Childhood

童年
  • 文章类型: Journal Article
    目的:关于生命阶段体重转变和心血管疾病(CVDs)的证据有限。我们旨在探索从出生到童年到中年的体重过渡模式以及心血管事件的风险。
    方法:共有193,905名来自英国生物库的参与者被纳入。出生时的体重,童年,在基线时(2006-2010年)收集中年和中年。CVD结果在2022年收集。我们构建了从出生到10岁到中年的27种过渡模式。Cox比例风险模型得出了体重转换模式和CVD之间的风险比(HR)和95%置信区间(CI)。进行了中介分析。还计算了速率提前期(RAP)。
    结果:几种体重转变模式与心血管疾病的风险明显相关,包括“低出生体重→10岁高体重→中年肥胖”(HR2.64,95%CI2.24-3.11),“低出生体重→10岁时低体重→中年时肥胖”(2.27,1.93-2.66),“高出生体重→10岁时低体重→中年时肥胖”(2.29,1.96-2.67),和“高出生体重→10岁高体重→中年肥胖”(2.14,1.89-2.42),显示与HF的相关性更强。这些模式的RAP对于CVD为8.3-10.6年,对于HF为10.0-13.1年。出生体重与CVD之间的关联有50%是由中年时的体重介导的。
    结论:我们的研究结果强调了在整个生命过程中体重管理对降低心血管疾病风险的重要性,尤其是在中年时保持健康的体重。
    OBJECTIVE: Evidence on weight transitions across life stages and cardiovascular diseases (CVDs) is limited. We aimed to explore weight transition patterns from birth to childhood to midlife and risk of incident CVDs.
    METHODS: A total of 193,905 participants from the UK Biobank were included. Weight at birth, childhood, and midlife were collected at baseline (2006-2010). CVD outcomes were collected at year 2022. We constructed 27 transition patterns from birth to age 10 years to midlife. Cox proportional hazard models yielded hazard ratios (HRs) and 95% confidence intervals (CI) between weight transition patterns and CVDs. Mediation analyses were performed. Rate advancement periods (RAP) were also calculated.
    RESULTS: Several weight transition patterns were clearly linked to risk of CVDs, including \"Low birth weight → high weight at age 10 years → obesity at midlife\" (HR 2.64, 95% CI 2.24-3.11), \"Low birth weight → low weight at age 10 years → obesity at midlife\" (2.27, 1.93-2.66), \"High birth weight → low weight at age 10 years → obesity at midlife\" (2.29, 1.96-2.67), and \"High birth weight → high weight at age 10 years → obesity at midlife\" (2.14, 1.89-2.42), which showed even stronger association with HF. RAPs of these patterns were 8.3-10.6 years for CVD and 10.0-13.1 for HF. 50% of the association between birth weight and CVDs was mediated by weight at midlife.
    CONCLUSIONS: Our findings highlight the importance of weight management throughout the life course in reducing the risk of CVDs, especially maintaining a heathy weight at midlife.
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  • 文章类型: Journal Article
    背景:不良童年经历(ACE)对一个人的心理发展产生重大影响,并使他们在成年期容易受到各种有害后果的影响,例如不同形式的侵略。相反,积极的童年经历(PCE)作为保护因素,缓冲ACE的不良反应,促进适应性行为和心理健康。然而,PCEs在ACEs与攻击性之间的关系中的作用仍未被探索。
    目的:探讨社区样本中PCEs在ACEs与攻击性及其不同性别之间的关系中的调节作用。
    方法:1541名葡萄牙成年人的样本通过社会人口统计问卷回答了在线方案,仁慈的童年经历量表,童年历史问卷,和Buss-Perry侵略问卷.
