搜索结果：The Lancet. Child & adolescent health

While coronavirus disease 2019 (COVID-19) continues to spread across the globe, many countries have decided to close schools as part of a physical distancing policy to slow transmission and ease the burden on health systems. The UN Educational, Scientific and Cultural Organization estimates that 138 countries have closed schools nationwide, and several other countries have implemented regional or local closures. These school closures are affecting the education of 80% of children worldwide. Although scientific debate is ongoing with regard to the effectiveness of school closures on virus transmission,1Cohen J Kupferschmidt K Countries test tactics in ‘war’ against COVID-19.Science. 2020; 367: 1287-1288Crossref PubMed Scopus (255) Google Scholar the fact that schools are closed for a long period of time could have detrimental social and health consequences for children living in poverty, and are likely to exacerbate existing inequalities. We discuss two mechanisms through which school closures will affect poor children in the USA and Europe. First, school closures will exacerbate food insecurity. For many students living in poverty, schools are not only a place for learning but also for eating healthily. Research shows that school lunch is associated with improvements in academic performance, whereas food insecurity (including irregular or unhealthy diets) is associated with low educational attainment and substantial risks to the physical health and mental wellbeing of children.2Schwartz AE Rothbart MW Let them eat lunch: the impact of universal free meals on student performance.J Policy Anal Manage. 2019; (published online Oct 10.)DOI:10.1002/pam.22175Crossref Scopus (77) Google Scholar, 3Bitler MP Seifoddini A Health impacts of food assistance: evidence from the United States.Annu Rev Resour Economics. 2019; 11: 261-287Crossref Scopus (26) Google Scholar The number of children facing food insecurity is substantial. According to Eurostat, 6·6% of households with children in the European Union—5·5% in the UK—cannot afford a meal with meat, fish, or a vegetarian equivalent every second day. Comparable estimates in the USA suggest that 14% of households with children had food insecurity in 2018.4United States Department of AgricultureFood security in the United States.https://www.ers.usda.gov/data-products/food-security-in-the-united-states/Date accessed: March 25, 2020Google Scholar Second, research suggests that non-school factors are a primary source of inequalities in educational outcomes. The gap in mathematical and literacy skills between children from lower and higher socioeconomic backgrounds often widens during school holiday periods.5Alexander KL Entwisle DR Olson LS Lasting consequences of the summer learning gap.Am Sociol Rev. 2007; 72: 167-180Crossref Scopus (414) Google Scholar The summer holiday in most American schools is estimated to contribute to a loss in academic achievement equivalent to one month of education for children with low socioeconomic status; however, this effect is not observed for children with higher socioeconomic status.6Cooper H Nye B Charlton K Lindsay J Greathouse S The effects of summer vacation on achievement test scores: a narrative and meta-analytic review.Rev Educ Res. 1996; 66: 227-268Crossref Scopus (538) Google Scholar Summer holidays are also associated with a setback in mental health and wellbeing for children and adolescents.7Morgan K Melendez-Torres GJ Bond A et al.Socio-economic inequalities in adolescent summer holiday experiences, and mental wellbeing on return to school: analysis of the school health research network/health behaviour in school-aged children survey in Wales.Int J Environ Res Public Health. 2019; 161107Crossref Scopus (31) Google Scholar Although the current school closures differ from summer holidays in that learning is expected to continue digitally, the closures are likely to widen the learning gap between children from lower-income and higher-income families. Children from low-income households live in conditions that make home schooling difficult. Online learning environments usually require computers and a reliable internet connection. In Europe, a substantial number of children live in homes in which they have no suitable place to do homework (5%) or have no access to the internet (6·9%). Furthermore, 10·2% of children live in homes that cannot be heated adequately, 7·2% have no access to outdoor leisure facilities, and 5% do not have access to books at the appropriate reading level.8Guio AC Gordon D Marlier E Najera H Pomati M Towards an EU measure of child deprivation.Child Indic Res. 2018; 11: 835-860Crossref PubMed Scopus (55) Google Scholar In the USA, an estimated 2·5% of students in public schools do not live in a stable residence. In New York city, where a large proportion of COVID-19 cases in the USA have been observed, one in ten students were homeless or experienced severe housing instability during the previous school year.9National Center for Homeless EducationFederal Data Summary. School Year 2015–16 through 2017–18.https://nche.ed.gov/wp-content/uploads/2020/01/Federal-Data-Summary-SY-15.16-to-17.18-Published-1.30.2020.pdfDate: 2020Date accessed: April 3, 2020Google Scholar While learning might continue unimpeded for children from higher income households, children from lower income households are likely to struggle to complete homework and online courses because of their precarious housing situations. Beyond the educational challenges, however, low-income families face an additional threat: the ongoing pandemic is expected to lead to a severe economic recession. Previous recessions have exacerbated levels of child poverty with long-lasting consequences for children's health, wellbeing, and learning outcomes.10Cantillon B Chzhen Y Handa S Nolan B Children of austerity. Impact of the great recession on child poverty in rich countries. UNICEF, Oxford University Press, New York2017https://www.unicef-irc.org/publications/pdf/Children_of_austerity.pdfDate accessed: April 3, 2020Google Scholar Policy makers, school administrators, and other local officials thus face two challenges. First, the immediate nutrition and learning needs of poor students must continue to be addressed. The continuation of school-provided meals is essential in preventing widespread food insecurity. Teachers should also consider how to adapt their learning materials for students without access to wireless internet, a computer, or a place to study. Second, local and national legislators must prepare for the considerable challenges that await when the pandemic subsides. At the local level, an adequate response must include targeted education and material support for children from low-income households to begin to close the learning gap that is likely to have occurred. From a policy perspective, legislators should consider providing regular income support for households with children during the impending economic crisis to prevent a deepening and broadening of child poverty. Without such action, the current health crisis could become a social crisis that will have long-lasting consequences for children in low-income families. We declare no competing interests. COVID-19 puts societies to the test

