Background Subacute sclerosing panencephalitis (SSPE) is a rare, fatal, late complication of measles that develops years after infection, particularly following measles in early childhood. In Japan, measles incidence has declined markedly after improved vaccination coverage and verification elimination; however, recent SSPE epidemiology remains poorly characterized. Methods SSPE cases were identified from the Intractable Disease Treatment Research Project, the Research Project on the Treatment of Children with Specified Chronic Diseases, and Okinawa-specific publications. Measles-related outpatient visits (1986-2007) were estimated by public health center jurisdiction using annual pediatric sentinel surveillance reports and outpatient visit volumes from the Static Survey of Medical Institutions. Ratio estimation with finite population correction was applied. Results Seventeen SSPE cases were identified, 71% in males. SSPE onset occurred during 1994-2009, at a mean age of 8.1 years. The year of measles infection was known for 14 cases, most frequently 1990. For risk estimation, 16 infections occurring during 1986-2007 were included. SSPE risk was estimated as one per 3944 estimated measles-related outpatient visits (95% CI: 1054-6995). In 1990, SSPE risk was one per 1828 outpatient visits (95% CI: 836-2820). Among infants aged < 1 year, SSPE risk was one per 910 outpatient visits (95% CI: 416-1403). Conclusions Estimating denominators for medically attended measles cases from sentinel surveillance enabled quantification of SSPE risk during historical outbreaks in Okinawa. The higher risk during infancy emphasizes the long-term consequences of measles transmission and the need to maintain high measles vaccination coverage.
Children who start school at a younger age are more likely to receive pharmacological treatment for attention deficit hyperactivity disorder (ADHD). This pattern is widely attributed to peer-comparison biases, but the relative importance of different underlying mechanisms remains debated. We use administrative data from England to study how school starting age affects ADHD prescription rates from ages 5 to 15. Exploiting a sharp school-entry cutoff and comparing children born just before and after September 1, we estimate both age- and grade-specific effects of early school entry. We find that early starters are 40-50% more likely to be treated for ADHD by age 15. This long-term gap is entirely driven by first-time prescriptions among children aged 5 to 8. Using a novel decomposition strategy, we isolate the roles of relative age, absolute age, the length of school exposure, and age at school entry. We find that relative age is the primary long-term driver, aligning with previous evidence on peer-comparison bias, while absolute age and the length of school exposure have only short-lived effects. Our findings suggest that early starters are more likely to receive marginal diagnoses due to their relative immaturity, and we recommend refining diagnostic guidelines and classroom grouping practices to reduce diagnostic gaps. Supplementary information The online version contains supplementary material available at 10.1007/s00148-026-01190-y.
Introduction Strategies for reducing infant mortality require accurate, local, population-level data. We conducted a population-based observational study in three countries in South Asia to describe risk factors, causes and rates of mortality in young infants. Methods Pregnancies, births and pregnancy outcomes were determined through household surveillance, and cause of deaths was ascertained by verbal autopsy. Cox regression was used to identify risk factors for deaths during days 0-<3, 3-<7 and 7-<60. Results Among 73 622 pregnancy outcomes, 4638 deaths were identified, including 1669 stillbirths (36.0%), 1347 (29.0%) deaths among non-registered liveborn infants who died before the first home visit by community health workers (CHWs), and 1622 (35.0%) deaths that occurred during days 0-<60 among liveborn registered infants. Most deaths among liveborn infants (59.3%, 1757 of 2965) took place within 3 days of birth. The most common causes of death over the young infant period were infections/sepsis (32.5%, n=963 of 2,965), birth asphyxia (29.0%, n=859) and preterm birth/low birth weight (14.1%, n=418). Risk factors for mortality included early morbidity (need for resuscitation, intrapartum infection/antibiotics, multiple gestation, congenital anomalies), environmental factors (smoke exposure, maternal betel chewing) and poor maternal access to quality care (history of a prior neonatal death, lack of care seeking for labour complications). Protective factors included biology (female sex, higher birth weight), essential newborn care (immediate breastfeeding, clean cord care) and access to quality maternal and newborn care (antenatal care, facility birth, skilled birth attendant, maternal education, household wealth). Conclusions Our population-based data highlight the importance of addressing deaths due to birth asphyxia and infections, while recognising that the relative burden of deaths due to preterm birth and congenital anomalies is increasing globally. Access to quality community-based and facility-based maternal and newborn care is critical to efforts to reduce mortality in young infants in high-mortality settings such as rural South Asia.
