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Despite a significant accumulation of research, there has been little systemic implementation of evidence-based practices (EBP) in youth mental health care. The fragmentation of the evidence base complicates implementation efforts. In light of this challenge, we sought to pilot a system that consolidates and coordinates the entire evidence base in a single direct service model (i.e., Managing and Adapting Practice; MAP) in the context of a legal reform of psychotherapy training in Germany. This pilot study aimed to evaluate the feasibility of the implementation of MAP into the curriculum of the reformed German masters program. Eligible participants were students in the masters program at Philipps-University Marburg during the winter-term 2022/2023. Students first learned about MAP through introductions and role plays (seminar 1), followed by actively planning and conducting interventions using MAP resources for patients in a case seminar under supervision (seminar 2). A repeated-measures survey was conducted to investigate students knowledge gains, perception of MAP and changes in their self-rated confidence to use EBP. Results indicated that students perceive MAP to be manageable to learn. Positive progress was achieved with regard to their knowledge and self-reported confidence to use EBP, although interpretation and generalization of the results are limited by small and homogeneous samples, lack of statistical power and missing comparison groups. The feasibility of the implementation and suitability of measures are discussed. Important implications could be drawn with regard to future investigations.

To assess the effectiveness and safety of repeated low-level red light (RLRL), which is a newly available treatment for myopia control in children and adolescents with high myopia. Multicenter, randomized, parallel-group, single-blind clinical trial (randomized controlled trial; NCT05184621). Between February 2021 and April 2022, 192 children aged 6 to 16 years were enrolled. Each child had at least 1 eye with myopia of cycloplegic spherical equivalent refraction (SER) at least –4.0 diopters (D), astigmatism of ≤2.0 D, anisometropia of ≤3.0 D, and best-corrected visual acuity (BCVA) of 0.2 logarithm of the minimum angle of resolution or better. Follow-up was completed by April 2023. Participants were randomly assigned at a 1:1 ratio to intervention (RLRL treatment plus single-vision spectacles) or control (single-vision spectacles) groups. The RLRL treatment was administered for 3 minutes per session, twice daily with a minimum interval of 4 hours, 7 days per week. The primary outcome and key secondary outcome were changes in axial length (AL) and cycloplegic SER measured at baseline and the 12-month follow-up visit. Participants who had at least 1 postrandomization follow-up visit were analyzed for treatment efficacy. Among 192 randomized participants, 188 (97.91%) were included in the analyses (96 in the RLRL group and 92 in the control group). After 12 months, the adjusted mean change in AL was –0.06 mm (95% confidence interval [CI], –0.10 to –0.02 mm) and 0.34 mm (95% CI, 0.30 to 0.39 mm) in the intervention and control groups, respectively. A total of 48 participants (53.3%) in the intervention group were still experiencing axial shortening >0.05 mm at the 12-month follow-up. The mean SER change after 12 months was 0.11 D (95% CI, 0.02to 0.19 D) and –0.75 D (95% CI, –0.88 to –0.62 D) in the intervention and control groups, respectively. Repeated low-level red light demonstrates stronger treatment efficacy among those with high myopia, with 53.3% experiencing substantial axial shortening. Repeated low-level red light provides an excellent solution for the management of high myopia progression, a significant challenge in ophthalmology practice. The author(s) have no proprietary or commercial interest in any materials discussed in this article. [ABSTRACT FROM AUTHOR]

The relationship between vitamin D and cardiovascular health (CVH) in children remains unclear. We aimed to explore the association between vitamin D and CVH metrics using the latest Life's Essential 8 (LE8) among Chinese children and adolescents. A cross-sectional study containing 2680 participants aged 7–18 years (1340 boys and 1340 girls) was performed in South China in 2013. Vitamin D levels were categorized as follows: ≥20 ng/mL (sufficiency), 12 - < 20 ng/mL (inadequacy), and <12 ng/mL (deficiency). The CVH metrics of LE8 was assessed by overall CVH score, health behavior score, health factor score and high CVH, among which the health behaviors included diet, physical activity, nicotine exposure, and sleep health, as well as the health factors contained body mass index, blood lipids, blood glucose, and blood pressure. Different regression models were used to assess the associations between vitamin D levels and CVH metrics of LE8. Results showed that the prevalence of vitamin D deficiency and inadequacy was 7.5% and 44.4%, respectively. Boys had lower levels in overall CVH score, health behavior score, and health factor score than girls. After adjusting for potential confounds, upward trends in diet score, health behavior score, and high CVH were observed with increasing vitamin D levels. Vitamin D levels were positively associated with high CVH based on LE8, and more attention should be paid on boys due to whose lower levels in CVH metrics. • This is the first study to explore the association between vitamin D and CVH basing on the latest LE8 among Chinese children. • Vitamin D levels were positively associated with diet score, health behavior score, and high CVH. • Boys had poorer CVH status than girls in overall CVH score, health behavior score, and health factor score. • More than half of children and adolescents aged 7–18 years had insufficient vitamin D. [ABSTRACT FROM AUTHOR]

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AbstractThe triple burden of malnutrition (TBM) is increasing globally, but significant evidence gaps exist regarding its burden and drivers among children in Southeast Asian (SEA) countries. We systematically searched four databases (PROSPERO-CRD42023420129) and Google Scholar through February 2024. We assessed stunting and overweight prevalence among children aged 0–18 years old across four SEA countries (Indonesia, Malaysia, Thailand, and Vietnam) from recent national surveys. We conducted random-effect meta-analyses to estimate the pooled prevalence of micronutrient deficiencies, and the pooled odds ratio for TBM-associated determinants using an adapted socio-ecological framework. 176 studies were included for systematic review, with 132 studies eligible for meta-analysis. Our findings illustrate significant variation in TBM across countries, dependent on region, age, and sex. Pooled prevalence [95% CI] of anemia, iron, vitamin A, and D deficiencies were 25% [22, 29], 14% [10, 18], 6% [4, 8], and 40% [32, 48], respectively (I2>90%). Determinants of the TBM included child-individual factors, poor early-life nutrition, and family household characteristics including maternal nutrition and education, socioeconomic, family size, sanitation, and food security. However, macro-level environmental impacts were less documented. Our findings emphasize the need for robust, timely monitoring of TBM data, including micronutrient biomarkers, and targeted policy intervention in SEA countries. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions We aim (1) to examine secular trends in height, weight, and waist circumference (WC) among Peruvian children and adolescents living in the city of Junín and (2) to compare their growth status with the World Health Organization (WHO) and US Centers for Disease Control and Prevention (CDC) reference data.The sample included 2874 Peruvians (n = 1681 in the 2009 cohort and n = 1193 in the 2019 cohort) aged 6–16 years from the district of Junín (4107 m of altitude). Height, weight, and WC were measured using standardized protocols. Within each sex, a two‐way between‐subjects analysis of variance—age, and cohort as main factors and age‐by‐cohort as the interaction—was used to test for differences in height, weight, and WC. STATA 17 software was used in all statistical analyses.Height revealed a positive secular trend among girls, aged 6–11 years, and among boys up to 14 years of age. Similar positive secular trends in weight and WC were found across all age groups in both boys and girls. Compared to North American peers, children in the 2009 cohort were shorter, lighter, and had a smaller WC. For weight and WC, the 2019 cohort overlapped the 50th percentile across all age groups (except for 16‐year‐old girls).Both boys' and girls' height, weight, and WC showed positive secular trends between 2009 and 2019, with statistically significant differences varying across age groups. Peruvian youth of both sexes were shorter and lighter than their North American peers. [ABSTRACT FROM AUTHOR]

Background: Higher sedentary behavior (SB) and lower physical activity (PA) are associated with negative physical and mental health outcomes. SB and PA can be objectively assessed using inertial sensors to evaluate body movements. This study aimed to quantify the association between instrumented measures of SB (i-SB) and PA (i-PA) and depression among children and adolescents using a systematic review and meta-analysis of observational studies. Methods: An electronic search was conducted on six databases up to May 12, 2024. A dose--response meta-analysis was conducted to determine the association between i-SB and i-PA and depression, expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Results: Five cross-sectional and 11 longitudinal studies comprising 26,109 participants met the inclusion criteria. Comparing the most sedentary with the least sedentary groups of participants resulted in a pooled ORs of 1.05 (95% CI 0.94-1.16). Comparing the least active with the most active groups of participants resulted in pooled ORs of 0.93 (95% CI 0.84-1.07), 0.89 (95% CI 0.79-1.00), 0.83 (95% CI 0.66-0.99), and 0.73 (95% CI 0.58-0.89) for light, moderate-to-vigorous (MV), vigorous, and total PA, respectively. Robust error meta-regression analyses showed clear dose--response relationships between i-SB and i-MVPA and depression. Conclusion: Both i-SB and i-PA were significantly associated with risk of depression in children and adolescents, which may become non-significant after mutual adjustment for i-PA and i-SB. [ABSTRACT FROM AUTHOR]

