The Role of Dietary Patterns and Nutritional Supplements in the Management of Mental Disorders in Children and Adolescents: An Umbrella Review of Meta-Analyses: Le rôle des habitudes alimentaires et des suppléments nutritionnels dans la prise en charge des troubles mentaux chez les enfants et les adolescents : une méta-revue de méta-analyses.

OBJECTIVE: In recent years, the relationship between nutrition and mental health has gained considerable interest. We identified, synthesized, and appraised all meta--analyses of randomized controlled trials (RCTs) and observational studies reporting on the efficacy of dietary patterns and nutrient supplements in the prevention and treatment of mental disorders in children and adolescents. METHODS: Systematic research in MEDLINE, PsycINFO, Scopus, and Cochrane Database of Systematic Reviews was completed on 8 January 2024. RESULTS: Our research found 24 meta-analyses: 14 on RCTs, 8 on observational studies, and 2 combining both. Emerging evidence suggests that omega-3, in particular eicosapentaenoic acid, and Vitamin D may have adjunctive benefits in the treatment of attention deficit hyperactivity disorder (ADHD), while no evidence was found for autism spectrum disorder (ASD). Observational data also indicated that prenatal folic acid supplementation (>400 µg daily) was associated with a reduced risk of ASD in offspring. In terms of dietary habits, several meta-analyses of observational data revealed that healthy dietary patterns (rich in fruits, vegetables, and fibre, low in saturated fats) during the prenatal period, childhood, and adolescence were linked to a significantly reduced risk of internalizing disorders and externalizing disorders. Conversely, unhealthy dietary habits (high in sugars, saturated animal fats, and industrial foods, low in fruits, vegetables, and fibre) are associated with an elevated risk of these mental health issues. However, the number of available studies on dietary interventions for the treatment of depression, ASD, and ADHD was limited, and the results obtained were either nonsignificant or contradictory. CONCLUSION: Our findings emphasize the need to establish clear causal relationships between dietary habits and the risk of mental illness in children and adolescents. Moreover, further investigation of the benefits observed with some nutrient supplements (such as omega-3 and vitamin D for ADHD) through larger-scale RCTs is imperative to establish more robust conclusions.

We investigated the link between nutrition and mental health in children and adolescents through a meta-review of 24 relevant meta-analyses. Emerging evidence suggests potential benefits of Omega-3 and Vitamin D in treating ADHD, while no evidence supports their effectiveness in ASD. Observational data also indicate that prenatal folic acid supplementation may lower ASD risk. Healthy dietary patterns reduce the risk of internalizing and externalizing disorders, whereas unhealthy habits elevate the risk. Limited studies on dietary interventions for depression, ASD, and ADHD provide inconclusive results. In summary, our results emphasize the need to clearly understand the cause-and-effect relationships between dietary habits and mental health risks in young individuals. Larger-scale randomized controlled trials are essential for confirming the observed benefits of nutrient supplements such as omega-3 and vitamin D in treating ADHD and for forming more reliable conclusions.

Do caring teachers protect African American youth with adverse adolescent experiences from risky behaviors?

The current study aims to fill the existing research gaps by investigating the role of teacher care in protecting African American adolescents in under-resourced neighborhoods from negative outcomes of adverse life events. The study included 638 adolescents from four under-resourced neighborhoods in Chicago's Southside who were assessed to determine the moderating role of caring teachers on the relationship between adverse adolescent experiences and risky sexual behaviors, substance use, bullying perpetration, and violent behaviors. Caring teachers had a significant moderating effect on the association between adverse experiences and both bullying perpetration and violent behaviors. Adolescents who perceived their teachers as caring showed lower tendencies towards bullying and violence, even if they had adverse experiences. These results highlight the crucial role of teacher care in supporting African American adolescents from under-resourced neighborhoods who have experienced adverse life events. It emphasizes educators' role in shaping our youth's future, especially those facing adversity and at a crossroads in their lives.

Despite adverse life events, adolescents who perceived their teachers as caring were less at risk of engaging in bullying and violence. Caring teachers are especially important for African American adolescents in under-resourced neighborhoods.

Understanding challenges related to menstrual hygiene management: Knowledge and practices among the adolescent girls in urban slums of Jaipur, India.