    结果:ACE与攻击性呈正相关,包括身体和语言上的攻击,愤怒,和敌意,女性报告的ACE患病率更高,愤怒程度更高。男性在身体和言语攻击方面得分更高。此外,适度分析阐明了PCEs对女性ACEs与攻击性之间以及男女ACEs与愤怒之间关系的调节作用.PCE减轻ACE的不利影响,减少侵略和愤怒的水平。
    结论:这项研究强调了童年经历和成人侵略之间复杂的相互作用,强调ACE和PCE对男性和女性的不同影响。通过澄清这些动态,干预措施可以量身定做,以支持PCE等保护因素。这最终将促进更健康的发展轨迹,并减少成年后侵略的发生率。
    BACKGROUND: Adverse childhood experiences (ACEs) have a significant impact on a person\'s psychological development and predispose them to various harmful consequences in adulthood, such as different forms of aggression. Contrarily, positive childhood experiences (PCEs) operate as protective factors, buffering against the adverse effects of ACEs and promoting adaptive behaviors and psychological well-being. However, the role of PCEs in the relationship between ACEs and aggression remains relatively unexplored.
    OBJECTIVE: To explore the moderation role of PCEs in the relationship between ACEs and aggression and its different components across sexes in a community sample.
    METHODS: A sample of 1541 Portuguese adults answered an online protocol with a sociodemographic questionnaire, the Benevolent Childhood Experiences Scale, the Childhood History Questionnaire, and the Buss-Perry Aggression Questionnaire.
    RESULTS: ACEs were positively correlated with aggression, including physical and verbal aggression, anger, and hostility, with women reporting a higher prevalence of ACEs and higher levels of anger. Men revealed higher scores in physical and verbal aggression. Furthermore, moderation analyses clarified the moderating effect of PCEs on the relationship between ACEs and aggression in women and between ACEs and anger in both sexes. PCEs attenuate the adverse impact of ACEs, reducing aggression and anger levels.
    CONCLUSIONS: This study stresses the complex interplay between childhood experiences and adult aggression, highlighting the differential effects of ACEs and PCEs across men and women. By clarifying these dynamics, interventions can be tailored to bolster protective factors like PCEs. This will ultimately foster healthier developmental trajectories and reduce the prevalence of aggression in adulthood.
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  • 文章类型: Journal Article
    流行病学研究表明,生命早期的营养缺乏与以后的疾病风险增加有关。本研究旨在探讨生命早期饥荒暴露与白内障的相关性。
    我们在研究中纳入了来自中国纵向健康长寿调查(CLHLS)2018年横截面数据的5,931名参与者。根据饥荒期间的年龄将受试者分为三组:成年期组,学龄期饥荒暴露组,和青少年饥荒暴露组。利用二元逻辑回归模型,我们调查了早期饥荒暴露与白内障之间的关系.
    与成年期组相比,学龄期暴露组(OR=2.49,95CI=1.89-3.27)和青少年暴露组(OR=1.45,95CI=1.20-1.76)在老年阶段患白内障的风险均较高.并观察了早年饥荒对老年人白内障风险影响的性别差异,特别是表明,与经历类似暴露的男性相比,经历过儿童饥荒的女性的风险更高。
    在生命的早期阶段暴露于饥荒与老年患白内障的风险增加有关。为了预防老年人的白内障,尤其是女性,应采取措施解决这些特定时期的营养不足。
    UNASSIGNED: Epidemiological studies have shown that early-life nutritional deficiencies are associated with an increased risk of diseases later in life. This study aimed to explore the correlation between famine exposure during the early stages of life and cataracts.
    UNASSIGNED: We included 5,931 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2018 cross-sectional data in our study. Subjects were categorized into three groups by their age during the famine: adulthood group, school age famine exposure group, and teenage famine exposure group. Utilizing binary logistic regression models, we investigated the relationship between early-life famine exposure and cataracts.
    UNASSIGNED: Compared to the adulthood group, both the school age exposure group (OR = 2.49, 95%CI = 1.89-3.27) and teenage exposure group (OR = 1.45, 95%CI = 1.20-1.76) had a heightened risk of developing cataracts in elderly stage. And the sex differences in the impact of famine during early years on elderly cataract risk were observed, particularly indicating a higher risk among women who experienced childhood famine compared to men with similar exposure.
    UNASSIGNED: Famine exposure during the early stages of life is associated with a heightened risk of developing cataracts in old age. To prevent cataracts in elderly individuals, particularly in females, measures should be taken to address nutritional deficiencies in these specific periods.
