Lancet Child & Adolescent Health最新文献

{"title":"Political will to tackle childhood violence in Latin America","authors":"Udani Samarasekera","doi":"10.1016/S2352-4642(24)00338-9","DOIUrl":"10.1016/S2352-4642(24)00338-9","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Pages 85-86"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043933","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":"Admission to acute medical wards for mental health concerns among children and young people in England from 2012 to 2022: a cohort study","authors":"Joseph L Ward PhD ,&nbsp;Adriana Vázquez-Vázquez PhD ,&nbsp;Kirsty Phillips MSc ,&nbsp;Kate Settle BSc ,&nbsp;Hanifa Pilvar PhD ,&nbsp;Prof Francesca Cornaglia PhD ,&nbsp;Prof Faith Gibson PhD ,&nbsp;Prof Dasha Nicholls MD Res ,&nbsp;Prof Damian Roland PhD ,&nbsp;Gabrielle Mathews MBBS ,&nbsp;Prof Helen Roberts DPhil ,&nbsp;Prof Russell M Viner PhD ,&nbsp;Lee D Hudson PhD","doi":"10.1016/S2352-4642(24)00333-X","DOIUrl":"10.1016/S2352-4642(24)00333-X","url":null,"abstract":"<div><h3>Background</h3><div>There are challenges in providing high quality care for children and young people who are admitted to acute medical wards for mental health concerns. Although there is concern that these admissions are increasing, national data describing these patterns are scarce. We aimed to describe trends in these admissions in England over a 10-year period, and to identify factors associated with repeat admission and length of stay.</div></div><div><h3>Methods</h3><div>In this cohort study we used data on all admissions to medical wards in England among children and young people aged 5–18 years from April 1, 2012, to March 31, 2022. We classified admissions for mental health concerns using the Global Burden of Disease Study cause hierarchy. We described national trends in admissions for mental health concerns over time by sex, age, ethnicity, and index of multiple deprivation quintile. We examined associations between sociodemographic and clinical factors and odds of the admission lasting more than 1 week, as well as hazard ratios of repeat admissions, using mixed-effects models.</div></div><div><h3>Findings</h3><div>We identified 342 511 admissions for any cause in children and young people aged 5–18 years in 2021–22 in England, of which 39 925 (11·7%) were for mental health concerns. 21 337 (53·4%) admissions for mental health concerns were due to self-harm. Between 2012–13 and 2021–22, annual admissions for mental health concerns increased from 24 198 to 39 925 (65·0% increase), whereas all-cause admissions increased from 311 067 to 342 511 (10·1% increase). Increases were particularly steep in females aged 11–15 years, rising from 9091 to 19 349 (112·8% increase), and for eating disorders, rising from 478 to 2938 (514·6% increase). In 2021–22, 3130 (7·8%) admissions for mental health concerns lasted longer than 1 week, compared with 12 044 (3·5%) all-cause admissions. Of 239 541 children and young people who were admitted for mental health concerns between 2012–13 and 2021–22, 32 107 (13·4%) had a repeat admission within 6 months. The odds of long-stay admission and hazard ratios for being readmitted were significantly higher for children and young people aged 11–15 years, those who were female, those from less deprived areas, and those with eating disorders than among other groups.</div></div><div><h3>Interpretation</h3><div>We found large increases in the number of children and young people admitted to acute medical wards for mental health concerns over a 10-year period. Further work is needed to understand factors driving these trends and how to improve care for children and young people with mental health concerns admitted to medical wards.</div></div><div><h3>Funding</h3><div>National Institute for Health and Care Research</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Pages 112-120"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043944","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":"Characteristics of children and adolescents with multidrug-resistant and rifampicin-resistant tuberculosis and their association with treatment outcomes: a systematic review and individual participant data meta-analysis","authors":"Anthony J Garcia-Prats MD ,&nbsp;Maria Garcia-Cremades PhD ,&nbsp;Vivian Cox MD ,&nbsp;Tamara Kredo PhD ,&nbsp;Rory Dunbar PhD ,&nbsp;Prof H Simon Schaaf PhD ,&nbsp;Prof James A Seddon PhD ,&nbsp;Jennifer Furin MD ,&nbsp;Jay Achar MBBS ,&nbsp;Kendra Radke PhD ,&nbsp;Tina Sachs MSc ,&nbsp;Amanzhan Abubakirov MD ,&nbsp;Saman Ahmed MPH ,&nbsp;Onno W Akkerman PhD ,&nbsp;Nadia Abdulkareem Al Ani MSc ,&nbsp;Farhana Amanullah MD ,&nbsp;Nafees Ahmad PhD ,&nbsp;Laura F Anderson PhD ,&nbsp;Meseret Asfaw MD ,&nbsp;Funeka Bango MPH ,&nbsp;Prof Anneke Hesseling PhD","doi":"10.1016/S2352-4642(24)00330-4","DOIUrl":"10.1016/S2352-4642(24)00330-4","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;There are few data on the treatment of children and adolescents with multidrug-resistant (MDR) or rifampicin-resistant (RR) tuberculosis, especially with more recently available drugs and regimens. We aimed to describe the clinical and treatment characteristics and their associations with treatment outcomes in this susceptible population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a systematic review and individual participant data meta-analysis. Databases were searched from Oct 1, 2014, to March 