Little is known about the diagnostic trajectories following a first psychiatric diagnosis in childhood or adolescence. Such knowledge could aid clinicians in treatment, risk prediction, and psychoeducation. This study presents a comprehensive nationwide overview of diagnostic trajectories in children and adolescents after their first diagnosis in child and adolescent psychiatric hospitals.

Patients aged 0 to 17 years who received their first psychiatric diagnosis between January 1996 and December 2011 were identified through the Danish National Patient Registries. Shifts at the International Classification of Diseases (ICD-10) two-cipher level (F00-F99), grouped into 19 categories, were identified. Subsequent diagnoses during 10 years of follow-up until December 2021 were identified and analyzed using state sequence analysis and Cox proportional hazard regression models.

A total of 77,464 children and adolescents (32,733 [42.26%] girls) were identified with a first-time psychiatric diagnosis. Among these, 46.7% of girls and 37.6% of boys had at least one diagnostic shift after 10 years of follow-up. High entropy and low diagnostic stability were found in first-time diagnoses often presenting in adolescence, such as affective disorders, psychotic illness, and personality disorders, while lower entropy and high diagnostic stability were found in neurodevelopmental disorders and eating disorders. For most categories, girls had higher mean entropy measures than boys (P < 0.05).

Diagnostic shifts are common in child and adolescent psychiatric services, particularly when the first contact occurs in adolescence. Adequate focus on psychoeducation about emerging diagnostic shifts, and on timely detection, particularly in girls, and particularly in adolescence, is warranted.

To compare the international BMI standard/references of the International Obesity Task Force (IOTF), MULT and the WHO and to analyse the association between changes in BMI growth channelling (BMI-GC) during childhood and the risk of being overweight in early adolescence.

Participant data from the Millennium Cohort Study (MCS), young lives (YL) and Generation XXI (G21) cohorts were obtained at three time points. Lin’s concordance correlation coefficient (CCC) and the weighted Kappa coefficient were used to assess the agreement among the BMI standard/references. The relative risk (RR) of being overweight at 9·5–13·5 years, based on an increase in BMI-GC (amplitude ≥ 0·67) between 3·5–6 years and 6·5–9 years, was calculated, with estimates adjusted for sex, ethnicity and socio-economic status.

Ethiopia, India, Portugal, Vietnam and United Kingdom.

Totally, 12 624 participants from the MCS, YL and G21 studies.

The prevalence of overweight across the three ages groups was higher when using the WHO standard/reference (12·8–25·9 %) compared with the MULT (17·1–22·9 %) and IOTF (13·0–19·3 %) references. However, substantial agreement (0·95 < CCC ≤ 0·99) was found among these standard/references. Children who increased their BMI-GC by ≥ 0·67 and < 0·86 were more likely to be overweight at 9·5–13·5 years (MULT-RR = 2·49, 95 % CI: 2·00, 3·09/ WHO-RR = 2·47, 95 % CI: 1·96, 3·12/ IOTF-RR = 2·31, 95 % CI: 1·82, 2·93), compared with those who have stayed in their BMI-GC.

A change in the BMI-GC among normal-weight children during childhood was associated with a significantly higher risk of being overweight at 9·5–13·5 years. These findings suggest that monitoring BMI-GC in children could be a tool to intervene and to prevent overweight in early adolescence.

Otolaryngology/ear, nose and throat conditions are common in clinical practice, yet undergraduate exposure in UK medical schools remains limited. The coronavirus disease 2019 pandemic created opportunities to innovate medical education. This review explores the scope of advance in otolaryngology undergraduate education following the coronavirus disease 2019 pandemic.

A search of MEDLINE, Embase, Cochrane, and Education Resources Information Center databases was conducted. Studies that met inclusion criteria were subject to risk-of-bias assessment and narrative analysis.

Interventions such as mixed reality, cadaveric teaching, and anatomical models improved short-term performance and student satisfaction. Surveys limited advancement in clinical exposure to otolaryngology/ear, nose and throat, when compared to pre-coronavirus-disease literature.

Despite the potential for reform following the pandemic, there has been no significant advancement in the provision of undergraduate medical education in the post-coronavirus-disease era. Standardisation of undergraduate education is needed to mirror recent changes to assessment in undergraduate education in the UK.

Children born very preterm (VPT; ≤32 weeks’ gestation) are at higher risk of developing behavioural problems, encompassing socio-emotional processing and attention, compared to term-born children. This study aimed to examine multi-dimensional predictors of late childhood behavioural and psychiatric outcomes in very preterm children, using longitudinal clinical, environmental, and cognitive measures.

