Successive implementation of seven-valent then 13-valent pneumococcal conjugate vaccines (PCVs) led to a marked decrease in pneumococcal disease burden, including pneumococcal meningitis. We assessed ...the long-term effect of implementation of PCVs on incidence of pneumococcal meningitis in children in France over a 16-year period.
We did a quasi-experimental, population-based interrupted time-series analysis with a nationwide prospective survey over 16 years in France, recruiting children aged younger than 15 years from 227 paediatric wards from January, 2001, to December, 2016. The main outcome by the time-series model was the estimated incidence of pneumococcal meningitis per 100 000 children (of a population of 12·6 million children in 2017) before and after PCV7 and PCV13 implementation. The time-series model was based on segmented regression with autoregressive error.
We enrolled 1778 children with pneumococcal meningitis. PCV13 implementation led to a significant reduction in monthly incidence of pneumococcal meningitis from 0·12 per 100 000 children before PCV13 to a nadir of 0·07 in December, 2014 (−38%, 95% CI −56·1 to −20·4; p<0·0001). A sharp increase occurred during 2015 and 2016, (+2·3% per month, incidence of 0·13 per 100 000 children at the end of the study period, p=0·0002), mainly related to an increase of serotype 24F, which was frequently penicillin resistant.
The early effect of PCV13 implementation greatly reduced the incidence of pneumococcal meningitis in children less than 15 years old. However, a sharp rebound in incidence linked to the emergence of serotype 24F compromised the long-term PCV efficacy. If confirmed in future studies and in other countries, pneumococcal meningitis incidence rebound and 24F emergence should be considered when developing next-generation PCVs.
The French Pediatric Infectious Diseases Group, Association Clinique et Thérapeutique Infantile du Val de Marne, Pfizer, and for the National Reference Centre for Pneumococci, the French National Health Agency.
Aim
To evaluate the relationship between the movement abnormalities of the impaired upper limb in children with unilateral cerebral palsy (CP) and bimanual performance.
Method
Twenty‐three children ...with unilateral CP (mean age 11y 10mo SD 2y 8mo) underwent evaluation of bimanual performance (Assisting Hand Assessment AHA) and a three‐dimensional movement analysis to measure deviations in the movement of their affected upper limb, and compared with 23 typically developing children (TDC) (mean age 11y 11mo SD 2y 5mo). Kinematic indices, such as the Global Arm Profile Score (APS), which summarizes the global movement deviation of the upper limb from the norm, and the Global Arm Variable Score (AVS), which represent movement deviations for a given joint, were calculated and correlated to AHA.
Results
Values of kinematic indices were significantly higher in children with unilateral CP than in TDC. A strong correlation between Global‐APS and AHA score (r=−0.75) was found. Other significant correlations were found with Global‐AVS, especially in distal joints.
Interpretation
Children with unilateral CP had more movement deviations than TDC. The global movement deviation of the impaired upper limb was strongly correlated with bimanual performance. The influence of distal abnormalities confirms the importance of considering these limitations in therapeutics.
What this paper adds
Children with unilateral cerebral palsy had more movement deviations than typically developing children in unimanual tasks.
A strong relationship was found between movement deviations of the impaired upper limb and bimanual performance.
Resumen
Anomalías del movimiento cinemático y rendimiento bimanual en niños con parálisis cerebral unilateral
Objetivo
Evaluar la relación entre las anomalías del movimiento de la extremidad superior comprometida en niños con parálisis cerebral unilateral (PC) y su rendimiento bimanual.
Metodo
Veintitrés niños con PC unilateral (edad media 11 años y 10 meses DS 2 años y 8 meses) se sometieron a evaluación del rendimiento bimanual (Assisting Hand Assessment AHA siglas en ingles) y un análisis del movimiento tridimensional para medir las desviaciones en el movimiento de la extremidad superior comprometida, se comparó con 23 niños con desarrollo típico (edad promedio 11 años 11 meses DS 2 años 5 meses). Los índices cinemáticos, como la Puntuación Global del miembro (Global Arm Profile Score. Global‐APS), que resume la desviación global del movimiento de la extremidad superior con respecto al normal y la Puntuación Global variable (Global‐AVS) del mismo, que, a su vez, representan las desviaciones de movimiento para una articulación determinada, se calcularon y correlacionaron con el AHA.
Resultados
Los valores de los índices cinemáticos fueron significativamente más altos en niños con PC unilateral que en niños con desarrollo típico. Se encontró una fuerte correlación entre Global‐APS y AHA (r=−0.75). Otras correlaciones significativas se encontraron con Global‐AVS, especialmente en las articulaciones distales.
