BMJ Paediatrics Open最新文献

{"title":"My culture soothes","authors":"Karen Daniela Rodríguez-Zúñiga, María Camila Pinzón-Segura","doi":"10.1136/bmjpo-2024-002915","DOIUrl":"https://doi.org/10.1136/bmjpo-2024-002915","url":null,"abstract":"In the poignant words of a 12-year-old indigenous girl from the Pijao ethnicity (Tolima, Colombia), who shared her perspective before succumbing to leukaemia, we gain a profound understanding of health from her unique cultural viewpoint. Growing up in El Escobal, indigenus community, with her sister, she experienced the spiritual strength and unity that their culture attributes to twins. For her, health was deeply intertwined with the traditions and rituals of her people, emphasising the healing powers of plants and spiritual harmonisation. She observed a stark contrast between indigenous and Western perspectives on medicine and spirituality. In her reflection, the young girl highlighted the universal language of mutual learning and support that transcends cultural differences. Her message underscores the importance of cultural harmony and the healing power of shared human experiences, advocating for a world where diverse beliefs and practices contribute to collective strength and understanding. This text was her response to the question, \"What is health?\" as part of one of the methodological exercises in the doctoral research of Pinzón-Segura MC. Teoría del Intersticio Afectivo: Un nuevo enfoque feminista decolonial de análisis de políticas públicas [Internet]. Bogotá: Repositorio virtual de la Universidad Nacional de Colombia; 2024. The thesis, awarded with the distinction of summa cum laude, included various methods such as participant observation, sociological interviews, and discourse analysis of government documents. The question \"What is health?\" specifically guided 40 creative narrative workshops, which were an integral component of the ethnography and arts-based research design.","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255455","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":"Child rights and the necessity for an Optional Protocol for the Protection of Children in Armed Conflicts","authors":"Jeffrey Goldhagen, Tom Adamkiewicz","doi":"10.1136/bmjpo-2024-002843","DOIUrl":"https://doi.org/10.1136/bmjpo-2024-002843","url":null,"abstract":"This year marks the 35th and 100th anniversaries of the UN Convention on the Rights of the Child (CRC, 1989) and Declaration of the Rights of the Child (1924), and the 75th anniversary of the Geneva Conventions (1949). Yet, shockingly, this year’s United Nations (UN) Report on Children and Armed Conflict decries the ‘… complete disregard for child rights, notably the inherent right to life’ in today’s escalating armed conflicts.1 According to the UN, in 2023 a total of 32 990 grave violations were verified against 22 557 children. The number of children killed (5301) and maimed (6348) increased overall by a staggering 35% as compared with 2022, and, in Israel and Palestinian territories by 155%, Sudan 480% and Myanmar 123%. Burkina Faso, the Democratic Republic of the Congo, Somalia, Syria, Ukraine and other regions have also been affected.1 Verification of Palestinian children killed is ongoing. In most modern conflicts, 90% of casualties are civilians, including children. Through direct harm, destruction of infrastructure, blockades, sanctions, and repeated dislocations—armed conflicts cause physical, mental, developmental and behavioural trauma to children that often affect them long after cessation of hostilities.1–4 An estimated 3.2 million children under 5 years of age died in armed conflicts between 2000 and 2019.2 Why do international laws, conventions and statutes provide insufficient protection to children, and can this be improved? In 2002 the Rome Statute established the International Criminal Court to complement national courts in litigating individuals that commit grave crimes, such as Crimes of Genocide, defined as acts committed with the intent to destroy, in whole or in part, a national, ethnic, racial or religious group. War crimes are also included and are defined as severe breaches of the Geneva Conventions. The latter outlines how civilians, …","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255453","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":"Neonatal and short-term outcome after late vertical transmission in congenital CMV-infected fetuses following primary first-trimester maternal seroconversion","authors":"Bart De Keersmaecker, Sanne Vanwinkel, Katrien Lagrou, Katrien Jansen, Gunnar Naulaers, Luc De Catte","doi":"10.1136/bmjpo-2024-002773","DOIUrl":"https://doi.org/10.1136/bmjpo-2024-002773","url":null,"abstract":"Objective To document the course of neonatal and short-term outcomes in pregnancies after first trimester CMV (cytomegalovirus) seroconversion and negative amniotic fluid (AF) CMV PCR. Methods We included 375 patients with a first-trimester CMV seroconversion and amniocentesis at ≥21 weeks. Termination of pregnancy (TOP) was offered in case antenatally severe CMV-related fetopathy was