Objective: This study aimed to determine the factors associated with knowledge and practices related to menstrual hygiene management among adolescent girls in urban slums in Jaipur, India. Material and Methods: A cross-sectional study among 417 adolescent girls was conducted. Descriptive statistics, Chi-square, and bivariate and multivariate logistic regression methods were used to analyze the data and determine the associated factors. Findings: Only 48.7% of girls had a correct understanding of menstruation. In addition, 55.1% of the menstruating girls had faced health problems related to mensuration in the last 6 months; however, only 47.6% visited a health facility for treatment. Educational status of the girl (AOR = 1.89, 95% CI = 0.88-4.06), mother's education (AOR = 2.19, 95% CI = 1.30-3.67) and income (AOR = 1.89, 95% CI = 0.67-3.95), father's income (AOR = 1.42, 95% CI = 0.76-2.95), and counseling by field health workers (AOR = 2.08, 95% CI = 1.23-3.51) were found to be associated with knowledge about menstruation. Girl's education (AOR = 1.49, 95% CI = 0.74-2.95), mother's education (AOR = 1.46, 95% CI = 0.7-2.84) and income (AOR = 1.314, 95% CI = 0.44-2.02), father's education (AOR = 1.64, 95% CI = 0.55-3.08) and income (AOR = 2.0, 95% CI = 0.86-3.28), and counseling by field health workers (AOR = 1.48, 95% CI = 0.76-2.64) were found to be associated with the type of absorbents used. Conclusion: The findings from the study show that the awareness about mensuration and utilization of health services among adolescent girls is low. There is a need to create an enabling environment for girls to access knowledge and health services related to menstruation by creating awareness at the community level, strengthening outreach by field health workers, and ensuring privacy in healthcare facilities.

Help-seeking processes related to targeted school-based mental health services: systematic review.

BACKGROUND: One in seven adolescents globally are affected by mental health conditions, yet only a minority receive professional help. School-based mental health services have been endorsed as an effective way to increase access to mental health support for people at risk, or currently presenting with mental health conditions, throughout adolescence. Despite this, low treatment utilisation prevails, therefore the aim of this review is to contribute insights into the processes related to adolescents' accessing and engaging with essential targeted mental health support within schools. METHODS: This systematic review extracted qualitative, quantitative and mixed-methods data to determine what processes affect adolescents seeking help from targeted school-based mental health services (TSMS). Searches were conducted in EMBASE, Medline, PsycINFO, CINAHL, ERIC, Web of Science, in addition to manual searching and expert consultations. Data were synthesised following guidelines for thematic synthesis and narrative style synthesis. RESULTS: The search resulted in 22 articles reflecting 16 studies with participant sample sizes ranging from n = 7 to n = 122. Three main themes were identified: 'access-related factors', 'concerns related to stigma', and 'the school setting'. These findings elucidate how help-seeking processes are variable and can be facilitated or hindered depending on the circumstance. We identified disparities with certain groups, such as those from low-socio economic or ethnic minority backgrounds, facing more acute challenges in seeking help. Help-seeking behaviours were notably influenced by concerns related to peers; an influence further accentuated by minority groups given the importance of social recognition. Conflicting academic schedules significantly contribute to characterising treatment barriers. CONCLUSIONS: The findings of this review ought to guide the delivery and development of TSMS to facilitate access and promote help-seeking behaviours. Particularly, given the evidence gaps identified in the field, future studies should prioritise investigating TSMS in low- and middle-income settings and through quantitative methodologies. REGISTRATION: The protocol for this systematic review was registered on PROSPERO (ID CRD42023406824).

Evaluating the real-world implementation of the Family Nurse Partnership in England: a data linkage study.

