Previous research has established an association between anxiety disorders and suicidal thoughts and attempts; however, much remains unknown about the role of specific anxiety symptoms, anxiety severity, and the impact of co-occurring depression and hopelessness. This study examined (a) the independent relationship between anxiety severity and suicidal thoughts and attempts, and (b) the independent relationships between different anxiety symptoms and suicidal thoughts and attempts. Additionally, we analyzed a subset of youth with anxiety symptoms to examine, (c) depression severity and hopelessness as predictors of suicidal thoughts and attempts. Participants were 2104 youth (ages 12-17) who presented to an Emergency Department (ED) from the Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) cohort. Youth self-reported anxiety, depression, and hopelessness at baseline and reported suicidal thoughts and attempt at three- and/or 6-month follow-up. Among the subset of 652 youth with anxiety (≥3 on SCARED-C), depression and hopelessness were examined as predictors of suicidal thoughts and attempts. Anxiety severity significantly predicted ideation at follow-up, even after accounting for demographics (race/ethnicity, sex, parental education, welfare), depression, hopelessness, and previous suicide attempts (OR = 1.08, 95% CI [1.01-1.61]). However, anxiety severity did not predict suicide attempts after accounting for depression. Specific anxiety domains were not associated with attempts, and only separation anxiety was associated with ideation (OR = 1.04, 95% CI [1.00-1.08]). Among the subset of youth reporting anxiety, depression severity was associated with suicide attempts at follow-up, (OR = 1.08, 95% CI [1.04-1.14]). Depression (OR = 1.11, 95% CI [1.08-1.15]) and hopelessness (OR = 1.03, 95% CI [1.01-1.05]) each uniquely predicted suicidal ideation. Anxiety severity, rather than specific anxiety domains, may drive subsequent suicidal thoughts and attempts. Among youth with anxiety, depression predicted both attempts and ideation at follow-up, whereas hopelessness predicted only ideation. Shared aspects of anxiety and depression may underlie youth suicide risk.
Childhood mental and behavioral health problems have increased in recent years in the United States, yet limited research has examined how positive childhood experiences (PCEs) across family and community contexts are associated with mental health across development. Using data from 68,000 children aged 6-17 years in the 2022-2023 National Survey of Children's Health, this study assessed whether Family- and community-level PCEs were independently and cumulatively associated with depression, anxiety, and behavioral problems. Family and community PCEs were categorized as low, moderate, or high. Weighted logistic regression models estimated associations with mental and behavioral health outcomes, with and without adjustment for adverse childhood experiences (ACEs) and sociodemographic characteristics. Predicted probabilities were calculated to evaluate cumulative patterns across contexts. Low family PCEs were associated with higher odds of depression (AOR = 1.53; 95% CI, 1.25-1.89), anxiety (AOR = 1.25; 95% CI, 1.05-1.48), and behavioral problems (AOR = 1.65; 95% CI, 1.36-2.09), and low community PCEs showed similar associations across outcomes. These associations remained robust after adjustment for ACEs and sociodemographic factors. Although interaction effects were small, predicted probabilities revealed a clear cumulative pattern, with the lowest risk observed when both family and community PCEs were high. Findings suggest that family and community PCEs were each independently associated with mental and behavioral health outcomes, and predicted probabilities revealed a cumulative pattern across PCE domains. These findings underscore the importance of supporting both family and community environments, as each context showed independent associations with depression, anxiety, and behavioral problems across developmental stages, highlighting the value of multilevel approaches to support child and adolescent mental and behavioral health.