documented either by ultrasound or by MRI. AF CMV PCR-negative fetuses underwent a PCR CMV on neonatal urine (NU). Perinatal and short-term infant outcomes were investigated by a questionnaire, sent to parents. Results AF CMV PCR was positive in 118/375 cases (31.4%). TOP was performed in 46/118 (38.9%) and fetal demise occurred twice. Questionnaires were sent to 327 patients with an overall response rate of 77%. Three groups were considered: Group 1: the early infected group (AF CMV PCR positive; N=62), group 2: the late infected group (AF CMV PCR negative, NU CMV PCR positive; N=7) and group 3: the control group (AF+NU CMV PCR negative; N=160). Compared with group 3, group 1 was more frequently symptomatic at birth (6.2% vs 19.4%; p=0.006). In short-term follow-up, hearing impairment (23.5%; p<0.001), mild motor deficit - defined as abnormal early motor development or the need for physiotherapy in later life (21.6%; p=0.005) - and subnormal vision (15.7%; p=0.02) were significantly more frequent. Compared with group 3, group 2 showed more often jaundice (57.1%; p=0.04) and petechiae (28.6%; p=0.04) at birth, but other short-term symptoms were lacking. Conclusion Although neonates may screen positive on urine for CMV after an AF CMV negative PCR, they show rarely and only mild sequelae in early life. Data are available upon reasonable request.","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201757","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":"Comparative efficacy of pharmacological and non-pharmacological interventions for mitigating pain and anxiety associated with venipuncture: a randomised controlled trial","authors":"Sherzad Khudeida Suleman, Nizer Yahya, Stefan Nilsson, Karin Enskär","doi":"10.1136/bmjpo-2024-002881","DOIUrl":"https://doi.org/10.1136/bmjpo-2024-002881","url":null,"abstract":"Background Venipuncture is one of the most commonly performed medical procedures in paediatric care, but it can also be one of the most painful and distressing experiences for patients. Finding effective strategies to manage pain and fear associated with venipuncture is crucial for improving the paediatric patient experience and promoting positive health outcomes. This study aimed to evaluate the efficacy of a combined approach using a topical analgesic cream (TKTX cream) and a distraction technique (Trace Image and Colouring for Kids-Book, TICK-B) in reducing pain intensity and fear levels in children undergoing venipuncture procedures. Methods We conducted this randomised controlled trial among 176 children aged 6–12 years undergoing venipuncture. Participants were randomly assigned to four groups: TICK-B, TKTX cream, TICK-B+TKTX cream and a control group. Pain and fear were measured using the Wong-Baker FACES Pain Rating Scale and Children’s Fear Scale. The study was carried out from 20 February 2024 to 1 June 2024 at the emergency unit of Heevi paediatric teaching hospital in the Kurdistan region of Iraq. In the intervention groups, TICK-B was applied for 2–3 min before needle insertion, and TKTX cream was applied 20 min before the venipuncture procedure. All outcome measures were evaluated 2–3 min after the completion of the venipuncture procedure. Results The combined TICK-B (colouring book) and TKTX cream (topical anaesthetic) intervention was the most effective in reducing both pain intensity (mean score 2.80 vs 7.24 in the control, p<0.001) and fear levels (mean score 0.93 vs 2.83 in the control, p<0.001) during and after venipuncture procedures compared with individual interventions and control. Conclusions The combined TICK-B distraction and TKTX cream topical anaesthetic intervention was the most effective in reducing pain intensity and fear during and after venipuncture in children, providing a practical strategy for healthcare providers to optimise needle procedure management. Trial registration number [NCT06326125][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT06326125&atom=%2Fbmjpo%2F8%2F1%2Fe002881.atom","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201758","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":"Incidence and outcome of biliary atresia in Shanghai, China from 2015 to 2016: a cohort study","authors":"Yifan Yang, Rui Dong, Gong Chen, Shan Zheng, Weili Yan, Zhen Shen","doi":"10.1136/bmjpo-2023-002475","DOIUrl":"https://doi.org/10.1136/bmjpo-2023-002475","url":null,"abstract":"Demographic characteristics and clinical data of all newly diagnosed biliary atresia patients in Shanghai were collected from 1 January 2015 to 31 October 2016. The total number of live births was 377 420 during the study period, and the incidence of biliary atresia in Shanghai was 10.86 per 100 000 (95% CI 7.8 to 17.74), with 62.9% and 45.7% cases retaining native liver survival at 2 and 5 years after Kasai procedure, respectively. Implementation of systematic screening measures for biliary atresia in China is needed.","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255454","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":"Correction: ‘Understanding patient partnership in health systems: lessons from