Participants were 153 VPT children previously enrolled in the Evaluation of Preterm Imaging study who underwent neuropsychological assessments at 18–24 months, 4–7 years and 8–11 years as part of the Brain Immunity and Psychopathology following very Preterm birth (BIPP) study. Predictors of late childhood behavioural and psychiatric outcomes were investigated, including clinical, environmental, cognitive, and behavioural measures in toddlerhood and early childhood. Parallel analysis and exploratory factor analysis were conducted to define outcome variables. A prediction model using elastic-net regularisation and repeated nested cross-validation was applied to evaluate the predictive strength of these variables.

Factor analysis revealed two key outcome factors in late childhood: externalising and internalising-socio-emotional problems. The strongest predictors of externalising problems were response inhibition, effortful control and internalising symptoms in early childhood (cross-validated R2=.256). The strongest predictors of internalising problems were autism traits and poor cognitive flexibility in early childhood (cross-validated R2=.123). Cross-validation demonstrated robust prediction models, with higher accuracy for externalising symptoms.

Early childhood cognitive and behavioural outcomes predicted late childhood behavioural and psychiatric outcomes in very preterm children. These findings underscore the importance of early interventions targeting cognitive development and behavioural regulation to mitigate long-term psychiatric risks in very preterm children.

The objectives of this study were to (1) document factors that promoted or hindered the successful implementation of small quantity lipid-based nutrient supplements (SQ-LNS) for children 6–23 months and pregnant and lactating women (PLW) and (2) gather programme staff perspectives on considerations for expanding SQ-LNS programmes in their context.

We used qualitative methods to interview programme staff (n 23), conduct distribution site observations (n 9) and facilitate focus group discussions with caregivers of children 6–23 months (n 9) and PLW (n 6) with 6–8 participants per group across the three countries.

The study was conducted in SQ-LNS programme sites in Honduras, Niger and Somalia.

We found high acceptability of SQ-LNS among caregivers of children 6–23 months and PLW women. However, caregivers and PLW were dissatisfied with the size of the product in Niger and Somalia and PLW disliked the aftertaste of iron in Honduras. In Somalia, PLW referred to high levels of food insecurity. We also found variation in how the partners designed their SQ-LNS programmes (e.g. enrolment and exit criteria), the level of communication around SQ-LNS and problem-solving to support appropriate use of SQ-LNS. Partners tracked anthropometric measurements in all countries and used the information to assess changes and, in some cases, noted improvements in child anthropometry and vaccination rates.

Programmes need to consider several operational factors during implementation, such as securing household food access in highly food-insecure areas, counselling on the use of SQ-LNS and evidence-based criteria for enrolment, exit and supplementation duration.

Kawasaki disease, an acute systemic small- and medium-vessel vasculitis, is mostly detected in children under 5 years old.

We aimed to explore the predictive value of long non-coding ribonucleic acid small nucleolar RNA host gene 5 (SNHG5) and microRNA (miRNA)-27a for the effect of standard intravenous immunoglobulintherapy on children with Kawasaki disease.

The study included 182 children undergoing standard intravenous immunoglobulin therapy for Kawasaki disease and another 182 healthy children receiving physical examinations as a control group. LncRNA SNHG5 and miRNA-27a expression levels were determined at admission.

The ineffective group had higher levels of interleukin-6, C-reactive protein, procalcitonin, lncRNA SNHG5, and miRNA-27a and Kobayashi score than those of the effective group (P < 0.05). Multivariate regression analysis showed that Kobayashi score, interleukin-6, C-reactive protein, procalcitonin, lncRNA SNHG5, and miRNA-27a were associated with the treatment outcomes (P < 0.05). LncRNA SNHG5 and miRNA-27a levels were positively correlated with Kobayashi score, interleukin-6, receiver operating characteristic and procalcitonin levels (r > 0, P < 0.05). High Kobayashi score and levels of interleukin-6, c-reactive roe, procalcitonin, lncRNA SNHG5, and miRNA-27a were influencing factors for treatment failure (odds ratio > 1, P < 0.05). The areas under the curves of lncRNA SNHG5, miRNA-27a, and their combination were 0.757, 0.766, and 0.831, respectively.

LncRNA SNHG5 and miRNA-27a are highly expressed in children with Kawasaki disease, and their levels are closely correlated with the efficacy of standard immunoglobulin therapy.

Limited studies have examined the association between the whole range of parental psychopathology and offspring major depression (MD). No previous study has examined this association by age of onset of offspring MD, or restricting to parental psychiatric diagnoses before offspring birth.

