BMJ Paediatrics Open最新文献

{"title":"A new approach to children's work that prioritises resilience, well-being and agency: emerging findings from a 'cash plus' intervention in Bangladesh.","authors":"Neil Howard, Keetie Roelen, Giel Ton, Mauricio Espinoza Hermoza, Saklain Al Mamun, Kabita Chowdhury, Taslima Aktar, Lopita Huq","doi":"10.1136/bmjpo-2023-002422","DOIUrl":"10.1136/bmjpo-2023-002422","url":null,"abstract":"<p><strong>Background: </strong>Criticism of mainstream approaches to child labour is widespread and well-established. The Child Labour Action Research in South and Southeast Asia (CLARISSA) Cash Plus pilot sought to address these critiques through an innovative programme that prioritised the development of household resilience and well-being, and through increasing household capacity to make alternative choices around children's work.</p><p><strong>Research: </strong>Funded by the UK's Foreign, Commonwealth and Development Office, this pilot delivered unconditional cash transfers (UCTs) and needs-based case management and community mobilising across an entire slum neighbourhood in Dhaka, Bangladesh. Cash worth about 20% of household monthly income was delivered to all households for 7 months, with case work and community organising wrapped around for 21 months. The intended outcomes were that families would be able to increase their economic resilience and develop alternative capacities to meet their needs, with the intended goals of increasing well-being and the ability to make choices other than difficult or dangerous work for children. Research into impact was rooted in contribution analysis and combined bimonthly monitoring surveys administered by the community mobilisers; surveys at multiple time points; three rounds of targeted focus group discussions; three rounds of key informant interviews with case study households; community mobiliser diaries; and ethnographic observation.</p><p><strong>Results and conclusions: </strong>The results strongly suggest that UCTs reduce poverty, increase economic resilience; improve well-being; and generate various household-level improvements that relate directly and indirectly to children's work. They further suggest that case work and community organising act as a beneficial form of social protection and a tool for developing locally appropriate micro-responses to collective problems that commonly impact directly on well-being and indirectly on children's work. These results point to the potential for this intervention to be scaled-up in efforts to achieve the eighth Sustainable Development Goal of ensuring decent work for all, including the elimination of child labour.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999883","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":"Fuelling our passions with the Health Hackathon.","authors":"Taiba Hussain, Yonalee Polwaththa Gallage, Smita Shah","doi":"10.1136/bmjpo-2024-003270","DOIUrl":"10.1136/bmjpo-2024-003270","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982556","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":"Impact of exposure to opioids in pregnancy on offspring developmental outcomes in the preschool years: an umbrella review.","authors":"Senga Robertson, Thomas Hughes, James Boardman, Alison McFadden, Anne Whittaker, Louise Marryat","doi":"10.1136/bmjpo-2024-003058","DOIUrl":"10.1136/bmjpo-2024-003058","url":null,"abstract":"<p><strong>Background: </strong>Early child development sets the course for optimal outcomes across life. Increasing numbers of children worldwide are exposed to opioids in pregnancy and frequently live in environments associated with adverse developmental outcomes. Although multiple systematic reviews have been published in this area, they use different exposures and different types of outcomes. This umbrella review aims to bring together these systematic reviews to provide a comprehensive overview of the evidence around the association between prenatal opioid exposure and preschool developmental outcomes.</p><p><strong>Methods: </strong>PubMed, MedLine, PsycInfo and Google Scholar were searched up to July 2024. Eligible studies were systematic reviews, meta-analyses or scoping reviews exploring prenatal opioid exposure (illicit opioids and prescribed treatments for opioid dependence) and developmental outcomes up to age 5. Reviews were screened by two authors. Quality assessment was undertaken using the Joanna Briggs Institute checklist for umbrella reviews. Degree of overlap was examined. Due to heterogeneity within the sample, no meta-analyses were undertaken and results were synthesised narratively.