Scarce human resources for health and high injury-related mortality coincide with inequities in accessing quality trauma education programs in low- and middle-income countries. Existing observational studies restrict assessments of trauma training program impacts on providers' knowledge. Evaluation of trauma education programs outside clinical trial settings hinders their effectiveness in influencing clinical practice and policy changes for patient outcomes. This study aimed to assess the impact of the Rural Trauma Team Development Course (RTTDC) on clinical processes and patient outcomes of motorcycle-accident-related neurological and/or musculoskeletal injuries in selected Ugandan hospitals. This was a pragmatic 2-arm, parallel, multiperiod, cluster randomized controlled trial. The participants were trauma care frontline personnel and patients aged 2-80 years at 3 intervention and 3 control Ugandan hospitals (1:1 allocation). Hospitals were randomly allocated to intervention or control groups using permuted block sequences. Sequence codes were generated off-site by an independent statistician using Sealed Envelope (version 1.23.1; Sealed Envelope Ltd). Both patient participants and outcome assessors were blinded to allocation. Hospital allocation codes were concealed until the point of assignment. In the intervention arm, 500 trauma care frontliners received RTTDC, whereas patients received standard care. In the control arm, patients received standard care without RTTDC for staff. The primary outcomes were time from accident to admission and from referral to dispatch. The secondary outcomes were all-cause 90-day mortality and morbidity related to neurological and/or musculoskeletal injuries. We followed the CONSORT (Consolidated Standards of Reporting Trials) guidelines for reporting cluster randomized trials. We analyzed 1003 participants (501 intervention and 502 control). The intervention arm had a shorter median (IQR) prehospital time of 1 hour (0.50-2) and referral-to-dispatch interval during interfacility transfers of 2 hours (1.25-2.75). This contrasted with 2 hours (1.50-4) and 4 hours (2.50-4.10) in the control arm, respectively (P<.001). The 90-day mortality was more than halved in the intervention (5%, 24/457) vs in the control arm (13%, 58/430) (P<.001). Fewer participants in the intervention group had unfavorable Glasgow Outcome Scale scores (9%, 42/457) vs (20%, 87/430) (P<.001). No difference was found in musculoskeletal injury morbidity outcomes (P=.57). Rural trauma team development training demonstrated potential for improved organizational time efficiency and clinical outcomes for neurological injuries without negatively impacting musculoskeletal injury morbidity outcomes. Evidence from this trial supports that locally contextualized, trainee-led rural trauma team development interventional programs are feasible in low- and middle-income countries. However, despite being a multicenter study conducted across 6 geographically distinct hospitals, the research is limited in generalizability due to its focus on a single health care system within 1 country, retrospective trial registration, exclusion of prehospital deaths, and a relatively small number of clusters, which could introduce measurement bias.