Depressive disorder is a significant public health problem worldwide, which adversely affects children and adolescents’ health. Impaired fasting blood glucose (IFG) is more common in depressive disorder, which becomes a clinical problem that needs to be focused on. The study purposed to determine the prevalence and related factors of IFG in Chinese children and adolescents with depressive disorder and the relationship between triglyceride and high-density lipoprotein cholesterol (TG/HDL-C) ratio and IFG. This research encompassed 756 individuals aged 8 to 18 with major depressive disorders, all diagnosed under DSM-5 criteria at the Third People’s Hospital of Fuyang from January 2020 to December 2021. We detected fasting blood glucose (FBG) and lipid levels and assessed the suicidal behaviors and depressive symptoms severity of each participant. The sociodemographic and included study variables were collected and analyzed. Our study employed multiple logistic regression to discern independent factors affecting IFG in conjunction with depressive disorders among children and adolescents. The prevalence of IFG was 6.5% (49/756). IFG was positively correlated with FBG, BMI, TG, TG/HDL-C, and was negatively correlated with gender and the type of antidepressant drug taken. Binary logistic analysis showed that male (OR = 2.57, 95% CI: 1.43–4.63, P = 0.002) and higher levels of TG (OR = 1.63, 95% CI: 1.11–2.38, P = 0.013) were independently associated with IFG in children and adolescents with depressive disorder. The incidence of IFG in children and adolescents with depressive disorder was high and was positively related to the TG/HDL-C ratio. The evaluation and management of IFG in pediatric depression should extend beyond pharmacological interventions. Comprehensive strategies in both assessment and management of IFG are essential to address this condition effectively in young patients facing depressive disorders. [ABSTRACT FROM AUTHOR]

Background: Recent studies suggested that the combination of tobacco smoke exposure (TSE) and dietary nutrients intake may be related to a higher or lower risk of hypertension. However, the relationship between dietary magnesium (Mg) intake, TSE and the odds of hypertension remain unclear. This study aimed to evaluate the association of TSE, dietary Mg intake and the odds of hypertension among children and adolescents. Method: Data of this study were extracted from the National Health and Nutrition Examination Surveys (NHANES) 2007–2018. Dietary Mg intake was calculated as the average of two days of dietary and supplementations intake. Serum cotinine concertation ≥ 0.05 µg/L or at least one-person smoking in the household was considered as exposing to the tobacco smoke. The weighted univariate and multivariate logistic regression models were utilized to explore the associations of dietary Mg intake, TSE and the odds of hypertension among children and adolescents with the evaluation index of odds ratio (ORs) and 95% confidence intervals (CIs). Subgroup analyses based on different age, gender and overweight were further assessed these associations. Results: A total of 7,122 children and adolescents aged 8–17 years old and with the blood pressure measurement were included. Of which, 948 (13.31%) had hypertension. After adjusting all covariates, we observed children and adolescents exposed to tobacco smoke was related to higher odds of hypertension (OR = 1.34, 95%CI: 1.01–1.78); children and adolescents not reached the dietary Mg references intakes was related to higher odds of hypertension (OR = 1.48, (95%CI: 1.11–1.97); compared to children and adolescents non-TSE and reached the DRIs of Mg, those not reached the DRIs of Mg and exposed to tobacco smoke have the highest odds of hypertension (OR = 1.94, 95%CI: 1.30–2.89, P for trend = 0.002). These associations of dietary Mg intake, TSE and hypertension remain robust after the stratified analysis based on age, gender and overweight was conducted. Conclusion: Our findings suggested there were a robust association between dietary Mg intake, TSE and hypertension in children and adolescents. Those children and adolescents with deficiency dietary Mg intake and exposed to tobacco smoke may have the high odds of hypertension. More restrictions on smoking as well as Mg supplementation in the prevention and treatment of hypertension among children and adolescents might be justified. [ABSTRACT FROM AUTHOR]

Introduction: The present study investigates the feasibility and usability of a sensorbased eHealth treatment in psychotherapy for pediatric obsessive-compulsive disorder (OCD), and explores the promises and pitfalls of this novel approach. With eHealth interventions, therapy can be delivered in a patient's home environment, leading to a more ecologically valid symptom assessment and access to experts even in rural areas. Furthermore, sensors can help indicate a patient's emotional and physical state during treatment. Finally, using sensors during exposure with response prevention (E/RP) can help individualize therapy and prevent avoidance behavior. Methods: In this study, we developed and subsequently evaluated a multimodal sensor-based eHealth intervention during 14 video sessions of cognitivebehavioral therapy (CBT) in 20 patients with OCD aged 12-18. During E/RP, we recorded eye movements and gaze direction via eye trackers, and an ECG chest strap captured heart rate (HR) to identify stress responses. Additionally, motion sensors detected approach and avoidance behavior. Results: The results indicate a promising application of sensor-supported therapy for pediatric OCD, such that the technology was well-accepted by the participants, and the therapeutic relationship was successfully established in the context of internet-based treatment. Patients, their parents, and the therapists all showed high levels of satisfaction with this form of therapy and rated the wearable approach in the home environment as helpful, with fewer OCD symptoms perceived at the end of the treatment. Discussion: The goal of this study was to gain a better understanding of the psychological and physiological processes that occur in pediatric patients during exposure-based online treatment. In addition, 10 key considerations in preparing and conducting sensor-supported CBT for children and adolescents with OCD are explored at the end of the article. This approach has the potential to overcome limitations in eHealth interventions by allowing the real-time transmission of objective data to therapists, once challenges regarding technical support and hardware and software usability are addressed. [ABSTRACT FROM AUTHOR]

Background: There is broad scientific evidence for the effectiveness of individual trauma-focused evidence-based treatments (EBTs) such as "trauma-focused cognitive behavioural therapy" (TF-CBT) for children and adolescents with posttraumatic stress symptoms. However, there is a significant research-to-practice gap resulting in traumatized children in high-income countries in Europe having only very limited access to these treatments. The aim of this study was, therefore, to identify common barriers and successful dissemination and implementation (D&I) strategies of evidence-based trauma-focused treatments (in particular TF-CBT) in seven European countries. Methods: For this study, we chose a mixed-method approach: an online survey among certified European TF-CBT trainers (N = 22) and the collection of country-based narratives from TF-CBT experts in different European countries (Finland, Germany, Italy, Netherlands, Norway, Sweden). Results: Common modifiable barriers to the implementation of TF-CBT were identified on different levels (e.g. government or treatment level), and successful D&I strategies were highlighted across all countries, such as translations of materials. Additionally, the experts from the country narratives put together a broad overview of TF-CBT research in Europe. Conclusions: The results of this study revealed that especially learning collaborations and the development of joint European efforts in funding and researching D&I strategies are crucial for future implementation of trauma-focused EBTs in Europe. [ABSTRACT FROM AUTHOR]

Objective: Previous studies assessing factors associated with drug‐resistant epilepsy (DRE) were constrained by their amalgamation of all epilepsy syndromes in their analyses and the absence of uniform criteria for defining DRE. Our objective was to identify predictors of DRE among the four primary childhood epilepsy syndrome groups within a cohort of children with new onset seizures, using the International League Against Epilepsy (ILAE) definition of DRE and the recent classification of epilepsies. Methods: This is a prospective study of 676 children with new onset seizures initiated on antiseizure medication. Patients were monitored for the occurrence of DRE according to the ILAE criteria and were categorized into one of four epilepsy groups: self‐limited focal epilepsies (SeLFEs), genetic generalized epilepsies (GGEs), developmental epileptic encephalopathies (DEEs), and focal epilepsies. Cox regression analysis was performed to identify predictors of DRE within each epilepsy group. Results: Overall, 29.3% of children were classified as having DRE, with the highest incidence observed among children diagnosed with DEEs (77.7%), followed by focal epilepsies (31.5%). Across the entire cohort, predictors of DRE included the presence of an epileptogenic lesion, a higher pretreatment number of seizures, experiencing multiple seizure types, presence and severity of intellectual and developmental delay, myoclonus, and younger age at epilepsy onset. Within the GGEs, only a younger age at seizure onset and experiencing multiple seizure types predicted DRE. Among focal epilepsies, predictors of DRE included the presence of an epileptogenic lesion, experiencing multiple seizure types, and having a greater number of pretreatment seizures. Within the DEEs, predictors of DRE were the occurrence of tonic seizures. Predictors of DRE within SeLFEs could not be identified. Significance: This study indicates that different epilepsy syndromes are associated with distinct predictors of drug resistance. Anticipation of drug resistance within various groups is feasible using accessible clinical variables throughout the disease course. [ABSTRACT FROM AUTHOR]

