Search Results (549)

Background/Objectives: The increasing population of childhood cancer survivors presents new challenges for healthcare systems worldwide. While advances in oncological treatments have dramatically improved survival rates, survivors face a broad spectrum of late effects that extend beyond the biological to encompass profound psychological and social dimensions. Methods: This quasi-systematic review synthesizes data from recent studies on adolescent survivors, revealing significant disruptions in cognitive function, mental health, social integration, education, romantic relationships, and vocational outcomes. Results: This review highlights the inadequacy of a solely biomedical model and advocates for a biopsychosocial approach to long-term follow-up care. An emphasis is placed on the necessity of personalized, interdisciplinary, and developmentally informed interventions, especially in countries like Poland, where structured survivorship care models remain underdeveloped. Conclusions: The findings underscore the importance of integrating medical, psychological, and social services to ensure adolescent cancer survivors achieve not only physical recovery but also meaningful life participation and emotional well-being. Full article

Background/Objectives: Communication disorders in childhood, including expressive, receptive, pragmatic, and fluency impairments, have been consistently linked to mental health challenges such as anxiety, depression, and behavioural difficulties. However, existing research remains fragmented across diagnostic categories and developmental stages. This scoping review aimed to synthesise empirical evidence on the relationship between communication disorders and mental health outcomes in children and adolescents and to identify key patterns and implications for practice and policy. Methods: Following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) and Arksey and O’Malley’s framework, this review included empirical studies published in English between 2000 and 2024. Five databases were searched, and ten studies met the inclusion criteria. Data were charted and thematically analysed to explore associations across communication profiles and emotional–behavioural outcomes. Results: Four interconnected themes were identified: (1) emotional and behavioural manifestations of communication disorders; (2) social burden linked to pragmatic and expressive difficulties; (3) family and environmental stressors exacerbating child-level challenges; and (4) a lack of integrated care models addressing both communication and mental health needs. The findings highlight that communication disorders frequently co-occur with emotional difficulties, often embedded within broader social and systemic contexts. Conclusions: This review underscores the need for developmentally informed, culturally responsive, and interdisciplinary service models that address both communication and mental health in children. Early identification, family-centred care, and policy reforms are critical to reducing inequities and improving outcomes for this underserved population. Full article

The hemostatic system in the newborn is a complex entity, characterized by dynamism in its development; therefore, the correct measurement of its potential is challenging. In this narrative review, we analyzed the current knowledge of the “developmental hemostasis” of the newborn; we also studied the performance of routine coagulation tests in its evaluation, with considerations about the establishment of neonatal age-specific normal ranges and about the role of preanalytical variables, in particular, hematocrit (which could represent an important cause of error); we also focused on the increasing importance of viscoelastic coagulation tests, which are becoming increasingly widespread (especially in some settings such as intensive care unit) and are able to quickly provide information about the hemostatic function of the newborn, even if they lack adequate standardization in the neonatal period. Full article

Background: Pediatric Crohn’s Disease (CD) affects more than physical health, influencing emotional well-being, social integration, and developmental milestones, with an impact on disease management. This study aimed to explore adolescents’ lived experiences with CD and identify factors influencing their motivation for self-management. Methods: A descriptive, cross-sectional qualitative study was conducted using a semi-structured, self-administered online questionnaire. Participants (n = 10) were adolescents with CD who had been diagnosed for over three years and were recruited from a tertiary pediatric gastroenterology center. Data included demographics, clinical characteristics, IMPACT-III (HRQOL), and PROMIS short forms. Open-ended responses underwent thematic analysis using the framework developed by Braun and Clarke. Results: Participants (80% female, median age 16.2 years, median disease duration 4.6 years) were all in clinical remission (median PCDAI = 2) and with good quality of life (median IMPACT-III = 80.7). Six themes emerged: (1) disease knowledge, (2) emotional responses, (3) coping and adaptation, (4) social support, (5) daily life and school impact, and (6) transition to adult care. Most participants demonstrated strong disease literacy and reported effective coping strategies. Emotional responses to diagnosis ranged from relief (60%) to distress (40%); relapses commonly triggered anxiety and fear. Therapeutic changes and disease monitoring were perceived as beneficial (100%) but with concern. Diagnostic procedures were viewed as burdensome by 70% of respondents. School performance and extracurricular participation were negatively affected in 40% during flares. Concerns regarding the future were reported by 40% of participants, with 30% believing that CD might limit life aspirations. While 60% managed their disease independently, 30% relied on parental support. All acknowledged the need for transition to adult care, though readiness varied. Conclusions: This study illustrates the overall impact of disease on pediatric CD patients. It reports significant emotional challenges and difficulties, as well as an impact on daily life, despite good disease knowledge. The findings underscore the importance of psychosocial well-being, ongoing mental health assessment, non-invasive monitoring, and holistic care, emphasizing the patient perspective, in managing pediatric CD. Full article

