Adolescence drinking behavior is steadily increasing while the mean age of first- time drinkers has decreased. The aims of this study were to examine the potential effect of the "Teenagers Don't Drink" application on preventing alcohol use among Thai adolescents. This quasi-experimental design with cluster-level allocation was conducted among adolescents aged 10-14 years in Chiang Mai, Thailand, between March and May 2022. A total of 50 adolescents were recruited based on the calculated sample size; 25 participants who met the inclusion criteria were selected by simple random sampling for each group. The intervention group received the mobile application "Teenagers don't drink". The control group received an adolescence drinking prevention manual. The data was gathered using Alcohol Use Disorders Identification Test (AUDIT), Alcohol Knowledge, Attitude towards Drinking, Drinking Refusal Self-efficacy, Parental control and support regarding alcohol consumption, and Intention to not Drink Alcohol Questionnaires before and one month after the intervention. Data were analyzed using descriptive statistics, Wilcoxon Matched Signed Rank Test, Paired T-test, Mann-Whitney U Test, and Independent t-test with STATA version 15. A significance level of less than 0.05 was considered. Between groups score comparisons showed a statistically significant differences in terms of knowledge about alcoholic beverages (P=0.003), attitude towards drinking (P<0.001), drinking refusal self-efficacy (P=0.003), parental control and support regarding alcohol consumption (P=0.003), and intention to not drink alcohol (P<0.001) after the intervention. The "Teenagers Don't Drink" application may improve adolescents' comprehension of alcoholic beverages, pertinent laws and regulations, and life skills associated with alcohol use prevention. The program seems capable of aiding initiatives to avoid or diminish alcohol intake among adolescents in communal environments.
Adverse childhood experiences (ACEs) are a form of childhood trauma that can negatively impact children's development and health throughout their life span. Experiencing any ACE as a child could jeopardise the optimal development and health of children, particularly negatively affecting their social and emotional well-being. Literature regarding childhood trauma frequently indicates the need for more interventions. This study aims to explore strategies that promote social and emotional skill development, which can be incorporated into a therapeutic board game. Semi-structured interviews were conducted with 15 mental health professionals experienced in working with youth and ACEs. The interview guide was based on the social cognitive theory as a conceptual framework, as it has been proven effective in interventions focusing on increasing knowledge of health topics and teaching and developing skills. Reflexive thematic analysis was used. Results are presented in three themes, including (i) personal and cognitive factors: using both scenario-based and discussion prompts, (ii) behaviour factors: incorporating guided practice and enactive mastery, and (iii) environmental factors: promoting healthy relationships as a social norm. These findings suggest that therapeutic games can be developed and structured to effectively address the needs of those who have experienced ACEs. Future studies should prioritise the creation of innovative therapeutic approaches that are tailored to the unique needs of teenagers with ACEs, to provide support and skills development.