As the threat of child malnutrition increases, the focus remains mostly on short-term consequences. Long-term sequelae are increasingly recognised but lack strong evidence, and many studies face methodological limitations. A retrospective cohort of survivors of the 1984-1985 Great-Ethiopian Famine was compared with two novel control groups: born post-famine; and age category- and sex-matched controls. Exposure to famine at different age categories was explored (fetal, 0-2, 2-5, 5-10 and 10-18 years). Follow-up was 40 years later. Outcomes included anthropometry, body composition, arterial stiffness, mental health, and risk of cardiometabolic and non-communicable diseases (NCDs). Adjusted differences and 95% CI between exposed and controls were calculated. Compared with matched and post-famine controls, adjusted differences (95% CI) for exposed group were: height, -1.4 cm (-2.4 to -0.3) and -2.4 cm (-3.7 to -1.1); weight, -1.4 kg (-2.7 to -0.1) and -1.7 kg (-3.3 to -0.1); diastolic blood pressure (DBP), -2.8 mm Hg (-4.4 to -1.1) and 2.8 mmHg (0.9 to 4.7); handgrip strength, -1.7 kg (-2.7 to -0.6) and -4.1 kg (-5.5 to -2.7); brachial augmentation index, 5.4% (0.3% to 10.5%) and 16.1% (10.1% to 22.1%); aortic augmentation index, 6.0% (1.5% to 10.4%) and 11.7% (6.1% to 17.3%); subscapular skinfold thickness, 1.1 mm (0.2 to 1.9) and 1.2 mm (0.1 to 2.3); triceps skinfold thickness, 1.8 mm (0.8 to 2.7) and 2.1 mm (1.0 to 3.3) and waist-to-height ratio, 0.01 (0.003 to 0.02) and 0.01 (0.001 to 0.02), respectively. When comparing risk by timing of exposure, individuals exposed during early childhood (0-2 years), preschool age (2-5 years), and late childhood (5-10 years) had reduced adult stature of -2.8 cm (-4.8 to -0.9), -2.8 cm (-4.7 to -0.9) and -2.1 cm (-4.0 to -0.2), respectively, and increased triceps skinfold of 1.7 mm (-0.5 to 3.8), 3.2 mm (0.8 to 5.6) and 3.8 mm (1.6 to 6.02), respectively. Early-life famine exposure is associated with smaller adult size and several, but not all NCD risks. Lower DBP in survivors compared with matched controls is surprising and might reflect differential susceptibility to specific later-life health risks. Greater arterial stiffness underscores the need to identify both preclinical and clinical risk. In contrast to exposure in utero, risk was higher among those exposed during early childhood (0-2 years), preschool (2-5 years) and late childhood (5-10 years). The study underscores the need for a dual approach in low- and middle-income settings: tackling the immediate undernutrition while also anticipating and mitigating long-term NCD risk in populations exposed to early-life severe malnutrition or famine.
Childhood anxious solitude/withdrawal (AS) predicts social anxiety disorder symptoms (SAS) in childhood and adolescence. However, the nature and timing of transactions between AS and SAS across development and the impact of ecological transitions is poorly understood. This investigation modeled cross-lagged effects between AS and SAS from 4th to 7th grade (approximately 9-12 years of age), to evaluate increased transactions after the middle school transition (MST) in the fall of 6th grade and thereafter. Biological sex differences in transactions were also tested. Participants were 230 American children (57% girls), half of whom were oversampled for AS. Peers nominated children for AS and children self-reported SAS in 4th through 7th grade. Results of a multigroup (biological sex) auto-regressive cross-lagged panel model revealed both stability in AS and SAS from 4th through 7th grade, as well as significantly more transactions between AS and SAS after the MST and during the first two years of middle school than during the last two years of elementary school. AS predicted increases in SAS just after the MST (spring 5th to fall 6th grade), and during the first year (fall to spring 6th grade) and second year (fall to spring 7th grade) of middle school. Conversely, SAS predicted an increase in AS from the spring of 6th grade to the fall of 7th grade. Most transactions occurred for both sexes, but several sex-specific transactions are also described. Results support a transactional model of AS and SAS co-development in early adolescence and the importance of ecological transitions.
Interrater agreement on child temperament and personality is often found to be low to moderate. While some interpret this finding as a psychometric problem, others argue that it may instead reflect the distinct contexts and perspectives that shape each informant's perception of the child. To gain a better understanding of this issue, we adapted the parent version of the Integrative Late Childhood Temperament Inventory (ILCTI) for use in children and teachers and examined the agreement between parents, children, and teachers. We collected 280 self- and teacher-ratings of the ILCTI from 9-14-year-old Austrian children and young adolescents. We also obtained parent ratings for 110 children and a second teacher rating for 57 children. Results on psychometric properties supported internal consistency reliability and criterion validity (meaningful associations with internalizing and externalizing problems and school performance) for all three versions. Interrater agreement across all items of the ILCTI (as assessed by dyad-centered agreement), and on the six individual temperament dimensions was highest among teachers, followed by parent-child, parent-teacher, and teacher-child agreement. Interestingly, low parent-teacher agreement was associated with more behavioral and emotional problems in children. Possible explanations for differences in the extent of interrater agreement among rater groups are discussed.