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  • 文章类型: Journal Article
    早期介绍,非手术治疗成功率高,儿童肠套叠的低发病率和死亡率在中高收入国家很常见,但在许多中低收入国家并不常见。
    为了评估配置文件中的趋势,我们医院肠套叠的治疗方式和结果。
    为期12年的回顾性研究,分为两个6年。使用SPSS进行数据输入/分析,并比较了这两个时期之间的各种指标。两个独立均值的双尾t检验用于比较均值,而双尾Fisher精确检验用于比较分类变量。结果以表格形式呈现,means,范围,百分比和小于0.05的p值被认为具有统计学意义。
    非手术治疗成功的比例显着增加(18.6%vs34%,p=0.03),手术手法减少的发生率降低(27.1%vs12.8%;p=0.026),手术治疗减少(78.5%vs63.9%,p=0.034),增加干预前超声的利用率(75%vs96.7%,p<0.0001)和住院时间减少(10.47±7.95天vs7.24±4.86天;p=0.004)。
    成功的非手术治疗对肠套叠的整体治疗的贡献显着增加,而手术手法减少的贡献显着减少,肠切除没有变化。术前超声检查使用率显著增加,而平均住院时间显著减少,但是演讲迟到了,发病率和死亡率无显著变化.
    UNASSIGNED: Early presentation, high rate of successful non-operative treatment, low morbidity and mortality in childhood intussusception is common in High and Upper Middle-Income Countries but not in many Lower middle- and Low-income countries.
    UNASSIGNED: To assess the trends in the profile, treatment modalities and outcomes of intussusception in our hospital.
    UNASSIGNED: Retrospective study over a 12-year period divided into two 6-year periods. Data entry/analysis was done using SPSS and various indices were compared between these two periods. Two-tailed t-test for two independent means was used to compare means while two-tailed Fisher exact tests were used to compare categorical variables. Results were presented as tables, means, ranges, percentages and a p-value less than 0.05 was deemed statistically significant.
    UNASSIGNED: There was a significant increase in the proportion of successful non-operative treatment (18.6% vs 34%, p=0.03), reduction in the incidence of operative manual reduction (27.1% vs 12.8%; p=0.026), reduction in operative treatment (78.5% vs 63.9%, p=0.034), increased utilization of pre-intervention ultrasound (75% vs96.7%, p<0.0001) and reduction in hospital stay duration (10.47 ±7.95days vs 7.24±4.86 days; p=0.004).
    UNASSIGNED: Contribution of successful non-operative treatment to the overall treatment of intussusception significantly increased while that of operative manual reduction significantly reduced and bowel resection showed no change. Preoperative utilization of ultrasonography significantly increased while mean duration of admission reduced significantly, but late presentation, morbidity and mortality rates had no significant changes.
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  • 文章类型: Journal Article
    目的:本研究使用金标准测量方法确定了与儿童肥胖和体脂分布相关的代谢模块。
    方法:我们使用了329名儿童(年龄5.3±0.3岁;BMI15.7±1.5kg/m2)的横断面数据,这些数据来自妊娠和生长中葡萄糖调节的遗传学(Gen3G),前瞻性出生前队列。我们使用金标准双能X射线吸收法(DXA)定量了1038种血浆代谢物并测量了身体成分,除了皮肤褶皱,腰围,BMI。我们应用加权相关网络分析来识别高度相关的代谢物模块网络。Spearman的部分相关性用于确定肥胖与代谢物模块和具有错误发现率(FDR)校正的个体代谢物的关联。
    结果:我们确定了一个由120种代谢物组成的“绿色”模块,主要由脂质(主要是鞘磷脂和磷脂酰胆碱)组成,显示与总脂肪和躯干脂肪的DXA估计呈正相关(所有FDRp<0.05)(ρ调整=0.11-0.19),皮褶测量(ρ调整=0.09-0.26),和BMI和腰围(ρ调整=0.15和0.18,分别)。按性别分层时,这些相关性相似。在这个模块中,鞘磷脂(d18:2/14:0,d18:1/14:1)*,鞘磷脂亚种是细胞膜的重要组成部分,表现出最强的联想。
    结论:一个代谢模块与儿童肥胖指标相关。
    OBJECTIVE: This study identified metabolite modules associated with adiposity and body fat distribution in childhood using gold-standard measurements.