Despite the increasing prevalence of autism spectrum disorder (ASD) in the US, underlying temporal trends in newly recorded diagnoses remain poorly understood. To evaluate age- and sex-specific incidence trends of ASD from 2016 to 2024 and quantify the temporal patterns before and after the COVID-19 pandemic and diagnostic substitution. This retrospective cohort study used electronic health record data from a large US health care system. Analyses were conducted from October to December, 2025. The study population included 171 134 participants (stratified as children [0-9] years, adolescents [10-18] years, and adults [≥19] years) who maintained continuous engagement with the health care system, defined as having at least 1 clinical encounter annually from 2016 to 2024. The primary outcome was the annual incidence of newly recorded diagnoses of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes F84.0 and F84.5. Temporal trends were analyzed using joinpoint regression to calculate annual percentage changes (APCs) and identify significant inflection points. Among 171 134 participants (mean [SD] age, 26.78 [16.38], 63.8% female), females received autism diagnoses a mean (SD) of 3.4 years later than males (age at diagnosis, 15.7 years for female individuals vs 12.3 years for male individuals; P < .001). Male autism incidence remained stable or declined 2016 to 2024; female incidence increased significantly post-2020 (APC, 19.0%; 95% CI, 12.1% to 33.4%). In the pediatric cohort, decreasing annual incidence among males (APC, -2.0%; 95% CI, -3.7% to -0.3%; to APC, -2.0%, 95% CI, -3.7% to -0.3%) alongside increasing incidence for females since 2020 (APC, 17.4; 95% CI, 9.0% to 45.3%). In adolescent males, incidence declined from 2016 to 2018 (APC, -29.6%; 95% CI, -48.9% to -1.2%), and stabilized from 2018 to 2024. In adolescent females, autism incidence increased significantly between 2020 and 2024 (APC, 22.3%; 95% CI, 6.1% to 62.8%). In adult males, autism incidence showed a downward trend in the 2016 to 2024 period, while in adult females, the APC from 2016 to 2024 was positive, but the finding was not statistically significant (APC, 8.0%; 95% CI, -0.9% to 20.0%). In this cohort study, ASD diagnoses increased disproportionately among females after 2020 while remaining stable or declining among males. These patterns suggested that increasing ASD prevalence reflected improved identification of historically underrecognized presentations rather than a uniform population-level increase. These findings highlight the need for screening strategies that address sex-specific presentations.
The genetics of dystonia have been extensively investigated in population-based and multicenter cohorts. In this study, we analyzed a consecutively recruited, single-center German dystonia cohort using whole-exome sequencing (n = 153 affected individuals [n = 152 index cases from 152 dystonia families], n = 10 unaffected family members). Pathogenic or likely pathogenic variants were identified in established (n = 7) and less-established (n = 4) dystonia-associated genes, resulting in a diagnostic yield of 7.2% (11/152); all variants were heterozygous. Consistent with previous European studies, earlier age at onset (≤ 40 years; p value = 0.0218) was significantly associated with increased diagnostic yield and demonstrated acceptable predictive value (AUC = 0.76). This study (1) underscores the importance of both shared features-such as clinical characteristics associated with diagnostic yield-and distinct genetic features, including a relatively lower diagnostic rate and differences in the composition of implicated genes across cohort designs, and (2) suggests that exome-based testing may identify clinically relevant variants beyond the classic dystonia genes in selected patients undergoing diagnostic evaluation.
The purpose of this study was to estimate lens opacity (LO) and associated risk factors in patients with ABCA4 associated Stargardt disease (STGD1). This is a secondary analysis of the multicenter ProgStar study. Patients with molecularly confirmed STGD1 aged ≥6 years from the United States and Europe were enrolled and followed for 2 years. LO was graded using the Age-Related Eye Disease Study (AREDS) protocol during slit lamp examinations. Baseline prevalence and 2-year incidence of LO were estimated. Logistic regression with generalized estimating equation was used to identify risk factors associated with LO. Of the 259 participants, 54% were women, 86% were Caucasian, and the median age of STGD1 symptom onset was 19 years. At baseline, median age = 31 (interquartile range [IQR] = 21-44, range = 6-68) years; LO prevalence = 14.3% (69/483) of study eyes. Older age and later disease symptom onset were significantly associated with LO prevalence: for every decade older, adjusted odds ratio (adjOR) = 4.6 (95% confidence interval [CI] = 2.6-7.9); adjOR for every decade later in symptom onset = 0.7 (95% CI = 0.4-1.0). Among the 354 eyes without LO at baseline, 2-year incidence was 5.6%. Older age was associated with incidence: adjOR for every decade older = 4.1 (95% CI = 1.8-9.1). Posterior-subcapsular cataract was rare and nuclear cataract was the most prevalent or incident type. LO prevalence in ProgStar is higher than in age-matched general population. Age and age of symptom onset were risk factors of LO, suggesting both biological and accelerated aging due to retinal degeneration in STGD1. Trials of STGD1 should closely monitor safety in the anterior segment and consider excluding patients expecting cataract surgery soon.
