Participatory pedagogies enable reflection on pedagogical practices in Early Childhood Education. Pedagogical projects, as a methodological approach aligned with participatory pedagogies, foster attentive and sensitive listening to children. Thus, this article presents an account of an experience conducted in October 2025 by a teacher at a municipal daycare center in Queimadas, Paraíba (PB), with a "Maternal II" group (children aged 3 and 4). The focus is on the "Life of Dinosaurs" pedagogical project, which emerged from the children's own interests. The study aims to discuss project-based pedagogy in Early Childhood Education through this account of the "Life of Dinosaurs" project. Methodologically, we utilize an experience report, a format that shares knowledge produced by an individual or group with others in the field regarding a specific theme. Data were generated through observations, field notes, and photographs, enabling direct engagement with the events and subjects under study. The study demonstrated the potential of project-based pedagogy in Early Childhood Education to foster children's agency and, consequently, their learning.
Objective The diagnosis of central precocious puberty (CPP) in girls relies on the invasive gonadotropin-releasing hormone (GnRH) stimulation test. Urinary luteinizing hormone (LH) is a noninvasive candidate biomarker, but evidence from Chinese populations and its integration into multivariable prediction frameworks remain limited. We evaluated the diagnostic accuracy of first-morning urinary LH for CPP, established sex- and pubertal stage–specific reference intervals, and developed a two-step prediction model based on a bone age decomposition. Methods In this single-center retrospective diagnostic accuracy study, we enrolled 808 children: 295 girls with early breast development (146 CPP, 149 non-CPP), 271 healthy girls, and 242 healthy boys (reference intervals only). First-morning urine was assayed for LH, follicle-stimulating hormone (FSH), and creatinine. Diagnostic performance was evaluated primarily in the 295 symptomatic girls, with an extended analysis in 566 girls including healthy controls; multivariable logistic regression decomposed bone age into chronological age (CA) and the BA–CA difference as separate predictors. Results Urinary LH showed moderate accuracy for CPP in the primary symptomatic cohort (AUC 0.692, 95% CI 0.630–0.752), peaking in girls aged 7–8 years (AUC 0.708, 95% CI 0.621–0.785); the extended cohort gave similar results (AUC 0.712; secondary, spectrum-extended estimate). The LH-to-creatinine ratio offered no improvement. Basal serum LH was the superior single marker (AUC 0.868 vs 0.692, P < 0.001). The noninvasive Model 1 (CA + BA–CA + urinary LH + breast Tanner stage + uterine length) achieved a C-statistic of 0.853 (sensitivity 73.3%, specificity 83.2%), with CA, BA–CA, and urinary LH as independent predictors. Adding basal serum LH and FSH (Model 2) improved the C-statistic to 0.909; urinary LH retained independent significance (aOR 1.280, P = 0.024), whereas basal FSH was inversely associated with CPP. Bootstrap-corrected C-statistics were 0.838 (Model 1) and 0.893 (Model 2). Pubertal-onset cutoffs were >1.02 mIU/mL in girls and >0.95 mIU/mL in boys. Conclusions Decomposing bone age into CA and BA–CA enables tiered CPP risk stratification: the noninvasive model supports initial screening without blood sampling, and the complete model refines risk once serum gonadotropins become available. Urinary LH is a clinically useful component of tiered diagnostic algorithms for CPP.
Contemporary neuroscience has moved from classical localisationist accounts of language towards models in which language emerges from interacting neural systems. This critical integrative review examines the developing language network during middle childhood, with particular attention to neuroplasticity, verbal working memory, phonological processing, speech perception, oral repetition, and additional-language learning. It also considers intensive oral memorisation, including Qur'anic memorisation, as a culturally situated learning experience involving repeated listening, recitation, serial retrieval, articulation, attention, and teacher-guided correction. The review does not assume that memorisation improves intelligence or additional-language proficiency; instead, it identifies cognitive and linguistic processes that can be examined empirically. Contemporary evidence indicates that language relies on interacting cortical, white-matter, subcortical, and cerebellar systems rather than an isolated language centre. During childhood, functional specialisation, connectivity, attention, memory, and language processing continue to develop. Additional language learning provides further evidence for experience-dependent plasticity, although outcomes vary with age, exposure, proficiency, instruction, and individual differences. The Arabic–English phonetic interface is considered cautiously, particularly stop-voicing and voice-onset-time patterns. The review emphasises that /p/ is not a native phonemic contrast in Modern Standard Arabic and is absent as a native phoneme in many Arabic varieties, rather than assuming it is absent from all Arabic dialects. The authors propose a Developmentally Informed Neuro-Language Framework (DINF) to connect neural development, cognitive-linguistic processing, cultural learning experience, and pedagogy. DINF is conceptual and requires empirical validation. The review concludes by proposing a research agenda for Libyan children that separates culturally situated learning experience from measurable cognitive, phonological, auditory, and additional-language outcomes.
Attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized as a lifespan neurodevelopmental disorder, yet the mechanisms underlying its changing clinical presentation across development remain poorly understood. Although childhood ADHD is typically characterized by hyperactivity, impulsivity, and inattention, symptom expression frequently evolves during adolescence and adulthood toward greater reward dysregulation, executive dysfunction, motivational impairment, internal restlessness, and changing manifestations of emotional dysregulation. Existing neurobiological models have substantially advanced understanding of ADHD pathophysiology but provide limited explanation for how symptom continuity can coexist with developmental changes in clinical expression. Here, we propose the Developmental Dopamine Trajectory Hypothesis, which posits that DAT related dopaminergic dysregulation may interact with the sequential maturation of frontostriatal, mesolimbic, and mesocortical circuits to contribute to developmental changes in ADHD symptom expression across the lifespan. A central proposition of the framework is that the functional consequences of DAT related dopaminergic dysregulation depend on the developmental state of the neural circuits on which it acts. Within this framework, childhood manifestations may arise primarily from interactions between dopaminergic vulnerability and developing frontostriatal networks, adolescent manifestations from increasing involvement of reward and emotion related circuitry, and adult manifestations from interactions with mature executive control and motivational systems. By integrating evidence from longitudinal clinical studies, neuroimaging, electrophysiology, pharmacology, genetics, and translational DAT models, the proposed framework provides a mechanistic model for how developmental changes in neural circuit state may contribute to changing symptom expression despite continuity of underlying neurobiological vulnerability. The hypothesis generates testable predictions regarding longitudinal symptom trajectories, developmental biomarker changes, potential developmental differences in treatment responsiveness, and adolescence as a proposed critical neurodevelopmental transition period. Reconceptualizing ADHD through a developmental dopaminergic framework places developmental timing and neural circuit maturation at the center of the relationship between dopaminergic vulnerability and clinical phenotype, providing a basis for future longitudinal, mechanistic, and developmentally informed research across the lifespan.
Raly James Perez Custodio, Stephan Getzmann, Edmund Wascher et al.
BACKGROUND: Assistive devices can benefit a wide range of people, including those living with disabilities; those affected by severe forms of disease or trauma; and those requiring rehabilitation. Access to these devices is limited in low- and middle-income countries. PURPOSE: The study explored parents' perspectives on the availability and use of assistive devices among children with cerebral palsy at the Greater Accra Regional Hospital in Ghana. MATERIALS AND METHODS: An explorative qualitative research design was employed, with purposive sampling used in recruiting parents of children with cerebral palsy. Data were collected through in-depth, face-to-face interviews using a semi-structured interview guide. Data were analysed through thematic analysis. RESULTS: Three main themes emerged: (1) parents' knowledge and understanding of assistive devices, (2) parents' experiences of children's usage of assistive devices, and (3) availability and accessibility of assistive devices for children with cerebral palsy. Participants demonstrated basic knowledge of assistive devices, mainly identifying mobility aids such as wheelchairs and walkers. While some expressed satisfaction with the benefits of these devices, others were dissatisfied with the limited range and lack of advanced technologies. Significant barriers to access were identified, including limited availability, complex acquisition processes, delays in obtaining devices, and high costs. CONCLUSION: The study concludes that, among children with cerebral palsy, access to assistive devices is constrained not only by the availability of the devices but also by a mismatch between children's individual functional needs and the type, affordability, and accessibility.
Comfort Ama Osei, Richard Kwaku Bawah, James Nii Amar Aryiku et al.
Sleep regulation in children and adolescents relies on the interaction between homeostatic and circadian processes. The internal biological clock, located within the suprachiasmatic nuclei, is primarily synchronized by light. This light is detected by intrinsically photosensitive retinal ganglion cells (ipRGCs), which are highly sensitive to short-wavelength blue light. Evening exposure to LED lighting and electronic screens can suppress melatonin secretion, promoting sleep phase delay. Children and adolescents are exceptionally vulnerable to this effect due to both anatomical and developmental factors. Combined with cognitive arousal from social media and the Fear of Missing Out (FOMO), this creates a "perfect storm," resulting in behavioral bedtime procrastination and a natural shift toward an evening chronotype. While it is crucial to distinguish this common developmental and behavioral shift from a clinical disorder, cumulative circadian disruption and social jetlag remain significant risk factors for Delayed Sleep-Wake Phase Disorder (DSWPD). Furthermore, chronic sleep restriction exhibits observational associations with poorer academic performance, potential long-term metabolic disturbances (such as obesity and insulin resistance), and an elevated risk of mood disorders and depression. Available evidence highlights the critical importance of light hygiene, including limiting evening screen exposure and promoting morning natural light. Medical interventions, such as melatonin and chronotherapy, should be carefully reserved for severe clinical cases. Finally, future longitudinal studies utilizing personal light dosimetry are needed, alongside systemic solutions like delayed school start times, to protect pediatric sleep health.