Objective: This epidemiological study estimated the lifetime prevalence of chronic physical illness (i.e., an illness that lasted or was expected to last ≥6 months) and 6-month prevalence of mental disorder and multimorbidity (i.e., ≥1 physical illness and ≥1 mental disorder) in youth. Associations between physical illness and mental disorder were quantified, including the number of illnesses. Secondary objectives examined factors associated with mental disorder, after controlling for physical illness. Methods: Data come from 10,303 youth aged 4–17 years in the 2014 Ontario Child Health Study (OCHS). Physical illness was measured using a list of chronic conditions developed by Statistics Canada. Mental disorders were measured using the OCHS Emotional Behavioural Scales. The Health Utility Index Mark III assessed overall functional health. Results: Weighted prevalence estimates showed 550,090 (27.8%) youth had physical illness, 291,986 (14.8%) had mental disorder, and 108,435 (5.4%) had multimorbidity. Physical illness was not associated with mental disorder. However, youth with 2 physical illnesses, as compared to no physical illnesses, had increased odds of having any mental (OR = 1.75 [1.08, 2.85]), mood (OR = 2.50 [1.39, 4.48]) and anxiety disorders (OR = 2.40 [1.33, 4.31]). Mean functional health scores demonstrated a dose–response association across health status categories, with the highest scores among healthy youth and the lowest scores among multimorbid youth (all p <.05). Conclusion: Chronic physical illness and mental disorders are prevalent in youth. Youths with 2 physical illnesses have a higher likelihood of mental disorders. Higher functional health scores protected against all mental disorders. Mental health interventions for youth should promote strong overall functional health. Plain Language Summary Title: Physical-Mental Multimorbidity in Ontario Youth Plain Language Summary: This study examined mental disorders in Ontario youth with and without chronic physical illnesses. Youth with at least one physical illness and one mental disorder have physical-mental multimorbidity. 27.8% of youth had chronic physical illness (that lasted at least six months), 14.8% had mental disorder, and 5.4% had multimorbidity. Risk factors for any mental, mood, and anxiety disorders included living with two chronic physical illnesses. Overall functional health of youth declined from youth that were healthy (no physical illness or mental disorder), chronic physical illness only, mental illness only, to multimorbid youth. Youth mental health interventions should promote strong overall functional health. [ABSTRACT FROM AUTHOR]

The International Grief Questionnaire (IGQ) is a self-report measure of ICD-11 Prolonged Grief Disorder (PGD) in adults. This study sought to develop and validate a caregiver-report version of the IGQ for children and adolescents aged 7–17 years; the IGQ-Caregiver Version (IGQ-CG). 639 parents living in Ukraine provided data on themselves and one child in their household as part of the " The Mental Health of Parents and Children in Ukraine Study: 2023 Follow-up" study. The latent structure of the scale was tested using confirmatory factor analysis (CFA), while convergent validity was assessed through associations with other mental health correlates. Prevalence rates of probable ICD-11 PGD were estimated. CFA results supported a correlated two-factor model ('core' and 'associated' symptoms) and the internal reliability of the scale scores were acceptable. Convergent validity was supported through significant correlations with internalizing symptoms, while contact with the deceased, time since bereavement, and parental PGD were associated with higher scores on the IGQ-CG latent variables. The prevalence of probable ICD-11 PGD was 1.4%, and amongst those with a lifetime bereavement, the conditional rate was 3.2%. The IGQ-CG produces reliable and valid scores for ICD-11 PGD symptoms in children and adolescents as reported by their caregivers. Plain language summary: Prolonged Grief Disorder (PGD) is recognized as a grief-specific disorder included in the ICD-11. The International Grief Questionnaire (IGQ) is available to assess ICD-11 PGD symptoms in adults. However, there is no self-report measure available to assess ICD-11 PGD symptoms in children and adolescents. The researchers developed and validated a caregiver-report version of the IGQ for children and adolescents; the IGQ-Caregiver Version (IGQ-CG). Researchers found that the IGQ-CG was an accurate and consistent measure of PGD. Results showed that 1.4% of the sample met diagnostic requirements for ICD-11 PGD. The newly developed IGQ-CG can assist in the assessment and treatment of ICD-11 PGD in children and young people. [ABSTRACT FROM AUTHOR]

Purpose: To access the attitudes of service users about the sharing of health records for research and to foster collaboration between municipal health services and the specialist health services in Norway. Methods: Members (n ≈ 2000) of the Norwegian mental health service users' organizations (SUO's), ADHD Norway, the Autism Association and the Tourette Association, representing Central Norway, participated in the study, (N = 108, 5.4% response rate). Descriptive statistics were used to evaluate distributions of responses to the questionnaire. Results: Service users reported being aware that municipal health services collaborate with the specialist health service (62%), with mental health care in the specialist health service (57%), and child and adolescent psychiatric services (61%). A large proportion of individuals were aware of the benefits of sharing their health records (93%), have trust in the use of data by health authorities (81%), and were willing to share records to benefit fellow patients (84%). Personal experience (69%) and impressions from mainstream media (55%) had the most influential impact on users' views of the Health Platform, an electronic health communication system. A majority of users had a negative perception of the Health Platform, even though some expect it to become a valuable tool in the future (50%). Conclusions: Service users are aware of and positive about benefiting others by sharing health records. They trust the health authorities, however, have negative attitudes about the Health Platform, apparently based on personal experiences and media influence. However, service users can see the potential usefulness of the Health Platform in the future. [ABSTRACT FROM AUTHOR]

Globalisation and population movement have led to an increasing number of migrant children residing in areas non-endemic for schistosomiasis. However, diagnosing and managing schistosomiasis in children remain controversial. This study aims to investigate the prevalence of schistosomiasis in migrant children and to describe the diagnostic approach and management strategies, including long-term follow-up, to explore the potential role of serological tests in evaluating treatment response. We conducted a retrospective descriptive study spanning from January 2014–July 2021 at a referral unit for Paediatric Tropical Diseases in Madrid (Spain). The study included patients under 18 years diagnosed with schistosomiasis. Of 679 children screened for schistosomiasis, 73 (10.8%) tested positive. The median age was 16.3 years [IQR 9–17.6], 74% male. The majority originated from Sub-Saharan Africa (47%) and Asia (47%). Only 40% presented with symptoms, with gastrointestinal (18%) and cutaneous (17%) manifestations being the most common. Eosinophilia was observed in 43% (median [IQR]: 1103/mm3 [671–1536]), and ova were visualised in the urine of 2/50 (4.0%). Praziquantel treatment was administered to 92%, and 5 patients required retreatment. Follow-up data were available for 58 (80%) over a median period of 9 months [IQR 6–19.8], revealing a progressive decline in eosinophil count, IgE titres, and ELISA optical density. Conclusion: In this series, the prevalence of schistosomiasis among migrant children was significant (10%), highlighting the importance of including serological tests in migrant health screening. The disease is largely asymptomatic, eosinophilia is often absent, and visualisation of ova in urine is exceedingly rare. Eosinophil count, IgE titres, and ELISA optical density could prove valuable as an initial approach for monitoring inflammation during follow-up assessments. What is Known: • The burden of disease related to schistosomiasis is significant, particulary in children, and it is advisable to screen this vulnerable population. What is New: • Eosinophilia may not be present in parasitic infections, so serological tests are crucial for screening migrant children. • Serological monitoring facilitates long-term management of migrant children with schistosomiasis. [ABSTRACT FROM AUTHOR]

Anxiety disorders and obsessive-compulsive disorder (OCD) are among the most common mental health conditions in children and adolescents and are associated with various impairments and long-term consequences. Evidence-based treatments exist but are often lacking in elements needed to effectively treat youth with more severe presentations. This case report illustrates a patient's treatment course in an innovative program for children, adolescents, and young adults with severe anxiety. The program offers a continuum of outpatient, evidence-based care tailored to the severity of the patient's condition. The case study focuses on "Jane," an adolescent female with anxiety as well as obsessive-compulsive spectrum disorders, who had previously received extensive treatment without sustained improvement. Through the program's three treatment phases, Jane and her parents demonstrated consistent engagement and adherence to treatment. Jane showed significant progress, with rapid reduction in symptoms and functional impairment. This case report underscores key elements of this treatment that address gaps in traditional approaches to care, particularly for patients with severe presentations, including the coordinated, team-based approach; the continuum of evidence-based, phased treatment titrated to need; the utilization of virtual individual, group and parent-focused care and between-session coaching to enhance learning generalization; and the use of measurement-based care. Further research is warranted to evaluate the generalizability and long-term outcomes of this program and its potential to transform the treatment landscape for pediatric anxiety and OCD. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the pattern and trend of Musculoskeletal (MSK) disorders in people aged 5–19 years from 1990 to 2021. The data was sourced from the Global Burden of Disease study 2021. The Age-standardized DALYs rates (ASDR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and age-standardized incidence rate (ASIR) and their corresponding average annual percent change (AAPC) for MSK disorders were evaluated by sex, region, and sociodemographic index (SDI) quintiles. Globally, the ASPR of MSK disorders among children and adolescents increased per 100,000 population from 3048.66 (95% confidence interval [CI]: 2336.68–3887.02) in 1990 to 3105.46 (95% CI: 2421.09–3904.95) in 2021 (AAPC 0.06 [95% CI: 0.05–0.07]). In 2021, individuals aged 15–19 experienced the highest burden compared to those aged 5–9 and 10–14. In 2021, high SDI countries had the highest ASIR, ASPR, ASDR of MSK disorders. The AAPC of ASPR in high SDI countries showed a stark contrast to that in low SDI countries for the same period (AAPC 0.48 vs. AAPC −0.03). From 1990 to 2021, in low SDI and low-middle SDI countries, the increase in DALYs was primarily due to population growth. However, in middle SDI, high-middle, and high SDI countries, the increases were mainly due to epidemiological changes. Globally, patients aged 10–14 experienced better care compared to those in the 5–9 and 15–19 age groups. Specific preventive health measures are needed for females and adolescents aged 15–19 in high SDI countries. [ABSTRACT FROM AUTHOR]

