Adolescent Mortality Research Articles

Racial/ethnic trends in opioid and polysubstance opioid overdose mortality in adolescents and young adults, 1999–2020

ObjectivesPrevious reports have described variations in opioid overdose mortalities among different race/ethnicity groups. We have analyzed racial/ethnicity trends in opioid and polysubstance opioid overdose mortalities in adolescents and young adults to further characterize differences and potential sub-epidemics within this specific population. MethodsWe used mortality data from the U.S. Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death file from 1999 to 2020. Drug overdose mortalities were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Joinpoint regression was used to examine mortality rates for all opioids, opioids with a stimulant, opioids with benzodiazepines, and opioids with alcohol among racial/ethnic groups (non-Hispanic white, non-Hispanic Black, Hispanic, non-Hispanic other) in adolescents and young adults. ResultsThe Average Annual Percent Change (AAPC) for mortality due to opioid and polysubstance opioid overdose increased for all racial/ethnic groups where data was available for analysis from 1999 to 2020. For mortality due to any opioid and any opioid with a stimulant, the greatest AAPC was seen among non-Hispanic Blacks. ConclusionsUnprecedented increases in mortality due to opioid overdose occurred in the last two decades among adolescents and young adults. Heterogenous trends support the notion that the previously defined opioid overdose epidemic “waves” may not accurately depict the effects of the crisis in all race/ethnicity groups. Additionally, alarming increases in opioid-stimulant overdose mortality starting in 2012 further characterize the interrelated effects of the third and fourth waves.

Projected Life Expectancy for Adolescents With HIV in the US

Life expectancy is a key measure of overall population health. Life expectancy estimates for youth with HIV in the US are needed in the current HIV care and treatment context to guide health policies and resource allocation. To compare life expectancy between 18-year-old youth with perinatally acquired HIV (PHIV), youth with nonperinatally acquired HIV (NPHIV), and youth without HIV. Using a US-focused adolescent-specific Monte Carlo state-transition HIV model, we simulated individuals from age 18 years until death. We estimated probabilities of HIV treatment and care engagement, HIV progression, clinical events, and mortality from observational cohorts and clinical trials for model input parameters. The simulated individuals were 18-year-old race and ethnicity-matched youth with PHIV, youth with NPHIV, and youth without HIV; 47%, 85%, and 50% were assigned male sex at birth, respectively. Individuals were categorized by US Centers for Disease Control and Prevention-defined HIV acquisition risk: men who have sex with men, people who ever injected drugs, heterosexually active individuals at increased risk for HIV infection, or average risk for HIV infection. Distributions were 3%, 2%, 12%, and 83% for youth with PHIV and youth without HIV, and 80%, 6%, 14%, and 0% for youth with NPHIV, respectively. Among the simulated youth in this analysis, individuals were 61% Black, 24% Hispanic, and 15% White, respectively. HIV status by timing of acquisition. Life expectancy loss for youth with PHIV and youth with NPHIV: difference between mean projected life expectancy under current and ideal HIV care scenarios compared with youth without HIV. Uncertainty intervals reflect varying adolescent HIV-related mortality inputs (95% CIs). Compared with youth without HIV (life expectancy: male, 76.3 years; female, 81.7 years), male youth with PHIV and youth with NPHIV had projected life expectancy losses of 10.4 years (95% CI, 5.5-18.1) and 15.0 years (95% CI, 9.3-26.8); female youth with PHIV and youth with NPHIV had projected life expectancy losses of 11.8 years (95% CI, 6.4-20.2) and 19.5 years (95% CI, 13.8-31.6), respectively. When receiving ideal HIV care, life expectancy losses were projected to improve for youth with PHIV (male: 0.5 years [95% CI, 0.3-1.8]: female: 0.6 years [95% CI, 0.4-2.1]) but were projected to persist for youth with NPHIV (male: 6.0 years [95% CI, 5.0-9.1]; female: 10.4 years [95% CI, 9.4-13.6]). This adolescent-focused microsimulation modeling analysis projected that youth with HIV would have shorter life expectancy than youth without HIV. Projected differences were larger for youth with NPHIV compared with youth with PHIV. Differences in mortality by sex at birth, sexual behavior, and injection drug use contributed to lower projected life expectancy among youth with NPHIV. Interventions focused on HIV care and social factors are needed to improve life expectancy for youth with HIV in the US.

