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This study aimed to describe the prevalence and characteristics (sources, motivations, perceived health risks, accessibility) of medical use and misuse of addictive prescription drugs (APDs), and the prevalence of poor mental wellbeing and self-harm among adolescents in Estonia. In addition, this study examined associations between APD use status (non-use, medical use, misuse) and mental health indicators (mental wellbeing, self-harm). Data came from the nationally representative 2024 European School Survey Project on Alcohol and Other Drugs (ESPAD) survey of 15-16-year-olds in Estonia (n = 2,019). Respondents were classified as non-users, medical users, or misusers based on lifetime APD use. Motivations, sources, perceived health risks, accessibility, mental wellbeing, and self-harm were assessed. Multivariable logistic regression examined associations between APD use status and mental health indicators. Overall, 27.8% of adolescents reported APD medical use and 18.3% misuse, with higher prevalence among girls. Sedatives and sleeping pills were the most commonly medically used and misused APDs. Most misused APDs were obtained from home, and self-treatment motives predominated. Poor mental wellbeing (44.4%) and self-harm (17.6%) were most prevalent among misusers. APD misuse (. non-use) was associated with poor mental wellbeing, self-harm and female gender; misuse (vs. medical use) with self-harm; and APD medical use (vs. non-use) with self-harm and female gender. The strongest association was found between APD misuse (vs. non-use) and self-harm (adjusted odds ratio = 2.78). APD medical use and misuse are common among Estonian adolescents. APD misuse co-occurred with poor mental wellbeing and self-harm, highlighting the importance of integrating APD misuse prevention into broader adolescent mental health and substance use strategies.

The Brazilian Unified Health System (SUS), a public and universal system, has expanded its role in oral healthcare over the last two decades, which has been associated with improvements in epidemiological indicators of the population's oral health. In the context of significant social inequities, the coexistence of SUS and a strong private sector in the provision of dental services raises questions about SUS's role and limits in reducing inequities in access to dental care. This study aims to identify, among Brazilian urban adults, factors associated with the use of dental services in the public and private sectors, compared with non-use, and, among those who use dental services, factors associated with the use in the private sector, compared with the public sector. This was a national cross-sectional study based on the SB Brasil 2023 survey. The complex sample included 9,019 adults aged 35-44 years. Multinomial logistic regression was employed to examine use versus non-use of public and private dental services, and binomial logistic regression to examine private versus public use among users. Almost 1/3 of adults did not use dental services in two years. Higher education and dental insurance were strong predictors of private-sector use, whereas income ≤ 2 minimum wages (MW) was associated with higher odds of public-sector use, compared with non-use. A relevant interaction between education and income was observed. In considering service use between the private and public sectors, greater access was noted among men, those with higher education, those with higher income, and those with dental insurance, with the conjunction of the latter two factors potentiating their individual effects. Specialized dental treatments were also mostly accessed in the private sector. Socioeconomic inequalities remain the main explanation for variation in the use of dental services in Brazil, but results suggest that the SUS has helped expand access for more socioeconomically vulnerable populations, enabling a higher likelihood of dental services use (vs. non-use), and providing the most likely services to be used by them, in contrast with the private sector. Expanding coverage and offering specialized dental services remain challenges for the system.

To assess the changes in the characteristics of women undergoing induced abortion and their contraceptive choices before and after the implementation of the "three-child" policy, and to inform strategies for improving reproductive health services in China. We conducted a retrospective comparative study at a tertiary maternity hospital in Fujian, China. Women who underwent induced abortion between 31 May 2019 and 30 May 2020 (pre-policy period) and those who underwent the procedure between 31 May 2023 and 30 May 2024 (post-policy period) were included. We used R software (version 4.3.2) to compare contraceptive use and method choices prior to the abortion, as well as the primary reasons for unintended pregnancy between pre- and post-policy periods. In the pre-policy period, non-use of contraception was the leading cause of unintended pregnancy (43.38%), primarily attributed to a perception of low pregnancy risk. Among contraceptive users, condoms were the most common method (26.47%). Post-policy, the rate of contraceptive non-use decreased to 32.19%. However, reliance on low-efficacy methods persisted, with condoms (43.49%) and withdrawal (23.51%) remaining predominant. Non-use of contraception and reliance on low-efficacy methods remained the primary contributors to unintended pregnancies among women undergoing induced abortion both before and after the three-child policy. Higher educational attainment was associated with lower contraceptive failure risk. These findings underscore the urgent need to improve access to effective contraceptive methods and strengthen reproductive health education to reduce unintended pregnancies and safeguard women's reproductive health.