</p><p><strong>Results: </strong>11 reviews were included containing 478 individual papers. The overlap was slight (corrected cover area=5%). Developmental outcomes associated with prenatal opioid exposure included visual function, motor skills, externalising problems and language difficulties. No conclusive evidence was available for cognitive development or internalising symptoms. In cognitive, and motor, skills, findings differed by age, with later preschool findings being weaker. Authors frequently highlighted issues with poor quality research in the original studies, including small sample sizes and lack of controlling for confounding.</p><p><strong>Conclusions: </strong>Multiple areas of child development were associated with prenatal opioid exposure; however, evidence was weak. Robust research, with larger sample sizes and adequate accounting for confounding, is needed to provide accurate information for women of childbearing age and practitioners to guide policy and ensure that appropriate funding, support and follow-up are in place.</p><p><strong>Prospero registration number: </strong>CRD42022307992.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944319","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":"Advertising and child health.","authors":"Imti Choonara","doi":"10.1136/bmjpo-2024-003260","DOIUrl":"10.1136/bmjpo-2024-003260","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944280","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":"miR-21 and cathepsin B in familial Mediterranean fever: novel findings regarding their impact on disease severity.","authors":"Sinem Durmus, Remise Gelisgen, Ramila Hajiyeva, Amra Adrovic, Mehmet Yildiz, Emrah Yucesan, Kenan Barut, Ozgur Kasapcopur, Hafize Uzun","doi":"10.1136/bmjpo-2024-003064","DOIUrl":"10.1136/bmjpo-2024-003064","url":null,"abstract":"<p><strong>Objective: </strong>The limited predictive effect of genotype on familial Mediterranean fever (FMF) phenotype suggests that epigenetic factors and alternative mechanisms that may cause IL-1β release could contribute to phenotypic heterogeneity. The objective of this study was to examine the role of IL-1β levels and miR-21-5p, cathepsin B and pyrin levels, which were identified as potential factors causing IL-1β release through the use of bioinformatics tools, in the pathogenesis of FMF and their relationship with disease severity.</p><p><strong>Materials and methods: </strong>50 paediatric patients with FMF and 40 healthy children were enrolled in this study. Patients were divided into subgroups according to Pras disease severity score. Serum miR-21-5p expression levels were assessed by qRT-PCR, while serum pyrin, IL-1β and cathepsin B levels were determined by ELISA.</p><p><strong>Results: </strong>Serum miR-21-5p was significantly downregulated in FMF patients compared with the control group (p<0.001), while serum pyrin, IL-1β and cathepsin B levels were markedly elevated (p<0.001 for each). Only miR-21-5p was negatively correlated with IL-1β (r=-0.855; p<0.001). In moderately severe FMF patients, miR-21-5p exhibited a statistically significant downregulation (p<0.001), whereas IL-1β and cathepsin B showed a statistically significant increase (p<0.001 and p<0.05, respectively). Furthermore, the Pras score showed a strong negative correlation (r=-0.738; p<0.001) with miR-21-5p levels. Multivariate logistic regression showed that in FMF, a one-unit decrease in miR-21 increased disease severity risk 6.76-fold, while a one-unit increase in cathepsin B raised it 1.71-fold.</p><p><strong>Conclusion: </strong>This might be considered one of the mechanisms for subclinical inflammation in paediatric FMF patients through increased activation of cytokines via the downregulation of miR-21-5p. Our findings suggest that miR-21-5p and IL-1β play key roles in subclinical inflammation, and these molecules might be a potential therapeutic target.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944264","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":"Building relational well-being: empowering street-connected young people to transition from precarity to security through youth associations.","authors":"Kate McAlpine, Isabel Cooper, Raphael Dennis","doi":"10.1136/bmjpo-2024-002857","DOIUrl":"10.1136/bmjpo-2024-002857","url":null,"abstract":"<p><p>Street-connected young people (SCYP) in Tanzania face intersecting challenges, including economic vulnerability, social marginalisation and limited access to supportive networks. This study examines the impact of the Youth Association (YA) model, implemented by Railway Children Africa, and does so through the lens of the relational well-being approach, which emphasises the interplay of material, relational and subjective dimensions of well-being, as well as personal, societal and environmental