Background: The COVID‑19 pandemic and associated public health measures have disrupted the lives of people around the world. It is already evident that the direct and indirect psychological and social effects of the COVID‑19 pandemic are insidious and affect the mental health of young children and adolescents now and will in the future. The aim and objectives of this knowledge-synthesis study were to identify the impact of the pandemic on children’s and adolescent’s mental health and to evaluate the effectiveness of different interventions employed during previous and the current pandemic to promote children’s and adolescents’ mental health. Methodology: We conducted the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included experimental randomized and nonrandomized controlled trials, observational studies, and qualitative studies. Results: Of the 5828 articles that we retrieved, 18 articles met the inclusion criteria. We thematically analyzed them and put the major findings under the thematic areas of impact of the pandemic on children’s and adolescents’ mental health. These studies reported that pandemics cause stress, worry, helplessness, and social and risky behavioral problems among children and adolescents (e.g., substance abuse, suicide, relationship problems, academic issues, and absenteeism from work). Interventions such as art-based programs, support services, and clinician-led mental health and psychosocial services effectively decrease mental health issues among children and adolescents. Conclusion: Children and adolescents are more likely to experience high rates of depression and anxiety during and after a pandemic. It is critical that future researchers explore effective mental health strategies that are tailored to the needs of children and adolescents. Explorations of effective channels regarding the development and delivery of evidenced-based, age-appropriate services are vital to lessen the effects and improve long-term capacities for mental health services for children and adolescents. Key Practitioner Message: The COVID-19 pandemic’s physical restrictions and social distancing measures have affected each and every domain of life. Although the number of children and adolescents affected by the disease is small, the disease and the containment measures such as social distancing, school closure, and isolation have negatively impacted the mental health and well-being of children and adolescents. The impact of COVID-19 on the mental health of children and adolescents is of great concern. Anxiety, depression, disturbances in sleep and appetite, as well as impairment in social interactions are the most common presentations. It has been indicated that compared to adults, this pandemic may continue to have increased long term adverse consequences on children’s and adolescents’ mental health. As the pandemic continues, it is important to monitor the impact on children’s and adolescents’ mental health status and how to help them to improve their mental health outcomes in the time of the current or future pandemics.

