Children

Background/Objectives. Autism spectrum disorder (ASD) has been associated with microbiome alterations, but the relative contribution of environmental and individual factors remains unclear. This study explored oral and gut microbiome profiles in environmentally matched dizygotic triplets discordant for ASD. Materials and Methods. Triplets in the 5-9 year age range, including one child with ASD and two neurotypical siblings, underwent standardized oral examination. Oral tongue-dorsum and rectal swab samples were analyzed by 16S rRNA sequencing. Taxonomic composition and beta diversity were evaluated descriptively. Results. Dominant bacterial phyla were broadly similar across siblings, but oral microbial profiles showed greater interindividual variation. The participant with ASD had the highest dental biofilm accumulation, predominance of Streptococcus, and reduced representation of several secondary genera. One neurotypical sibling with mild gingival inflammation showed greater representation of Fusobacterium, Prevotella, and Leptotrichia. Beta diversity demonstrated clearer interindividual separation among oral than gut samples. Conclusions. Individual-specific factors may influence microbiome patterns even under highly similar environmental and dietary conditions. These findings support further investigation of the oral microbiome as a complementary component of ASD microbiome research.

AIM: To evaluate whether selective motor control quantified from spontaneous infant movement recordings provides diagnostic and prognostic information for cerebral palsy (CP) beyond established movement-based assessments. METHOD: This multicenter diagnostic and prognostic accuracy study included 302 infants (151 with CP) with spontaneous movement recordings obtained between 10 and 20 weeks corrected age from cohorts in Australia and the United States. All eligible infants with CP were included, and a comparison sample without CP was randomly selected. Recordings were scored using the Baby Observational Selective Control Appraisal (BabyOSCAR), Motor Optimality Score Revised (MOS-R), and General Movements Assessment (GMA). Outcomes at 2 years or older included CP diagnosis, Gross Motor Function Classification System (GMFCS) level, and motor distribution. RESULTS: BabyOSCAR discriminated CP diagnosis (area under the curve [AUC] 0.98), including children later classified in GMFCS level I. Among infants with CP, BabyOSCAR discriminated GMFCS levels I - II from III - V (AUC 0.89). BabyOSCAR absolute asymmetry also discriminated unilateral CP from all other infants (AUC 0.90). Diagnostic discrimination was also observed for MOS-R (AUC 0.94) and GMA (AUC 0.86). INTERPRETATION: Quantifying selective motor control from brief infant movement recordings may provide complementary early information about CP diagnosis, functional level, and motor distribution.

Background: In Tanzania and many other resource-limited settings, early diagnosis of Autism Spectrum Disorder (ASD) is often delayed due to a lack of culturally validated screening tools. Most available ASD screening tools were developed in Western countries and may not reflect local cultural and linguistic contexts. Purpose: This study aimed to culturally adapt and linguistically validate the Swahili versions of both the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT R/F) and the Social Communication Questionnaire (SCQ) for use in the Tanzanian context. Methods: A sequential mixed-methods study was conducted in Moshi Municipality and Hai District, Kilimanjaro Region, Tanzania. The study involved translation, cross-cultural adaptation, cognitive debriefing, expert panel review, and pilot testing of the psychometric evaluation of the M-CHAT R/F and SCQ. Qualitative interviews and focus group discussions explored comprehension and contextual appropriateness of the tools. Pilot testing involved 32 caregivers of children aged 1-8 years. Internal consistency was assessed using Cronbach's alpha and KR-20. Results: Participants found both the adapted tools understandable and culturally appropriate. Unfamiliar examples, such as vacuum cleaners and dinosaurs, were replaced with locally familiar examples including domestic animals, loud music, and vehicle sounds. The M-CHATR/F demonstrated acceptable internal consistency (Cronbach's alpha = 0.77; KR-20 = 0.79), while the SCQ showed good reliability (Cronbach's alpha= 0.83; KR-20 = 0.84). Cognitive debriefing and expert review confirmed the clarity and comprehension of the adapted tools for community use. Conclusion: The adapted Swahili versions of the M-CHAT R/F and SCQ demonstrated promising preliminary reliability and cultural relevance for ASD screening in Tanzania. These findings support the use of culturally tailored screening tools to improve early identification and referral of children with ASD in Tanzania. Keywords: Autism Spectrum Disorder, Cultural adaptation, M-CHAT R/F, SCQ, Swahili, Screening tools

