Lancet Child & Adolescent Health最新文献

{"title":"Asthma symptoms, severity, and control with and without a clinical diagnosis of asthma in early adolescence in sub-Saharan Africa: a multi-country, school-based, cross-sectional study","authors":"Victoria O Oyenuga BSc , Gioia Mosler PhD , Prof Emmanuel Addo-Yobo MD , Prof Olayinka O Adeyeye FMCP , Bernard Arhin BSc , Prof Farida Fortune PhD , Prof Christopher J Griffiths DPhil , Marian Kasekete MMed , Elizabeth Mkutumula MPH , Reratilwe Mphahlele PhD , Prof Hilda A Mujuru MMed , Sofia Muyemayema MPH , Rebecca Nantanda PhD , Lovemore M Nkhalamba MSc , Oluwafemi T Ojo MBBS FMCP , Sandra Kwarteng Owusu MPhil , Ismail Ticklay MMED , Peter O Ubuane MBChB FWACPaed , Rafiuk C Yakubu FWACP , Lindsay Zurba BCur , Prof Jonathan Grigg MD","doi":"10.1016/S2352-4642(24)00232-3","DOIUrl":"10.1016/S2352-4642(24)00232-3","url":null,"abstract":"<div><h3>Background</h3><div>Rapid urbanisation and population growth in sub-Saharan Africa has increased the incidence of asthma in children and adolescents. One major barrier to achieving good asthma control in these adolescents is obtaining a clinical diagnosis. To date, there are scant data on prevalence and severity of asthma in undiagnosed yet symptomatic adolescents. We therefore aimed to assess symptom prevalence and severity, the effect of symptoms on daily life, and objective evidence of asthma in young adolescents from sub-Saharan Africa with and without a clinical diagnosis of asthma by spirometry and fractional exhaled nitric oxide (FeNO).</div></div><div><h3>Methods</h3><div>We designed a two-phase, multi-country, school-based, cross-sectional study to assess symptom prevalence and severity in sub-Saharan African adolescents. In phase 1 we surveyed young adolescents aged 12–14 years who were attending selected primary and secondary schools in Blantyre in Malawi, Durban in South Africa, Harare in Zimbabwe, Kampala in Uganda, Kumasi in Ghana, and Lagos in Nigeria. The adolescents were screened for asthma symptoms using the International Study of Asthma and Allergies in Children (ISAAC) questionnaire. Then, after opt-in consent, symptomatic adolescents were invited to complete a detailed survey on asthma severity, treatment, and exposure to environmental risk factors for phase 2. Adolescents performed the European Respiratory Society's diagnostic tests for childhood asthma. A positive asthma test was classified as a forced expiratory volume in 1 sec (FEV<sub>1</sub>) predicted under 80%, a FEV<sub>1</sub> under the lower limits of normal, or FEV<sub>1</sub> divided by forced vital capacity (FEV<sub>1</sub>/FVC) under the lower limits of normal; positive bronchodilator responsiveness or reversibility was defined as either an increase in absolute FEV<sub>1</sub> of 12% or more, or an increase of 200 mL or more, or both, after 400 μg of salbutamol (shortacting β2 agonist) administered via a metered-dose inhaler and spacer, or FeNO of 25 parts per billion or higher, or any combination of these. The study was registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT03990402</span><svg><path></path></svg></span>) and is complete.</div></div><div><h3>Findings</h3><div>Between Nov 1, 2018, and Nov 1, 2021, we recruited 149 schools from six regions in six sub-Saharan countries to participate in the study. We administered phase 1 asthma questionnaires from Jan 20, 2019 to Nov 11, 2021, and from 27 407 adolescents who were screened, we obtained data for 27 272 (99·5%). Overall, 14 918 (54·7%) adolescents were female and 12 354 (45·3%) adolescents were male, and the mean age was 13 years (IQR 12–13); nearly all recruited adolescents were of black African ethnicity (26 821 [98·3%] of 27 272). In phase 1, a total of 3236 (11·9% [95% CI 11·5–12·3]) reported wheeze in the past 12 months, and 644 (19·9%) of 3","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 859-871"},"PeriodicalIF":19.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The neonatal intensive care unit: a father's perspective","authors":"Jules Morgan","doi":"10.1016/S2352-4642(24)00262-1","DOIUrl":"10.1016/S2352-4642(24)00262-1","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 11","pages":"Pages 783-784"},"PeriodicalIF":19.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EDCs: a threat to child health","authors":"The Lancet Child & Adolescent Health","doi":"10.1016/S2352-4642(24)00263-3","DOIUrl":"10.1016/S2352-4642(24)00263-3","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 11","pages":"Page 773"},"PeriodicalIF":19.