BACKGROUND: There are specific guidelines regarding the level of physical activity (PA) required to provide health benefits. However, the research underpinning these PA guidelines does not address the element of social health. Furthermore, there is insufficient evidence about the levels or types of PA associated specifically with psychological health. This paper first presents the results of a systematic review of the psychological and social health benefits of participation in sport by children and adolescents. Secondly, the information arising from the systematic review has been used to develop a conceptual model. METHODS: A systematic review of 14 electronic databases was conducted in June 2012, and studies published since 1990 were considered for inclusion. Studies that addressed mental and/or social health benefits from participation in sport were included. RESULTS: A total of 3668 publications were initially identified, of which 30 met the selection criteria. There were many different psychological and social health benefits reported, with the most commonly being improved self-esteem, social interaction followed by fewer depressive symptoms. Sport may be associated with improved psychosocial health above and beyond improvements attributable to participation in PA. Specifically, team sport seems to be associated with improved health outcomes compared to individual activities, due to the social nature of the participation. A conceptual model, Health through Sport, is proposed. The model depicts the relationship between psychological, psychosocial and social health domains, and their positive associations with sport participation, as reported in the literature. However, it is acknowledged that the capacity to determine the existence and direction of causal links between participation and health is limited by the fact that the majority of studies identified (n=21) were cross-sectional. CONCLUSION: It is recommended that community sport participation is advocated as a form of leisure time PA for children and adolescents, in an effort to not only improve physical health in relation to such matters as the obesity crisis, but also to enhance psychological and social health outcomes. It is also recommended that the causal link between participation in sport and psychosocial health be further investigated and the conceptual model of Health through Sport tested.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including-but not restricted to-child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry. CONCLUSION: There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.

BACKGROUND: Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. Little is known, however, about the effectiveness of LHW interventions. OBJECTIVES: To assess the effects of LHW interventions in primary and community health care on maternal and child health and the management of infectious diseases. SEARCH STRATEGY: For the current version of this review we searched The Cochrane Central Register of Controlled Trials (including citations uploaded from the EPOC and the CCRG registers) (The Cochrane Library 2009, Issue 1 Online) (searched 18 February 2009); MEDLINE, Ovid (1950 to February Week 1 2009) (searched 17 February 2009); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (February 13 2009) (searched 17 February 2009); EMBASE, Ovid (1980 to 2009 Week 05) (searched 18 February 2009); AMED, Ovid (1985 to February 2009) (searched 19 February 2009); British Nursing Index and Archive, Ovid (1985 to February 2009) (searched 17 February 2009); CINAHL, Ebsco 1981 to present (searched 07 February 2010); POPLINE (searched 25 February 2009); WHOLIS (searched 16 April 2009); Science Citation Index and Social Sciences Citation Index (ISI Web of Science) (1975 to present) (searched 10 August 2006 and 10 February 2010). We also searched the reference lists of all included papers and relevant reviews, and contacted study authors and researchers in the field for additional papers. SELECTION CRITERIA: Randomised controlled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to improve maternal or child health or the management of infectious diseases. A 'lay health worker' was defined as any health worker carrying out functions related to healthcare delivery, trained in some way in the context of the intervention, and having no formal professional or paraprofessional certificate or tertiary education degree. There were no restrictions on care recipients. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data using a standard form and assessed risk of bias. Studies that compared broadly similar types of interventions were grouped together. Where feasible, the study results were combined and an overall estimate of effect obtained. MAIN RESULTS: Eighty-two studies met the inclusion criteria. These showed considerable diversity in the targeted health issue and the aims, content, and outcomes of interventions. The majority were conducted in high income countries (n = 55) but many of these focused on low income and minority populations. The diversity of included studies limited meta-analysis to outcomes for four study groups. These analyses found evidence of moderate quality of the effectiveness of LHWs in promoting immunisation childhood uptake (RR 1.22, 95% CI 1.10 to 1.37; P = 0.0004); promoting initiation of breastfeeding (RR = 1.36, 95% CI 1.14 to 1.61; P < 0.00001), any breastfeeding (RR 1.24, 95% CI 1.10 to 1.39; P = 0.0004), and exclusive breastfeeding (RR 2.78, 95% CI 1.74 to 4.44; P <0.0001); and improving pulmonary TB cure rates (RR 1.22 (95% CI 1.13 to 1.31) P <0.0001), when compared to usual care. There was moderate quality evidence that LHW support had little or no effect on TB preventive treatment completion (RR 1.00, 95% CI 0.92 to 1.09; P = 0.99). There was also low quality evidence that LHWs may reduce child morbidity (RR 0.86, 95% CI 0.75 to 0.99; P = 0.03) and child (RR 0.75, 95% CI 0.55 to 1.03; P = 0.07) and neonatal (RR 0.76, 95% CI 0.57 to 1.02; P = 0.07) mortality, and increase the likelihood of seeking care for childhood illness (RR 1.33, 95% CI 0.86 to 2.05; P = 0.20). For other health issues, the evidence is insufficient to draw conclusions regarding effectiveness, or to enable the identification of specific LHW training or intervention strategies likely to be most effective. AUTHORS' CONCLUSIONS: LHWs provide promising benefits in promoting immunisation uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality when compared to usual care. For other health issues, evidence is insufficient to draw conclusions about the effects of LHWs.

Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health. Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion. Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss. Findings: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries. Conclusions and Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

This study addresses a critical gap in adolescent health education strategies in the Philippines, as highlighted by the Young Adult Fertility and Sexuality (YAFS) survey series, which overlooks the use of games as a medium for disseminating health information. To bridge this gap, the research introduces AHlam Na, a game-based mobile application designed to enhance adolescents' awareness and understanding of key health-related topics. Using a single-group pretest-posttest design, the study involved forty junior high school students from a randomly selected school in the Philippines. They interacted with the application that embedded adolescent health topics into its gameplay. Data collected through pretest and post-test surveys revealed a significant improvement in the student's knowledge and attitudes toward adolescent health after engaging in the game, indicating that game-based learning effectively enhances their learning experience. The positive reception and knowledge gains suggest that AHlam Na is a promising tool for promoting adolescent health awareness. Based on these findings, it is recommended that the application be integrated into the adolescent health curriculum in sch

The COVID-19 pandemic has caused unprecedented changes in the lives of 1.6 billion children and adolescents. First non-representative studies from China, India, Brazil, the US, Spain, Italy, and Germany pointed to a negative mental health impact. The current study is the first nationwide representative study to investigate the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) and mental health of children and adolescents in Germany from the perspective of children themselves. A representative online survey was conducted among n = 1586 families with 7- to 17-year-old children and adolescents between May 26 and June 10. The survey included internationally established and validated instruments for measuring HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), and depression (CES-DC). Results were compared with data from the nationwide, longitudinal, representative BELLA cohort study (n = 1556) conducted in Germany before the pandemic. Two-thirds of the children and adolescents reported being highly burdened by the COVID-19 pandemic. They experienced significantly lower HRQoL (40.2% vs. 15.3%), more mental health problems (17.8% vs. 9.9%) and higher anxiety levels (24.1% vs. 14.9%) than before the pandemic. Children with low socioeconomic status, migration background and limited living space were affected significantly more. Health promotion and prevention strategies need to be implemented to maintain children's and adolescents' mental health, improve their HRQoL, and mitigate the burden caused by COVID-19, particularly for children who are most at risk.

COVID-19 was declared a pandemic in March 2020, resulting in many countries worldwide calling for lockdowns. This study aimed to review the existing literature on the effects of the lockdown measures established as a response to the COVID-19 pandemic on the mental health of children and adolescents. Embase, Ovid, Global Health, PsycINFO, Web of Science, and pre-print databases were searched in this PRISMA-compliant systematic review (PROSPERO: CRD42021225604). We included individual studies reporting on a wide range of mental health outcomes, including risk and protective factors, conducted in children and adolescents (aged ≤ 19 years), exposed to COVID-19 lockdown. Data extraction and quality appraisal were conducted by independent researchers, and results were synthesised by core themes. 61 articles with 54,999 children and adolescents were included (mean age = 11.3 years, 49.7% female). Anxiety symptoms and depression symptoms were common in the included studies and ranged 1.8-49.5% and 2.2-63.8%, respectively. Irritability (range = 16.7-73.2%) and anger (range = 30.0-51.3%), were also frequently reported by children and adolescents. Special needs and the presence of mental disorders before the lockdown, alongside excessive media exposure, were significant risk factors for anxiety. Parent-child communication was protective for anxiety and depression. The COVID-19 lockdown has resulted in psychological distress and highlighted vulnerable groups such as those with previous or current mental health difficulties. Supporting the mental health needs of children and adolescents at risk is key. Clinical guidelines to alleviate the negative effects of COVID-19 lockdown and public health strategies to support this population need to be developed.

