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Objective: Map the current literature investigating autonomy development, identity development, and peer relationships in young people aged 10-24 years with chronic pain.Methods: A scoping review method was used to systematically search four databases (APA PsycNET, PubMed, Web of Science, and Cinahl) for peer-reviewed articles. Search results were screened against inclusion and exclusion criteria to ensure they met the objective. Eligible papers were assessed for quality, their data relating to the objective were extracted, and results are synthesized.Results: Searches returned 3,815 papers after the removal of duplicates, with 42 papers included in the full review. The majority of papers investigated peer relationships (86%). Fewer papers investigated autonomy (43%) and identity (21%) development. Included papers were mostly quantitative (64%), with fewer qualitative (34%) and mixed-methods papers (2%). Overall, we found bidirectional relationships between chronic pain in young people, their social development, and a range of functional outcomes. However, the mechanisms underlying these relationships remain relatively unexplored.Conclusions: Review results are mapped onto the model proposed by Palermo et al. (2014). Guided by this model, clinical treatment for young people with chronic pain should consider social development. The model also sets out a future research agenda focused on exploring: (a) identity development, (b) the mechanisms underlying the relationships between social-developmental domains, pain, and outcomes, (c) a variety of participants and populations, and (d) a variety of methods, including longitudinal study designs. [ABSTRACT FROM AUTHOR]

Introduction Cancer in adolescence raises unique challenges for all involved. In healthy populations, the transition from childhood to adulthood is seen as a normal phase of the human life course focused primarily on the process of identity formation. For young people diagnosed with cancer, there are specific, negative impacts to consider. In this paper, the impact on intimacy, body image, and sexuality are discussed and the need for innovative supportive solutions highlighted. Aim Based on a presentation given at the ISSM conference in Washington, DC, the paper describes the challenges in providing effective supportive care in relation to sexuality in young people surviving cancer. Main Outcome Measures Discussion of key issues involved when developing psychosexual interventions for this age group. Methods A scan of available evidence was combined with examples of recent service and research developments. Results The limited amount of available research belies the complexity of providing effective supportive care in relation to sexuality for young people both during and after cancer. As the number of long-term survivors of cancer during childhood and adolescence increases, there will be increasing demand for attention to be paid to the supportive care needs of this population; including issues of relationships and sexuality. Two examples of novel interventions are presented. Conclusions Services provided for cancer survivors must consider the unique challenges facing different age groups. For young people diagnosed during adolescence and young adulthood there is a need to enhance the evidence base, and to apply this evidence in practice contexts. Locating the need for further developments within a Complex Intervention Framework may assist in the development of interventions that can be developed and tested in a logical, step-wise fashion. [ABSTRACT FROM AUTHOR]

The majority of the literature focused on whether consent should be extended to the adolescent population arises from themes adapted from American tort law. In contrast to the USA, Ontario does not delineate an age of consent for medical treatment and relying on American guidelines to guide practice in Ontario is problematic. While the literature is saturated with discussions for and against seeking adolescent consent, there are currently no bioethical guidelines on adolescent consent in the province of Ontario. This paper explores adolescent refusal of care and adolescent request for care in opposition to parental wishes. The paper seeks to answer the following questions: What is the difference between an adolescent and an adult in medical decision-making? What are the barriers to seeking adolescent consent? And, can the neurobiological argument be an accurate guide for obtaining adolescent consent? [ABSTRACT FROM AUTHOR]

The article comments on a research paper on puberty suppression with gonadotropin-releasing hormone agonists in transgender and gender-diverse (TGD) youth. Topics discussed include a background on mental health in TGD youth, the use of language for medical professionals in an affirming practice setting, and suppression of puberty in TGD youth.

Intimate partner violence (IPV) remains a widespread global phenomenon. Among various factors, a low level of education is considered a significant risk factor for experiencing IPV. This paper evaluates whether a secondary school stipend program introduced in 1994 for rural girls affected the long-term prevalence of IPV in Bangladesh. The study exploits two sources of variation in the intensity of program exposure and geographic eligibility and finds that cohorts of rural women eligible for the program experienced significant declines in IPV. Evidence on mechanisms suggests that the program delayed marriage formation and changed partner quality, namely their education and employment, consistent with positive assortative matching resulting from women's improved educational attainment. There are no significant changes in labor market outcomes, decision making within the household, or women's attitude toward the acceptability of domestic violence. Marital matches present a plausible channel through which the program reduces the risk of IPV. [ABSTRACT FROM AUTHOR]

This paper uses a dynamic latent factor model to investigate the determinants of not in education, employment or training (NEET) status among adolescents in the United Kingdom. We bring together within one framework various determinants of NEET status, such as educational achievements, non‐cognitive skills, family socio‐economic factors, aspirations, mental health and local labour market conditions. We model the educational progress over multiple periods through the life of the young person, up to the completion of compulsory schooling. By taking into account this progression, we can determine the direct and indirect impacts of different determinants of NEET status, and the stage in the life of the young person at which each determinant is important. Our findings suggest that cognitive ability (as measured by educational achievements) remains the key predictor of NEET status. Further, while a range of individual and family factors determines NEET status, the impact of most of these factors is largely indirect, through ability formation and not necessarily direct. To gauge the relative contributions of various determinants, we conduct simulations to predict the probability of the young person being NEET under different scenarios and assumptions. The exercise indicates that the effects of aspirations of the young person, their school engagement, and the local youth unemployment rate on the likelihood of the young person being NEET are as large as boosting their cognitive skills. [ABSTRACT FROM AUTHOR]

Social media applications are used daily by billions to communicate. Adolescents living in state care are no different, yet the potential implications of their social media use are. Despite the global use of social media and evidence highlighting their role in social capital cultivation, how adolescents living in state care make use of social media remains unknown, with discussions tending to focus exclusively on risk. Using data from a four-year Digital Life Story Work (DLSW) research programme, this paper explores adolescents' and social care professionals' (n =45) perspectives on the everyday use of social media by adolescents living in state care. Using an ethnographic multi-method approach, extracts of conversations from the four English residential homes engaged in the DLSW programme were thematically analysed. Three major themes emerged; contacts as currency, promoting and protecting the self and transitions. Analysis illustrates how adolescents living in state care use social media as active digital agents and the need to reframe this usage to enable benefits to be enacted. The paper concludes that urgent research is needed to enable practitioners and policy makers to show a deeper appreciation of the potentials of social media, enabling a more balanced approach to succeed in practice. [ABSTRACT FROM AUTHOR]

This paper examines the development of the impact of family background on young people's political engagement during adolescence and early adulthood in order to test a number of hypotheses derived from the impressionable years and family socialization perspectives. The study analyses data of the British Household Panel Study and Understanding Society to assess these hypotheses. Political interest and voting intentions are used as outcomes of political engagement. The study finds parental education to have no effect on initial levels of these outcomes at age 11 but to be positively related to the change in these outcomes between ages 11 and 15. This indicates that the effect of parental education becomes stronger over time and that social disparities in political engagement are widening significantly during early adolescence. In contrast, parental political engagement is positively related to initial levels of voting intentions at age 11 but not related to the change in voting intentions between ages 11 and 15, which supports the hypothesis drawn from the family socialization perspective. Neither parental education nor parental political engagement are related to post-16 changes in political engagement. These results point to early adolescence as a crucial period for the manifestation of social inequalities in political engagement. They provisionally suggest that the influence of parental education runs through educational conditions in lower secondary and that these conditions could play an important role in amplifying the said inequalities. [ABSTRACT FROM AUTHOR]

Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disorder affecting the skeleton of children and adolescents. Whole-body MRI (WBMRI) is key in the diagnosis and follow-up of CRMO. Imaging protocols should include sagittal short Tau inversion recovery of the spine, imaging of the hands and feet, and T1 images for distinguishing normal bone marrow. CRMO lesions can be metaphyseal, epiphyseal and physeal—potentially causing growth disturbance and deformity. Spinal lesions are common, important and can cause vertebral collapse. Lesion patterns include multifocal tibial and pauci-focal patterns that follow a predictable presentation and course of disease. Common pitfalls of WBMRI include haematopoietic marrow signal, metaphyseal signal early on in bisphosphonate therapy and normal high T2 signal in the hands and feet. Pictorial reporting assists in recording lesions and follow-up over time. The purpose of this paper is to review the different WBMRI protocols, imaging findings, lesion patterns and common pitfalls in children with CRMO [ABSTRACT FROM AUTHOR]

Adolescence is an essential stage of life for developing actions related to health promotion, especially in health education (HE). Public policies advocate for the expansion of participative technologies in this field, as well as different theoretical and methodological perspectives subsidize these. Among these, Paulo Freire's reference guide is practiced in Brazil and around the world. From the Freirean perspective, Thematic Investigation (TI) defines the content of the educational practice. This paper describes a methodological proposal of the Freirean Thematic Investigation for developing health educational practices and promoting health among adolescents. Initially, we describe the conception of the Freirean rationale that sets the grounds for the proposed method: human being, dialogical education and reality and their connections with HE with adolescents in a critical perspective. The methodological proposal is systematized into five stages: (i) Approaching adolescents and the field of educational practices; (ii) Reading reality; (iii) Seminars for analyzing reality reading and preparing the codifications; (iv) Critical analysis of reality; and (v) Planning educational practices. The TI confronts the adult-centric perspectives that characterize adolescent health care. Moreover, as a praxis, TI is a process of reflection and action with adolescents, allowing for not only the discovery of the themes that build educational practices but also for solutions (untested feasibility) for the individual and collective problems experienced by adolescents concerning their health. [ABSTRACT FROM AUTHOR]

The purpose of the current study is to examine the relationship between polyvictimization, school social climate, and depression in adolescents. Authors also looked at whether school social climate acts as a moderator of the interaction between polyvictimization and depressive symptoms. Furthermore, to have a deeper analysis, they included—as control variables—factors that have been shown in previous research to have an impact on depression, including age, gender discrimination, family support, and mood control. In total, 411 Chilean adolescents participated in the study from public (72.2 percent), semiprivate (17.4 percent), and private schools (10.4 percent). Four paper-based instruments were used to measure school social climate, depression, family support, and polyvictimization, and additional information was solicited with a sociodemographic data questionnaire. Regression analysis showed that both polyvictimization (β =.10, p =.03) and school social climate (β = –.10, p =.03) were predictors of depressive symptomatology. However, the interaction between polyvictimization and school social climate was not significant (β =.07, p =.73). [ABSTRACT FROM AUTHOR]

This paper presents empirical and methodological findings from an art-based, participatory process with a group (n  = 16) of adolescent and young advisors in the Western Cape Province of South Africa. In a weekend workshop, participants reflected on their participation in 12 years of health and development-related research through theatre, song, visual methodologies and semi-structured interviews. Empirical findings suggest that participants interpreted the group research encounter as a site of empowerment, social support and as a socio-political endeavour. Through song, theatre and a mural illustration, they demonstrated that they value 'unity' in research, with the aim of ameliorating the conditions of adolescents and young people in other parts of South Africa and the continent. Methodological findings document how participants deployed art-based approaches from South Africa's powerful history of activism, including the struggle against apartheid, the fight for anti-retroviral therapy and more recent social movements towards decolonization. [ABSTRACT FROM AUTHOR]

Background Preventative interventions may be effective in reducing and preventing symptoms of mental ill health in children and young people. However, there is a paucity of research in this area that explores the views of young people. This paper reports on a qualitative study to inform the future development of attractive and appropriate early and preventative school-based mental health interventions. Methods Semi-structured interviews were conducted with a purposive sample of 12 young people aged 14–17 in North East England. Interviews were audio-recorded, transcribed, anonymised and analysed following a thematic approach. Results Four key themes were identified, relevant to those providing, designing and commissioning early and preventative mental health interventions in schools: 'mental health literacy', 'risk factors for wellbeing decline', 'experience of school-based support' and 'recommendations for future support'. Conclusions Young people have varying levels of mental health literacy, but are able to identify academic stress, bullying and the transition from primary to secondary school as leading causes of worry. Young people want more regular and in-depth mental health education, tailored levels of support in school and improved training for teachers. [ABSTRACT FROM AUTHOR]

Objectives Previous research in the United States suggests contextual income mobility may play a role in explaining the disparities between life expectancy in the United States and peer countries. This article aims to extend previous research by estimating the consequences of average individual exposure to mobility regimes during childhood and adolescence on adult health. Methods This study draws its data from two longitudinal datasets that track the county of residence of respondents during childhood and adolescence, the Panel Study of Income Dynamics and the National Longitudinal Survey of Youth 1997. We implement marginal structural models to assess the association of the average exposure to county income mobility on five health outcomes and behaviors. Results The results are only partially consistent with a systematic association between exposure to income mobility and health outcomes. Evidence obtained from the National Longitudinal Survey of Youth suggests less income mobility might increase the probability of smoking by age 30. Discussion The paper provides a precise assessment of the hypothesis that childhood exposure to income mobility regimes may influence health status through behavior later in life and contribute to longevity gaps. Only partial evidence on smoking suggests an association between income mobility and health, so we discuss potential reasons for the disparities in results with previous research. [ABSTRACT FROM AUTHOR]

To prepare for the development of the 2021 Centers for Disease Control and Prevention (CDC) sexually transmitted infections treatment guidelines, the CDC convened a committee of expert consultants in June 2019 to discuss recent abstracts and published literature on the epidemiology, diagnosis, and management of sexually transmitted infections.This paper summarizes the key questions, evidence, and recommendations for the diagnosis and management of uncomplicated Chlamydia trachomatis (CT) infections in adolescents and adults that were reviewed and discussed for consideration in developing the guidelines. The evidence reviewed mostly focused on efficacy of doxycycline and azithromycin for urogenital, rectal, and oropharyngeal CT infection, CT risk factors in women, performance of CT nucleic acid amplification tests on self-collected meatal specimens in men, and performance of newer CT point-of-care tests. [ABSTRACT FROM AUTHOR]

