Archives of Disease in Childhood最新文献

{"title":"Implementation of the children and young people's health partnership model of paediatric integrated care: a mixed-methods process evaluation.","authors":"Rose-Marie Satherley, James Newham, Elizabeth Cecil, Julia Forman, Clare Kelly, Ingrid Wolfe, Raghu Lingam","doi":"10.1136/archdischild-2024-327664","DOIUrl":"10.1136/archdischild-2024-327664","url":null,"abstract":"<p><strong>Objective: </strong>A process evaluation of the Children and Young People's Health Partnership (CYPHP) model of integrated care for the interpretation of trial findings and building evidence on the implementation of integrated care for children.</p><p><strong>Design: </strong>A mixed-methods process evaluation.</p><p><strong>Setting: </strong>CYPHP was implemented at scale across two inner-city London boroughs in South London, England, as a pragmatic cluster-randomised controlled trial involving nearly 98 000 children, with a nested process evaluation.</p><p><strong>Participants: </strong>Linked data were available from 73 000 participants. Qualitative data collection was through 102 interviews (group and 1:1) and observations.</p><p><strong>Interventions: </strong>Local child health clinics delivered by paediatricians and general practitioners and a nurse-led early intervention service for children with tracer conditions (asthma, eczema and constipation), decision support, a primary care hotline, self-management support and health promotion.</p><p><strong>Main outcome measures: </strong>Five domains of the RE-AIM implementation framework: Reach, Effectiveness, Adoption, Implementation and Maintenance.</p><p><strong>Results: </strong>Implementation varied depending on resource availability, competing priorities and natural changes over time. Successful implementation drivers included cohesive interprofessional and partnership collaboration.</p><p><strong>Conclusions: </strong>Integrated care for children can be implemented at scale, but variability, particularly low reach, may limit measurable impact at the population level. Significant health system strengthening, implementation plasticity and contextual tailoring are crucial for ensuring the efficacy and sustainability of impactful integrated care for children.</p><p><strong>Trial registration number: </strong>NCT03461848.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"603-611"},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"UK-ROX. What an incredible randomised controlled study.","authors":"","doi":"10.1136/archdischild-2025-329300","DOIUrl":"https://doi.org/10.1136/archdischild-2025-329300","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":"110 8","pages":"611"},"PeriodicalIF":4.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current provision of point of care ultrasound in UK paediatric critical care: an online survey.","authors":"Charlotte G Morea, Christopher Beaves, Peter Shires, Antonia Hargadon-Lowe, Oliver Ross, Michael J Griksaitis","doi":"10.1136/archdischild-2024-327934","DOIUrl":"10.1136/archdischild-2024-327934","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"667-668"},"PeriodicalIF":4.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent and parental views on weight and weight management: a qualitative study.","authors":"Melissa Little, Susan A Jebb, Paul Aveyard","doi":"10.1136/archdischild-2024-327306","DOIUrl":"10.1136/archdischild-2024-327306","url":null,"abstract":"<p><strong>Objective: </strong>To examine the views of adolescents with excess weight and parents of adolescents with excess weight towards weight and weight management.</p><p><strong>Design: </strong>A qualitative study design using semi-structured phone interviews. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis to interpret the data.</p><p><strong>Settings: </strong>Parents and adolescents based in the UK and recruited through schools, social media and youth centres.</p><p><strong>Participants: </strong>Ten parents and 16 adolescents, including four linked parent-child dyads.</p><p><strong>Results: </strong>Both parents and adolescents reported that adolescents felt societal pressure to achieve an 'ideal body' and that this pressure was the primary motivator for weight loss. All interviewed parents perceived themselves as overweight; however, those who had minimal weight-based shame were more likely to normalise weight discussions, reducing weight shame in their children. Adolescents preferred parents to display healthy behaviours rather than initiate weight-based discussions; however, they wanted to feel supported if the conversations were self-initiated.</p><p><strong>Conclusion: </strong>Weight is a sensitive issue in intergenerational relationships, primarily driven by feelings of shame. Adolescents feel supported by a 'show not tell' approach from parents, which is more likely in families with less shame. While guidelines encourage clinicians to initiate weight-related conversations, this may not be welcomed by adolescents, although they do want confidence that they could access weight management support if they choose to seek help.