BMC Pediatrics最新文献

{"title":"Butyrate inhibits histone deacetylase 2 expression to alleviate liver fibrosis in biliary atresia.","authors":"Yilin Zhao, Xiaodan Xu, Shaowen Liu, Xueting Wang, Jiayinaxi Musha, Tengfei Li, Liang Ge, Yan Sun, Shujian Zhang, Li Zhao, Jianghua Zhan","doi":"10.1186/s12887-025-05635-3","DOIUrl":"https://doi.org/10.1186/s12887-025-05635-3","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have found a reduction in butyrate-producing bacteria in the gut microbiota of infants with biliary atresia (BA). Butyrate is also an important inhibitor of histone deacetylase 2 (HDAC2). This study aims to explore how butyrate alleviates liver fibrosis in BA through HDAC2.</p><p><strong>Methods: </strong>Fibrosis-related pathways associated with butyrate were analyzed using the GSE46960 database. BA liver sections were used to validate factor expression. The effects of HDAC2 and butyrate and the pathway were performed in vitro experiments. Butyrate intervention was performed in bile duct ligation (BDL) mice, and alterations in the gut microbiota were analyzed using fecal 16S rRNA sequencing. The impact of butyrate and related pathways on liver fibrosis in BDL mice was further evaluated.</p><p><strong>Results: </strong>The IL-6/STAT3 pathway showed a clear correlation with butyrate in BA. HDAC2 promoted LX-2 activation via the IL-6/STAT3 pathway, while butyrate inhibited LX-2 activation by suppressing HDAC2. Butyrate not only alleviated liver fibrosis but also improved the gut microbiota structure in BDL mice.</p><p><strong>Conclusion: </strong>Butyrate may improve liver fibrosis in BA by regulating HDAC2 expression and modulating the IL-6/STAT3 pathway. Therefore, butyrate could serve as a promising therapeutic option for mitigating liver fibrosis in BA.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"25 1","pages":"286"},"PeriodicalIF":2.0,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981032","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":"Gene proteins, growth factors/their receptors in the wall of chronic calculous cholecystitis-affected gallbladder children.","authors":"Darja Derbeneva, Mara Pilmane, Aigars Petersons","doi":"10.1186/s12887-025-05650-4","DOIUrl":"https://doi.org/10.1186/s12887-025-05650-4","url":null,"abstract":"<p><strong>Background: </strong>Chronic calculous cholecystitis is the main cause of cholecystectomies in children, and 50.5% of patients with gallstones are asymptomatic at the time of diagnosis. However, the morphopathogenesis of chronic cholecystitis with cholelithiasis is unclear and may involve various genes, gene proteins, and growth factors.</p><p><strong>Methods: </strong>Tissues were obtained from four males (aged 6-18 years) and two females (aged 15 and 14 years) during planned cholecystectomies. Five healthy gallbladder tissues were obtained from the archival postmortem tissue of children. SHH, IHH, HGF, IGF1, IGF1R, and HOXB3 were detected by immunohistochemistry and evaluated semiquantitatively. Statistical analysis was used to identify statistically significant differences and correlations between the factors.</p><p><strong>Results: </strong>Decreased numbers of SHH-, IHH-, and IGF1R-positive cells, along with an increased number of HOXB3-positive cells, were observed in patients. SHH-positive epitheliocytes and connective tissue cells; IHH-positive cells in all locations; IGF1R-positive epitheliocytes, endotheliocytes, and smooth muscle cells; and HOXB3-positive smooth muscle cells were significantly different among the groups. However, the strongest negative correlation was found between HOXB3-positive smooth myocytes and SHH- and IHH-positive connective tissues, and the strongest positive correlation was detected among epithelial IHH, SHH, and IGF1R, as well as between IGF1R in the epithelium and endothelium of the blood vessels.</p><p><strong>Conclusions: </strong>The reduced number of cells positive for the primary endodermal proteins SHH/IHH and the decreased number of IGFR1-positive cells suggest their potential roles in the development of chronic calculous cholecystitis. Additionally, the increased number of HOXB3-positive cells under these conditions likely implies stimulated growth properties, whereas HGF and IGF1 appear to have a reduced contribution to the pathogenesis of chronic calculous cholecystitis.