Aim This study aimed to map evidence on disclosure support for communicating hereditary tumor-related information to children and adolescents and identify evidence gaps. Methods This scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported in accordance with PRISMA-ScR. Guided by the Population-Concept-Context framework, we identified literature addressing support for disclosing hereditary tumor-related information to children aged ≤ 18 years. PubMed, MEDLINE, CINAHL, and the Cochrane Library were searched through April 2025, without language or study design restrictions. Data were charted and synthesized according to resource characteristics, support content, theoretical foundations, and evaluation approaches. Results Ten studies described eight resources, including booklets, picture books, decision-support tools, educational programs, and a multiple-family discussion group. Most resources focused on elementary school-aged children and emphasized parent-led disclosure. Common content included basic genetic concepts, disease and inherited risk information, and surveillance or preventive measures. In contrast, psychosocial elements were less consistently incorporated. Only three studies evaluated disclosure support (i.e., one randomized controlled trial, one pre-post study, and one qualitative study). Reported theoretical foundations included the Ottawa Decision Support Framework, health behavior change theories, bibliotherapy, and cognitive developmental theory. Conclusions Only a small number of resources have been empirically evaluated, and psychosocial components were not consistently described or explicitly incorporated. Developmentally appropriate, theory-informed approaches-particularly decision-support and bibliotherapy-based resources-may help families engage in informed disclosure and build shared understanding. Future research should develop, implement, and rigorously evaluate structured interventions suitable for routine clinical practice, in collaboration with children, parents, and healthcare professionals.
Achondroplasia (ACH), a skeletal dysplasia, is characterized by disproportionate short stature and impaired quality of life. In Japan, growth hormone (GH) therapy has been available since 1997, and vosoritide, a C-type natriuretic peptide analog, was approved in 2022. Although clinical trials have demonstrated vosoritide's efficacy, real-world comparative data in Japan are scarce. We conducted a retrospective study of 22 children with ACH treated with vosoritide for over 6 months at a single institution between February 2018 and May 2025. Patients were divided into two groups: GH-naïve group (Group A, n = 13), receiving vosoritide alone, and a switch group (Group B, n = 9), who transitioned from prior GH treatment. Growth outcomes included annualized growth velocity (AGV) and height standard deviation scores (HT-SDS) calculated using Japanese and ACH-specific (HT-SDS_ACH) references. Group A (median age: 2.10 years) demonstrated significant improvements in HT-SDS_ACH at years 3 (p = 0.0022), 4 (p = 0.0004), 5 (p = 0.007), and 6 (p = 0.0012). Group B (median age: 10.1 years), with a median of 6.10 years of GH exposure, showed significant increases at 1 year (p = 0.047) and 2.5 years (p = 0.0054) after switching. In Group B, HT-SDS_ACH remained stable among patients starting vosoritide before age 4, but improved significantly in those beginning later. Injection site pain occurred in three patients, leading to one discontinuation. Vosoritide improves linear growth in children with ACH, including those previously treated with GH, showing greater benefit when started at ≥4 years, though earlier use may offer advantages.
Background A mode of birth decision aid (DA) can provide information and support discussions about the potential risks and benefits (outcomes) associated with planning a vaginal or caesarean birth. Evidence shows that DAs can enhance patient knowledge, reduce decisional conflict, minimise inconsistencies in decision-making support, especially in maternity settings, and promote informed decision making. Despite these benefits, DAs specific to mode of birth are currently lacking in routine antenatal care. This paper outlines the process we followed to reach consensus on which outcomes of planned mode of birth should be included in a mode of birth DA. Methods Outcome identification and selection occurred in three phases. Phase 1 involved compiling a long list of outcomes from systematic reviews, the NICE Caesarean Birth Guidance and qualitative interviews with stakeholders. In Phase 2, this list was refined via a 2 round Delphi survey to prioritise outcomes considered important. An outcome reached consensus if ≥70% of all participants, or 70% of women/partners rated it as “critically important” (7–9), and <15% rated it as “not important” (1–3). Phase 3 involved two stakeholder consensus meetings to finalise the outcome list. Results Seventy-one outcomes were identified. Following two Delphi rounds and consensus meetings, 54 outcomes were rated as critically important. Seventeen outcomes were consistently rated as not critical across both the survey and consensus phases, meaning that ≥70% of participants in each phase did not consider them essential for informing women during pregnancy. Of these, 8 were retained due to NICE recommendations and ultimately, 9 outcomes were excluded. The final list included 44 maternal and 18 child outcomes. Maternal outcomes related to assistance with birth, complications at the time of birth, issues during recovery, pelvic floor, psychological issues, sexual function, and future pregnancy. Child outcomes related to morbidity and death, disease, obesity, issues with cognitive development and physical development. Conclusions Sixty-two priority outcomes were identified for inclusion in a planned mode of birth DA.