Advancements in Photothermal Therapy Using Near-Infrared Light for Bone Tumors.

Bone tumors, particularly osteosarcoma, are prevalent among children and adolescents. This ailment has emerged as the second most frequent cause of cancer-related mortality in adolescents. Conventional treatment methods comprise extensive surgical resection, radiotherapy, and chemotherapy. Consequently, the management of bone tumors and bone regeneration poses significant clinical challenges. Photothermal tumor therapy has attracted considerable attention owing to its minimal invasiveness and high selectivity. However, key challenges have limited its widespread clinical use. Enhancing the tumor specificity of photosensitizers through targeting or localized activation holds potential for better outcomes with fewer adverse effects. Combinations with chemotherapies or immunotherapies also present avenues for improvement. In this review, we provide an overview of the most recent strategies aimed at overcoming the limitations of photothermal therapy (PTT), along with current research directions in the context of bone tumors, including (1) target strategies, (2) photothermal therapy combined with multiple therapies (immunotherapies, chemotherapies, and chemodynamic therapies, magnetic, and photodynamic therapies), and (3) bifunctional scaffolds for photothermal therapy and bone regeneration. We delve into the pros and cons of these combination methods and explore current research focal points. Lastly, we address the challenges and prospects of photothermal combination therapy.

325 The Economic Impact of Pediatric and Adolescent Gunshot Wound Mortality

INTRODUCTION: Gunshot wounds (GSW) are the leading cause of pediatric/adolescent mortality in the United States. The total economic impact of lost productivity has not been previously quantified. METHODS: The CDC WONDER database was utilized to document GSW fatalities of individuals 19 years and younger between 2001-2021. The weighted net present value (NPV) of potential future lost income for each child was calculated based on the Social Security Administration’s estimated NPV of lifetime earnings at age 20, using a 4% discount rate, and factoring in updated US census data on education status, graduation rates, and wage-gaps. Each year’s total lost income was adjusted to 2022 USD using the CPI-W. Sensitivity analysis tested the robustness of our model parameters’ variability on our model results. RESULTS: 64,503 total pediatric/adolescent GSW mortalities have occurred since 2001. Total estimated NPV income loss in 2022 USD is $58.78 Billion. This correlates with an estimated loss to Social Security of $7.29 Billion. Sensitivity analyses found that changes in salary had the highest potential impact on the final outcomes. Overall, the worst-case income scenario (-20% change in base salary) showed an estimated $47 Billion economic loss in 2022 USD. A similar analysis for total pediatric mortality due to neurological disease showed an economic loss of $18.86 Billion. CONCLUSIONS: The economic impact of income lost due to pediatric GSW fatalities between 2001-2021 is estimated to be $58.78 billion, with minimum value of $47 billion after sensitivity analysis. This estimate likely undervalues the total economic impact of pediatric gun violence since it is based on median salaries and excludes medical treatment, long-term disability/morbidity, multiplier effects, or future offspring productivity. The total cost to society of pediatric GSW mortality significantly exceeds all neurologic-related mortality and is too high for physicians and policymakers to ignore.

Clinicopathological Analysis of Pediatric Posterior Fossa Tumors: Insights from a National Neurosurgical Center

BACKGROUNDː Pediatric posterior fossa tumors are the significant cause of morbidity and mortality in children and adolescents. This study aimed to investigate the characteristics of the patient population and report the experience in managing and treating children with these tumors, as well as their survival outcomes in Kazakhstan.<br /> METHODSː This retrospective study analysed data from the archives of the Pediatric Neurosurgery Department and included 214 pediatric patients with PFT in the period from January 2015 to December 2020.<br /> RESULTSː The study included 214 patients with a mean age of 7.29 ± 4.26 years. The most common tumor pathology observed in this study was medulloblastoma (33.18%). Grade I tumors showed a notable median survival of 56.64 months (95% CI, 53.93-59.35), surpassing Grade II tumors at 50.38 months (95% CI, 40.57-60.2). Grade III and IV tumors had median survivals of 38.64 months (95% CI, 31.11-46.17) and 38.76 months (95% CI, 33.96-43.56). Multivariate analysis using Cox regression model revealed significant predictors of overall survival. Grade III-IV tumors (RR = 0.577, 95% CI 0.462-0.720, p = 0.000), delayed resection (RR = 0.950, 95% CI 0.717-1.104, p = 0.000), and brainstem tumors (RR = 2.454, 95% CI 1.791-5.751, p = 0.000) had poorer survival. Tumor volume, age, and adjuvant chemotherapy were not significant predictors of 5-year survival (p > 0.05).<br /> CONCLUSIONSː The study found similar death rates in children with pilocytic astrocytoma compared to other population studies. Regrettably, the 5-year survival rate for medulloblastoma and ependymoma indicates a poorer outcome compared to previous reports.