drivers of well-being. Using a mixed methods design, this study tracked 116 SCYP in Mwanza and Dar es Salaam, Tanzania, through four stages of the YA model. Quantitative data revealed gains: 71% transitioned into stable housing, 84% reported increased pride and self-worth and 58% initiated income-generating projects. Qualitative insights provided deeper context, capturing participants' reflections on how peer networks and leadership opportunities, and vocational training fostered self-confidence, economic independence and community integration. Participants' recommendations included expanding educational opportunities, enhancing health services and addressing logistical barriers to increase the model's accessibility and impact. This study demonstrates the transformative potential of relationally driven interventions for vulnerable young people. By leveraging existing networks and prioritising relational support, the YA model offers an effective pathway for SCYP to transition from precarity to stability. The findings underscore the importance of participatory approaches and call for further research into the invisible networks of care supporting SCYP, ensuring that future interventions are responsive to their lived experiences and evolving needs.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944281","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":"Understanding variation in management of early-onset neonatal sepsis in India: a vignette-based survey.","authors":"Samuel McAleese, Tushar B Parikh, Basma Ouddi, Christina M Schumacher, Julia Johnson","doi":"10.1136/bmjpo-2024-003095","DOIUrl":"10.1136/bmjpo-2024-003095","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic use for early-onset neonatal sepsis (EONS) is common, but prolonged exposure can lead to poor outcomes. Laboratory capacity and infection prevention initiatives may impact antibiotic use for EONS in neonatal intensive care units. The objective of this study was to examine the influence of institutional capacity on antibiotic prescribing for EONS in India.</p><p><strong>Methods: </strong>Between September 2023 and January 2024, we surveyed Indian paediatricians and neonatologists regarding institutional capacity and antibiotic prescribing practices for EONS. Five vignettes with varying maternal and infant risk profiles explored participants' decision to initiate empiric antibiotics at birth and the timing of discontinuation of antibiotics in term and preterm infants at risk for EONS. Variation in reported initiation and discontinuation of empiric antibiotic use by institutional capacity and antimicrobial stewardship initiatives were assessed using logistic regression models.</p><p><strong>Results: </strong>Of 317 respondents, most (91%) reported antimicrobial stewardship initiatives at their institution and 56% reported receiving blood culture results within 48 hours. Screening tests such as complete blood count and C reactive protein were used in 56%-67% of cases, and abnormal results led to longer courses with fewer than 10% of respondents discontinuing antibiotics by 72 hours. When controlling for infant and maternal characteristics, the adjusted OR of observing infants without empiric antibiotics at birth was 0.38 (95% CI 0.16 to 0.70) for participants without infection prevention initiatives and was 1.57 (95% CI 1.05 to 2.35) for participants with timely (<48 hours) reporting of blood culture results, respectively. Infection prevention initiatives and laboratory capacity were not associated with increased odds of early discontinuation of empiric antibiotics for EONS.</p><p><strong>Conclusions: </strong>Infection prevention and laboratory capacity may decrease the initiation of empiric antibiotics but are not associated with early discontinuation of empiric antibiotics for EONS. The use of sepsis screening tests remains common in Indian neonates and requires additional study.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944328","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":"Clinical and ultrasound assessment of body composition in preterm infants at discharge: an observational study.","authors":"Montserrat Izquierdo Renau, Elsa García González, Carla Balcells-Esponera, Beatriz Del Rey Hurtado de Mendoza, Emilio J Inarejos Clemente, Isabel Iglesias-Platas","doi":"10.1136/bmjpo-2024-002774","DOIUrl":"10.1136/bmjpo-2024-002774","url":null,"abstract":"<p><strong>Objectives: </strong>While the target of growth of very preterm infants (VPIs) during Neonatal Intensive care unit (NICU) admission is still controversial, the most accepted objective is that they should follow their intrauterine trajectory in terms of growth and body composition (BC). BC is difficult to measure in clinical daily routine but proxies like body ratios and skinfolds have been used. Prenatal and postnatal factors can influence the growth and BC of VPIs in the NICU.