Background/objectives: The Family Nurse Partnership is an intensive home visiting programme for adolescent mothers. We aimed to evaluate the effectiveness of the Family Nurse Partnership on outcomes up to age 7 using national administrative data. Design: We created a linked cohort of all mothers aged 13-19 using data from health, educational and children's social care and defined mothers enrolled in the Family Nurse Partnership or not using Family Nurse Partnership system data. Propensity scores were used to create matched groups for analysis. Setting: One hundred and thirty-six local authorities in England with active Family Nurse Partnership sites between 2010 and 2017. Participants: Mothers aged 13-19 at last menstrual period with live births between April 2010 and March 2019, living in a Family Nurse Partnership catchment area and their firstborn child(ren). Interventions: The Family Nurse Partnership includes up to 64 home visits by a family nurse from early pregnancy until the child's second birthday and is combined with usual health and social care. Controls received usual health and social care. Main outcome measures: Indicators of child maltreatment (hospital admissions for injury/maltreatment, referral to social care services); child health and development (hospital utilisation and education) outcomes and maternal hospital utilisation and educational outcomes up to 7 years following birth. Data sources: Family Nurse Partnership Information System, Hospital Episode Statistics, National Pupil Database. Results: Of 110,520 eligible mothers, 25,680 (23.2%) were enrolled in the Family Nurse Partnership. Enrolment rates varied across 122 sites (range: 11-68%). Areas with more eligible mothers had lower enrolment rates. Enrolment was higher among mothers aged 13-15 (52%), than 18-19 year-olds (21%). Indicators of child maltreatment: we found no evidence of an association between the Family Nurse Partnership and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 for children born to Family Nurse Partnership mothers (6.6% vs. 5.7%, relative risk 1.15; 95% confidence interval 1.07 to 1.24). Child health and developmental outcomes: there was weak evidence that children born to Family Nurse Partnership mothers were more likely to achieve a Good Level of Development at age 5 (57.5% vs. 55.4%, relative risk 1.05; 95% confidence interval 1.00 to 1.09). Maternal outcomes: There was some evidence that Family Nurse Partnership mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs. 9.3%, relative risk 0.92; 95% confidence interval 0.88 to 0.97). Younger and more vulnerable mothers received higher numbers of visits and were more likely to achieve fidelity targets. Meeting the fidelity targets was associated with some outcomes. Limitations: Bias by indication and variation in the intervention and usual care over time and between areas may have limited our ability to detect effects. Multiple testing may have led to spurious, significant results. Conclusions: This study supports findings from evaluations of the Family Nurse Partnership showing no evidence of benefit for maltreatment outcomes measured in administrative data. Amongst all the outcomes measured, we found weak evidence that the Family Nurse Partnership was associated with improvements in child development at school entry, a reduction in rapid repeat pregnancies and evidence of increased healthcare-seeking in the mother and child. Future work: Future evaluations should capture better measures of Family Nurse Partnership interventions and usual care, more information on maternal risk factors and additional outcomes relating to maternal well-being. Study registration: The study is registered as NIHR CRN Portfolio (42900). Funding: This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/19) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.

The Family Nurse Partnership is an intensive home visiting service that offers first-time young mothers up to 64 visits with a family nurse from pregnancy to their child's second birthday. The Family Nurse Partnership aims to improve birth outcomes, child health and development and promote economic self-sufficiency among young mothers. Previous research in England found no differences in birthweight, maternal smoking, repeat pregnancies or accident and emergency attendances between mothers who did or did not take part in the Family Nurse Partnership. However, children in the Family Nurse Partnership group had better measures of development at school age. We aimed to add to the evidence from earlier studies, by using electronic records that are routinely collected as part of health, education and social care services, to compare outcomes for around 26,000 mothers enrolled in the Family Nurse Partnership between 2010 and 2019 with similar mothers who were not enrolled. This study showed that around one in four mothers who were eligible for the programme were enrolled in the Family Nurse Partnership, and family nurses gave priority to mothers who were younger, more deprived or who had other markers of vulnerability (e.g. a history of substance misuse violence, self-harm or mental health conditions). We found no evidence of a difference in indicators of child maltreatment between mothers who were enrolled in the Family Nurse Partnership and those who were not enrolled, but we found weak evidence to suggest that children born to mothers enrolled in the Family Nurse Partnership were more likely to achieve a Good Level of Development at school entry (age 5). We also saw that mothers enrolled in the Family Nurse Partnership were less likely than those who were not enrolled to have their next child within 18 months of their first child. More research is needed to understand which elements of intensive home visiting services work best, for whom and when. This will help inform decisions about whether it is better to offer highly intensive services for a small portion of the target population or to extend and enhance existing universal health visiting services to better support all adolescent mothers.

Three-Year Outcomes With Fractional Flow Reserve-Guided or Angiography-Guided Multivessel Percutaneous Coronary Intervention for Myocardial Infarction.

