Among US teenagers, 79% of HIV infections are attributable to male-to-male sexual contact; yet, few interventions have been shown to effectively reduce sexual risk among gay and bisexual adolescents (GBA). Parent communication about sex is associated with adolescent sexual risk, and interventions to improve parent communication have been shown to successfully reduce sexual risk among heterosexual samples. However, no interventions designed specifically for parents of GBA have been tested in clinical trials. Parents and Adolescent Talking About Healthy Sexuality (PATHS) is a web-based intervention we created for parents of GBA that aims to improve parent communication about sexuality and HIV and increase parent behaviors supportive of GBA sexual health. This trial aims to test whether delivering PATHS to parents of GBA ages 14-19 years will improve GBA sexual health outcomes in the 6 months following intervention delivery. Secondary aims are to test whether the intervention's effects are sustained at 12 months after the intervention and to examine whether effects are mediated through specific parent behaviors. In total, 350 parents of GBA will be recruited online via social media advertising and randomized to receive either PATHS or an active control. PATHS is fully automated, self-paced, and can be completed in a single session lasting under an hour. The active control is an education entertainment film created to provide general support and guidance to parents of GBA. Both parents and their GBA sons will complete online assessments every 3 months over a 1-year period. Primary outcomes will be evaluated at 6 months after the intervention, and then, the control arm will crossover and receive PATHS, and dyads will be followed for another 6 months. Primary outcomes include both adolescent sexual preparedness (eg, condom skills) as well as HIV-related sexual risk behavior (ie, condomless anal or vaginal sex that is not protected by pre-exposure prophylaxis). The study was funded in March 2022, and we completed enrollment of 393 parent-GBA dyads in September 2025. We project that all participants will have completed study activities by November 2026, with data analysis and results of the trial forthcoming in the first quarter of 2027. If proven efficacious, PATHS will be among the first HIV prevention interventions shown to reduce sexual risk for GBA. Moreover, as other adolescent-focused interventions emerge, PATHS' unique focus on parents will offer a complementary, additional means for reaching GBA who do not engage with other intervention options. ClinicalTrials.gov NCT05852600; https://clinicaltrials.gov/study/NCT05852600. PRR1-10.2196/81316.
Despite the increased incidence of disordered eating among adolescents and low help-seeking rates, there is currently a lack of evidence supporting use of screening tools for this population. The present study aimed to address this gap by examining the factor structure, gender invariance, and psychological correlates of the Weight Concerns Scale (WCS) in a large sample of Australian adolescents to evaluate its potential suitability as a screening tool. Participants (n = 1022) aged 12-17 (Mage = 14.73; SD = 1.55) were recruited from five public secondary schools in South Australia between May and August 2023. All participants completed the WCS and psychological measures of life satisfaction, resilience, psychological distress, self-injurious thoughts and behaviours. Confirmatory factor analysis replicated the original one-factor structure: χ²(5) = 44.83, p < .001, RMSEA = 0.09, CFI = 0.99. Measurement non-invariance was found by gender and socio-economic-status, suggesting the scale functions differently across these subgroups. A cut-off score of ≥ 47 on WCS was associated with elevated psychological distress across all groups except for boys from lower socio-economic-status backgrounds. The present study is the first to apply confirmatory factor analysis to the WCS in adolescents. Future research needs to establish validity of the WCS as a screen in adolescents in terms of associations with ED psychopathology and behaviours. In addition, validation against diagnostic interview is crucial to establishing the WCS as a screening tool.