The aim of this study was to investigate the association between serum homocysteine levels and female sexual function in reproductive-age women presenting with sexual dysfunction complaints and to evaluate relationships with vitamin B12 and folic acid levels. This cross-sectional study included 114 sexually active women aged 18-45 years presenting with sexual dysfunction complaints. Female sexual function was assessed using the Female Sexual Function Index. Fasting serum homocysteine, vitamin B12, and folic acid levels were measured. Correlation analyses, group comparisons, and multivariable linear regression were performed. A priori sample size calculation indicated that at least 84 participants were required to detect a moderate correlation (ρ=0.30) with 80% power. Female Sexual Function Index scores were available for 111 participants and homocysteine levels for 99 participants. The mean Female Sexual Function Index total score was 24.69±4.34, below the established cut-off for sexual dysfunction. Serum homocysteine levels were not associated with Female Sexual Function Index total or domain scores (ρ=-0.035, p=0.726). No significant differences were observed between homocysteine groups defined by ≤10 and >10 μmol/L or ≤15 and >15 μmol/L. Age showed a moderate negative correlation with the desire domain (ρ=-0.362, p<0.001). In multivariable regression, homocysteine, vitamin B12, and folic acid were not independent predictors of Female Sexual Function Index total score. In this symptomatic population, homocysteine levels were not associated with female sexual function. These findings should be interpreted cautiously due to the lack of a control group. Further large-scale, population-based studies are needed.
Data on respiratory syncytial virus (RSV) acute respiratory infection (ARI) among community-dwelling U.S. adults aged 18 to 64 years, particularly those with high-risk conditions (HRC), remain limited. This study estimated incidence and attack rates of RSV-ARI and RSV lower respiratory tract disease (LRTD) in adults with and without HRCs. A multistate, community-based prospective cohort of adults aged 18 to 64 years with and without HRCs was followed from October 2022 to September 2024. Incidence rates and annual attack rates of RSV-ARI and RSV-LRTD were calculated by HRC presence and age group. Of 3375 adults with at least 1 HRC, the RSV-ARI incidence rate was 17.9 per 1000 person-years (attack rates: year 1, 1.87%; year 2, 1.56%), compared with 14.8 per 1000 person-years (year 1, 1.33%; year 2, 1.50%) among adults without HRCs. RSV-LRTD incidence was 10.0 per 1000 person-years in adults with HRCs versus 5.7 per 1000 person-years in those without. Asthma, congenital immunodeficiency, and immunosuppressive medication use were associated with increased incidence of RSV-ARI and RSV-LRTD; whereas adults with solid organ transplant and chronic kidney disease had a significantly higher incidence rate of RSV-LRTD compared to those without these conditions. Adults aged 18 to 49 years with HRCs had significantly higher RSV-LRTD incidence (9.6 vs 4.3 per 1000 person-years). After adjustment for age and sex, having ≥1 HRC was associated with a 62% increased RSV-LRTD risk, rising to 117% among adults aged 18 to 49 years. Adults with HRCs-particularly asthma, congenital immunodeficiency, chronic kidney disease, immunosuppressive medication use, and solid organ transplant-experienced higher RSV-ARI and RSV-LRTD incidence. The elevated RSV-LRTD burden was most pronounced in adults aged 18 to 49 years with HRCs.