Abstract Background The globally low birth weight is estimated to account for about 15-20% of all births. Global annual preterm delivery is about fifteen million, more than 60% of which occurs in Asia and Sub-Saharan Africa. The Kenyan preterm birth rate is estimated to be 14 per 100 live births. Prematurity, the leading cause of low birth weight, and its associated complications account for a large proportion of neonatal and under 5 morbidity and mortality. Premature and low birth weight (LBW) infants have rapid growth with increased nutritional demands despite their inadequate nutrient stores. This predisposes them to post-natal growth restriction (PNGR). Timely and adequate nutrition is important to prevent PNGR that has been shown to have long term neurodevelopmental and growth consequences. Immaturity and clinical instability of these infants makes providing adequate nutrition for them a great challenge. This study was done to determine the prevalence of and factors associated with PNGR among LBW infants at discharge from a rural public referral hospital in Kenya. Methods This was a single center retrospective descriptive study, of infants with birth weight <1800g discharged between 1st January 2022 and 31st December 2023, done to determine the prevalence of and the factors associated with PNGR among these infants at discharge. PNGR was defined as poor growth after birth during the initial hospitalization period. Cross sectional PNGR was discharge weight less than 10th centile while longitudinal PNGR was a drop in centiles lines for weight at discharge. Moderate PNGR was discharge weight between 3rd and 10th centile while severe PNGR was discharge weight less than the 3rd centile. Weight at birth and discharge was obtained and presented as Z scores and centiles using the respective gender specific intergrowth 21 charts. Maternal, clinical and nutritional data were also obtained from the patient files and analyzed to determine their association with PNGR. Results Among the 143 LBW infants included in the study, the prevalence of PNGR was 63% (n=90) (severe 44.8%) and 53.2% (n=76) (severe 16.1%) for cross sectional and longitudinal PNGR respectively. Statistically significant associations for longitudinal PNGR were found in patients who received any supplements aOR(95%CI) 3.0(1.1-8.3) p=0.037, took 14 days or more to regain birth weight aOR (95%CI) 0.1(0.1-0.4) p=<0.01 and were admitted for 30 days or more aOR(95%CI) 0.3(0.1-0.9) p=0.025. Conclusion More than half of LBW infants in Nyeri County Referral Hospital are discharged with PNGR, a sizeable proportion with severe form. There is need to update local LBW infants feeding protocols to include breast milk fortification, parenteral nutrition and avail resources to support the high nutritional needs of this population.

Objectives: Collaboration among health care professionals and the services they provide can be strengthen by interprofessional education (IPE). IPE can be implemented at the undergraduate level. Accordingly, the objective of the present study was to evaluate senior students' understanding of the terms interdisciplinarity and multidisciplinarity within the context of IPE. Methods: A retrospective cross-sectional study design was used. Students understanding of interdisciplinarity and multidisciplinarity was assessed through an assessment question completed by three consecutive cohorts of senior undergraduate dental students at the UBC Faculty of Dentistry between 2021/22 and 2023/24 (N = 177). Responses had a maximum of 100 words and were categorized into one of four predetermined themes: concordant knowledge (when both definitions were correct), discordant rhetoric (when both definitions were incorrect), switched ideas (when the definitions were reversed), and altered discourse (when the concepts of discipline and specialty were conflated). Descriptive and inferential statistical analyses were performed using SPSS Version 31. Results: Of the 177 students enrolled, 164 provided responses to the question on multidisciplinarity and interdisciplinarity: 60 students in 2021/22, 51 students in 2022/23, and 53 students in 2023/24; the mean age was 25 years and 88 were female. Of the four predetermined themes, 45.7% of responses reflected concordant knowledge, 15.9% discordant rhetoric, 18.3% switched ideas, and 20.1% altered discourse. The logistic regression analysis showed age associated with a higher probability of providing the correct definitions (adjusted OR = 1.39; 95% CI: 1.06 - 1.83; p = 0.017). Conclusions: Knowledge of interdisciplinary and multidisciplinary appeared to be retained by the majority of students. However, dental education programs, alongside other health professional training programs, should continue to incorporate interprofessional education through both didactic and experiential learning opportunities to equip students with the skills necessary to provide collaborative care in future practice.