Objectives This study aimed to describe the trends in cesarean delivery (CD) rates in Ontario using the modified Robson classification system, and identify the most common indications for CD. Methods We conducted a population-based retrospective cross-sectional study using data from the Better Outcomes Registry & Network, a comprehensive maternal-child registry in Ontario. The analysis included all pregnant persons who delivered a live- or stillborn infant weighing ≥500 g at ≥200 weeks gestation between April 1, 2012 and March 31, 2019. Results A total of 952 567 pregnant persons gave birth in Ontario, Canada, during the study period. Our findings demonstrated a slight increase in the overall CD rate over 7 fiscal years from 2012-2013 to 2018-2019. Robson group 5 (term, singleton, cephalic pregnancy with previous CD), groups 1 and 2 (nulliparous, term, singleton, cephalic pregnancy and no labour, induced labour, or spontaneous labour), and group 6 (nulliparous pregnancy with breech presentation) made the largest contributions to the overall CD rate over the study period. The top 5 primary indications for CD across all years included previous CD, atypical or abnormal fetal surveillance, malposition/malpresentation, non-progressive first stage of labour, and non-progressive second stage of labour. Conclusions The results enhance our understanding of the key drivers of CD rates. These findings will help to inform practice improvement, support policy change, and identify areas where future research is needed.
Background Cervical insufficiency is an important cause of recurrent second-trimester pregnancy loss and spontaneous preterm delivery. Cervical cerclage is a surgery done to strengthen the cervix to prolong the pregnancy in women who need it. The result of a cerclage can vary based on the obstetric history, gestational age at the time of the cerclage, cervical length, pregnancy type, and timing of the removal. Aim To compare the obstetric and demographic features, timing of cervical cerclage, gestational age at delivery, and maternal and neonatal outcomes of women who underwent cervical cerclage at a tertiary-care centre. Material and methods The study was a record-based observational study conducted in the Department of Obstetrics and Gynaecology, Government Medical College Jammu, in a retrospective manner. A review of the medical records was performed for 150 pregnant women who had undergone either history-indicated cervical cerclage, ultrasound-indicated cervical cerclage, or emergency cervical cerclage. A structured proforma was used to gather information about demographic data, previous obstetric history, gestational age at cerclage placement, pre-procedure cervical length, timing of cerclage removal, gestational age at delivery, birth outcome, birth weight, neonatal intensive care unit admission, and neonatal mortality. The categorical data were presented in frequencies and percentages. The Pearson chi-square goodness-of-fit test was used, and a p-value less than 0.05 was deemed to be statistically significant. Results The majority of participants were aged 31-40 years, accounting for 94 (62.7%) women. Most were nulliparous, 85 (56.7%), and 78 (52.0%) belonged to the middle socioeconomic group. A total of 95 (63.3%) women had experienced three or more previous abortions, while 48 (32.0%) had undergone cervical cerclage previously. Cerclage was performed at 14-17 weeks of gestation in 79 (52.7%) women, and 78 (52.0%) had a pre-procedure cervical length of more than 15 mm and up to 25 mm. Twin pregnancies accounted for 39 (26.0%) cases. Cerclage removal was performed between 36 and 37 weeks in 98 (65.3%) women. Delivery after 37 weeks occurred in 93 (62.0%) women, while 128 (85.3%) delivered at or beyond 34 weeks. The live-birth rate was 88.0% (132), NICU admission was required in 28 (18.7%) pregnancies, and neonatal mortality occurred in 6 (4.0%). Normal birth weight above 2.5 kg was recorded in 116 (77.3%) newborns. The distributions of the major study variables were statistically significant (p<0.05). Conclusion In most women, cervical cerclage correlated with good pregnancy and foetal outcomes. Most pregnancies were prolonged beyond 34 weeks and live-birth and neonatal survival rates were high. Proper timing of cerclage and patient selection could help to achieve better perinatal outcomes.
BACKGROUND: The quality of maternity experiences impacts the health and wellbeing of both the mother and baby. Widespread changes were made to maternity care and social support during the COVID-19 pandemic in the UK, altering the usual experience of pregnancy, birth and postnatal care. Remote care appointments and hospital/home visiting restrictions affected the extent to which women could receive medical, social, and emotional support. The aim of this study was to explore women’s experiences of pregnancy, birth, and the postnatal period during the COVID-19 pandemic in South East England. METHODS: In-depth interviews were conducted with 12 participants who had given birth during the COVID-19 pandemic. Participants were recruited from mother and baby groups and data were analysed thematically. RESULTS: Women felt isolated and under-supported during the perinatal period. This was most noted in the postnatal wards by women who experienced immobilisation and pain following caesarean section. Reported positive experiences were improved opportunity to bond with their child and avoidance of undue external child-rearing pressures and pregnancy-related negative stories. Telemedicine was considered useful for some participants, and felt unsafe for others. Innovative use of social media to share up-to-date information improved crucial communication. CONCLUSIONS: Changes in staffing and visiting restrictions contributed to unsatisfactory experiences at home and on postnatal wards. The study highlights shortcomings in pandemic maternity services, and the importance of planning for future critical incidents, to promote positive maternal and child health outcomes. Telemedicine and social media have the potential to improve care and foster a sense of community in maternity services, however, further evaluation to ensure safety is needed.