Parental psychological distress is a commonly examined risk factor for the emergence of child problem behaviors, but the factors that contribute to that relationship-such as limited parental resources like greater social support and coping skills-have not been adequately explored, particularly with attention to potential bidirectional relations that incorporate child evocative effects. The current longitudinal study examined maternal and paternal psychological distress in relation to perceived child externalizing behaviors, considering parental resources as mediators within a bidirectional model. The sample included a racially and socioeconomically diverse group of 201 primiparous mothers and 151 fathers. Mothers and fathers reported their current psychological distress, social support satisfaction, and problem-focused coping prenatally, at child age 18 months and at child age 4 years, as well as reporting on child externalizing behaviors in these latter two waves. Results suggest that mothers' psychological distress predicted perceived child externalizing behaviors in both toddlerhood and early childhood. However, for fathers, although their psychological distress did not predict their reports of child externalizing behaviors, perceived child externalizing appeared to predict later paternal psychological distress and social support satisfaction in early childhood, evidencing child evocative effects. No mediation by parental resources was identified for either mothers or fathers. Overall, this study underscores the intricate processes involved in understanding parent-perceived child externalizing behaviors and the importance of examining fathers and the role of children.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
Non-communicable diseases (NCDs) account for ~71% of all deaths globally, including 15 million premature deaths each year (deaths between 30-69 years of age). Instead of waiting until disease manifestation, focusing on the origins of NCDs during childhood offers a critical window of disease prevention and control. The CHILDREN_FIRST international cohort observatory study aims to investigate how the spatio-temporal evolution of the children's exposome profiles in the Mediterranean region influences early-life programming of chronic disease risk during the critical window of susceptibility in primary school years (6-11 years of age). The study protocol adopts the human exposome framework integrated with a personalized prevention approach, using multi-omics platforms and advanced machine learning algorithms implemented across Mediterranean countries, namely Cyprus, Greece, and Albania. The cohort will consist of children enrolled in the first grade of primary school, who will undergo annual follow-up assessments until completion of primary education. During the annual assessments, children's exposome parameters from the three main exposome domains will be evaluated using different assessment types, i.e., molecular biomarkers of exposure/effect, sensors, and questionnaires. Standardized biospecimen and data collection methods will be employed following harmonized standardized operating procedures. The reference model of Observational Medical Outcomes Partnership - Common Data Model (OMOP-CDM) developed and maintained as part of the Observational Health Data Sciences and Informatics (OHDSI) initiative will be used to conduct federated data analysis. This CHILDREN_FIRST study protocol is a human exposome-based initiative to establish a long-term prospective cohort infrastructure for biomedical research on children's health in the Mediterranean region. The cohort's exposome-based findings will systematically feed into the evaluation and design of chronic disease prevention programs. Expected results would inform evidence-based policy making and the development of health interventions for reducing the risk of NCDs in childhood and later in adult life.