Interpretación
Los niños con PC unilateral tenían más desviaciones de movimiento que en los niños con desarrollo típico. La desviación del movimiento global de la extremidad superior comprometida se correlacionó fuertemente con el rendimiento bimanual. La influencia de las anomalías distales confirma la importancia de considerar estas limitaciones en la terapéutica.
Resumo
Anormalidades na cinemática e performance bimanual em crianças com paralisia cerebral unilateral
Objetivo
Avaliar a relação entre as anormalidades do movimento do membro superior acometido em crianças com paralisia cerebral unilateral (PC) e o desempenho bimanual.
Métodos
Vinte e três crianças com PC unilateral (média de idade 11a 10m DP 2a 8m) foram avaliadas quanto ao desempenho bimanual (Assisting Hand Assessment AHA) e uma análise de movimento tridimensional para medir os desvios do movimento no membro superior acometido, e foram comparadas com 23 crianças com desenvolvimento típico (CDT) (média de idade 11a 11m DP 2a 5m). Índices cinemáticos, como o Escore Global do Perfil do Braço (EPB), que resume os desvios globais do membro superior do padrão, e o Escore Global de Variáveis do Braço (EVB), que representa os desvios do movimento em cada articulação, foram calculados e correlacionados com o AHA.
Resultados
Os valores dos índices cinemáticos foram significantemente maiores em crianças com PC unilateral comparas as CDT. Uma forte correlação entre EPB Global e escore HA (r=−0.75) foi encontrada. Outras correlações significantes foram encontradas com o EVB Global, especialmente nas articulações distais.
Interpretação
Crianças com PC unilateral apresentam mais desvios de movimento que as CDT. Os desvios de movimentos globais do membro superior acometido apresentaram uma forte correlação com o desempenho bimanual. A influência das anormalidades distais confirma a importância de se considerar essas limitações durante a terapia.
What this paper adds
Children with unilateral cerebral palsy had more movement deviations than typically developing children in unimanual tasks.
A strong relationship was found between movement deviations of the impaired upper limb and bimanual performance.
This article is commented on by Basu on pages 739–740 of this issue.
This article's has been translated into Spanish and Portuguese.
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To describe the characteristics of children treated with long term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) in France.
Cross-sectional national survey.
Paediatric ...CPAP/NIV teams of 28 tertiary university hospitals in France.
Children aged <20 years treated with CPAP/NIV since at least 3 months on June 1st, 2019.
An anonymous questionnaire was filled in for every patient.
The data of 1447 patients (60% boys), mean age 9.8 ± 5.8 years were analysed. The most frequent underlying disorders were: upper airway obstruction (46%), neuromuscular disease (28%), disorder of the central nervous system (13%), cardiorespiratory disorder (7%), and congenital bone disease (4%). Forty-five percent of the patients were treated with CPAP and 55% with NIV. Treatment was initiated electively for 92% of children, while 8% started during an acute illness. A poly(somno)graphy (P(S)G) was performed prior to treatment initiation in 26%, 36% had a P(S)G with transcutaneous carbon dioxide monitoring (PtcCO2), while 23% had only a pulse oximetry (SpO2) with PtcCO2 recording. The decision of CPAP/NIV initiation during an elective setting was based on the apnea-hypopnea index (AHI) in 41% of patients, SpO2 and PtcCO2 in 25% of patients, and AHI with PtcCO2 in 25% of patients. Objective adherence was excellent with a mean use of 7.6 ± 3.2 h/night. Duration of CPAP/NIV was 2.7 ± 2.9 years at the time of the survey.
This survey shows the large number of children treated with long term CPAP/NIV in France with numerous children having disorders other than neuromuscular diseases.
•1447 children were treated with long term CPAP or NIV in France on June 2019.•The number of children treated with CPAP or NIV in France has increased 14-fold between 2000 and 2019.•The most frequent disorders were upper airway obstruction (46%) and neuromuscular disease (28%).•45% of the children were treated with CPAP and 55% with NIV.
Epidural hematoma (EDH) in newborn infants is rare. We have described the history of 15 newborns with EDH to provide a better understanding of this pathology.
This is a descriptive case series study ...using a retrospective review of the medical records of newborns who were admitted to the Pediatric Intensive Care Unit and Neurosurgery Department with the diagnosis of birth EDH over a 24-year period (1979-2002).
There was no sex predominance, and most of the mothers were young, nulliparous women. The time latency from birth to the first signs varied from 0 to 24 hours. Clinical presentation was nonspecific: seizures and hypotonia were the main symptoms. The parietal area was the most frequent location. Surgical drainage was required in nine patients, and no deaths were reported.
This report highlights the clinicoradiological characteristics of newborn EDH, which occurs more frequently in newborns that experienced difficult delivery from a nulliparous mother. Surgery is not a rule; some patients can be managed with conservative treatment. The outcome is generally good.