Background To address social inequalities in adolescent substance use and consequent disparities in health, it is important to identify the mechanisms of the association between substance use and academic performance. We study the role of health literacy (HL) in the association between academic performance and weekly smoking, monthly alcohol use and cannabis ever-use among adolescents in Europe. Methods SILNE-R school survey data, which was collected in 2016–17 with paper-and-pencil-method from Hanover (GE), Amersfoort (NL) and Tampere (FI), were used (N  = 5088, age 13–19). Health Literacy for School-aged Children instrument was used to assess students' HL. Logistic regression analyzed the association of substance use with academic performance and HL, separately and in the same model. Linear and multinomial logistic regression analyzed the association between academic performance and HL. Results Poor academic performance compared with high was associated with smoking [odds ratio (OR) 3.94, 95% confidence interval (CI) 2.83–5.49], alcohol use (OR: 2.94, 95% CI: 2.34–3.68) and cannabis use (OR: 2.56, 95% CI: 1.89–3.48). Poor HL was also associated with each substance use (with ORs of 2.32, 1.85 and 1.29). HL was positively associated with academic performance (β = 1.04, 95% CI: 0.89–1.20). The associations between academic performance and substance use were only slightly attenuated after controlling for HL. Conclusions Academic performance and HL were both determinants of substance use, confirming their role in tackling the disparities in substance use. However, HL did not demonstrably mediate the association between academic performance and substance use. A wider set of factors needs to be tackled to address emerging social inequalities in adolescent substance use. [ABSTRACT FROM AUTHOR]

Adolescents on the autism spectrum may experience challenges with multiple domains of communication that impact their quality of life. Both music therapists and speech-language pathologists (SLPs) implement activities to address these challenges. Empirical evidence suggests that incorporating music into treatment can be an effective way to improve communication. The purpose of this article is to provide suggestions for music therapists assisting adolescents on the autism spectrum to improve their communication skills and ways to collaborate with SLPs in doing so. In this paper, we discuss interprofessional collaborative models (e.g. interdisciplinary, transdisciplinary) and competencies (e.g. coordination, adaptability), as well as music-based clinical experiences that appeal to adolescents, and target improvement of communication skills for learners with complex communication needs. [ABSTRACT FROM AUTHOR]

A systematic review and narrative synthesis to determine the effectiveness of contraception service interventions for young people delivered in health care premises was undertaken. We searched 12 key health and medical databases, reference lists of included papers and systematic reviews and cited reference searches on included articles. All retrieved literature was screened at title and abstract levels, and relevant articles were taken through to full paper appraisal. Data relating to study design, outcomes and quality were extracted by one reviewer and independently checked by a second reviewer. We included interventions that consisted of contraceptive service provision for young people, and also interventions to encourage young people to use existing contraceptive services. The searches identified 23 studies that met the inclusion criteria. The papers focused on: new adolescent services, outreach to existing services, advanced provision of emergency contraception, condom/contraceptive provision and advice and repeat pregnancy prevention. The literature in general is not well developed in terms of good quality effectiveness studies and key outcome measures. However, it is possible to make recommendations in terms of outreach versus targeted young people’s services in health care settings, advanced provision of emergency contraception and long-acting reversible contraception to prevent repeat adolescent pregnancy. [ABSTRACT FROM PUBLISHER]

Background While tobacco smoking has declined among UK youth in recent decades, cannabis use has begun to show some growth. Given their interrelationship, growth in cannabis use may act as a barrier to continued reduction in youth smoking. This paper assesses recent tobacco and cannabis use trends in Wales, and their association, to explore whether change in cannabis use might have impacted youth tobacco smoking prevalence. Methods Repeat cross-sectional data on tobacco and cannabis use were obtained from biennial Welsh Student Health and Wellbeing surveys between 2013 and 2019. Data were pooled and analysed using logistic regression with adjustment for school-level clustering. Results No change in regular youth tobacco smoking was observed between 2013 and 2019. In contrast, current cannabis use increased during this time, and cannabis users had significantly greater odds of regular tobacco smoking. After adjusting for change in cannabis use, a significant decline in youth tobacco smoking was observed (OR 0.95; 95% confidence intervals: 0.92, 0.97). Conclusion Recent growth in cannabis use among young people in Wales may have offset prospective declines in regular tobacco smoking. Further reductions in youth smoking may require more integrated policy approaches to address the co-use of tobacco and cannabis among adolescents. [ABSTRACT FROM AUTHOR]

Background: This article presents the scope and development of the Health Behaviour in School-aged Children (HBSC) study, reviews trend papers published on international HBSC data up to 2012 and discusses the efforts made to produce reliable trend analyses. Methods: The major goal of this article is to present the statistical procedures and analytical strategies for upholding high data quality, as well as reflections from the authors of this article on how to produce reliable trends based on an international study of the magnitude of the HBSC study. HBSC is an international cross-sectional study collecting data from adolescents aged 11-15 years, on a broad variety of health determinants and health behaviours. Results: A number of methodological challenges have stemmed from the growth of the HBSC-study, in particular given that the study has a focus on monitoring trends. Some of those challenges are considered. When analysing trends, researchers must be able to assess whether a change in prevalence is an expression of an actual change in the observed outcome, whether it is a result of methodological artefacts, or whether it is due to changes in the conceptualization of the outcome by the respondents. Conclusion: The article present recommendations to take a number of the considerations into account. The considerations imply methodological challenges, which are core issues in undertaking trend analyses. [ABSTRACT FROM AUTHOR]

Background: Consistent evidence shows the importance of preventing smoking at young ages, when health behaviours are formed, with long-term consequences on health and survival. Although tobacco control policies and programmes targeting adolescents are widely promoted, the cost-effectiveness of such interventions has not been systematically documented. We performed a systematic review on the cost-effectiveness of policies and programmes preventing tobacco consumption targeting adolescents. Methods: We systematically reviewed literature on the (i) cost and effectiveness of (ii) prevention policies targeting (iii) smoking by (iv) adolescents. PubMed, Web of Science, Cochrane, CEA-TUFTS, Health Economic Evaluations, Wiley Online Library, Centre for Reviews and Dissemination Database, the National Institute for Health and Care Excellence and Google Scholar databases were used, and Google search engine was used for other grey literature review. Results: We obtained 793 full-text papers and 19 grey literature documents, from which 16 studies fulfilled the inclusion criteria. Of these, only one was published in the last 5 years, and 15 were performed in high-income countries. Eight analyzed the cost-effectiveness of school-based programmes, five focused on media campaigns and three on legal bans. Policies and programmes were found to be cost-effective in all studies, and both effective and cost-saving in about half of the studies. Conclusions: Evidence is scarce and relatively obsolete, and rarely focused on the evaluation of legal bans. Moreover, no comparisons have been made between different interventions or across different contexts and implementation levels. However, all studies conclude that smoking prevention policies and programmes amongst adolescents are greatly worth their costs. [ABSTRACT FROM AUTHOR]