30, 2020. To be eligible, studies must have included more than five children or adolescents (0–19 years of age) treated for microbiologically confirmed or clinically diagnosed MDR or RR tuberculosis within a defined treatment cohort, and reported on regimen composition and treatment outcomes. Abstracts were screened independently by two authors to identify potentially eligible records. Full texts were reviewed by two authors independently to identify studies meeting the eligiblity criteria. For studies meeting eligiblity criteria, anonymised individual patient data was requested and individiual level data included for analysis. The main outcome assessed was treatment outcome defined as treatment success (cure or treatment completed) versus unfavourable outcome (treatment failure or death). Multivariable logistic regression models were used to identify associations between clinical and treatment factors and treatment outcomes. This study is registered with Prospero (CRD42020187230).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;1417 studies were identified through database searching. After removing duplicates and screening for eligibility, the search identified 23 369 individual participants from 42 studies, mostly from India and South Africa. Overall, 16 825 (72·0%) were successfully treated (treatment completed or cured), 2848 died (12·2%), 722 (3·1%) had treatment failure, and 2974 (12·7%) were lost to follow-up. In primary analyses, the median age was 16 (IQR 13–18) years. Of the 17 764 (87·1%) participants with reported HIV status, 2448 (13·8%) were living with HIV. 17 707 (89·6%) had microbiologically confirmed tuberculosis. After adjusting for significant factors associated with treatment outcome, the use of two (adjusted odds ratio [OR] 1·41 [95% CI 1·09–1·82]; p=0·008) or three (2·12 [1·61–2·79]; p&lt;0·0001) WHO-classified group A drugs (bedaquiline, moxifloxacin, levofloxacin, and linezolid) compared with the use of no group A drugs at all was positively associated with treatment success.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Younger and clinically diagnosed children are underrepresented among those treated for MDR and RR tuberculosis and should be a focus for case-finding efforts. Overall treatment outcomes in our analysis were better than in adults but lower than the international targets of 90% or more individuals successfully treated. Treatment with more group A drugs was associated with better treatment ou","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Pages 100-111"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043948","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":"Dancing with dad","authors":"Sophie Cousins","doi":"10.1016/S2352-4642(25)00003-3","DOIUrl":"10.1016/S2352-4642(25)00003-3","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Page 87"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043971","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":"Patricia Young: advocating for children in humanitarian crises","authors":"Udani Samarasekera","doi":"10.1016/S2352-4642(25)00004-5","DOIUrl":"10.1016/S2352-4642(25)00004-5","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Page 88"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043989","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":"A toolbox for innovative paediatric research","authors":"The Lancet Child & Adolescent Health","doi":"10.1016/S2352-4642(25)00005-7","DOIUrl":"10.1016/S2352-4642(25)00005-7","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Page 77"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043780","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":"Adapt to survive and thrive: the time is now for adaptive platform trials for preterm birth","authors":"Prof Brett J Manley PhD ,&nbsp;Christopher J D McKinlay PhD ,&nbsp;Prof Katherine J Lee PhD ,&nbsp;Prof Katie M Groom PhD ,&nbsp;Clare L Whitehead PhD","doi":"10.1016/S2352-4642(24)00328-6","DOIUrl":"10.1016/S2352-4642(24)00328-6","url":null,"abstract":"<div><div>In this Viewpoint, we discuss the challenges facing perinatal clinical researchers, many of which are unique to this field, and how traditional two-arm randomised trials using frequentist analysis might no longer be fit for purpose for perinatology. We propose a solution: the adoption of adaptive platform trials (APTs) with Bayesian methodology to address perinatal research questions to improve outcomes of preterm birth. APTs use a master protocol as a foundation to efficiently assess multiple interventions simultaneously for a particular disease. APTs can study these interventions in a perpetual manner, with interventions allowed to enter or leave the platform on the basis of preplanned decision algorithms. In this Viewpoint, we outline the ways in which APTs can overcome some of the issues facing perinatal clinical research, and the challenges and essential requirements for the design and implementation of perinatal APTs that should be considered.