The Emergency Severity Index (ESI) is the most widely used triage system in US emergency departments (EDs), but its performance in triaging children presenting with behavioral health symptoms is not well studied. To assess the frequency of overtriage and undertriage and to identify characteristics associated with both among children presenting to the ED with behavioral health symptoms. This retrospective cross-sectional study was performed in 15 US EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) Registry. Participants included children and adolescents aged 5 to 17 years presenting to EDs within the PECARN Registry with a behavioral health chief concern from January 1, 2021, to December 31, 2023. Data were analyzed from July 1, 2024, to January 15, 2026. Sociodemographic and clinical characteristics. Appropriate triage, overtriage, and undertriage were defined using combinations of first-obtained vital signs, Glasgow Coma Scale, pain score, receipt of emergency medications, distinct resource types used (eg, laboratory tests, imaging studies), and disposition. Multivariable logistic regression assessed characteristics associated with overtriage and undertriage, compared with appropriate triage, adjusting for year and site effects. A total of 78 411 ED visits by children and adolescents with a behavioral health chief concern (37 328 [47.6%] aged 10-14 years; median age, 14.4 [IQR, 12.4-16.1] years; 47 496 [60.6%] female) were included in the analysis. Of 74 564 visits with nonmissing data, 25 668 (34.4%) were appropriately triaged, 42 589 (57.1%) were overtriaged, and 6307 (8.5%) were undertriaged. The adjusted odds of overtriage were higher for visits by children aged 5 to 9 years (adjusted odds ratio [AOR], 4.43; 95% CI, 4.13-4.76) compared with those aged 10 to 14 years and for visits by non-Hispanic Black (AOR, 1.17; 95% CI, 1.12-1.22) compared with non-Hispanic White patients. The adjusted odds of undertriage were higher for visits by Hispanic patients (AOR, 1.46; 95% CI, 1.31-1.63) and non-Hispanic Black patients (AOR, 1.28; 95% CI, 1.19-1.37) compared with non-Hispanic White patients and for those with Spanish language preference (AOR, 1.31; 95% CI, 1.11-1.54) compared with those preferring English. In this cross-sectional study of children presenting to the ED with behavioral health symptoms, overtriage was common, and the likelihood of overtriage and undertriage differed by sociodemographic characteristics. Prospective studies are needed to assess behavioral health triage practices and to design triage systems that allocate resources accurately and equitably.
Prior theoretical and empirical work demonstrates associations between peer victimization and later aggressive behavior. To better understand this link in early childhood, the present study examined children's basal cortisol levels and parental warmth as moderators of the association between peer victimization in the fall of preschool (T1) and changes in aggression from T1 to T2 (preschool spring). Participants were 262 3- to 5-year-old children (M age = 4.30 years, SD = 0.31). At T1, children provided samples of salivary cortisol and parents reported on their warm parenting practices. Teachers reported on children's physical and relational peer victimization at T1 and physical and relational aggression at T1 and T2. Greater T1 relational victimization was associated with significant increases in relational aggression from T1 to T2. Children with low levels of basal cortisol displayed decreases in physical aggression when experiencing high levels of physical victimization at T1. Associations between victimization and later aggression were not significantly moderated by parental warmth. These results may help identify children who may benefit from intervention to prevent the development of aggressive behavior and subsequent academic and psychological challenges.
Childhood behavioral difficulties are recognized as early indicators of future psychiatric disorders, yet their long-term predictive validity in non-Western settings remains underexplored. This study investigated the predictive value of childhood behavioral assessments in determining adult psychiatric outcomes among 300 individuals in Ghana followed longitudinally from childhood to early adulthood. Using the Child Behavior Checklist (CBCL), both externalizing behaviors (e.g., aggression, hyperactivity) and internalizing behaviors (e.g., anxiety, withdrawal) were assessed between 2005 and 2015, while adult mental health outcomes including mood, anxiety, substance use, and psychotic disorders were measured with standardized diagnostic instruments such as the MINI, PHQ-9, and GAD-7. Logistic regression analyses revealed that both internalizing (B = 0.87, OR = 2.39, p < .001) and externalizing (B = 1.23, OR = 3.42, p < .001) behaviors significantly predicted adult psychiatric outcomes, even after controlling for sociodemographic factors. Exposure to trauma (OR = 4.67, p < .001) and low parental education (OR = 1.80, p < .01) increased risk, while early intervention (OR = 0.54, p < .01) served as a protective factor. The overall model demonstrated good fit and strong discriminative power (Nagelkerke R² = 0.29; AUC = 0.83). Cross-cultural validity analyses showed that childhood behavioral scores predicted adult psychiatric disorders effectively, with the strongest accuracy for mood disorders (AUC = 0.82) and overall psychiatric risk (AUC = 0.85). Moderate predictive power was found for psychotic (AUC = 0.73) and neurodevelopmental disorders (AUC = 0.75), and weaker for substance use (AUC = 0.68). Moderation analyses indicated that gender, socioeconomic status, family structure, exposure to trauma, parental involvement, and residence significantly influenced these relationships, with trauma being the strongest risk enhancer. The study highlights the predictive utility of culturally adapted behavioral assessments and underscores the need for early screening and family-centered interventions within Ghana's education and health systems to mitigate long-term mental health risks.