Context Obesity has emerged as a global health issue for the pediatric population, increasing the need to investigate physiopathological aspects to prevent the appearance of its cardiometabolic complications. Chrononutrition is a field of research in nutritional sciences that investigates the health impact of 3 different dimensions of feeding behavior: regularity of meals, frequency, and timing of food intake. Objective We carried out a systematic review and meta-analysis to investigate the association between chrononutrition in children and adolescents and the risk of overweight/obesity or a cluster of metabolic abnormalities related to glucose and lipid metabolism, blood pressure, and cardiovascular disease risk. Data Extraction A literature search was performed using PubMed, EMBASE, and The Cochrane Library for relevant articles published before August 2022. Data Analysis A total of 64 articles were included in the narrative synthesis (47 cross-sectional and 17 cohort studies), while 16 studies were included in the meta-analysis. Meta-analysis showed that non–daily breakfast consumers (≤6 d/wk) had a higher risk of overweight/obesity (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.08–1.82] compared with daily breakfast eaters (7 d/wk). Similarly, irregular breakfast consumption (only 0-to-3 times/wk) increased the risk of abdominal obesity (waist-to-height ratio ≥ 0.5) compared with regular consumption (5-to-7 times/wk) (OR, 1.38; 95% CI, 1.26–1.49). There was evidence to suggest that a regular frequency of meal consumption (≥4 times/d) is preventive against overweight/obesity development compared with fewer meals (≤3 times/d) (OR, 0.83; 95% CI, 0.70–0.97). In the narrative synthesis, snacking habits showed controversial results, while food timing was the most understudied dimension. Conclusion Overall, our data indicate a potential implication of chrononutrition in affecting pediatric metabolic health; however, the evidence of this association is limited and heterogeneous. Further prospective and intervention studies with a consistent approach to categorize the exposure are needed to elucidate the importance of chrononutrition for pediatric metabolic health. [ABSTRACT FROM AUTHOR]

The frequency with which Internalizing and Externalizing symptoms co-occur suggests that, behind both domains, there may be a common susceptibility represented by a general psychopathology factor. However, it's still unclear whether this common susceptibility is affected by age-related variations. Internalizing (i.e., Fear and Distress) and Externalizing symptoms were evaluated in 803 twin pairs from the population-based Italian Twin Registry. Model-fitting analysis was performed separately in the 6–14 and 15–18 age groups to estimate genetic and environmental contributions to the covariance among symptoms. For the 6–14 group, a multivariate Cholesky model best fitted the data, while, for the 15–18 group, the best fit was provided by a Common Pathway model in which nearly 50% of total variance of each trait was mediated by common genetic factors. Our findings support a common susceptibility behind Internalizing and Externalizing symptoms, mainly genetic in origin, that becomes more evident at the beginning of puberty. [ABSTRACT FROM AUTHOR]

Background: Pediatric obesity treatment is based on high-intensity lifestyle counseling. However, high dropout rates and low effectiveness have been reported, even in specialized centers. Mobile health technologies have been used to overcome these limits with contrasting results. This study aims at evaluating the effectiveness of a six-month intervention with a mobile app for the treatment of pediatric obesity at 6 and 12 months of follow-up. Methods: Seventy-five patients were randomly assigned to standard care or standard care plus mobile app (2:1) using an online randomizer system. The mobile app delivered high-intensity lifestyle counseling for diet and physical activity. Results: At six months of follow-up, the M-App group showed significantly lower dropout rates compared to standard care (p = 0.01). The risk of dropout was significantly higher in controls compared to the intervention group (OR 3.86, 95% C.I. 1.39–10.42, p = 0.01). After one year, we observed lower albeit non-statistically significant dropout rates in the M-App compared to the standard care group (p = 0.24). No differences were observed in z-score BMI and percentage of BMI reduction between the two groups. Conclusions: Our findings suggest that the mobile app might help in the clinical management of children and adolescents with obesity in terms of dropout reduction. [ABSTRACT FROM AUTHOR]

Background: The prevalence of clinically diagnosed depressive disorders (DD) in Chinese left-behind children (LBC) remains unknown. We aim to estimate the prevalence of DD, discuss the associations between DD and self-harm (SH) behaviors in a large representative sample of Chinese LBCs chosen from Yunnan province. Methods: A total of 5462 LBCs were selected from the most recent datasets of the Mental Health Survey for Children and Adolescents in Yunnan (MHSCAY), a mega population-based two-phase cross-sectional survey. Weighted prevalence rates and designed Logistic regression were adopted to estimate the prevalence of DD and the association between DD and SH. Results: The weighted prevalence of lifetime and current DD were 4.22% (95% CI: 3.13-6.00%) and 3.84% (95% CI: 2.85-5.00%) in Chinese LBCs. Higher lifetime and current DD prevalence rates were observed in girls and those reported adverse parental marital status and SH behaviors. The absence of DD was associated with significantly decreased odds of SH behavior (OR = 0.06), repetitive SH (OR = 0.09), using multiple SH methods (OR = 0.09), and severe SH (OR = 0.15). Subsequently performed stratified analyses identified prominent effect modification by sex and age, as a stronger association between DD and SH was found in girls (OR = 0.02 versus OR = 0.07 in boys) and younger adolescents (OR = 0.08 versus OR = 0.22 in older adolescents). Conclusion: The prevalence of DD was high in Chinese LBCs. DD was associated with prominently increased risk of SH behaviors in LBCs. Attention and intervention are needed in this vulnerable population. [ABSTRACT FROM AUTHOR]

Objective To understand intake frequency of sugar-sweetened beverages (SSBs) and the consumption habit among primary and secondary students. To explore the relationship of SSBs cognition and behavior, and to provide a basis for reducing students' intake of SSBs. Methods A multi-stage sampling process was employed to select subjects from primary and middle school in Shenzhen. Network questionnaire survey was conducted to collecting information in September and October, 2021. Spearman rank correlations was used to analyze relationships of various types of SSBs consumption frequency. Multivariable linear regression model was used to examine the relationship between SSBs cognition score and consumption frequency score. Hierarchical analysis to explore the interactions. Results A total of 16 840 primary and secondary students aged 6 to 18 years old were included. The prevalence of SSBs consumption at least 3 time/week was 58.9%, the grades 1-3, 4-6 and middle school students were 52.3%, 60.3% and 67.6%. Parents (73.3%) were the main buyers of SSBs, convenience stores (73.7%) were the main places and delicious (77.2%) was the major cause of choices. There was a positive correlation between the intake frequency of different types of SSBs (P < 0.001). The results of multivariate linear regression showed that the higher the cognition was, the lower the intake frequency of SSBs was (β = 0.179, 95%CI: 0.155-0.204). There was a multiplicative interaction between the cognitive score of SSBs and the educational level of parents (P < 0.00l). Conclusion The intake frequency of SSBs was high among primary and middle school students in Shenzhen, and the cognitive level of SSBs was related to the intake frequency and the educational level of parents. [ABSTRACT FROM AUTHOR]

Objective Background Methods Results Conclusion Using a double‐dummy pilot randomized controlled trial design, we aimed to determine the feasibility and acceptability of comparing remote electrical neuromodulation (REN) to typical care intravenous pharmacologic interventions for the treatment of children and adolescents visiting the emergency department (ED) with migraine, and to compare parallel‐group versus crossover trial designs.There are limited data to guide the management of migraine in the ED. Children and adolescents are interested in neuromodulation, and specifically REN, for treatment in this setting, but there are no existing data on this approach.We employed a double‐dummy, double‐blind, pilot randomized controlled trial that tested two designs in two phases: a parallel‐group design and a crossover design (ClinicalTrials.gov identifier: NCT05102591). The intervention arms consisted of: (i) active REN stimulation with matched normal saline placebo intravenously, and (ii) matched sham REN stimulation, intravenous metoclopramide (0.15 mg/kg, maximum 10 mg), and intravenous ketorolac (0.5 mg/kg, maximum 30 mg). Youth aged 8.0–<18.0 years visiting a Canadian tertiary care pediatric ED with migraine attacks as per criteria B–E of the International Classification of Headache Disorders third edition were eligible. Primary outcomes were focused on trial feasibility and acceptability, and preliminary efficacy and safety data were also collected.A total of 34% (22/65) of those who screened eligible were enrolled. Three participants (14%) withdrew prior to receiving any study interventions. In all, 10 participants were allocated to typical care, and nine to REN. All treated participants (19/19) completed all assessments. Recruitment was higher during the parallel‐group phase: 1.1 participants/month versus 0.6 participants/month, and 36% (17/47) versus 28% (five of 18) of screened eligible were enrolled in the parallel‐group and crossover phases, respectively. Participants reported positive impressions of REN use in the ED, e.g., higher mean (standard deviation [SD]) levels of interest in using REN only at 3.7 (1.0) versus 2.8 (1.0) in using intravenous interventions only for a future ED visit. Participants and clinical staff reported overall positive impressions regarding the study protocol. Employing an 11‐point pain numerical rating scale, the mean (SD) reduction in pain severity score was 2.1 (1.3) and 2.9 (2.9) from baseline to 1 h, and 2.4 (1.6) and 4.0 (3.5) from baseline to 2 h for REN and intravenous interventions, respectively. One participant in the typical care group and none in the REN group experienced adverse events.We demonstrated the feasibility and acceptability of our trial protocol and of using REN to treat youth presenting to the ED with migraine. The parallel‐group design generated a higher recruitment rate than the crossover design. Our preliminary efficacy and safety data suggest that REN could be non‐inferior to typical care, but we were not powered for these outcomes. Further research on REN's use in the ED setting is warranted. [ABSTRACT FROM AUTHOR]