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"630-635"},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycerol intoxication syndrome in young children, following the consumption of slush ice drinks.","authors":"Shona Lc Brothwell, Patricia E Fitzsimons, Adam Gerrard, Bernd C Schwahn, Christopher Stockdale, Ann Bowron, Mark Anderson, Claire E Hart, Romanie Hannah, Francesca Ritchie, Sanjeev A Deshpande, Srividya Sreekantam, Gemma Watts, Sufin Yap, Helen Mundy, Aravindan Veiraiah, Abigail Collins, Alison Cozens, Andrew A Morris, Ellen Crushell","doi":"10.1136/archdischild-2024-328109","DOIUrl":"10.1136/archdischild-2024-328109","url":null,"abstract":"<p><strong>Introduction: </strong>Slush ice drinks are commonly available refreshments, aimed at children and young people. Glycerol is used to maintain the slush effect in the absence of a high sugar content.</p><p><strong>Objective: </strong>To describe a series of children who became acutely unwell shortly after consuming a slush ice drink; their presentation mimics specific inherited metabolic diseases (IMDs).</p><p><strong>Methods: </strong>A retrospective case review of 21 children who presented to centres across the UK and Ireland from 2009 through 2024 was carried out.</p><p><strong>Results: </strong>Almost all of the children (93%) became unwell within 60 min of slush ice drink consumption. None had any relevant past medical history. The median age at presentation was 3 years 6 months (range 2 years - 6 years 9 months). Presenting features include acute decrease in consciousness (94%), hypoglycaemia (95%), metabolic (lactic) acidosis (94%), pseudohypertriglyceridaemia (89%) and hypokalaemia (75%). Glyceroluria was present in all acute urine organic acid samples. No underlying IMD was found in the 14 patients who underwent further enzymatic or genetic testing. The majority (95%) subsequently avoided slush ice drinks and did not have reoccurrence.</p><p><strong>Conclusion: </strong>Consumption of slush ice drinks containing glycerol may cause a clinical syndrome of glycerol intoxication in young children, characterised by decreased consciousness, hypoglycaemia, lactic acidosis, pseudohypertriglyceridaemia and hypokalaemia. This mimics inherited disorders of gluconeogenesis and glycerol metabolism. Clinicians and parents should be alert to the phenomenon, and public health bodies should ensure clear messaging regarding the fact that younger children, especially those under 8 years of age, should avoid slush ice drinks containing glycerol.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"592-596"},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood folate level needed for fully effective fortification in the prevention of neural tube defects.","authors":"Nicholas J Wald, Stephen H Vale, Jonathan P Bestwick, Joan K Morris","doi":"10.1136/archdischild-2024-328115","DOIUrl":"10.1136/archdischild-2024-328115","url":null,"abstract":"<p><strong>Objective: </strong>Neural tube defects (NTDs) are a preventable folate deficiency disorder; increasing folic acid intake through food fortification increases serum and red blood cell folate and reduces the risk of an NTD pregnancy. There is controversy over the blood folate level needed to achieve the full preventive effect because of discrepant study conclusions.</p><p><strong>Methods: </strong>Results from two published studies were used to determine the relationship between serum folate and NTD risk which was compared with the observed result in a randomised trial of folic acid that increased serum folate from 5 ng/mL to 44 ng/mL among women who took a 4 mg daily periconceptional folic acid supplement.</p><p><strong>Results: </strong>Both studies showed a proportional (logarithmic) relationship between serum folate and NTD risk without evidence of a folate threshold above which there is no further NTD risk reduction. The suggestion of a threshold is due to the incorrect interpretation of the folate-NTD risk association when plotted on arithmetic scales, which conceals the proportional relationship between the two. Also, both studies accurately estimated the observed result from the randomised trial that achieved a median serum folate level of 44 ng/mL and an 83% preventive effect. This is much higher than has been achieved with current levels of folic acid fortification with serum folate between 10 and 16 ng/mL, resulting in an approximate 20% preventive effect.</p><p><strong>Conclusion: </strong>To achieve fully effective fortification, median population serum folate levels need to be about 44 ng/mL, which would globally prevent about 250 000 NTD cases every year.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"651-656"},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increases in vaccine-preventable disease outbreaks.","authors":"","doi":"10.1136/archdischild-2025-329293","DOIUrl":"https://doi.org/10.1136/archdischild-2025-329293","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":"110 8","pages":"591"},"PeriodicalIF":4.