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The expanding field of genetic developmental and epileptic encephalopathies: current understanding and future perspectives","authors":"Nicola Specchio MD ,&nbsp;Marina Trivisano MD ,&nbsp;Prof Eleonora Aronica MD ,&nbsp;Simona Balestrini MD ,&nbsp;Prof Alexis Arzimanoglou MD ,&nbsp;Gaia Colasante PhD ,&nbsp;Prof J Helen Cross MD ,&nbsp;Sergiusz Jozwiak MD ,&nbsp;Prof Jo M Wilmshurst MD ,&nbsp;Federico Vigevano MD ,&nbsp;Prof Stéphane Auvin MD ,&nbsp;Prof Rima Nabbout MD ,&nbsp;Prof Paolo Curatolo MD","doi":"10.1016/S2352-4642(24)00196-2","DOIUrl":"10.1016/S2352-4642(24)00196-2","url":null,"abstract":"<div><div>Recent advances in genetic testing technologies have revolutionised the identification of genetic abnormalities in early onset developmental and epileptic encephalopathies (DEEs). In this Review, we provide an update on the expanding landscape of genetic factors contributing to DEEs, encompassing over 800 reported genes. We focus on the cellular and molecular mechanisms driving epileptogenesis, with an emphasis on emerging therapeutic strategies and effective treatment options. We explore noteworthy, novel genes linked to DEE phenotypes, such as <em>gBRAT-1</em> and <em>GNAO1</em>, and gene families such as <em>GRIN</em> and <em>HCN</em>. Understanding the network-level effects of gene variants will pave the way for potential gene therapy applications. Given the diverse comorbidities associated with DEEs, a multidisciplinary team approach is essential. Despite ongoing efforts and improved genetic testing, DEEs lack a cure, and treatment complexities persist. This Review underscores the necessity for larger international prospective studies focusing on both seizure outcomes and developmental trajectories.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 11","pages":"Pages 821-834"},"PeriodicalIF":19.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home phototherapy: an essential component of managing hyperbilirubinaemia","authors":"Wanlin Cui","doi":"10.1016/S2352-4642(24)00234-7","DOIUrl":"10.1016/S2352-4642(24)00234-7","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 11","pages":"Page e16"},"PeriodicalIF":19.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular thrombectomy for childhood stroke (Save ChildS Pro): an international, multicentre, prospective registry study","authors":"Peter B Sporns MD MHBA ,&nbsp;Kartik Bhatia MD ,&nbsp;Prof Todd Abruzzo MD ,&nbsp;Lisa Pabst MD ,&nbsp;Stuart Fraser MD ,&nbsp;Melissa G Chung MD ,&nbsp;Prof Warren Lo MD ,&nbsp;Prof Ahmed Othman MD ,&nbsp;Sebastian Steinmetz MD ,&nbsp;Ulf Jensen-Kondering MD ,&nbsp;Stefan Schob MD ,&nbsp;Daniel P O Kaiser MD ,&nbsp;Wolfgang Marik MD ,&nbsp;Prof Christina Wendl MD ,&nbsp;Ilka Kleffner MD ,&nbsp;Prof Hans Henkes MD ,&nbsp;Hermann Kraehling MD ,&nbsp;Thi Dan Linh Nguyen-Kim MD ,&nbsp;Prof René Chapot MD ,&nbsp;Umut Yilmaz MD ,&nbsp;Prof Moritz Wildgruber MD PhD","doi":"10.1016/S2352-4642(24)00233-5","DOIUrl":"10.1016/S2352-4642(24)00233-5","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone. Intravenous thrombolysis was considered part of best medical treatment and therefore permitted in both groups. The primary outcome was the difference in median modified Rankin Scale (mRS) score between baseline (pre-stroke) and 90 days (±10 days) post-stroke, assessed by the Wilcoxon rank test (α=0·05). Efficacy outcomes in the endovascular thrombectomy and best medical treatment groups were compared in sensitivity analyses using propensity score matching. The Save ChildS Pro study is registered at the German Clinical Trials Registry, DRKS00018960.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between Jan 1, 2020, and Aug 31, 2023, of the 241 patients in the Save ChildS Pro registry, 208 were included in the analysis (115 [55%] boys and 93 [45%] girls). 117 patients underwent endovascular thrombectomy (median age 11 years [IQR 6–14]), and 91 patients received best medical treatment (6 years [3–12]; p&lt;0·0001). The median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score on admission was 14 (IQR 10–19) in the endovascular thrombectomy group and 9 (5–13) in the best medical treatment group (p&lt;0·0001). Both treatment groups had a median pre-stroke mRS score of 0 (IQR 0–0) at baseline. The change in median mRS score between baseline and 90 days was 1 (IQR 0–2) in the endovascular thrombectomy group and 2 (1–3) in the best medical treatment group (p=0·020). One (1%) patient developed a symptomatic intracranial haemorrhage (this patient was in the endovascular thrombectomy group). Six (5%) patients in the endovascular thrombectomy group and four (5%) patients in the best medical treatment group had died by day 90 (p=0·89). After propensity score matching for age, sex, and PedNIHSS score at hospital admission (n=79 from each group), the change in median mRS score between baseline and 90 days was 1 (IQR 0–2) in the endovascular thrombectomy group and 2 (1–3) in the best medical treatment group (p=0·029). Regarding the primary outcome for patients with suspected focal cerebral arteriopathy, endovascular thrombectomy (n=18) and best medical treatment (n=33) showed no difference in 90-day media","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 882-890"},"PeriodicalIF":19.