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Patient satisfaction is an important indicator of healthcare quality and a determinant of treatment success. To assess parents'/carers' satisfaction with their children's/adolescents' orthodontic treatment and to investigate associations among study variables using a validated instrument. A cross-sectional survey study was conducted with parents/carers of 68 children/adolescents aged 6-17 years. Satisfaction was assessed using the Questionnaire of Satisfaction with Orthodontic Treatment, comprising 25 items distributed across three subscales: treatment process, psychosocial effect of treatment and treatment outcome. Sociodemographic and clinical data were also collected. Descriptive analyses and Poisson regression models were performed, with results expressed as odds ratio (OR) and 95% confidence interval (CI). Of the 68 parents/carers, 48 (70.6%) were male. Among the children/adolescents, 34 (50%) were male (mean age 12.84 years). Parents/carers from households with four or more individuals had significantly lower satisfaction scores on the treatment process subscale than those from households with three or fewer individuals (OR = 0.93; 95% CI = 0.83-0.98; P = 0.016). Parents/carers of children/adolescents who had undergone corrective treatment had significantly higher scores on the psychosocial effect subscale (OR = 1.10; 95% CI = 1.01-1.21; P = 0.023), treatment outcome subscale (OR = 1.07; 95% CI = 1.01-1.14; P = 0.016) and total score (OR = 1.06; 95% CI = 1.01-1.13; P = 0.032) than those whose children/adolescents had received interceptive/corrective treatment. Parents/carers of children/adolescents with more severe malocclusion reported significantly higher satisfaction scores than those with less severe malocclusion (OR = 1.02; 95% CI = 1.01-1.03; P = 0.010). Family size, type of orthodontic treatment and malocclusion severity were associated with parents'/carers' satisfaction with their children's/adolescents' orthodontic treatment. How satisfied parents and carers were with their children’s orthodontic treatmentWhy was the study done?Orthodontic treatment works better when patients and families are satisfied with the care they receive. Parents and carers play an important role when children and teenagers have orthodontic treatment.What did the researchers do?The researchers interviewed parents/carers of children/adolescents aged 6–17 years who had finished orthodontic treatment. They used questionnaires to ask about social and financial factors and about views on orthodontic care. The main questionnaire was the Questionnaire of Satisfaction with Orthodontic Treatment.What did the researchers find?The study included 68 parents/carers. Most respondents were male. Parents/carers from larger families, with four or more members, were less satisfied with the treatment. Satisfaction was higher when treatment had fewer phases and when the orthodontic problem was more severe before treatment started.What do the findings mean?Parents’/carers’ satisfaction was linked to family size, the number of treatment phases, and how severe the orthodontic problem was before treatment. Orthodontists should consider these factors when planning treatment and talking with families.

Adolescent nicotine use remains a major public health concern, particularly in the context of increasing e-cigarette uptake and gaps in tobacco-control communication. Effective prevention requires evidence on the information channels through which adolescents prefer to receive risk information about tobacco and nicotine products. This study examined adolescents' preferred sources for receiving information about the health risks of cigarettes, e-cigarettes, and waterpipes in Germany, and assessed differences by age, gender, school type, and nicotine-use status. Cross-sectional analysis of a large nationwide school-based survey across 14 of 16 German federal states. Data were drawn from the 2024/2025 wave of the Präventionsradar study and included 21,841 adolescents aged 9-17 years from 116 schools and 1,712 classes across 14 German federal states. Weighted descriptive analyses and multilevel logistic regression models were used to examine preferred information sources and information refusal. Models were adjusted for age, gender, school type, and current nicotine-product use, with random intercepts at the class level. Parents (30.2%), social media (21.5%), and physicians (18.6%) were the most frequently selected information sources. Younger adolescents more often selected parents, whereas older adolescents more often selected social media and peers. Adolescents currently using at least one tobacco or nicotine product were more likely to select friends and less likely to select parents, teachers, or physicians. They were also more likely to report not wanting health information. Information refusal was additionally associated with male gender and lower academic track. Adolescents' preferred sources of tobacco- and nicotine-related health information differ substantially by sociodemographic characteristics and nicotine-use status. These findings may inform the development of differentiated and multimodal communication strategies.