The 1950s–1970s Chinese send-down movement can be treated as a natural experiment to study the impact of adolescent exposure on subsequent health. This paper used data from the China Family Panel Studies 2010 to evaluate the long-term impact of the Chinese send-down movement on individual health later in life. Drawing from the life-course perspective, results from difference-in-differences models suggested that the send-down experience had a significant impact on worse self-rated health; the pathways from structural equation models showed that subsequent achievements—age of marriage and educational attainment—had mediating effects linking the send-down experience to worse self-rated health and better mental health, respectively. Taken together, our results highlight the roles of the send-down experience and post–send-down characteristics in shaping health outcomes later in life. [ABSTRACT FROM AUTHOR]

The human cerebral cortex undergoes profound structural and functional dynamic variations across the lifespan, whereas the underlying molecular mechanisms remain unclear. Here, with a novel method transcriptome-connectome correlation analysis (TCA), which integrates the brain functional magnetic resonance images and region-specific transcriptomes, we identify age-specific cortex (ASC) gene signatures for adolescence, early adulthood and late adulthood. The ASC gene signatures are significantly correlated with the cortical thickness (P -value <2.00e-3) and myelination (P -value <1.00e-3), two key brain structural features that vary in accordance with brain development. In addition to the molecular underpinning of age-related brain functions, the ASC gene signatures allow delineation of the molecular mechanisms of neuropsychiatric disorders, such as the regulation between ARNT2 and its target gene ETF1 involved in Schizophrenia. We further validate the ASC gene signatures with published gene sets associated with the adult cortex, and confirm the robustness of TCA on other brain image datasets. Availability: All scripts are written in R. Scripts for the TCA method and related statistics result can be freely accessed at https://github.com/Soulnature/TCA. Additional data related to this paper may be requested from the authors. [ABSTRACT FROM AUTHOR]

Developing meaningful indicators to track youth mental health (MH) is important to support the development and evaluation of responsive mental health promotion (MHP) initiatives that address the socio-economic determinants of youth MH. Development of relevant indicators is challenged, however, by the lack of knowledge regarding the relations among socio-economic factors and youth MH. Thirty diverse young people from a Canadian metropolitan area were engaged within a process of social praxis to explore their experiences of the inter-relationship between their socio-economic environments and their MH and their processes of seeking to realize their MH. Participants emphasized 'needs' as foundational to MH, whereas 'wants', driven by materialistic and wealth-oriented values and social norms, constrained their MH. Their reflections on the inter-relations among their MH and socio-economic processes highlight eight inter-related MH needs within the Canadian socio-economic context. In this paper, we present these needs and show how these needs, young people's affective states, and their access to resources within co-evolving socio-economic processes (to enable their needs) illustrate the fundamental inter-relation between young people's MH and socio-economic processes. We identify implications for measuring youth MH within MHP practice, including the importance of iterative indicator frameworks that include measures of young people's access to resources to enable their MH needs and their degree of distress. [ABSTRACT FROM AUTHOR]

Background This paper studies the evolution of transitions from first cigarette use to daily use by socioeconomic status (SES) among French adolescents over the course of 17 years, in a context of decreasing prevalence of tobacco use. Methods A total of 182 266 adolescents participated in the nationally representative ESCAPAD survey at nine different time points between 2000 and 2017. Discrete time-event analysis was used to model the transition to daily cigarette use as a function of SES, gender, age at onset and the use of other psychoactive substances. Results Although lifetime cigarette smoking and daily cigarette smoking decreased significantly over the studied time span, suggesting a positive impact of prevention policies, disadvantaged adolescents were consistently more prone to engage in daily cigarette smoking, more so in 2017 than 15 years earlier. In the same time span, transitions from initiation to daily cigarette smoking have shortened, with an accelerated pace among underprivileged adolescents. Conclusions Accelerated transitions from initiation to daily cigarette use are a prevalent trend among disadvantaged adolescents in France. Efforts to mitigate the impact of marketing strategies and to promote health literacy should be pursued to reduce social inequalities in health. [ABSTRACT FROM AUTHOR]

This paper has the following aims: (i) to explore the extent to which students who received an intervention involving HIV/AIDS and sexuality perceived that their teacher cared for their health and well-being, (ii) to investigate the characteristics of students who reported to have caring teachers and (iii) to document the association between students’ perceptions of care and reported onset of sexual activity. Data were obtained from the second follow-up survey of a prospective study carried out among high school students in South Africa (Cape Town and Mankweng). We analyzed data from 3483 students who met the inclusion criteria. Students from the intervention group perceived greater care from teachers than students in the control group. Female students and students from Cape Town perceived having received more care, and their perception of care was associated with the number of lessons received, how often students expressed their opinions in class and how often teachers talked about HIV/AIDS, condoms and abstinence. Students who perceived that their teacher cared for their health and well-being were less likely to initiate sexual intercourse. This is the first paper to demonstrate the salience of the concept of care in studies of school-based HIV/AIDS prevention programs in sub-Saharan Africa. [ABSTRACT FROM PUBLISHER]

Background The major risk factors driving the global burden of disease are diet related. Adolescence presents a window of opportunity for establishing healthy dietary trajectories. Yet around the world, adolescents experience many barriers that prevent them from consuming diets that would give them the foundation for long, healthy and productive adult lives. Sources of data A narrative literature search of most relevant original, review and meta-analyses, restricted to English was conducted in Medline, Web of Science and PubMed up to December 2019 together with published papers known to the author concerning the current dietary advice and challenges for adolescent nutrition. Areas of agreement Adolescence is a critical period of growth and development and adequate nutrition is essential. Sufficient population data indicate adolescents are not meeting dietary recommendations and are a vulnerable population group for malnutrition in all its forms. Areas of controversy Despite extensive studies on dietary risk factors and the global burden of disease and population data demonstrating inadequate nutritional intake in adolescent populations, few effective interventions and policies have been scaled up to support adolescent nutrition. Growing points Improving the diets of adolescents, especially vulnerable adolescents from low- and middle-income countries and socioeconomically disadvantaged backgrounds, has the potential to impact individuals, societies and economies. Areas timely for developing research Future research should focus on vulnerable adolescent populations by addressing food environments, food insecurity and ensuring effective programmes and strategies are integrated within broader adolescent health strategies and implemented into government policies. [ABSTRACT FROM AUTHOR]

The article comments on the papers that evaluated the smoking prevention project in Europe. Jackie Green, professor at Leeds Metropolitan University, said that the papers made a valuable contribution to the people's understanding of smoking in adolescence. Lilian Lechner, professor at Open University of the Netherlands, commented that the papers mentioned goals, objectives, and methods without describing them.

