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The long-term consequences of childhood hypertension (HTN) subtypes remain unclear. In this cohort study, we examined whether childhood isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH) are differentially associated with adult HTN and subclinical target organ damage (TOD). The study included 1228 participants from the Beijing Blood Pressure Cohort Study with a mean follow-up of 22.9 ± 0.6 years. Childhood blood pressure subtypes were classified as non-hypertensive, ISH, IDH, or SDH. Adult outcomes included HTN, cardiac remodeling, arterial stiffness, kidney damage, and overall TOD, defined as the presence of any of these abnormalities. We found that ISH was the predominant childhood hypertensive subtype (78.4%). Compared with non-hypertensive children, those with childhood ISH had a higher risk of adult HTN and cardiac remodeling and showed adverse arterial stiffness phenotypes, including higher carotid-femoral and brachial-ankle pulse wave velocity and greater risks of aortic and peripheral arterial stiffness. Childhood IDH and SDH showed distinct patterns of association, mainly involving aortic stiffness and left ventricular hypertrophy, respectively; these subgroup-specific estimates should be interpreted cautiously. In conclusion, childhood hypertensive subtypes were associated with differing long-term cardiovascular phenotypes, with the most consistent evidence observed for ISH. These findings support closer long-term surveillance of childhood HTN, particularly ISH.

Background: Estimating the association between childhood emotional maltreatment (CEM) and trauma-related outcomes is important for prevention and intervention.Objective: We synthesised the evidence by differentiating between emotional abuse and emotional neglect, examining post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) and exploring moderators and mediators.Method: Following PRISMA guidelines, seven databases were searched up to 19/03/2026 (PROSPERO-CRD42024598358) for studies on the association between CEM and PTSD/CPTSD. Study quality was assessed using an adapted Newcastle-Ottawa Scale (NOS), and certainty of evidence was evaluated using the GRADE framework.Results: Of 11,479 records, 62 were included in the review, of which 57 studies provided 132 effect sizes for a random-effects multilevel meta-analysis (N = 323,776). Study quality was overall fair (Mean NOS = 5.8). A positive association between CEM and PTSD/CPTSD (k = 132, r = .27, 95% CI [.23, .30]) 95% PI [-.04, .53] with substantial heterogeneity (I² = 86.5%). Higher estimates were identified for emotional abuse (k = 71, r = .29, 95% CI [.25, .33]) compared to emotional neglect (k = 55, r = .24, 95% CI [.19, .28]). Effect sizes were similar for CPTSD (k = 29, r = .29, 95% CI [.24, .35]) and PTSD (k = 103, r = .26, 95% CI [.22, .30]). No differences were observed by sex, age, or population type (clinical vs. non-clinical). However, higher estimates were identified in high-income settings and more developed contexts. Narrative synthesis identified cognitive, affective, physiological and interpersonal mechanisms as potential mediators. The certainty of the evidence was generally low. Limitations include the predominance of cross-sectional designs, reliance on self-report measures of CEM and variability across outcome measures.Conclusions: These findings underscore the importance of CEM in trauma-related symptomatology and support the need for its systematic assessment in clinical and research settings, particularly by highlighting differences between emotional abuse and emotional neglect. Childhood emotional maltreatment, particularly emotional abuse, is associated with trauma-related outcomes, including PTSD and complex PTSD.Evidence on complex PTSD remains limited, highlighting the need for further research on childhood emotional maltreatment and a broader range of trauma-related outcomes.Evidence on underlying mechanisms is scarce: region and socioeconomic status act as moderators, while psychological and affective processes may mediate these associations.Large longitudinal and cross-cultural studies using harmonised assessment approaches, including both subjective and objective measures, are needed to clarify causal pathways linking childhood emotional maltreatment to PTSD and complex PTSD.