Background: Foster care alumni face increased health challenges across the domains of mental and physical health, yet there is a paucity of research examining the associations between care experiences, health, and sleep quality in alumni aged 30 and above. Objectives: Our exploratory mixed-method study examined the sleep quality of North American group care leavers aged 30+ to understand whether sleep quality in adulthood is associated with earlier child welfare system experiences during childhood and adolescence. Secondly, we examined the association between sleep quality and overall concurrent health. Methods: Using a convenience sample of 41 alumni of care aged 30–85 and 16 qualitative interviews, we explored the intricate connections between group care leavers’ developmental trauma, sleep quality, and health. Linear regression and qualitative content analysis were utilized to understand how sleep was related to well-being in aging care alumni. Results: Adult sleep was significantly associated with the perceived quality of their youth out-of-home placement experiences (β = 0.421, p < 0.01), controlling for friendship support networks and demographic variables. Adult sleep quality was a significant predictor of overall health (β = −0.328, p < 0.05). Qualitative interviews elucidated insights into the importance and linkages of child welfare system experiences, adult sleep, and well-being. Conclusions: Our research highlights the enduring association between child welfare placement experiences, and sleep functioning well into adulthood, even when accounting for contemporaneous social support and other demographic indicators. Practitioners should be inquiring directly about sleep, and future longitudinal research should delve deeper into the nature of sleep difficulties and their association with health and well-being. Full article

Background: Borderline personality disorder (BPD) is a severe psychiatric condition characterised by emotional instability, impulsivity, interpersonal dysfunction, and self-injurious behaviours. Despite growing clinical interest, the neuropsychological mechanisms underlying these symptoms are still not fully understood. This review aims to summarise findings from neuroimaging, psychophysiological, and neurodevelopmental studies in order to clarify the neurobiological and physiological basis of BPD, with a particular focus on emotional dysregulation and implications for the treatment of adolescents. Methods: A narrative review was conducted, integrating results from longitudinal neurodevelopmental studies, functional and structural neuroimaging research (e.g. FMRI and PET), and psychophysiological assessments (e.g., heart rate variability and cortisol reactivity). Studies were selected based on their contribution to understanding the neural correlates of BPD symptom dimensions, particularly emotion dysregulation, impulsivity, interpersonal dysfunction, and self-harm. Results: Findings suggest that early reductions in amygdala volume, as early as age 13 predict later BPD symptoms. Hyperactivity of the amygdala, combined with hypoactivity in the prefrontal cortex, underlies deficits in emotion regulation. Orbitofrontal abnormalities correlate with impulsivity, while disruptions in the default mode network and oxytocin signaling are related to interpersonal dysfunction. Self-injurious behaviour appears to serve a neuropsychological function in regulating emotional pain and trauma-related arousal. This is linked to disruption of the hypothalamic-pituitary-adrenal (HPA) axis and structural brain alterations. The Unified Protocol for Adolescents (UP-A) was more effective to Mentalization-Based Therapy for Adolescents (MBT-A) at reducing emotional dysregulation compared, though challenges in treating identity disturbance and relational difficulties remain. Discussion: The reviewed evidence suggests that BPD has its in early neurodevelopmental vulnerability and is sustained by maladaptive neurophysiological processes. Emotional dysregulation emerges as a central transdiagnostic mechanism. Self-harm may serve as a strategy for regulating emotions in response to trauma-related neural dysregulation. These findings advocate for the integration of neuroscience into psychotherapeutic practice, including the application of neuromodulation techniques and psychophysiological monitoring. Conclusions: A comprehensive understanding of BPD requires a neuropsychologically informed framework. Personalised treatment approaches combining pharmacotherapy, brain-based interventions, and developmentally adapted psychotherapies—particularly DBT, psychodynamic therapy, and trauma-informed care—are essential. Future research should prioritise interdisciplinary, longitudinal studies to further bridge the gap between neurobiological findings and clinical innovation. Full article