Objectives: Dentists prescribe approximately one in ten antibiotics worldwide, yet antimicrobial stewardship (AMS) remains underemphasized in dental education. Large language models (LLMs) may support AMS training, but their proficiency and clinical reasoning in this context remain unclear. We evaluated GPT-4o's accuracy and clinical reasoning on dental antibiotic prescribing questions, stratified by question difficulty. Methods: We assembled 125 multiple-choice questions on dental antibiotic prescribing from eight peer-reviewed studies (2017-2023). GPT-4o answered each question and generated a clinical justification. Accuracy was assessed against source-study answer keys and examined across difficulty quartiles. Justifications were evaluated using an adapted 12-axis human-evaluation framework assessing scientific consensus, extent and likelihood of harm, inappropriate and missing content, bias, and both correct and incorrect comprehension, retrieval, and reasoning. Prophylaxis-specific questions were analysed separately. Results: GPT-4o correctly answered 72% of questions. Accuracy remained relatively stable across difficulty quartiles (78%, 78%, 65%, 70%). Experts rated 95.4% of justifications positively across the 12 axes. Comprehension, retrieval, and reasoning each exceeded 96.2% positive ratings. Missing content was the main weakness (7.8%), and 7.1% of justifications showed a moderate-to-severe potential for harm. Performance on prophylaxis-specific questions (98.1%) exceeded non-prophylaxis questions (93.0%). Conclusions: GPT-4o demonstrated moderate-to-high proficiency and clinically defensible reasoning in dental antibiotic prescribing questions. However, residual risks indicate that it is not suitable for unsupervised clinical use but shows potential as a supervised AMS educational tool.

Objective: To examine whether Medicaid-enrolled preschoolers with untreated decayed teeth received dental treatment within one year of enrollment and identify the factors associated with a treatment gap. Methods: A retrospective cohort analysis of data from a cluster-randomized trial conducted in 18 community-based pediatric primary care practices in Northeastern Ohio (2017-2022). Treatment receipt was determined using Medicaid claims, with treatment gap defined as fewer teeth with treatment claims than teeth found on baseline exam with decay. Multivariable logistic regression assessed the association of treatment gap with child age, sex, race/ethnicity, caregiver education, and number and location of baseline decayed teeth. Results: Of 766 eligible children, 487 (63.6%) attended the dentist within one year. Among 155/487 (31.8%) with baseline untreated decay, 90/155 (58.1%) had a treatment gap. Odontograms visually showed that decay was concentrated on upper anterior and posterior teeth. A treatment gap was associated with a greater number of decayed posterior teeth (OR = 1.90, 95% CI: 1.60-2.30) and decayed anterior teeth (OR = 2.19, 95% CI: 1.51-3.39), both p < 0.001. Other socio-demographic variables were not significantly associated with a treatment gap. Conclusion: More than half of Medicaid-enrolled children attending well-child visits had a dental treatment gap after 1 year. This pattern may reflect dentists' hesitancy to restore primary teeth nearing exfoliation and needing multiple dental visits to complete needed restorative treatment. To address this gap, non-surgical interventions such as silver diamine fluoride can be applied by pediatric primary care providers to control the bacteria and prevent disease progression.

Background: Children in Central Africa face compounded vulnerabilities, yet no comprehensive review has synthesized evidence on ECC prevalence or risk factors. This study aims to determine the prevalence and identify risk factors associated with early childhood caries (ECC) in the Central Africa Sub-region. Methods: This systematic review and meta-analysis was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the ID CRD420251019424. A comprehensive literature search was conducted across PubMed, African Journals Online, Scopus, Web of Science, CINAHL, and ProQuest as well as through Google Scholar and other grey literature sources, with no language restrictions. Eligible studies were limited to cross-sectional, cohort, case-control, and clinical trials that reported baseline data on the prevalence and risk factors of ECC in the Central Africa sub-region among children under the age of six. There was no restriction on publication date. Exclusion criteria included letters to the editor, commentaries, studies without accessible full texts, systematic reviews, reviews lacking original data, studies with overlapping data already included, and non-peer-reviewed sources such as books. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool. A random-effects meta-analysis was conducted using Review Manager 5.4.1, and heterogeneity was assessed using the I statistic. Results: Five studies met the eligibility criteria, encompassing 640 participants. Three of the studies were from Cameroon, and one from the Democratic Republic of Congo and the Central African Republic, respectively. One study that did not report the prevalence of ECC and another non-peer-reviewed publication were excluded from the meta-analysis. The prevalence of ECC in the region ranged between 29.4% and 80% with a pooled prevalence of 57% (95% CI: 22 to 92%; I = 98%). Identified risk factors for ECC were related to oral hygiene behaviours, diet and feeding practices, parental/caregiver factors, and access to dental care. Conclusions: ECC is highly prevalent in Central Africa, driven by preventable factors. Urgent region-specific policies and programs are needed to improve preventive services and address data gaps across this under-resourced subregion.

