Search Results (571)

IgA nephropathy is the most common primary glomerulonephritis, with pathohistological changes described by the Oxford classification, while the Banff classification is used in transplant pathology. This study included 253 patients with IgA nephropathy in native kidneys, divided into the pediatric (n = 105) and adult (n = 148) groups. It aimed to examine clinical, and Oxford and Banff morphological parameters in relation to age, correlations of clinical data with pathohistological parameters, and predictors of the disease outcome. Pediatric patients more frequently presented with macroscopic hematuria, while adults showed higher urea and creatinine levels, and lower eGFR. Examining Oxford classification parameters, chronic glomerular and tubulointerstitial lesions were more common in adults. Banff parameters revealed more frequent chronically active glomerular, inflammatory, chronic tubulointerstitial, and vascular lesions in adults. All inflammatory, chronic tubulointerstitial, and vascular parameters correlated with serum urea levels, eGFR and CKD stage in adults, while less frequent in pediatric patients. Tubulointerstitial Oxford and Banff parameters were strong predictors of CKD and proteinuria progression in children, while such predictors were fewer in adults; segmental glomerulosclerosis predicted hematuria progression in adults. Banff parameters (cg, t, ti, i, i-IFTA, ptc, cv), not in Oxford classification, significantly predict outcomes and are recommended for incorporation into IgA nephropathy reports. Full article

Hand hygiene (HH) is essential for preventing disease transmission, particularly in schools where children are in close contact with other children. This study evaluated a school-based intervention on observed HH practices and hand cleanliness in six primary schools in Guatemala. Hand cleanliness was measured using the Quantitative Personal Hygiene Assessment Tool. The intervention included (1) HH behavior change promotion through Handwashing Festivals, and (2) increased access to HH materials at HH stations. Handwashing Festivals were day-long events featuring creative student presentations on HH topics. Schools were provided with soap and alcohol-based hand rub throughout the project to support HH practices. Appropriate HH practices declined from 51.2% pre-intervention to 33.1% post-intervention, despite an improvement in median Quantitative Personal Hygiene Assessment Tool scores from 6 to 8, indicating cleaner hands. Logistic regression showed higher odds of proper HH when an assistant was present. The decline in HH adherence was likely influenced by fewer assistants and changes in COVID-19 policies, while improvements in hand cleanliness may reflect observational bias. These findings emphasize the importance of sustained behavior change strategies, reliable HH material access, and targeted interventions to address gaps in HH practices, guiding school health policy and resource allocation. Full article

In China, grandparents play a significant role in childrearing. This study aims to identify latent profiles of intergenerational parenting styles and explore their impact on grandchildren’s behavioral outcomes. A total of 1432 Chinese children (M_age = 12.58 years; 45.25% boys) completed questionnaires assessing perceived grandparenting styles, while fathers and mothers independently reported their own parenting practices. Latent Profile Analysis (LPA) identified three distinct parenting profiles: “Grandparents Positive–Parents Negative” (GP–PN, 18.37%), “Grandparents Positive–Parents Positive” (GP–PP, 59.15%), and “Grandparents Negative–Parents Positive” (GN–PP, 22.48%). Regression analyses revealed that the number of siblings, grade level, and grandparent type could significantly predict profile membership. Notably, consistent and positive intergenerational parenting styles were associated with fewer problem behaviors in children. Furthermore, the relationship between parenting profiles and problem behaviors was mediated by the quality of the grandparent–parent relationship. These findings suggested that grandparents and parents should coordinate their parenting styles when raising grandchildren together. Full article