BackgroundEvidence supporting calcitonin gene-related peptide monoclonal antibody (CGRP mAb) use in adolescents with migraine is limited. Rapid recovery for daily school functioning is particularly important during this stage of life. We aimed to evaluate early functional outcomes in daily and school activities, as well as headache-related outcomes after initiating CGRP mAb therapy in Japanese adolescents with migraine.MethodsThis single-center retrospective cohort study included patients aged 15-17 years who received CGRP mAb therapy (galcanezumab, fremanezumab or erenumab) for migraine between May 2021 and July 2025. The primary outcome was time to clinically meaningful improvement on the Headache Impact Test-6 (HIT-6) scores, comprising a reduction of ≥ 6 points from baseline, and was analyzed using the Kaplan-Meier method. Secondary outcomes included tracking longitudinal HIT-6 trajectories with mixed-effects models for repeated measures, exploratory univariable comparisons for early response (≥ 6-point reduction within 10-14 weeks), questionnaire-based daily functioning assessments, and safety evaluations.ResultsOf 34 adolescents who initiated CGRP mAb therapy, 33 participated in HIT-6 analyses. The cumulative response rate began increasing immediately after treatment initiation, reaching 68.3% (95% confidence interval = 44.6-81.8%) within the 10-14-week period; approximately half of the responders achieved meaningful improvement by weeks 4-6. Mixed-effects models for repeated measures analyses adjusted for baseline HIT-6 scores showed a least-squares mean change of -9.4 points at 12 weeks (95% confidence interval = -14.2 to -4.6; p < 0.001), with benefits sustained over follow-up. Among questionnaire respondents (n = 27), school attendance or concentration in the classroom was the most affected activity before treatment (70.4%) and 88.9% indicated that their primary treatment goals were mostly or partially achieved. Adverse events were reported by 40.7% of participants, primarily injection-site reactions (29.6%), none of which led to therapy discontinuations or modifications.ConclusionsIn this real-world adolescent cohort, CGRP mAb therapy was associated with early and clinically meaningful improvements in headache-related impact and self-reported functioning. Safety and tolerability findings are particularly notable given the limited evidence in this age group. Further prospective controlled studies are warranted to validate these findings and to identify predictors of early functional response.
 Tuberculosis (TB) has remained a significant public health challenge for many years. Individuals with weakened immune systems because of other illnesses are particularly vulnerable to contracting TB. In March 2020, South Africa implemented a disease control strategy which ceased and disrupted daily routines, including healthcare services delivery. The study aimed to determine and describe the impact of coronavirus disease 2019 (COVID-19) lockdown restrictions on the utilisation of TB services, pre-COVID-19 and peri-COVID-19.  A cross-sectional retrospective study using National Institute for Communicable Diseases (NICD) and National Department of Health (NDoH) data from Johannesburg, South Africa, was conducted to assess COVID-19 restrictions' impact on TB service use from January 2018 to December 2021, examining trends across periods and influencing factors. The study included individuals who sought TB services, showed TB symptoms, or tested positive or negative for TB during the study period.  The secondary data collected included children ( 10 years old), young adolescents (10-14 years old), older adolescents (15-19 years old), young adults (20-24 years old), adults (25-49 years old) and older adults (≥ 50 years old). Tuberculosis service use was highest among adult females aged 25-29 years old (51.3%) and lowest among females ≥ 50 years old (32.6%).  A marked decline in TB service use was observed during the peri-COVID-19 period. Results demonstrated that COVID-19 restrictions caused a substantial and sustained decline in TB service utilisation in Johannesburg, even when accounting for broader determinants of care-seeking.Contributions: This study provides valuable insight into the impact of COVID-19 restrictions on TB service utilisation and highlights the broader societal effects of a pandemic.
We aimed to gain knowledge on children's development by distinguishing developmental profiles based on neurological and motor assessments in infancy, and motor and cognitive assessments at early school age. Profile characteristics and the associations between profiles and behavioural characteristics at early school age were also examined. Based on their neurological and motor scores at an age between 3 and 18 months, we invited 703 Dutch children of 4-5 years old (369 with atypical and 334 with typical infant neuromotor behaviour) of whom 518 (74%) participated in the current study. A latent profile analysis was performed to identify the developmental profiles. We examined profile characteristics and compared the parent-reported behavioural and emotional difficulties, ASD traits and ADHD traits at early school-age between the developmental profiles. We found four developmental profiles: 'typical development', 'early advanced development', 'developmental catch-up' and 'developmental difficulties'. Being a boy was associated with the 'developmental difficulties' profile and being a girl and high parental educational level were associated with the 'typical development' profile. Children in the 'developmental difficulties' profile showed the most behavioural and emotional difficulties, ASD traits and ADHD traits The four profiles pointed to highly varying developmental patterns, underlining the inter- and intra-individual variability of development and showing the challenges of predicting later developmental outcome based on infancy assessments.