Background Despite cerebrospinal fluid (CSF) analysis being the gold standard for definitively diagnosing meningitis, its practical application has presented considerable difficulties, especially in environments with limited resources. Cranial ultrasound (CUS), while not a replacement for CSF analysis, provides rapid imaging to identify meningeal irregularities. Nevertheless, achieving a timely diagnosis of meningitis, particularly in its nascent stages, remains problematic, and healthcare professionals exhibit a notably low awareness of CUS's utility in diagnosing this condition. Methods This was a prospective cohort that recruited 273 term mother-neonate pairs. The neonates were initially divided into those with sepsis-meningitis (exposure group) and those with sepsis (non-exposure group) based on clinical assessment done by the admitting team. The research team further divided the participants into 4 diagnostic subgroups based on CUS findings: positive CUS for meningitis, positive clinical diagnosis for meningitis, positive CUS & clinical diagnosis for meningitis and those with negative CUS & clinical diagnosis for meningitis /sepsis only. Data on socio-demographics, clinical characteristics, blood works and CSF analysis reports, neurologic deficits and mortality outcomes were recorded for each neonate. Descriptive and inferential statistics were performed. Results The 4 diagnostic subgroups based on CUS findings were: positive CUS for meningitis (24.5%), positive clinical diagnosis for meningitis (4.4%), positive CUS & clinical diagnosis for meningitis (6.6%) and those with negative CUS & clinical diagnosis for meningitis /sepsis only (64.5%). Overall, duration of hospitalization was 11 days (range 2-45 days; interquartile range [IQR] 6,16) and the median chronological age of the neonates was 13 days (IQR 7, 21). Meningitis was suspected in 11% of neonates admitted with clinical sepsis. Uptake for lumbar puncture (LP) or ventricular tap (VT) was low at 4.4% (n = 12), underlining barriers to CSF-based diagnosis in this setting. Late-onset sepsis was associated with only 31.9% of NSM. The chronological age of the neonates at admission (p=0.002) and their duration of hospitalization (p=0.042) were significantly different across the 4 categories of neonates. Prominent sulci, hyperechoic brain lesions, ventriculitis, and lateral ventriculomegaly were the most common abnormal findings on CUS. Overall, neonates with meningitis presented later in age and stayed longer on the ward than those with sepsis: clinical meningitis diagnosis was likely to be made in older neonates and was associated with a shorter duration of hospitalization than CUS-diagnosed meningitis. Overall mortality rate was 2.2%. Mortality (16.7%) was highest amongst those with clinical & CUS diagnosed-NSM. Prevalence of Near-Miss cases of NSM was at least 27.6%. A neonate with clinical diagnosis of NSM was 3.94 times (95% CI 1.80, 8.62; p<0.001) more likely to have abnormal CUS at the time of admission. Percent agreement between the clinical and CUS diagnosis for NSM was 71.1%. Nine (75%) out of the 12 CSF reports was positive for meningitis; and the majority 55.6% (5) of the positive CSF report belonged to the category of neonates with sepsis only. Compared to CSF analysis, sensitivity of clinical diagnosis of NSM was 22.2%; specificity was 33.3%; positive predictive value (PPV) was 50%; negative predictive value (NPV) was 12.5% and likelihood ratio (LR) was 0.33. Whereas, sensitivity of CUS was 44.4%; specificity of CUS was 66.7%; PPV was 80%; NPV was 28.6% and LR was 1.33. Conclusion The CUS was only moderately effective at diagnosing meningitis whereas the presence of positive CSF among neonates with sepsis only within this study, further reaffirms the irreplaceability of CSF analysis in the diagnosis of NSM. Nevertheless, the integration of clinical assessment and CUS findings for diagnosing NSM emerged as possessing greater clinical significance in contexts characterized by limited resources. The systematic adoption of CUS for neonates exhibiting features suggestive of sepsis or meningitis (while exploring measures to improve on uptake of CSF analysis) could enhance the promptness of diagnosis, inform the selection of suitable therapeutic interventions, and potentially mitigate mortality rates and the occurrence of long-term neurological impairments, especially within environments facing resource limitations.