The long-term consequences of attention deficit hyperactivity disorder (ADHD) in females remain underrecognized both in research and clinical practice. Multimorbidity (two or more long-term conditions) is increasingly viewed as a key outcome yet its prevalence, complexity and sociodemographic determinants are understudied in this group. Here, in this longitudinal cohort study, we examined the combined influence of childhood socioeconomic deprivation and ADHD diagnosis on multimorbidity risk in women in early adulthood (that is, aged 18-32 years) and used latent class analysis to explore clustering patterns. Three findings emerged: females with childhood ADHD had a significantly higher risk of adult multimorbidity; childhood ADHD and socioeconomic deprivation increased this risk both in isolation and synergistically, with 39% of the multimorbidity burden attributable to their interaction; and distinct multimorbidity clusters emerged, with the most adverse marked by psychiatric complexity. These results highlight girls with ADHD from disadvantaged backgrounds as a high-risk group requiring earlier, integrated care.

The natural history of the most common ATP1A3-related disease, alternating hemiplegia of childhood (AHC), has not been determined. We investigated three hypotheses: (1) AHC worsens over time; (2) several novel factors correlate with long-term outcomes; and (3) AHC manifests high mortality. In a large cross-sectional study with a nested period of prospective 1-3-year follow-up, 115 patients (0.3-46.0 years old, 9 centers/5 countries) were evaluated using across-center-standardized protocol and validated scales. Univariable and multivariable linear-mixed-effects models with random intercepts and random slopes for age, adjusted for confounding variables, allowed for the determination of the effect of age throughout the total age range of patients studied. Course: We identified a distinction between two periods, namely the period of early childhood (age 1-5 years) and the period of later childhood to mid-adulthood. Intellectual and non-paroxysmal disability indexes (IDS, NPDI) scores as well as the Vineland Adaptive Behavior Composite and its subscales worsened during early childhood, but not in the period after that. The extent of motor skills impairment did not differ with age in either period. Within the PDI (paroxysmal disability index) scores, dystonia severity scores did not differ with age in either period; however, plegia severity scores did improve with age after 5 years of age. Prognostic variables included the following: (1) Epilepsy was associated with worse NPDI, intellectual, and fine and gross motor skills. (2) Worse early life PDI and NPDI scores were significantly associated with worse respective scores at the latest follow-up. (3) Worse early life NPDI scores were also associated with worse IDS and fine and gross motor scores at the latest follow-up. (4) D801N mutation was associated with worse PDI. (4) E815K mutation was associated with worse IDS. Mortality was 1.12 deaths/100 patient-years and 6.5 sudden unexpected death in epilepsy (SUDEP) deaths/1000 patient-years. AHC is a progressive disease, and early childhood is the vulnerable period. We identified several novel prognostic indicators and a mortality rate, which provide critical information not only regarding prognostication, counseling, and underlying pathophysiology but also for planning therapeutic studies.

Although adverse childhood experiences (ACEs) increase risk for mental illness at the population level, existing ACEs screens are less helpful in forecasting individual outcomes, suggesting they may not capture significant elements of childhood adversity. We have previously identified unpredictable parental and household experiences as an ACE that portends poorer cognitive and mental health. However, the contribution of unpredictability to established ACEs in real-world settings is unknown. Here, leveraging existing ACEs screening in California, we added the five-item Questionnaire on Unpredictability in Childhood (QUIC-5) in 19 pediatric clinics spanning broad sociodemographic constituencies and compared in ~30,000 children the link of each screen with mental health diagnoses. Scores on either the ACEs or QUIC-5 associated with probabilities of depression, externalizing symptoms, sleep disorders, anxiety and somatic symptoms. Each screen provided unique contributions and combining them often doubled the strength of associations. For depression and sleep disorders, the QUIC-5 identified vulnerable individuals missed by ACEs screen, improving risk detection and facilitating future interventions.