Repetitive head impacts (RHIs) are associated with later-life neurodegeneration. Because soccer is the most widely played sport among youth worldwide, identifying early changes associated with RHI is important. To determine whether participation in 1 season of youth soccer is associated with changes in cognition, behavior, balance, brain structure or function, or blood biomarkers compared with noncontact sports. Prospective longitudinal cohort study at European centers (Munich, Germany; Leuven, Belgium; and Oslo, Norway). Male adolescent soccer players and noncontact athletes were each studied across a single competitive season with assessments at preseason, postseason, and 2 months later. Data were analyzed from January 2023 to March 2025. Soccer players were compared with noncontact athletes. In addition, self-reported heading of a soccer ball was assessed among soccer players as a measure of RHI. Cognition, behavior, balance, magnetic resonance imaging (brain structure, function, and biochemistry), and plasma biomarkers. Male adolescent soccer players (n = 82; mean [SD] age, 14.8 [0.6] years) did not differ from noncontact sport athletes (n = 47; mean [SD] age, 14.7 [0.7] years) in cognition, behavior, balance, cortical thickness, brain volumes, white-matter microstructure, or functional connectivity. At preseason, soccer players had higher total N-acetylaspartate (tNAA; β, -0.379 [95% CI, -0.627 to -0.131]; P = .003), glial fibrillary acidic protein (GFAP; β, -0.055 [95% CI, -0.103 to -0.006]; P = .03), and neurofilament light chain (NfL; β, -0.071 [95% CI, -0.122 to -0.020]; P = .01) than noncontact sport controls. Across the season, tNAA (β, 0.047 [95% CI, 0.020-0.074]; P = .001) declined in soccer players and increased in controls, converging by postseason. Group trajectories of GFAP and NfL did not differ between groups. Within soccer players, heading exposure was not significantly associated with changes in any outcome. In this cohort study of adolescent males, no statistically significant differences were detected over 1 season between soccer players and noncontact sport athletes in cognition, behavior, or brain structure and function. Group differences in GFAP and NfL may represent early signs of exposure, but lack of association with heading exposure warrants further investigation. These results highlight the need for large, multiyear studies to inform health policy.
Adolescent alcohol consumption is a known risk factor for developing alcohol use disorder (AUD) in adulthood, but individual susceptibility varies widely, contributed to by differences in factors that are not well-understood. Identifying patterns of developmental trajectories in voluntary alcohol consumption behavior during adolescence could provide insight into biological underpinnings of AUD risk. Machine learning (ML) offers powerful pattern recognition capabilities that may help forecast future behavioral trajectories based on early-stage data. This study aimed to evaluate the performance of twelve supervised ML algorithms in predicting developmental trajectories of voluntary alcohol consumption behavior in adolescent mice using sequentially truncated datasets. Simulated balanced datasets of alcohol consumption in adolescent mice were generated based on previously published biological data. We applied a sequential dataset truncation strategy to train and evaluate ML models on progressively longer spans of behavioral data. Prediction accuracy for trajectory pattern classification was assessed for each truncation point, and goodness-of-fit was modeled using four curve-fitting equations, including locally estimated scatterplot smoothing (LOESS), which provided best fit and was selected for downstream comparative analysis. LOESS-fitted accuracy progression curves enabled quantitative comparison across models. Six ML algorithms-Random Forest, Logistic Regression, Multilayer Perceptron, Linear Discriminant Analysis, K-Nearest Neighbors, and Support Vector Machine-achieved outstanding results, with 98% or better prediction accuracy by experiment end and 90% or better accuracy at midpoint. Four additional algorithms-Stochastic Gradient Descent, Decision Tree, Gradient Boosting Classifier, and Multinomial Naive Bayes-achieved acceptable accuracy values (77-95% at midpoint, and 91-96% at experiment end). In contrast, two models (Quadratic Discriminant Analysis and Gaussian Process Classifier) performed poorly and displayed declining accuracy trends with more data. This study demonstrates that certain supervised ML algorithms can accurately predict behavioral outcomes from early-stage data. This approach holds promise for guiding molecular and cellular analyses at time points prior to behavioral phenotype's fully manifesting, making it possible to identify potential biological drivers that initiate the onset of harmful behavior of alcohol consumption during adolescence development.