Veterans are more likely than non-veterans to report disability and to use tobacco products. Although prior research has linked disability status and related functional difficulties with tobacco use in the general population, research among veterans is limited. The sample included 10,542 U.S. military veterans who completed the 2020-2023 National Health Interview Survey. Tobacco use was categorized as non-use, single-product use, or poly-tobacco use. Functional difficulties were measured in NHIS using the Washington Group Short Set and categorized as no, some, or significant difficulties. Binary and multinomial logistic regression models adjusted for relevant sociodemographic covariates. Veterans with some functional difficulties had higher odds of cigarette, e-cigarette, and pipe use compared with those reporting no difficulties (AORs 1.35-1.90), whereas veterans with significant functional difficulties had more than twice the odds of such product use. Veterans with some or significant functional difficulties were at higher relative risk of poly-tobacco use (vs. non-use), and significant difficulties were associated with higher relative risk of poly-tobacco use (vs single-product use) relative to those with no difficulties. Compared with veterans reporting some difficulties, those with significant difficulties had higher odds of cigarette (AOR = 1.49) and e-cigarette use (AOR = 1.54), and higher relative risk of poly-tobacco use (vs non-use: RRR = 1.74; vs single-product use: RRR = 1.50). Results indicated a graded association between severity of disability-related functional difficulties and tobacco use patterns among veterans. Future research should develop and test tobacco cessation interventions tailored to veterans with varying levels of disability-related functional difficulties. The results provide evidence that greater severity of disability-related functional difficulties is associated with higher odds of both single-tobacco and poly-tobacco product use among U.S. military veterans. Veterans with more severe functional limitations may be particularly vulnerable to poly-tobacco use, which may place such veterans at heightened risk for tobacco-related harms. Findings underscore the utility of incorporating assessment of disability-related functional difficulties into tobacco risk screening and developing accessible, tailored cessation interventions for veterans who experience varying levels of functional impairment.

The use of electronic nicotine delivery systems (ENDS) has increased globally. Evidence of the association between xerostomia and ENDS remains limited. We evaluated the association between nicotine product use and xerostomia severity in a multinational sample from the Middle East and North Africa (MENA) region. In this cross-sectional study, adults aged 18-40 years from 18 MENA countries were recruited via convenience sampling through social media platforms between December 2023 and March 2024. Xerostomia symptoms were assessed using the xerostomia Inventory (XI). Directed acyclic graphs guided confounder selection. Regression models examined the association between nicotine product use and xerostomia symptom scores. Among 11,451 participants (6975 [60.9%] non-users, 1913 [16.7%] exclusive ENDS users, 1778 [15.5%] exclusive combustible tobacco users, and 785 [6.9%] dual users), all current-use categories were associated with higher XI scores than non-use after adjustment for age, sex, and exercise frequency: exclusive ENDS users (standardised &#x3b2;&#x2009;=&#x2009;0.385; p&#x2009;<&#x2009;0.001), exclusive combustible tobacco users (&#x3b2;&#x2009;=&#x2009;0.201; p&#x2009;<&#x2009;0.001), and dual users (&#x3b2;&#x2009;=&#x2009;0.324; p&#x2009;<&#x2009;0.001). Current use of any nicotine product was associated with higher xerostomia scores than non-use, with the strongest associations observed among exclusive ENDS users and dual users.