•Childhood experience of parents’ lying is related to lying to parents in adulthood.•Childhood experience of parents’ lying is related to adulthood maladjustments.•Parenting by lying may negatively ...impact children’s later psychosocial functioning.
Parenting by lying refers to the parenting practice of deception to try to control children’s behavioral and affective states. Although the practice is widely observed across cultures, few studies have examined its associations with psychological outcomes in adulthood. The current research fills this gap by sampling 379 young Singaporean adults who reported on their childhood exposure to parenting by lying, their current deceptive behaviors toward parents, and their psychosocial adjustment. Results revealed that the adults who remembered being exposed to higher levels of parenting by lying in childhood showed higher levels of deception toward their parents and higher levels of psychosocial maladjustment. Our findings suggest that parenting by lying may have negative implications for children’s psychosocial functioning later in life.
In this study, a suite of complementary environmental geochemical analyses, including NMR and gas chromatography-mass spectrometry (GC-MS) analyses of central metabolites, Fourier transform ion ...cyclotron resonance mass spectrometry (FTICR-MS) of secondary metabolites, and lipidomics, was used to investigate the influence of organic matter (OM) quality on the heterotrophic microbial mechanisms controlling peatland CO
, CH
, and CO
:CH
porewater production ratios in response to climate warming. Our investigations leverage the Spruce and Peatland Responses under Changing Environments (SPRUCE) experiment, where air and peat warming were combined in a whole-ecosystem warming treatment. We hypothesized that warming would enhance the production of plant-derived metabolites, resulting in increased labile OM inputs to the surface peat, thereby enhancing microbial activity and greenhouse gas production. Because shallow peat is most susceptible to enhanced warming, increases in labile OM inputs to the surface, in particular, are likely to result in significant changes to CO
and CH
dynamics and methanogenic pathways. In support of this hypothesis, significant correlations were observed between metabolites and temperature consistent with increased availability of labile substrates, which may stimulate more rapid turnover of microbial proteins. An increase in the abundance of methanogenic genes in response to the increase in the abundance of labile substrates was accompanied by a shift toward acetoclastic and methylotrophic methanogenesis. Our results suggest that as peatland vegetation trends toward increasing vascular plant cover with warming, we can expect a concomitant shift toward increasingly methanogenic conditions and amplified climate-peatland feedbacks.
Parents around the world engage in the practice of parenting by lying, which entails lying to manipulate children's emotional states and behavior. The current study is the first to examine whether ...exposure to parenting by lying in childhood is associated with later dishonesty and psychosocial maladjustment in adulthood. Female undergraduate adults retrospectively reported their experiences of parenting by lying during childhood, the current frequency at which they lie to their parents, and their current psychosocial functioning. We found that adults who recalled relatively high levels of parenting by lying during childhood both lie to their parents more often and experience greater psychosocial adjustments problems in adulthood than adults who recalled relatively low levels of parenting by lying during childhood. This study is the first to suggest that parenting by lying during childhood may be associated with negative moral and social outcomes later in life.
Abstract Background Excess energy intake from meals consumed away from home is implicated as a major contributor to obesity, and ∼50% of US restaurants are individual or small-chain (non–chain) ...establishments that do not provide nutrition information. Objective To measure the energy content of frequently ordered meals in non–chain restaurants in three US locations, and compare with the energy content of meals from large-chain restaurants, energy requirements, and food database information. Design A multisite random-sampling protocol was used to measure the energy contents of the most frequently ordered meals from the most popular cuisines in non–chain restaurants, together with equivalent meals from large-chain restaurants. Setting Meals were obtained from restaurants in San Francisco, CA; Boston, MA; and Little Rock, AR, between 2011 and 2014. Main outcome measures Meal energy content determined by bomb calorimetry. Statistical analysis performed Regional and cuisine differences were assessed using a mixed model with restaurant nested within region×cuisine as the random factor. Paired t tests were used to evaluate differences between non–chain and chain meals, human energy requirements, and food database values. Results Meals from non–chain restaurants contained 1,205±465 kcal/meal, amounts that were not significantly different from equivalent meals from large-chain restaurants (+5.1%; P =0.41). There was a significant effect of cuisine on non–chain meal energy, and three of the four most popular cuisines (American, Italian, and Chinese) had the highest mean energy (1,495 kcal/meal). Ninety-two percent of meals exceeded typical energy requirements for a single eating occasion. Conclusions Non–chain restaurants lacking nutrition information serve amounts of energy that are typically far in excess of human energy requirements for single eating occasions, and are equivalent to amounts served by the large-chain restaurants that have previously been criticized for providing excess energy. Restaurants in general, rather than specific categories of restaurant, expose patrons to excessive portions that induce overeating through established biological mechanisms.
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