Caregivers of children with disabilities are at increased risk of experiencing poor mental health due to the compound effects of financial and family stressors. This study aims to identify risk and protective factors for poor mental health, particularly depression, among caregivers of young children with disabilities. This is a secondary data analysis, including a total of 1518 caregivers who were enrolled at baseline in a cluster randomised trial evaluating the effects of Sugira Muryango, a home-visiting parenting intervention, on early child development and violence prevention outcomes. A total of 309 primary caregivers were identified as having a child aged 12-36 months who screened positive for some form of developmental delay. Associations between key sociodemographic and household characteristics and depression outcomes were explored using multivariable linear regression models. Among the sample of caregivers of children with disabilities, 65% met the clinical cut-off for likely depression. Economic hardship (β=0.158, p<0.001), food insecurity (β=0.009, p<0.01) and caregiver illness (β=0.183, p<0.01) were significant risk factors for depression. In contrast, family unity (β=-0.013, p<0.001) was an important protective factor for depression among these caregivers. Among married/cohabiting caregivers, intimate partner violence (IPV) was associated with higher mean depression scores (β=0.306, p<0.001), though the inclusion of family unity in the full model (inclusive of risk and protective factors) attenuated the impact of IPV on depression. Programmes targeting children with disabilities should also address the mental health needs of parents. Mental health difficulties are common for caregivers living in poverty, especially those raising a child with a disability or developmental delay. Additionally, parenting programmes that reduce family violence and build family unity should be prioritised by policymakers interested in improving the mental health and well-being of families facing extreme poverty.
Schizophrenia is a significant neurodevelopmental mental illness. However, research on the trends related to the disease burden of schizophrenia in pediatric and adolescent populations remains limited. This study intends to examine the changes in the burden of schizophrenia among younger individuals from 1990 to 2021, with the objective of identifying areas that require targeted interventions and preventive measures. Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were evaluated to report the incidence and prevalence of schizophrenia among individuals aged 10 to 24 years between 1990 and 2021, across global, regional, and national levels. We provided case numbers and rates per 100,000 individuals. Additionally, we examined trends in schizophrenia concerning age, gender, and socio-demographic index (SDI). Average annual percentage changes (AAPC) were calculated, and years with the most significant trends were identified utilizing joinpoint regression analysis. The study cohort was divided into three age categories: 10 to 14 years, 15 to 19 years, and 20 to 24 years. In 2021, the global incidence and prevalence rates of schizophrenia among young adults and adolescents were 25.6 (95% UI, 18.0-35.1) and 105.7 (95% UI, 70.7-147.5) per 100,000 individuals, respectively, reflecting a decline from 26.6 (95% UI, 19.1-35.8) and 110.5 (95% UI, 75.6-152.0) in 1990. Noticeable changes in schizophrenia incidence were found in 1998, 2001, and 2010. By sex, the incidence rate among men has always been higher than that among women. By age groups, the incidence of schizophrenia increased sharply with age. By SDI quintile, countries with low SDI experienced the most significant rise in both incidence and prevalence rates. At the national level, adolescents and young adults aged 10-24 in Australia reported the highest ASIR for schizophrenia, followed by New Zealand and the United States. The most substantial increase in schizophrenia prevalence rate was noted in Tropical Latin America. From 1990 to 2021, the global incidence of schizophrenia among adolescents and young adults followed a significant three-phase trend: an initial decline, followed by an increase from around 2000 to 2010, and a subsequent decrease in recent years. These findings underscore the need for future research and policy efforts to prioritize reducing health disparities and improving mental health outcomes for at-risk populations-particularly young individuals in low SDI regions. Timely detection and intervention remain essential to mitigate the impact of schizophrenia on individuals and society.