    METHODS: We used cross-sectional data from 329 children at mid-childhood (age 5.3 ± 0.3 years; BMI 15.7 ± 1.5 kg/m2) from the Genetics of Glucose regulation in Gestation and Growth (Gen3G), a prospective pre-birth cohort. We quantified 1038 plasma metabolites and measured body composition using the gold-standard dual-energy x-ray absorptiometry (DXA), in addition to skinfold, waist circumference, and BMI. We applied weighted-correlation network analysis to identify a network of highly correlated metabolite modules. Spearman\'s partial correlations were applied to determine the associations of adiposity with metabolite modules and individual metabolites with false discovery rate (FDR) correction.
    RESULTS: We identified a \'green\' module of 120 metabolites, primarily comprised of lipids (mostly sphingomyelins and phosphatidylcholine), that showed positive correlations (all FDR p < 0.05) with DXA estimates of total and truncal fat (ρadjusted = 0.11-0.19), skinfold measures (ρadjusted = 0.09-0.26), and BMI and waist circumference (ρadjusted = 0.15 and 0.18, respectively). These correlations were similar when stratified by sex. Within this module, sphingomyelin (d18:2/14:0, d18:1/14:1)*, a sphingomyelin sub-specie that is an important component of cell membranes, showed the strongest associations.
    CONCLUSIONS: A module of metabolites was associated with adiposity measures in childhood.
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  • 文章类型: Journal Article
    暂无摘要。
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  • 文章类型: Journal Article
    背景:沙特阿拉伯青少年超重和肥胖的患病率逐渐增加。肥胖与各种发病率和死亡率的风险增加有关。确定导致该年龄组肥胖的因素对于实施有针对性的预防措施至关重要。
    目的:这项研究的目的是确定居住在塔布克市的9至17岁青少年超重和肥胖的危险因素。沙特阿拉伯。
    方法:在2021-2022学年在塔布克市的Alabnaa学校进行了一项病例对照研究,沙特阿拉伯。这项研究包括超重/肥胖个体(病例,n=125)和正常体重个体(对照,n=201)根据体重指数选择,并根据世界卫生组织定义5至19岁个体超重和肥胖的参考进行分类。使用自我管理问卷从两组中收集数据。
    结果:该研究分析了125名超重/肥胖学生和201名体重正常的学生,他们的性别和年龄相匹配(p>0.05)。Logistic回归分析确定了青少年超重或肥胖的几个危险因素。研究发现家族肥胖史与肥胖可能性增加5.735倍相关(95%CI:3.318-9.912,p<0.001)。肥胖的另一个重要危险因素是每天经常食用四餐或更多餐(调整后的比值比:3.091,95%CI:1.094-8.736,p=0.033)。使用电子设备超过5小时的学生出现肥胖的可能性是其2.422倍(p=0.006)。
    结论:某些因素可能会增加9至17岁青少年超重或肥胖的风险。这些因素包括经常吃饭,长时间使用电子设备,家族肥胖史,以及肥胖不是一种疾病的误解。需要量身定制的学校健康计划来改善学生的健康生活方式和饮食行为,尽量减少久坐娱乐和电子设备的使用,让孩子们参加体育活动。
    BACKGROUND: The prevalence of overweight and obesity among adolescents in Saudi Arabia has been progressively increasing. Obesity is associated with an increased risk of various morbidities and mortality. Identifying the factors that contribute to obesity in this age group is crucial for implementing targeted prevention measures.
    OBJECTIVE: The aim of this study was to identify risk factors for overweight and obesity among adolescents aged nine to 17 years residing in Tabuk City, Saudi Arabia.