AimThis study evaluated the effect of a Roy Adaptation Model (RAM)-based educational intervention on A1C levels and adaptive behaviors in adolescents with type 1 diabetes, and its contribution to physiological, psychosocial, and behavioral adaptation within a holistic nursing framework.MethodsThis randomized controlled trial included 60 adolescents aged 11 to 18 years followed in a pediatric endocrinology clinic. Participants were randomly assigned to an intervention group receiving structured RAM-based education, individualized tasks, and follow-up support (n = 30), or a control group receiving an educational brochure (n = 30). Data were collected at baseline and three months postintervention using a Sociodemographic Form, the Diabetes Knowledge Assessment Form, and clinical A1C records.ResultsCompared with the control group, the intervention group showed significant improvements in diabetes knowledge, adaptive behaviors, and A1C levels (p < .05). Interventions targeting RAM's adaptive modes contributed to glycemic control by strengthening psychosocial adaptation.ConclusionRAM-based nursing interventions promote physiological, psychosocial, and behavioral adaptation in adolescents with type 1 diabetes. Structured education enhances self-care, glycemic control, and coping. Integrating holistic nursing approaches into pediatric diabetes care is essential for improving outcomes.
A growing body of research has identified multiple risk factors contributing to adolescents' problematic online behaviors (POBs) and has documented their cumulative effects. However, previous studies have rarely differentiated types of cumulative risk or examined their interactive influences. To address this gap, the present study conceptualized cumulative risk as comprising two distinct dimensions: general cumulative risk (eg parent-child alienation and peer relationship) and specific cumulative risk (eg parental technoference and peer phubbing). Using data from a sample of 2,852 middle school students, this study employed structural equation modeling (SEM) to simultaneously examine the predictive effects of both risk dimensions, as well as their interactions, on three domains of POBs: problematic mobile phone use, problematic short video use, and problematic social media use. Results indicated that both general and specific cumulative risk significantly and positively predicted all forms of POBs. Furthermore, with the exception of problematic short video use, general cumulative risk amplified the adverse effects of specific cumulative risk on adolescents' POBs. These findings provide empirical support for an integrative risk model of POBs that elucidates the joint effects of general and specific cumulative risk on problematic online engagement. Theoretical implications for understanding risk processes and practical implications for targeted intervention strategies are discussed.
Tobacco use remains a leading cause of preventable morbidity and mortality and is commonly initiated in adolescence. We evaluated whether Smokerface-Poster, a low-intensity, appearance-based school campaign promoting a photoaging app, could attenuate smoking uptake among early adolescents. In this two-arm cluster-randomized controlled trial, 126 German secondary schools (9797 grade 6/7 students; 96.0% were 11-13 years old; 51.4% male; 48.6% female) were allocated to intervention or control. Intervention schools displayed two classroom posters for 24 months. Smoking behavior was assessed at baseline and 24 months. As primary outcome, we investigated the between‑group difference in the change in 30-day smoking prevalence, with a number needed to treat (NNT) of < 100 students predefined as clinically relevant per protocol. Baseline smoking prevalence was 7.4% in the control vs. 7.9% in the intervention group. At 24 months post-intervention, smoking prevalence increased by 19.2 %age points in control vs. 18.1 %age points in the intervention group (number needed to treat=93; adjusted ratio of odds ratios 0.87, 95% CI 0.69-1.09; p = 0.228). Favorable, non-significant patterns were also observed for anti-smoking intentions and attitudes. Although the between-group difference was not statistically significant, the intervention reached the predefined threshold for clinical relevance, with an NNT of 93. This suggests that, for every 93 students exposed to the Smokerface-Poster campaign, one fewer adolescent would be expected to smoke over the two-year follow-up. Given its low cost of < €50 per 100 students, the intervention appears to be a promising approach to supporting school-based smoking prevention.