Krzysztof Leś, Magdalena Kronenberg, Tomasz Męcik-Kronenberg
BACKGROUND: Active case finding (ACF) for tuberculosis (TB) can reduce transmission, yet efficient targeting requires high-quality surveillance data. We investigated the potential costs and impact of targeted ACF, guided by local estimates of the annual risk of TB infection (ARTI) derived from Mycobacterium tuberculosis (Mtb) immunoreactivity survey data in children aged <5 years. METHODS AND FINDINGS: Using mathematical models parameterized with local data, we compared three case-finding approaches across 33 urban neighborhoods in Blantyre, Malawi: passive case finding (PCF) only; PCF with untargeted ACF; and PCF with ARTI-guided targeted ACF. Health outcomes (life expectancy, disability-adjusted life years [DALYs]) and costs were estimated using a Markov microsimulation model. Costs were assessed from health system and societal perspectives. Results were calculated for different assumptions about the relationship between ARTI and true TB prevalence. Compared to PCF-only, untargeted ACF was estimated to improve life expectancy by 3.3 years (95% credible interval (CrI) [1.7, 5.4]) for individuals with TB disease, but at high cost. Targeted ACF covering half of the study population was estimated to identify 80% of all individuals with TB and achieved a lower cost per DALY averted (US$400, 95% CrI [20,1,000]) than untargeted ACF (US$700, 95% CrI [100, 1,500]). In the main analysis, these cost-effectiveness ratios exceeded available cost-effectiveness thresholds for Malawi, although cost-effectiveness improved under assumptions of higher TB prevalence or greater transmission reduction. The findings are based on mathematical modeling and are subject to several limitations, including assumptions regarding the relationship between ARTI and TB prevalence, which remains uncertain. CONCLUSIONS: Targeting ACF using Mtb immunoreactivity survey data could substantially improve health impact and cost-effectiveness compared to untargeted approaches. However, low-cost approaches for collecting these data are needed for wider adoption.
Sun Kim, Melike Hazal Can, Hannah M. Rickman et al.
Purpose The purpose of this study is to describe the clinical presentation of the HLA-DRB1*15:01 positive non-anterior uveitis phenotype in paediatric uveitis and to determine if early markers that may indicate a possible risk of MS, white matter lesions on brain MRI and OCT RNFL or GCL thinning, are present in this subgroup.Methods In a cohort of 65 patients with non-infectious non-anterior paediatric uveitis patients we retrospectively characterized the uveitis phenotype based on underlying HLA-DRB1*15:01 genotype and described the clinical parameters on OCT and FA of 87 HLA-DRB1*15:01 negative and 37 HLA-DRB1*15:01 positive eyes.Results HLA-DRB1*15:01 positive patients had intermediate uveitis almost three times as often as HLA-DRB1*15:01 negative patients with uveitis (70.0% versus 24.4% respectively, p = 0.001). Cells in the anterior chamber were seen less often in HLA-DRB1*15:01 positive patients compared to in HLA-DRB1*15:01 negative patients (55.0% versus 90.7% respectively, p = 0.001). Meanwhile, vitreous floaters were found more frequently in HLA-DRB1*15:01-positive compared to -negative cases (80.0% versus 53.3% respectively, p = 0.041). Also, fern-like capillary leakage was almost twice as common in HLA-DRB1*15:01 positive compared to HLA-DRB1*15:01 negative patients (64.7% versus 34.1% respectively, p = 0.032). Multiple sclerosis developed in one HLA-DRB1*15:01 positive patient (5.0%), 15 years after intermediate uveitis was diagnosed.Conclusion The HLA-DRB1*15:01 allele is associated with intermediate uveitis in children, with absence of anterior chamber cells, presence of vitreous floaters and peripheral capillary fern-like leakage as distinct clinical features. At this point the usefulness of HLA-DRB1*15:01 typing for predicting the risk of multiple sclerosis is yet to be determined.
Jytte Hendrikse, Viera Kalinina Ayuso, Annette Ossewaarde‐van Norel et al.