Irritability affects one-third of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and is associated with negative outcomes. The family environment plays a prominent role in the child's development, and therefore on the risk for irritability, especially during the preschool period. The aim of this study was to investigate the association between multiple family environmental factors and irritability in preschool children with ADHD. This is a cross-sectional analysis nested within a randomized clinical trial with preschool children with ADHD-the MAPPA study. Here, 128 children (107 males, 21 females) aged 3-5 years with complete data were included. Irritability was measured by the Affective Reactivity Index. Three dimensions of family environmental factors were considered: parenting, family environment, and maternal characteristics (comprising maternal psychopathology, temperament, and cognitive ability). Analyses were conducted to evaluate the association of individual factors with irritability, followed by a multiple linear regression model. Associations were found between irritability and both parenting and maternal characteristics, particularly psychopathology and temperament. The multiple linear regression model revealed a greater frequency of negative over positive comments in the Preschool Five-Minute Speech Sample alongside less positive parenting practices and maternal ADHD symptoms as the family environmental factors significantly associated with child irritability. Findings remained significant after controlling for child sex and child ADHD symptom severity. Our findings indicated that maternal individual characteristics and parenting practices are associated with irritability in preschool children with ADHD, supporting the importance of family environment in understanding this condition. A thorough assessment of parenting practices and parental psychopathology is relevant when planning interventions aimed at reducing irritability in preschoolers with ADHD.
To examine trends in microvascular complications in adolescents from 1990 to 2019. Retinopathy, albuminuria, and peripheral and autonomic nerve function (pupil size and heart rate variability [HRV]) were assessed in 2,761 adolescents aged 12-20 years (duration ≥5 years) over 5,487 visits. Generalized estimating equations were used to examine the association between decades T1 (1990-1999), T2 (2000-2009), and T3 (2010-2019), and modifiable risk factors, including HbA1c variability, were assessed by coefficient of variation (CV). Retinopathy (T1 40%, T2 21%, T3 20%; P < 0.001) and early elevation of mean albumin-to-creatinine ratio (ACR) (T1 35%, T2 29%, T3 28%; P = 0.009) plateaued and peripheral nerve abnormality rates decreased (T2 35%, T3 28%; P = 0.007), while HRV abnormality (T2 37%, T3 38%; P = 0.884) and albuminuria (T1 6%, T2 4%, T3 4%; P = 0.164) were unchanged. Over time, multiple daily injection (MDI)/continuous subcutaneous insulin infusion (CSII) use increased, with a decrease in the proportion of adolescents achieving HbA1c <7.0% (T1 7.4%, T2 9.6%, T3 14.1%). In a multivariable model including HbA1c, HbA1c CV, diabetes duration, diastolic blood pressure, and insulin dose per kilogram body weight, retinopathy and early elevation of albumin excretion rate (AER) were associated with twice daily insulin versus MDI/CSII (odds ratio 1.59 [95% CI 1.23-2.06; P < 0.001], 1.26 [1.06-1.48]; P = 0.007]). After adjusting for mean intrapersonal HbA1c, higher HbA1c CV was associated with early elevation of AER/ACR (1.27 [1.05-1.53; P = 0.015]), albuminuria (1.26 [1.04-1.52; P = 0.018]), and HRV abnormality (1.49 [1.08-2.05; P = 0.015]). Diabetes complications decreased then plateaued over time. These findings support lower glycemic targets, CSII use, and targeting of modifiable risk factors and HbA1c CV to reduce complications risk in youth with type 1 diabetes. The role of hybrid closed loop therapy should be evaluated in the future.
Early exposure to maternal depression can increase risk for offspring mental health problems across the lifespan. Less is known about the transdiagnostic pathways through which maternal depression influences offspring mental health risk in young adulthood. This pre-registered study tested the prospective associations of maternal depression (total exposure and instability) with offspring mental health in young adulthood and evaluated adolescent emotion dynamics as transdiagnostic mechanisms. This study used data from the Future Families and Child Wellbeing Study (FFCWS; n = 4898). Maternal depression was assessed when children were 1, 3, 5, and 9 years old and offspring young adult depression and anxiety was assessed at age 22 with structured clinical interviews. Adolescent daily and biweekly positive and negative emotions were assessed in two Future of Families and Child Wellbeing study substudies (n range = 513-1049) when offspring were 15 years old. Informed by theory and past research, we calculated variability, instability, and inertia to assess emotion dynamics and instability to assess maternal depression dynamics. We tested study aims using logistic regression, multivariate regression, and mediation models. Total exposure to maternal depression predicted greater odds of offspring young adult depression whereas instability in maternal depression was not directly associated with offspring mental health. Offspring biweekly emotion dynamics during adolescence significantly predicted subsequent anxiety and depression. Additionally, greater instability in maternal depression was associated with lower biweekly instability in sadness during adolescence, which was in turn associated with greater likelihood of young adult anxiety. Associations were independent of mean emotion levels and covariates. Overall, findings highlight the importance of considering how the dynamics of mood and emotions across generations (e.g., mother, offspring) and timescales (e.g., daily, biweekly, yearly) may shape young adult psychopathology. To build from these initial findings, future studies could investigate these processes using genetically informative longitudinal designs, causal mediation analyses, and continuous measures of maternal depression.