Background/Objectives: This exploratory study examined the potential effectiveness of cognitive enhancement interventions targeting basic cognitive prerequisites and communicative abilities in girls with Rett syndrome. Special attention was given to evaluating telerehabilitation as a feasible alternative to traditional in-person therapy, particularly for individuals with severe impairments and limited access to care. Methods: Twenty-four girls diagnosed with Rett syndrome (mean age = 13.7 years, SD = 7.1), all meeting the basic cognitive prerequisites defined by the GAIRS scale, were randomly assigned to two groups: a telerehabilitation group (n = 12) and an in-person rehabilitation group (n = 12). Interventions were delivered in school settings and focused on two core areas: basic cognitive skills (e.g., object recognition, spatial and temporal concepts, form and color discrimination, and cause–effect reasoning) and communication skills (e.g., comprehension and expression through gestures, images, or verbal output). Results: Both groups showed significant improvements in the cognitive and communicative domains, with generally comparable outcomes. Notably, the telerehabilitation group demonstrated relatively greater gains in verbal expression and cause–effect understanding. Correlational analyses indicated positive associations between the cognitive and communicative improvements, particularly between spatial understanding and expressive abilities. However, these findings should be interpreted with caution due to the sample size and study design limitations. Conclusions: These preliminary findings suggest that cognitive enhancement programs may support developmental gains in girls with Rett syndrome and that telerehabilitation could represent a viable alternative for those unable to access in-person care. Given the limited sample size and absence of qualitative measures, further research is necessary to validate its effectiveness and understand its role within comprehensive care models. Full article

The growing prevalence of AI chatbots in everyday life has prompted educators to explore their potential applications in promoting student success, including support for classroom engagement and communication. This exploratory study emerged from semester-long observations of class participation apprehensions in an introductory educational psychology course, examining how chatbots might scaffold students toward active and independent classroom contribution. Four students experiencing situational participation anxiety voluntarily participated in a pilot intervention using AI chatbots as virtual peer partners. Following comprehensive training in AI use and prompt design given to the entire class, participants employed systematic consultation frameworks for managing classroom discourse trepidations. Data collection involved regular instructor meetings documenting student experiences, challenges, and developmental trajectories through qualitative analysis emphasizing contextual interpretation. While students reported general satisfaction with chatbot integration, implementation revealed three critical complexities: temporal misalignment between AI consultation and real-time discussion dynamics; feedback inflation creating disconnects between AI reassurance and classroom reception; and unintended progression from supportive scaffolding toward technological dependency. Individual outcomes varied, with some students developing independence while others increased reliance on external validation. AI-assisted participation interventions demonstrate both promise and limitations, requiring careful consideration of classroom dynamics. Effective implementation necessitates rehearsal-based rather than validation-focused applications, emphasizing human mentorship and community-centered approaches that preserve educational autonomy while leveraging technological scaffolding strategically. Full article