Higher sport specialization levels have been associated with increased mental health issues. A recently validated questionnaire, the Wisconsin Sport Specialization Questionnaire (WISSQ), may provide clarity about the degree of sport specialization to investigate associations with mental health/quality of life (QoL) among adolescent athletes. To examine the association of sports specialization, as measured by the WISSQ, and mental health/QoL outcomes among uninjured adolescent athletes, as well as the effect of age on the interaction between mental health/QoL outcomes and sport specialization. Cross-sectional study; Level of evidence, 2. During the preseason assessment, performed in July and August from 2023 to 2025, participants completed the WISSQ and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global 25 (Version 1.1). A multiple linear regression model was constructed that evaluated the association between 6 PROMIS domains and WISSQ ratings, adjusting for age, sex, and self-reported physical activity volume. To address the secondary purpose, linear regression models with an interaction term were used to examine the association between each PROMIS domain and age with sport specialization. A total of 251 uninjured adolescent athletes completed the study (mean ± SD age, 15.9 ± 1.4 years). The mean WISSQ rating was 54.1 (SD, 15.4). Results from the multivariable linear regression model indicated that higher depressive symptoms (β = 0.46; 95% CI, 0.16-0.76; P = .003) and pain interference ratings (β = 0.30; 95% CI, 0.02-0.57; P = .03) were significantly associated with higher WISSQ ratings, after adjusting for baseline physical activity, age, sex, and history of anxiety or depression diagnosis. For the secondary purpose, there was a significant interaction between fatigue and age group on sport specialization (β coefficient = 0.49; 95% CI, 0.02-0.95; P = .04). The relationship between fatigue and sport specialization differed by age: a stronger association occurred among older adolescents than younger adolescents. There were no other age × QoL interactions. This study demonstrated that higher depressive symptoms and pain interference ratings were significantly associated with higher WISSQ ratings. In addition, there was a significant interaction between fatigue and age group, with a stronger association identified among older adolescents. Higher specialized and older adolescent athletes may be more at risk for developing mental health/QoL concerns and may benefit from more targeted screening.

The integrated motivational-volitional (IMV) model of suicidal behaviour has received growing empirical support, yet few studies have tested its core pathways (defeat → entrapment → suicidal ideation → suicide attempts) in clinical psychiatric adolescent populations. Evidence on volitional moderators influencing the transition from ideation to action remains limited. This study aimed to (a) test the core pathways of the IMV model and (b) examine whether volitional moderators differentiate between adolescents with suicidal ideation and those who have attempted suicide. In this cross-sectional study, 203 Danish adolescents aged 13-19 years were recruited from an out-patient child and adolescent psychiatry department, including patients in treatment or referred for initial assessment. Participants completed validated measures assessing IMV constructs. Path analysis tested the core pathways and multinomial logistic regression examined associations between volitional moderators and group membership (no suicidal behaviour, suicidal ideation only and suicide attempt), with Wald tests comparing effects across outcomes. Findings supported the core IMV pathway, with the entrapment-ideation pathway being weakest. Volitional moderators were more strongly associated with suicide attempts than suicidal ideation, with significant differences confirmed by Wald tests. A dose-response pattern showed increasing likelihood of suicide attempts with greater exposure to volitional moderators; effect sizes differed significantly between ideation (odds ratio 2.21) and attempts (odds ratio 3.94). Results support the IMV model and highlight the role of volitional moderators in differentiating between suicidal ideation and attempts. These findings support a shift towards theory-informed psychosocial assessment in clinical adolescent populations.