Relapse of aligned mandibular anterior teeth and the progressive collapse of the mandibular anterior arch are historically striking problems for orthodontists. The etiology of this collapse, and the cause of mesial molar drift, are unknown. However, light continuous (quasi-continuous) intra-oral pressures and forces applied to the mandibular dentition have been implicated. To explore this further, we use three-dimensional finite element analysis to investigate the influence of these intra-oral loads (tongue pressure, lip-cheek pressure, and interdental force) on mandibular arch collapse and mesial molar drift. Dentitions of three-dimensional finite element mandibular models were subjected to a wide range of simulated tongue pressures, lip-cheek pressures, and transseptal fiber-mediated interdental forces reported in the literature. Resulting crown displacement measurements from these isolated loads were made along with measurements resulting from simultaneous combined application of literature-defined mean tongue pressure, lip-cheek pressure, and interdental force. Our results indicate that tongue pressure alone results in generalized arch expansion and tooth spacing while lip-cheek pressure and interdental force result in generalized arch collapse, anterior crowding, and mesial molar displacement. Simultaneous application of tongue pressure, lip-cheek pressure, and interdental force mean values, as would occur in vivo, results in incisor crowding, intercanine width reduction, and mesial molar displacement. Our results suggest mandibular anterior arch collapse (incisor crowding / intercanine width reduction), and mesial molar displacement result from simultaneous application of tongue pressure, lip-cheek pressure, and interdental force.

Background: Early childhood caries remains one of the most prevalent and among the most neglected chronic diseases of childhood in low- and middle-income countries, and cariogenic feeding practices introduced in infancy are a principal, modifiable driver. National, spatially explicit estimates of such practices are lacking for Ghana, constraining geographically targeted interventions. Methods: We analyzed 3,007 children aged 6-23 months from the 2022 Ghana Demographic and Health Survey, linked to 600 georeferenced clusters. A composite cariogenic feeding index was built from bottle feeding, sugar-sweetened beverage consumption, and other cariogenic foods; a child was classified as exposed if any one component was present. Complex survey design was handled by Taylor series linearization. Determinants were examined using survey-weighted and two-level random-intercept logistic regression, and spatial clustering was assessed using global and local Morans I and Getis-Ord Gi* from a five-nearest-neighbour weights matrix. Results: Weighted national prevalence was 52.97% (95% confidence interval 50.19-55.75), ranging from 27.95% in the Savannah Region to 73.55% in the Western Region and patterned by residence (63.07% urban versus 43.90% rural) and wealth (32.87% in the poorest versus 74.45% in the richest quintile). Wealth and maternal education were the strongest multilevel correlates: the richest households showed roughly four times the odds of exposure relative to the poorest (adjusted odds ratio 4.00), and higher maternal education showed roughly two and a half times the odds relative to no education (adjusted odds ratio 2.51). The intraclass correlation coefficient was 0.219. Global Morans I was 0.231 (z = 9.73, p < 0.001), confirming significant positive spatial autocorrelation, with high-high clusters along the southern coastal belt (Western, Central, Greater Accra, Volta) and low-low clusters in the middle and northern belts (Bono, Ahafo, Upper West, Northern, North East). Conclusions: Cariogenic feeding among Ghanaian infants is common, socioeconomically patterned, and spatially clustered rather than random. Oral health promotion through routine growth monitoring and immunization platforms should be prioritized in the high-high clusters, while closing socioeconomic gradients would yield collateral benefit nationally. Trial registration: Not applicable. Keywords: cariogenic feeding, early childhood caries, infant and young child feeding, spatial analysis, Morans I, Getis-Ord Gi*, multilevel modeling, Ghana. Demographic and Health Survey; oral health epidemiology

