, and social health. Opportunities to engage in outdoor free play-and risky play in particular-have declined significantly in recent years, in part because safety measures have sought to prevent all play-related injuries rather than focusing on serious and fatal injuries. Risky play is defined by thrilling and exciting forms of free play that involve uncertainty of outcome and a possibility of physical injury. Proponents of risky play differentiate \"risk\" from \"hazard\" and seek to reframe perceived risk as an opportunity for situational evaluation and personal development. This statement weighs the burden of play-related injuries alongside the evidence in favour of risky play, including its benefits, risks, and nuances, which can vary depending on a child's developmental stage, ability, and social and medical context. Approaches are offered to promote open, constructive discussions with families and organizations. Paediatricians are encouraged to think of outdoor risky play as one way to help prevent and manage common health problems such as obesity, anxiety, and behavioural issues.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11261819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}