Nonnutritive sweeteners (NNS) are increasingly incorporated into ultraprocessed foods and beverages, yet psychosocial drivers of NNS consumption across age groups in low- and middle-income settings remain poorly characterized. Understanding how knowledge, attitudinal beliefs, and information sources shape NNS consumption is essential for designing effective nutrition interventions. This study examined age-related patterns of NNS consumption among adolescents and adults and evaluated how knowledge, attitudes, and sources of nutrition information interact to influence consumption practices. A cross-sectional study was conducted among 2769 adolescents (10-19 y) and adults (&#x2265;20 y) in southeast Nigeria. Data were collected using a structured questionnaire assessing sociodemographic characteristics, NNS-related knowledge, attitudinal beliefs, consumption practices, and information sources. Mediation and conditional process analyses evaluated whether attitudinal beliefs mediated the knowledge-practice relationship and whether this mediation varied by knowledge level, age group, and information source. Logistic regression identified predictors of high NNS consumption. Adolescents (83.1%) showed a significantly higher prevalence of NNS consumption than adults (16.9%) (P < 0.001). Results from the logistic regression revealed that being an adolescent was strongly associated with higher NNS consumption [adjusted odds ratio (AOR) = 19.45; 95% confidence intervals (CI): 15.43, -24.51]. Information sources from health professionals (AOR = 0.67; 95% CI: 0.47, -0.95) and the presence of underlying disease (AOR = 0.50; 95% CI: 0.31, -0.82) were significantly associated with lower consumption. Mediation analysis indicated that positive attitudes partially mediated the relationship between knowledge and consumption practice (indirect effect P < 0.05). NNS consumption patterns exhibited significant age-related variance and are shaped by a complex interplay between knowledge, belief-based attitudes, and the prevailing information environment. Public health nutrition interventions must evolve beyond traditional knowledge dissemination and adopt a multifaceted approach that addresses information quality, food environments, and age-targeted programs.

There is growing concern that smartphones and social media (S/SM) disrupt adolescent sleep, wellbeing and cognition, yet causal evidence from robust interventions is limited. To assess the acceptability of a total 21-day&#x2009;S/SM detox, we conducted a preregistered (https://osf.io/79zd2) pilot randomised controlled trial with 82 adolescents aged 13-18&#x2009;years from UK schools. Participants were randomly assigned to a total S/SM detox (N&#x2009;=&#x2009;26), total S/SM detox with access to a basic 'brick' phone (N&#x2009;=&#x2009;26) or a business-as-usual control (N&#x2009;=&#x2009;30). Pre-and post-intervention measures of sleep, wellbeing and cognition were collected using surveys, wearables and cognitive tasks. Retention was high, with 13% attrition across groups. At 21-days, one or both detox groups showed tentative improvements in sleep duration, daytime sleepiness, depressive symptoms, perceived stress and working memory relative to the controls, however, these changes were not maintained at a 2-month follow-up. Open-ended post-detox reflections encompassed a range of both positive and negative experiences, with reported challenges including boredom, functional reliance on smartphones and fear of missing out. Nevertheless, 83% endorsed the need for government action. Digital detoxes appear feasible for generating causal evidence; however, they can also pose functional challenges to young people. Fully powered trials should address these challenges, potentially via more targeted intervention approaches (e.g. switching off the internet on smartphones, particularly at bedtime).