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"25 1","pages":"288"},"PeriodicalIF":2.0,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968655","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":"Kikuchi-Fujimoto disease concurrent with aseptic meningitis or encephalitis in children: a case-control study.","authors":"Bing Liu, Yi Sun, Bing Hu, Wen-Yuan Shi, Tian-Ming Chen, Lin-Lin Liu, Gang Liu","doi":"10.1186/s12887-025-05648-y","DOIUrl":"https://doi.org/10.1186/s12887-025-05648-y","url":null,"abstract":"<p><strong>Background: </strong>This study was performed to summarize the clinical and laboratory features of children with Kikuchi-Fujimoto disease concurrent with aseptic meningitis or encephalitis.</p><p><strong>Methods: </strong>A case-control study of children diagnosed with Kikuchi-Fujimoto disease at Beijing Children's Hospital from January 2015 to December 2023 was conducted to determine the characteristics of the disease when concurrent with aseptic meningitis or encephalitis.</p><p><strong>Results: </strong>Our cohort of 64 cases of Kikuchi-Fujimoto disease included 16 children with central nervous system involvement and 48 controls. Among the 16 affected children, the male: female ratio was 1.7:1.0. The age at onset ranged from 3 to 13 years, with a median age of 8 years. All 16 cases had fever, 15 had cervical lymph node tenderness, 11 had headache, and 14 showed decreased white blood cell counts in routine blood tests. Imaging of the head revealed abnormalities in 11 cases, specifically leukoencephalopathy with mostly bilateral involvement. Cervical lymph node tenderness, headache, confusion, convulsions, and elevated C-reactive protein were significantly associated with Kikuchi-Fujimoto disease concurrent with aseptic meningitis or encephalitis (p < 0.05). There was also a significant difference in lactate dehydrogenase levels between children with and without central nervous system involvement (575.8 ± 221.3 vs. 440.0 ± 163.1 U/L, p = 0.014).</p><p><strong>Conclusions: </strong>For children with Kikuchi-Fujimoto disease, careful evaluation for central nervous system involvement is warranted when cervical lymph node tenderness, elevated C-reactive protein, or elevated lactate dehydrogenase is present. In children presenting with aseptic meningitis or encephalitis, Kikuchi-Fujimoto disease should be considered as a differential diagnosis.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"25 1","pages":"287"},"PeriodicalIF":2.0,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965536","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":"The reliability and validity of a Chinese version of the Beach Center Family Quality of Life Scale in Mainland China for families of children with autism.","authors":"Lu Liu, Lang-Fang Xie, Yi-Pei Xing, Yu Wang, Yue Ji, Miao-Ying Chen, Shuo Zhao, Fang Wang, Hai Li","doi":"10.1186/s12887-025-05649-x","DOIUrl":"https://doi.org/10.1186/s12887-025-05649-x","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this study was to translate the Family Quality of Life (FQOL) Scale into simplified Chinese and assess its reliability and validity in mainland China for families of children with autism.</p><p><strong>Methods: </strong>The FQOL Scale was professionally translated from English into simplified Chinese using a forward-backward process. We conducted a survey in which families with autistic kids were asked to participate, it comprised of a general condition questionnaire and the FQOL Scale translated to Chinese. A total of 402 families took part in the study, out of which 333 data sets were complete and available for analysis. The FQOL Scale model was subject to exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to probe its scale dimensional design and structure, as well as its adaptability to autistic children and their families using SPSS AMOS 24.0. The internal consistency and reliability was examined using Cronbach's α (SPSS 22.0). And stepwise regression analysis was conducted to predict parents' attitudes towards prognosis based on the five dimensions of the modified Chinese version of the FQOL Scale (SPSS 22.0).</p><p><strong>Results: </strong>The data analysis yielded a revised Chinese version of the FQOL Scale. The analysis revealed that the overall reliability coefficient of the scale, as indicated by Cronbach's α, was 0.918. The results of the CFA provided support for the best fit of a five-factor model (χ2 = 285.237, CFI = 0.930, TLI = 0.916, SRMR = 0.061, RMSEA = 0.062). The predictive equation for parents' attitudes towards prognosis based on the five-dimensional model of the modified Chinese version of the FQOL Scale was as follows: Parent prognostic attitude = -0.863 + 0.456* Parenting + 0.2* Physical/Material Well-being.