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We compare suicidal behavior outcomes for adolescents who select "no response" on Ask Suicide-Screening Questions (ASQ) items in the emergency department (ED) with those of adolescents who screen negative or positive. The multisite Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study prospectively enrolled adolescents at ED visits, randomizing a subset to follow-up of six-month duration. Participants and parents/guardians completed mental health surveys during the ED encounter and (if applicable) at 3- and 6-month. Risk group was assigned based on ED ASQ score (positive, negative, or nonresponse). Primary outcomes were suicidal ideation, suicide attempt, and mental health service use within 6 months. There were 6411 participants assigned to an ASQ group; 2296 participated in follow-up. Nonresponse was associated with intermediate risk for suicidal ideation (nonresponse group adjusted odds ratio [OR] 2.14 [95% CI 1.33-3.41]; positive group 4.35 [2.93-6.51]), attempt (nonresponse group adjusted OR 2.82 [0.97-8.41]; positive group 5.35 [2.25-14.33]), and mental health care receipt (nonresponse group unadjusted OR 3.42 [1.56-7.59]; positive group 9.88 [5.60-17.79]). Youth choosing nonresponse on suicide screening questions may be at elevated risk for suicidal ideation and behavior; ED clinicians should not default to treating these youth as negative screens.

Although the prevalence of affective comorbidities with eating disorders (ED) has been well established, the three-way relation between ED, depression, and anxiety symptoms has not been explored in an intensive adolescent treatment setting. This study analyzed data from a sample of teenage girls with anorexia nervosa in higher levels of care (n = 457) to assess the relations between changes in ED symptoms, depression, and anxiety over the course of ED treatment. This study demonstrated that improvements in depression and anxiety are significantly associated with improvement in ED symptoms. Findings support the importance of routine assessments for depression and anxiety among adolescents with anorexia nervosa in higher levels of care and a transdiagnostic approach to treatment that addresses shared underlying mechanisms. Future research that aims to uncover mediators and moderators of these relations is warranted to enhance clinical efforts.

Research on autobiographical memory (AM) in anorexia nervosa (AN) has largely focused on quantitative aspects such as specificity, while qualitative investigations of thematic patterns remain limited. This study aimed to compare the content of cued AMs between individuals with AN and healthy controls (HCs) using a qualitative approach. Sixty-three adults (AN = 43; HC = 20) completed a computerised written version of the Autobiographical Memory Test, generating memories in response to six-self- or moral-disgust-related cue-words. A total of 189 AMs (AN = 129; HC = 60) were coded using a conventional qualitative content analysis. Fourteen codes were constructed from the data, two of which were excluded from theme development. Three overarching themes were identified: (1) relational wounds - the role of others, (2) relational vigilance, and (3) identity disturbance. AMs reflecting iatrogenic harm, body mistrust, betrayal, impact of interpersonal experiences, moral self-evaluation, shame, and feelings of wrongness or being different were unique to, or more frequent in, the AN group than HCs. Across themes, individuals with AN exhibited more intense, enduring, and unresolved relational and self-related difficulties, whereas HCs described similar experiences in a more situational, flexible, and adaptive manner. A qualitative exploration of the content of cued AMs from people with AN is a novel approach to understanding its phenomenology. In this study, interpersonal and self-related mistrust were prominent features of AMs in people with AN. Understanding these qualitative differences in AM content may inform interventions aimed at restoring relational trust and self-acceptance.