BACKGROUND: In patients with multivessel disease with successful primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction, the FLOWER-MI trial (Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction) showed that a fractional flow reserve (FFR)-guided strategy was not superior to an angiography-guided strategy for treatment of noninfarct-related artery lesions regarding the 1-year risk of death from any cause, myocardial infarction, or unplanned hospitalization leading to urgent revascularization. The extension phase of the trial was planned using the same primary outcome to determine whether a difference in outcomes would be observed with a longer follow-up. METHODS: In this multicenter trial, we randomly assigned patients with ST-segment-elevation myocardial infarction and multivessel disease with successful percutaneous coronary intervention of the infarct-related artery to receive complete revascularization guided by either FFR (n=586) or angiography (n=577). RESULTS: After 3 years, a primary outcome event occurred in 52 of 498 patients (9.40%) in the FFR-guided group and in 44 of 502 patients (8.17%) in the angiography-guided group (hazard ratio, 1.19 [95% CI, 0.79-1.77]; P=0.4). Death occurred in 22 patients (4.00%) in the FFR-guided group and in 23 (4.32%) in the angiography-guided group (hazard ratio, 0.96 [95% CI, 0.53-1.71]); nonfatal myocardial infarction in 23 (4.13%) and 14 (2.56%), respectively (hazard ratio, 1.63 [95% CI, 0.84-3.16]); and unplanned hospitalization leading to urgent revascularization in 21 (3.83%) and 18 (3.36%; hazard ratio, 1.15 [95% CI, 0.61-2.16]), respectively. CONCLUSIONS: Although event rates in the trial were lower than expected, in patients with ST-segment-elevation myocardial infarction undergoing complete revascularization, an FFR-guided strategy did not have a significant benefit over an angiography-guided strategy with respect to the risk of death, myocardial infarction, or urgent revascularization up to 3 years. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02943954.

Neurological dysfunction screening in a cohort of adolescents with type 1 diabetes: a six-year follow-up.

Aims: Diabetic neuropathy (DN) is one of the most insidious microvascular complications in patients with type 1 diabetes (T1DM) and initial signs may appear during childhood. The aim of this study is to evaluate associations between the Nerve Conduction Studies (NCS) outcomes at enrollment with neuropathy screening questionnaires performed six years later in a cohort of asymptomatic adolescents followed up until early adulthood, affected by T1DM. Methods: We performed NCS in a cohort of seventy-two adolescents with T1DM and eighteen healthy controls. Six years later, screening questionnaires for DN were proposed: Michigan Neuropathy Screening Instrument (MNSI, specific for symptoms of somatic dysfunction), Composite Autonomic Symptom Score 31 (COMPASS 31, specific for abnormalities of the autonomic component) and Clarke questionnaire (perception of hypoglycemia). Thirty-two TD1M subjects agreed to participate in the follow-up; main clinical-metabolic parameters, including the number of episodes of hypoglycemia in the past twelve months, were collected. Results: 11.8% of subjects showed changes compatible with DN through the MNSI questionnaire, while 41% declared a reduced perception of hypoglycemia on the Clarke questionnaire. No significant correlation was observed between the clinical-metabolic parameters or altered response to NCS and scores of MNSI and COMPASS 31 questionnaires. On the other hand, an association was observed between NCS abnormalities and a high number of hypoglycemic events after six years (97-fold increased risk, p = 0.009). Conclusion: The frequency of somatic alterations in the study population is 11.8%, whereas the frequency of symptoms correlated with autonomic damage is about 41%. An autonomic impairment recorded at NCS may represent a six-year risk factor for increased hypoglycemic episodes, even if more extensive studies are needed to investigate this possible relationship further.

Tanzanian adolescents' attitudes toward abortion: innovating video vignettes in survey research on health topics.

BACKGROUND: The purpose of this study was to pilot an innovative cartoon video vignette survey methodology to learn about young people's perspectives on abortion and sexual relationships in Tanzania. The Animating Children's Views methodology used videos shown on tablets to engage young people in conversations. Such conversations are complicated because abortion is highly stigmatized, inaccessible, and illegal in Tanzania. METHODS: The cartoon video vignette methodology was conducted as a part of a quantitative survey using tablet computers. Hypothetical situations and euphemistic expressions were tested in order to engage adolescents on sensitive topics in low-risk ways. Qualitative interviews and focus groups validated and further explored the perspectives of the young respondents. RESULTS: Results indicate that 12-17 year-olds usually understand euphemistic expressions for abortion and are aware of social stigma and contradictory norms surrounding abortion from as young as age twelve. Despite the risks involved with abortion, this study finds adolescents sometimes view abortion as a reasonable solution to allow a girl to remain in school. Additional findings show that as adolescents wrestle with how to respond to a schoolgirl's pregnancy, they are considering both the (un)affordability of healthcare services and also expectations for gender roles. CONCLUSIONS: Digital data collection, such as the Animating Children's Views cartoon video vignettes used in this study, allows researchers to better understand girls' and boys' own perspectives on their experiences and reproductive health.

The Animating Children's Views project used cartoon video vignettes to collect quantitative and qualitative data on girls' and boys' (infrequently included) perspectives about this sensitive topic as these young people aged into and figured out how to navigate sexual maturity in rural and urban Tanzania. This novel survey technique leveraged digital technology to better engage young people's perspectives about sensitive health topics. Despite the risks involved with abortion, this study finds adolescents sometimes view abortion as a reasonable solution to allow a girl to remain in school. Additional findings show that as adolescents wrestle with how to respond to a schoolgirl's pregnancy, they are considering both the (un)affordability of healthcare services and also expectations for gender roles. We argue that digital data collection allows survey research to include girls and boys, to better understand how reproductive health outcomes are inextricably linked to their future lives.