Based on the field investigation of West Bengal, this paper investigates whether the school-aged children of the marginal farmer households are full-time paid labourers or unpaid domestic labourers along with schooling or regular students. Probit Regression analysis is applied here to assess the influencing factors for reducing the size of the child labour force in practice. The result shows that the higher is the earning of the adult members of the households, the lower is the incidence of child labour. Moreover, the credit accessibility of the mother from the Self-help group and more person-days of the father in work in a reference year are also responsible for reducing the possibility of a child turning into labour. The study further suggests that the younger age of the father, education of fathers, and low operational landholdings are positive and significant determinants to decide on a child education by restricting their excessive domestic work burden.

The study investigated the impact of healthcare system efficiency on the delivery of maternal, newborn, and child services in Africa. Data Envelopment Analysis and Tobit regression were employed to assess the efficiency of 46 healthcare systems across the continent, utilizing the Variable Returns to Scale model with Input orientation to evaluate technical efficiency. The Tobit method was utilized to explore factors contributing to inefficiency, with inputs variables including hospital, physician, and paramedical staff, and outputs variables encompassing maternal, newborn, and child admissions, cesarean interventions, functional competency, and hospitalization days. Results revealed that only 26% of countries exhibited efficiency, highlighting a significant proportion of 74% with inefficiencies. Financial determinants such as current health expenditures, comprehensive coverage index, and current health expenditure per capita were found to have a negative impact on the efficiency of maternal-child services. These findings underscore a marginal deficiency in technical efficiency within Africa's healthcare systems, emphasizing the necessity for policymakers to reassess the roles of bot

Maternal and child health is a critical concern around the world. In many global health programs disseminating preventive care and health information, limited healthcare worker resources prevent continuous, personalised engagement with vulnerable beneficiaries. In such scenarios, it becomes crucial to optimally schedule limited live-service resources to maximise long-term engagement. To address this fundamental challenge, the multi-year SAHELI project (2020-2025), in collaboration with partner NGO ARMMAN, leverages AI to allocate scarce resources in a maternal and child health program in India. The SAHELI system solves this sequential resource allocation problem using a Restless Multi-Armed Bandit (RMAB) framework. A key methodological innovation is the transition from a traditional Two-Stage "predict-then-optimize" approach to Decision-Focused Learning (DFL), which directly aligns the framework's learning method with the ultimate goal of maximizing beneficiary engagement. Empirical evaluation through large-scale randomized controlled trials demonstrates that the DFL policy reduced cumulative engagement drops by 31% relative to the current standard of care, significantly outperform

BACKGROUND: The purpose was to: 1) perform a systematic review of studies examining the relation between physical activity, fitness, and health in school-aged children and youth, and 2) make recommendations based on the findings. METHODS: The systematic review was limited to 7 health indicators: high blood cholesterol, high blood pressure, the metabolic syndrome, obesity, low bone density, depression, and injuries. Literature searches were conducted using predefined keywords in 6 key databases. A total of 11,088 potential papers were identified. The abstracts and full-text articles of potentially relevant papers were screened to determine eligibility. Data was abstracted for 113 outcomes from the 86 eligible papers. The evidence was graded for each health outcome using established criteria based on the quantity and quality of studies and strength of effect. The volume, intensity, and type of physical activity were considered. RESULTS: Physical activity was associated with numerous health benefits. The dose-response relations observed in observational studies indicate that the more physical activity, the greater the health benefit. Results from experimental studies indicate that even modest amounts of physical activity can have health benefits in high-risk youngsters (e.g., obese). To achieve substantive health benefits, the physical activity should be of at least a moderate intensity. Vigorous intensity activities may provide even greater benefit. Aerobic-based activities had the greatest health benefit, other than for bone health, in which case high-impact weight bearing activities were required. CONCLUSION: The following recommendations were made: 1) Children and youth 5-17 years of age should accumulate an average of at least 60 minutes per day and up to several hours of at least moderate intensity physical activity. Some of the health benefits can be achieved through an average of 30 minutes per day. [Level 2, Grade A]. 2) More vigorous intensity activities should be incorporated or added when possible, including activities that strengthen muscle and bone [Level 3, Grade B]. 3) Aerobic activities should make up the majority of the physical activity. Muscle and bone strengthening activities should be incorporated on at least 3 days of the week [Level 2, Grade A].