Although disgust proneness has been implicated in the development of obsessive-compulsive disorder (OCD), studies to date have failed to identify the core symptom of disgust proneness that may be most strongly associated with OCD and its treatment. Accordingly, we used network analysis to examine which symptoms are most central to disgust proneness and the extent to which such symptoms predicted OCD symptoms before and after treatment. Adolescent participants (N = 434) in a residential treatment program for severe OCD, anxiety, and mood disorders completed pre- and post-treatment measures of OCD, disgust proneness, and general mood symptoms. Network analysis was used to identify the most central symptoms (nodes) and associations between symptoms (edges) of disgust proneness. The results revealed that the most central indicator in the pre- and post-treatment network were symptoms of 'animal-reminder disgust' (i.e., seeing blood in meat at the grocery store) that remind humans of their own mortality and bodily vulnerability. However, the pre- and post-treatment networks did not significantly differ (i.e., no network invariance). Accounting for OCD diagnostic status, animal-reminder disgust symptoms that were central in the network accounted for significant variance in OCD and general mood symptoms at pre- and post-treatment. These findings suggest that aversion towards animal-reminder cues are central symptoms of disgust proneness that may have predictive validity. The implications of these findings for conceptualizing theoretical and treatment models of disgust proneness in OCD are discussed.
Adolescent idiopathic scoliosis (AIS) is a complex, three-dimensional (3D) spinal deformity characterized by both coronal curvature and axial rotation. Traditional radiographic measurements primarily reflect the internal spinal alignment but do not fully capture external surface asymmetry or rotational components. Moreover, patients' perceptions of their trunk deformity often diverge from radiographic findings. This discrepancy may be attributed to various sources of bias in patient self-assessment. The present study aimed to investigate the relationship between preoperative 3D body surface measurements and body image perception in patients with AIS. We conducted a retrospective analysis of patients diagnosed with Lenke type 1 AIS who were scheduled to undergo posterior spinal correction and fusion surgery at our institution between April 2022 and April 2024. Preoperative trunk asymmetry was assessed as the height difference of the 3D back surface using a 3D back scanner (Sanamedi, Tokyo, Japan). Radiographic parameters and patient-reported outcomes were compared with 3D surface measurements. Correlation analyses were performed using Pearson's correlation coefficient or Spearman's rank correlation coefficient, depending on the distribution of the data. A total of 52 female patients were included, with a mean age of 15.4 ± 2.3 years. Analysis of all cases indicated that 3D surface measurements were moderately correlated with the Cobb angle (ρ = 0.51, p < .001). In contrast, no significant correlations were found between 3D surface measurements and any domain of the Scoliosis Research Society-22 questionnaire. Weak to moderate correlations were observed in the Walter reed visual assessment scale (ρ = 0.29-0.40, p < .05). This study demonstrated that 3D surface measurements correlate with radiographic parameters, supporting their validity in assessing spinal deformity. Although 3D surface measurements showed statistically significant but weak to moderate correlations with radiographic parameters, discrepancies were observed between objective assessments and patients' subjective perception. Further research involving a broader range of deformity type is warranted to better clarify these relationships.
The profound physical, emotional, and social changes that accompany adolescence typically coincide with increases in maternal stress and decreases in the quality of the mother-child relationship. Does one follow from the other? The present longitudinal study tested the hypothesis that perceived changes in adolescent children forecast increases in maternal stress, which contribute to deteriorating mother-child relationship quality, anticipating more perceived changes in children. Participants were 299 mothers (Mage = 40.19, SD = 5.01 years) in two-parent households, with children (152 boys and 147 girls; ages 9-13) attending public primary and middle schools in an eastern Lithuanian community. Nearly all participants were ethnic Lithuanian. Maternal reports of stress, perceived changes in children, and mother-child relationship quality (i.e., negativity and social support) were collected three times over the course of a year. Direct longitudinal associations emerged from maternal perceptions of changes in the child to heightened maternal stress, from maternal stress to deteriorating mother-child relationship quality, and from diminished relationship quality to escalating changes in children. Full-longitudinal mediation analyses confirmed each of the hypothesized indirect effects: (a) Time 1 perceived changes in the child → Time 2 maternal stress → Time 3 mother-child relationship quality, (b) Time 1 maternal stress → Time 2 mother-child relationship quality → Time 3 perceived changes in the child, and (c) Time 1 mother-child relationship quality → Time 2 perceived changes in the child → Time 3 maternal stress. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Reports suggest rising trends in non-suicidal self-injury (NSSI) and disordered eating (DE) amid worsening adolescent mental health; however, the use of single-item measures obscures these findings. Moreover, there are no studies of time trends in NSSI/DE co-occurring with other mental health problems. The present study used multi-item measures to examine time trends in the prevalence of NSSI, DE, other mental health problems, and their co-occurrence in two separate school cohorts (2007/2008; 2024/2025) in the same Swedish municipality. Clinically relevant cutoffs were applied to self-report measures of NSSI (revised Deliberate Self-Harm Inventory), DE (Risk Behaviour related to Eating Disorders; girls only), and mental health problems (MHP; Strengths and Difficulties Questionnaire - self-report). Analyses included gender-stratified mixed models (time trends per outcome) and binominal generalized log-linear models (time trends in NSSI/DE×MHP concurrence). Response rates were ≈ 90% in 2007/2008 (N = 987-992; Mage = 13.71-14.76) and ≈ 80% in 2024/2025 (N = 810-836; Mage = 13.71-14.79). Among girls, there were threefold increases in the prevalence of repetitive NSSI and high-risk DE combined with other mental health problems (NSSI + MHP from 6.6 to 21.0%; DE + MHP from 2.7 to 8.7%). The prevalence of repetitive NSSI or high-risk DE without co-occurring mental health problems did not change. Among boys, there was no increase in repetitive NSSI with/without other mental health problems. The rising trends in the prevalence of NSSI and DE among girls indicate worsening mental health, suggesting a need for increased attention and action from the healthcare system.
The global ACTION Teens study (NCT05013359) was a cross-sectional study that aimed to identify the perceptions, attitudes, behaviors, and barriers to effective obesity care among adolescents living with obesity (ALwO), their caregivers, and healthcare professionals (HCPs). Here, we present the results of the survey conducted in Mexico. This was an online survey-based study conducted among ALwO (with a body mass index ≥95th percentile for their age and sex), caregivers, and HCPs. A total of 722 (72%) ALwO, 802 (80%) caregivers, and 301 (100%) HCPs completed the survey. ALwO and caregivers tended to underestimate the ALwO's weight: 52 and 36%, respectively, considered the ALwO's weight to be slightly above normal, and 32 and 51%, respectively, considered it to be normal. Among the ALwO, 48% considered their health to be at least very good, whereas 73% of the caregivers perceived the same. More than half of caregivers (55%) believed that their children would naturally lose weight as they grew taller. The main motivators for losing weight in ALwO were to improve fitness or to be in better shape (51%), while the main barriers were lack of motivation (37%) and uncontrolled hunger (36%). Most ALwO (96%) and caregivers (98%) whose HCP brought up the topic of weight appreciated discussions about weight with their HCPs. Our findings highlight a significant gap in awareness and understanding of obesity among ALwO, caregivers, and HCPs in Mexico. This underscores the urgent need for evidence-based, culturally tailored education and interventions to address this critical public health issue.
暂无摘要（点击查看详情）
Maternal depression has been consistently linked to child ADHD symptoms, though much of this research is cross-sectional, single informant, and focused on prenatal or early postnatal depression. Consequently, the direction and temporality of this association is poorly understood. We used Random-Intercepts, Cross-Lagged Panel models (RI-CLPM) to examine bidirectional and transactional associations between maternal depression and child ADHD across pre-adolescence. Mothers and children (n = 1,806; 52% male, 77% White) participated across four waves during the COVID-19 pandemic (ages 10-13). At each timepoint, mothers self-reported depressive symptoms and children self-reported hyperactivity and inattention symptoms. Mothers also reported children's symptoms at the latter three waves. Parallel RI-CLPMs were estimated separately by informant and symptom dimension. Across both informants, maternal depression was associated with child hyperactivity and inattention at the between-dyad level (correlations ranging from .27 to .39). The clearest evidence of within-dyad association emerged for child-reported hyperactivity: higher child-reported hyperactivity at age 10 predicted higher maternal depressive symptoms at age 11, which in turn predicted higher child hyperactivity at age 12. Indirect effect analyses supported this transactional pathway. Maternal-reported models provided more limited but broadly convergent evidence for within-dyad effects on hyperactivity. Within-dyad effects were not observed for maternal- or child-reported inattention. Sociodemographic factors did not moderate cross-lagged parameters. Findings support transactional models of child development, with reciprocal associations between maternal depressive symptoms and child ADHD symptoms appearing most evident for hyperactivity. However, substantial overlap across ADHD symptom dimensions warrants caution in drawing strong conclusions about symptom-specific differences.