Parent-adolescent conflict and problematic internet use among Chinese adolescents: the mediating role of depression and the moderating role of school climate.

BACKGROUND: Problematic Internet use (PIU) may lead adolescents to physical, emotional, social, or functional impairment due to the risky, excessive, or impulsive internet use manner. How do the experiences of adolescents influence them using the internet in a problematic manner? The answer to this question is the key to preventing and intervening PIU of adolescents. To address this question, we focus on the interactions among family (parent-adolescent conflict), school (school climate), and individual factors (PIU, depression), exploring the influence factors of PIU. METHODS: A moderated mediation model was constructed to explore the relationship between variables. Using a two-wave longitudinal design with a six-month interval between timepoints, this study collected data from 801 Chinese adolescents (411 boys, Mage = 14.68) by questionnaires. Path analysis was employed to test the model and participants' age, sex and baseline were controlled. RESULTS: Parent-adolescent conflict at Time 1 (T1) was positively related to PIU at Time 2 (T2) in adolescents. Depression at T2 mediated the relationship between parent-adolescent conflict at T1 and PIU at T2. School climate at T2 significantly moderated the mediation effect of depression on the relationship between parent-adolescent conflict at T1 and PIU at T2. Specifically, positive school climate could significantly weaken the negative effect of depression on PIU for adolescents with low level of depression. CONCLUSIONS: The present study reveals that parent-adolescent conflict leads to PIU in adolescents through depression whilst the school climate moderates the impacts of depression on PIU. This adds further evidence regarding the significance of systematically and consistently incorporating family and school in the alleviating of problem behaviors displayed by teens.

MyHospitalVoice - a digital tool co-created with children and adolescents that captures patient-reported experience measures: a study protocol.

BACKGROUND: Children and adolescents have the right to participate in decisions concerning their health and express their views, also regarding hospital experiences. Patient-reported experience measures (PREMs) are valuable tools for systematically incorporating patient voices into healthcare systems. New developments have focused on PREMs for children and adolescents, though they are more commonly used in adults. A recent systematic review mapping their use for children and adolescents indicates a growing interest in this area. However, most PREMs are completed by proxy, in this case parents, so they do not necessarily reflect children's experiences or align with their rights. Innovation is required to support and engage children and adolescents in responding to these types of questionnaires. METHODS: Collaborating with children and adolescents (4-17 years), the primary aim of this study is to develop and validate the tool MyHospitalVoice containing digital and developmentally appropriate PREMs. The secondary aim is to document and evaluate the approaches used to involve children and adolescents and to assess the impact of their involvement. Based on the European Organisation for Research and Treatment of Cancer framework, we will divide its development and validation into four phases. First, we will discuss PREM items with children and adolescents, who will select and prioritise what they perceive as most important. Second, we will create items targeting different age groups (4-7, 8-12, and 13-17 years) and design a responsive digital interface with child and youth friendly ways of responding to the questionnaires. Third, we will explore how children and adolescents perceive MyHospitalVoice using cognitive interviewing techniques and other age-appropriate methods. Last, we will pilot test MyHospitalVoice to explore patient experiences and response rates. In each phase, children and adolescents will play an active role. We will involve young adults as peer researchers in the project group to ensure that their perspectives are part of the decision-making process. DISCUSSION: This project will contribute to research on co-creating with children and adolescents and enhance our understanding of their patient experiences. A validated tool like MyHospitalVoice can help improve quality of care by translating the needs and preferences of children and adolescents into clinical practice.

Novel CHATogether family-centered mental health care in the post-pandemic era: a pilot case and evaluation.