Preterm birth is associated with increased risk for communication difficulties, yet early neural markers of later outcomes remain poorly understood. This study examined associations between structural and functional brain connectivity in infancy and communication skills at 24to 30 months in children born very preterm ([&le;]32 weeks gestation). Participants (n = 180) MRI at term-equivalent age during natural sleep. Resting-state functional and diffusion data were used to derive structural and functional connectivity across regions implicated in communication. At follow-up, communication outcomes were assessed using Communication and Symbolic Behavior Scales (CSBS), which captures verbal, gestural, social-affective, and symbolic communication skills. We analyzed 22x22 functional and structural connectomes among selected ROIs, using a LASSO regression approach to identify connectivity associated with CSBS scores adjusting for demographic and medical covariates. Significant relationships were observed between both functional and structural connectivity and communication skills, differing by domain. Functional connectivity between left and right temporal regions was positively associated with overall communication scores, whereas several structural connections involving cortical, cerebellar, and subcortical regions showed negative associations. Distinct connectivity patterns were also associated with gestural, verbal, social-affective, and symbolic communication skills. These findings demonstrate that variability in early brain connectivity is associated with later communication outcomes in children born very preterm. We found both significant positive and negative associations after adjusting for relevant covariates; these patterns potentially reflect compensatory or atypical network organization. These results highlight the value of multimodal neuroimaging in identifying early neural correlates of communication in this high-risk population.

Abstract Background: Even though significant advances in diagnosis, treatment, and prevention strategies have been implemented, neonatal sepsis remains a common concern in clinical practice, especially in low-resource countries. It is one of the major causes of death during the first month of life. This study aimed to assess clinical outcomes and predictors of mortality among neonates with neonatal sepsis admitted to public hospitals in selected Hospitals in Addis Ababa, Ethiopia. Methods: A hospital-based prospective cohort study design was conducted among 466 neonates admitted with neonatal sepsis from September 2024 to January 2025. All neonates who were admitted to selected Hospitals of Addis Ababa city after being clinically or laboratory-diagnosed with neonatal sepsis by the attending physician were included in the study. Data were entered into EpiData 4.2 and analyzed by SPSS version 26. Bivariate and multivariate Cox regression were used to identify the relationship between dependent and independent variables. Finally, variables with p-value [&le;] 0.05 were taken as significant factors associated with poor clinical outcome. Results: The study was conducted among 466 neonates admitted with neonatal sepsis. Of all neonates admitted with neonatal sepsis, 372 (79.8%) were discharged with good outcomes, and 94 (20.2%) had a poor outcome/died. Duration of ruptured membrane being >12hr (AOR=7.02, 95 % (CI: 1.85, 26.57), marital status /divorced (AOR=3.12, 95 % (CI: 1.67, 7.45),rural residence (AOR= 6.05, 95 % (CI: 2.03-16.53), assisted instrumental delivery (AOR= 5.99, 95 % (CI: 1.46-17.11), meconium-stained amniotic fluid ((AOR= 9.48, 95 % (CI: 0.49-18.61)), no initiate exclusive breast feed within one hour (AOR= 3.20, 95 % (CI: 0.90-7.52), chest in drawing (AOR= 5.81, 95 % (CI: 1.75-11.23) were significantly associated with neonatal mortality. Conclusion: Neonatal mortality was moderately high. Meconium-stained amniotic fluid, prolonged duration of ruptured membrane (>12hr), Mode of delivery (instrumental delivery), and chest in drawing are among the predictors of neonatal mortality. Keywords: -Clinical outcome,Neonatal sepsis, Mortality, predictors, Ethiopia.

Gastrointestinal (GI) conditions are common among children with neurodevelopmental disabilities (NDDs), and are associated with functional impairment, behavioral symptoms, and increased health care utilization. A unique relationship between autism and GI dysfunction has been proposed, leading to a focus on autism in GI research, management guidelines, and clinical tool development. Leveraging >20 years of electronic health record data and a cohort of 42,204 cases with attention-deficit/hyperactivity disorder, autism, cerebral palsy, epilepsy, or intellectual disability and 297,402 controls without NDDs, we quantified associations between NDDs and GI conditions in children. GI conditions were more common in cases than controls across all individual NDDs; intellectual disability and cerebral palsy were most strongly associated with having a GI condition. In this work, clinically recognized GI morbidity was elevated across all NDDs and not unique to autism, suggesting that a broader, transdiagnostic approach to GI dysfunction in children with NDDs is warranted.

