Research

Open AccessArticle

Improving Functioning of Children Birth to Five with Emotional and Behavioral Problems: The Role of Comprehensive Mental Health Services and Supports

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Alison K. Cohen

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Tracy Hazelton

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Henrissa Bassey

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Margie Gutierrez-Padilla

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Carolyn Novosel

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Chloe R. Nichols

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Sonia Jain

Pediatr. Rep. 2023, 15(1), 33-44; https://doi.org/10.3390/pediatric15010005 - 09 Jan 2023

Viewed by 1187

Abstract

Introduction: Emotional and behavioral problems are growing among children ages birth to five, and racial/ethnic and socioeconomic disparities exist. Comprehensive, culturally responsive, family-driven systems of care, such as the one operated by California’s diverse, urban Alameda County, offer one potential intervention. Methods: We [...] Read more.

Introduction: Emotional and behavioral problems are growing among children ages birth to five, and racial/ethnic and socioeconomic disparities exist. Comprehensive, culturally responsive, family-driven systems of care, such as the one operated by California’s diverse, urban Alameda County, offer one potential intervention. Methods: We used client-level service data (n = 496 children) to calculate descriptive statistics and regression analyses (including multilevel models to account for observations for the same client at multiple points in time). We estimated the prevalence of mental health issues and assessed the association between the length of time using services and emotional and behavioral functioning. Results: Comprehensive mental health services and supports were associated with improved emotional and behavioral functioning outcomes for children over time, even after controlling for other risk factors. Discussion: Systems of care appear to support the multidimensional functioning of children and their families. Full article

(This article belongs to the Special Issue Feature Papers in Pediatric Reports)

Open AccessArticle

Is It Time for “Time-In”?: A Pilot Test of the Child-Rearing Technique

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Pediatr. Rep. 2022, 14(2), 244-253; https://doi.org/10.3390/pediatric14020032 - 23 May 2022

Viewed by 5416

Abstract

Time-out, a mainstay of non-punitive discipline for over 60 years, has been criticized for isolating and distancing children from others. An alternative technique, one promoted by advocates of positive parenting practices, is labeled “time-in”. This procedure is intended to help the child connect [...] Read more.

Time-out, a mainstay of non-punitive discipline for over 60 years, has been criticized for isolating and distancing children from others. An alternative technique, one promoted by advocates of positive parenting practices, is labeled “time-in”. This procedure is intended to help the child connect to the parent, communicate their feelings, and learn how to self-regulate. Although the technique has been advocated in the positive parenting literature since at least the 1990s, there are few empirical studies evaluating it. This pilot mixed-models study was designed as an initial test to determine whether mothers, following a brief training, would use the procedure over a two-week period, and how they would view it. Based on the daily reports as well as post-intervention interview of a small sample of mothers, the technique was evaluated as easy to use and effective. This study provides initial information about mothers’ use of the technique and sets the stage for a comprehensive set of studies to rigorously test and evaluate the technique. Full article

(This article belongs to the Special Issue Feature Papers in Pediatric Reports)

Open AccessArticle

Lupus Nephritis, Autoantibody Production and Kidney Outcomes in Males with Childhood-Onset Systemic Lupus Erythematosus

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Pediatr. Rep. 2022, 14(2), 220-232; https://doi.org/10.3390/pediatric14020030 - 06 May 2022

Cited by 3 | Viewed by 2712

Abstract

Childhood-onset systemic lupus erythematosus (cSLE) only represents 20% of all SLE patients, and males with SLE only represent 10%. To study this rare SLE subset, males diagnosed with cSLE over a 30-year period were identified. Organ involvement, autoantibody production, hypocomplementemia, and kidney biopsy [...] Read more.

Childhood-onset systemic lupus erythematosus (cSLE) only represents 20% of all SLE patients, and males with SLE only represent 10%. To study this rare SLE subset, males diagnosed with cSLE over a 30-year period were identified. Organ involvement, autoantibody production, hypocomplementemia, and kidney biopsy findings were compared to cSLE females. Outcomes were assessed using SLE Disease Activity Index scores, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and Childhood Arthritis and Rheumatology Research Alliance definitions for nephritis responsiveness. Of 95 males and 545 females with cSLE, 62% and 57% developed nephritis, respectively. Median age of cSLE onset was 14 years in both genders. Among males, 80% of non-Hispanic whites, 64% of blacks, 59% of Hispanics, and 50% of Asians developed nephritis. The prevalence of pure and mixed class V membranous nephritis was 33%. Median follow-up was 3.2 years (range 0.1–18). Complete kidney responses were seen in 70% after a median 24 months; however, relapse rates were 46%. Kidney disease flares were 56% nephritic and 44% proteinuric. Males and females with cSLE present with comparable rates and nephritis class. While overall and kidney response rates are favorable, kidney disease relapses are common among males. Full article