Background: While Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) often co-occur, the nature of the relationship between their symptoms is not well understood. Network analysis of psychopathology allow for detailed examinations of symptom interactions, providing an effective approach to explore the patterns of comorbidity between TS and ADHD symptoms. Methods: This study included 3,958 participants (male/female = 3,004/954, age mean ± SD = 8.60 ± 2.25 years). We collected data on TS symptoms using the Motor Tic, Obsessions and Compulsions, Vocal Tic Evaluation Survey (MOVES), and ADHD symptoms using the Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV). Network analysis was employed to construct a combined network of TS and ADHD symptoms at the symptom level. We utilized the expected influence (EI) and bridge EI metrics to explore the core and bridge symptoms within the network. Results: The network structure demonstrated a moderate number of non-zero connections between TS and ADHD symptoms, constituting 23.06% of all potential connections. Core symptoms in the comorbidity network included "Often has difficulty sustaining attention in tasks or play activities," "Certain bad words or thoughts keep going through my mind," and "Words come out that I can't stop or control." Bridging symptoms identified were "Words come out that I can't stop or control," "I do certain things like jumping or clapping over and over," "I can't control all my movements," and "Often talks excessively." Conclusion: The core and bridging symptoms identified in this study serve as potential therapeutic targets for the treatment of TS and ADHD comorbidity in clinical children and adolescents. [ABSTRACT FROM AUTHOR]

Background: The reference values of eNO have certain differences among people of different countries and races. We aimed to obtain the reference value of eNO in healthy children and adolescents (6–18 years old) in China and to explore the associations between the reference values with ages, gender, heights, BMI, and regions. Methods: We measured FeNO50 levels in 5949 healthy Chinese children and adolescents, FeNO200 and CaNO levels in 658 participants from 16 provinces of 7 administrative areas in China aged 6–18. All persons were studied after obtaining informed consent from children and their parents. Results: The mean FeNO50 of 5949 Chinese children and adolescents aged 6–18 years was 14.1 ppb, with a 95% confidence interval of 1-38.1 ppb. The mean FeNO200 of 658 persons was 6.9 ppb with a 95% upper confidence interval of 15.0 ppb, and the mean CaNO was 3.0 ppb with a 95% upper confidence interval of 11.2 ppb. In the 6–11 age group, age and height were correlated with the logarithm of FeNO50 (P < 0.001, P < 0.05). There was no significant correlation between the logarithm of FeNO200 and gender, age, height and BMI (all P > 0.05). The logarithm of CaNO was correlated with gender (P < 0.05). In the 12–18 age group, gender, height, and region were correlated with the logarithm of FeNO50 (all P < 0.001). There was only a weak correlation between the logarithm of FeNO200 and height (P < 0.001). The logarithm of CaNO was negatively correlated with age (P < 0.05). Conclusions: Higher FeNO50, FeNO200 and CaNO values were found in healthy children and adolescents in China compared with foreign reports, and is affected by age, height, gender, and region. This study provides useful references for clinical application of eNO in children, especially Asian children. [ABSTRACT FROM AUTHOR]

Purpose: Physical interventions during subacute rehabilitation have potential to improve functional recovery. This study explored the perspectives of children and adolescents with acquired brain injury (ABI) and their parents with respect to physical rehabilitation during the subacute phase. Methods: Thirteen children and adolescents with ABI and their parents were included and interviewed using semi-structured interviews. Interview transcripts were analysed using inductive thematic analysis approach. Results: Six themes were identified: 1) beliefs of physical rehabilitation, 2) content of physical rehabilitation, 3) tailored care, 4) impact of context, 5) communication and 6) transition. The importance of intensive physical practice was widely supported. The positive can-do mentality was emphasised to create an atmosphere of hope, meaning that every effort would be made to achieve maximum recovery. Intensive involvement of parents is considered essential during subacute rehabilitation including an open and mutual dialogue about the focus of rehabilitation, therapy goals and future participation in their own environment. Conclusions: Our findings highlight the need for an intensive rehabilitation approach, tailored to the individual's needs. The perspectives of children and adolescents and their parents in our study contribute to a better understanding of factors that are important for optimal recovery through physical rehabilitation during the subacute phase. IMPLICATIONS FOR REHABILITATION: Children with acquired brain injury and their parents indicate the potential and thus the importance of intensive physical practice to enhance optimal recovery. Involvement of parents and the potential of their continuous presence during subacute rehabilitation may have a positive impact on the effect of rehabilitation efforts. The positive can-do mentality of rehabilitation professionals creates an atmosphere of hope and is an important requisite to achieve maximum recovery. Open dialogue between clinicians and the family is warranted about the focus of interventions. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to examine the geographical variation in physical fitness levels among Chinese children and adolescents in Shaanxi province. Methods: A total of 19,175 children from Shaanxi province with physical fitness data in 2019, participated in the study. Physical fitness was assessed using body mass index, force vital capacity, 50 m sprint, sit and reach, 1 min rope skipping, sit-ups, 50 m × 8 round-trip running, standing long jump, pull-ups, 800 m, and 1000 m running, and their standardized scores were aggregated to form a summary score. The total score is used to classify the physical fitness levels into four grades (excellence to failure). Results: The Guanzhong (GZ) region scored the highest, while Northern Shaanxi (NS) scored the lowest. The excellence rate for physical fitness was highest in GZ and lowest in NS, while the failure rate was highest in NS and lowest in GZ. Notably, children and adolescents in NS demonstrated the best endurance levels despite their overall lower fitness scores. The comprehensive physical fitness among Chinese children and adolescents in Shaanxi province showed significant regional disparities. GZ region exhibited the highest physical fitness levels, while Northern Shaanxi had the lowest. Conclusions: Region-specific interventions and targeted health policies are essential to address these disparities and improve the overall physical health status of children and adolescents in Shaanxi province. [ABSTRACT FROM AUTHOR]

Summary The efficacy and safety of recombinant human thrombopoietin (rhTPO) in children and adolescent patients with chronic primary immune thrombocytopenia (ITP) remains unclear. A multicentre, randomized, double‐blind, placebo‐controlled phase III trial was performed. Patients aged 6–17 years, diagnosed with ITP and resistant or relapsed to corticosteroid treatment were included. For the trial, part 1 was exploratory and part 2 was the main analysis, with part 1 determining whether part 2 was stratified by age. Patients in part 1 were treated with rhTPO (the 6‐ to 11‐/12‐ to 17‐year‐old groups; 1:1). Patients in part 2 were randomized (3:1) to receive either rhTPO treatment or placebo. Patients received rhTPO or placebo at a dose of 300 U/kg once daily for up to 14 days. A total of 68 patients were included [part 1 (12 patients), part 2 (56 patients)]. The total response rate (TRR) in part 1 was 50.0% (95% CI: 21.09%–78.91%). For part 2, the TRR was 58.5% (95% CI: 42.11%–73.68%) and 13.3% (95% CI: 1.66%–40.46%) in the rhTPO and placebo groups (FAS) respectively. The difference in TRR between the rhTPO group and placebo group was 45.2% (95% CI: 22.33%–68.08%) and 44.6% (95% CI: 21.27%–67.85%) on the FAS and per‐protocol set (PPS), respectively, which indicates the superiority of rhTPO treatment. [ABSTRACT FROM AUTHOR]