Acute kidney injury (AKI) is common among neonates in the intensive care unit and has been linked to abnormal neurodevelopment, yet long-term effects on brain structure remain uncharacterized. In this secondary analysis, we compared brain white matter integrity, measured by fractional anisotropy (FA) on 3T MRI, in children ages 5 to 12 years born preterm with (n=5) versus without (n=10) a history of neonatal AKI. Contrary to our hypothesis, children with prior neonatal AKI showed higher FA across seven white matter regions in unadjusted analyses. After adjustment for sex, birth weight, and age at MRI, the AKI group retained significantly greater FA in the corticospinal tract ({beta}=0.7, 95% CI 0.09-1.31) and superior frontooccipital fasciculus ({beta}=0.68, 95% CI 0.02-1.34). Because elevated FA may reflect compensatory glial responses rather than improved neurological function, these findings suggest neonatal AKI may have lasting, complex effects on white matter microstructure. Larger studies pairing neuroimaging with neurocognitive assessment are needed.

Objective To develop an intelligent predictive indicator system for determining weaning and extubation timing in mechanically ventilated patients, providing a theoretical foundation for clinical decision support systems and intelligent assessment in critical care nursing. Methods A literature review was conducted to identify and extract factors influencing weaning and extubation timing in mechanically ventilated patients, forming the initial item pool for the indicator system. A Delphi expert consultation questionnaire was designed and administered to 21 experts from relevant fields over two rounds. Item screening and revision were performed using the boundary value method, based on the arithmetic mean of importance scores, coefficient of variation (CV), and qualitative expert feedback. Results The effective response rate was 100% for both rounds. The expert authority coefficient (Cr) was 0.89 in the first round and 0.93 in the second round. Kendall's W was 0.244 ({chi}{superscript 2} = 1038.944, P < 0.001) in the first round and 0.079 ({chi}{superscript 2} = 350.343, P < 0.001) in the second round. Following the first round of evaluation of 203 items--which resulted in 13 additions, 23 modifications, and the separation of weaning/extubation dimensions--the second round comprised 211 evaluation items. The final system encompassed 6 primary indicators and 58 secondary indicators (with tertiary indicators under each), covering the complete clinical trajectory: medical history, ICU admission assessment, pre-weaning/extubation assessment, weaning assessment, extubation assessment, and post-extubation outcomes. Conclusion This indicator system was developed through a rigorous process with high expert authority and good consensus. The indicators are clinically comprehensive, nursing-operable, and suitable for intelligent modeling. This system can serve as a core framework for risk warning, timing judgment, and intelligent prediction system development for weaning and extubation in mechanically ventilated patients.

Objective To evaluate the effect of vendor-integrated AI-assisted abdominal ultrasound software on operational efficiency and sonographer workload compared with manual scanning. Methods In this prospective randomised crossover study (January to February 2026), 32 healthy adults each underwent two upper abdominal examinations, one manual and one using vendor-integrated AI software (AI Abdomen Release 3.5; ACUSON Sequoia), in randomised order by two experienced sonographers, each participant scanned once by each sonographer. Scan time, hand-console interaction (keystrokes, hand travel, hover, jerk) from a custom depth-camera hand-tracking system, and operator modifications to AI outputs were recorded. Workload was assessed after each scan with the weighted NASA Task Load Index (NASA-TLX). Analysis used linear mixed-effects models. Results AI-assisted scanning reduced scan time (52.4 s, approximately 9%; 95% CI 23.7 to 81.2; P = 0.001), keystrokes (55, approximately 28%; P < 0.001) and hand travel (4.57 m, approximately 39%; P < 0.001), although the time saving was concentrated in one sonographer. Weighted NASA-TLX did not differ between conditions (-3.9 points; 95% CI - 9.3 to 1.5; P = 0.17), but subscale analyses showed reductions in mental demand (- 6.3; P = 0.03) and effort (- 7.0; P = 0.04), with no compensating increases. Sonographers modified 48 of 184 AI-generated values. Conclusion AI assistance improved operational efficiency and reduced self-reported mental demand and effort, with no compensating increase on other subscales. Gains arose under a controlled, abbreviated protocol in healthy volunteers and varied between operators, and are better read as a reshaping of operator work than its removal.