Research on chronic suicidal thoughts and behaviors (STB) in Australia is limited. This study aimed to determine the prevalence and identify predictors of chronic STB among Australian males. A nine-year retrospective cohort study was conducted, analysing data from the first four waves of the Ten to Men Study. The study included 3,070 males who reported lifetime STB at Wave 1. Chronic STB was defined as the presence suicidal thoughts, plans, or attempts over subsequent waves. Modified Poisson and mixed-effects Poisson regression models were used to identify predictors. The prevalence of chronic suicidal thoughts and attempts were 34.5% and 13.6%, respectively, with an overall chronic STB prevalence of 37.2%. At Wave 2, depression (IRR = 1.59; 95% CI [1.28, 1.98]; P < 0.001), homosexuality (IRR = 1.50; 95% CI [1.06, 2.14]; P = 0.023), and alcohol use disorder (IRR = 1.21; 95% CI [1.01, 1.46]; P = 0.044) were significantly associated with chronic STB. Over nine years, depression (IRR = 2.57; 95% CI [2.05, 3.22]; P < 0.001), alcohol use disorder (IRR = 1.53; 95% CI [1.27, 1.85]; P < 0.001), disability (IRR = 1.43; 95% CI [1.12, 1.82]; P = 0.004), and marijuana use (IRR = 1.33; 95% CI [1.05, 1.67]; P = 0.016) were key predictors. Among Australian men who report lifetime STB, more than one in three experience chronic STB over a nine-year period. Depression, alcohol use disorder, disability, illicit substance use, and socioeconomic factors emerged as primary predictors. Further research is needed to explore intervention strategies addressing these factors.
Maternal attention-deficit/hyperactivity disorder (ADHD) is increasingly recognised during the reproductive years, often with delayed diagnosis. Although ADHD has been linked to perinatal complications, it remains unclear whether risks reflect ADHD itself, comorbidity, vulnerability, behaviours, and medication use. We examined associations between maternal ADHD, stratified by diagnosis before and after childbirth, and ADHD medication exposure during pregnancy with a range of pregnancy, childbirth, and neonatal outcomes. We conducted a nationwide register-based cohort study, including 741,905 singleton live births in Denmark (2010-2022). Childbirths were classified by maternal ADHD diagnosis before childbirth (n = 12,859), after childbirth (n = 15,683), and no ADHD (n = 713,363). Among women diagnosed before childbirth, ADHD medication exposure was classified; no exposure (n = 10,118), first-trimester (n = 1,129) and continued (n = 1,612) based on prescription-timing. Analyses were preformed using Poisson GEE, accounting for repeated births and adjusting for sociodemographics, psychiatric history, and somatic comorbidity. Maternal ADHD diagnosed before childbirth was associated with preterm childbirth (aRR 1.13, 95% CI 1.04-1.22; aRR 1.29, 95% CI 1.07-1.56) and low birthweight (aRR 1.19, 95% CI 1.09-1.30). Early pregnancy haemorrhage was modestly elevated for ADHD diagnosed before and after childbirth (aRR 1.15, 95% CI 1.08-1.25; aRR 1.14, 95% CI 1.07-1.22). ADHD diagnosed after childbirth was associated with infection (aRR 1.19, 95% CI 1.11-1.27), hyperemesis (aRR 1.23, 95% CI 1.13-1.34), and Apgar score < 7) (moderate aRR 1.48, 95% CI 1.09-2.01; severe aRR 1.32, 95% CI 1.09-1.59). ADHD medication in pregnancy (vs. unmedicated) was associated with gestational hypertension (first-trimester aRR 1.57, 95% CI 1.21-2.02; continued aRR 1.39, 95% CI 1.01-1.91). Maternal ADHD, whether diagnosed before childbirth or postpartum, was associated with small increases in selected obstetric and neonatal risks after adjustment for relevant sociodemographic and clinical factors. Continued use of ADHD medication was significantly associated with gestational hypertension only. However, these findings should be interpreted with caution due to the potential for residual confounding, including confounding by indication.