Although muscle mass increases during puberty, it plateaus in girls and slowly increases in boys after around 15 years of age. This study investigated the relationship between phase angle and impedance ratio as indicators of muscle quality and age in Japanese individuals aged 15-18 years and examined their relationship with grip strength. Participants included 838 high school, college, or university students (534 boys, 304 girls). Body composition, phase angle, and impedance ratio were measured using a multi-frequency bioelectrical impedance analyzer. Phase angle was calculated from the resistance and reactance to a 50-kHz alternating current, while impedance ratio was calculated from the impedance to 5- and 250-kHz currents. Grip strength was measured using a Smedley dynamometer. Significant effects of age were observed for body size, fat-free mass, grip strength, phase angle, and impedance ratio in the boys. Compared to 16-year-olds, 17-year-olds showed a significantly higher phase angle and significantly lower impedance ratio in whole body, upper limb, and lower limb. In contrast, no significant main effects of age were observed for any of these measures in the girls. Phase angle and impedance ratio were significantly correlated with grip strength at each age in both sexes. These results suggest that phase angle and impedance ratio can be used to assess muscle strength at any age during late adolescence. However, age-specific values may be preferable for boys in late adolescence when using the reference or percentile values for phase angle and impedance ratio. Key words Muscle quality " Muscle mass " Muscle strength " Puberty " Adolescence.
No recent study has examined whether method of abortion is associated with psychotropic medication use, an indicator of mild mental health problems. To examine whether medication or procedural abortions were associated with increased risk of psychotropic medication use. This population-based Danish registry cohort study followed the psychotropic medication redemptions of females aged 12 to 38 years having elective, first first-trimester abortions between January 1, 2000, and December 31, 2018, from 1 year before their medication or procedural abortion until their first psychotropic medication prescription claim (redemption), December 31, 2018, emigration from Denmark, or death, whichever came first. Analyses were conducted between June 2023 and June 2025. First abortion method (first medication abortion or first procedural abortion). Any first psychotropic medication prescription redemption, first antidepressant medication redemption, and first antianxiety medication redemption during the study period. Incidence rate ratios (IRRs) were calculated in adjusted regression models. Bonferroni-corrected P values were used to account for multiple tests. Of 67 390 females included in this study (mean [SD] age, 21.8 [4.6] years), 4575 (6.8%) had a prior psychiatric diagnosis; 33 793 had a record of a first medication abortion, 33 597 had a record of a first procedural abortion, and 19 979 (29.6%) had a first psychotropic medication redemption during the study period. In fully adjusted models, using the conventional P value level of .05, compared with the year before a medication or procedural abortion, there were small increased risks of any first psychotropic medication redemption in the first year after medication abortion (IRR, 1.10; 95% CI, 1.02-1.19; P = .01) and procedural abortion (IRR, 1.09; 95% CI, 1.01-1.16; P = .02). There were no statistically significant associations in 1 to 2 years and 2 to 5 years after abortion relative to the year before an abortion for each abortion method. There were decreased risks of any first psychotropic medication redemption more than 5 years after medication abortion (IRR, 0.85; 95% CI, 0.78-0.91; P < .001) and more than 5 years after procedural abortion (IRR, 0.83; 95% CI, 0.78-0.88; P < .001). Using the Bonferroni-corrected P value of .002, the small increased risks of psychotropic medication redemption observed in the first year after an abortion no longer met the criteria for statistical significance, while the lower risks for more than 5 years after abortion continued to meet the criteria for statistical significance. In this Danish population-based cohort study, compared with the year before a medication or procedural abortion, small increased risks of psychotropic medication prescription redemptions were observed during the first year after abortion, and decreases in risk of psychotropic medication prescription redemptions were observed more than 5 years after abortion when using conventional levels of statistical significance. The small increased risks observed in the first year after an abortion no longer met the criteria for statistical significance following Bonferroni adjustment for multiple statistical tests. Additional research may be needed to replicate and understand these results.