Background: Technology has provided a new way of life for adolescents. Strategies aimed at improving health behaviors through digital platforms can offer promising results. However, since peers can modify behaviors related to food and exercise, studying digital interventions based on peer influence to improve weight status of adolescents is important. Objective: To assess an eHealth app's effectiveness in adolescent population improvements in age- and sex-adjusted BMI percentiles. The study also examined social relationships of adolescents pre- and postintervention, identifying group leaders to study their profiles, eating, physical activity habits, and app usage. Methods: BMI percentiles were calculated following World Health Organization guidelines. Participants' diets and physical activity levels were assessed using the KIDMED questionnaire and PAQ-A. Social network variables were analyzed using SNA methodology, with reciprocal friendships used to compute the "degree" measure for centrality. Results: The sample included 210 individuals in the intervention group and 91 in the control group, with a 60.1% participation rate. Adolescents in the intervention group modified their BMI

Mental health disorders in children and adolescents are highly prevalent yet undertreated. A detailed understanding of the reasons for not seeking or accessing help as perceived by young people is crucial to address this gap. We conducted a systematic review (PROSPERO 42018088591) of quantitative and qualitative studies reporting barriers and facilitators to children and adolescents seeking and accessing professional help for mental health problems. We identified 53 eligible studies; 22 provided quantitative data, 30 provided qualitative data, and one provided both. Four main barrier/facilitator themes were identified. Almost all studies (96%) reported barriers related to young people's individual factors, such as limited mental health knowledge and broader perceptions of help-seeking. The second most commonly (92%) reported theme related to social factors, for example, perceived social stigma and embarrassment. The third theme captured young people's perceptions of the therapeutic relationship with professionals (68%) including perceived confidentiality and the ability to trust an unknown person. The fourth theme related to systemic and structural barriers and facilitators (58%), such as financial costs associated with mental health services, logistical barriers, and the availability of professional help. The findings highlight the complex array of internal and external factors that determine whether young people seek and access help for mental health difficulties. In addition to making effective support more available, targeted evidence-based interventions are required to reduce perceived public stigma and improve young people's knowledge of mental health problems and available support, including what to expect from professionals and services.

Despite the growing research on users' perceptions of health AI, adolescents' perspectives remain underexplored. This study explores adolescents' perceived benefits and risks of health AI technologies in clinical and personal health settings. Employing Design Fiction, we conducted interviews with 16 adolescents (aged 13-17) using four fictional design scenarios that represent current and future health AI technologies as probes. Our findings reveal that with a positive yet cautious attitude, adolescents envision unique benefits and risks specific to their age group. While health AI technologies were seen as valuable learning resources, they also raised concerns about confidentiality with their parents. Additionally, we identified several factors, such as severity of health conditions and previous experience with AI, influencing their perceptions of trust and privacy in health AI. We explore how these insights can inform the future of design of health AI technologies to support learning, engagement, and trust as adolescents navigate their healthcare journey.