In recent years, there has been a noticeable increase in performance-related concerns and a heightened fear of failure among children and adolescents across various settings, such as academics and sports. Despite this trend, research specifically addressing performance anxiety remains limited, with most studies focusing on the broader category of social anxiety. This study addresses this gap by investigating how perceived parental criticism and self-compassion among children/adolescents mediate the relationship between parental overprotection and performance anxiety during childhood and adolescence. The sample comprises 428 dyads of children/adolescents (M = 10y 9 m, SD = 1y 8 m; range = 6-15 years) and their respective educational guardian (85.6% female), recruited from school settings. A sequential mediation model was estimated to analyze the direct and indirect effects of parental overprotection on children's/adolescents' performance anxiety, through their perception of parental criticism and levels of self-compassion. Higher levels of parental overprotection were linked to higher levels of performance anxiety through the children's/adolescents' perception of parental criticism and the sequence of the two mediators under study. This study underscores the need for parental interventions to reduce parental overprotection and criticism and suggests that compassion-based interventions could be particularly effective in helping children/adolescents lower their levels of performance anxiety.
Breastfeeding is associated with short- and long-term beneficial effects on child health, including greater cognitive development, and enhanced immune programming. However, the underlying biological mechanisms are only partially understood, with epigenetics emerging as a potential contributor. In this study, we aimed to investigate whether breastfeeding practices are associated with differential DNA methylation (DNAm) in childhood blood. We conducted meta-analyses of epigenome-wide association studies (meta-EWASs) in 3421 children from eleven international population-based birth cohorts from the Pregnancy And Childhood Epigenetics (PACE) Consortium. Breastfeeding was assessed as "ever" being breastfed vs. "never", and duration of any and exclusive breastfeeding. DNAm was measured in childhood blood (ages 5-12 years) using the Illumina 450 K or EPIC arrays, with cord blood at birth used as negative outcome control. At False Discovery Rate (FDR) < 5%, positive associations at six cytosine-phosphate-guanine (CpG) sites were identified in childhood blood: four with duration of exclusive breastfeeding, and three with duration of exclusive breastfeeding of more than three months compared to never. The annotated genes (ALAD, FNBP4, and CHFR) are related to developmental and immune processes. None of these CpG sites were FDR-significant in cord blood prior to breastfeeding. Breastfeeding was associated with differential DNAm in childhood blood at a limited number of CpG sites. Future studies in diverse populations are needed to examine the robustness of these associations, the sources of heterogeneity, and the generalizability of the findings.
Bereavement, especially following the loss of a child, is a profoundly distressing life event associated with heightened risks of depression and anxiety. However, limited evidence exists on the symptom-level structure and statistical interrelations of these conditions among bereaved individuals, particularly in low- and middle-income countries (LMICs). Using nationally representative data from the 2022 Bangladesh Demographic and Health Survey (BDHS), we identified 2276 bereaved mothers. We applied psychological network analysis to estimate the partial correlation network structure of nine-item Patient Health Questionnaire (PHQ-9) depressive and seven-item Generalized Anxiety Questionnaire (GAD-7) anxiety symptoms. Centrality, predictability, and bridge metrics were computed. Network comparison tests (NCTs) assessed structural invariance across bereavement subgroups. Bayesian directed acyclic graphs (DAGs) were used to explore conditional dependency patterns and probabilistic edge orientations among symptoms. The prevalence of probable major depressive disorder (MDD) was 6.69% (95% CI: 5.52-7.86). Prevalence estimates were comparable by bereavement recency, with overlapping confidence intervals among mothers bereaved within the past 3 years (5.34%, 95% CI: 3.06-9.15) and those bereaved more than 3 years earlier (6.83%, 95% CI: 5.69-8.19). The symptom network revealed interconnected domains corresponding to anxiety and depression symptoms. Trouble relaxing and psychomotor disturbance showed the highest strength centrality, while suicidal ideation exhibited the highest predictability in the network. Bridge centrality analysis identified feeling afraid, sadness, irritability, and psychomotor disturbance as the strongest cross-domain connectors linking anxiety and depression symptoms. Bayesian DAG analysis indicated strong conditional dependencies among worry-related anxiety symptoms, while psychomotor disturbance showed a strong conditional association with suicidal ideation. This study offers novel symptom-level insights into bereavement-related anxiety and depression among mothers in Bangladesh. The observed symptom patterns are consistent with enduring depressive and anxiety symptoms rather than acute grief alone. Symptom-focused approaches targeting central and bridge symptoms may support more efficient screening and scalable intervention strategies in bereaved populations.