Health care transition (HCT) is underexplored among autistic adolescents and young adults (AYAs). We explored autistic AYAs' HCT experiences through virtual semi-structured interviews with 19 participants (mean age&#x2009;=&#x2009;21.4&#x2009;years; range&#x2009;=&#x2009;15-25). Data were analyzed using reflexive thematic analysis and interpreted through self-determination theory (SDT). Participants described HCT as marked by increased expectations for independent health care management without commensurate preparation, relational continuity, or structural support. Findings were organized around SDT domains of competence, autonomy, and relatedness, which were interconnected. Gaps in competence constrained autonomy and contributed to stress and care avoidance. Autonomy was negotiated and situational, often supported through ongoing caregiver involvement rather than full independence. Relatedness was undermined by fragmented care, limited continuity, and experiences of being dismissed by providers. Structural factors (transportation, insurance acceptance, provider availability, and rurality) shaped when and how these psychological needs could be met, amplifying transition-related challenges. Autistic AYAs want to take ownership of their care, but successful HCT depends on developmentally scaffolded skill-building, supportive interdependence, and health systems that foster competence, autonomy, and relatedness. Findings highlight the need for autism-responsive HCT models that incorporate gradual preparation, provider training, caregiver-supported autonomy, and structural accommodations, particularly in rural communities.Lay AbstractMoving from pediatric to adult health care can be challenging for autistic adolescents and young adults, especially in rural areas. We interviewed 19 autistic participants ages 15 to 25 to understand their experiences of health care transition. We analyzed interviews to identify themes and organized findings around three needs: feeling capable of managing health care (skills and confidence), having appropriate choice and control, and feeling supported and taken seriously by health care providers. Participants often described being expected to manage appointments, medications, and communication with providers more independently, without enough preparation or clear guidance. Many reported that limited skills or confidence made it harder to take charge of their care and contributed to stress and sometimes avoiding care. Independence was not "all-or-nothing": participants described sharing responsibilities with caregivers in ways that changed across situations, rather than becoming fully independent at once. Participants also described challenges with continuity and relationships such as switching providers, fragmented services, and feeling dismissed, making it harder to feel understood and supported. Practical barriers shaped these experiences, including transportation, whether providers accepted insurance, limited local providers, and rural distance. Overall, participants wanted to take more ownership of their health, but they emphasized the need for step-by-step skill-building, supportive shared responsibility with caregivers, and health care systems that help autistic young people feel capable, in control, and supported, especially in rural communities.

Adolescent idiopathic scoliosis (AIS) is a prevalent spinal deformity that impairs physical function and quality of life. While supervised exercise is recommended for moderate cases, its effectiveness remains debated. This meta-analysis evaluates the impact of exercise therapy on Cobb angle, trunk rotation (ATR), and quality of life (QoL) in AIS patients. We systematically searched PubMed, Web of Science, EBSCO and China National Knowledge Infrastructure (CNKI) databases from inception to October 2025 for randomized controlled trials (RCTs) investigating exercise in AIS. Study quality was assessed using the PEDro scale. Data synthesis involved pooling effect sizes, conducting subgroup analyses, and assessing publication bias using Stata 18. A total of 26 studies (21 RCT and five controlled trials) were included in the meta-analysis. The exercise intervention demonstrated statistically significant improvements across multiple functional domains: reduced the Cobb angle (Hedge's = 1.22, 95% CI [0.90-1.53]), improved the ATR (Hedge's systematically searched 1.25, 95% CI [0.74-1.76]), and enhanced QoL (Hedge's systematically searched 0.73, 95% CI [0.38-1.09]). Subgroup analyses further indicated that Schroth-based training (Hedge's = 1.304) and combined approaches (e.g., exercise with orthotic management) yielded the most favorable outcomes. Importantly, both short-term (&#x2264;12 weeks, 1-2 sessions/week) and long-term (&#x2265;25 weeks, &#x2265;5 sessions/week) intervention durations demonstrated significant clinical efficacy. Exercise therapy demonstrates significant potential as a fundamental conservative intervention for improving spinal morphology, function, and quality of life in adolescents with idiopathic scoliosis. The current evidence supports its integration into primary clinical management protocols. Future research should focus on conducting multi-center randomized controlled trials to validate long-term efficacy and to establish optimal, individualized intervention protocols.