Chronic hepatitis caused by the hepatitis D virus (HDV) represents one of the most aggressive forms of viral liver disease, associated with accelerated progression to cirrhosis and an increased risk of hepatocellular carcinoma. Its management is not yet well standardized, which justifies the exploration of digital tools to improve the care of these patients. To evaluate the user experience, perceived usefulness, and usability of the NORA mobile application in patients with hepatitis D virus and/or HDV infection, as well as to analyze the determinants of non-use from a patient-centered perspective. Cross-sectional observational study conducted in outpatient hepatology clinics. A total of 52 patients were included (19 users, 11 non-users, and 22 new users). Sociodemographic, clinical, and app usage variables were collected. Usability was assessed using the Mobile App Usability Questionnaire. Users rated the application positively (Mobile App Usability Questionnaire 5.07&#xb1;1.43), particularly highlighting the quality-of-life and education modules, while biometric modules were the least used. The main improvements proposed included expanded educational content (57.9%), improved data visualization (31.6%), and greater communication with the healthcare team (21.1%). Lack of motivation was the main barrier among non-users (72.7%). Expectations exceeded actual use in most modules, suggesting areas for improvement. Adoption was associated with detectable HDV RNA and recent follow-up. NORA is a well accepted tool among users and is perceived as useful for the follow-up of patients with HDV. Optimizing aspects related to education, communication, and functionality could further enhance its impact in telemedicine. However, the methodological limitations of the study prevent any conclusions from being drawn regarding its clinical impact.

Evidence on how adolescent vaping relates to subjective wellbeing remains mixed. We compared life satisfaction across mutually exclusive patterns of cigarette and e-cigarette use in England. We analysed cross-sectional data from the 2023 Smoking, Drinking and Drug Use among Young People in England survey. After exclusions for missing nicotine-use data (n&#xa0;=&#xa0;761) and invalid life satisfaction responses (n&#xa0;=&#xa0;2,242), 14,463 adolescents aged 11-15&#xa0;years were included. Current nicotine-use pattern was classified as: no current nicotine use, exclusive e-cigarette use, exclusive cigarette smoking, or dual use. Linear regression with robust standard errors estimated crude and adjusted mean differences in life satisfaction (0-10) relative to non-use. Models adjusted for age, gender, ethnicity and family affluence; additional analyses used ordered logistic regression and tested interactions. Most pupils reported no current nicotine use (n&#xa0;=&#xa0;13,275; 91.8%); 866 (6.0%) were exclusive e-cigarette users, 61 (0.4%) exclusive cigarette smokers, and 261 (1.8%) dual users. Compared with non-users, adjusted mean life satisfaction was lower among exclusive e-cigarette users (&#x3b2;&#xa0;=&#xa0;&#xa0;-&#xa0;1.20; 95% CI -1.40 to -1.01), exclusive cigarette smokers (&#x3b2;&#xa0;=&#xa0;&#xa0;-&#xa0;1.09; 95% CI -1.94 to -0.25), and dual users (&#x3b2;&#xa0;=&#xa0;&#xa0;-&#xa0;1.29; 95% CI -1.71 to -0.88). Predicted adjusted means were 6.74 for non-users and 5.54, 5.65, and 5.45 for exclusive e-cigarette users, exclusive cigarette smokers, and dual users, respectively. Associations were similar for boys and girls and across family affluence (interaction p&#xa0;=&#xa0;0.187 and p&#xa0;=&#xa0;0.848), but differed by ethnicity (p&#xa0;=&#xa0;0.0007), with wider confidence intervals in some subgroups. Ordered logistic regression was consistent: adjusted odds ratios for higher life satisfaction were 0.45 (95% CI 0.40-0.51) for exclusive e-cigarette use, 0.51 (0.27-0.95) for exclusive cigarette smoking, and 0.44 (0.32-0.59) for dual use. Current nicotine use, whether vaping, smoking, or both, was associated with lower life satisfaction, with dual users reporting the lowest adjusted levels. Given the cross-sectional design and potential residual confounding, longitudinal studies with repeated measures are needed to clarify whether nicotine use precedes lower life satisfaction, whether lower life satisfaction predicts subsequent nicotine use, or whether both reflect shared psychosocial and social risk factors.