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of gender dysphoria and gender incongruence in children and young people attending primary care practices in England: retrospective cohort study.","authors":"Stuart William Jarvis, Lorna K Fraser, Trilby Langton, Catherine Elizabeth Hewitt, Tim Doran","doi":"10.1136/archdischild-2024-327992","DOIUrl":"10.1136/archdischild-2024-327992","url":null,"abstract":"<p><strong>Objective: </strong>To examine trends in diagnosis of gender dysphoria and related conditions in children and young people attending primary care practices in England.</p><p><strong>Design: </strong>Longitudinal analysis of electronic primary care records from the Clinical Practice Research Datalink (CPRD) Aurum database linked to hospital and Index of Multiple Deprivation data.</p><p><strong>Setting: </strong>Primary care practices in England between 2011 and 2021.</p><p><strong>Participants: </strong>3782 patients aged 0-18 years with a recorded history of gender dysphoria/incongruence and matched comparators with autism spectrum conditions or eating disorder.</p><p><strong>Main outcome measures: </strong>Incidence rates and prevalence of gender dysphoria/incongruence; prescribing rates for medical treatments; co-occurrence of anxiety, depression and self-harm.</p><p><strong>Results: </strong>Between 2011 and 2021, incidence rates of recorded gender dysphoria/incongruence increased from 0.14 (95% CI 0.08 to 0.20) to 4.4 (95% CI 4.1 to 4.7) per 10 000 person years, and from 2014 the rate increased more rapidly in recorded females than males. There was no significant association between gender dysphoria/incongruence and area level deprivation. Of the 3782 children and young people with a record of gender dysphoria/incongruence, 176 (4.7%) were prescribed puberty suppressing hormones; 302 (8.0%) were prescribed masculinising/feminising hormones; and 1994 (52.7%) had a record of anxiety, depression or self-harm. Compared with matched comparators, those experiencing gender dysphoria/incongruence had similar recorded rates of anxiety and higher rates of depression and self-harm.</p><p><strong>Conclusions: </strong>Recorded prevalence of gender dysphoria/incongruence increased substantially in children and young people between 2011 and 2021, particularly in recorded females. Levels of anxiety, depression and self-harm were high, indicating an urgent need for better prevention and treatment of mental health difficulties in these patients.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"612-621"},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical presentation of bone tumours in children and young people: a systematic review and meta-analysis.","authors":"Jo-Fen Liu, Dhurgshaarna Shanmugavadivel, Ashley Ball-Gamble, David Walker","doi":"10.1136/archdischild-2024-327879","DOIUrl":"10.1136/archdischild-2024-327879","url":null,"abstract":"<p><strong>Background: </strong>Children and young people (CYP) with bone tumours often experience lengthy intervals prior to diagnosis that can lead to increased morbidity and mortality. Early diagnosis is key to optimising treatment options and long-term outcomes. This review aims to describe symptomatology at diagnosis, in order to develop interventions to accelerate diagnosis.</p><p><strong>Methods: </strong>A literature search of MEDLINE and EMBASE was conducted for studies published between January 2008 and May 2023, reporting signs and symptoms in CYP with bone tumours. Pooled proportions of symptoms and signs were calculated.</p><p><strong>Results: </strong>16 studies (1452 patients; 492 osteosarcoma and 932 Ewing's sarcoma) were included in the analysis. The most prevalent symptoms were pain (64%, 95% CI 52% to 75%) and swelling (22%, 95% CI 6% to 42%). Other symptoms included fever, pain and swelling, history of trauma, pathological fracture, palpable mass, functional limitation, increased volume and limp. Subanalysis identified differences in symptom clusters: osteosarcoma more frequently presented with a history of trauma, pathological fracture, pain on weight-bearing, pain worse at night, pain at rest and weight loss. Ewing's sarcoma was associated with fever, functional limitation and a palpable mass.</p><p><strong>Conclusions: </strong>These data highlight the differences in presentations between osteosarcoma and Ewing sarcoma, which may account for differences in survival and outcome. This will be used to inform professional and public health interventions through the Child Cancer Smart campaign to accelerate diagnosis for all. This review also highlights the need for a renewed research focus to identify patients earlier in the disease development as a strategy to improve the current static outcomes.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"622-629"},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global paediatric workforce crisis: lessons from South Korea.","authors":"Young June Choe, Kee-Hyoung Lee","doi":"10.1136/archdischild-2024-327893","DOIUrl":"10.1136/archdischild-2024-327893","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"665-666"},"PeriodicalIF":4.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}