Non-suicidal self-injury (NSSI) typically begins in adolescence and is associated with higher impulsivity and compromised white matter microstructure in the brain. Identifying early predictors of NSSI is a high priority. We used data from the Adolescent Brain Cognitive Development Study to examine whether baseline white matter, specifically generalized fractional anisotropy (GFA), and different facets of impulsivity were prospectively associated with NSSI onset two years later (Y2). We also examined interactions with sex. We identified 209 youth aged 8-11 years who reported NSSI at Y2, but not at baseline (incident NSSI; iNSSI) and 209 controls matched by demographic and clinical characteristics. We conducted a Least Absolute Shrinkage and Selection Operator (LASSO) regularization, which yielded an AUC of .60, to narrow down predictors for logistic regression. Significant main effects indicated that lower GFA of the left parolfactory section of the cingulum (OR = 0.63) and higher negative urgency (OR = 1.54) were prospectively associated with Y2 NSSI. Sex interactions indicated that the relations between Y2 NSSI and lower GFA of the left parolfactory section of the cingulum (OR = 1.75) and higher negative urgency (OR = 0.60) were driven by males. Higher sensation seeking (OR = 1.36) and lack of perseverance (OR = 1.46) were more strongly associated with Y2 NSSI among females than males. Future work is needed to better understand the course of development of white matter microstructure and impulsivity as it relates to NSSI.

A 15-year-old female patient presented with recurrent episodes of hematemesis over six months, with no identifiable source on initial evaluations, including upper gastrointestinal (GI) endoscopy and abdominal angiography. Despite a thorough workup for bleeding diatheses, the etiology remained elusive until whole-genome sequencing revealed a homozygous mutation in the ADAMTS2 gene, confirming Ehlers-Danlos syndrome (EDS), dermatosparaxis type (dEDS). Although bleeding is more common in vascular EDS, recurrent GI bleeding in this patient likely resulted from vessel wall weakness and defective collagen processing associated with dEDS. Management included celiprolol, vitamin C, multivitamins, and multidisciplinary follow-up. This case underscores the importance of genetic testing in diagnosing atypical connective tissue disorders and highlights a multidisciplinary approach for managing complex cases with recurrent, unexplained bleeding.

Adolescents in low- and middle-income countries (LMICs) experience a disproportionately high burden of emotional and behavioral problems (EBPs), shaped by early adversities, limited psychosocial support, and structural disadvantages. In Bangladesh, mental health concerns among adolescents remain under-recognized, with limited data on how mental health symptoms cluster and which subgroups are at elevated risk. Identifying distinct risk profiles is essential for informing targeted interventions. Using data from a cross-sectional school-based survey (N = 1040), we applied latent class analysis (LCA) to identify mental health risk profiles based on emotional symptoms, conduct problems, insomnia, suicidal behavior, truancy, physical fights, bullying, and peer/social isolation. Multinomial logistic regression models were used to examine associations between latent class membership and adverse childhood experiences (ACEs), family/peer relational factors, and sociodemographic characteristics. Three distinct mental health and behavioral risk classes were identified: low risk (36.3%), moderate risk (36.1%), and high risk (27.6%). The high-risk class showed elevated internalizing symptoms, externalizing behaviors, and psychosocial adversities, including conduct problems, loneliness, truancy, bullying, and physical fighting. In the fully adjusted model, sexual abuse (aOR = 2.64) and witnessing violence aganist the mother (aOR = 3.56) were the strongest predictors of high-risk membership. Lack of peer support was significantly associated with both moderate-risk (aOR = 2.13) and high-risk (aOR = 2.25) membership, whereas poor parental understanding increased the odds of moderate-risk classification (aOR = 1.70). In the interaction model, females exposed to household mental illness had disproportionately higher odds of belonging to the high-risk class. Adolescent mental health in Bangladesh is shaped by a complex interplay of trauma, family functioning, and gender. Trauma-informed, gender-sensitive interventions are urgently needed to address these disparities.

Turner syndrome (TS) is associated with delayed puberty, abnormal breast development, and increased risk of certain diseases. The purpose of this article is to present the current state of breast development assessment in TS patients, focusing on the use of ultrasound (US), mammography, and MRI, regarding their utility in monitoring changes in women with TS. A comprehensive literature review was conducted using databases like PubMed and Medline. There are currently no specific recommendations for breast US in TS patients, and because no conclusive US classification of breast development with distinctive sonographic features in the breast has been established, breast US in women with TS remains a diagnostic challenge. Proposed US scales for breast development in adolescent girls and fibroglandular tissue evaluation in men with gynecomastia are suggested as potential tools for monitoring breast development in women with Turner syndrome. Further research is highlighted as crucial to improving diagnostic and therapeutic approaches.