    METHODS: A case-control study was conducted during the 2021-2022 academic year at Alabnaa Schools in Tabuk City, Saudi Arabia. The study included overweight/obese individuals (cases, n = 125) and normal-weight individuals (controls, n = 201) who were selected based on their body mass index and classified according to the World Health Organization\'s reference for defining overweight and obesity in individuals aged five to 19 years. Data were collected from both groups using a self-administered questionnaire.
    RESULTS: The study analyzed 125 overweight/obese students and 201 normal-weight students who were matched for sex and age (p > 0.05). Logistic regression analysis identified several risk factors for overweight or obesity among adolescents. A family history of obesity was found to be associated with a 5.735 times increased likelihood of obesity (95% CI: 3.318-9.912, p < 0.001). Another significant contributing risk factor for obesity was frequent consumption of four or more meals per day (adjusted odds ratio: 3.091, 95% CI: 1.094-8.736, p = 0.033). Students who used electronic devices for more than five hours were 2.422 times more likely to exhibit obesity (p = 0.006).
    CONCLUSIONS: Certain factors may increase the risk of overweight or obesity in adolescents aged nine to 17 years. These factors include frequent eating, prolonged use of electronic devices, family history of obesity, and the misconception that obesity is not an illness. Tailored school health programs are needed to improve students\' healthy lifestyles and eating behaviors, minimize sedentary entertainment and use of electronic devices, and engage children in physical activity.
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  • 文章类型: Journal Article
    继发性骨质疏松症是潜在的疾病或其治疗导致骨量减少和骨结构恶化的病症,增加骨折的风险。儿童期和青春期诊断和治疗的重要性是由于其长期的负面影响。在这项研究中,我们的目标是确定诊断结果,治疗功效,儿童期继发性骨质疏松症的随访特点。
    在2000年1月至2021年1月期间诊断为继发性骨质疏松症的61例患者被纳入研究。这项研究是一项横断面和描述性研究。当诊断出原发性潜在疾病并接受继发性骨质疏松症治疗时,研究参与者必须未满18岁。从患者档案中收集患者数据。患者数据是从医院的患者档案中获得的,并通过IBMSPSSStatisticsforWindows20.0版(IBMCorp,Armonk,NY,美国)。
    对61例患者(28名女性/33名男性)进行了评估。继发性骨质疏松患者最常见的基础疾病是炎症性疾病(57.7%),神经肌肉疾病(26.2%),免疫缺陷(13.1%),急性淋巴细胞白血病(8.2%),代谢性疾病(8.2%),和实体器官移植。(8.2%),骨髓移植(6.6%)和癫痫(6.6%)。诊断为继发性骨质疏松症的平均实际年龄为11.89±4.88岁。在潜在的原发性慢性疾病发作后6.39±5.13年,对他们进行了骨质疏松症评估。78.7%的患者有一种或多种慢性药物使用。系统性类固醇使用率为59%,化疗药物23%,免疫调节药物19.7%,抗癫痫药8.2%,吸入类固醇4.9%,IVIG1.6%,和抗结核药物1.6%。此外,1.6%的患者使用睾酮作为替代,3.3%L-甲状腺素,1.6%的雌激素,和1.6%的生长激素。在49.2%的患者中检测到骨痛。所有患者治疗前均有椎体骨折。对45例继发性骨质疏松症患者给予双膦酸盐治疗。治疗后6个月,平均骨密度(BMD)和骨矿物质含量值有统计学意义的增加,(p<0.001)。年龄和身高年龄的BMDZ评分值显着增加(p<0.001)。患者的BMD值在治疗后平均增加了31.15%。双膦酸盐治疗后,患者的骨折数量和骨痛均显着减少(p<0.01)。当比较接受和未接受类固醇治疗的患者时,两组在双膦酸盐治疗中的获益相似.
    继发性骨质疏松症是一种受多种因素影响的疾病,例如引起骨质疏松症的原发性疾病,长期使用药物,尤其是类固醇.如果不及时治疗,骨质疏松症会导致骨痛等重要疾病,骨折,固定化,减少骨骼的线性生长。当用于治疗儿童继发性骨质疏松症时,双膦酸盐可显著改善BMD并降低骨折风险。
    UNASSIGNED: Secondary osteoporosis is a condition when the underlying disease or its treatment causes the bone mass to decrease and the bone structure to deteriorate, increasing the risk of fracture. The importance of diagnosis and treatment during childhood and adolescence is due to its long-term negative effects. In this study, our objectives were to determine the diagnostic findings, treatment efficacy, and follow-up characteristics of childhood with secondary osteoporosis.