Background/Objectives: Speech intelligibility (SI) is a key indicator of spoken language development, especially for children with hearing loss, as it directly impacts communication and social engagement. However, due to logistical and methodological challenges, SI assessment is often underutilised in clinical practice. This study aimed to evaluate the accuracy and consistency of an artificial intelligence (AI)-based transcription model in assessing SI in young children with cochlear implants (CI), hearing aids (HA), or normal hearing (NH), in comparison to naïve human listeners. Methods: A total of 580 speech samples from 58 five-year-old children were transcribed by three naïve listeners and the AI model. Word-level transcription accuracy was evaluated using Bland–Altman plots, intraclass correlation coefficients (ICCs), and word error rate (WER) metrics. Performance was compared across the CI, HA, and NH groups. Results: The AI model demonstrated high consistency with naïve listeners across all groups. Bland–Altman analyses revealed minimal bias, with fewer than 6% of sentences falling outside the 95% limits of agreement. ICC values exceeded 0.9 in all groups, with particularly strong agreement in the NH and CI groups (ICCs > 0.95). WER results further confirmed this alignment and indicated that children with CIs showed better SI performance than those using HAs. Conclusions: The AI-based method offers a reliable and objective solution for SI assessment in young children. Its agreement with human performance supports its integration into clinical and home environments for early intervention and ongoing monitoring of speech development in children with hearing loss. Full article

Background: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare genetic disorder, often leading to injuries and serious infections. In 2018, we established a multidisciplinary clinic (MDC) to provide structured, proactive care. We assessed the MDC’s impact on hospitalizations, surgeries, and infection rates. Methods: A retrospective study of genetically confirmed CIPA patients, treated from 2014 to 2024. Data from electronic medical records were compared between the pre-MDC (2014–2017) and post-MDC (2018–2024) periods. The core MDC team includes an infectious disease specialist, orthopedic surgeon, and nurses. The patients are stratified according to their carriage of resistant organisms and are managed using strict infection control measures. Follow-ups are scheduled routinely or as needed. Treatment is guided by clinical findings and culture results. Results: A total of 59 patients were included in the study. The baseline age did not differ significantly between the two periods. Hospitalization rates declined by 30.7% (from 57.7 to 40.0 per 1000 days), and clinic visits decreased by 42.9% (25.5 to 14.6). Overall surgical rates remained stable (2.8 to 2.7), with a 61.9% decrease in eye surgeries and a 130.5% increase in elective tooth extractions. Infection rates increased by 52% (from 6.6 to 10.1 per 1000 days). Conclusions: The implementation of the MDC bundle led to reduced hospitalizations, clinic visits, and eye surgeries, alongside the increased use of elective tooth extractions and culture testing. Closer monitoring and early infection management contributed to fewer severe complications. These findings support the value of structured, proactive multidisciplinary care in improving outcomes for children with CIPA. Full article

Extraneous details in visual representations can prompt children to use well-rehearsed, yet inappropriate, strategies that can hinder mathematics learning. Prior domain knowledge can reduce the negative effects of extraneous details in instructional materials. The present study tested whether prior knowledge of fractions and instruction on measurement division (MD) could overcome children’s inappropriate counting strategies when solving fraction division problems with images of LEGO^® bricks. Fourth and fifth graders (N = 39) were randomly assigned to two instructional conditions: one that demonstrated how to solve fraction division problems using LEGO bricks that included explanations on MD concepts, and the other with the same demonstrations but without explanations. All participants then completed a task that measured whether the studs on the bricks prompted inappropriate counting when solving the problems. Almost one-third of the sample counted the studs to some degree. Greater prior knowledge of fractions concepts and knowledge of how to represent fractions with LEGO bricks were related to fewer inappropriate counting strategies, but contrary to expectations, fraction magnitude was not related. The two conditions did not differ on participants’ counting strategies. Extraneous details on LEGO bricks are related to the application of well-practiced counting strategies for children with lower domain knowledge. Full article