</p><p><strong>Conclusion: </strong>The modified Chinese version of the FQOL Scale is suitable in mainland China for families of children with autism and has good reliability and model fit. The two dimensions of Parenting and Physical/Material Well-being can significantly predict parents' prognostic attitude, indicating that the better the status of Parenting and Physical/Material Well-being, the better the parents' prognosis attitude.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"25 1","pages":"285"},"PeriodicalIF":2.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954357","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":"Kangaroo mother care among hospitalised neonates: evaluation of the validity of duration measurement methods compared to observation linked to the OMWaNA trial in Uganda.","authors":"Victor S Tumukunde, Isaac Sekitoleko, Charles Opondo, Moffat Nyirenda, Cally J Tann, Joy E Lawn, Melissa M Medvedev","doi":"10.1186/s12887-025-05629-1","DOIUrl":"https://doi.org/10.1186/s12887-025-05629-1","url":null,"abstract":"<p><strong>Background: </strong>Studies evaluating the impact of kangaroo mother care (KMC) on neonatal mortality and morbidity often rely on healthcare worker records or caregiver reports to measure intervention duration. However, the accuracy of these methods remains uncertain. We examined the validity of different methods of KMC duration measurement amongst neonates ≤ 2000 g in Uganda.</p><p><strong>Methods: </strong>This observational study was embedded within the OMWaNA trial, which examined the impact of KMC on neonatal mortality before clinical stability. An independent observer (considered the gold standard) monitored neonates every 2 h to confirm KMC position, using an Android tablet-based application adapted from the EN-BIRTH study. The gold standard was compared to routine healthcare workers' charting and caregiver diary reports of KMC.</p><p><strong>Results: </strong>Among 222 caregiver-newborn pairs, 219 initiated KMC. The mean daily KMC duration recorded by the gold standard was 8·4 h (SD 3·5). Healthcare workers reported an average of 8·5 h (SD 4·0), while caregivers reported 10·4 h (SD 3·8). The mean difference was 0·2 h less for healthcare workers (95% CI -0·3 to 0·6) and 1·7 h more for caregivers (-2·1 to -1·3) compared to the gold standard. Agreement rates for individual KMC episodes were 55·2% (95% CI 54·4-55·9) for healthcare workers and 58·2% (57·2-59·0) for caregivers. Participants with a helper (substitute KMC provider) had longer daily duration compared to those without (mean difference 1·89 h [0·89 - 2·84]; p < 0·001).</p><p><strong>Conclusion: </strong>Healthcare worker records provide a reasonably accurate estimate of KMC duration at the population level, supporting the integration of KMC indicators into national health information systems to facilitate monitoring and evaluation. The presence of a helper increases KMC duration, underscoring the need for research to identify strategies to increase family involvement.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"25 1","pages":"283"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976517","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":"Geographic equity in essential newborn care practices in Ethiopia: a cross-sectional study.","authors":"Tadesse Guadu Delele, Lars Åke Persson, Joanna Schellenberg, Della Berhanu, Seblewengel Lemma, Atkure Defar, Theodros Getachew Zemedu, Girum Taye, Solomon Shiferaw, Zewditu Abdissa Denu, Amare Tariku, Meseret Zelalem, Kassahun Alemu Gelaye","doi":"10.1186/s12887-025-05645-1","DOIUrl":"https://doi.org/10.1186/s12887-025-05645-1","url":null,"abstract":"<p><strong>Background: </strong>Essential newborn care is a set of measures every newborn baby needs, regardless of its birthplace. Geographic equity in essential newborn care refers to the fairness of access to newborn care across different regions. These practices vary across different social groups, but evidence on the geographic equity of newborn care in Ethiopia is scarce. We aimed to assess the geographic distribution and equity of selected essential newborn care practices (initial skin-to-skin care, delayed bathing, proper cord care, timely breastfeeding initiation, and immunizations of BCG and first-dose polio vaccines) recommended by the World Health Organization among neonates born at health facilities and homes in Ethiopia.