    UNASSIGNED: 61 patients diagnosed with secondary osteoporosis between January 2000 and January 2021 were included in the study. The research is a cross-sectional and descriptive study. Study participants had to be under 18 years of age when the primary underlying disease was diagnosed and received treatment for secondary osteoporosis. Patient data were collected from patient files. Patient data were obtained from patient files in hospitals and were interpreted through the IBM SPSS Statistics for Windows version 20.0 (IBM Corp, Armonk, NY, USA).
    UNASSIGNED: 61 patients (28 women/33 men) were evaluated. The most common underlying primary diseases in patients with secondary osteoporosis were inflammatory diseases (57.7%), neuromuscular diseases (26.2%), immunodeficiency (13.1%), acute lymphoblastic leukemia (8.2%), metabolic diseases (8.2%), and solid organ transplantation. (8.2%), bone marrow transplantation (6.6%) and epilepsy (6.6%). The average chronological age when secondary osteoporosis was diagnosed was 11.89±4.88 years. They were evaluated for osteoporosis 6.39±5.13 years after the onset of the underlying primary chronic diseases. 78.7% of the patients had one or more chronic drug use. Systemic steroid use was 59%, chemotherapeutics 23%, immunomodulatory drugs 19.7%, antiepileptic drugs 8.2%, inhaled steroids 4.9%, IVIG 1.6%, and antituberculosis drugs 1.6%. Additionally, 1.6% of the patients were using testosterone as replacement, 3.3% L-Thyroxine, 1.6% estrogen, and 1.6% growth hormone. Bone pain was detected in 49.2% of the patients. All patients had vertebral fractures before treatment. Bisphosphonate treatment was given to 45 patients with secondary osteoporosis. There was a statistically significant increase in mean bone mineral density (BMD) and bone mineral content values six months after treatment, (p<0.001). There was a significant increase in BMD Z-score values for chronological and height age (p<0.001). The patients\' BMD values increased on average by 31.15% with treatment. Following bisphosphonate treatment, there was a significant reduction in both fracture number and bone pain in patients (p<0.01). When patients who received and did not receive steroid treatment were compared, both groups received similar benefits from bisphosphonate treatment.
    UNASSIGNED: Secondary osteoporosis is a condition that is influenced by many factors, such as the primary disease causing osteoporosis, chronic medication use, especially steroids. If left untreated, osteoporosis leads to important diseases such as bone pain, bone fractures, immobilization, and reduced linear growth of bone. When used to treat childhood secondary osteoporosis, Bisphosphonates significantly improve BMD and reduce fracture risk.
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  • 文章类型: Journal Article
    海马依赖性记忆系统和纹状体依赖性记忆系统根据成人的反馈时间调节强化学习,但他们在开发过程中的贡献仍不清楚。在一项为期两年的纵向研究中,6至7岁的儿童执行强化学习任务,在该任务中,他们立即收到反馈,或者在他们的回应后有短暂的延迟。儿童的学习被发现是敏感的反馈定时调制在他们的反应时间和逆温度参数,量化价值导向决策。他们展示了朝着更优化的基于价值的学习的纵向改进,它们的海马体积显示出延长的成熟。更好的延迟模型衍生学习与较大的海马体积纵向共变,符合成人文学。相比之下,儿童较大的纹状体体积与较好的即时和延迟模型纵向学习相关.这些发现表明,第一次,早期海马对儿童中期强化学习动态发展的贡献,与成人相比,神经分化较少,合作记忆系统更多。
    The hippocampal-dependent memory system and striatal-dependent memory system modulate reinforcement learning depending on feedback timing in adults, but their contributions during development remain unclear. In a 2-year longitudinal study, 6-to-7-year-old children performed a reinforcement learning task in which they received feedback immediately or with a short delay following their response. Children\'s learning was found to be sensitive to feedback timing modulations in their reaction time and inverse temperature parameter, which quantifies value-guided decision-making. They showed longitudinal improvements towards more optimal value-based learning, and their hippocampal volume showed protracted maturation. Better delayed model-derived learning covaried with larger hippocampal volume longitudinally, in line with the adult literature. In contrast, a larger striatal volume in children was associated with both better immediate and delayed model-derived learning longitudinally. These findings show, for the first time, an early hippocampal contribution to the dynamic development of reinforcement learning in middle childhood, with neurally less differentiated and more cooperative memory systems than in adults.