Adolescents with HIV (AWH) have higher rates of detectable viral loads (DVL) than adults. We sought to identify clinical and psychosocial predictors of DVL among AWH in optimized care environments. We prospectively recruited 1,250 AWH (aged 10-19) from four youth-friendly HIV clinics in Eswatini and Lesotho (May 2023-October 2024). Participant clinical data was abstracted from an electronic medical record, and participants completed validated surveys assessing depression, anxiety, stigma, self-efficacy, adverse childhood experiences, and substance use. We developed predictive models from clinical and survey data using logistic regression, elastic net regression, and random forest algorithms, with 70/30 train-test splits. Of 1,222 participants with viral loads, 163 (13.4%) had DVL (≥50 copies/mL). The cohort was evenly distributed by gender and predominantly included older adolescents (72.3% aged 15-19) with perinatally-acquired HIV (median age at diagnosis 2 years). Most (95.1%) received dolutegravir-based therapy. Key features associated with DVL from the models included: prior DVL within 2 years (OR 5.4, 95%CI 3.34-8.74), non-dolutegravir regimens (OR 4.11, 95%CI 1.36-12.42), and survey responses related to low self-efficacy, stigma fears, size of the household, and adherence behaviors. Model performance for prediction of DVL was moderate, with AUROCs for all models ranging between 0.729 and 0.744. While clinical factors, particularly a prior DVL and non-DTG regimen, were associated with DVL, few psychosocial features consistently emerged across predictive models. The high viral suppression rates (86.5%) in these youth-friendly environments demonstrate effective comprehensive care. Results suggest individualized rather than algorithmic approaches may better support adolescents with persistent adherence challenges.

Surgical stress can lead to postoperative anxiety and depression, especially in adolescents. These complications reduce quality of life and increase medical burdens, but perioperative psychological interventions for adolescents are limited, and related mechanisms remain unclear. Esketamine (S-ketamine), an N-methyl-D-aspartate receptor (NMDAR) antagonist, has analgesic, sedative, antidepressant, and anxiolytic effects, yet its efficacy and safety in adolescent surgical patients have not been systematically studied. This study seeks to investigate the prophylactic efficacy of subanesthetic-dose S-ketamine in mitigating postoperative anxiety and depression among adolescent patients. In this prospective double-blind randomized placebo-controlled trial, 92 American Society of Anesthesiologists (ASA) I-II adolescents aged 13-18 years undergoing elective surgery were randomly assigned to receive intravenous esketamine (0.25 mg/kg) or normal saline at skin incision. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS); serum C-reactive protein (CRP) and interleukin-6 (IL-6) were measured; pain was evaluated using the NRS. Adverse events were recorded. Eighty patients completed the study. The esketamine group had significantly lower anxiety scores on postoperative days 1, 3, 7, and 14 (P < 0.05). Depression scores differed significantly only on day 14 (P = 0.043). There were no significant between&#x2011;group differences in inflammatory markers or adverse events. Esketamine was a protective factor against postoperative anxiety (OR = 0.38, P < 0.05). Subanesthetic-dose esketamine during surgery effectively reduces postoperative anxiety and partially alleviates depressive symptoms in adolescents with acceptable safety. Limited by sample size and single&#x2011;center design, multicenter studies with longer follow&#x2011;up are warranted.