Melasma is one of the most common physiological hyperpigmentation disorders observed during pregnancy, and its clinical characteristics and risk factors have been extensively investigated. However, evidence regarding the relationship between pregnancy-related melasma and body perception remains limited. This descriptive cross-sectional study aimed to determine the prevalence of melasma among pregnant women and to examine its association with body perception. This study included 450 pregnant women in the central city center of the Central Anatolia Region of Türkiye who met the inclusion criteria. Data were collected using the Introductory Information Form, the Melasma and Skin Type Characteristics Assessment Form, and the Body Perception Scale (BPS) and analyzed using descriptive statistics, comparative analyses, and logistic regression. Melasma was identified in 37.8% of the participants, and the centrofacial pattern was the most common presentation (56.5%). A statistically significant association was found between pregnancy-related melasma and total BPS scores (p < 0.05). Pregnant women without melasma had significantly higher mean BPS scores than those with melasma (150.83 ± 17.18 vs. 146.15 ± 15.16; p = 0.004). Logistic regression analysis demonstrated that low educational and income levels, a personal or family history of melasma, and Fitzpatrick skin type IV were significant predictors of pregnancy-related melasma (p < 0.05), accounting for 61% of the variance. The findings indicate the need for a holistic assessment of physiological skin changes and body perception during pregnancy, as well as the integration of counseling, education, and nursing care interventions targeting risk factors into routine prenatal care.
Replacement therapy for congenital adrenal hyperplasia (CAH) in childhood includes hydrocortisone and, in salt-wasting forms, addition of fludrocortisone. Immediate-release hydrocortisone often fails to adequately suppress early morning 17-hydroxyprogesterone (17OHP) levels. Hydrocortisone modified-release capsules (HMRC, Efmody®) were approved by the EMA in 2021 for the treatment of patients aged ≥12 years with CAH. This study evaluates the efficacy and safety of HMRC in children and adolescents based on real-world data collected from the I-CAH registry. A single-center retrospective analysis of children with CAH was conducted. Linear mixed models (LMMs) were used to calculate pre-post comparisons of 17OHP saliva profiles, growth rate, bone age, body mass index, hydrocortisone and fludrocortisone dosage, blood pressure, and safety parameters before and during HMRC therapy (study registration, https://drks.de/search/de, DRKS00038319). The median age of the 36 children with CAH at the time of treatment switching to HMRC was 10 years (interquartile range [IQR]: 8-14 years). Of these, 15 were prepubertal and 21 were (post)pubertal. HMRC therapy was associated with a deceleration of previously increased growth velocity (pre-switch: 0.1 SDS/year, 95% CI: 0.0 to 0.2; post-switch: -0.1 SDS/year, 95% CI: -0.2 to 0.1) and with a reduction of median difference of bone age and chronological age by 0.50 years (IQR -1.17-0.27, range -2.2-2.00). Mean hydrocortisone dose increased by 2.4 mg/m²/day during HMRC treatment. Mean morning 17OHP concentrations significantly decreased from 337 ng/L (95% CI: 240-437) to 214 ng/L (95% CI: 155-294) after switching to HMRC treatment. No adrenal crisis was observed. Twice-daily HMRC therapy can also improve CAH therapy in children and adolescents in terms of hormonal control and growth.
The maintenance of normal ovarian function depends on the presence of two structurally intact X chromosomes, which explains the high risk of premature ovarian insufficiency in individuals with Turner syndrome (TS). Most aneuploid germ cells undergo apoptosis during embryonic gonadal development, resulting in the formation of streak gonads in the majority of individuals with a 45,X karyotype. However, the role of X-monosomy in ovarian somatic cells, which provide the microenvironment essential for oocyte survival and development, remains poorly understood. To our knowledge, this is the first study to investigate the association between X chromosome aneuploidy in ovarian somatic cells and peripheral blood lymphocytes and ovarian function in adolescents with mosaic TS. The aim of this exploratory case-series study was to comprehensively evaluate the clinical, hormonal, ultrasonographic, morphological, morphometric, immunohistochemical, and molecular cytogenetic characteristics of the ovaries in adolescents with mosaic TS and spontaneous pubertal development. Five adolescents with mosaic TS underwent assessment of ovarian reserve markers and ovarian tissue cryopreservation. Follicle density (FD), expression of oocyte-specific markers (GDF9, BMP15, and CD117), and X chromosome mosaicism in 2-6 oocytes, 50-300 granulosa cells (GCs), and 50 ovarian stromal cells per participant were evaluated. Despite ongoing puberty and normal gonadotropin levels, reduced serum anti-Müllerian hormone (AMH) and inhibin B concentrations were observed in some participants. A normal X chromosome complement was identified in all analyzed oocytes. Ovarian stromal cells were predominantly monosomic for the X chromosome, whereas GCs demonstrated substantial intra- and inter-individual variability in X chromosome mosaicism. No clear relationship was observed between X chromosome mosaicism in peripheral blood lymphocytes and ovarian tissue. Age-appropriate FD was observed only in participants whose follicles contained more than 60% non-monosomic GCs (XX or XXX). The findings suggest that ovarian function in adolescents with mosaic TS may be associated not only with the chromosomal status of oocytes but also with that of GCs. Peripheral blood karyotype did not reliably reflect ovarian tissue mosaicism in this exploratory series, highlighting the importance of comprehensive evaluation of ovarian reserve markers when counseling patients with TS regarding fertility preservation.