This paper examines how primary care can improve for teenagers who are experiencing mental or emotional turmoil. This is an important health issue because at least 15% of teenagers experience mental health problems at any one time, there are indications that this proportion is rising, and there is evidence that suicide rates are rising in young people. The paper discusses how troubled teenagers can be identified, cared for and managed by primary care providers within the UK, although some of the information presented is from other countries. It identifies inter-relationships with other health behaviours and risk factors. The GP's role in assessing a troubled teenager is discussed, as well as a consideration of individual and contextual issues to frame a ‘triple’ diagnosis, i.e. a diagnosis simultaneously in biomedical, individual and contextual terms. A review of present knowledge of management is presented. The paper concludes that there are several deficiencies at present, namely a lack of identification of teenage distress, a lack of training for GPs in teenage health, a lack of a research base, a lack of resources and finally a lack of information provided by any teenagers who have experienced turmoil and could give useful insights into their experience. [ABSTRACT FROM PUBLISHER]

The implementation of school-based obesity-prevention programs is understudied. Kids SIP smart ER is a 6-month, school-based, behavioral intervention for Appalachian middle school students and includes a teacher implementation strategy. Kids SIP smart ER effectively reduced students' sugar-sweetened beverages (SSB) when Researcher-Led. However, Teacher-Led effectiveness and fidelity are unknown. To explore the relative SSB effects when Kids SIP smart ER was Researcher-Led versus Teacher-Led and to examine teacher fidelity. This study of secondary outcomes used a quasi-experimental analytic approach of a Hybrid Type 1 effectiveness–implementation and cluster randomized controlled tria (RCT) of Kids SIP smart ER. Student SSB behaviors and teacher self-rated fidelity were assessed, respectively, with the validated Beverage Intake Questionnaire (BEVQ-15) and lesson-specific checklists. Analyses included descriptive statistics and modified two-part models with time-fixed effects and school-year cohort cluster controls. The analytic sample included students from six control schools (n = 220), six Researcher-Led intervention schools (n = 306), and five Teacher-Led intervention schools (n = 218), as well as eight teachers. Teacher-Led intervention students decreased SSB by −14.3 ounces/day (95% confidence interval = −15.4, −13.2; P <.001). Relative to control and to Researcher-Led intervention, the Teacher-Led treatment effect among students was −11.6 ounces SSB/day (P <.001, effect size = 0.75) and −4.3 (P =.004, effect size = 0.25), respectively. Teachers returned fidelity checklists for 90% of planned lessons. Fidelity averaged 94% (SD = 4.0%) among returned forms and 85% (SD = 18.9%) when missing forms were counted as zeros. Teachers can implement Kids SIP smart ER with high fidelity and produce statistically and clinically meaningful improvements in students' SSB behaviors. Findings have implications for the sustained implementation of Kids SIP smart ER and other school-based obesity-prevention programs. Clinical Trial information : NCT03740113. [ABSTRACT FROM AUTHOR]

Background: There is evidence that mental health problems are increasing and substance use behaviours are decreasing. This paper aimed to investigate recent trends in mental ill health and health-related behaviours in two cohorts of UK adolescents in 2005 and 2015.Methods: Prevalences in mental health (depressive symptoms, self-harm, anti-social behaviours, parent-reported difficulties) and health-related behaviours (substance use, weight, weight perception, sleep, sexual intercourse) were examined at age 14 in two UK birth cohorts; Avon Longitudinal Study of Parents and Children (ALSPAC, N = 5627, born 1991-92) and Millennium Cohort Study (MCS, N = 11 318, born 2000-02). Prevalences and trend estimates are presented unadjusted and using propensity score matching and entropy balancing to account for differences between samples.Results: Depressive symptoms (9% to 14.8%) and self-harm (11.8% to 14.4%) were higher in 2015 compared with 2005. Parent-reported emotional difficulties, conduct problems, hyperactivity and peer problems were higher in 2015 compared with 2005 (5.7-8.9% to 9.7-17.7%). Conversely, substance use (tried smoking, 9.2% to 2.9%; tried alcohol, 52.1% to 43.5%, cannabis, 4.6% to 3.9%), sexual activity (2% to 0.9%) and anti-social behaviours (6.2-40.1% to 1.6-27.7%) were less common or no different. Adolescents in 2015 were spending less time sleeping (<8 h 5.7% to 11.5%), had higher body mass index (BMI) (obese, 3.8% to 7.3%) and a greater proportion perceived themselves as overweight (26.5% to 32.9%). The findings should be interpreted bearing in mind limitations in ability to adequately harmonize certain variables and account for differences in attrition rates and generalizability of the two cohorts.Conclusions: Given health-related behaviours are often cited as risk factors for poor mental health, our findings suggest relationships between these factors might be more complex and dynamic in nature than currently understood. Substantial increases in mental health difficulties, BMI and poor sleep-related behaviours highlight an increasing public health challenge. [ABSTRACT FROM AUTHOR]

Background: In prominent international documents and professional position papers, confidentiality was recognized as a necessary condition for effective reproductive healthcare of adolescents. Although legally guaranteed, it is questionable if the right to confidentiality of adolescents is respected in healthcare practice in Serbia.Objectives: To assess primary care physicians' perspectives on the legal right of minors to confidentiality in sexual and reproductive healthcare, as well as their experiences in practice.Methods: Qualitative, semi-structured face-to-face interviews with 12 primary care pediatricians and gynecologists at several municipalities of the city of Belgrade were performed. Interview transcripts were analyzed using qualitative content analysis method.Results: Most interviewees were aware of their legal obligations and support the general idea of granting adolescents the right to confidentiality. They recognized that the lack of confidentiality assurances prevents adolescents' access to sensitive care. However, physicians expressed concerns regarding medical situations when parents should be notified, which was reflected in their inconsistent respect of said right in actual practice. Several organizational obstacles were emphasized by interviewees, including insufficient number of physicians, time constraints, poor access to gynecological services and vague definitions of legal provisions.Conclusion: If the aim is for adolescents' right to confidentiality to be consistently respected in practice, primary care physicians need to be systematically educated about legal provisions and given comprehensive clinical guidelines. The general positive attitude towards confidentiality expressed by the primary care physicians implies that a possibility exists to engage them as main advocates for improvements in access to the necessary health care. [ABSTRACT FROM AUTHOR]

This paper argues for a re-examination of mental health responses to refugee youth seeking asylum in high-income countries. Reviewing international literature related to mental health and social care services for refugee children and youth and drawing upon Foucault's concepts of power, truth and discourse, we explore and question the predominance of the bio-medical model in responding to refugee children's distress. We demonstrate that, despite notable initiatives and developments in social work theory and practice, the bio-medical model has, in many ways, become a 'regime of truth', with the power to define refugees' problems and thus shape the policies and services that affect their lives. While not denying that many refugee youth and their families may benefit from such therapeutic interventions, it is our contention that working with this population requires a significant expansion, diversification and transformation of the current paradigm informing social work practice to incorporate the multiple and unique cultures and contexts of this population. We conclude with a discussion of promising practices and interventions with refugee youth and families. [ABSTRACT FROM AUTHOR]