the Canadian patient partner survey’","authors":"BMJ Publishing Group Ltd","doi":"10.1136/bmjpo-2023-002423corr1","DOIUrl":"https://doi.org/10.1136/bmjpo-2023-002423corr1","url":null,"abstract":"Howard N. Digital micro-banking as a health and protection intervention for street-connected children and youth? Analysis from a Togolese pilot. BMJ Paediatrics Open 2024;8:e002423. doi:10.1136/bmjpo-2023-002423 …","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201760","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":"Uncovering early predictors of cerebral palsy through the application of machine learning: a case-control study.","authors":"Sara Rapuc, Blaž Stres, Ivan Verdenik, Miha Lučovnik, Damjan Osredkar","doi":"10.1136/bmjpo-2024-002800","DOIUrl":"10.1136/bmjpo-2024-002800","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral palsy (CP) is a group of neurological disorders with profound implications for children's development. The identification of perinatal risk factors for CP may lead to improved preventive and therapeutic strategies. This study aimed to identify the early predictors of CP using machine learning (ML).</p><p><strong>Design: </strong>This is a retrospective case-control study, using data from the two population-based databases, the Slovenian National Perinatal Information System and the Slovenian Registry of Cerebral Palsy. Multiple ML algorithms were evaluated to identify the best model for predicting CP.</p><p><strong>Setting: </strong>This is a population-based study of CP and control subjects born into one of Slovenia's 14 maternity wards.</p><p><strong>Participants: </strong>A total of 382 CP cases, born between 2002 and 2017, were identified. Controls were selected at a control-to-case ratio of 3:1, with matched gestational age and birth multiplicity. CP cases with congenital anomalies (<i>n</i>=44) were excluded from the analysis. A total of 338 CP cases and 1014 controls were included in the study.</p><p><strong>Exposure: </strong>135 variables relating to perinatal and maternal factors.</p><p><strong>Main outcome measures: </strong>Receiver operating characteristic (ROC), sensitivity and specificity.</p><p><strong>Results: </strong>The stochastic gradient boosting ML model (271 cases and 812 controls) demonstrated the highest mean ROC value of 0.81 (mean sensitivity=0.46 and mean specificity=0.95). Using this model with the validation dataset (67 cases and 202 controls) resulted in an area under the ROC curve of 0.77 (mean sensitivity=0.27 and mean specificity=0.94).</p><p><strong>Conclusions: </strong>Our final ML model using early perinatal factors could not reliably predict CP in our cohort. Future studies should evaluate models with additional factors, such as genetic and neuroimaging data.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104137","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":"Spinal muscular atrophy in an upper-middle-income nation before the advent of reimbursed disease-modifying therapies.","authors":"Kullasate Sakpichaisakul, Kamornwan Katanyuwong, Utcharee Intusoma, Tanitnun Paprad, Piradee Suwanpakdee, Chaiyos Khongkhatithum, Oranee Sanmaneechai","doi":"10.1136/bmjpo-2024-002775","DOIUrl":"10.1136/bmjpo-2024-002775","url":null,"abstract":"<p><strong>Objective: </strong>To elucidate the clinical characteristics and standard of care (SoC) of spinal muscular atrophy (SMA) patients in Thailand, focusing on primary endpoints: age at death and a composite of death or tracheostomy need.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Seven tertiary centres across Thailand.</p><p><strong>Patients: </strong>Records of 110 patients with genetically confirmed SMA, spanning 2012-2021.</p><p><strong>Interventions: </strong>Historical data review; no active interventions.</p><p><strong>Main outcome measures: </strong>Age at death and a composite measure of death or tracheostomy necessity.</p><p><strong>Results: </strong>The cohort included 1 SMA0, 50 SMA1, 40 SMA2 and 19 SMA3 cases. Median ages at the onset and diagnosis of SMA1 were 3 and 6.2 months. Of SMA1 patients, 63% required ventilators, and eight received dimethyltryptamines (DMTs) at a median of 15 months (range 6.4-24.5 months). The median time from onset to DMT was 11 months (range 4.2-20.5 months). Among SMA1 patients, 73% died by the study's end. SMA2 and SMA3 patients' median onset ages were 11 and 24 months, respectively, with diagnosis at 24.8 and 68.7 months. Half of all types received physical therapy.</p><p><strong>Conclusions: </strong>Significant delays in diagnosis and SoC access, including DMTs, were observed, underscoring urgent needs for improved diagnostic and care strategies to enhance SMA patient outcomes in Thailand.