BACKGROUND: The COVID-19 pandemic impacted children, adolescents, and their families, with significant psychosocial consequences. The prevalence of anxiety, depression, and self-injurious behaviors increased in our youth, as well as the number of suicide attempts and hospitalizations related to suicidal ideation. Additionally, parents' mental health saw increasing rates of depression, irritability, and alcohol use combined with worsening family function, child-parent connectedness, positive family expressiveness, and increases in family conflict. In light of these statistics, we created CHATogether (Compassionate Home, Action Together), a pilot family-centered intervention using multi-faceted psychotherapeutic approaches to improve familial communication and relational health between adolescents and their parents. This paper discusses the implementation of the CHATogether intervention at the Adolescent Intensive Outpatient Program (IOP), providing an example of the intervention through an in-depth pilot case, and evaluation of the program's acceptability and feasibility. METHODS: This paper describes a case in detail and evaluation from a total of 30 families that completed CHATogether in the initial pilot. Each family had 4-6 one-hour CHATogether sessions during their 6-week treatment course at the IOP. Before and after CHATogether, adolescents and their parents separately completed a questionnaire designed to explore their perceived family conflicts. After completion of the program, participants completed a brief quality improvement survey to assess their overall experience with CHATogether. In the reported case, the family completed Patient-Reported Outcomes Measurement Information System (PROMIS) depressive and anxiety symptoms scales, Conflict Behavior Questionnaires (CBQ), 9-item Concise Health Risk Tracking Self-Report (CHRT-SR9), and help-seeking attitude from adults during distress and suicide concerns. RESULTS: The pilot case showed a trend of improvement in reported depressive and anxiety symptoms, child-parent conflicts, subfactors of suicide risk including pessimism, helplessness, and despair, help-seeking acceptability from parents for suicide concerns, and the establishment of individualized family relationship goals. Preliminary feedback from participating families demonstrated positive effects on intra-family communication and improvement in the overall family dynamic. Adolescents (n = 30/30) and their parents (n = 30/30) rated "strongly agree" or "agree" that their families had benefited from CHATogether and welcomed participation in future program development. CONCLUSION: This study presents CHATogether as a novel family-centered intervention to address post-pandemic family mental health stress, especially when a family system was disrupted and negatively affected the mental health of children and adolescents. The intervention facilitated positive child-parent communication on a variety of topics, through tools such as emotional expression and help-seeking behavior. The reported pilot case and evaluation suggested CHATogether's acceptability and feasibility in a clinical context. We also provided quality improvement feedback to guide future studies in establishing the efficacy of CHATogether and other similar models of clinical family interventions.

Confidence in adolescent contraceptive counseling among residents and fellows training at the University of Texas Southwestern in Dallas, Texas.

OBJECTIVES: Evaluate trainees' perceptions of past training and confidence in counseling about five contraceptive methods. STUDY DESIGN: Trainees completed an online survey in 2020. Logistic regressions evaluated the relationship between participant characteristics and confidence. RESULTS: Among 227 respondents (63% response rate), pediatric trainees reported the least confidence in counseling across each contraceptive method. Past training and confidence were associated. CONCLUSIONS: Gaps in training should be addressed to improve confidence in contraceptive counseling among pediatricians in reproductively restricted states. IMPLICATIONS: This study highlights gaps in physician trainee confidence regarding adolescent contraception counseling that should be addressed to improve adolescent sexual and reproductive healthcare.

Prediction of adolescent weight status by machine learning: a population-based study.

BACKGROUND: Adolescent weight problems have become a growing public health concern, making early prediction of non-normal weight status crucial for effective prevention. However, few temporal prediction tools for adolescent four weight status have been developed. This study aimed to predict the short- and long-term weight status of Hong Kong adolescents and assess the importance of predictors. METHODS: A population-based retrospective cohort study of adolescents was conducted using data from a territory-wide voluntary annual health assessment service provided by the Department of Health in Hong Kong. Using diet habits, physical activity, psychological well-being, and demographics, we generated six prediction models for successive weight status (normal, overweight, obese and underweight) using multiclass Decision Tree, Random Forest, k-Nearest Neighbor, eXtreme gradient boosting, support vector machine, logistic regression. Model performance was evaluated by multiple standard classifier metrics and the overall accuracy. Predictors' importance was assessed using Shapley values. RESULTS: 442,898 Primary 4 (P4, Grade 4 in the US) and 344,186 in Primary 6 (P6, Grade 6 in the US) students, with followed up until their Secondary 6 (Grade 12 in the US) during the academic years 1995/96 to 2014/15 were included. The XG Boosts model consistently outperformed all other model in predicting the long-term weight status at S6 from P4 or P6. It achieved an overall accuracy of 0.72 or 0.74, a micro-averaging AUC of 0.92 or 0.93, and a macro-averaging AUC of 0.83 or 0.86, respectively. XG Boost also demonstrated accurate predictions for each predicted weight status, surpassing the AUC values obtained by other models. Weight, height, sex, age, frequency and hours of aerobic exercise were consistently the most important predictors for both cohorts. CONCLUSIONS: The machine learning approaches accurately predict adolescent weight status in both short- and long-term. The developed multiclass model that utilizing easy-assessed variables enables accurate long-term prediction on weight status, which can be used by adolescents and parents for self-prediction when applied in health care system. The interpretable models may help to provide the early and individualized interventions suggestions for adolescents with weight problems particularly.