With improving survival in childhood cancer, the focus is shifting toward early survivorship, a critical period for recovery and transition to long-term care. Data from low- and middle-income countries (LMICs) on outcomes during this phase remain limited. We conducted a retrospective study of childhood cancer survivors (aged 5-18 years) enrolled in a dedicated survivorship clinic at a tertiary cancer center in India between 2013 and 2024. Early survivorship was defined as the period within 5 years of diagnosis following treatment completion. Primary outcomes included school rejoining and academic performance; secondary outcomes included nutritional status (underweight and overweight) and revaccination. Multivariable logistic regression was used to identify predictors of outcomes. A total of 596 survivors were included (mean age 14.3 years; 70% male). School rejoining was high (568/587, 96.8%); however, 50 (8.8%) of those who rejoined subsequently dropped out. Good academic performance was associated with lower odds of school dropout (OR 0.42, 95% CI 0.20-0.88; p = 0.02), while treatment period, socioeconomic status, diagnosis, and maternal education were not significantly associated. Overweight increased significantly across treatment periods (2014-2016: OR 2.17, p = 0.047; 2017-2020: OR 2.63, p = 0.004), with a concurrent decline in underweight. Higher socioeconomic status was associated with lower odds of underweight (OR 0.45, p = 0.001). No independent predictors of revaccination were identified. Early survivorship in this LMIC cohort is characterized by high school re-entry but incomplete educational retention, alongside a transition from undernutrition to increasing overweight. These findings highlight the need for structured, multidisciplinary follow-up models during early survivorship to support sustained educational engagement, nutritional health, and preventive care.

Globally, children and adolescents exposed to Adverse Childhood Experiences (ACEs) face an increased risk of developing mental health disorders. The prevalence of these mental disorders is further amplified by the lack of access to specialised mental health treatment especially in low resource settings. There is an urgent need for scalable mental health interventions that can effectively address the needs of these vulnerable populations. Non-specialist-delivered interventions, such as PROACT (Psychoeducation, Relaxation, Problem-solving, Activation, and Cognitive Coping Therapy), represent a promising scalable approach that could help bridge the existing mental health treatment gap in low-resource settings. This study aimed to assess changes in depression, anxiety, and post-traumatic stress symptoms among children and adolescents exposed to adverse childhood experiences following participation in the PROACT intervention delivered by trained social workers in Nairobi, Kenya. Mixed-methods pre-post study design was employed. Twenty purposively selected sites across Nairobi County each contributed one social worker (N&#xa0;=&#xa0;20), who received training to deliver the intervention. A total of 40 children participated and received 4-6 PROACT sessions. Quantitative data were analysed using STATA version 17. Paired t-tests were used to compare baseline and endline scores, while mixed-effects linear regression models with participant ID as a random effect were fitted to estimate changes in outcomes over time and account for repeated measures. Statistically significant improvements were observed across all mental health outcomes. Mean anxiety scores decreased from 6.2 at baseline to 2.7 at endline (mean difference: -3.5; 95% CI: -4.7 to -2.2; p < 0.001), while mean depression scores decreased from 6.4 to 2.9 (mean difference: -3.6; 95% CI: -4.9 to -2.3; p < 0.001). Mean PTSD scores decreased from 16.7 (95% CI: 12.8-20.5) at baseline to 7.3 (95% CI: 4.4-10.1) at endline (mean difference: -9.4; 95% CI: -14.6 to -9.3; p < 0.001). Mixed-effects linear regression analyses corroborated these findings, demonstrating significant reductions in PTSD (&#x3b2; = -9.44), anxiety (&#x3b2; = -3.48), and depression (&#x3b2; = -3.59) symptoms (all p < 0.001). The PROACT intervention was feasible and acceptable when delivered by social workers in Nairobi primary healthcare facilities and was associated with improvements in mental health outcomes among children and adolescents. These findings highlight the potential of task-sharing approaches to expand access to mental healthcare in low- and middle-income countries (LMICs) and warrant further evaluation in controlled studies.