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric endovascular thrombectomy: balancing strength of numbers and accuracy of precision medicine","authors":"Manoëlle Kossorotoff","doi":"10.1016/S2352-4642(24)00257-8","DOIUrl":"10.1016/S2352-4642(24)00257-8","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 844-845"},"PeriodicalIF":19.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authentic First Nations health research","authors":"Allison J Hempenstall ,&nbsp;Francis Nona","doi":"10.1016/S2352-4642(24)00258-X","DOIUrl":"10.1016/S2352-4642(24)00258-X","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 11","pages":"Pages 777-778"},"PeriodicalIF":19.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trimodal skin health programme for childhood impetigo control in remote Western Australia (SToP): a cluster randomised, stepped-wedge trial","authors":"Hannah M M Thomas PhD ,&nbsp;Stephanie L Enkel MPH ,&nbsp;Marianne Mullane BSc ,&nbsp;Tracy McRae PhD ,&nbsp;Timothy C Barnett PhD ,&nbsp;Prof Jonathan R Carapetis PhD ,&nbsp;Raymond Christophers ,&nbsp;Prof Julianne Coffin PhD ,&nbsp;Rebecca Famlonga MAH ,&nbsp;John Jacky ,&nbsp;Mark Jones MBiostat ,&nbsp;Julie Marsh PhD ,&nbsp;Kelli McIntosh ,&nbsp;Vicki O'Donnell ,&nbsp;Edward Pan BA ,&nbsp;Glenn Pearson BA ,&nbsp;Slade Sibosado ,&nbsp;Bec Smith MC-HHS ,&nbsp;Prof Thomas Snelling PhD ,&nbsp;Prof Andrew Steer PhD ,&nbsp;Edie Wright","doi":"10.1016/S2352-4642(24)00229-3","DOIUrl":"10.1016/S2352-4642(24)00229-3","url":null,"abstract":"<div><h3>Background</h3><div>Skin infections affect physical health and, through stigma, social-emotional health. When untreated, they can cause life-threatening conditions. We aimed to assess the effect of a holistic, co-designed, region-wide skin control programme on the prevalence of impetigo.</div></div><div><h3>Methods</h3><div>The SToP (See, Treat, and Prevent Skin Sores and Scabies) trial is a pragmatic, open-cohort, stepped-wedge cluster randomised trial involving participants aged 0–18 years in nine remote communities of the Kimberley, Western Australia. The trial involves programmatic interventions in three domains: See (skin checks and skin infection recognition training), Treat (skin infection treatment training, sulfamethoxazole–trimethoprim for impetigo, and ivermectin for scabies), and Prevent (co-designed health promotion and environmental health). Four clusters, defined as pragmatic aggregations of communities, were randomised in two steps to progressively receive the activities during ten visits. The primary outcome was the proportion of school-aged children (aged 5–9 years) with impetigo. We adopted an intention-to-treat analysis and compared the intervention with the control (usual care before the start of intervention) states to derive a time and cluster averaged effect using Bayesian modelling. This study is registered with Australian New Zealand Clinical Trials Registry, ACTRN12618000520235.</div></div><div><h3>Findings</h3><div>Between Sept 19, 2018, and Nov 22, 2022, 915 children were consented and 777 (85%) had skin checks performed on at least one of ten possible visits between May 5, 2019, and Nov 22, 2022. Of the participants, 448 (58%) of 777 were aged 5–9 years at one or more of the visit timepoints and were eligible for primary outcome assessment. A decline in impetigo occurred across all clusters, with the greatest decline during the observational period of baseline skin checks before commencement of the interventional trial activities activities. The mean (95% credible interval) for the conditional posterior odds ratio for observing impetigo in the intervention compared with the control period was 1·13 (0·71–1·70). The probability that the intervention reduced the odds of observing impetigo was 0·33.</div></div><div><h3>Interpretation</h3><div>A decreased prevalence of impetigo during the observational period before the commencement of trial activities was sustained across the trial, attributable to the trimodal skin health initiative. Although the prevalence of impetigo reduced, there is no direct evidence to attribute this to the individual effects of the trial activities. The wholistic approach inclusive of skin checks collectively contributed to the sustained reduction in impetigo.</div></div><div><h3>Funding</h3><div>Western Australia Department of Health, Australian National Health and Medical Research Council, and Healthway.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 11","pages":"Pages 809-820"},"PeriodicalIF":19.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primaquine for children, once and for all","authors":"Tsige Ketema ,&nbsp;Quique Bassat","doi":"10.1016/S2352-4642(24)00231-1","DOIUrl":"10.1016/S2352-4642(24)00231-1","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 11","pages":"Pages 775-777"},"PeriodicalIF":19.9,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}