Adolescent pregnancy remains an important public health concern in Ghana and other low- and middle-income settings. Pregnant adolescents often initiate antenatal care later than recommended or attend irregularly, increasing the risk of adverse maternal and newborn outcomes. While determinants of antenatal care use have been widely studied, less is known about how individual, family, and health system factors interact to shape adolescents' care seeking experiences. This study explored influences on antenatal care utilisation among pregnant adolescents in an urban municipality in southern Ghana. A qualitative descriptive study was conducted in the La Nkwantanang Madina Municipality in the Greater Accra Region of Ghana. Data were collected through in-depth interviews, focus group discussions, and key informant interviews with pregnant adolescents, caregivers, midwives, and community members. Interviews were conducted in English or Twi, audio recorded, transcribed verbatim, and analysed thematically. Forty-two participants were included: 15 pregnant adolescents, 6 caregivers, 5 midwives, and 16 community members. Three interrelated themes shaped antenatal care utilisation: individual influences, family influences, and health system influences. Delayed pregnancy recognition, stigma, and financial constraints contributed to late initiation of care. Family responses, including support or disapproval, influenced attendance patterns. Health system factors such as provider attitudes, waiting time, privacy concerns, and out of pocket costs also shaped utilisation, although supportive care experiences encouraged continued attendance. Antenatal care utilisation among pregnant adolescents is shaped by interacting individual, family, and health system influences. Strengthening adolescent responsive services, supportive family engagement, and reducing structural barriers may improve timely and consistent antenatal attendance.

Hepatic artery pseudoaneurysm is a rare but potentially life-threatening vascular condition, with risks of rupture, fistula formation, and massive hemorrhage. It most commonly occurs secondary to trauma, infection, inflammation, or iatrogenic injury. In this report, the case of a 15-year-old boy with idiopathic juvenile arthritis who presented with chronic anemia, intermittent right upper quadrant and epigastric pain, low-grade fever, and occasional vomiting for two years is reported, with repetitive attacks of pancreatitis. Ultrasound of the abdomen showed sludge in the gallbladder. Magnetic resonance cholangiopancreatography (MRCP) showed the lumen of the gallbladder with an ill-defined fluid level suggestive of a sludge ball, and a wall thickness of 3 mm. So, a laparoscopic cholecystectomy was performed on the basis of the patient's symptoms and findings. Postoperatively, after one month, the patient had symptoms of abdominal pain, melena, and a fall in hemoglobin. CT scan and selective angiography revealed a small pseudoaneurysm arising from the medial branch of the left hepatic artery with associated biliary duct dilatation, suggestive of an arteriobiliary fistula. The patient underwent transcatheter coil embolization. Post-embolization angiography confirmed complete occlusion of the pseudoaneurysm with preserved hepatic arterial flow. Early recognition and timely endovascular intervention are essential to prevent life-threatening complications, including rupture and massive hemorrhage.

Cardiovascular disease (CVD) is the leading cause of death in Malaysia, with risk factors emerging in childhood. The American Heart Association's Life's Essential 8 defines cardiovascular health (CVH) through eight factors: diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, cholesterol, and glucose. While CVH assessment in primary care is critical for long-term CVD prevention, insights from low- and middle-income countries, including Malaysia, remain limited. This study aimed to explore the barriers and facilitators of implementing CVH assessment in children and adolescents in the Malaysian primary care settings. We conducted a qualitative study using semi-structured interviews with policymakers, healthcare professionals (HCPs), adolescents (12-18 years), and parents of children (5-11 years). Data were analysed using directed content analysis guided by the Tailored Implementation for Chronic Diseases (TICD) framework. Interviews with 51 participants identified multilevel barriers across system, provider, and patient levels. Policymakers and HCPs highlighted limited school health and primary care capacity, resource constraints, insufficient paediatric-specific training, and fragmented care coordination. HCPs perspectives reflected variation in perceived feasibility, with some expressing concerns regarding implementation complexity and competing priorities. Parents and adolescents reported a low perceived need for screening, fear of procedures, and stigma. Facilitators included alignment with existing adolescent health programmes, perceived feasibility when integrated into existing workflows, and opportunities for task-sharing and community engagement, although these were often dependent on local resources and coordination. Implementation of CVH assessment is shaped by interacting system-, provider-, and patient-level factors within a broader healthcare orientation. Supporting implementation requires enhancing paediatric-specific training, enabling task-shifting, and integrating CVH assessment into routine workflows. Improved referral pathways, care coordination, and integration into existing adolescent health programmes may further facilitate uptake in primary care.