Background/Objectives: Atypical sensory processing is increasingly recognized as a transdiagnostic dimension of neurodevelopmental disorders (NDDs), with critical implications for emotional and behavioral regulation. This study aimed to identify distinct sensory profiles in preschool children with NDDs and to examine their associations with emotional–behavioral and cognitive/developmental functioning. Methods: A total of 263 children (aged 21–71 months) diagnosed with autism spectrum disorder (ASD), language disorder (LD), or other NDDs (ONDD) were recruited. Sensory processing was assessed using the SPM-P, emotional–behavioral functioning was assessed via the CBCL 1½–5, and cognitive/developmental levels were assessed through standardized instruments. Latent profile analysis (LPA) was conducted to identify sensory subtypes. Group comparisons and multinomial logistic regression were used to examine profile characteristics and predictors of profile membership. Results: Three sensory profiles emerged: (1) Multisystemic Sensory Dysfunction (20.1%), characterized by pervasive sensory and emotional difficulties, primarily observed in ASD; (2) Typical Sensory Processing (44.9%), showing normative sensory and emotional functioning, predominantly LD; and (3) Mixed Subclinical Sensory Processing (35%), with subclinical-range scores across multiple sensory and emotional domains, spanning all diagnoses. Higher cognitive functioning and fewer internalizing symptoms significantly predicted membership in the typical profile. A gradient of symptom severity was observed across profiles, with the Multisystemic group showing the most pronounced emotional–behavioral impairments. Conclusions: Distinct sensory–emotional phenotypes were identified across diagnostic categories, supporting a dimensional model of neurodevelopment. Sensory profiles were strongly associated with emotional functioning, independently of diagnostic status. Early sensory assessment may therefore offer clinically meaningful insights into emotional vulnerability and inform targeted interventions in preschool populations with NDDs. Full article

Background. Parents of autistic children face challenges that can negatively affect the quality of the parent–child relationship. This study aimed to explore the potential protective role of parental resolution about positive (closeness) and negative (conflict and dependence) aspects of the parent–child relationship, with parenting stress and caregiving burden as mediators. Methods. A cross-sectional study (ethical approval: CE n. 92949) was conducted with 51 Italian parents of autistic children. A multiple mediation model was tested. Results. Parental resolution had a significant total effect (β = 0.012; BootLLCI = 0.002; BootULCI = 0.024) and a significant direct effect on the parent–child relationship (β = 0.223; BootLLCI = 0.058; BootULCI = 0.389), indicating that resolving the child’s diagnosis could potentially influence parents’ perceptions of their relationship with their child, possibly leading to views of it being somewhat closer, experiencing fewer conflicts, and involving a lower degree of dependence. An indirect effect via parenting stress was also significant (β = −0.130; BootLLCI = −0.009; BootULCI = −0.291), while caregiving burden did not show a mediating effect. Conclusion: Despite the exploratory and cross-sectional nature of this study, the findings highlight the importance of promoting family well-being in the context of autism. The findings may inform future research on parental resources and guide clinicians in developing intervention programmes to mitigate the emotional impact of receiving a child’s autism diagnosis. Full article

Background/Objectives: Although public health organizations encourage family walking, no studies have examined children’s physical activity and enjoyment during outdoor parent–child walks. This study addresses those gaps by examining children’s moderate-to-vigorous physical activity (MVPA) and enjoyment during outdoor walks with their parents, along with parental barriers and their relationship with parent’s self-efficacy and co-activity minutes. Methods: Fifty parent–child dyads (children aged 6–12 years) completed 10 min, self-paced outdoor walks while wearing waist-worn ActiGraph monitors. Parents reported perceived barriers to walking outdoors with their child and self-efficacy for supporting their child’s daily physical activity. Results: Children reported high enjoyment (mean = 5.1 on a six-point scale) and attained high physical activity intensity (71.3% of time in MVPA, 22.0% in vigorous activity, mean step count = 1200). Parents reported an average of 2.6 barriers (SD = 1.0) to walking outdoors with their child, with poor weather (70%) and lack of time (70%) reported most frequently. Each additional barrier was associated with a 1.3-point reduction in parents’ self-efficacy (p = 0.007). Two barriers (‘diverse interests between parent and child’ and ‘other parent-suggested barriers’) were significantly associated with fewer co-activity minutes per week (p < 0.001). Conclusions: Our study highlights the benefits of parent–child outdoor walking for promoting MVPA and enjoyment in children. Because perceived barriers may lower parents’ self-efficacy in supporting their child’s physical activity, addressing these barriers may be essential for the success of family-based interventions that encourage walking together outdoors. Full article