Background: The increasing incidence of revision total hip arthroplasties (rTHAs), particularly due to failure of the acetabular components and severe bone loss, necessitates reliable surgical solutions. Iliac stemmed cups (ISCs) have emerged as effective options for managing complex pelvic defects, including Paprosky type 3A and 3B acetabular defects, severe developmental dysplasia, and selected pelvic discontinuities. This review examines the historical evolution, clinical indications, and outcomes associated with ISCs. Methods: This narrative review analyzed the historical and recent literature concerning various ISC designs. We critically assessed clinical outcomes, complication rates, and implant survival from 13 key studies. Results: ISCs have progressed significantly from initial monobloc designs to contemporary modular configurations, substantially enhancing surgical versatility and biomechanical stability. Clinical outcomes varied with reported complications such as infection, dislocation, mechanical failure, and aseptic loosening ranging from 10% to over 30%. Newer modular implants like the Sansone cup have demonstrated improved outcomes, with complication rates below 10% and five-year survival rates exceeding 95%. Conclusions: ISCs are reliable and versatile implants, particularly suited to address significant pelvic bone deficiencies. Optimal surgical techniques and careful implant selection remain essential to minimize complications and achieve favorable long-term functional outcomes, making these implants valuable tools in complex hip arthroplasty. Full article

Background/Objectives: Wolf–Hirschhorn syndrome (WHS; OMIM #194190) is a rare neurodevelopmental disorder, caused by deletions in the distal short arm of chromosome 4. It is characterized by developmental delay, epilepsy, intellectual disability, and distinctive facial dysmorphism. Clinical presentation varies widely, complicating prognosis and individualized care. Methods: We assembled a cohort of 140 individuals with genetically confirmed WHS from Spain and Latin-America, and developed and validated a multidimensional, Clinician-Reported Outcome Assessment (ClinRO) based on the Global Functional Assessment of the Patient (GFAP), derived from standardized clinical questionnaires and weighted by HPO (Human Phenotype Ontology) term frequencies. The GFAP score quantitatively captures key functional domains in WHS, including neurodevelopment, epilepsy, comorbidities, and age-corrected developmental milestones (selected based on clinical experience and disease burden). Results: Higher GFAP scores are associated with worse clinical outcomes. GFAP showed strong correlations with deletion size, presence of additional genomic rearrangements, sex, and epilepsy severity. Ward’s clustering and discriminant analyses confirmed GFAP’s discriminative power, classifying over 90% of patients into clinically meaningful groups with different prognoses. Conclusions: Our findings support GFAP as a robust, WHS-specific ClinRO that may aid in stratification, prognosis, and clinical management. This tool may also serve future interventional studies as a standardized outcome measure. Beyond its clinical utility, GFAP also revealed substantial social implications. This underscores the broader socioeconomic burden of WHS and the potential value of GFAP in identifying high-support families that may benefit from targeted resources and services. Full article

Pediatric delirium (PD) is an acute neuropsychiatric syndrome marked by fluctuating disturbances in attention and cognition, frequently observed in pediatric intensive care units (PICUs) and associated with increased morbidity, mortality, and long-term cognitive impairment. Despite its clinical significance, PD remains underdiagnosed due to challenges inherent in assessing consciousness and cognition in children at varying developmental stages. Several bedside tools have been developed and validated in recent years, including the Cornell Assessment of Pediatric Delirium (CAPD), PreSchool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU); Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU), and Sophia Observation Withdrawal Symptoms—Pediatric Delirium Scale (SOS-PD), enhancing early recognition and management of PD in critically ill children. This narrative review explores the historical background, epidemiology, risk factors, pathophysiology, clinical subtypes, diagnostic tools, and current prevention and treatment strategies for PD from newborns to 21 years old. The screening tools available and the integration of non-pharmacological interventions, such as environmental modifications and family-centered care, as well as cautious and selective pharmacological management, are emphasized in this review. Early identification and targeted interventions are essential to mitigate the adverse outcomes associated with PD. Full article

Prolonged hospital stays separate children from their families and adversely impact the well-being of both. Children with medical complexity (CMC) often have long hospital stays and sometimes spend months to years missing their childhoods, often alone in their rooms. Caregivers of CMC must navigate many barriers to discharge during long hospital stays, which further strains the family system. In this review, we summarize the developmental vulnerabilities of chronically hospitalized CMC and propose that the hospital environment itself confers additional risk for poor neurodevelopmental outcomes. We will discuss the opportunities for pediatric post-acute care (PPAC) hospitals to create spaces where medical treatment, developmental recovery, and family integration in care can exist simultaneously. We then describe how the Care Beyond the Bedside model developed by one PPAC hospital aims to diminish the detrimental effects of prolonged hospitalization on CMC and their families by prioritizing developmental opportunity alongside medical stability. Critical components of this care model are patient and family spaces designed for community, safety training to supervise patients away from the bedside, and investment in staffing and programming to support the model. This care model acknowledges that play and healing are inextricably linked and that children develop best when they are out of bed, participating in life with their families. Full article