Tuberculosis (TB) remains a global health threat, affecting over a million children under the age of 15 annually. Many children with TB do not receive treatment due to challenges in diagnosis. We performed a multi-omics analysis for pediatric TB by integrating plasma proteomics and metabolomics data from children with presumptive TB across four high-burden countries. Pathway enrichment analysis was conducted using multiGSEA to identify relevant immune and metabolic pathways. We also applied mixOmics and multiview approaches for diagnostic biomarker discovery and compared the performance of multi-omics signatures with those derived from single-omics datasets. Enrichment analysis revealed several immune and metabolic pathways, including PTEN and RUNX2 regulation pathways, as well as arginine and proline metabolism, that were uniquely identified through data integration. While the multi-omics model showed marginal improvement over single-omics models, proteomics alone generally outperformed metabolomics and demonstrated greater potential for accurately classifying Confirmed TB versus Unlikely TB in children. These findings demonstrate the advantage of combining complementary molecular layers to gain a deeper understanding of disease mechanisms and highlight the potential of proteomics for improving pediatric TB diagnosis.

To investigate emotion recognition abilities in paediatric patients affected by obstructive sleep apnea syndrome (OSAS) and explore related neurocognitive alterations. Fifty children aged 6-11 years diagnosed with OSAS and 50 matched controls underwent polysomnography, emotion recognition testing (TEC), and physical activity monitoring. Neurocognitive assessments included analysis of brain morphology, EEG activity, and metabolic markers from previous literature. OSAS in children negatively impacts emotion recognition and neurocognitive functions due to brain structural and functional alterations. These findings support the need for early diagnosis and treatment to mitigate cognitive and emotional deficits associated with paediatric OSAS.

The aim was to investigate the incidence of sepsis and use of antibiotics among extremely preterm infants, given the limited number of population-based studies examining this. This retrospective study in Eastern Denmark included all liveborn infants from 23&#x2009;+&#x2009;0&#x2009;weeks/days to 27&#x2009;+&#x2009;6&#x2009;weeks/days of gestation from 2019 to 21. Data on dispensed intravenous antibiotics were obtained from the regional joint electronic health platform. Early-onset sepsis was defined as occurring within the first 72&#x2009;h of life and late-onset sepsis from 3 to 90&#x2009;days. Positive blood culture episodes were classified as proven sepsis. Within the first six months of life, 187 of the 232 (81%) infants received intravenous antibiotics. Empirical treatment was initiated for early-onset sepsis in 164 of the 232 infants (71%) and late-onset sepsis in 118 (51%). Late-onset sepsis accounted for 90% of proven sepsis, predominantly caused by Staphylococcus aureus and Coagulase-negative Staphylococcus. Antibiotic use for late-onset sepsis was three-fold higher than for early-onset sepsis (9902 versus 3413&#x2009;days per 1000 live births). Sepsis caused two deaths (9 per 1000 live births infants). Suspected early-onset sepsis was the most common indication for antibiotic initiation, but late-onset accounted for most proven sepsis episodes and antibiotic exposure in extremely preterm infants.