The amount of time previously spent awake or asleep strongly impacts the sleep electroencephalogram (EEG), especially slow waves during nonrapid-eye-movement (NREM) sleep. These effects on the sleep EEG meaningfully interact with age and to a lesser extent developmental disorders such as attention-deficit hyperactivity disorder (ADHD). We aimed to determine whether EEG oscillations during wakefulness were likewise affected by the interaction of sleep and development, using data collected from 163 participants aged 3-25 years old (62 female). We analyzed age- and sleep-dependent changes in two measures of oscillatory activity (amplitudes and density) and aperiodic activity (offsets and exponents). Finally, we compared wake EEG in children with ADHD (N = 58) to neurotypical controls, with habitual good sleep quality required for inclusion. We found that oscillation amplitudes exhibited the same dynamics as sleep slow waves: decreasing with age, decreasing after sleep, and the overnight decrease decreasing with age. Strikingly, wake oscillation densities in the alpha band decreased overnight in children but increased overnight in adolescents and adults. Aperiodic measures were affected by both sleep and age albeit with minimal interaction. No wake measure showed significant effects of ADHD, suggesting that previously reported differences in patients may reflect uncontrolled variability in sleep quality rather than disorder-specific effects. While these results do not disentangle homeostatic from circadian effects, they underscore the need to control for sleep/wake history and measurement scheduling in all EEG experiments, especially when focusing on children and adolescents.
Children's language development starts in utero, with language-relevant brain areas starting to develop and differentiate during the second trimester of pregnancy. Postnatal development in language-relevant brain areas such as the inferior frontal gyrus (IFG) and superior temporal gyrus (STG) has been shown to be related to language skills. In this study, as part of the Cambridge Human Imaging and Longitudinal Development (CHILD) project, prenatal structural characteristics of the IFG and STG (30th - 33rd GW) and their association with English children's language skills, obtained longitudinally at two postnatal assessment points (n = 24 and n = 25) was examined. Prenatal bilateral STG volume was found to be associated with expressive vocabulary 2-3 years after birth (M = 139.1 weeks), as measured by the Communicative Development Inventory (CDI). These results highlight the relevance of prenatal brain development for language acquisition after birth. SUMMARY: Postnatal structural characteristics of neural language network, including IFG and STG, are known to be related to language skills in children and adults Structural characteristics of IFG and STG were assessed prenatally in this study and related to language outcomes in early childhood Bilateral STG volume at birth predicts vocabulary scores 2-3 years later Findings support the importance of prenatal brain development for postnatal language acquisition.