Limited options for developmentally appropriate continuing care represent a critical barrier for youth in recovery. As one of the few options designed specifically for adolescents, recovery high schools (RHSs) warrant investigation to better understand their effects and the mechanisms through which they operate. This study examined the long-term effects of RHS attendance and tested whether peer-level social change operates as a mechanism. Data were drawn from a longitudinal, group-design study of RHS effectiveness. Twelve-month follow-up substance use outcomes were compared between 146 adolescents who enrolled in RHSs after treatment and a propensity score-balanced comparison group of 117 adolescents who enrolled in traditional schools. Time-lagged mediation models tested whether recovery-positive peer affiliation at the 6-month follow-up mediated these effects. Relative to the comparison group at the 12-month follow-up, adolescents who attended an RHS were less likely to have alcohol use disorder (OR = 0.31) or a drug use disorder (OR = 0.42), reported fewer cannabis use days (IRR = 0.62), and had higher odds of abstinence (OR = 2.53) after adjusting for baseline levels. Recovery-positive peer affiliation mediated the beneficial effects of RHS attendance on meeting criteria for a drug use disorder, cannabis use frequency, and abstinence. These findings provide robust evidence of the long-term beneficial effects of RHS attendance and indicate that some benefits result from improvements in recovery-positive peer affiliation. Improving access to youth-focused recovery supports that facilitate positive social network changes could help reduce relapse risk and sustain treatment effects.
Argentina experienced a historic increase in dengue incidence during the 2023/2024 season, far exceeding the levels reported in previous cycles. The objective was to characterize dengue-related morbidity and mortality during this period. Descriptive observational study based on epidemiological surveillance. Data were obtained from the National Health Surveillance System (SNVS 2.0). R Studio. A total of 583 259 dengue cases were analyzed. The Northwest region showed the highest cumulative incidence, whereas the Central region registered the largest absolute number of cases. Adults accounted for 78% of cases and children/adolescents for 22%. Females represented 55%. Severe forms occurred in 0.3% of cases. There were 419 deaths, with an overall case-fatality rate of 0.07% (92% adults and 8% children/adolescents). Median age was 52 years [IQR 37-72] in adults and 8 years [IQR 3-14] in children/adolescents. Comorbidities were present in 38% of adults and 21% of children/adolescents (p=0.04). Median time from symptom onset to consultation was 3 days [IQR 1-5], and to death, 6 days [IQR 4-9]. Serotype identification was achieved in 45% of cases: DENV-2 (59%), DENV-1 (40%), and coinfections (1%). Atypical presentations were documented in 7%. The epidemiological scenario showed dynamism and heterogeneity, underscoring the need to strengthen health-system preparedness, optimize surveillance, and improve clinical response to reduce dengue-related morbidity and mortality and to anticipate and mitigate future epidemics. Introducción: Argentina registró un aumento histórico en la incidencia de dengue durante la temporada 2023/2024, superando ampliamente los valores registrados en temporadas previas. El objetivo fue caracterizar la morbimortalidad asociada en dicho período. Materiales y métodos: Estudio observacional descriptivo basado en vigilancia epidemiológica. Se utilizaron los datos registrados en el Sistema Nacional de Vigilancia de Salud (SNVS 2.0). Análisis de datos: R Studio. Resultados: Se analizaron 583 259 casos de dengue. La región Noroeste presentó la mayor incidencia acumulada mientras que la región Centro, el mayor número absoluto. El 78% correspondió a población adulta y el 22% a población infantojuvenil. El 55% fue de sexo femenino. El 0.3% presentó formas graves. Se registraron 419 casos fallecidos, cuya letalidad global fue 0.07% (92% población adulta y 8% infantojuvenil). La mediana de edad fue 52 años [RIC= 37‐72] en adultos y 8 años [RIC= 3‐14] en infantojuveniles. Se registraron comorbilidades en el 38% del primer grupo y en el 21% del segundo (p=0.04). La mediana en días entre el inicio de síntomas y la consulta fue de 3 [RIC= 1‐5] y al fallecimiento de 6 [RIC= 4‐9]. Se identificó el serotipo en el 45%: DENV-2 (59%), DENV-1 (40%) y coinfección (1%). Se reportaron formas atípicas en 7%. Conclusión: El escenario epidemiológico evidenció dinamismo y heterogeneidad, resaltando la necesidad de fortalecer la preparación del sistema de salud, optimizar la vigilancia y mejorar la respuesta asistencial para reducir la morbimortalidad y anticipar y mitigar futuras epidemias de dengue.