</p><p><strong>Methods: </strong>We analyzed cross-sectional survey data from 2,493 neonates in the Performance Monitoring for Action (PMA) Ethiopia 2019-2020 survey in five regions and the Addis Ababa City Administration. The survey employed a cross-sectional study design, and the data were collected from 2019 to 2020. We studied the geographic variation of selected essential newborn care practices using Global Moran's I statistics and hot and cold spot analysis (Local Getis-Ord Gi* statistic), and the coverage of these practices were predicted for the whole country using Kriging interpolation.</p><p><strong>Results: </strong>This study showed that selected essential newborn care practices were higher among neonates in health facilities, those born in Central, Northern, Southern, and a few areas in Southwest and Northwest Ethiopia. Geographic inequities were demonstrated in delayed bathing in facility and home births, proper cord care in facility births, and first immunizations in both facility and home births. Geographic inequities were not observed for initial skin-to-skin care and timely breastfeeding initiation.</p><p><strong>Conclusion: </strong>Selected essential newborn care practices were higher among neonates born in health facilities, and the recommended essential newborn care practices were higher in Central and Northern Ethiopia. There were geographic inequities in delayed bathing and immunizations of BCG and first-dose polio vaccines among neonates born in health facilities and homes. Enhancing facility delivery, availing first vaccinations in facilities, and improving discharge counseling for mothers during antenatal, delivery, and postnatal care are crucial to ensuring geographic equity in essential newborn care in Ethiopia.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"25 1","pages":"281"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972656","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":"The impact of school periods and long holiday periods on the occurrence of neurally mediated syncope in children.","authors":"Shuo Wang, Ping Liu, Xiaohui Gong, Jizhi Xu, Tuoyu Gan, Yuwen Wang, Hong Cai, Runmei Zou, Cheng Wang","doi":"10.1186/s12887-025-05625-5","DOIUrl":"https://doi.org/10.1186/s12887-025-05625-5","url":null,"abstract":"<p><strong>Objective: </strong>To explore the impact of school periods and long holiday periods on the occurrence of neurally mediated syncope (NMS) in children.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 262 children with NMS. The children were aged 4-17 years, 119 males. 244 cases were diagnosed as vasovagal syncope, and 18 cases as postural orthostatic tachycardia syndrome. The data on the age, sex, syncope triggers, hemodynamic types, family history of syncope of children with syncope during long holiday periods group (n = 68) and school periods group (n = 194) were compared.</p><p><strong>Results: </strong>(1) Incidence of syncope: The incidence of syncope during school periods (74.05%) was higher than that during long holiday periods (25.95%). (2) Comparison of sex and triggers: The constituent ratio of females with syncope during school periods was higher than that of males (P < 0.05). Among the triggers, the proportion of sudden postural change during long holiday periods was higher than that during school periods (26.47% vs. 21.13%, P < 0.05). (3) Univariate analysis: Situational syncope was a potential protective factor when syncope occurred during school periods (OR 0.23, 95%CI 0.07-0.76, P < 0.05), and being female was a potential risk factor (OR 1.92, 95%CI 1.10-3.35, P < 0.05). (4) Comparison of multiple models: In the risk of syncope occurring during school periods, situational syncope reduced the risk by 79% compared with no trigger, and being female increased the risk by 78% compared with being male.</p><p><strong>Conclusions: </strong>The occurrence of NMS-related syncope events in children is associated with school periods and long holiday periods. During school periods, being female is a risk factor for syncope, while situational syncope is a protective factor.