(This article belongs to the Special Issue Feature Papers in Pediatric Reports)

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Open AccessArticle

Patient Satisfaction and Perceived Quality of Care with Telemedicine in a Pediatric Gastroenterology Clinic

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Pediatr. Rep. 2022, 14(2), 181-189; https://doi.org/10.3390/pediatric14020025 - 12 Apr 2022

Cited by 3 | Viewed by 1854

Abstract

Introduction: The coronavirus disease 2019 pandemic necessitated a shift to telemedicine for many clinics. This study aimed to better understand patient perception regarding telemedicine visits in a pediatric subspecialty clinic and to describe differences in management provided virtually versus in-person. Materials and Methods: [...] Read more.

Introduction: The coronavirus disease 2019 pandemic necessitated a shift to telemedicine for many clinics. This study aimed to better understand patient perception regarding telemedicine visits in a pediatric subspecialty clinic and to describe differences in management provided virtually versus in-person. Materials and Methods: This survey study and chart review was conducted at the Doernbecher Children’s Hospital gastroenterology outreach clinics from May to June, 2020. The main hospital is located in Portland, Oregon, with the outreach clinics located in Salem, Eugene, and Medford, Oregon. Families were surveyed within 2 weeks of their visit, with a 6-month follow up survey. Results: There were 111 respondents to the initial survey (34% response rate). The majority of patients had initial positive impressions of telemedicine, with 75% feeling that the quality of telemedicine visits were as good as or better than in-person visits. At 6 months, there were 80 respondents (34% response rate), and this positive impression persisted with 72% of families reporting no negatives from their telemedicine experience. New patients seen via telemedicine were prescribed medications more frequently than those seen in-person (73% versus 45%, p = 0.02). Discussion: Patients and families felt the benefits of telemedicine visits outweighed the limitations both initially and at 6-month follow up. Telemedicine offers an effective alternative for pediatric subspecialty care especially for select conditions and follow up visits. However, the more frequent prescriptions could reflect the adaptation of clinical practice with the telemedicine platform, and further studies are needed. Full article

(This article belongs to the Special Issue Feature Papers in Pediatric Reports)

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Review

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Open AccessReview

Hereditary Hemorrhagic Telangiectasia in Pediatric Age: Focus on Genetics and Diagnosis

by

Cesare Danesino

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Claudia Cantarini

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Carla Olivieri

Pediatr. Rep. 2023, 15(1), 129-142; https://doi.org/10.3390/pediatric15010011 - 10 Feb 2023

Viewed by 1483

Abstract

Hereditary Hemorrhagic Telangiectasia (HHT) or Rendu–Osler–Weber Syndrome (ROW) is an autosomal dominant vascular disease, with an estimated prevalence of 1:5000. Genes associated with HHT are ACVRL1, ENG, SMAD4, and GDF2, all encoding for proteins involved in the TGFβ/BMPs signaling [...] Read more.

Hereditary Hemorrhagic Telangiectasia (HHT) or Rendu–Osler–Weber Syndrome (ROW) is an autosomal dominant vascular disease, with an estimated prevalence of 1:5000. Genes associated with HHT are ACVRL1, ENG, SMAD4, and GDF2, all encoding for proteins involved in the TGFβ/BMPs signaling pathway. The clinical diagnosis of HHT is made according to the “Curaçao Criteria,” based on the main features of the disease: recurrent and spontaneous epistaxis, muco-cutaneous telangiectases, arteriovenous malformations in the lungs, liver, and brain, and familiarity. Since the clinical signs of HHT can be misinterpreted, and the primary symptom of HHT, epistaxis, is common in the general population, the disease is underdiagnosed. Although HHT exhibits a complete penetrance after the age of 40, young subjects may also present symptoms of the disease and are at risk of severe complications. Here we review the literature reporting data from clinical, diagnostic, and molecular studies on the HHT pediatric population. Full article

(This article belongs to the Special Issue Feature Papers in Pediatric Reports)

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Open AccessReview

Myopericarditis in a Male Adolescent Following the Second Shot of COVID-19 Pfizer m-RNA Vaccine: Typical Example and Analysis of 110 Single Case Reports

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Pediatr. Rep. 2022, 14(4), 401-409; https://doi.org/10.3390/pediatric14040048 - 26 Sep 2022

Viewed by 1714

Abstract

One of the most powerful weapons against COVID-19 is vaccines. After the worldwide spread of the disease, m-RNA vaccines were authorized not only in adult patients, but also in children and adolescents aged 12–18. Since then, alarming reports of cases of myocarditis and/or [...] Read more.