Previous studies have reported differences in levels of mental wellbeing between autistic and non-autistic adolescents and between girls and boys. However, it is unclear to what extent being autistic or a particular gender influences mental wellbeing in adolescence. The importance of social relationships for mental wellbeing is well established, but it is unknown to what extent this may differ between autistic and non-autistic adolescents and between autistic girls and boys. Data from the Millennium Cohort Study were used. Measures of social experience included social support and social alienation at age 14 (N = 11,056). Mental wellbeing was measured at age 17 (N = 10,034). Moderated regression analyses after multiple imputation were used to determine (i) whether autism diagnosis moderates the effect of social experience on mental wellbeing and (ii) whether the interaction between gender and autism diagnosis moderates the effect of social experience on mental wellbeing (N = 16,370). In this nationally representative sample, levels of mental wellbeing are lower for autistic adolescents and for girls. Autistic girls had the lowest wellbeing, with large differences relative to non-autistic boys (mean difference: -3.09; 95% CI: -4.565, -1.612) and non-autistic girls (mean difference: -1.66; 95% CI: -3.13, -0.180). Autistic boys had lower wellbeing compared to non-autistic boys (mean difference: -1.68; 95% CI: -2.54, -0.824) and non-autistic girls (mean difference: -1.43; 95% CI: -1.69, -1.18). Autism does not moderate the effect of social experiences on mental wellbeing. No moderations were found on the effect of social experiences on mental wellbeing when all potential interactions are considered. Social support and social alienation during early adolescence equally impact the mental wellbeing of autistic and non-autistic individuals at later adolescence. Considering the low mental wellbeing of autistic adolescents, there is a critical need to improve their social experiences.
To describe the distribution profile of untreated dental caries in Brazilian adolescents, using the PUFA index, and identify the main associated factors. This is a cross-sectional study based on data from the 2023 National Survey of Oral Health. The sample consisted of 8,053 adolescents aged 15 to 19 years. The dependent variable was the presence of untreated caries, measured by the PUFA index. Independent variables included sociodemographic and oral health-related factors such as impacts on quality of life and access to dental services. Descriptive and bivariate analyses were performed using the Rao-Scott test and multiple logistic regression, considering a significance level of 5% (p<0.05). We verified that 12.5% of Brazilian adolescents had at least one tooth affected by some repercussion of untreated caries. There were statistically significant associations between PUFA≥1 and the adolescents' socioeconomic conditions, such as lower level of education, low family income, being beneficiary of government cash transfer programs, in addition to Black skin color/race. We observed a negative impact on the quality of life of 22.4% of adolescents with PUFA index ≥1, and 19.1% had never had a dental appointment. Low family income, presence of pain in the last six months, and self-perceived need for dental treatment were factors strongly associated with PUFA≥1. Social determinants influenced the progression of dental caries in adolescents. Therefore, social policies targeting Black adolescents and expanded access to dental services are essential to reduce oral health problems in this more vulnerable population.
While exome and/or genome sequencing (ES/GS) are highly effective in identifying pathogenic variants, they may not capture the functional consequences of variants. RNA sequencing (RNA-seq), when used alongside ES/GS, addresses this limitation. A systematic semi-quantitative review included 200 studies reporting ES/GS or that followed by RNA-seq diagnostic rates from 2014 to 2024 was conducted. While the weighted average diagnostic rate for ES/GS followed by RNA-seq was 0.44 ranging from 0.34 to 0.53), studies with ES/GS alone reported a pooled diagnostic rate of 0.37 (95% CI: 0.35-0.39; p = 0.18). The subset of studies with ES/GS as first-tier test followed by RNA-seq revealed a trend towards improved diagnostic yields with the addition of RNA-seq (OR: 1.31, 95% CI: 1.08-1.58, p = 0.01). For participants undiagnosed by ES/GS, RNA-seq contributed an incremental diagnostic rate of 5.4% (95% CI: 0.006-0.60, p = 0.018), achieved through confirming or reclassifying candidate variants as pathogenic/likely pathogenic; and an additional diagnostic rate of 3.3% (95% CI: 0.021-0.088, p = 0.002) through discovering novel variants. Our results also highlight the advantages of tissue over blood samples in improving the diagnostic yield, particularly of RNA-seq, in which additional 6.2% for confirming ES/GS identified candidates (95% CI: 0.028-0.97, p < 0.001), and another addition of 6.2% for new variants discovery (95% CI: 0.025-0.099, p = 0.001) were found. Our findings emphasise the synergistic value of hypothesis-driven and hypothesis-free approaches in transcriptomic data analysis. This integration of RNA-seq into ES/GS workflows has shown promise in improving molecular diagnosis of genetic diseases.