Type 1 diabetes (T1D) in children and adolescents requires a lifelong commitment to disease control, which involves insulin treatment and constant blood glucose monitoring. Framed by Albert Bandura's self‐efficacy theory, we focused on analysing the impact of domain‐specific self‐efficacy for T1D control in children and adolescents and its relationship with different indicators of glycaemic control over time. The study included 205 participants (56.1% male), including 51.7% children and 48.3% adolescents aged 6–18 (M = 13.27, SD = 3.66) years in four longitudinal phases (6 months between phases). The results revealed that higher self‐efficacy predicted better health outcomes, with more time spent actively monitoring glucose and more time in the target range. The positive effect of self‐efficacy was observed to be maintained over time. This study underscores the importance of taking into account the developmental timing in the onset of T1D. There was a significant relationship between self‐efficacy and glucose indicators in adolescents. Although their glucose indicators were worse, self‐efficacy became more relevant as they moved from parental management to the self‐management of T1D. Implications of the results show the positive effect of self‐efficacy on health per glucose indicators, thus suggesting interventions that promote self‐efficacy in this population. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Bipolar disorder (BD) hospitalization rates in children and adolescents vary greatly across place and over time. There are no population‐based studies on youth BD hospitalizations in Spain.We identified all patients aged 10–19 hospitalized due to BD in Spain between 2000 and 2021, examined their demographic and clinical characteristics, and assessed temporal trends in hospitalizations – overall and stratified by age and presence of additional psychiatric comorbidity. We used Joinpoint regressions to identify inflection points and quantify whole‐period and annual percentage changes (APCs) in trends.Of 4770 BD hospitalizations in 10–19‐year‐olds between 2000 and 2021 (average annual rate: 4.8 per 100,000), over half indicated an additional psychiatric comorbidity, most frequently substance abuse (62.2%), mostly due to cannabis (72.4%). During the study period, admissions increased twofold with an inflection point: Rates increased annually only between 2000 and 2008, for APCs 34.0% (95% confidence interval: 20.0%, 71.1%) among 10–14‐year‐olds, 10.3% (6.4%, 14.3%) among 15–19‐year‐olds, and 15.5% (11.5%, 22.7%) among patients with additional psychiatric comorbidity. Between 2009 and 2021, rates decreased moderately among 10–14‐year‐olds – APC: −8.3% (−14.1%, −4.4%) and slightly among 15–19‐year‐olds without additional psychiatric comorbidity – APC: −2.6(−5.7, −1.0), remaining largely stable among 15–19‐year‐olds overall.Recent trends in hospitalization due to BD in 10–19‐year‐olds in Spain indicate salient increases in the early 2000s – especially among (i) patients aged 10–14 (decreasing moderately after 2009 among 10–14‐year‐olds and plateauing among 15–19‐year‐olds) and (ii) patients with additional psychiatric comorbidity (i.e., cannabis use disorder). These findings suggest links with recent changes in clinical practices for children and recent trends in substance use among Spanish youth. [ABSTRACT FROM AUTHOR]

Introduction: Conservative treatments such as physical therapies are usually the most indicated for the management of musculoskeletal pain; therefore, a detailed description of interventions enables the reproducibility of interventions in clinical practice and future research. The objective of this study is to evaluate the description of physical interventions for musculoskeletal pain in children and adolescents. Methods: We considered randomized controlled trials that included children and adolescents between 4 and 19 years old with acute or chronic/persistent musculoskeletal pain. We included physical therapies related to all types of physical modalities aimed at reducing the intensity of pain or disability in children and adolescents with musculoskeletal pain. The description of interventions was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. We performed electronic searches in the following databases: CENTRAL, MEDLINE, EMBASE, CINAHL, PsyINFO and PEDro up to April 2024. The description of physical interventions was presented using frequencies, percentages and 95% confidence intervals (CIs) of the TIDieR checklist items described in each study. We also calculated the total TIDieR score for each study and presented these data as mean and standard deviation. Results: We included 17 randomized controlled trials. The description measured through the TIDieR checklist scored an average of 11 (5.2) points out of 24. The item of the TIDieR that was most described was item 1 (brief name) and most absent was item 10 (modifications). Conclusion: The descriptions of physical interventions for the treatment of musculoskeletal pain in children and adolescents are partially described, indicating the need for strategies to improve the quality of description to enable true clinical reproducibility. [ABSTRACT FROM AUTHOR]

Aims/Introduction Materials and Methods Results Conclusions Coefficient of variation (CV) is an indicator for glucose variability in continuous glucose monitoring (CGM), and the target threshold of %CV in type 1 diabetes is proposed to be ≤36%. This study aimed to evaluate the clinical significance of CV in children and adolescents with type 1 diabetes.Participants included 66 children with type 1 diabetes. A total of 48 participants were treated with multiple daily injections of insulin, and 18 with continues subcutaneous insulin infusion, using intermittently scanned CGM. The frequencies of the CGM metrics and glycosylated hemoglobin values were examined, and the significance of a threshold %CV of 36% was evaluated.The mean frequencies in time in range (TIR), time below range, %CV and the mean glycosylated hemoglobin value were 59.3 ± 16.1, 4.0 ± 3.5, 39.3 ± 6.2 and 7.3 ± 0.8%, respectively. The frequencies of participants who achieved a TIR >70% and a %CV of ≤36% were 24.1 and 27.3%, respectively. A total of 18 participants with a %CV of ≤36% had significantly higher TIR, lower time below range and lower glycosylated hemoglobin than the 48 with a %CV of >36% (72.6 ± 12.6 vs 52.4 ± 13.6, 2.4 ± 1.9 vs 4.6 ± 3.6, 6.9 ± 0.8 vs 7.4 ± 0.7%, respectively).Children and adolescents with type 1 diabetes using intermittently scanned CGM had difficulties in achieving the recommended targets of TIR and CV. However, the target %CV of ≤36% seems to be an appropriate indicator for assessing glycemic control and risk of hypoglycemia in pediatric patients with type 1 diabetes with any treatment. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between overweight/obesity, vitamin D deficiency, and sarcopenia in children and adolescents. Methods In 2021, a multi-stage stratified cluster random sampling survey was conducted among primary and secondary school students in Shenzhen, which included questionnaire surveys, physical examinations, and laboratory tests. Body composition was assessed using bioelectrical impedance analysis. Logistic regression analysis was employed to evaluate the effects of overweight/obesity and vitamin D deficiency on sarcopenia in children, followed by interaction analysis. Results Among 4 931 children aged 6 to 17 years, the prevalence of sarcopenia was 10.3%, overweight obesity was 23.0%, and the rate of vitamin D deficiency was 41.2%. After adjusting for confounding factors in a multivariable logistic regression model, the risk of sarcopenia in children with overweight/obesity and vitamin D deficiency was found to be 118.107 times higher (95%CI: 73.035-190.995) than that in children without either condition. There was a multiplicative interaction between overweight/obesity and vitamin D deficiency (OR=2.436, 95%CI: 1.009-5.882). The additive interaction results also suggested a synergistic effect between overweight obesity and vitamin D deficiency, with interaction indices (S), relative excess risk due to interaction (RERI), and attributable proportion (AP) being 1.684 (95%CI: 1.250-2.270), 47.591 (95%CI: 10.098-85.083), and 40.280% (95%CI: 22.650-57.910), respectively. Interaction analysis by age group further confirmed the presence of an interaction between overweight/obesity and vitamin D deficiency. Conclusion Overweight obesity and vitamin D deficiency are risk factors for sarcopenia in children and adolescents, and there may be a synergistic effect between the two. [ABSTRACT FROM AUTHOR]

Objective: Differentiated thyroid cancer (DTC) is the most common pediatric endocrine cancer but studies are scarce. Latest recommendations advocate for an individualized risk-based approach to select patients for additional therapy. Lymphovascular invasion is not considered, despite being a well-known risk factor in the adult population. The aim of this study was to describe the outcomes of a cohort of DTC patients diagnosed at pediatric age and to evaluate the impact of lymphovascular invasion on the risk of persistence/ recurrence. Methods: A retrospective study of patients diagnosed with DTC at pediatric age from 2010 to 2022 at a single center was performed. All patients had total thyroidectomy. Radioactive iodine therapy (RAI) was used in selected patients. The response to therapy and occurrence of persistent/recurrent disease were evaluated. Results: A total of 21 DTC were diagnosed, mostly papillary thyroid carcinoma (PTC) (81.0%, n=17). Six patients (28.6%) had nodal involvement and one (4.8%) had lung metastasis at the time of the diagnosis. Lymphovascular invasion was present in 11 patients (52.4%). After surgery, 13 patients (61.9%) underwent RAI. The mean follow-up time was 5.7±3.1 years. In total, 6 patients (31.6%) experienced persistent/recurrent disease during the follow-up time. Among PTC patients, persistent/recurrent disease was more frequent in the presence of lymphovascular invasion [55.6% (5/9) vs. 0.0% (0/6), p=0.031]. Conclusion: An individualized risk-based approach is recommended. Our study suggests that lymphovascular invasion may be associated with a higher risk of persistence/recurrence and should therefore be considered for decision making in children and adolescents with PTC. [ABSTRACT FROM AUTHOR]

Purpose: In adults, diets rich in protein seem beneficial in relation to satiety, weight loss, and weight management; however, studies investigating dietary protein and weight development in children are scarce and inconsistent. This nonrandomized controlled trial aimed to investigate the effect of a higher protein diet during lifestyle intervention on anthropometry and metabolic biomarkers in children with overweight and obesity. Methods: Children (n:208) were recruited from two multicomponent lifestyle camps. One camp was assigned as the intervention group. In the intervention group, carbohydrates-rich foods at breakfast and two in-between-meals were replaced with protein-containing foods to increase the amount of protein from ~ 10–15 energy percent (E%) per day to ~ 25E% per day. Other components were similar between groups. Anthropometry and biochemical measurements were collected at baseline, 10 weeks (after camp) and 52 weeks. Results: The intervention group had a non-significant improvement in BMI-SDS (− 0.07 SD (− 0.19; 0.05), p = 0.24) compared to the control group, but in general, there was no effect of a higher protein diet on anthropometry and metabolic biomarkers. Overall, 10 weeks at camp resulted in a more favorable body composition [− 6.50 kg (p < 0.00), − 0.58 BMI-SDS (p < 0.00), and − 5.92% body fat (p < 0.00)], and improved metabolic health, with most changes maintained at 52 weeks. Conclusion: A higher protein diet had no significant effect on body composition and metabolic health; however, these lifestyle camps are an efficiatious treatment strategy for childhood obesity. Clinical trial registration: clinicaltrials.gov with ID: NCT04522921. Preregistered August 21st 2020. [ABSTRACT FROM AUTHOR]