The population of patients with unintentional acute poisoning is large, yet clinicians pay relatively little attention to the psychological state of this group. This study aimed to investigate the current status of post-traumatic stress disorder (PTSD) and its main influencing factors in patients with unintentional acute poisoning and provide data support and a theoretical basis for the prevention of PTSD and reduction of its incidence in this population. Convenience sampling was used to select 312 patients with unintentional acute poisoning who were admitted to a tertiary hospital in Shandong Province between January 1, 2022, to September 30, 2023. Data were collected using the general information questionnaire, Poison Severity Score, General Self-Efficacy Scale, Simple Coping Style Questionnaire, shortened Chinese version of the Family Resilience Assessment Scale, Perceived Social Support Scale, and PTSD Checklist. Statistical analyses included t-tests, one-way ANOVA, correlation analysis, and multiple linear regression. The PTSD positivity rate among the patients with unintentional acute poisoning was 27.56%. Social support, general self-efficacy, and compensation insurance were protective factors against PTSD in these patients, whereas chronic medical history and poisoning severity were risk factors. Multiple regression analysis revealed that these factors collectively explained 88.5% of the variance in the PTSD total scores based on the results of multiple regression analysis. The incidence of PTSD is high in patients with unintentional acute poisoning. Early clinical assessment is warranted, especially for those with severe poisoning and chronic disease. Active interventions to enhance self-efficacy and social support should be implemented.
Typhoid fever remains a vaccine-preventable cause of childhood and adolescent morbidity in settings with limited water, sanitation, diagnostic capacity, and treatment capacity. We used Global Burden of Disease Study 2021 estimates to assess typhoid fever burden among individuals aged 0-19 years in 204 countries and territories from 1990 to 2021, with projections to 2045. We analyzed prevalence, incidence, deaths, and disability-adjusted life-years (DALYs); estimated average annual percentage changes using joinpoint regression; decomposed changes into epidemiological and demographic components; assessed Sociodemographic Index (SDI)-related inequality using the Slope Index of Inequality and Concentration Index; benchmarked countries against SDI-adjusted incidence frontiers; and projected future burden using Bayesian age-period-cohort models. Globally, the age-standardized incidence rate declined from 653.07 per 100,000 population in 1990 to 194.81 in 2021, while incident cases decreased from 14.76 million to 4.98 million. Deaths declined from 152,567 to 69,364, and DALYs from 12.93 million to 5.86 million. Despite these reductions, the burden remained concentrated in South Asia, sub-Saharan Africa, Oceania, and low- and low-middle-SDI settings. In 2021, South Asia accounted for 3.37 million incident cases, 44,095 deaths, and 3.74 million DALYs. Decomposition showed that declining age-specific rates drove global reductions, whereas population growth partly offset gains in lower-DI settings. Negative inequality indices indicated persistent concentration of burden among lower-SDI countries. Frontier analysis identified large excess-incidence gaps in South Asia, Oceania, Southeast Asia, and parts of sub-Saharan Africa. Projections suggested continued global reductions under historical-trend assumptions but persistent concentration in South Asia and widening uncertainty. Integrated typhoid conjugate vaccine scale-up, water and sanitation investment, diagnostic strengthening, and antimicrobial-resistance surveillance remain priorities for equitable typhoid control.