Importance: Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies. Objective: To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories. Design, Setting, and Participants: This study examined levels, trends, and spatiotemporal patterns of cause-specific mortality and nonfatal health outcomes using standardized approaches to data processing and statistical analysis. It also describes epidemiologic transitions by evaluating historical associations between disease indicators and the Socio-Demographic Index (SDI), a composite indicator of income, educational attainment, and fertility. Data collected from 1990 to 2017 on children and adolescents from birth through 19 years of age in 195 countries and territories were assessed. Data analysis occurred from January 2018 to August 2018. Exposures: Being under the age of 20 years between 1990 and 2017. Main Outcomes and Measures: Death and disability. All-cause and cause-specific deaths, disability-adjusted life years, years of life lost, and years of life lived with disability. Results: Child and adolescent deaths decreased 51.7% from 13.77 million (95% uncertainty interval [UI], 13.60-13.93 million) in 1990 to 6.64 million (95% UI, 6.44-6.87 million) in 2017, but in 2017, aggregate disability increased 4.7% to a total of 145 million (95% UI, 107-190 million) years lived with disability globally. Progress was uneven, and inequity increased, with low-SDI and low-middle-SDI locations experiencing 82.2% (95% UI, 81.6%-82.9%) of deaths, up from 70.9% (95% UI, 70.4%-71.4%) in 1990. The leading disaggregated causes of disability-adjusted life years in 2017 in the low-SDI quintile were neonatal disorders, lower respiratory infections, diarrhea, malaria, and congenital birth defects, whereas neonatal disorders, congenital birth defects, headache, dermatitis, and anxiety were highest-ranked in the high-SDI quintile. Conclusions and Relevance: Mortality reductions over this 27-year period mean that children are more likely than ever to reach their 20th birthdays. The concomitant expansion of nonfatal health loss and epidemiological transition in children and adolescents, especially in low-SDI and middle-SDI countries, has the potential to increase already overburdened health systems, will affect the human capital potential of societies, and may influence the trajectory of socioeconomic development. Continued monitoring of child and adolescent health loss is crucial to sustain the progress of the past 27 years.

While prior research has focused on providers, caregivers, and adult patients, little is known about adolescents' perceptions of AI in health learning and management. Utilizing design fiction and co-design methods, we conducted seven workshops with 23 adolescents (aged 14-17) to understand how they anticipate using health AI in the context of a family celiac diagnosis. Our findings reveal that adolescents have four main envisioned roles of health AI: enhancing health understanding and help-seeking, reducing cognitive burden, supporting family health management, and providing guidance while respecting their autonomy. We also identified nuanced trust and a divided view on emotional support from health AI. These findings suggest that adolescents perceive AI's value as a tool that moves them from efficiency to meaning-one that creates time for valued activities. We discuss opportunities for future health AI systems to be designed to encourage adolescent autonomy and reflection, while also supporting meaningful, dialectical activities.

BACKGROUND: Rapid demographic, epidemiological, and nutritional transitons have brought a pressing need to track progress in adolescent health. Here, we present country-level estimates of 12 headline indicators from the Lancet Commission on adolescent health and wellbeing, from 1990 to 2016. METHODS: Indicators included those of health outcomes (disability-adjusted life-years [DALYs] due to communicable, maternal, and nutritional diseases; injuries; and non-communicable diseases); health risks (tobacco smoking, binge drinking, overweight, and anaemia); and social determinants of health (adolescent fertility; completion of secondary education; not in education, employment, or training [NEET]; child marriage; and demand for contraception satisfied with modern methods). We drew data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, International Labour Organisation, household surveys, and the Barro-Lee education dataset. FINDINGS: From 1990 to 2016, remarkable shifts in adolescent health occurred. A decrease in disease burden in many countries has been offset by population growth in countries with the poorest adolescent health profiles. Compared with 1990, an additional 250 million adolescents were living in multi-burden countries in 2016, where they face a heavy and complex burden of disease. The rapidity of nutritional transition is evident from the 324·1 million (18%) of 1·8 billion adolescents globally who were overweight or obese in 2016, an increase of 176·9 million compared with 1990, and the 430·7 million (24%) who had anaemia in 2016, an increase of 74·2 million compared with 1990. Child marriage remains common, with an estimated 66 million women aged 20-24 years married before age 18 years. Although gender-parity in secondary school completion exists globally, prevalence of NEET remains high for young women in multi-burden countries, suggesting few opportunities to enter the workforce in these settings. INTERPRETATION: Although disease burden has fallen in many settings, demographic shifts have heightened global inequalities. Global disease burden has changed little since 1990 and the prevalence of many adolescent health risks have increased. Health, education, and legal systems have not kept pace with shifting adolescent needs and demographic changes. Gender inequity remains a powerful driver of poor adolescent health in many countries. FUNDING: Australian National Health and Medical Research Council, and the Bill & Melinda Gates Foundation.