Childhood medulloblastoma (MB) survivors face elevated second primary malignancy (SPM) risk because of multimodal treatment. Prior studies were limited by small samples, older data, and methods that ignored competing risks. We aimed to quantify SPM risk using contemporary SEER data and competing risk methodology. Using the SEER 17 registries database (2000-2023), we identified 1806 patients diagnosed with MB at ages 0-19&#xa0;years. Standardized incidence ratios (SIRs) were calculated using the MP-SIR module. Cumulative incidence functions (CIFs) were estimated within a competing risk framework, with non-SPM death as the competing event. Fine-Gray regression was fitted to identify independent predictors of SPM, yielding subdistribution hazard ratios (sHRs). Of 1806&#xa0;MB patients, 104 (5.8%) developed SPMs over a mean follow-up of 111&#xa0;months. The overall SIR was 21.87 (males) and 20.78 (females). The most frequent SPM types were brain/central nervous system tumors (n&#x2009;=&#x2009;26; SIR&#x2009;=&#x2009;63.64), thyroid cancer (n&#x2009;=&#x2009;23; SIR&#x2009;=&#x2009;75.17 in males), and leukemia (n&#x2009;=&#x2009;19; SIR&#x2009;=&#x2009;25.60), with acute myeloid leukemia exhibiting SIRs of 99.41-100.95. On Fine-Gray regression, more recent diagnosis era was the only factor statistically associated with SPM occurrence; compared with 2000-2005, sHRs were 1.72 (95% CI 1.05-2.83; P&#x2009;=&#x2009;0.031) for 2012-2017 and 2.28 (95% CI 1.04-5.01; P&#x2009;=&#x2009;0.039) for 2018-2023. This era association should be interpreted cautiously, as it is likely driven by longer follow-up, more intensive surveillance, and declining competing mortality in recently diagnosed cohorts rather than a true increase in the underlying biologic risk of SPM; similarly, the null associations for radiation therapy and chemotherapy do not exclude a true effect, given the limited treatment detail available in SEER. Among 5-year survivors, cumulative SPM incidence surpassed non-SPM death beyond 15&#xa0;years. Mortality after SPM diagnosis was 51.9%. Childhood MB survivors face a substantially elevated SPM risk persisting beyond two decades. Brain tumors, thyroid cancer, and therapy-related leukemia predominate. These findings support lifelong surveillance incorporating thyroid screening, neuroimaging, and hematologic monitoring for MB survivors.

Research and clinical practice on childhood maltreatment largely rely on retrospective self-reports. However, self-reports are often considered unreliable due to concerns about memory biases and shifting subjective appraisals. Here, in a meta-analysis of 49 studies including n&#x2009;=&#x2009;38,332 individuals followed for an average of 2.4 years (range&#x2009;=&#x2009;2 months to 12 years), we found that retrospective self-reports of maltreatment are overall highly stable (r&#x2009;=&#x2009;0.79). However, stability was lower in population-representative samples than in clinical or convenience samples, for neglect compared with abuse, and in children compared with adults. In children, but not adults, stability declined with longer follow-up. These findings challenge the view that retrospective self-reports are inherently unstable, although further research is needed to investigate long-term stability. Reshaping trauma-related appraisals may require deliberate intervention and might be most effective during childhood when memories appear more malleable.

Recently, we have witnessed a growing shift from an emphasis on problematic processes to that on positive processes and outcomes in developmental psychopathology and psychological research more generally. Adopting this lens, we addressed three aims. One, we examined developmental sequelae of cumulative positive childhood experiences (PCEs) in infancy, but in contrast to typical retrospective recall, we deployed multiple behavioral and parent-reported measures in a prospective design. We examined children's socioemotional strengths and competencies - rather than diminished or absent problems - as outcomes at preschool age. Two, we examined how PCEs exert their impact, proposing children's competence at toddler age as a mediator. Three, we proposed children's negative emotional reactivity (anger proneness) as a moderator, expecting anger-prone children to be especially affected by variations in early positive experiences. A longitudinal study of 200 mothers, fathers, and infants (96 girls, 104 boys; 20% not "White alone") from the U.S. Midwest, followed from 8 months to 4.5 years, confirmed the utility of a conceptual and methodological approach that emphasizes cumulative early PCEs and positive socioemotional outcomes and supported both hypotheses (mediation: B = 0.05, SE = 0.02, 95% CI [0.02, 0.10]; moderation: B = 0.12, SE = 0.06, 95% CI [0.01, 0.25]).