Adolescence is a developmental period during which many mental health problems emerge or worsen. Recently, there has been a shift towards identifying risk factors that predict psychopathology across a range of diagnostic boundaries-known as 'transdiagnostic' approaches. There are several social and emotional risk factors for specific mental health diagnoses that have been well-characterised. Yet, there is limited understanding about how these socio-affective risk factors map onto transdiagnostic symptoms. We identified profiles of socio-affective functioning in early adolescence and how these profiles are associated with transdiagnostic symptoms of mental health problems. Adolescents at heightened risk of general psychopathology aged 12-14 (N = 559, M age = 13.26, SDage = 0.72, 58.14% female) were recruited as part of a mental health trial. Participants completed questionnaire and task-based measures assessing emotion functioning (emotion perception, emotion regulation, and interoception), social relationships (with peers and family members), and mental health. Using a simple artificial neural network that projects a high-dimensional input to a 2D topology we were able to map differences in questionnaire- and task-based socio-affective profiles. Clustering was then used to identify zones within that 2D topology, indicating relatively homogenous profiles. Associations between these zones and transdiagnostic mental health symptoms were examined. We identified three reliable clusters of socio-affective functioning from the questionnaire measures and four clusters from the task-based measures. There were significant differences between questionnaire clusters on general psychopathology and p-free internalising symptoms, whereas there were only significant differences between task clusters on general psychopathology. This study demonstrated the potential of data-driven methods to derive profiles of socio-affective functioning that are associated with transdiagnostic mental health problems. Through identifying socio-affective mechanisms that characterise these clusters, these findings can be used to identify active ingredients for future intervention development to prevent the onset and worsening of mental health problems in adolescence.
Children with perinatally acquired HIV (PHIV) and those exposed to HIV but uninfected (HEU) are at increased risk for adverse cognitive and behavioral outcomes, particularly in sub-Saharan Africa. This study evaluated the efficacy of brain powered games (BPG), a mobile computerized cognitive rehabilitation intervention, on neurocognitive outcomes among children with PHIV, HEU, and HIV unexposed uninfected children (HUU) in Uganda and Malawi. We conducted a randomized controlled trial in Uganda and Malawi enrolling 599 children aged 5 to 12 years (PHIV = 120, HEU = 239, HUU = 240). Participants were randomized to a 12-week BPG intervention or a waitlist. Neuropsychological outcomes were assessed at baseline, postintervention, and 6-month follow-up using the Kaufman Assessment Battery for Children Second Edition (KABC-II), test of variables of attention, and Cogstate. Linear mixed-effects models estimated intervention effects, separately by country. In Uganda, children receiving BPG demonstrated higher Learning composite scores (3.34; 95% CI, 1.03-5.65), Mental Processing Index scores (2.39; 95% CI, 0.78-4.01), and Nonverbal Index scores in KABC-II (2.28; 95% CI, 0.27-4.28) immediately postintervention compared with waitlist. Cogstate Maze Learning was higher postintervention (0.02; 95% CI, 0.004-0.043) and at 6 months (0.02; 95% CI, 0.003-0.040). In Malawi, Planning scores (-2.22; 95% CI, -4.39 to -0.05) and Delayed Recall scores (-2.87; 95% CI, -5.22 to -0.51) in KABC-II were lower in the intervention arm postintervention, whereas Cogstate Identification scores were higher (-0.03; 95% CI, -0.05 to -0.004). Mobile cognitive training produced modest, domain-specific cognitive benefits, with effects varying by context and HIV exposure status.
