Temporal trends of avoidable mortality among children under-five in China from 2004 to 2021
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Ethical considerations in AI for child health and recommendations for child-centered medical AI
There does not exist any previous comprehensive review on AI ethics in child health or any guidelines for management, unlike in adult medicine. This review describes ethical principles in AI for child health and provides recommendations for child-centered medical AI. We also introduce the Pediatrics EthicAl Recommendations List for AI (PEARL-AI) framework for clinicians and AI developers to ensure ethical AI enabled systems in healthcare for children.
Enhancing children’s numeracy and executive functions via their explicit integration
Executive functions (EF) are crucial to regulating learning and are predictors of emerging mathematics. However, interventions that leverage EF to improve mathematics remain poorly understood. 193 four-year-olds (mean age = 3 years; 11 months pre-intervention; 111 female, 69% White) were assessed 5 months apart, with 103 children randomised to an integrated EF and mathematics intervention. Our pre-registered hypotheses proposed that the intervention would improve mathematics more than practice as usual. Multi-level modelling and network analyses were applied to the data. The intervention group improved more than the control group in overall numeracy, even when controlling for differences across settings in EF and mathematics-enhancing practices. EF and mathematics measures showed greater interconnectedness post-intervention. In addition, disadvantaged children in the intervention group made greater gains than in the control group. Our findings emphasise the need to consider EFs in their integration with co-developing functions, and in their educational and socio-economic context.
The control of movement gradually transitions from feedback control to feedforward adaptation throughout childhood
The ability to adjust movements in response to perturbations is key for an efficient and mature nervous system, which relies on two complementary mechanisms — feedforward adaptation and feedback control. We examined the developmental trajectory of how children employ these two mechanisms using a previously validated visuomotor rotation task, conducted remotely in a large cross-sectional cohort of children aged 3–17 years and adults (n = 656; 353 males & 303 females). Results revealed a protracted developmental trajectory, with children up to ~13–14 years showing immature adaptation. Younger children relied more on feedback control to succeed. When adaptation was the only option, they struggled to succeed, highlighting a limited ability to adapt. Our results show a gradual shift from feedback control to adaptation learning throughout childhood. We also generated percentile curves for adaptation and overall performance, providing a reference for understanding the development of motor adaptation and its trade-off with feedback control.
Clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia
X-linked hypophosphataemia (XLH) is a rare metabolic bone disorder caused by pathogenic variants in the PHEX gene, which is predominantly expressed in osteoblasts, osteocytes and odontoblasts. XLH is characterized by increased synthesis of the bone-derived phosphaturic hormone fibroblast growth factor 23 (FGF23), which results in renal phosphate wasting with consecutive hypophosphataemia, rickets, osteomalacia, disproportionate short stature, oral manifestations, pseudofractures, craniosynostosis, enthesopathies and osteoarthritis. Patients with XLH should be provided with multidisciplinary care organized by a metabolic bone expert. Historically, these patients were treated with frequent doses of oral phosphate supplements and active vitamin D, which was of limited efficiency and associated with adverse effects. However, the management of XLH has evolved in the past few years owing to the availability of burosumab, a fully humanized monoclonal antibody that neutralizes circulating FGF23. Here, we provide updated clinical practice recommendations for the diagnosis and management of XLH to improve outcomes and quality of life in these patients.
Symptomatic associations and sexual differences in depression and communication
Previous studies have explored the associations between parental and offspring’s depression and parent-child communication. However, few studies have investigated their symptomatic associations and potential sex differences. Therefore, this study aims to examine their associations and sex differences in parents and offspring. Based on the China Family Panel Studies (CFPS)-2020 study, depressive symptoms and parent-child communication were measured by the 8-item Center for Epidemiologic Studies Depression Scale (CESD-8) and independent questions, respectively. Network analysis was used to investigate the associations and to compare the sex differences of parents and offspring. A total of 1710 adolescents were included after cleaning process (N = 28,530). There were significantly stronger associations in boys’ “anhedonia” and “arguments with parents”, and in girls’ “happiness” and parents’ “joyfulness”. Furthermore, there were same-sex depression associations between children and parents (e.g., boys’ “despair”–fathers’ “joyfulness”; girls’ “anhedonia”–mothers’ “loneliness”). These results would help us to better understand the in depression and communication nuanced associations and to develop effective strategies for improving parental and offspring’s mental health.
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