One of the most powerful weapons against COVID-19 is vaccines. After the worldwide spread of the disease, m-RNA vaccines were authorized not only in adult patients, but also in children and adolescents aged 12–18. Since then, alarming reports of cases of myocarditis and/or pericarditis have been noted, primarily involving males after the second vaccine shot. A typical example of myopericarditis occurring in an adolescent a few days after the second shot of an m-RNA vaccine is described here. An in-depth review of all 110 single case reports published up to July 2022 with related features and outcomes is also presented. This is the first extensive analysis focused solely on a significant number of single case reports, which have usually been excluded from systematic reviews and meta-analyses carried out in the field. The analysis presented here confirms that most cases occurred in males after the second injection of an m-RNA vaccine. Cases were mild and responsive to the usual medical treatment. What is newly reported is that not only adolescents, but also older people, especially females, were affected by this adverse event. Full article

(This article belongs to the Special Issue Feature Papers in Pediatric Reports)

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Open AccessReview

Management of Anticoagulation during Extracorporeal Membrane Oxygenation in Children

by

Madhuradhar Chegondi

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Niranjan Vijayakumar

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Balagangadhar R. Totapally

Pediatr. Rep. 2022, 14(3), 320-332; https://doi.org/10.3390/pediatric14030039 - 11 Jul 2022

Cited by 1 | Viewed by 2050

Abstract

Extracorporeal Membrane Oxygenation (ECMO) is often used in critically ill children with severe cardiopulmonary failure. Worldwide, about 3600 children are supported by ECMO each year, with an increase of 10% in cases per year. Although anticoagulation is necessary to prevent circuit thrombosis during [...] Read more.

Extracorporeal Membrane Oxygenation (ECMO) is often used in critically ill children with severe cardiopulmonary failure. Worldwide, about 3600 children are supported by ECMO each year, with an increase of 10% in cases per year. Although anticoagulation is necessary to prevent circuit thrombosis during ECMO support, bleeding and thrombosis are associated with significantly increased mortality risk. In addition, maintaining balanced hemostasis is a challenging task during ECMO support. While heparin is a standard anticoagulation therapy in ECMO, recently, newer anticoagulant agents are also in use. Currently, there is a wide variation in anticoagulation management and diagnostic monitoring in children receiving ECMO. This review intends to describe the pathophysiology of coagulation during ECMO support, review of literature on current and newer anticoagulant agents, and outline various diagnostic tests used for anticoagulation monitoring. We will also discuss knowledge gaps and future areas of research. Full article

(This article belongs to the Special Issue Feature Papers in Pediatric Reports)

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Other

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Open AccessStudy Protocol

Recognizing the Emergent and Submerged Iceberg of the Celiac Disease: ITAMA Project—Global Strategy Protocol

Pediatr. Rep. 2022, 14(2), 293-311; https://doi.org/10.3390/pediatric14020037 - 10 Jun 2022

Cited by 3 | Viewed by 1876

Abstract

Coeliac disease (CD) is frequently underdiagnosed with a consequent heavy burden in terms of morbidity and health care costs. Diagnosis of CD is based on the evaluation of symptoms and anti-transglutaminase antibodies IgA (TGA-IgA) levels, with values above a tenfold increase being the [...] Read more.

Coeliac disease (CD) is frequently underdiagnosed with a consequent heavy burden in terms of morbidity and health care costs. Diagnosis of CD is based on the evaluation of symptoms and anti-transglutaminase antibodies IgA (TGA-IgA) levels, with values above a tenfold increase being the basis of the biopsy-free diagnostic approach suggested by present guidelines. This study showcased the largest screening project for CD carried out to date in school children (n=20,000) aimed at assessing the diagnostic accuracy of minimally invasive finger prick point-of-care tests (POCT) which, combined with conventional celiac serology and the aid of an artificial intelligence-based system, may eliminate the need for intestinal biopsy. Moreover, this study delves deeper into the “coeliac iceberg” in an attempt to identify people with disorders who may benefit from a gluten-free diet, even in the absence of gastrointestinal symptoms, abnormal serology and histology. This was achieved by looking for TGA-IgA mucosal deposits in duodenal biopsy. This large European multidisciplinary health project paves the way to an improved quality of life for patients by reducing the costs for diagnosis due to delayed findings of CD and to offer business opportunities in terms of diagnostic tools and support. Full article

(This article belongs to the Special Issue Feature Papers in Pediatric Reports)

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