The intersection of pediatric psychiatry and infectious disease can present complex diagnostic challenges, particularly when symptoms of organic medical etiology mimic severe psychiatric disorders. This case study analyzes the clinical trajectory of an adolescent patient who developed delirious mania - a subtype of catatonia combining manic, delirious, and psychotic features - following the administration of clarithromycin and amoxicillin for Helicobacter pylori (H. pylori) gastritis. Initially presenting with psychosis and delirium attributed to a prior Coronavirus Disease 2019 (COVID-19) infection and recurrent cannabis use, the patient underwent six hospital admissions over four months. While the patient's initial symptoms were thought to be likely due to cannabis-induced psychosis, the emergence of treatment-resistant delirious mania during her sixth admission led to treatment shifts that resulted in symptom improvement. This case review proposes a methodological framework for mitigating "anchoring bias" and identifying iatrogenic or other triggers in treatment-refractory psychiatric presentations. Ultimately, this work emphasizes the critical need for continuous medical re-evaluation in psychiatric settings as well as demonstrates that even common antibiotic regimens, like "triple therapy" for H. pylori, can precipitate severe neuropsychiatric syndromes in vulnerable adolescents.

Developmental trauma is a primary etiological factor in dissociative identity disorder (DID) and may lead to misdiagnosis due to symptom overlap with other psychiatric and neurological conditions. This case report describes an adolescent male with pronounced narcissistic vulnerability. The patient's background features an inconsistent parenting style-characterized by both overprotection and severe criticism-and significant paternal pressure to achieve academic success and embody an idealized, wise persona. Chronic exposure to these psychosocial stressors is hypothesized to have contributed to acute narcissistic rage, potentially associated with dissociative identity fragmentation. The initial clinical presentation involved functional neurological symptoms, which progressed to distinct identity states with amnesia. Treatment focused on supporting the patient's disrupted grandiose self-structure through an empathetic, mirroring psychotherapeutic approach. This intervention was associated with a marked reduction in dissociative symptoms. Further research is needed to clarify the complex role of narcissistic vulnerabilities in the development of dissociative identity presentations.

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Previous research has provided conflicting answers about whether the active use of social media, rather than just passive use, is linked to poor mental health. In addition, few studies have examined associations between social media use and mental health in international samples. Among adolescents aged 15-16 from 47 countries around the world (N&#x202f;=&#x202f;143,203), both active and passive social media use were associated with higher levels of anxious affect, though most associations with active use reversed or became non-significant when passive use was included in a multilevel model. Among girls across all regions, heavy passive social media users (7&#x202f;+ hours a day) were 88% more likely than light passive users (less than an hour a day) to strongly agree they got nervous easily; heavy active users were 64% more likely than light active users to strongly agree. Among boys, heavy passive social media users were 73% more likely than light passive users to strongly agree they worry about many things; heavy active users were 60% more likely than light active users to strongly agree. The associations appeared across all world regions, with effect sizes especially large in Central/Eastern Europe. Mean differences were larger among girls than boys, but relative risk elevations were larger among boys, likely due to lower base rates. Multilevel models identified significant interactions by gender. Thus, passive SMU (and sometimes active SMU) is associated with anxious affect, especially for girls.

Renal vein aneurysm (RVA) is an exceptionally rare vascular anomaly and an unusual cause of hydronephrosis. We report an asymptomatic 17-year-old male with persistent right hydronephrosis and preserved renal function. Serial ultrasonography demonstrated progressive pelvic dilatation, while repeat examination raised suspicion of an atypical extrapelvic component. Multimodal imaging, including ultrasonography, MAG3 scintigraphy, and computed tomography angiography, identified a right RVA, subsequently confirmed by laparoscopy and treated by aneurysmorrhaphy. Postoperative follow-up showed resolution of hydronephrosis. This case highlights the pivotal role of ultrasonography within a multimodal imaging approach for diagnosing rare vascular causes of persistent unexplained hydronephrosis.