Kawasaki disease (KD) occurring in childhood has been epidemiologically associated with increased adult cardiovascular risk, particularly in children who develop coronary aneurysms during the acute phase. However, the causal nature of this association remains uncertain. This study employed genetic causal association analysis to investigate potential causal effects of KD on adult-onset cardiovascular complications. This study provides new data from our cohort, representing the largest sample size for a KD genome-wide association study (GWAS) analysis and has not been reported before. We first enrolled a prospective KD cohort of 316 patients who received whole-exome sequencing (WES) analysis. We then performed a GWAS analysis and conducted further analyses using summary-level statistics from the IEU Open GWAS database, the GWAS Catalog, and our East Asian KD cohorts. The inverse variance weighted (IVW) method served as the primary analytical approach. All analyses were performed using R software. We established the largest WES-based KD cohort to date, with 316 children receiving WES and GWAS analyses. Then, in the following assessment, no significant causal associations were observed between KD and major adult cardiovascular outcomes. Replication analyses in European populations revealed modest evidence of potential causal associations with specific conditions. The IVW method indicated weak causal associations with ventricular arrhythmia (OR&#x2009;=&#x2009;1.0296, 95% CI&#x2009;=&#x2009;1.0037-1.0562, P&#x2009;=&#x2009;0.025) and chronic heart failure (OR&#x2009;=&#x2009;1.0110, 95% CI&#x2009;=&#x2009;1.0007-1.0213, P&#x2009;=&#x2009;0.0354) in particular traits. However, neither association was reproduced across independent GWAS datasets or corroborated by sensitivity analyses; therefore, these observations should be regarded as exploratory. This analysis provides genetic evidence that does not support a strong causal relationship between childhood KD and an increased risk of most adult cardiovascular diseases. Given the limited KD GWAS sample sizes and relaxed instrument-selection thresholds, these findings should be interpreted cautiously. However, they do not exclude clinically important long-term cardiovascular sequelae in patients with coronary artery involvement after KD.

To analyze the frequency of p53 and 1p anomalies and to study the association of these genetic biomarkers with histopathological and clinical outcomes in childhood solid tumors. A pilot study was conducted on 28 children with solid tumors up to 12 years of age. Participants were subjected to a needle biopsy. The material was divided into two parts: one placed in saline, for studying 1p loss of heterozygosity (LOH); other placed in formalin fixed, for histopathological examination and p53 analysis. Clinical, histopathological, and outcome status were noted. Statistical methods were applied. Data were also analyzed as any positive (either positive) or no positive (neither positive) to p53 and 1p LOH. Among 28 pediatric patients, p53 positivity was seen in 10 (36%) cases and 1p LOH in 14 (50%) cases, with 6 (20%) showing both. p53 positivity appeared more frequent in children <4 years in an exploratory subgroup analysis (P = 0.024). Tumors <5 cm were predominantly p53 negative (P = 0.019), while 1p LOH was significantly associated with larger tumors (>5 cm; P = 0.019). p53(-) status was seen in well-differentiated histology (P = 0.041). Either p53 or 1p LOH positivity was significantly linked to large tumors, while other tumor characteristics did not show any significant association. Mortality (n = 2) and relapse (n = 3) were observed only in patients positive for both markers. The chromosome 1p anomalies were relatively more frequent than reported. 1p LOH showed a significant association with larger tumor size, while p53-negative status was more frequently observed in smaller tumors and well-differentiated histology. However, tumor growth and adverse outcomes appeared more frequent when both markers were present concurrently, suggesting a possible synergistic adverse effect that requires confirmation in larger studies.