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104135","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":"Assessing the diagnostic accuracy of postnatal clinical scoring methods and foot length measurement for estimating gestational age and birthweight of newborns in low- and middle-income countries: a systematic review and meta-analysis.","authors":"Shiyam Sunder Tikmani, Thomas Mårtensson, Sumaira Khalid, Muhammad Uzair, Qammerulanissa Ali, Anum Rahim, Andreas Mårtensson, Sarah Saleem, Nick Brown","doi":"10.1136/bmjpo-2024-002717","DOIUrl":"10.1136/bmjpo-2024-002717","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to update systematic reviews and meta-analyses on the diagnostic accuracy of postnatal clinical scoring (PCS) methods and foot length (FL) measurement for assessing gestational age (GA) and birth weight in low-income and middle-income countries (LMICs). In addition, the quality of reference standards, including antenatal ultrasound (A-US), last menstrual period (LMP), PCS and newborn weighing scales, was also evaluated.</p><p><strong>Methods: </strong>Studies from LMICs published between January 2000 and February 2024 were searched, using databases such as PubMed, Web of Science, Cochrane Library, CINAHL and Scopus. Studies that compared PCS and/or FL with LMP and/or A-US to estimate GA or used calibrated newborn weighing scales for birthweight estimation were included. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-II tool and evaluated the quality of the reference standards. When sufficient data were available, pooled estimates were calculated using random-effects models.</p><p><strong>Results: </strong>A total of 50 studies were included. A-US was a reasonable tool for GA assessment if conducted by physicians using fetal biometry and the Hadlock method for GA estimation. LMP was reasonable when women had regular cycles, knew their LMP, were not using contraceptives and LMP data were collected by healthcare providers. When A-US was used as the reference standard, PCS methods estimated GA with a precision of ±2.8 to ±3.2 weeks. FL measurement <7.5 cm showed a pooled sensitivity of 76.2% and specificity of 36.6% for identifying preterm birth. FL measurement ≤7.6 cm had a pooled sensitivity of 78.6% and specificity of 65.7% for identifying low birth weight (LBW). High heterogeneity across studies was observed.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis highlights significant variability and methodological inconsistencies in using PCS methods and FL measurement for estimating GA and LBW in LMICs. The observed high heterogeneity across studies suggests a cautious interpretation of the results.</p><p><strong>Prospero registration number: </strong>CRD42020209455.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104130","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":"Evaluation of the WHO standards to assess quality of care for children with acute respiratory infections: findings of a baseline multicentre assessment (CHOICE) in Italy.","authors":"Marzia Lazzerini, Massimo Dagnelut, Paolo Dalena, Idanna Sforzi, Maristella Toniutti, Enrico Felici, Silvia Bressan, Gian Luca Trobia, Stefano Martelossi, Riccardo Lubrano, Silvia Fasoli, Federico Marchetti, Andrea Iuorio, Chiara Grisaffi, Silvia Galiazzo, Francesca Patanè, Chiara Stefani, Maria Luisa Casciana, Angela Troisi, Egidio Barbi","doi":"10.1136/bmjpo-2024-002552","DOIUrl":"10.1136/bmjpo-2024-002552","url":null,"abstract":"<p><strong>Background: </strong>Experience is lacking on the implementation of the WHO standards for improving the quality of care (QOC) for children at facility level. We describe the use of 10 prioritised WHO standard-based quality measures to assess provision of care for children with acute respiratory infections (ARI) in Italy.</p><p><strong>Methods: </strong>In a multicentre observational study across 11 emergency departments with different characteristics, we collected 10 WHO standard-based quality measures related to case management of children with ARI and no emergency/priority signs. Univariate and multivariate analyses were conducted.</p><p><strong>Results: </strong>Data from 3145 children were collected. Major differences in QOC across facilities were observed: documentation of saturation level and respiratory rate varied from 34.3% to 100% and from 10.7% to 62.7%, respectively (p<0.001); antibiotic prescription rates ranged from 22.6% to 80.0% (p<0.001), with significant differences in the pattern of prescribed antibiotic; hospitalisations rates ranged between 2.3% and 30.6% (p<0.001). When corrected for children's individual sociodemographic and clinical characteristics, the variable more consistently associated with each analysed outcome was the individual facility where the child was managed. Higher rates of antibiotics prescription (+33.1%, p<0.001) and hospitalisation (+24.7%, p<0.001) were observed for facilities in Southern Italy, while university centres were associated with lower hospitalisation rates (-13.1%, p<0.001), independently from children's characteristics.</p><p><strong>Conclusions: </strong>The use of 10 WHO standard-based measures can help quickly assess QOC for children with ARI. There is an urgent need to invest more in implementation research to identify sustainable and effective interventions to ensure that all children receive high QOC.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104138","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}