Paediatric emergencies account for only 5% of emergency deployments, but conversely, they pose a challenge for most emergency doctors. We retrospectively recorded 1055 deployments (2015-2024) of the Karlsruhe pediatric emergency ambulance and compared it with 1169 deployments (2003-2013) focusing on disease indications of the patients being treated. Small children formed the largest group (2003-2013: 45.3%; 2015-2024: 32.2%); deployments were seen more often in boys (2003-2013: 53.3%, 4.6% not identified; 2015-2024: 48.8%, 12.2% not identified). In all cases, 57.7% (2003-2013) and 69.4% (2015-2024) involved minor injuries/diseases. Most common were trauma (2003-2013: 25.9%; 2015-2024: 29.2%) and neurological diseases (2003-2013: 26.2%; 2015-2024: 20.7%). We observed a decrease of respiratory disorders (-7.2%), resuscitation (-2.2%), and sudden infant death syndrome (-0.8%); a rise in psychiatric presentations (+5.4%), ingestion/intoxication (+2.4%) and allergies/anaphylaxis (+2.4%). Females had an increased probability of psychiatric emergencies (OR 3.5; 95% CI 1.7-5.5). During the COVID-19-pandemic (2020/2021), the frequency of deployments dropped (-50%), psychiatric (+4.3%; OR 2.5; 95% CI 1.2-5.4) and obstetrics diagnoses (+3.8%) rose while trauma decreased (-11.1%; OR 0.6; 95% CI 0.4-0.8). A specific therapy was initiated in 82.2% (2003-2013) and 58.7% (2015-2024) of all the deployments. Our results revealed changes in the range of deployments between the two time frames as well as during the Covid-19 pandemic. We believe that the provision of preclinical emergency care for children-with their particular needs and range of disease indications (compared to adults) warrants discussion considering the need for reforms and additional medical qualifications. HINTERGRUND: Pädiatrische Notfälle sind mit 5 % der rettungsdienstlichen Einsätze selten und stellen für die Mehrheit der Notärzte eine Herausforderung dar. Es wurden 1055 Einsatzprotokolle (2015–2024) des Kindernotarztfahrzeuges Karlsruhe retrospektiv ausgewertet und mit 1169 Einsätzen (2003–2013) verglichen, insbesondere bezüglich der Einsatzindikation und vorliegender Krankheitsbilder. Kleinkinder stellten mit 45,3 % (2003–2013) sowie 32,2 % (2015–2024) die größte Gruppe dar mit Häufung des männlichen Geschlechts (2003–2013: 53,3 %, 4,6 % nicht erfasst; 2015–2024: 48,8 %, 12,3 % nicht erfasst). Bezogen auf alle Fälle lagen in 57,7 % (2003–2013) sowie 69,4 % (2015–2024) leichte Erkrankungsbilder/Verletzungen vor. Die häufigsten Einsatzindikationen waren Traumata (2003–2013: 25,9 %; 2015–2024: 29,2 %) und neurologische Erkrankungen (2003–2013: 26,2 %; 2015–2024: 20,7 %). Eine Abnahme zeigte sich bei respiratorischen Erkrankungen (−7,2 %), Reanimationen (−2,2 %) und „Sudden Infant Death Syndrome“ (−0,8 %); dagegen zeigte sich eine Zunahme psychiatrischer Einsatzbilder (+5,4 %), Ingestionen/Intoxikationen (+2,4 %) und Allergien/Anaphylaxien (+2,4 %). Eine erhöhte Wahrscheinlichkeit für psychiatrische Noteinsätze (OR 3,5; 95 % CI 1,7–5,5) wies das weibliche Geschlecht auf. Während der COVID-19 Pandemie (2020/2021) kam es zu einer Abnahme der Gesamteinsatzhäufigkeit (−50 %); hierbei zeigte sich ein Anstieg der Einsatzzahlen für psychiatrische (+4,3 %; OR 2,5; 95 % CI 1,2–5,4) und geburtshilfliche (+3,8 %) Einsätze sowie eine Abnahme traumatologischer Einsätze (−11,1 %; OR 0,6; 95 % CI 0,4–0,8). In 82,2 % (2003–2013) sowie in 58,7 % (2015–2024) aller Fälle wurde eine spezifische Therapie eingeleitet. Die Ergebnisse dieser Untersuchung zeigten Veränderungen im Einsatzspektrum zwischen den Jahren 2003–2013, 2015–2024 sowie der COVID-19-Pandemiezeit. Aufgrund des speziellen und unterschiedlichen Einsatzspektrums bei Kindern/Jugendlichen im Vergleich zu Erwachsenennotfällen ist eine Neuausrichtung der pädiatrischen rettungsdienstlichen Versorgung und Etablierung von fachlichen Zusatzqualifikationen zu diskutieren.