To examine the association between systemic Janus kinase (JAK) inhibitor use and the incidence of newly diagnosed dry eye disease (DED) in patients with rheumatoid arthritis (RA). This multi-institutional retrospective cohort study used de-identified electronic health records from the United States Collaborative Network. Adults aged 18 years or older with RA were categorized according to systemic JAK inhibitor use or non-use. A secondary active-comparator analysis compared JAK inhibitor users with rituximab-treated patients. Propensity score matching was performed to balance demographic characteristics, comorbidities, medication history, ocular conditions, and healthcare utilization. The primary outcome was newly diagnosed DED. Time-to-event analyses were conducted using Kaplan-Meier methods and Cox proportional hazards models. A total of 25,149 JAK inhibitor users and 150,250 non-users with RA were identified. After matching, each cohort contained 23,343 patients with balanced baseline characteristics. JAK inhibitor use was associated with a lower incidence of newly diagnosed DED compared with non-use within 1 year of follow-up (hazard ratio [HR], 0.633; 95% CI, 0.545-0.736). In the secondary active-comparator analysis, 6,637 JAK inhibitor users were matched to 6,637 rituximab-treated patients, and JAK inhibitor use remained associated with a lower incidence of newly diagnosed DED (HR, 0.613; 95% CI, 0.476-0.791). Individual-agent analyses showed directionally consistent associations for tofacitinib and upadacitinib. Findings were consistent across sensitivity analyses using varying follow-up durations and landmark definitions. In this large real-world cohort study, JAK inhibitor use was associated with a lower incidence of newly diagnosed DED among patients with RA, with similar findings in a rituximab active-comparator analysis. However, the observational design, residual confounding, and coding-based outcome definition preclude causal inference. Prospective studies incorporating standardized ocular surface assessments and direct RA disease activity measures are needed to clarify the clinical relationship between systemic JAK inhibition and DED.

Staphylococcus aureus (S. aureus) can cause life-threatening infections, with colonization often preceding infection. Understanding the determinants of S. aureus carriage may improve infection prevention. While smoking has been associated with S. aureus carriage, studies on smokeless tobacco products remain scarce. This study aimed to investigate whether the use of snuff (Swedish snus), a smokeless tobacco product, is associated with S. aureus carriage in adolescents. We used data from Fit Futures 1, a population-based cross-sectional study including 1,038 participants (93% attendance). A total of 457 boys and 443 girls had data on snuff use and two nasal and throat swab cultures for S. aureus carriage assessment. Snuff use was defined as occasional or daily use. Logistic regression analysis was used to examine the association between snuff use and S. aureus carriage, with odds ratios (ORs) adjusted for known risk factors. Snuff use was associated with a 64% higher odds of nasal carriage (95% CI = 1.18-2.26; carriage defined as one or two positive nasal cultures) compared to non-use. In sex-stratified analyses, this association was observed only among girls, with an adjusted OR of 1.62 (95% CI = 1.03-2.55; carriage defined as two positive nasal cultures) and an adjusted OR of 1.99 (95% CI = 1.25-3.16; carriage defined as one or two positive nasal cultures). Among girls using snuff, the adjusted OR for S. aureus throat carriage was 1.66 (95% CI 1.06-2.59; carriage defined as two positive throat cultures) compared to non-users. We identified an association between snuff use and S. aureus nasal and throat carriage among adolescent girls. Girls who used snuff had higher odds of S. aureus nasal (62%) and throat (66%) carriage compared to female non-users. Futures longitudinal studies are needed to clarify whether the observed associations reflect casual relationships.