Health service transitions of child, adolescent, and young adult cancer survivors between paediatric and adult cancer care services are pervasively fragmented, resulting in poor coordination, reduced satisfaction, and adverse outcomes for cancer survivors and significant others (e.g., caregivers and family members). Numerous trials and clinical guidelines have been developed to support care transitions, but their convergence, divergence, and methodological quality remain unclear. To advance clinical practice and quality research about care transitions, a synthesis of trials and guidelines on child, adolescent, and young adult care transition across age-appropriate cancer services is required to inform future research, practice, guideline, and policy development. A systematic review (CRD420251029796) was conducted. Studies were identified from searches of six bibliographic databases, four trial registers, and grey literature. Inclusion criteria focused on clinical guidelines or trials published between January 2020 and April 2025 that addressed age-related transitional cancer care. A total of 3706 records were identified. After screening, 18 records met the inclusion criteria: 10 clinical guidelines, 4 completed trials, and 4 ongoing trials with registrations. While general recommendations between guidelines were consistent, they diverged in detail relating to their local contexts. Only two ongoing trials, and no completed studies, included independent control groups. Completed trials were limited and highly variable in approach, components, and outcome measures, suggesting regionally specific guidelines enhance relevance, applicability, and transition practices. Future research should develop core outcome sets for care transition trials to facilitate comparison of outcomes and should develop robust study designs, including control groups.
The need for improved mental and behavioral health training for pediatric residents has been recognized for over 40 years. During this time, the prevalence of child behavioral health issues has steadily increased, culminating in the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declaring a national emergency in children's mental health in 2021. In response, the Accreditation Council for Graduate Medical Education (ACGME) implemented new mental health training requirements for pediatric residents beginning in July 2025. A core group of Brown University Health faculty designed and launched a structured rotation with milestone-informed goals and objectives, clinical experiences, and didactic components. These efforts align with Brown's longstanding commitment to address child and family mental health within a pediatric context. Pre- and post-surveys, qualitative data, and participant feedback were collected. Over 40 residents have participated in the rotation, appreciating the opportunity to tailor experiences to their individualized learning goals. A survey evaluating knowledge and comfort in assessing, diagnosing and treating common mental health conditions was administered before and after the didactic curriculum. Paired t-tests were conducted to evaluate changes in self-efficacy before and after the curriculum. Residents across all years of training reported improved knowledge and comfort in assessing, diagnosing and treating depression, suicide, and attention-deficit/hyperactivity disorder (ADHD) after delivery of the didactic mental health curriculum (all p ≤ 0.05, n = 15), and many of these improvements were sustained at six months. Areas for improvement include increasing first-year exposure to mental health training, creating longitudinal experiences, including direct clinical involvement within the Med-Psych service line, and expanding supported faculty time and resources for development.
Current National Institute for Health and Care Excellence (NICE) guidelines recommend family interventions for children and adolescents with psychosis. However, the evidence to support this has not been fully synthesised to date. This meta-analytic review investigated whether family interventions are effective in reducing psychosis symptoms and improving functioning among children and adolescents with psychosis. We included studies which (1) employed a controlled study design to examine the effectiveness of a family intervention, (2) only included children or adolescents with psychosis, and (3) assessed psychosis symptoms and/or general functioning. PubMed, Scopus, Web of Knowledge, OVID, CNKI, EBSCO and Cochrane CENTRAL were searched on the 19th of March 2024, supplemented by grey literature searches. Study quality was assessed with the Cochrane Risk of Bias Assessment Tools. Bayesian meta-analyses were conducted to examine changes in symptoms and functioning. Four studies (n = 111) met inclusion criteria. All studies assessed the effectiveness of different psychoeducation-based family interventions. The meta-analyses showed no significant effect of family interventions on psychosis symptoms (pooled effect size = -0.93, 95% CrI [-2.77, 0.90]) or functioning (pooled effect size = 0.90, 95% CrI [-1.07, 2.70]) and indicated weak evidence in favour of the null hypotheses. We did not find evidence of a significant benefit of family interventions on psychosis symptoms or functioning in children and adolescents with psychosis. All included studies had significant methodological issues, which may have introduced bias. These results highlight a lack of evidence of the effectiveness of family interventions in children and adolescents with psychosis.