Non-communicable diseases (NCDs) account for a growing proportion of morbidity and disability among children and adolescents worldwide. Contemporary NCD preventive strategies are predominantly adult-centric, resulting in delayed prevention and widening inequities, particularly in low- and middle-income countries. This neglect reflects a deeper structural and ethical failure, sustained by fragmented financing, siloed governance, commercial determinants of health, and short-term political priorities. Drawing on life-course theory, systems thinking, and principles of global health justice, childhood and adolescent NCD neglect can be understood as a systematic gap in long-term health governance that undermines human capital formation and entrenches socioeconomic disadvantage. A policy reorientation that positions early-life NCD prevention as a strategic investment in sustainable development is required. Priority reforms include embedding paediatric NCD services within universal health coverage, strengthening age-disaggregated surveillance systems, institutionalising intersectoral governance mechanisms, and establishing global accountability frameworks. Protecting children and adolescents from preventable NCDs constitutes not only a public health necessity but a moral, economic, and political imperative.

Maternal childhood maltreatment (CM) has been linked to adverse outcomes in the next generation, including infant sleep, which is crucial for healthy development. This study examined whether maternal sensitivity buffered these effects in 101 German and 117 U.S. mother-infant dyads. Mothers reported on their CM history. Infant night sleep duration was assessed at 3, 6, 9, 12, 18, and 24 months. Maternal sensitivity was observed at 6 months. In the German cohort, higher maternal CM predicted shorter infant night sleep (p = .009). Maternal sensitivity moderated this association (p = .038), emphasizing its protective role. While the replication of this interaction was inconclusive in the U.S. sample, the pooled effect across cohorts was significant (p = .03). In the U.S. cohort, maternal sensitivity predicted longer infant sleep (p = .029). Findings highlight that maternal sensitivity supports infant sleep and underscores the need to support parenting, especially in mothers with early adversity.

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Asthma is one of the most prominent chronic diseases in children and one of the most challenging ailments to diagnose in infants and preschoolers in the United States. Predictive models can be instrumental in improving early diagnosis, personalized treatment strategies, and disease progression. By utilizing nationalized data, this study focuses on building and comparing high-performing analytical predictive models based on the relevant risk factors and identifying the most influential predictors. We analyzed cross-sectional BRFSS Asthma Call-Back Survey data (2011-2020; N&#x202f;=&#x202f;9,813) and randomly split participants into training and testing sets. An XGBoost model (hyperparameters tuned via grid search) was developed and compared with SVM, random forest, LASSO, and GBM using accuracy, AUC, precision, and recall. Calibration was evaluated with reliability plots and improved using Platt scaling and isotonic regression. Predictor contributions were examined using variable-importance (VIP) and Shapley Additive Explanations (SHAP) plot. Of the five predictive models, the XGBoost was found to be the best performing model with AUC: 0.95, followed by random forest (AUC: 0.9345), GBM (AUC: 0.9341), SVM (AUC 0.9304), and LASSO (AUC 0.88); however, the random forest model was found to have the highest sensitivity (0.9786), and hence preferred for initial screening of asthma. On the independent test set, calibration (10-bin reliability curves; Brier/ECE/intercept-slope) improved most with isotonic regression, specifically for Random Forest (ECE 0.0158 to 0.0086; intercept -0.174 to -0.010), whereas Platt scaling often worsened calibration, with AUC remaining largely stable across models (AUC&#x202f;&#x2248;&#x202f;0.92-0.95). The top two contributing predictors were overnight hospitalization visits and time since the last asthma medication, accounting for 24.62 and 20.92%, respectively, of the asthma status, from the VIP. The analytical methodology of model development was found to be instrumental in the discovery of behavioral health-risk knowledge and to visualize the significance of predictive modeling from a multidimensional behavioral health survey. These insights can be instrumental in predicting different types of chronic lung diseases affecting people of all ages and can be useful for clinicians to diagnose asthma at an early stage, allowing for early intervention and proactive management.

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