Research shows that young people in the mental health sector may use music in ways that support their well-being, and sometimes in ways that result in feeling worse. A Healthy-Unhealthy Uses of Music Scale has been designed and validated to identify uses of music that intensify negative moods or rumination. In this paper we present a practice-based study, designed to examine the value of integrating the HUMS questions into brief music therapy interventions with young people receiving mental health support. We piloted integration of the HUMS into individual single-session music therapy with 23 young people in an acute youth mental health inpatient unit. Metric data from the HUMS were analyzed using quantitative strategies, and written answers to the questions were compared to identify patterns. Results suggested that there was no significant between-diagnosis difference in healthy and unhealthy uses of music. Young people described a range of benefits from the sessions, and these have been considered in relation to music therapy practice. Based on the findings, we offer four recommendations about the use of the HUMS questions for clinicians. We also discuss particular groups of young people for whom this approach might be relevant, as well as limitations of using the HUMS as a screening tool. [ABSTRACT FROM AUTHOR]

Relationships with media figures—referred to as parasocial relationships—provide a means for adolescents to explore and define their romantic and sexual identities (Boon & Lomore, 2001 ; Engle & Kasser, 2005 ; Karniol, 2001). However, more often than not, adolescents’ romantic attachments to media figures are ignored or dismissed as frivolous in the scholarly literature on youth development (Caughey, 1984 ; Jenkins, 1992 ; Willis, 1972). In this paper, we introduce a theoretical model of adolescent romantic parasocial attachment (ARPA) designed to facilitate a comprehensive, developmentally-based line of research that improves our understanding of the ways adolescents experience parasocial romance and the influence their experiences may have on their lives. Implications for the study of adolescent romantic development and future research directions are proposed. [ABSTRACT FROM AUTHOR]

Adaptive and adequately resourced health systems are necessary to achieve good health outcomes in post-conflict settings, however domains beyond the health system are also critical to ensure broader wellbeing. This paper focuses on the importance of psychosocial support services for adolescent girls in fragile contexts. Its starting point is that adolescence is a pivotal time in the life course but given the physical, cognitive and emotional changes triggered by the onset of puberty, it can also be a period of heightened sensitivity and vulnerability to trauma, social isolation, bullying by peers, a lack of supportive adults and gender-based and sexual violence. Our findings highlight why humanitarian and biomedical approaches in their current form are inadequate to address these complexities. Drawing on qualitative fieldwork (consisting of in-depth and key informant interviews as well as group discussions in Gaza, Liberia and Sri Lanka involving a total of 386 respondents across the three countries), we argue that going beyond biomedical approaches and considering the social determinants of health, including approaches to tackle discriminatory gendered norms and barriers to service access, are critical for achieving broader health and wellbeing. While all three case study countries are classified as post-conflict, the political economy dynamics vary with associated implications for experiences of psychosocial vulnerabilities and the service environment. The study concludes by reflecting on actions to address psychosocial vulnerabilities facing adolescent girls. These include: tailoring services to ensure gender and age-sensitivity; investing in capacity building of service providers to promote service uptake; and enhancing strategies to regulate and coordinate actors providing mental health and psychosocial support services. [ABSTRACT FROM AUTHOR]

Stress and strain among adolescents have been investigated and discussed largely within three separate disciplines: mental health, where the focus has been on the negative effects of stress on emotional health; criminology, where the emphasis has been on the effects of strain on delinquency; and biology, where the focus has been to understand the effects of stress on physiology. Recently, scholars have called for increased multilevel developmental analyses of the bio-psychosocial nature of risk and protection for behaviors of individuals. This paper draws on several different but converging theoretical perspectives in an attempt to provide an overview of research relevant to stress in adolescence and puts forth a new framework that aims to provide both a common language and consilience by which future research can analyze the effects of multiple biological, social and environmental factors experienced during specific developmental periods, and cumulatively over time, on harmful behavior during adolescence. We present a framework to examine the effects of stress on diverse behavioral outcomes among adolescents, including substance use, suicidal behavior, self-inflicted harm, and delinquency. [ABSTRACT FROM AUTHOR]

Background A compelling hypothesis about attention-deficit/hyperactivity disorder (ADHD) etiopathogenesis is that the ADHD phenotype reflects a delay in cortical maturation. Slow-wave activity (SWA) of non-rapid eye movement (NREM) sleep electroencephalogram (EEG) is an electrophysiological index of sleep intensity reflecting cortical maturation. Available data on ADHD and SWA are conflicting, and developmental differences, or the effect of pharmacological treatment, are relatively unknown. Methods We examined, in samples (M age = 16.4, SD  = 1.2), of ever-medicated adolescents at risk for ADHD (n = 18; 72% boys), medication-naïve adolescents at risk for ADHD (n = 15, 67% boys), and adolescents not at risk for ADHD (n = 31, 61% boys) matched for chronological age and controlling for non-ADHD pharmacotherapy, whether ADHD pharmacotherapy modulates the association between NREM SWA and ADHD risk in home sleep. Results Findings indicated medication-naïve adolescents at risk for ADHD exhibited greater first sleep cycle and entire night NREM SWA than both ever-medicated adolescents at risk for ADHD and adolescents not at risk for ADHD and no difference between ever-medicated, at-risk adolescents, and not at-risk adolescents. Conclusions Results support atypical cortical maturation in medication-naïve adolescents at risk for ADHD that appears to be normalized by ADHD pharmacotherapy in ever-medicated adolescents at risk for ADHD. Greater NREM SWA may reflect a compensatory mechanism in middle-later adolescents at risk for ADHD that normalizes an earlier occurring developmental delay. [ABSTRACT FROM AUTHOR]

Background Young adults in Neither in Employment, Education nor Training (NEET) are at risk of adverse labour market outcomes. Earlier studies often measured NEET status at one time point or compared persistent NEETs with non-NEETs, neglecting other patterns of NEET status. Evidence on early life factors associated with NEET patterns is lacking. This study aims to (i) identify patterns of NEET status over time and (ii) examine whether factors in childhood and adolescence are associated with these patterns. Methods Data were used from 1499 participants of the TRacking Adolescents' Individual Lives Survey (TRAILS), a Dutch prospective cohort study with 15-year follow-up. NEET status was assessed at ages 19, 22 and 26. Socioeconomic status of parents (SES), intelligence and negative life events were measured at age 11, educational attainment at age 26 and mental health problems at ages 11, 13.5 and 16. Data were analyzed using multinomial logistic regression analysis. Results Four NEET patterns were identified: (i) non-NEETs (85.2%), (ii) early NEETs (4.5%), (iii) late NEETs (5.7%) and (iv) persistent NEETs (4.5%). Reporting internalizing problems at age 11 was a risk factor for early and late NEETs [odds ratio (OR) 2.77, 95% confidence interval (CI) 1.16–6.62; OR 5.00, 95% CI 2.22–11.3, respectively]. Low parental SES, lower intelligence scores and negative life events (≥3) were risk factors for persistent NEETs (OR 4.45, 95% CI 2.00–9.91; OR 0.96, 95% CI 0.94–0.98; OR 4.42, 95% CI 1.62–12.08, respectively). Conclusions The results highlight the importance of timing and duration of NEET status and emphasize the need for tailored interventions to prevent specific NEET patterns. [ABSTRACT FROM AUTHOR]