Posterior spinal fusion (PSF) is the standard surgical treatment for progressive adolescent idiopathic scoliosis (AIS). While return to sport after PSF has been described, return to school (RTS) remains poorly defined despite its educational and psychosocial importance. This study aimed to quantify RTS timelines, compare anticipated versus observed absences, and evaluate demographic, surgical, psychosocial, and socioeconomic predictors. Consecutively enrolled English-speaking AIS and juvenile idiopathic scoliosis (JIS) patients undergoing PSF at a single institution between 2022 and 2025 were prospectively studied. Preoperative surveys captured demographics, school type, anticipated RTS, and awareness of accommodations available through a patient's school setting. Postoperative surveys documented actual RTS, attendance, and barriers. RTS was defined as the first day the patient resumed full-day, in-person school attendance. Partial day attendance, hybrid instruction, and virtual learning were not separately analyzed. The Pain Catastrophizing Scale assessed psychological status, and the Area Deprivation Index (ADI) measured socioeconomic context. Group comparisons used chi-square/Fisher's exact tests and t-tests/Mann-Whitney U; regression identified predictors. A total of 118 patients (84% female; mean age 14.5 &#xb1; 1.9 years) were included. Families anticipated 31.4 days of absence, while 71 postoperative respondents reported a mean absence of 46.8 &#xb1; 18.6 days (P = .022). Homeschool and private school students demonstrated numerically shorter RTS intervals than public school students (26.3, 32.8, and 43.1 days, respectively); however, these differences did not reach statistical significance (P = .160). Fusion length, sex, ADI, and race were not independent predictors of RTS. AIS/JIS patients undergoing PSF returned to school at a mean of 6.7 weeks, approximately 2 weeks later than anticipated. Exploratory analyses suggested possible differences by school type and psychosocial factors, which should be investigated further in future, larger studies. (1)There may be an educational gap, as families tend to underestimate the time required for their child to return to school (RTS).(2)Surgical and demographic factors, including length of fusion, sex, Area Deprivation Index, and race, were not associated with time to RTS. II, Prospective cohort study.

Acetabular dysplasia (AD) is a prominent cause of hip pain and dysfunction among adolescents and young adults (AYAs). The gold standard treatment is periacetabular osteotomy (PAO), but there is limited research regarding the perspectives of those considering this procedure. We explored the decision-making and needs of people with AD related to PAO to inform future decision aid development. We conducted semi-structured interviews with people with AD age &#x2265;13 years who underwent PAO >6 months ago. Questions explored experiences with AD diagnosis, PAO decision-making, and thoughts and preferences regarding a PAO decision aid. We inductively and deductively coded interviews to identify key themes. 17 participants (12 female, 5 male) completed the interview (age at first PAO = 19.6 &#xb1; 5.0 years, range 13-29 years; time from surgery to interview = 934.5 &#xb1; 405.7 days; range 312-1510 days). Key themes included: 1) Participants experienced two distinct pathways for AD diagnosis with the majority seeing multiple providers from symptom onset to AD diagnosis while others were diagnosed after imaging due to an acute musculoskeletal injury; 2) Participants overwhelmingly felt relief upon being diagnosed with AD; 3) Female and male participants disclosed PAO concerns that differed by sex; 4) Participants appreciated engaging in shared decision-making around PAO with their surgeon and healthcare team and valued open, transparent conversations about the surgery and recovery; 5) Participants desired tailored peer connections; 6) Participants would value a PAO decision aid that was online, interactive, and comprehensive. AYAs with AD experience different pathways to diagnosis and the decision to undergo a PAO. They value open, honest communication with their surgical team and peer connections, and favor the development of a comprehensive interactive online decision aid. This work can serve as a model for similar formative research for AYAs considering a variety of elective orthopaedic procedures. (1)Most people with acetabular dysplasia (AD) see multiple providers from symptom onset to diagnosis, and experience relief upon being diagnosed.(2)Females and males with AD considering periacetabular osteotomy (PAO) hold concerns that differ by sex.(3)People with AD considering PAO appreciate transparent and open communication with their surgeon and also desire tailored peer connections.(4)People with AD considering PAO would value a comprehensive decision aid that is online and interactive to facilitate the decision-making process. Level V.