BACKGROUND: We used anthropometric data from electronic health records (EHRs) of Swiss childrens hospitals to evaluate growth references and estimate centile curves. METHODS: We received EHRs extracted from seven Swiss childrens hospitals and analysed two samples: all children with a height, weight, body mass index (BMI), or head circumference recording, and a subsample restricted to children without diseases potentially affecting growth, weighted to represent the general population. We calculated mean z-scores based on the World Health Organization growth references adopted for Switzerland in 2011 (CH-WHO 2011) and current Swiss growth references (Swiss 2026). We estimated sex-specific centile curves in the subsample using generalised additive models for location, scale, and shape. RESULTS: We included 213,868 children with height, 448,002 with weight, 209,244 with BMI, and 67,397 with head circumference recordings. Mean z-scores in the all children sample were (CH-WHO 2011; Swiss 2026): height (0.10; -0.19), weight (0.16; -0.09), BMI (0.04; -0.07), head circumference (-0.28, -0.28); and in the subsample: height (0.34; 0.00), weight (0.27; 0.01), BMI (0.18; 0.05), and head circumference (0.04; 0.01). The 50th height, weight, BMI, and head circumference centiles of girls and boys in the subsample closely followed those of Swiss 2026, with slightly wider 3rd and 97th centiles in infancy and adolescence. CONCLUSION: Height, weight, BMI, and head circumference centiles aligned well with the Swiss 2026 growth references in Switzerland, demonstrating that hospital EHRs could contribute to future growth references.

This cross-sectional study evaluated the association of tooth loss and oral health-related quality of life (OHRQoL) with sexual function in adult women attending a primary dental care service. Methodology: Ninety-nine sexually active women aged 19-66 years were consecutively recruited from a primary dental care service between January and October 2023. Tooth loss was quantified by standardized oral examination. OHRQoL was assessed using the Oral Health Impact Profile-14 (OHIP-14), and sexual function was assessed using the Female Sexual Function Index (FSFI). Sexual dysfunction was defined as FSFI <=26.5. Spearman rank correlation was used for bivariate analyses. Multivariable logistic regression was used to evaluate factors associated with sexual dysfunction, including number of missing teeth, OHIP-14 score, age, and relationship status. Results: Tooth loss was present in 83.8% of participants, with a median of 4 missing teeth (interquartile range [IQR], 1-10). Sexual dysfunction was identified in 62.6% of women. FSFI scores were negatively correlated with number of missing teeth (rho = -0.407; p < 0.001), OHIP-14 score (rho = -0.279; p = 0.005), and age (rho = -0.334; p < 0.001). In multivariable logistic regression, OHIP-14 score was independently associated with sexual dysfunction (OR = 1.05; 95% CI, 1.01-1.10; p = 0.015), whereas number of missing teeth was not independently associated after adjustment. Conclusion: Worse OHRQoL was independently associated with sexual dysfunction, whereas tooth loss was associated with lower FSFI scores only in bivariate analysis. These findings are compatible with the hypothesis that the impact of tooth loss on sexual function may be partly explained by oral health-related quality of life, but longitudinal studies are required to test causal and mediational pathways. Keywords: tooth loss; oral health; quality of life; sexual dysfunction, physiological; women; cross-sectional studies

Background: Subepithelial connective tissue grafting remains a reference treatment for predictable root coverage. Although short- and medium-term outcomes of tunnel-based procedures are well documented, evidence regarding stability beyond 10 years remains limited. This study evaluated the long-term clinical performance of a minimally invasive tunnel technique combined with subepithelial connective tissue grafting (SCTG) under routine clinical conditions. Methods: This retrospective longitudinal cohort study included 74 patients (57 women and 17 men) contributing 710 gingival recession sites treated between 2009 and 2025. All sites were treated with a tunnel approach and SCTG, with enamel matrix derivative (EMD) used in selected cases. The mean follow-up was 6.0 for 4.0 years, with a maximum observation period of 16 years. The primary outcome was recession depth reduction. Secondary outcomes included complete root coverage (CRC), mean root coverage, and long-term marginal stability. Clinically relevant relapse was defined as a 1 mm increase in recession after initial healing. Results: Mean recession reduction was 2.72 mm. Complete root coverage was achieved at 83.4% of treated sites. At the final available follow-up, no treated site showed a clinically relevant relapse of 1 mm after initial healing, and no site deteriorated beyond its baseline recession level. Treatment effects were observed across anterior and posterior regions. Conclusions: Within the limitations of a retrospective cohort design, tunnel surgery combined with SCTG was associated with high root-coverage predictability and durable marginal soft-tissue stability for observation periods extending to 16 years. These real-world data support phenotype-enhancing, minimally invasive soft-tissue augmentation as a durable therapeutic strategy for localized and multiple gingival recessions. Keywords: gingival recession; tunnel technique; subepithelial connective tissue graft; root coverage; periodontal plastic surgery; long-term stability