Sustained intervention effects are needed for positive health impacts in populations; however, few published examples illustrate methods for assessing sustainability in health promotion programs. This paper describes the methods for assessing sustainability of the Lifestyle Education for Activity Program (LEAP). LEAP was a comprehensive school-based intervention that targeted change in instructional practices and the school environment to promote physical activity (PA) in high school girls. Previous reports indicated that significantly more girls in the intervention compared with control schools reported engaging in vigorous PA, and positive long-term effects on vigorous PA also were observed for girls in schools that most fully implemented and maintained the intervention 3 years following the active intervention. In this paper, the seven steps used to assess sustainability in LEAP are presented; these steps provide a model for assessing sustainability in health promotion programs in other settings. Unique features of the LEAP sustainability model include assessing sustainability of changes in instructional practices and the environment, basing assessment on an essential element framework that defined complete and acceptable delivery at the beginning of the project, using multiple data sources to assess sustainability, and assessing implementation longitudinally. [ABSTRACT FROM PUBLISHER]

This paper presents findings from a Department of Health-funded study into the emotional well-being of young people seeking asylum on their own in the UK. It discusses how young people accounted for only partly disclosing information about the circumstances surrounding their quest for asylum and subsequent aspects of their lives since arriving in the UK. Foucault's panoptic mechanism and its focus on the effects of power as dispersed through scrutiny are applied as a theoretical framework to contextualise these experiences. The paper shows that young people's decisions about how much of their current or past lives they share with others are more complex than indicated by earlier research. The paper argues that, for many young people, the predominant impetus for selective disclosure was a desire to retain a degree of agency as they navigated their way through immigration, asylum, social care, health and education systems and simultaneously sought to establish themselves in the social world. These findings have implications for how social care (and other) professionals engage and work with young people seeking asylum alone. [ABSTRACT FROM PUBLISHER]

Background: In this paper, we investigate cross-sectional and prospective relationships between various socioeconomic indicators and different health behaviours among boys and girls at ages 13-21, and whether socioeconomic status (SES) is related to changes in health behaviour over time. Methods: The study is based on a 10-year, two-generation prospective cohort study of health and lifestyle factors among a sample of Norwegian adolescents and their parents. Data presented here were collected at the ages of 13 (baseline), 15, 18 and 21. Parental and adolescent reports of socioeconomic factors were assessed along with a number of health-enhancing and health-compromising behaviours, both as single behaviours and as part of health behaviour indices. Results: Relatively few significant relationships are observed between parental occupation and adolescents' reported health behaviour when the latter is analysed as single behaviours. A significant, but weak, social gradient in health-enhancing behaviour is observed when measuring health behaviour as composite indices rather than single forms of behaviour. This is apparent both when applying parental SES variables or adolescents' own educational aspirations as proxy measures of their socioeconomic status. Conclusion: Future investigations of the presence of a social gradient in adolescent health behaviour should focus on composite measures of health behaviour. Further research is needed on potential mediating mechanisms behind the SES-health behaviour relationships in youth. [ABSTRACT FROM AUTHOR]

This paper discusses the continued development, theoretical framework, and utility of the Urban Hassles Index (UHI), which was designed to measure stressors affecting adolescents in the urban environment. These stressors are chronic and differ in context and content from the more acute life events that are usually measured in adolescent stressor indices. This paper highlights factor analysis results of the UHI and the conceptualization of the dimensions of the index. The UHI's utility as a rapid assessment tool for practitioners and others working with adolescents is discussed. Directions for future research are also highlighted. [ABSTRACT FROM PUBLISHER]

The paper employs a recently developed instrumental variable approach for the estimation of dynamic quantile regression models with fixed effects to model the dynamics of health outcomes. Our proposed estimator not only allows us to control for individual-specific heterogeneity via fixed effects in the dynamic quantile regression framework but may also reduce the bias that exists in conventional fixed effects estimation of dynamic quantile regression models with small numbers of time periods. Using data on the children of the US National Longitudinal Survey of Youth 1979 cohort, we examine the extent of true state dependence in youth depression conditional on unobserved individual heterogeneity and family socio-economic status. Our results suggest that true state dependence in youth depression among the survey respondents is very low and the observed positive association between previous and current depression is mainly due to time invariant unobserved individual heterogeneity. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) usually leads to a mild infectious disease course in children, while serious complications may occur in conjunction with both acute infection and neurological symptoms, which have been predominantly reported in adults. The neurological complications in these patients vary based on patient age and underlying comorbidities. Data on clinical features, particularly neurological features, and prognostic factors in children and adolescents are limited. This study provides a concise overview of neurological complications in pediatric COVID-19 cases.Materials and Methods: The retrospective study reviewed medical records of all patients who were admitted to our hospital and were diagnosed with COVID-19 by real-time reverse-transcription polymerase-chain-reaction (RT-PCR) assay between 11 March 2020 and 30 January 2021. Patients with a positive PCR result were categorized into two groups: outpatient departments patients and inpatient departments (IPD).Results: Of the 2530 children who underwent RT-PCR during the study period, 382 (8.6%) were confirmed as COVID-19 positive, comprising 188 (49.2%) girls and 194 (50.8%) boys with a mean age of 7.14±5.84 (range, 0-17) years. Neurological complications that required hospitalization were present in 34 (8.9%) patients, including seizure (52.9%), headache (38.2%), dizziness (11.1%) and meningoencephalitis (5.8%).Conclusion: The results indicated that neurological manifestations are not rare in children suffering from COVID-19. Seizures, headaches, dizziness, anosmia, ageusia and meningoencephalitis are major neurological manifestations during acute COVID-19 disease. Although seizures were the most common cause of hospitalization in IPD patients, the frequency of meningoencephalitis was quite high. Seizures were observed as febrile seizures for children under 6 years of age and afebrile seizures for those over 6 years of age. Febrile seizure accounted for half of all seizure children. [ABSTRACT FROM AUTHOR]

Background: Transport injuries are a major cause of mortality among adolescents. Our aim was to evaluate the circumstances and trauma associated with fatal accidents involving adolescents and two-wheeled vehicles. Methods: We analyzed retrospective data from the Finnish Crash Data Institute from 2008 to 2019 involving 10- to 24-year-old victims of fatal traffic accidents who were injured while riding a bicycle, moped or motorcycle. We collected data on patient characteristics, accident circumstances and possible treatment. These fatalities were compared with national mortality rates among the respective age groups. Results: We identified 147 fatalities over the 12-year period involving 20 bicycle, 50 moped and 77 motorcycle riders. Most accidents involved males (n=121, 82%). Less than half of vehicles were in good condition (46%); motorized vehicles were often illegally tuned (37%) or had tire problems (31%). Most of the accidents were collisions with another vehicle (n=99, 67%) or other objects (n=35, 24%). In 94% of cases, the Injury Severity Score was >25. Head injury was the most common cause of death (62%). Among 15-year-olds, every fifth death was due to accidents on two-wheeled vehicles. Conclusions: Fatal transport accidents among adolescents comprise several elements that should be incorporated into driver's education and in case of minors, also communicated to parents. These include the condition of the vehicle, proper helmet use and effects of speed on both control of the vehicle and the consequences of a possible collision. [ABSTRACT FROM AUTHOR]