This nested case–control study included 37,677 cases of MD and 145,068 controls, identified from Finnish national registers. Conditional logistic regression models examined the association between parental psychopathology and MD, adjusting for potential confounders.

Increased risk of MD, expressed as adjusted odds ratio and 95% confidence interval (aOR [95% CI]) were most strongly observed for maternal diagnoses of schizophrenia and schizoaffective disorders (2.51 [2.24–2.82]) and depression (2.19 [2.11–2.28]), and paternal diagnoses of schizophrenia and schizoaffective disorders (2.0 [1.75–2.29]) and conduct disorders (1.90 [1.40–2.59]). The aORs for any psychiatric diagnosis were (2.66 [2.54–2.78]) for mothers, (1.95 [1.86–2.04]) for fathers, and (4.50 [4.24–4.79]) for both parents. When both parents had any psychiatric diagnosis, the highest risk was for MD diagnosed at the age of 5–12 years (7.66 [6.60–8.89]); versus at 13–18 years (4.13 [3.85–4.44]) or 19–25 years (3.37 [2.78–4.07]). A stronger association with parental psychopathology and offspring MD was seen among boys than girls, especially among 13–19 years and 19–25 years.

Parental psychiatric disorders, including those diagnosed before offspring birth, were associated with offspring MD, indicating potential genetic and environmental factors in the development of the disorder.

Parents’ experiences of loss and grief in the context of caring for a child with life-limiting severe neurological conditions are complex. Supportive interventions delivered by multidisciplinary teams have the potential to mitigate illness-related and anticipatory grief before and after bereavement. To date, the literature on professionals’ discussion of loss and grief with parents has not been synthesized. This systematic review aims to synthesize the evidence to establish what is known about professionals’ experience of these discussions with this population, with particular emphasis on timing, frequency, and the setting in which discussions occur.

A scoping review was developed, informed by the Preferred Reporting Items for Systematic Reviews and Meta analyses – Scoping Extension guidelines and the PCC (Population, Concept, Context) framework. Three electronic databases (PsycINFO, CINAHL, and PubMED) were searched using medical subject heading (MeSH) terms and keywords search strings in January 2023. The search was not limited to year of publication. Overall, 35 articles were analyzed using a combination of descriptive analysis and thematic synthesis.

Two overarching themes were identified, “loss and grief are part of this context” and “lack of recognition of loss and grief,” illustrating that despite the lack of evidence of explicit discussion of these issues, some aspects of loss and grief appeared to guide or implicitly influence healthcare professionals’ practice. Failure to acknowledge loss and grief was associated with an increase in parental distress and had implications for future care planning.

Healthcare professionals are well placed to discuss loss and grief with parents of children with life-limiting severe neurological conditions. However, these discussions are only implicitly reported in the literature. Findings suggest that some professionals avoided discussing loss and grief. Bereavement outcomes are not typically considered in findings of the papers reviewed. Based on these findings, future research should focus on what this means for understanding professionals’ capacity to engage with loss and grief.

The most common cause of morbidity and mortality in type 1 diabetes mellitus is cardiovascular system involvement. Sudden death has been reported in type 1 diabetes mellitus patients. To analyse the use of the cardiac electrophysiological balance index in predicting ventricular arrhythmias in children with type 1 diabetes mellitus disease.

One hundred type 1 diabetes mellitus paediatric patients and 100 healthy children, divided into three groups according to their haemoglobin A1C levels, were included in the study. All participants were evaluated with transthoracic echocardiography, 12-lead electrocardiography, and 24-h Holter after a detailed physical examination. Systolic and diastolic function parameters, electrocardiography intervals, and heart rate variability parameters were evaluated.

The mean age in the type 1 diabetes mellitus and control groups was 11.52 (± 3.52) and 11.78 (± 3.45) years, respectively. In total, 57% of the type 1 diabetes mellitus group and 56% of the control group were male. The mean haemoglobin A1C value was 9.14% (± 1.79) and the disease duration was 3.71 years (± 3.13). The type 1 diabetes mellitus group had a higher QTc duration, deceleration time duration, A velocity, and a lower E/A ratio than the control group. In the type 1 diabetes mellitus group, Tpe, Tpe/QT ratio, QTc/QRS ratio, Tpe/QRS ratio, Tpe/(QT × QRS) ratio values were significantly higher than in the control group.

Children with type 1 diabetes mellitus are at risk for atrial and ventricular arrhythmias without valvular disease, ischemic heart disease, or diastolic dysfunction despite normal systolic function. No correlation was found between disease duration, metabolic control, autonomic function parameters, and arrhythmia risk; however, it was associated with diastolic function parameters.