Adolescence is a critical period for mental health, during which family dynamics and emotional experiences shape psychological well-being. Emotional abuse (EA) is associated with depressive symptoms (DS), yet its longitudinal processes remain unclear. This study examined longitudinal associations among EA, family functioning (FF), and DS in adolescents. A sample of 1887 Italian adolescents (Mage = 15.44, SD = 1.09) was recruited. Data were collected at baseline (T1), 6 months later (T2), and 12 months later (T3) to assess changes over time. Structural equation modeling was used to analyze bidirectional relationships and mediation effects. Results showed that emotional abuse at T1 and T2 was associated with poorer family functioning and higher depressive symptoms at later waves, whereas family functioning at T1 and T2 was associated with later depressive symptoms. No longitudinal effects were observed from family functioning to emotional abuse or from depressive symptoms to the other variables. Exploratory mediation analyses suggested indirect associations of T1 emotional abuse and family functioning with T3 depressive symptoms through T2 measures. These findings highlight a possible role of FF in the link between EA and DS, underscoring how dysfunctional family dynamics are related to higher levels of mental health challenges. These findings suggest that family relationships and communication may represent potentially relevant targets for future prevention and intervention research in adolescent mental health.
The requirement for medical clearance prior to starting physical activity in children and adolescents is a common practice, although there is controversy regarding which elements should be included. The Sociedad Argentina de Pediatría recommends filling out a complete medical history, physical examination, and doing one electrocardiogram in the post-pubertal stage. However, in daily consultation, additional studies are often requested which, when inappropriate, may become barriers to physical activity. This study aims to document practices requested as part of physical fitness clearance in our institution and determine what proportion would be potentially inappropriate. Cross-sectional study. We included children and adolescents enrolled in our hospital's health insurance plan during 2019 or 2022, with no prior diagnosis of heart disease, who had undergone at least one cardiological evaluation (a test or a cardiology consultation) requested for a physical clearance exam. A random sample was selected and medical records were reviewed using a structured guide to evaluate the types of requested or performed studies and their clinical justification. The study included 134 participants, of whom 122 (91%, 95% CI 86-96%) had at least one potentially inappropriate investigation. This proportion was higher in children under 13 years of age (98% vs. 85%, p < 0.01). The most frequently requested investigation was the electrocardiogram, followed by cardiology consultation. Inappropriate cardiology practices are common at our institution. These findings are useful for situational analysis and for planning quality improvement interventions. Introducción: La solicitud de una autorización médica antes de iniciar actividad física en población pediátrica es una práctica habitual, aunque existe controversia sobre los elementos que debe incluir. La Sociedad Argentina de Pediatría recomienda interrogatorio, examen físico y un electrocardiograma en la etapa pospuberal. Sin embargo, suelen solicitarse prácticas adicionales que, cuando son inapropiadas, pueden convertirse en barreras para la actividad física. Este estudio busca documentar las prácticas solicitadas como parte del apto físico en nuestra institución y determinar qué proporción serían potencialmente inapropiadas. Materiales y métodos: Estudio de corte transversal. Se incluyeron niños y adolescentes afiliados al seguro médico de nuestro hospital durante 2019 o 2022, sin diagnóstico previo de cardiopatía y que tuvieran al menos una evaluación