This study aims to investigate the safety and efficacy of the cholangioscope-assisted endoscopic retrograde appendicitis therapy in the treatment and diagnosis of pediatric acute uncomplicated appendicitis, clarify the clinical application value of this surgical approach and to compare the differences between the recurrence and non-recurrence groups postoperatively. This study retrospectively collected and evaluated clinical data from 50 pediatric patients diagnosed with acute uncomplicated appendicitis admitted to the Second Department of General Surgery at Shenzhen Children's Hospital between November 2024 and April 2025. All patients underwent cholangioscope-assisted endoscopic retrograde appendicitis therapy (ERAT). During the study, the demographic characteristics, clinical manifestations, laboratory test results, cholangioscope manifestations, treatment success rate, incidence of appendicitis recurrence and average hospital stay of the patients were systematically recorded and analyzed. Follow-up was conducted for the discharged patients. Among the 50 included children, 47 children (94%) were successfully treated. The average postoperative follow-up time was 7.8 months (95%CI 7.2-8.3), and the average operation time was 79.20 min (95%CI 66.60-91.81). During the follow-up period, six pediatric patients were diagnosed with recurrent appendicitis by ultrasonography and subsequently underwent surgical appendectomy.The average hospital stay was 3.96 days (95%CI 3.76-4.20). Significant differences existed between the groups with and without recurrence in terms of postoperative 12-hour liquid diet tolerance and endoscopic appendiceal lumen stenosis (P < 0.05). Cholangioscope-assisted endoscopic retrograde appendicitis therapy can be used as a surgical method for the treatment of pediatric acute uncomplicated appendicitis. Both early postoperative liquid diet tolerance and endoscopic appendiceal lumen stenosis may be related to appendicitis recurrence.
Postural kyphosis is a prevalent musculoskeletal condition characterized by impaired postural control, reduced quality of life, and an increased risk of psychosocial complications. This study aimed to investigate the effects of adding telerehabilitation-based motor imagery (MI) to home exercises on kyphosis level, posture, pain, depression, and quality of life in young adults with postural kyphosis. Thirty-five young adults with postural kyphosis were randomly assigned into two groups: Home Exercise (n = 19) and Home Exercise + MI Group (n = 16). The outcome measures included the kyphosis index (KI), wall occiput distance (W-OD), New York posture analysis (NYPA), visual analog scale (VAS), Beck depression scale (BDS), and scoliosis research society-22 (SRS-22). Both groups showed significant within-group changes over time on the majority of outcomes (p < 0.05). Compared with exercise alone, the Exercise + MI group showed greater improvements in KI (p < 0.001, g = 2.16), NYPA (p = 0.001, g = 1.39), BDS (p = 0.001, SMD = 1.33), and SRS-22 (p < 0.001, SMD = 2.53). Integration of MI into the telerehabilitation-delivered home-based exercise program showed significant improvements in postural alignment, depressive symptoms, and quality of life in young adults with postural kyphosis, compared with exercise alone. However, no difference was found in terms of pain reduction and postural stability. These findings suggest that MI may enhance neuromotor control and psychosocial outcomes when integrated into telerehabilitation-based exercise programs. https://clinicaltrials.gov/ NCT07122791.
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Restrictive practices (RPs) encompass interventions that limit an individual's freedom, such as restraint, seclusion, and enforced treatment. While widely studied in acute mental health settings, their use within inpatient eating disorder services remains underexplored despite evidence of high prevalence. In addition to these formal restrictive interventions, eating disorder inpatient wards commonly employ structured behavioural rules as part of nutritional rehabilitation programs, including enforced rest periods, supervised meals, locked bathrooms, and limits on fluids or activity. A scoping review methodology following a five-step framework was implemented. Four databases (CINAHL, MEDLINE, Embase, and PsycInfo) were searched. The analysis involved both numerical and narrative synthesis in line with the framework. Thirty-six studies were included. Most originated from the UK, focused on anorexia nervosa, and used quantitative designs, with a substantial proportion conducted in child and adolescent inpatient settings. Common RPs included nasogastric tube feeding under restraint, involuntary admission, and physical restraint. Prevalence varied widely, with a small subset of patients accounting for most RP episodes. RPs were primarily applied in response to medical or nutritional risk rather than aggression, differentiating them from acute psychiatric contexts. Evidence regarding outcomes such as weight restoration, length of stay, and mortality was inconsistent, and RPs were frequently described by patients and staff as distressing, coercive, and potentially traumatic. Findings highlight the distinct nature of RP use in eating disorder settings and the need for context-specific policies, ethical guidance, and intervention strategies to minimize harm while ensuring patient safety.