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Objective: To explore the experiences of volunteer responders attending a paediatric out-of-hospital cardiac arrests (POHCAs) in Denmark., Design: This qualitative study used the Reflective Lifeworld Research theoretical framework. Data were generated through nine in-depth, in-person or virtual semistructured interviews conducted with volunteer responders., Setting: The study was conducted in Denmark. We recruited volunteer responders from all of Denmark enrolled in the nationwide volunteer responder programme., Participants: Nine volunteer responders who were dispatched in response to a POHCA from 2020 to 2023 were included in the study., Results: The experiences of attending a POHCA were categorised into three key themes: the mission, the situation and the aftermath. The mission refers to the altruistic drive of volunteer responders to contribute to life-saving efforts. The situation reflects the profound shock experienced when volunteer responders realise that the patient is a child, alongside their ability to act decisively and initiate cardiopulmonary resuscitation in the situation. The aftermath reveals the deep sense of fulfilment derived from being present and actively involved in attempting to save a child's life, as well as the various emotions and reactions that the volunteer responders process after the event., Conclusion: Attending a POHCA is a profoundly intense experience that can leave an emotional impact on the volunteer responders. On arriving at the location, despite the initial shock upon realising that the patient is a child, the volunteer responders engage in the resuscitation attempt and offer support to the child's family. However, alerting the volunteer responders beforehand that the patient is a child may help mitigate the initial shock. Volunteer responders find significant meaning in their roles and express a strong commitment to saving lives, irrespective of the age of those in need., Competing Interests: Competing interests: This project is partly funded by TrygFonden, who also is the main actor providing the Heartrunner program in Denmark. However, the funder did not influence the study design, conduction, interpretation or publishing of the article., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Rapid recognition of pediatric out-of-hospital cardiac arrest (POHCA) is a critical component to prompt initiation of bystander interventions. We aimed to investigate barriers for responding to POHCA during emergency medical calls., Methods and Results: We included all POHCA calls (aged 0-18 years) from the emergency dispatch center in the Capital Region of Denmark between 2018 and 2021 and excluded POHCAs with no resuscitation order, found dead, where trained health professionals were on site, or where there was no possibility for initiation of cardiopulmonary resuscitation. A qualitative analysis was undertaken. POHCA calls were divided according to the speed of telecommunicator-recognition into 3 groups: POHCA recognition within 90 seconds (group 1), POHCAs recognition >90 seconds (group 2), and POHCAs recognized by the emergency medical services at ambulance arrival (group 3). A total of 20 calls were included. We identified 3 major barriers to telecommunicator recognition of POHCA. First, prolonged conversations between callers and telecommunicators focusing on the cause of the child's condition rather than adherence to the assessment of consciousness and breathing. Second, challenges in assessing breathing such as cases where the child had agonal or unregular breathing or gasping breaths. Finally, callers who were unable to communicate or follow instructions from the telecommunicator., Conclusions: Telecommunicator recognition of POHCA is challenged by factors such as prolonged conversations focusing on causes rather than initiating bystander interventions, barriers in assessing breathing, as well as callers' abilities to partake in communication with telecommunicators. Efforts to address these barriers in current dispatch protocols may improve recognition of POHCA.