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  • 文章类型: Journal Article
    关于特定非药物干预对血糖控制的影响的现有证据目前是有限的。因此,有必要确定哪些干预措施可以为年轻的1型糖尿病患者的代谢健康带来最显著的益处.本研究的目的是确定血糖控制的最佳非药物干预措施,通过糖化血红蛋白(HbA1c)测量,儿童和青少年1型糖尿病。在PubMed中进行了系统搜索,WebofScience,Scopus,和SPORTDiscus从成立到2023年7月1日。研究非药物干预措施的随机临床试验(RCT)(例如,身体活动,营养,和行为疗法)包括在内。主要结果是HbA1c水平的变化。次要结果是每日胰岛素剂量需求的变化。使用网络荟萃分析对涉及20项干预措施的6,815名参与者(49.43%的女孩)的74例RCT进行了分析。大多数干预措施显示出比标准治疗更高的疗效。然而,多组分锻炼,其中包括有氧和力量训练(n=214,标准化平均差[SMD]=-0.63,95%可信区间[95%CrI]-1.09至-0.16)和营养补充剂(n=146,SMD=-0.49,-0.92至-0.07)显示出最大的HbA1c下降。这些干预措施还导致每日胰岛素需求的更大下降(n=119,SMD=-0.79,95%CrI-1.19至-0.34)和(n=57,SMD=-0.62,95%CrI-1.18至-0.12,分别)。目前的研究强调了非药物选择,如多组分运动和营养补充剂,展示他们在1型糖尿病青少年中显著改善HbA1c的潜力。虽然需要额外的研究来证实它们的疗效,这些方法可被认为是治疗儿童和青少年1型糖尿病的潜在辅助治疗选择.
    The available evidence on the impact of specific non-pharmacological interventions on glycaemic control is currently limited. Consequently, there is a need to determine which interventions could provide the most significant benefits for the metabolic health of young individuals with type 1 diabetes mellitus. The aim of this study was to identify optimal nonpharmacological interventions on glycaemic control, measured by glycated haemoglobin (HbA1c), in children and adolescents with type 1 diabetes. Systematic searches were conducted in PubMed, Web of Science, Scopus, and SPORTDiscus from inception to July 1, 2023. Randomised clinical trials (RCT) investigating nonpharmacological interventions (e.g., physical activity, nutrition, and behavioural therapies) were included. Primary outcome was change in HbA1c levels. Secondary outcome was change in daily insulin dose requirement. Seventy-four RCT with 6,815 participants (49.43% girls) involving 20 interventions were analysed using a network meta-analysis. Most interventions showed greater efficacy than standard care. However, multicomponent exercise, which includes aerobic and strength training (n = 214, standardised mean difference [SMD] =- 0.63, 95% credible interval [95% CrI] - 1.09 to - 0.16) and nutritional supplements (n = 146, SMD =- 0.49, - 0 .92 to - 0.07) demonstrated the greatest HbA1c reductions. These interventions also led to the larger decreases in daily insulin needs (n = 119, SMD =- 0.79, 95% CrI -  1.19 to - 0.34) and (n = 57, SMD =- 0.62, 95% CrI -  1.18 to - 0.12, respectively). The current study underscores non-pharmacological options such as multicomponent exercise and nutritional supplements, showcasing their potential to significantly improve HbA1c in youth with type 1 diabetes. Although additional research to confirm their efficacy is required, these approaches could be considered as potential adjuvant therapeutic options in the management of type 1 diabetes among children and adolescents.
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