Although asthma and obesity are independently associated with neurodevelopmental disorders, whether their co-occurrence is associated with a higher burden of these disorders remains unclear. Using NHIS data from children and adolescents aged 10-17 years with complete BMI and neurodevelopmental data, 42,444 participants were stratified into four categories according to their asthma and obesity status: obesity-related asthma (OA), asthma without obesity (NOA), obesity without asthma (ONA), and neither condition (NC). Compared with the NC group, the adjusted odds ratios for attention-deficit/hyperactivity disorder, learning disability, autism spectrum disorder, and developmental delay were, respectively, 1.84 (95% CI 1.57-2.14), 1.87 (95% CI 1.57-2.22), 2.20 (95% CI 1.57-3.07), and 2.29 (95% CI 1.79-2.94) in the OA group; 1.56 (95% CI 1.40-1.74), 1.51 (95% CI 1.34-1.69), 1.12 (95% CI 0.87-1.43), and 1.50 (95% CI 1.26-1.79) in the NOA group; 1.23 (95% CI 1.10-1.38), 1.32 (95% CI 1.17-1.48), 1.53 (95% CI 1.21-1.93), and 1.31 (95% CI 1.10-1.56) in the ONA group. This study demonstrated a significant association between obesity-related asthma and neurodevelopmental disorders in children. The co-occurrence of obesity and asthma is associated with stronger associations than either condition alone. Our study showed that there was a significant association between obesity-related asthma and neurodevelopmental disorders in children. Our study also suggested that the co-occurrence of obesity and asthma is associated with stronger associations than either condition alone. Our study filled the research gap regarding the association between obesity-related asthma and childhood neurodevelopmental disorders. Our findings highlight the need for further longitudinal studies to examine whether integrated management of obesity and asthma is related to neurodevelopmental outcomes in children. These findings may help identify children with co-occurring obesity and asthma as a subgroup warranting closer developmental assessment.

High-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are options for respiratory support in infants with bronchiolitis. The aim of this study was to evaluate the use of HFNC and CPAP in infants with bronchiolitis at five hospitals in Norway to study time trends over seasons and differences in use between hospitals. In this multicentre retrospective study, we compared data from 1186 infants <&#x2009;12&#x2009;months of age hospitalized for bronchiolitis at five Norwegian hospitals during the winter seasons 2017-2018, 2018-2019, and 2021-2022. Over the three seasons, HFNC was provided to 29%-33% and CPAP to 8%-18% of all infants, but with a substantial difference between hospitals for both modalities. The change between seasons was less prominent but also differed between hospitals. The length of stay was longer, and the age and weight were lower in those receiving any non-invasive respiratory support, but this did not differ between infants treated with HFNC or CPAP. In Norwegian hospitals there was a substantial variation in the use of HFNC and CPAP for infants with bronchiolitis. This calls for unified and evidence-based guidelines for the use of non-invasive respiratory support for this patient group.

The Claremont Purpose Scale (CPS) was designed to assess youth purpose, but the English version has not yet undergone rigorous psychometric evaluation among adolescents. Prior validation efforts have also mostly relied on white-majority samples, raising concerns about generalizability. With 587 adolescents (Mage&#x2009;=&#x2009;16.38&#x2009;years, range&#x2009;=&#x2009;13-19), confirmatory factor analyses (CFA) supported correlated three-factor and second-order models equivalently. However, the beyond-the-self dimension had the weakest connections with the overarching purpose construct and other CPS dimensions, and exploratory tests suggested that the correlated three-factor model may have an empirical edge over the second-order configuration. Expected zero-order correlations provided evidence of convergent validity; up to partial scalar invariance across racial-ethnic groups was supported by multigroup CFA; and latent means testing and multigroup structural equation modeling failed to find differences between racial-ethnic groups in purpose level and adjustment associations. Findings are discussed from developmental and cultural perspectives, with implications for future adolescent purpose measurement.

This Response addresses methodological and conceptual issues raised in a Letter to the Editor concerning our recently published network analysis of autism characteristics and anxiety symptoms in autistic children and youth. We clarify concerns related to potential conceptual overlap between autistic characteristics and anxiety-related symptoms and address questions concerning the multinational nature of the dataset. We also summarize sensitivity and stability analyses showing that the identified bridge nodes are robust to variation in regularization parameters and operational definitions. Together, these clarifications support the interpretation of the reported network findings.