</p><p><strong>Design, setting and patients: </strong>We conducted a case-control study, including preterm infants born before 32 weeks gestational age at term-corrected age (TCA) and healthy late preterm or term infants as controls and also a retrospective cohort analysis of factors influencing VPI's BC at discharge. Patients had an anthropometric evaluation at discharge including weight, length, head circumference, body circumferences (waist, arm), skinfolds and abdominal ultrasound (US).</p><p><strong>Results: </strong>191 VPIs were eligible for discharge visits, but only 83 had a complete evaluation and we collected 26 controls. VPIs at TCA were smaller in weight, length and head circumference but had greater ratios (arm fat-to-circumference and waist-to-length). Abdominal fat assessed by US was smaller in VPIs compared with term infants. Intrauterine growth restriction-VPI remained smaller at TCA but experienced less weight z-score loss. Sex did not seem to influence growth and BC proxies at TCA. Higher nutritional support during the first 2 weeks of life was related to a lower loss of length z-scores, and exclusive human milk feeding correlates with arm fat-to-circumference ratio.</p><p><strong>Conclusions: </strong>Growth and BC of VPIs can be approached using simpler measures in clinical practice. Arm skinfolds and arm circumferences point to a greater adiposity of VPIs at TCA compared with term infants, while US does not show a greater visceral adiposity. Nutritional factors played a small effect in BC at the time of discharge.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944288","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":"Effect of early establishment of full enteral feeding with exclusive mother's own milk in preterm babies: a retrospective cohort study.","authors":"Urmila Umasekar, Prakash Amboiram, Umamaheswari Balakrishnan, Nalini Sirala Jagadeesh","doi":"10.1136/bmjpo-2024-002931","DOIUrl":"10.1136/bmjpo-2024-002931","url":null,"abstract":"<p><strong>Background: </strong>Human milk, especially the mother's own milk (MOM), is highly recommended for preterm babies considering its numerous benefits. Prioritising the use of exclusive MOM in enteral feeding plans is essential for maximising the health and development of preterm babies. This study evaluated the effect of early establishment of full enteral feed (FEF) with exclusive MOM on feeding rate and neonatal nutritional outcomes at discharge among preterm babies.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using medical records of single preterm babies born between 27 and 33⁺⁶ weeks of gestational age and admitted to a single tertiary care hospital in South India between June 2019 and May 2022. The primary exposure was the establishment of FEF with exclusive MOM. The outcomes assessed were the exclusive MOM feeding rate and neonatal nutritional outcomes at discharge.</p><p><strong>Results: </strong>A total of 160 preterm babies met the inclusion criteria. Among these 104 (65%) achieved FEF with exclusive MOM. The exclusive MOM feeding rate at discharge was significantly higher among preterm babies who achieved FEF with exclusive MOM, 91.3% vs 62.5% (RR: 1.46 (95% CI: 1.18 to 1.81)). Preterm babies who achieved FEF with exclusive MOM were five times more likely to continue exclusive MOM feeding at discharge (aOR: 5.37, 95% CI: 2.04 to 14.16). The median time taken to achieve exclusive MOM among the exposure group was 6 days (95% CI: 5.6 to 6.3) compared with 12 days (95% CI: 10.2 to 13.8) for the unexposed group (HR: 0.26 (95% CI: 0.17 to 0.38; p<0.001)). There was no significant difference in growth and neonatal complications between the groups. Availability of MOM within 48 hours was strongly associated with achieving FEF with exclusive MOM, with an adjusted OR of 6.12 (95% CI: 2.81 to 13.30).</p><p><strong>Conclusions: </strong>Early establishment of FEF with exclusive MOM increases the exclusive MOM feeding rate at discharge. Early access to MOM within 48 hours significantly enhances the likelihood of achieving FEF with exclusive MOM.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944318","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":"Climate change will impact childhood cancer risks, care and outcomes.","authors":"Hannah M Thompson, Perry Sheffield, Omar Shakeel, Nicole M Wood, Mark D Miller","doi":"10.1136/bmjpo-2024-003123","DOIUrl":"10.1136/bmjpo-2024-003123","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944285","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}