The transition from pediatric to adult medical care is associated with increased symptoms of anxiety, depression, and experiences with disease stigma for adolescents and young adults (AYA) with sickle cell disease (SCD). Community-informed conceptual frameworks suggest that caregiver communication could play an important role in enhancing AYA well-being during this critical period; yet this association has yet to be empirically investigated in this population. This study examined the influence of caregiver-AYA communication on psychosocial outcomes among AYA with SCD. AYA with SCD ages 16-25 were enrolled in a prospective, 3-month study. Participants completed baseline (T1) and follow-up surveys 3 months later (T2). Measures included the Parent-Adolescent Communication Scale, PROMIS Anxiety and Depression short forms, Measure of Sickle Cell Stigma, and Sickle Cell Self-Efficacy Scale. Cross-sectional and prospective bivariate and multivariate associations were investigated. Bivariate correlations showed that open caregiver-AYA communication at T1 was cross-sectionally associated with lower anxiety (r = -.35, p = .016), and prospectively associated with lower anxiety (r = -.31, p = .047), depression (r = -.31, p = .045), total stigma (r = -.36, p = .016) expected discrimination stigma (r = -.30, p = .048), and internalized stigma (r =  .40, p = .008). Communication at T1 remained negatively associated with total stigma (β = -.21, p = -.038), internalized stigma (β = -.24, p = .044) and expected discrimination stigma (β = -.28, p = .030) at T2 when controlling for age, gender, and baseline psychosocial factors. AYA who reported open caregiver communication at baseline reported significantly fewer symptoms of anxiety, depression, and stigma 3 months later. Thus, improving caregiver-AYA communication may improve AYA psychosocial functioning, which could lead to improved SCD-related care and transition.
To analyze sociodemographic factors associated with the use of dental services in Brazil, based on data from the National Oral Health Survey - SB Brasil 2023. This cross-sectional, population-based study used data from 40,489 individuals aged 18 years or older. The dependent variable was the use of dental services in the previous year. Analyses accounted for the complex sampling design, including weighting and design corrections. Descriptive and bivariate analyses (χ2 test) were conducted, followed by multiple logistic regression to estimate odds ratio (OR) and 95% confidence intervals (95%CI). Approximately 58.8% of respondents reported having used dental services in the previous year. A higher likelihood of use was associated with being female (OR=1.44; 95%CI 1.20-1.74), having higher educational attainment (complete higher education: OR=3.16; 95%CI 2.01-5.00), and higher income (>10 minimum wages: OR=2.79; 95%CI 1.63-4.78). Conversely, increasing age (OR=0.99; 95%CI 0.98-0.99) and residence in state capitals (OR=0.70; 95%CI 0.59-0.83) were associated with a lower likelihood of using dental services. Inequalities in the use of dental services persist in Brazil and are influenced by educational attainment, income, and vulnerability-related factors. These findings highlight the need for public policies aimed at reducing structural barriers and expanding equitable access to oral health care.