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex neurodevelopmental condition typically requiring information from multiple informants for accurate diagnosis. However, the consistency and diagnostic value of reports from teachers, parents, primary care providers (PCPs), and other professionals remain debated. This study aimed to examine the role and diagnostic accuracy of different informants in the referral and diagnostic process for ADHD in children aged 3–11. Methods: This retrospective study analyzed data from 120 children referred for suspected ADHD. Initial reports were obtained from teachers, parents, PCPs, and other professionals, and final diagnoses were determined through comprehensive neuropsychiatric evaluations. Diagnostic concordance and informant-specific contributions were assessed. Results: Of the 120 children, 64 (53.3%) received an ADHD diagnosis. Teachers were the most frequent informants, followed by parents, with fewer referrals from PCPs and other professionals. No significant differences in diagnostic accuracy were found among informants, aligning with previous studies suggesting that no single informant is superior in identifying ADHD. Notably, over 93% of referred children were diagnosed with a neuropsychiatric disorder, though not necessarily ADHD. Conclusions: The findings underscore the importance of combining reports from parents and teachers to capture symptom expression across different environments, which is essential for accurate ADHD diagnosis. Enhanced training for informants and a multidisciplinary approach is recommended to improve diagnostic accuracy and support early identification and intervention efforts. These results support nuanced evaluation strategies that account for informant variability and help mitigate potential misinterpretations of ADHD symptoms. Full article

HIV-1 proviral landscapes were investigated using near-full-length HIV single-genome sequencing on blood samples from five children with vertically acquired infection and on ART for ~7–9 years. Proviral structures were compared to published datasets in children prior to ART, children on short-term ART, and adults on ART. We found a strong selection for large internal proviral deletions in children, especially deletions of the env gene. Only 2.5% of the proviruses were sequence-intact, lower than in the comparative datasets from adults. Of the proviruses that retained the env gene, >80% contained two or more defects, most commonly stop codons and/or gag start mutations. Significantly fewer defects in the major splice donor site (MSD) and packaging signal were found in the children on short or long-term ART compared to the adults, and tat was more frequently defective in children. These results suggest that different selection pressures may shape the proviral landscape in children compared to adults and reveal potentially different genetic regions to target for measuring the intact HIV reservoir and for achieving HIV remission in children. Full article

Objectives: This study aimed to endoscopically assess nasal patency in terms of adenoid obstruction and its mucous coverage, as well as nasal obstruction caused by the inferior nasal turbinate in children with vocal fold nodules. Methods: A retrospective study was conducted involving 54 children admitted to an ENT clinic due to hoarseness caused by vocal fold nodules from 2022 to 2024. The study analyzed medical history, the results of performed flexible nasofiberoscopy and tympanometry. Results: Children with vocal fold nodules snored and slept with open mouths less frequently than the control group of other patients admitted to the ENT outpatient clinic without voice disorders (p = 0.003 and 0.004, respectively). Pathological mucous coverage of the adenoid was observed more often (p = 0.02). The mean adenoid size in the A/C ratio was 52.1% compared to 63.4% in the control group (p = 0.01). Conclusions: Children with vocal fold nodules typically have smaller adenoids, fewer incidents of snoring and open-mouth breathing, but more frequent pathological nasal mucus. It was not possible to prove that the incorrect breathing path through the mouth, causing reduced humidity of the inhaled air, affects the formation of vocal fold nodules. Full article