Abandonment of upper-limb prostheses has remained stubbornly common for more than two decades, despite substantial refinement of prosthetic hardware.&#xa0;A recent survey from a leading bionic-reconstruction group found that technological advancement did not significantly change acceptance rates; instead, structured prosthetic training and active patient participation in decision-making emerged as the factors most likely to improve device use. Read together with earlier work identifying fitting time-frame and client involvement as critical variables, these data relocate the problem of abandonment from the device to the process of rehabilitation. This editorial argues that the decisive variables in prosthesis acceptance are provider-side: the timing, structure, and shared-decision quality of the rehabilitation a patient receives. Drawing on the concept of learned non-use from stroke rehabilitation, I propose-as an interpretive framework rather than a demonstrated mechanism-that clinicians themselves may develop a parallel clinician learned non-engagement (LNE), a conditioned reduction of active engagement shaped by the same behavioral contingencies that drive patient non-use. If the field's central obstacle is no longer the hardware, then attention, measurement, and resources should shift toward the human processes that determine whether a well-engineered hand is ever truly adopted.&#xa0;Practically, this argues for building rehabilitation timing and provider engagement into care pathways as routinely measured outcomes, and for prioritizing prospective study of these process variables.

Published Donor Risk Indices are often used to estimate the risk associated with transplanting a donor liver. Such indices have been constructed by considering only livers that are transplanted and estimating the risk of graft loss or patient death. Until now, there has been no index available that reflects the chance of an offered organ not being transplanted in the United Kingdom (UK). This paper presents a UK Donor Utilisation Index (UKDUI) which quantifies the impact of donor factors upon liver non-use. By comparing our developed UKDUI with a commonly used UK Donor Risk Index, we are able to see that there are differences between the factors that influence liver non-use and the factors that influence liver post-transplant outcomes. Importantly, this UKDUI can be used in future studies to characterise and identify offered livers that are either more or less likely to be transplanted. For example, the UKDUI can be used for study inclusion criteria or for risk adjustment/stratification.

The benefits of spherical adsorptive carbon (SAC) for individuals with chronic kidney disease (CKD) remain uncertain. This study investigated the association between SAC use, dialysis initiation, and all-cause mortality in patients with advanced CKD using large-scale, real-world data. This multicenter, retrospective cohort study analyzed electronic health record data standardized through the Observational Medical Outcomes Partnership Common Data Model across three tertiary hospitals. Patients with CKD and serum creatinine levels &#x2265;2.0 mg/dL who received SAC at &#x2265;4 g/day for &#x2265;90 days were included, along with non-users. Risks of dialysis initiation and all-cause mortality were estimated using inverse probability of treatment weighting (IPTW)-weighted Cox proportional hazards models adjusted for relevant clinical variables. Among 15,324 patients, 3,989 received SAC. In IPTW-adjusted analyses, non-use of SAC was associated with an increased risk of dialysis initiation (hazard ratio, 1.125; 95% confidence interval, 1.018-1.243; p = 0.02). This association was observed in selected subgroups, particularly among patients aged <65 years and those with preserved kidney function. In a sensitivity analysis using a landmark approach, the association with dialysis initiation was attenuated. SAC non-use was also associated with an increased risk of all-cause mortality (hazard ratio, 1.659; 95% confidence interval, 1.487-1.851; p < 0.001), and this finding remained consistent in sensitivity analyses. The use of SAC was associated with a lower risk of all-cause mortality and showed a potential association with reduced risk of dialysis initiation in patients with advanced CKD, suggesting a possible role as an adjunctive therapy in this population.