This article describes the design and implementation of a Specialized Mental Health Clinical Pastoral Education (CPE) program for clergy and theological students of all spiritual, religious, and cultural backgrounds. Addressing the need for mental health competencies in religious leaders and chaplains, this training equips participants with specialized skills in individual and group mental health spiritual assessment and spiritual care. Program participants become effective members of a multiprofessional team, gain knowledge of mental health philosophies of concordant and discordant spiritual orienting systems, and gain greater relational capacity. The Mental Health CPE Program includes traditional and novel CPE elements: (1) clinical practice, (2) group and individual supervision, (3) didactic presentations and journal clubs, (4) verbatim (Protocols of patient encounters) and case presentations, (5) group leadership training and practica, and (6) experience of faith reflections. This article provides insights into the origins of CPE, a description of the implementation in a free-standing psychiatric hospital, and observed developmental changes of program participants. We include graduates’ anecdotal feedback about their learning experience and its impact on their leadership in chaplaincy and in religious communities. Additionally, we report on areas for future development and further study of the effectiveness of Mental Health CPE. Full article

Platinum-induced ototoxicity constitutes a significant adverse effect in pediatric oncology, frequently resulting in permanent hearing impairment with profound implications for quality of life, language acquisition, and scholastic performance. This comprehensive review critically evaluates contemporary ototoxicity monitoring practices across various pediatric oncology settings, analyzes current guideline recommendations, and formulates strategies for implementing standardized surveillance protocols. Through examination of recent literature—encompassing retrospective cohort investigations, international consensus recommendations, and functional outcome assessments—we present an integrated analysis of challenges and opportunities in managing chemotherapy-associated hearing loss among childhood cancer survivors. Our findings demonstrate marked heterogeneity in monitoring methodologies, substantial implementation obstacles, and considerable impact on survivors’ functional status across multiple domains. Particularly concerning is the persistent absence of an evidence-based consensus regarding the appropriate duration of audiological surveillance for this vulnerable population. We propose a structured framework for comprehensive ototoxicity management emphasizing prompt detection, standardized assessment techniques, and integrated long-term follow-up care to minimize the developmental consequences of platinum-induced hearing impairment. This approach addresses critical gaps in current practice while acknowledging resource limitations across diverse healthcare environments. Full article

Background: As national and international reports reveal, significant health care transition (HCT) service disparities exist for youth and young adults with intellectual and developmental disabilities (YYAs with IDD). The development of the HCT model necessitates informed perspectives from a broad constituency, including consumers and families. Parents’ retrospective perspectives of their sons’ or daughters’ HCT experiences are presented to enlarge the understanding of the service need. Methodology: Eleven parents were recruited virtually from parent support/disability advocate groups via an email distribution list of the Children’s Hospital Los Angeles University Center for Excellence in Developmental Disabilities. Parents who consented to participate were interviewed by phone using an interview guide with 11 open-ended items. Three questions focused on the barriers and facilitators associated with the HCT experience are reported. Findings: Four major themes were generated from the analysis of data gathered from parents pertaining to their sons’ or daughters’ health care transition experiences, focusing on the transfer of care. Two major themes were related to HCT barriers—Pediatric Care Contrasted with Adult-Focused Care and Transfer of Care Barriers—and two were related to HCT facilitators—Transfer of Care Facilitators and Transfer of Care Recommendations. Each of the major themes included subthemes. Conclusions: Parents openly shared their sons’ or daughters’ HCT experiences, which illuminated the scope of their challenges and the assistance received. These insights provide rich descriptions of the barriers they and their adult children faced as they proceeded with navigating new systems of health care. The reported data find support in other previously conducted studies. Full article