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Pages 131-137"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043890","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":"Harnessing n-of-1 trials for personalised paediatric care in the era of information overload","authors":"Joyce P Samuel","doi":"10.1016/S2352-4642(24)00299-2","DOIUrl":"10.1016/S2352-4642(24)00299-2","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Pages 82-84"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043982","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":"Creating child-inclusive societies","authors":"Prof Helen Skouteris PhD ,&nbsp;Michael Marmot FRCP ,&nbsp;Prof Sharon Bessell PhD","doi":"10.1016/S2352-4642(24)00254-2","DOIUrl":"10.1016/S2352-4642(24)00254-2","url":null,"abstract":"<div><div>In a global landscape defined by polycrisis, children are being failed. To address this failure, we ask an ambitious yet fundamental question: how do we create child-inclusive societies where every child thrives and has the best start in life, where intergenerational disadvantage is redressed, and where child poverty is ended? Building on the power of the social determinants of health in advancing equity and human wellbeing, we argue that child inclusiveness requires three foundational actions linked to the political, commercial, and social determinants of health: (1) prioritising implementation of transformative collaboration between policy makers, public bodies, and communities to improve outcomes for children; (2) reclaiming the public good through child-centred regulatory frameworks that aim to deliver health care and improve wellbeing; and (3) valuing the time to care for children and to build meaningful and responsive relationships with them. With innovative thinking about our societies and their core values, we can design child-inclusive interventions and derive relevant metrics and indicators to track progress.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Pages 71-76"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690203","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":"Effect of a youth-led early childhood care and education programme on children's development and learning in rural Sindh, Pakistan (LEAPS): a stepped-wedge cluster-randomised implementation trial","authors":"Prof Aisha K Yousafzai PhD ,&nbsp;Saima Siyal MA ,&nbsp;Emily E Franchett SM ,&nbsp;Quanyi Dai EdM ,&nbsp;Karima Rehmani MA ,&nbsp;Christopher R Sudfeld ScD ,&nbsp;Shelina Bhamani PhD ,&nbsp;Shahnaz Hakro MA ,&nbsp;Chin R Reyes PhD ,&nbsp;Prof Günther Fink PhD ,&nbsp;Liliana A Ponguta PhD","doi":"10.1016/S2352-4642(24)00304-3","DOIUrl":"10.1016/S2352-4642(24)00304-3","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;In low-income and middle-income countries, an estimated 181·9 million (74·6%) preschool-aged children do not receive adequate nurturing care in health, nutrition, protection, learning, and responsive care, thus jeopardising their healthy development across the life course. Working alongside the health sector, multisectoral actions including social protection and education are necessary to achieve child health and development outcomes. Innovations are needed to expand access to high-quality early childhood care and education (ECCE) for young children and opportunities for youth development. Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) is a two-generation programme that trains female youth aged 18–24 years to deliver ECCE. We evaluated the effectiveness of LEAPS to improve children's school readiness when delivered at scale in rural Pakistan.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We implemented a stepped-wedge cluster-randomised trial with three steps from Dec 3, 2018, to June 30, 2021. 99 villages (clusters) in four districts in rural Sindh, Pakistan, were randomly assigned (1:1:1) to introduce LEAPS across three steps. Eligible clusters were those that had a feeder primary school run by the National Commission for Human Development, a department of the Ministry of Federal Education and Professional Training; were safe; had space for a LEAPS preschool; could identify a female youth to deliver the ECCE service; and had not previously participated in the pilot study. Government partners trained female youth, aged 18–24 years, to provide community-based ECCE, enrolling up to 20 children, aged 3·5–5·0 years, per class. Population-based cross-sectional surveys were conducted at baseline and after each step for children who were eligible if they resided in the cluster, were aged 4·5–5·5 years at the time of the survey, and without any severe clinical health conditions or disability. The primary outcome was children's school readiness using the International Development and Early Learning Assessment (IDELA) composite score comprising emergent numeracy, emergent literacy, socio-emotional development, and motor skills. An intention-to-treat analysis was conducted, using linear mixed models accounting for clustering and the stepped-wedge design. The trial is registered with &lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt; (&lt;span&gt;&lt;span&gt;NCT03764436&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;LEAPS was implemented in 91 of 99 villages. In eight clusters, a LEAPS preschool could not be set up. For the intervention programme, the average enrolment of children in a LEAPS preschool was 19 (SD 3, range 12–20). A total of 3858 children (n=3852 with complete IDELA data) were assessed across the four survey rounds conducted between Jan 1, 2019, and March 31, 2021. LEAPS increased school readiness (standardised mean difference: 0·30 [95% CI 0·20–0·40","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Pages 25-36"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788346","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}