Study Question: Should fertility preservation be offered to children with Klinefelter syndrome (KS)?Summary Answer: Current evidence shows that fertility preservation should not be offered to adolescents with KS younger than 16 years because of lower retrieval rates for germ cells by testicular sperm extraction (TESE) compared with retrieval rates for adolescents and adults between 16 and 30 years.What Is Known Already: KS, the most common chromosomal disorder in men leading to non-obstructive azoospermia, is caused by the presence of at least one additional X chromosome. The onset of puberty in adolescents with KS leads to progressive degeneration of the testicular environment. The impact of the subsequent tissue degeneration on fertility potential of patients with KS is unknown, but in previous literature it has been suggested that fertility preservation should be started in adolescents as early as possible. However spermatozoa can be found by TESE in about 50% of adults with KS despite severe testicular degeneration. This review discusses the current evidence for fertility preservation in children and adolescents and possible prognostic markers for fertility treatment in KS.Study Design, Size, Duration: An extensive literature search was conducted, searching Pubmed, Embase, Cinahl and Web of Science from origin until April 2016 for 'Klinefelter syndrome' and 'fertility' and various synonyms. Titles and abstracts have been scanned manually by the authors for eligibility.Participants/materials, Setting, Methods: In total 76 studies were found to be eligible for inclusion in this review. Information from the papers was extracted separately by two authors.Main Results and the Role Of Chance: Various studies have shown that pre-pubertal children with KS already have a reduced number of germ cells despite a normal hormonal profile during childhood. The presence of spermatozoa in the ejaculate of adolescents with KS is extremely rare. Using TESE, the retrieval rates of spermatozoa for adolescents younger than 16 years old are much lower (0-20%) compared with those for adolescents and young adults between 16 and 30 years old (40-70%). Although spermatogonia can be found by TESE in about half of the peri-pubertal adolescents, there are currently no clinically functional techniques for their future use. Children and adolescents need to be informed that early fertility preservation before the age of 16 cannot guarantee fertility later in life and may even reduce the chances for offspring by removing functional immature germ cells which may possibly develop into spermatozoa after puberty. Furthermore, except for the age of patients with KS, there are no identified factors that can reliably be used as a predictive marker for fertility preservation.Limitations, Reasons For Caution: Most of the evidence presented in this review is based on studies including a small number of adolescents with KS. Therefore, the studies may have been underpowered to detect clinically significant differences for their various outcomes, especially for potential predictive factors for fertility preservation, such as hormone levels. Furthermore, the population of patients with KS diagnosed during childhood might be different from the adult population with KS where the diagnosis is based on infertility. Results based on comparisons between the two groups must be interpreted with caution.Wider Implications Of the Findings: Despite the limitations, this review summarizes the current evidence for managing fertility preservation in patients with KS to provide optimal health care.Study Funding/competing Interests: There was no funding for this study. S.F., Y.H., K.D., W.L.M.N., D.S., H.L.C.-v.d.G. and L.R. declare to have no conflicts of interests. D.D.M.B. reports grants from Merck Serono, grants from Ferring and grants from MSD, outside the submitted work. K.F. reports personal fees from MSD (commercial sponsor), personal fees from Ferring (commercial sponsor), grants from Merck-Serono (commercial sponsor), grants from Ferring (commercial sponsor) and grants from MSD (commercial sponsor), outside the submitted work. [ABSTRACT FROM AUTHOR]

Background: Epidemiologists are often interested in examining different hypotheses for how exposures measured repeatedly over the life course relate to later-life outcomes. A structured approach for selecting the hypotheses most supported by theory and observed data has been developed for binary exposures. The aim of this paper is to extend this to include continuous exposures and allow for confounding and missing data.Methods: We studied two examples, the association between: (i) maternal weight during pregnancy and birthweight; and (ii) stressful family events throughout childhood and depression in adolescence. In each example we considered several plausible hypotheses including accumulation, critical periods, sensitive periods, change and effect modification. We used least angle regression to select the hypothesis that explained the most variation in the outcome, demonstrating appropriate methods for adjusting for confounders and dealing with missing data.Results: The structured approach identified a combination of sensitive periods: pre-pregnancy weight, and gestational weight gain 0-20 weeks and 20-40 weeks, as the best explanation for variation in birthweight after adjusting for maternal height. A sensitive period hypothesis best explained variation in adolescent depression, with the association strengthening with the proximity of stressful family events. For each example, these models have theoretical support at least as strong as any competing hypothesis.Conclusions: We have extended the structured approach to incorporate continuous exposures, confounding and missing data. This approach can be used in either an exploratory or a confirmatory setting. The interpretation, plausibility and consistency with causal assumptions should all be considered when proposing and choosing life course hypotheses. [ABSTRACT FROM AUTHOR]

Juvenile systemic sclerosis (JSSc) is a rare disease of childhood and currently no international consensus exists with regard to its assessment and treatment. This SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) initiative, based on expert opinion informed by the best available evidence, provides recommendations for the assessment and treatment of patients with JSSc with a view to improving their outcome. Experts focused attention not only on the skin assessment but also on the early signs of internal organ involvement whose proper treatment can significantly affect the long-term outcome. A score for disease severity is proposed in order to perform a structured assessment of outcome over time but a validation in a wider patient population is recommended. Finally, a stepwise treatment approach is proposed in order to unify the standard of care throughout Europe with the aim to reduce morbidity and mortality in this disease. [ABSTRACT FROM AUTHOR]

Introduction Unintentional injuries represent a substantial public health burden among children and adolescents, and previous evidence suggests that there are disparities in injury by socioeconomic status (SES). This paper reports on a systematic review of literature on injury rates among children and adolescents by measures of SES. Methods A systematic literature search was conducted using six electronic databases: MEDLINE, PsycINFO, CINAHL, HealthSTAR, EMBASE, and SportsDiscus. This review considered children ages 19 years and under and publications between 1997 and 2017—representing an update since the last systematic review examined this specific question. Fifty-four articles were summarized based on study and participant descriptions, outcome and exposure, statistical tests used, effect estimates, and overall significance. Results Most articles addressed risk factors across all injury mechanisms; however, some focused particularly on burns/scalds, road traffic injuries, falls/drowning cases, and playground/sports injuries. Other studies reported on specific injury types including traumatic dental injuries, traumatic brain injuries, and fractures. The studies were of moderate quality, with a median of 15.5 (95% confidence interval [CI]: 15.34 to 15.66) out of 19. Thirty-two studies found an inverse association between SES and childhood unintentional injury, three found a positive association while twenty were not significant or failed to report effect measures. Conclusion Given the variability in definition of the exposure (SES) and outcome (injury), the results of this review were mixed; however, the majority of studies supported a relationship between low SES and increased injury risk. Public health practice must consider SES, and other measures of health equity, in childhood injury prevention programming, and policy. [ABSTRACT FROM AUTHOR]