Background/Objectives: Emotional interactions between mothers and children are essential for later developmental outcomes such as children’s health, social competence, and language skills. However, an observational assessment of such interactions cannot reveal how mothers perceive their relationships with their children. Therefore, in this study, we translated and validated the Japanese version of the Emotional Availability Self-Report (EA-SR-J) and examined its factor structure, reliability, and validity. Methods: The participants were 739 Japanese mothers with children aged from 1 month to 5 years and 11 months. Results: Exploratory factor analysis revealed 19 items and four factors (Affect Quality, Hostility, Mutual Attunement, and Child Involvement with Parent) for the EA-SR-J. However, Intrusiveness was removed, and some items were assigned to different factors compared with the original scale. Cronbach’s alpha of each subscale ranged from 0.81 to 0.88, indicating sufficient internal consistency. The convergent validity of the scale was confirmed with expected correlations with variables related to attachment and child-rearing style. Discriminant validity was confirmed by group differences in variables related to children’s autism spectrum disorder symptoms and mothers’ depression symptoms. Conclusions: Although the EA-SR-J contains fewer items than the original scale, with the Intrusiveness item removed, it remains a reliable and valid tool. Further studies using the Emotional Availability Scale based on observation are needed in the future. Full article

Background: Mental health issues among youth are a growing public health concern. Schools play a vital role in the early detection and prevention of mental health issues, with principals being central to the implementation of mental health initiatives. This study assessed the attitudes, preparedness, and practices of school principals regarding mental health promotion and prevention among school-aged children. Methods: A cross-sectional survey using computer-assisted web interviewing (CAWI) was conducted between March and April 2025. A 19-item questionnaire was sent to all 1564 primary and secondary school principals in the Lodz region. Data from 605 respondents (response rate: 38.7%) were analyzed. Results: A total of 94.9% of the principals reported an increase in student mental health problems over the past five years. Over one-quarter of school principals (26.3%) declared a very good or rather good level of preparation for teachers to work with students diagnosed with a mental disorder. Moreover, 42.3% declared a very good or rather good level of preparation of teachers for conversations with parents about mental health problems observed in their children. Mental health education was conducted in 94.7% of schools, and teacher training in 73.2% of schools. Secondary schools more often offered such training (81.9% vs. 70.7%; p = 0.01) and reported stronger support from specialist teachers (79.7% vs. 67.7%; p = 0.01) than primary schools did. Rural schools rated teacher-parent communication more positively (47.0% vs. 37.7%; p = 0.02) despite fewer training initiatives (68.7% vs. 77.7%; p = 0.01). Suicide response procedures were implemented in 78.5% of schools. Conclusions: The findings confirm a marked rise in student mental health needs and reveal structural disparities in providing school-based support. Enhancing school leadership, expanding teacher training, and ensuring systemic support may facilitate mental health promotion interventions in schools. Full article

Background/Objectives: Gastrostomy tube (GT) placement plays a vital role in managing children with chronic illnesses who are unable to meet their nutritional needs orally. While its clinical benefits are well established, limited data exist on caregivers’ satisfaction with GT use in Jordan. This study aimed to assess caregivers’ satisfaction and identify factors that influence their experiences by using a validated satisfaction scoring system in which a score greater than 20 indicates a high level of satisfaction. Methods: A cross-sectional study was conducted at Jordan University Hospital, including children under 18 years of age who underwent endoscopic GT insertion between July 2017 and December 2024. Caregivers completed the Structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8), and demographic and clinical data were collected. Statistical analyses explored associations between satisfaction levels and patient-, caregiver-, and healthcare-related factors. Results: A total of 46 caregivers participated. The median satisfaction score was 26.1, surpassing the high satisfaction threshold of 20. Overall, 63% of caregivers expressed satisfaction or high satisfaction with GT feeding, and 82.6% were satisfied with the support provided by the healthcare team. Additionally, 69.5% and 65.2% of caregivers reported improvements in their child’s nutritional status and overall family well-being, respectively. Notably, 89.1% observed a reduction in feeding time, and 84.8% reported fewer respiratory infections following GT placement. Over half of the caregivers (58.7%) indicated that they would have agreed to earlier GT placement if they had been more aware of its benefits. Conclusions: Caregivers reported high satisfaction with GT use, with scores well above the validated threshold indicating high satisfaction. These findings highlight the positive impact of GT placement on children’s health outcomes and family quality of life. Enhancing caregiver education and providing robust healthcare support are crucial to improving the management of children who require GT feeding. Full article