Importance: Young children often fall ill, leading to concern among their caregivers and urgent contact with health care services., Objective: To assess the effectiveness and safety of video tutorials to empower caregivers in caring for acutely ill children., Design, Setting, and Participants: Caregivers calling the out-of-hours Medical Helpline 1813 (MH1813), Emergency Medical Services Capital Region, Denmark, and their children aged 0.5 to 11.9 years were randomized to video tutorials (intervention) or telephone triage by a nurse or physician (control) from October 2020 to December 2021 and followed up for 72 hours blinded to the intervention. Data were analyzed from March to July 2022., Intervention: The intervention group had the call disconnected before telephone triage and received video tutorials on managing common symptoms in acutely ill children and when to seek medical help. Caregivers could subsequently call MH1813 for telephone triage., Main Outcomes and Measures: The primary outcome was caregivers' self-efficacy, reported in an electronic survey the following day. Secondary outcomes were satisfaction, child status, assessment by a general practitioner or physician at the hospital, telephone triage, and adverse events during the 72-hour follow-up period., Results: In total, 4686 caregivers and children were randomized to intervention (2307 participants) or control (2379 participants), with a median (IQR) child age of 2.3 (1.3-5.1) years and 53% male distribution in both groups (2493 participants). Significantly more caregivers in the intervention group reported high self-efficacy (80% vs 76%; crude odds ratio [OR], 1.30; 95% CI, 1.01-1.67; P = .04). The intervention group received fewer telephone triages during follow-up (887 vs 2374 in the control group). Intention-to-treat analysis showed no difference in secondary outcomes, but per-protocol subanalysis showed fewer hospital assessments when caregivers watched video tutorials (27% vs 35%; adjusted OR, 0.67; 95% CI, 0.55-0.82). Randomization to video tutorials did not increase adverse outcomes., Conclusions and Relevance: In this randomized clinical trial, offering caregivers video tutorials significantly and safely increased self-efficacy and reduced use of telephone triage. Children had fewer hospital assessments when caregivers watched videos. This suggests a future potential of health care information to empower caregivers and reduce health care utilization., Trial Registration: ClinicalTrials.gov Identifier: NCT04301206.

Background: Previous studies have shown that Tourette syndrome (TS) has an impact on academic achievements. The aim of this study was to investigate the association between the severity of tics and comorbidities and educational outcomes., Methods: From 2005 to 2007, 395 participants were included in a large cohort (314 with TS and 81 controls) and the mean age was 12.60 ± 2.64 years. The cohort was re-examined after 4 to 8 years (median 5.6) where n  = 276 participants (223 with TS and 53 controls) were included with a mean age of 18.52 ± 2.73 years. At both time points, severity of tics and the presence and severity of psychiatric comorbidity were assessed. Educational achievements were assessed through structured interviews., Results: Children with TS had a lower passing rate at lower secondary and high school compared to healthy controls. More severe vocal tics were associated with fewer passing lower secondary school at a prospective level. At a cross-sectional level, more severe motor tics were associated with fewer passing high school. Tic severity only influenced children with TS without comorbidity. The severity of comorbidity was found to be associated with the educational level at a longitudinal view, but not cross-sectional., Conclusion: Overall, children with TS had a lower passing rate at lower secondary school and high school compared to healthy controls. We found that this difference was more likely driven by the severity of comorbidities than tic severity. It is important to be aware of academic achievement in children with TS in order to give them the right support and thereby optimize educational opportunities., Competing Interests: None declared., (Thieme. All rights reserved.)

Prenatal exposure to maternal hyperglycemia is associated with an increased risk of later adverse metabolic health. Changes in the regulation of peroxisome proliferator-activated receptor-γ coactivator-1α (PPARGC1A) in skeletal muscle and subcutaneous adipose tissue (SAT) is suggested to play a role in the developmental programming of dysmetabolism based on studies of human subjects exposed to an abnormal intrauterine environment (e.g., individuals with a low birth weight). We studied 206 adult offspring of women with gestational diabetes mellitus (O-GDM) or type 1 diabetes (O-T1D) and of women from the background population (O-BP) using a clinical examination, oral glucose tolerance test, and gene expression and DNA methylation of PPARGC1A in skeletal muscle and SAT. Plasma glucose was significantly higher for both O-GDM and O-T1D compared with O-BP (P < 0.05). PPARGC1A gene expression in muscle was lower in O-GDM compared with O-BP (P = 0.0003), whereas no differences were found between O-T1D and O-BP in either tissue. PPARGC1A DNA methylation percentages in muscle and SAT were similar among all groups. Decreased PPARGC1A gene expression in muscle has previously been associated with abnormal insulin function and may thus contribute to the increased risk of metabolic disease in O-GDM. The unaltered PPARGC1A gene expression in muscle of O-T1D suggests that factors other than intrauterine hyperglycemia may contribute to the decreased PPARGC1A expression in O-GDM., (© 2016 by the American Diabetes Association.)