Multiple maxillofacial desmoid tumours: a case report.

Desmoid tumors (DTs) are rare benign neoplasms but cause significant mortality due to their locally infiltrative nature and propensity to recur. Most DTs occur in the extremities and trunk. Head and neck DTs are uncommon but can have a significant impact on a patient's facial appearance. However, there is limited information available about the diagnosis and treatment for multiple DTs located in head and neck. We report the first case of multiple maxillofacial DTs in a 14-year-old boy. He had painless submandibular masses for three months and MRI imaging reveals abnormal high signals on the submandibular and bilateral zygomatic regions. Considering facial aesthetics, via intraoral incision we obtained a biopsy from the largest mass. Pathological examination confirmed a diagnosis of DT. We selected the wait-and-see strategy and clinically monitored the rest of the masses. During the subsequent 1-year follow-up, the masses were stagnant and appeared to involute. According to the development and outcome of this case, a conservative treatment for craniofacial DTs is suggested; however, greater clarity concerning management and prognosis could derive from prospective study of a larger patient cohort in the future.

A controversial issue in adolescents: Is the effect of digital games on creative personality traits positive or negative?

AIM: This study aimed to determine the effect of digital games on the creativity of adolescents. METHODS: This study was designed as a cross-sectional study using simple random sampling following the STROBE checklist. It was conducted with 384 adolescents between January and June 2022. Data were collected using the Digital Game Addiction Scale for Children and the Creative Personality Traits Scale. RESULTS: The adolescents were at risk for digital game addiction and had moderate creativity levels. The adolescents who had a male sex, had mothers who received primary education, started playing digital games before the age of 6 years, were using the internet for >5 h a day, had no activity other than playing digital games, and preferred action, adventure, and fighting games had higher digital game addiction levels than the other adolescents. In addition, the male adolescents had higher creativity levels than the female adolescents. There was a significant negative relationship between digital game addiction and creative personality traits among the adolescents. Digital game addiction had a negative effect on creativity. CONCLUSIONS: Adolescents are at risk for digital game addiction and have moderate creativity levels. Digital game addiction negatively affects the development of creative personality traits. Interventions should be planned to prevent digital game addiction among adolescents, and adolescents should be guided to increase awareness of the effects of digital games on their creativity.

Advances in the treatment of Philadelphia chromosome negative acute lymphoblastic leukemia.

There have been major paradigm shifts in the treatment of Philadelphia chromosome negative (Ph-) acute lymphoblastic leukemia (ALL) in the last decade with the introduction of new immunotherapies and targeted agents, adoption of pediatric-type chemotherapy protocols in younger adults as well as chemotherapy light approaches in older adults and the incorporation of measurable residual disease (MRD) testing to inform clinical decision making. With this, treatment outcomes in adult Ph- ALL have improved across all age groups. However, a subset of patients will still develop relapsed disease, which can be challenging to treat and associated with poor outcomes. Here we review the treatment of Ph- ALL in both younger and older adults, including the latest advancements and future directions.

Interaction of serotonin/GLP-1 circuitry in a dual preclinical model for psychiatric disorders and metabolic dysfunction.

Isolation of rodents throughout adolescence is known to induce many behavioral abnormalities which resemble neuropsychiatric disorders. Separately, this paradigm has also been shown to induce long-term metabolic changes consistent with a pre-diabetic state. Here, we investigate changes in central serotonin (5-HT) and glucagon-like peptide 1 (GLP-1) neurobiology that dually accompany behavioral and metabolic outcomes following social isolation stress throughout adolescence. We find that adolescent-isolation mice exhibit elevated blood glucose levels, impaired peripheral insulin signaling, altered pancreatic function, and fattier body composition without changes in bodyweight. These mice further exhibited disruptions in sleep and enhanced nociception. Using bulk and spatial transcriptomic techniques, we observe broad changes in neural 5-HT, GLP-1, and appetitive circuits. We find 5-HT neurons of adolescent-isolation mice to be more excitable, transcribe fewer copies of Glp1r (mRNA; GLP-1 receptor), and demonstrate resistance to the inhibitory effects of the GLP-1R agonist semaglutide on action potential thresholds. Surprisingly, we find that administration of semaglutide, commonly prescribed to treat metabolic syndrome, induced deficits in social interaction in group-housed mice and rescued social deficits in isolated mice. Overall, we find that central 5-HT circuitry may simultaneously influence mental well-being and metabolic health in this model, via interactions with GLP-1 and proopiomelanocortin circuitry.