Background: Iron-deficiency anemia (IDA) is characterized by depleted iron availability together with anemia and can occur during periods of rapid growth, pregnancy, chronic disease, and older age. Its clinical consequences are not uniform across the life course. Evidence is distributed across obstetric, pediatric, internal medicine, nephrology, cardiology, and inflammatory bowel disease literature, and studies frequently differ in how iron deficiency and anemia are defined. This review examines clinical outcomes associated with IDA across major life stages while explicitly separating evidence concerning IDA from evidence concerning anemia of unspecified cause or iron deficiency without anemia. Methods: This evidence review synthesizes published systematic reviews, meta-analyses, and representative primary studies concerning iron-deficiency anemia (IDA) and related iron-deficiency states across the lifespan. Evidence is organized by life stage and clinical domain, with attention to the distinction between confirmed IDA, iron deficiency without anemia, and anemia without documented iron deficiency. This manuscript is a narrative evidence synthesis; it does not report a newly conducted, reproducible database search or de novo study-selection process. Results: The verified literature supports clinically important associations between iron deficiency and outcomes across the life course, but the strength of evidence differs by age and outcome. During pregnancy, maternal anemia is associated with low birth weight, preterm birth, perinatal mortality, stillbirth, and maternal mortality in large meta-analyses, although these studies often evaluate anemia rather than laboratory-confirmed IDA. In childhood, observational evidence links early iron deficiency with later cognitive, behavioral, and motor outcomes, while intervention evidence is heterogeneous; a 2023 meta-analysis of 13 randomized-trial reports found improvements in intelligence, attention/concentration, and memory with iron supplementation among school-age children, but no significant improvement in school achievement. In adults with iron deficiency without anemia, randomized evidence supports improvement in self-reported fatigue but not objective physical capacity. In inflammatory bowel disease and chronic kidney disease, IDA and iron deficiency commonly coexist with substantial comorbidity, and iron treatment has been evaluated for hematologic and clinical outcomes. In heart failure, contemporary randomized evidence indicates that intravenous iron in iron-deficient patients can reduce recurrent heart-failure hospitalization and cardiovascular death composites, although the evidence concerns iron deficiency in heart failure and is not synonymous with isolated IDA. In older adults, anemia is associated with adverse outcomes, but attributing these associations specifically to IDA requires careful adjustment for inflammation, kidney disease, malignancy, nutritional status, and other comorbidities. Conclusions: IDA is clinically relevant across the lifespan, but the evidence should not be summarized as a single uniform causal effect. The most consistent evidence concerns pregnancy outcomes, symptomatic burden and fatigue, pediatric hematologic response to iron, and selected outcomes in chronic disease. Evidence for long-term neurodevelopmental and cardiovascular effects is biologically plausible but more heterogeneous and frequently confounded. Future systematic reviews should use explicit laboratory definitions of IDA, distinguish exposure from treatment, separate anemia of other causes, and report outcomes by age and clinical setting.
Background. Juvenile idiopathic arthritis (JIA) comprises a heterogeneous group of chronic inflammatory arthritides of childhood in which immune-mediated and immune-inflammatory mechanisms play a central pathogenic role. In addition to musculoskeletal involvement, persistent systemic inflammation, endothelial dysfunction, and exposure to potentially nephrotoxic medications may contribute to subclinical renal involvement. Historically, kidney complications in JIA were recognized mainly at advanced stages, including secondary AA amyloidosis and clinically overt drug-related nephrotoxicity. More recent clinical studies indicate that subtle urinary, functional, and vascular abnormalities may be detectable early in the disease course, before the development of clinically apparent renal dysfunction. The purpose was to synthesize current evidence on early clinical, laboratory, hemodynamic, and molecular markers of renal involvement in children with JIA, to characterize their potential role in early detection and treatment monitoring, and to formulate a risk-oriented approach to nephrological surveillance. Materials and methods. A structured narrative literature review was conducted using publications retrieved from PubMed. English-language articles published from 2021 through 2026 were screened. Eligible publications included original clinical studies, retrospective and prospective cohort studies, and meta-analyses reporting quantitative or qualitative data on renal status in children with confirmed JIA, including proteinuria or albuminuria, hematuria, cystatin C-based estimated glomerular filtration rate (eGFR), tubular injury biomarkers, and ambulatory blood pressure monitoring (ABPM). Studies published before 2021, duplicate records, and publications unrelated to renal outcomes in JIA were excluded. The pediatric age range was 1.5–18 years. Results. The reviewed evidence was consistent with a pathophysiological spectrum of renal involvement in JIA, ranging from endothelial activation and low-grade urinary abnormalities to changes in glomerular filtration and vascular regulation. Treatment-naive children with newly diagnosed JIA showed higher 24-hour urinary protein excretion and urinary red blood cell counts than healthy controls. Cystatin C-based eGFR identified reduced filtration estimates in a proportion of children with active JIA, while ABPM demonstrated abnormal circadian blood pressure profiles, including a non-dipping pattern. Conclusions. Subclinical renal involvement in JIA may be underrecognized and can precede overt nephropathy. Integration of quantitative urinary protein or albumin assessment, cystatin C-based eGFR, and ABPM into risk-based clinical surveillance may facilitate earlier recognition of renal abnormalities and more timely adjustment of therapy.
M.Sh. Madaminova, Ilhamdzhan Karimdzhanov, K.Kh. Turakulova et al.