cardiológica (estudio o consulta con cardiología) solicitada durante un apto físico. Se tomó una muestra aleatoria simple y se revisaron historias clínicas mediante una guía estructurada para evaluar los tipos de estudios solicitados o realizados y su justificación clínica. Resultados: Se incluyeron 134 participantes, de los cuales 122 (91%, IC95% 86-96%) tenían al menos una práctica potencialmente inapropiada. Esta proporción fue mayor en menores de 13 años (98% vs. 85%, p <0.01). La práctica más frecuentemente solicitada fue el electrocardiograma, seguida de la consulta con cardiología. Conclusión: Las prácticas cardiológicas inapropiadas son comunes en nuestra institución. Estos hallazgos son útiles para realizar un diagnóstico de situación y planificar intervenciones de mejora.
Oppositional symptoms in youth are characterized by an angry or irritable mood and excessive defiance (eg, arguing), negatively impacting the mental well-being of children, adolescents, and their caregivers. Pediatric digital mental health interventions (DMHIs) that approach care from a whole-family perspective may effectively address mental health (MH) symptoms in both pediatric participants and their caregivers, though this has not been explored in the context of oppositional symptoms. The purpose of this study was to assess oppositional symptoms in children and adolescents (aged 6 to 17 years) participating in care within the real-world conditions of a family-centered DMHI. We aimed to (1) examine baseline oppositional severity and its associations with child demographic and clinical characteristics (eg, co-occurring MH symptoms), and caregiver symptoms; (2) evaluate demographic, clinical, and engagement factors associated with oppositional symptoms during care with the DMHI; and (3) determine whether changes in oppositional symptoms during care are associated with improvements in caregivers' stress, burnout, and sleep. Retrospective analyses included 3781 child-caregiver pairs who participated in coaching and therapy with Bend Health Inc, a family-centered, pediatric DMHI. Assessments at baseline and monthly during care measured pediatric and caregiver symptoms. Children and adolescents were grouped by oppositional severity at baseline: not significant, subclinical, and clinical. Pediatric characteristics, care type, and caregiver symptoms were compared between groups. Linear mixed-effects models assessed oppositional symptoms over months and then tested whether oppositional severity and rate of symptom improvement were associated with caregiver outcomes over time. Baseline oppositional symptoms were not significant for 51.55% (1949/3781), subclinical for 26.47% (1001/3781), and clinical for 21.98% (831/3781). More severe oppositional symptoms were associated with younger age (P<.001), nonfemale sex (P<.001), White race or ethnicity (P<.001), higher rates of MH diagnoses (all P<.001), and higher rates of co-occurring inattention, hyperactivity, depression, and sleep problems (all P<.001). Odds of elevated caregiver symptoms increased with more severe oppositional symptoms (all P<.001). At the end of care (final follow-up), oppositional symptoms improved for 73.93% (740/1001) with subclinical symptoms and 82.43% (685/831) with clinical symptoms. Symptom trajectories followed a logarithmic curve, with the greatest improvements in the first several months (P<.001). While more severe oppositional symptoms were associated with more severe caregiver stress, burnout, and sleep problems (all P<.001), monthly improvements in caregiver symptoms were significantly larger for those whose child improved more quickly (all P<.001). Family-centered DMHIs may effectively address pediatric oppositional symptoms, as well as co-occurring impairments in caregiver well-being. These findings highlight the broader, system-level impact of scalable DMHIs (such as Bend) in addressing complex family MH needs. Future work should examine these effects in the long term and evaluate opposition-specific care pathways within DMHIs.