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"25 1","pages":"284"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958674","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":"Focus on physiotherapy and manual therapy for infants in Norway, a cross-sectional study on referral practice, and planned interventions.","authors":"Hege Handeland, Kari Anne Indredavik Evensen, Hilde Stendal Robinson","doi":"10.1186/s12887-025-05627-3","DOIUrl":"https://doi.org/10.1186/s12887-025-05627-3","url":null,"abstract":"<p><strong>Background: </strong>The Norwegian health care system has a mandatory program for close and systematically follow-up on all children, starting in early infancy through the Child Health Care Centers in the municipalities. Additionally, some infants are referred to physiotherapists and manual therapists for several reasons. Little is known about who is referring them and the cause for the referral. In Norway, physiotherapists working with infants can be employed in the communities or work in outpatient clinics, both are within the primary health care system. The main purpose of the present study was to explore the referral practice of infants to physiotherapy and compare those treated by physiotherapists and manual therapists in primary health care in Norway. Furthermore, to describe the planned interventions.</p><p><strong>Methods: </strong>Cross-sectional study including 444 infants (age under 12 months) referred to physiotherapists or manual therapists working in primary health care in Norway.</p><p><strong>Results: </strong>Median age (range) of the infants was 14 (1, 52) weeks and 344 were born at due date. Most infants examined by a physiotherapist were referred from other health personnel and more of the referrals to manual therapists were from parents due to their concern. Age at examination was between week 1-12 for 42% of the participants. Infants referred for motor development problems were equally distributed between the physiotherapists and manual therapists. All premature infants were referred to the physiotherapists. Concerning the interventions, both physiotherapists and manual therapists planned to use advice, handling, and stimulation. More of the physiotherapists reported to focus on advice related to motor development and the use of prone play.</p><p><strong>Conclusion: </strong>The infants in Norway are referred to physiotherapists and/or manual therapists for numerous reasons, and the distribution of diagnoses between the therapists seem reasonable. Infants are mostly referred by other health personnel but also because of parents' own concern. Based on recommendations, some infants with asymmetries should be examined earlier.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NCT03626389. Registered on August 13th, 2018 (retrospectively registered).</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"25 1","pages":"282"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977149","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":"Study protocol for assessing the effectiveness, implementation fidelity and uptake of attachment & child health (ATTACH™) Online: helping children vulnerable to early adversity.","authors":"Nicole Letourneau, Lubna Anis, Cui Cui, Ian D Graham, Kharah Ross, Kendra Nixon, Jan Reimer, Miranda Pilipchuk, Emily Wang, Simone Lalonde, Suzanna Varro, Maria Jose Santana, Ashley Stewart-Tufescu, Angela Soulsby, Barbara Tiedemann, Leslie Hill, Tiffany Beks, Martha Hart","doi":"10.1186/s12887-024-05232-w","DOIUrl":"https://doi.org/10.1186/s12887-024-05232-w","url":null,"abstract":"<p><strong>Background: </strong>Exposure to early childhood adversities, such as family violence, parental depression, or low-income, undermine parent-child relationship quality and attachment leading to developmental and mental health problems in children. Addressing impacts of early childhood adversity can promote children's development, giving them the best start in life. Parental reflective function (RF), or parents' ability to understand their own and children's mental states, can strengthen parent-child relationships and attachment and buffer the negative effects of early adversity. We developed and tested ATTACH™ (Attachment and Child Health), an effective RF intervention program for parents and their preschool-aged children at-risk from early adversity. Pilot studies revealed significantly positive impacts of ATTACH™ from in-person (n = 91 observations of 64 dyads) and online (n = 10 dyads) implementation. The two objectives of this study are to evaluate: (1) effectiveness, and (2) implementation fidelity and uptake of ATTACH™ Online in community agencies serving at-risk families in Alberta, Canada. Our primary hypothesis is ATTACH™ Online improves children's development. Secondary hypotheses examine whether ATTACH™ Online improves children's mental health, parent-child relationships, and parental RF.