Waiting times for lower limb prosthesis in the public healthcare sector of South Africa can exceed 12-months. A cause of long waiting times is shortage of prosthetic components. However, sometimes prostheses are abandoned. Recycling components from unused prostheses to mitigate the shortage of components has not been studied. This study aimed to determine the reasons for lower limb prosthesis abandonment and to explore the possibility of recovering unused prostheses for component recycling in the public healthcare sector of the Eastern Cape Province, South Africa. A cross-sectional survey was conducted among individuals who had stopped using or had an unused lower limb prosthesis. Participants were recruited using total population sampling from three public hospitals with Orthotics and Prosthetics centres in the Eastern Cape. During routine follow-up (July-August 2025), 92 individuals who had received a lower limb prosthesis between January 2021 and January 2025, or their next of kin where applicable, were contacted. Individuals still using their prosthesis and children (<18 years) were excluded. The remaining 45 non-users or next of kin were invited to participate. A self-developed structured questionnaire was administered via short (10-15 minute) interviews, and data were analyzed descriptively using SPSS (version 31). A total of 43 participants aged 18-77 years (median 54; interquartile range 24), including 54% (n=23) male participants, consented to participate and completed the interviews. Twenty-two participants (51%) reported poorly fitting sockets as the reason for non-use. Forty-two (98%) participants were in favour of recycling components. Forty (93%) of the unused prostheses were modular. The majority were transtibial (81%), followed by transfemoral (12%) and knee disarticulation (7%). The main barrier to recycling identified was damaged components (19%). Thirty-nine (91%) prostheses were recovered from which 190 components can possibly be recycled. The findings extend existing knowledge on prosthesis abandonment and highlight an opportunity to implement component recycling practices to improve access, reduce waiting times, and lower costs in low-resource settings with high prosthetic service demand. The study may have important implications for prosthetic service delivery and policy in the Eastern Cape and South Africa.

Routine health care increasingly requires digital access for appointment scheduling, medication refills, test-result review, clinician messaging, remote monitoring, and telehealth. For older adults with cardiovascular-risk conditions, complete internet disconnection may indicate accumulated geriatric vulnerability and barriers to continuous care. We examined whether complete digital disconnection was associated with mortality or residential-care transition and whether the risk gradient was driven by connectivity rather than telehealth use. We constructed staggered-entry prospective cohorts using rounds 11-14 of the National Health and Aging Trends Study (2021-2025). Community-dwelling Medicare beneficiaries aged &#x2265;65 years with hypertension, heart disease, or diabetes entered the cohort in round 11, 12, or 13 and were followed through round 14. Digital integration was categorized as telehealth use, connected non-use, or complete disconnection. Outcomes were all-cause mortality and a composite of death or transition to nursing-home or residential care. The primary analysis used survey-weighted discrete-time survival models with entry-cohort fixed effects and participant-level cluster-robust variance estimation. Models were sequentially adjusted for demographic, socioeconomic, health, frailty-related, and geriatric-vulnerability factors. Robustness was assessed using multiple imputation, competing-risks models, E-values, and sensitivity analyses addressing reverse causation. Among 12,139 person-baseline observations from 6,530 adults, the survey-weighted prevalence of complete disconnection was 29.7%. Compared with non-disconnected participants, completely disconnected adults had a higher unadjusted risk of the composite outcome; after adjustment for health and frailty-related factors, the association attenuated but persisted (composite hazard ratio [HR], 1.39; 95% CI, 1.12-1.73; mortality HR, 1.50; 95% CI, 1.16-1.94). The survey-weighted 3-year absolute risk difference was 12.1 percentage points. Telehealth users and connected non-users had similar adjusted risks (composite HR, 0.99; 95% CI, 0.79-1.24). Associations weakened after adjustment for functional status and exclusion of first-interval events. Complete digital disconnection was a reproducible and readily measured prognostic marker of mortality or residential-care transition among older adults with cardiovascular-risk conditions. These findings support a prognostic rather than causal interpretation. Age-friendly digital care should preserve offline-accessible pathways for older adults who remain completely disconnected.