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in children and adolescents (CAA) and its treatment plan includes a multimodal approach. Psychoeducation is a potential therapeutic modality in the multimodal treatment of ADHD. Psychoeducation intervention generally consists of single or multiple sessions providing education to the recipient regarding ADHD with the aim to facilitate an informed, self‐responsible management of the disorder and to improve the quality of life of patients and their families. Previous reviews have highlighted the positive effects of parental psychoeducation on ADHD symptoms, behavioral problems and social skills of CAA with ADHD. However, the effects of child only and combined parental and CAA psychoeducation interventions are unclear and under investigated. In the current paper, for the first time, we review, individually, the outcomes of parent only psychoeducation, child only psychoeducation and combined parental and CAA psychoeducation across a range of domains in CAA with ADHD. The findings reveal that including psychoeducation in the treatment of ADHD may improve clinical symptoms, social skills, functioning and family relationships in CAA with ADHD. Practitioner points: Child and combined psychoeducation may improve social skills in attention deficit hyperactivity disorder (ADHD).Child and combined psychoeducation may improve functional impairment in ADHD.Parent psychoeducation may reduce parental stress. [ABSTRACT FROM AUTHOR]

Background: Despite emerging evidence for the effectiveness of school‐based suicide prevention programmes worldwide, there are few being implemented in the United Kingdom, and their social validity (i.e., the feasibility, acceptability, and utility) is not yet known. Aims: We aimed to conduct a scoping study to determine: (1) the social validity and potential benefits of school‐based suicide prevention interventions, (2) the perceived need for such interventions, and (3) barriers and facilitators to implementation. Sample and Methods: A total of 46 participants took part. Semi‐structured interviews were conducted with mental health professionals (N = 8), school staff (N = 8), and parents whose children had experienced suicidal ideation/behaviours (N = 3) in England. Focus groups were also completed with children and young people (N = 27) aged 15–18 across three state secondary schools. Data were analysed using thematic framework analysis. Results: Three themes were identified: (1) the need for and importance of suicide prevention in children and young people, (2) schools as a setting for delivery, and (3) key components of suicide prevention programmes. Conclusions: Participants overwhelmingly agreed that there is a need for a greater and more consistent emphasis on school‐based suicide prevention. School appears to be an acceptable location for suicide prevention, and participants felt discussions about suicide should begin at the start of secondary school. However, there are potential barriers that need to be considered, including tailoring for neurodiversity, challenging cultural/family beliefs and stigma, managing personal experiences of suicidal thoughts or previous bereavement from suicide, and a lack of existing training for school staff. [ABSTRACT FROM AUTHOR]

The assessment of body fat of children in primary care requires consideration of the dynamic changes in height, weight, lean mass, and fat mass during childhood growth. To achieve this, we aim to develop a predictive equation based on anthropometric values, with optimal diagnostic utility. This is a cross-sectional observational study, involving schoolgoers aged 11–17 years in the Vigo metropolitan area. Out of 10,747 individuals, 577 were randomly recruited. Variables: age, sex, ethnicity/country of origin, weight, height, 8 skinfolds, 3 diameters, 7 perimeters, and 85% percentile of body fat mass as the gold standard. Generalized additive regression was selected by cross-validation and compared using receiver operating characteristic curves (ROC curves). Sensitivity, specificity, positive and negative predictive values, true positive and true negative values, false positive and false negative values, accuracy, and positive and negative likelihood ratios were calculated. Two models were identified. The optimal model includes sex, weight, height, leg perimeter, and arm perimeter, with sensitivity of 0.93 (0.83–1.00), specificity of 0.91 (0.83–0.96), accuracy of 0.91 (0.84–0.96), and area under the curve (AUC) of 0.957 (0.928–0.986). The second model includes sex, age, and body mass index, with sensitivity of 0.93 (0.81–1.00), specificity of 0.90 (0.80–0.97), accuracy of 0.90 (0.82–0.96), and an AUC of 0.944 (0.903–0.984). Conclusion: Two predictive models, with the 85th percentile of fat mass as the gold standard, built with basic anthropometric measures, show very high diagnostic utility parameters. Their calculation is facilitated by a complementary online calculator. What is Known: • In routine clinical practice, mainly in primary care, BMI is used to determine overweight and obesity. This index has its weaknesses in the assessment of children. What is New: • We provide a calculator whose validated algorithm, through the determination of fat mass by impedanciometry, makes it possible to determine the risk of overweight and obesity in the community setting, through anthropometric measurements, providing a new practical, accessible and reliable model that improves the classification of overweight and obesity in children with respect to that obtained by determining BMI. [ABSTRACT FROM AUTHOR]

Skin and subcutaneous diseases are one of the most common problems affecting the health of children and adolescents. The purpose of this study was to investigate the burden of skin and subcutaneous diseases among children and adolescents and its association with socioeconomic status. Data was obtained from the Global Burden of Disease Study 2019. The number of cases, incidence rate, number of deaths, and death rate in 204 countries and territories from 1990 to 2019 were extracted and stratified by age, sex, and socioeconomic status. In 2019, the global incidence and death rates of skin and subcutaneous diseases in children and adolescents were 57966.98 (95% Uncertainty Interval [UI] 53776.15 to 62521.24) per 100,000 and 0.21 (95% UI 0.13 to 0.26) per 100,000, respectively. From 1990 to 2019, the global incidence rate increased by 5.80% (95% UI 4.82–6.72%) and the death rate decreased by 43.68% (95% UI 23.04–65.27%). The incidence and death rates were negatively correlated with socioeconomic status. Incidence rates were not different between females and males, but death rates were higher among females than males. The highest incidence and death rates were found in the 1-4-year age group and < 1-year age group, respectively. The global burden of skin and subcutaneous diseases in children and adolescents was characterized by regional imbalances. The global burden of skin and subcutaneous diseases in children and adolescents from poorer regions requires more attention. This study provides strong evidence for global policymaking for childhood and adolescent diseases. [ABSTRACT FROM AUTHOR]

This study aims to investigate the clinical features of differentiated thyroid carcinoma (DTC) in children and adolescents under 18 years and assess the impact of surgery combined with thyroid hormone and radioactive iodine (RAI) on their prognosis. A retrospective observational study was conducted, involving children/adolescents with DTC who underwent surgery at the Head and Neck Department of Tianjin Medical University Cancer Institute and Hospital from January 1998 to December 2018. Among 198 patients, 130 (65.7 %) were female. According to the American Thyroid Association guidelines, cases were categorized as low (106, 53.5 %), intermediate (54, 27.3 %), and high (38, 19.2 %) risk. The follow-up duration ranged from 3 to 23 years. Local recurrence and distant metastasis were identified in 21 (10.6 %) and 14 (7.1 %) cases, respectively. All patients received levothyroxine, while RAI therapy was administered to intermediate- and high-risk patients. The local recurrence and distant metastasis rates in these two groups were 33.3 and 39.5 %, respectively, with no recurrence or metastasis in the low-risk group. Persistent without structural evidence of disease were 0.9, 3.7, and 26.3 % at end of follow-up for the low-, intermediate-, and high-risk groups, respectively. The overall survival rates for all three groups were 100 %, while disease-free survival rates were 99.1, 63.0, and 34.2 % for the low-, intermediate-, and high-risk groups, respectively. Children/adolescents with low-risk DTC exhibited a favorable prognosis even without RAI. However, intermediate- and high-risk DTC patients, despite RAI and levothyroxine treatment, showed elevated rates of persistent disease, local recurrence, and distant metastasis. [ABSTRACT FROM AUTHOR]

Background This study aimed to assess the association between outdoor activity and myopia among children and adolescents and investigate whether sleep time could mediate this relationship. Methods This cross-sectional study was performed on students aged 4–16 years in China, from August 2021 to January 2022. Outdoor activity was assessed by the Assessment Questionnaire of Exposure to Sunlight Activities for Students (AQESAS). Binary logistic regression combined with the mediation analysis was used to analyze the association of AQESAS with myopia and the mediating effect of sleep time on this relationship. Results The prevalence of myopia was 53.51% (N  = 1609). Multivariate logistic regression analysis showed that more sleep time (OR = 0.794, 95%CI: 0.707–0.893) and a higher score of AQESAS (OR = 0.989, 95%CI: 0.981–0.996) were significantly associated with a decreased risk of myopia. Mediation analysis revealed that sleep time plays a mediating role in the association between outdoor activity and myopia (ACME = −0.0006, P  < 0.001), and the mediation proportion was 19.7%. Conclusion Outdoor activity affects myopia directly and indirectly through sleep time. The result suggested that children may be able to reduce the risk of myopia by promoting sleep through increased awareness of outdoor activity and exposure to sunlight. [ABSTRACT FROM AUTHOR]