Adolescence is a high-risk period for co-occurring conditions like chronic pain, anxiety, and depression. Although digital psychological interventions offer a scalable and accessible alternative to traditional care, their comprehensive efficacy in addressing these interconnected symptoms remains underexplored. This meta-analysis evaluates the effects of digital interventions on pain in adolescents with comorbid emotional problems, with secondary outcomes including anxiety and depressive symptoms. We systematically searched five databases for randomized controlled trials through October 5, 2025, ultimately including 12 studies. Statistical analyses were performed in Review Manager 5.4 and Stata 17.0 using a random-effects model and specifically focused on adolescents with comorbid conditions. The review protocol was registered with PROSPERO. Subgroup analyses were conducted based on intervention type (Internet-based Cognitive Behavioral Therapy [iCBT], self-management, and Internet-based Acceptance and Commitment Therapy [iACT]). A total of 12 studies involving 1403 adolescents were included. Meta-analysis indicated that digital interventions significantly improved pain (SMD = -0.21, 95% CI: [-0.35, -0.06]) and anxiety (SMD = -0.15, 95% CI: [-0.21, -0.10]). The effects of digital psychosocial interventions on depression were not statistically significant. Digital interventions show potential in managing pain and anxiety among adolescents with comorbidities. Future efforts should prioritize integrated intervention programs that combine pain management with emotion regulation, establishing them as foundational components within the broader care system to complement routine clinical practice. This systematic review was prospectively registered with PROSPERO (CRD420251270961) on 12 December 2025. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251270961.
Within the United States, suicide ranks as the second leading cause of death among the adolescent population, with continual increases projected in the future. Ultimately, much research focuses on depression and anxiety in adolescents; however, little focus has been given to the concept of fear and its role as a precursor to suicidal ideation and attempt. The concept of fear is the focus of this concept analysis to further understand its role in adolescent suicide. For this concept analysis, Walker and Avant's method was utilized to review and thoroughly examine the concept of fear. The Standards for Reporting Qualitative Research (SRQR) guideline is followed. Utilizing specific criteria in narrowing the search, a total of 43 articles were reviewed to identify attributes of the concept fear. After reviewing the literature to identify all possible uses of the concept, such as fear of disclosure, fear of negative evaluation, fear of social exclusion, fear of cultural consequences, and fear in outside contexts, defining attributes consist of dread, stigma, and exclusion. Cases are further examined to show a model, related, contrary, and borderline case. Antecedents, both psychosocial and systemic, are reviewed and established as bullying, social rejection from peers, familial response, perceptions of providers, and gaps in consistent screening. Consequences may cause an adolescent to underreport symptoms or withdraw, leading to potential suicidal ideation and attempt. Ultimately, utilizing routine universal suicide screening and close monitoring within healthcare settings may be the key to reducing fear and preventing adolescent suicide.
to analyze the social determinants of health involved in adolescent students' mental distress in the municipality of Cuiabá. a qualitative study, linked to a matrix project, based on the social determinants of health theoretical model by Solar and Irwin. Data came from a matrix research study, analyzing 98 interviews with adolescents aged 12 to 18 years. The interviews were guided by a self-assessment instrument for emotional aspects and social competencies: Youth Self-Report. Qualitative data analysis was carried out using the thematic analysis proposed by Braun and Clarke. in light of the adopted theoretical model, three subcategories emerged from the structural determinants of health category, and six subcategories from the intermediate determinants of health category. by using the Solar and Irwin model, it was possible to identify that the social determinants of health play an important role in manifestation of mental health symptoms among adolescents.
to identify the socioeconomic and behavioral profile of adolescents who self-identify as lesbian, gay, bisexual, transvestite, transgender, and others, as well as their experiences of peer violence and its motivations. a cross-sectional, descriptive study was conducted among 949 adolescents aged 14 to 19 years, using self-administered electronic questionnaires, which were analyzed using crude and relative frequencies and 95% confidence intervals. cisgender adolescents (81.0%), middle-class students (44.7%), Black or Brown students (57.4%), and public-school students (67.2%) predominated. The prevalence of bullying was 67.8%, with 13.0% motivated by sexual orientation, and cyberbullying was identified in 11.5%. Condom use was higher during the first sexual intercourse (50.7%) than during the last (40.3%). Current alcohol use was around 47.2%, cigarette use was 9.1%, and drug use was 15.1%. it is concluded that the adolescents in this study face high rates of violence, social exclusion, and behavioral vulnerabilities, reinforcing the need for integrated strategies to promote inclusive and safe environments, as well as public policies aimed at equity and health for this population.