Introduction: Cochlear implantation is a well-established treatment for adults with bilateral postlingual deafness. In recent years, increasing research attention has focused on its use in patients with single-sided deafness (SSD) with or without tinnitus. Restoration of binaural auditory input through cochlear implantation may partially reestablish binaural processing. Methods: We conducted a narrative review of the literature focusing on studies examining the basic mechanisms associated with hearing impairment in SSD, as well as cochlear implantation outcomes in this population, including hearing performance, tinnitus suppression, and quality of life (QoL). We also reviewed comparative studies between cochlear implants (CIs) and alternative hearing devices, along with current candidacy criteria and the challenges associated with cochlear implantation in this patient group. Results: Current evidence suggests that CIs can provide significant benefits in this population, including tinnitus reduction or suppression, improved speech perception in both quiet and noise, enhanced sound localization, and better disease-specific and overall QoL. Furthermore, numerous studies-despite some variability in outcomes-indicate that CIs may offer superior performance compared with alternative options, such as contralateral routing of signals hearing aids (CROS-HAs) and bone-conduction devices, particularly in terms of speech perception, localization, tinnitus control, and aspects of QoL. Nevertheless, appropriate candidacy criteria and key challenges-most notably device non-use-should be carefully considered when evaluating cochlear implantation in this patient population. Conclusions: Further research is required to address these challenges and to advance a more personalized approach to cochlear implantation in individuals with SSD, with the aim of optimizing outcomes and reducing cochlear implant non-use.

Since its establishment by the World Health Organization (WHO), the surgical safety checklist (SSC) is variably adopted worldwide despite evidence of advantages related to its use. To our knowledge, no data exists about the use of the SSC in DRC. We aimed to report the frequency of its use and reasons for its non-use. Using Google Forms, a survey was conducted in the Democratic Republic of the Congo public hospitals for 20 days (25 April to 15 May 2024). Fifty-nine hospitals were included in the survey, and 32 (54.2%) are using the SSC for a mean time of 4 (&#xb1;&#x2009;2) years. Of these, 16 (50%) use it regularly, with a surgeon coordinating the checklist process in 14 hospitals (43.8%). Twenty-seven hospitals do not use the SSC due to the absence of training for its use in 16 hospitals (59.3%) or due to the unavailability of the SSC in 15 hospitals (55.6%). Half of the public hospitals in DRC have used the SSC for an average of 4 years. Lack of previous training and unavailability of the SCC are the main reasons of its non-use. Seminars and training on the use of SSC would allow its use in these health facilities.

To evaluate whether cochlear implantation reduces listening-related fatigue in children with unilateral hearing loss. Prospective within-subjects crossover study. Three academic medical centers specializing in pediatric cochlear implantation. Fatigue was assessed using the Vanderbilt Fatigue Scale and PedsQL&#x2122; 3.0 Multidimensional Fatigue Scale. Parent- and child-reported versions were completed after consecutive days of baseline cochlear implant use and following a three-day discontinuation during a holiday break. Paired t-tests compared conditions (P <0.05). Univariable regressions examined associations with age, sex, and deafness duration. Intraclass correlation coefficients assessed parent-child agreement. Of 69 eligible patients, 37 responded; 18 declined due to reluctance to discontinue CI use. Nineteen children (mean age 8.6&#xa0;y, 26.3% male, mean deafness duration 3.4&#xa0;y) completed the study. Parent-reported fatigue significantly worsened after implant non-use in mental (P=0.01) and physical domains (P=0.04) on the Vanderbilt scale, and in cognitive fatigue (P=0.03) on the PedsQL. Child-reported scores trended toward greater fatigue during non-use, though not statistically significant. Younger age and male sex were associated with higher fatigue in parent reports. Intraclass correlation coefficients indicated moderate to good parent-child agreement. Cochlear implantation alleviates listening-related fatigue in children with unilateral hearing loss, particularly in cognitive and physical domains as perceived by parents. Fatigue represents a clinically meaningful, non-audiological outcome in candidacy assessment and postoperative evaluation.