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This retrospective study aimed to investigate the association of initial muscular fitness (MF) with weight loss and metabolic health status in 282 children and adolescents with obesity during 3 to 4 weeks of diet- and exercise-based interventions. Metabolically healthy obesity (MHO) definitions established in 2023 and MF standards based on the 2021 Chinese children's grip strength grading were applied. The proportion of metabolically unhealthy obesity (MUO) was higher in the high MF group than in their low MF counterparts at baseline. After the intervention, neither group transitioned from MUO to MHO due to the high frequency of low HDL-C. High MF females showed a higher percentage of high systolic blood pressure (SBP) than low MF females before and after intervention. High MF males exhibited greater improvements in waist circumference, hip circumference, waist-hip ratio, triglycerides, total cholesterol, and LDL-C than low MF males. The benefits of weight loss and blood lipids obtained by males are more evident than those obtained by females under the same MF level. Thus, attention should be paid to females during weight loss regardless of MF levels. Precision therapy should prioritize the management of blood pressure and avoid excessive reduction in HDL-C levels to sustain metabolic health. [ABSTRACT FROM AUTHOR]

AIM: To investigate the diagnostic value of the axial length/corneal radius of curvature(AL/CR)for myopia in children and adolescents.METHODS: PubMed, Embase, The Cochrane Library, CNKI, CBM, WanFang Data and VIP databases were searched to collect clinical research on the value of AL/CR in diagnosing myopia in children and adolescents, and the retrieval time was from establishment to September 30, 2023. The QUADAS-2 tool was used to evaluate the quality of the extracted literature. A random-effects model was used to pool diagnostic test data, Meta-regression and subgroup analysis were performed to explore sources of heterogeneity.RESULTS: A total of 10 articles involving 19 872 study participants were included, and Meta-analysis showed that the pooled sensitivity of the AL/CR for the diagnosis of myopia in children and adolescents was 0.91[95%CI(0.90-0.91)], the pooled specificity was 0.84 [95%CI(0.84-0.85)], and area under the SROC curve of 0.95 [95%CI(0.93-0.96)].CONCLUSION: The AL/CR is a good indicator of myopia in children and adolescents.

Background The prevalence of overweight and obesity among children and adolescents is continuously rising. As countries have developed several school-based nutrition policies to control overweight and obesity, it is important to examine the effectiveness of nutrition policies. Objective To evaluate the effect of the centralized distribution of food material system on overweight and obesity rates among children and adolescents aged 6-15 years. Methods In April 2023, a total of 104 749 BMI data from sixteen schools aged 6 to 15 years (8 schools were included in the unified food distribution system and recorded as the unified distribution group, and 8 schools were not included in the unified food distribution and supply system and recorded as the non-unified distribution group) in Wuxi were retrospectively collected between 2017 and 2021. The data of physical examination was collected from Student Health Monitoring System in Jiangsu Province. The overweight and obesity epidemiologic trends among children and adolescents were analyzed from 2017 to 2021 in Wuxi, and the changes in BMI-Z scores and trends in overweight and obesity rates among children and adolescents were compared before and after the implementation of the centralized distribution of food material system by the Joinpoint regression and grey GM (1, 1) model. Results The prevalence of overweight and obesity among in children and adolescents aged 6-15 years was increasing from 2017 to 2021. The results of the Joinpoint regression analysis indicated that the prevalence of overweight (APC 1.8% vs 4.6%) and obesity (APC 6.9% vs 13.3%) among students included in the system exhibited a slower rate of increase than among those not included. The disparity in the increase of BMI-Z scores among students included in the system and those not included changed from -0.055 (95%CI=-0.108--0.002) to -0.195 (95%CI=-0.246--0.145) before and after the implementation of the system. The results of grey GM (1, 1) model showed that the incidence rate of overweight among children and adolescents in Wuxi in 2022, 2023 and 2024 was 22.02%, 22.39% and 22.77% respectively, with the incidence rate of overweight being 17.02%, 18.50% and 20.12% respectively. Conclusion The increasing trend in the prevalence of overweight and obesity, as well as the increase in BMI-Z scores among children and adolescents, has slowed down after the implementation of the centralized distribution of food material system. The system may be an effective method of improving the nutritional status of children and adolescents. Therefore, it is recommended that the centralized distribution of food material system still needs to be implemented and the monitoring area needs to be expanded.

Abstract Depressive disorder is a significant public health problem worldwide, which adversely affects children and adolescents’ health. Impaired fasting blood glucose (IFG) is more common in depressive disorder, which becomes a clinical problem that needs to be focused on. The study purposed to determine the prevalence and related factors of IFG in Chinese children and adolescents with depressive disorder and the relationship between triglyceride and high-density lipoprotein cholesterol (TG/HDL-C) ratio and IFG. This research encompassed 756 individuals aged 8 to 18 with major depressive disorders, all diagnosed under DSM-5 criteria at the Third People’s Hospital of Fuyang from January 2020 to December 2021. We detected fasting blood glucose (FBG) and lipid levels and assessed the suicidal behaviors and depressive symptoms severity of each participant. The sociodemographic and included study variables were collected and analyzed. Our study employed multiple logistic regression to discern independent factors affecting IFG in conjunction with depressive disorders among children and adolescents. The prevalence of IFG was 6.5% (49/756). IFG was positively correlated with FBG, BMI, TG, TG/HDL-C, and was negatively correlated with gender and the type of antidepressant drug taken. Binary logistic analysis showed that male (OR = 2.57, 95% CI: 1.43–4.63, P = 0.002) and higher levels of TG (OR = 1.63, 95% CI: 1.11–2.38, P = 0.013) were independently associated with IFG in children and adolescents with depressive disorder. The incidence of IFG in children and adolescents with depressive disorder was high and was positively related to the TG/HDL-C ratio. The evaluation and management of IFG in pediatric depression should extend beyond pharmacological interventions. Comprehensive strategies in both assessment and management of IFG are essential to address this condition effectively in young patients facing depressive disorders.

Anaphylaxis is an acute allergic reaction with rapid clinical development and risk of death. This article provides an analysis of literary sources devoted to intensive care of anaphylaxis in childhood. It was revealed that the prevalence of anaphylaxis is increasing, in children and adolescents as well. The main triggers of anaphylaxis in pediatric practice include food products, insect bites and drugs. Anaphylaxis is an IgE-mediated hypersensitivity reaction of type 1, characterized by the release of chemical mediators that lead to smooth muscle contraction, increased permeability and vasodilation and vagal activation. Clinically, anaphylaxis is manifested by allergic skin rash, angioedema, obstruction of the upper respiratory tract (URT), broncho-obstructive syndrome (BOS), arterial hypotension, tachycardia. Intensive care for anaphylaxis in children begins with stabilization of the condition: stopping the entry of a possible allergen into the body, hospitalization in the anesthesiology and intensive care unit, restoring patency of the URT, conducting oxygen therapy, monitoring vital functions. The first-line drug for the treatment of anaphylaxis in children is adrenaline at a dose of 0.01 mg/kg, which stops all the main pathophysiological links of anaphylaxis. Adrenaline autoinjectors are not used in the Russian Federation. Second-line drugs for intensive care for anaphylaxis in children include glucocorticosteroids (GCS), antihistamines, bronchodilators and infusion therapy. The effectiveness of GCS in anaphylaxis in children has not been proven, antihistamines can relieve skin manifestations of an allergic reaction, but do not affect vital disorders. Bronchodilators reduce BOS and are an additional treatment, while infusion therapy eliminates hypovolemia. Knowledge and timely implementation of modern care algorithms for anaphylaxis in children and adolescents will improve the quality of emergency care and reduce the risk of fatal outcomes in this pathology.

Abstract Background There is broad scientific evidence for the effectiveness of individual trauma-focused evidence-based treatments (EBTs) such as “trauma-focused cognitive behavioural therapy” (TF-CBT) for children and adolescents with posttraumatic stress symptoms. However, there is a significant research-to-practice gap resulting in traumatized children in high-income countries in Europe having only very limited access to these treatments. The aim of this study was, therefore, to identify common barriers and successful dissemination and implementation (D&I) strategies of evidence-based trauma-focused treatments (in particular TF-CBT) in seven European countries. Methods For this study, we chose a mixed-method approach: an online survey among certified European TF-CBT trainers (N = 22) and the collection of country-based narratives from TF-CBT experts in different European countries (Finland, Germany, Italy, Netherlands, Norway, Sweden). Results Common modifiable barriers to the implementation of TF-CBT were identified on different levels (e.g. government or treatment level), and successful D&I strategies were highlighted across all countries, such as translations of materials. Additionally, the experts from the country narratives put together a broad overview of TF-CBT research in Europe. Conclusions The results of this study revealed that especially learning collaborations and the development of joint European efforts in funding and researching D&I strategies are crucial for future implementation of trauma-focused EBTs in Europe.