Combined effects of sugar-sweetened beverage consumption, screen-based sedentary behavior, and sleep duration on South Korean adolescent obesity: a cross-sectional study.

PURPOSE: This study examined the combined effects of sugar-sweetened beverage (SSB) consumption, screen-based sedentary behaviors, and sleep duration on adolescent obesity. METHODS: It followed a cross-sectional study design and conducted secondary analysis on data from 20,497 high school students who participated in the 17th (2021) Korea Youth Risk Behavior Web-based Survey. This study underwent logistic regression analysis in complex sampling analysis. RESULTS: The combinations of low and medium consumption of SSBs, excessive screen-based sedentary behaviors, and short sleep durations were associated with a 1.18 and 1.12 fold increased likelihood of obesity (95% confidence interval [CI]=1.03-1.35) and (95% CI=1.02-1.22), respectively. The combination of high SSB consumption, appropriate screen-based sedentary behaviors, and short sleep duration (adjusted odds ratio [aOR]=1.15, 95% CI=1.01-1.31) and high SSB consumption, excessive screen-based sedentary behaviors, and short sleep duration (aOR=1.40, 95% CI=1.16-1.69) were associated with obesity. CONCLUSION: Integrated and tailored programs considering combination patterns of SSB consumption, screen-based sedentary behaviors, and short sleep duration need to be developed for preventing adolescent obesity.

Association between allergic diseases, generalized anxiety disorder, and depressive symptoms in South Korean adolescents: a secondary data analysis of the 2022 Korea Youth Risk Behavior Survey.

PURPOSE: This study investigated the relationship between allergic diseases, general anxiety disorder, and depressive symptoms among Korean adolescents. METHODS: A secondary analysis was conducted on the findings of the 18th Korea Youth Risk Behavior Survey (2022). The study included 51,850 adolescents and analyzed the relationships among allergic diseases, general anxiety disorder, and depressive symptoms using complex samples logistic regression analysis. RESULTS: Among the Korean adolescents, 12.7% experienced general anxiety disorder, while 28.7% experienced depressive symptoms. The prevalence of allergic diseases was 5.7% for asthma, 36.3% for allergic rhinitis, and 22.2% for atopic dermatitis. General anxiety disorder was associated with asthma and allergic rhinitis but not atopic dermatitis. Depressive symptoms were associated asthma, allergic rhinitis, and atopic dermatitis. CONCLUSION: Examining the correlation among allergic diseases, general anxiety disorder, and depressive symptoms in adolescents underscores the need for implementing suitable strategies. Moreover, when addressing general anxiety disorder and depressive symptoms in adolescents, it becomes crucial to consider the presence of allergic diseases.

Association between smartphone overdependence and mental health in South Korean adolescents: a secondary data analysis.

PURPOSE: The rising prevalence of smartphone overdependence among adolescents and its detrimental impact on mental health have become a growing concern. This study aimed to investigate the association between smartphone overdependence and the mental health of Korean adolescents. METHODS: Participants were drawn from the 16th Korea Youth Risk Behavior Web-based Survey conducted in 2020. The dependent variable as smartphone overdependence, while the main exposure of interest was mental health, encompassing generalized anxiety disorder (GAD), perceived stress, sources of perceived stress, perceived loneliness, and perceived depressive symptoms. The study employed the Rao-Scott chi-square test and multiple logistic regression using IBM SPSS version 26.0. RESULTS: The participants comprised 54,948 adolescents aged 13 to 18 years. Among them, 25.1% (n=13,775) were categorized as smartphone overdependence group. Specifically, 20.3% of adolescents who reported GAD ≥10 and 22.5% of those who reported experiencing high levels of perceived loneliness were identified as smartphone overdependent. The GAD increased a risk of smartphone overdependence by 2.61 times (95% confidence interval [95% CI]: 2.46-2.77). Perceived loneliness was associated with 1.98-fold (95% CI: 1.87-2.09) increased risk of smartphone overdependence. Additionally, conflict with peers was found to increase the risk of smartphone overdependence by 4.63-fold (95% CI: 3.89-5.52), followed by conflict with parents (odds ratio [OR]: 4.52, 95% CI: 3.84-5.31), and family environment (OR: 4.52, 95% CI: 3.75-5.46). CONCLUSION: The findings underscore a significant association between smartphone overdependence and mental health in Korean adolescents. Healthcare services to improve their emotional coping and interpersonal skills are necessary.