</p><p><strong>Methods: </strong>We will conduct an effectiveness-implementation hybrid (EIH) type 2 study. Effectiveness will be examined with a quasi-experimental design while implementation will be examined via descriptive quantitative and qualitative methods informed by Normalization Process Theory (NPT). Effectiveness outcomes examine children's development and mental health, parent-child relationships, and RF, measured before, after, and 3 months post-intervention. Implementation outcomes include fidelity and uptake of ATTACH™ Online, assessed via tailored tools and qualitative interviews using NPT, with parents, health care professionals, and administrators from agencies. Power analysis revealed recruitment of 100 families with newborn to 36-month-old children are sufficient to test the primary hypothesis on 80 complete data sets. Data saturation will be employed to determine final sample size for the qualitative component, with an anticipated maximum of 20 interviews per group (parents, heath care professionals, administrators).</p><p><strong>Discussion: </strong>This study will: (1) determine effectiveness of ATTACH™ Online and (2) understand mechanisms that promote implementation fidelity and uptake of ATTACH™ Online. Findings will be useful for planning spread and scale of an effective online program poised to reduce health and social inequities affecting vulnerable families.</p><p><strong>Trial registration: </strong>Name of registry: https://clinicaltrials.gov/ .</p><p><strong>Registration number: </strong>NCT05994027. Date of registration: July 22, 2023.</p><p><strong>Protocol version: </strong>Version 1.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"25 1","pages":"280"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972659","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":"Avoidable visits to the paediatric emergency department: associated factors and lessons learned from the pandemic.","authors":"João Viana, João Vasco Santos, Andreia Pinto, Almeida Santos, Alberto Freitas","doi":"10.1186/s12887-025-05523-w","DOIUrl":"10.1186/s12887-025-05523-w","url":null,"abstract":"<p><strong>Purpose: </strong>The main goal of this study is to identify the associated factors with avoidable admissions in ED, comparing pre-COVID and COVID periods.</p><p><strong>Methods: </strong>This was retrospective study that took place in a Paediatric Emergency Department of a metropolitan, university-affiliated hospital in Portugal. All visits to paediatric emergency department between 2014 and 2020 were considered.</p><p><strong>Results: </strong>There was a decrease of 7.2% points in avoidable visits between pre-COVID and COVID periods. Considering both periods, this study identifies older ages, being admitted to the paediatric emergency department between 4 and 7 a.m., referral and having visited the emergency department previously within 72 h as major factors associated with a reduced likelihood for avoidable visits. On the other hand, it identifies an increased likelihood of avoidable visits in the 3 to 5 years old age group, visits that occurred during the Summer and visits that occurred between 8 and 11 p.m. When considering what changed between pre-COVID and COVID periods, while having visited the paediatric emergency department 72 h prior made it less likely for the patient to be an avoidable visit during the pandemic period, this tendency has inverted, making it more likely for return visits to be avoidable.</p><p><strong>Conclusions: </strong>The relatively low decrease in avoidable visits' ratios between pre-COVID and COVID periods, associated with the similar distribution of attendance during the day and lower odds ratio of avoidable visits during periods when primary care is available, suggests that avoidable visits are a chronical problem of the National Health system's structure and its usage, not having a single factor nor a combination of factors as a driving force. Nevertheless, this study identified several factors associated with avoidable visits to the emergency department. Therefore, it can aid policy makers to create targeted interventions to mitigate this problem.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"25 1","pages":"279"},"PeriodicalIF":2.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802489","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}