Abstract 5467: Identification of possible new treatment options for rare pediatric CNS tumors using a panel of validated and characterized PDX models

Abstract Central nervous system (CNS) malignancies are the most frequent group of childhood solid tumors. While pediatric mortality due to CNS tumors has decreased over the past 40 years, however, there has been no significant change in brain and other CNS tumor mortality in children and adolescents since 2007*. Advances in research and innovative therapies are crucial to improving outcomes and reducing mortality. Collaborative efforts between researchers, healthcare professionals, and the pharmaceutical industry play a pivotal role in developing more effective treatments for these indications. One important piece in this endeavor is the availability of well characterized preclinical models for rigorous preclinical testing. In the framework of the ITCCP4 consortium (www.ITCCP4.eu) our group determined the pharmacological profile of ten orthotopically implanted pediatric brain tumor PDX models. The panel comprises amongst others four CNS-BCOR models, one ZFTA::RELA ependymoma model and two models of PFA ependymoma. We tested the models in a single mouse trial format with 16 arms covering standard of care therapy including radiation as well as targeted agents. All tumors were intracranially implanted into immune-compromised NSG mice. Tumor load was determined using a fluorescence based in vivo imaging technology based on the lentiviral transient transduction of PDX cells with iRFP713 prior to implantation into the brain. In addition, body weight and neurological scoring were monitored to determine the overall condition of the animals. At the end of the study brain tissue was harvested and tumor load confirmed by immunohistochemistry. Vismodegib, a first in class inhibitor of the hedgehog signaling pathway, was the most efficacious treatment with a significantly extended overall survival (Log Rank, p< 0.001) and a reduced tumor load compared to untreated control arms. The effect was most prominent in the subclass of CNS-BCOR models leading to growth delay or stable disease. Several targeted agents such as Ipatasertib (AKT inhibitor), Idasanutlin (MDM2-antagonist) and standard of care such as Carboplatin and Radiotherapy induced stable disease as well but had no significant effect on overall survival. The positive results for Vismodegib, Ipatasertib as well as Idasanutlin will be validated in a smaller subset of models in a conventional set-up to confirm the current dataset. In summary, the single mouse trial format using intracranially implanted PDX models proved to be a feasible tool to identify most promising drug candidates for pediatric ependymoma. *Ostrom QT, Price M, Ryan K, Edelson J, Neff C, Cioffi G, et al.. CBTRUS statistical report: pediatric brain tumor foundation childhood and adolescent primary brain and other central nervous system tumors diagnosed in the United States in 2014-2018. Neuro-Oncology (2022) 24(Supplement_3):iii1-38. Citation Format: Eva Oswald, Dorothee Lenhard, Kanstantsin Lashuk, Olivier Delattre, Didier Surdez, Johannes Gojo, Daniela Lötsch-Gojo, Walter Berger, Stefan Pfister, Julia B. Schueler. Identification of possible new treatment options for rare pediatric CNS tumors using a panel of validated and characterized PDX models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5467.

Global Burden of Tuberculosis in Adolescents and Young Adults: 1990-2019.

Tuberculosis (TB) is a major health threat in adolescents and young adults. However, its burden in this population remains unclear. This study aimed to assess TB burden and changing trends in individuals aged 10 to 24 years from 1990 to 2019. All data were obtained from the Global Burden of Disease Study 2019. We calculated the percentage of relative changes in incident cases, deaths, and disability-adjusted life years (DALYs). The temporal trends of the incidence, mortality, and DALYs were assessed using estimated annual percentage changes (EAPCs). At global level, TB incidence (per 100 000 population) decreased from 144.12 in 1990 to 97.56 in 2019, with average 1.28% (95% confidence interval [CI]: 1.36%-1.19%) of decline per year. Similar decreasing trends occurred across sex, age, sociodemographic index regions, and in most Global Burden of Disease study regions and countries. TB incidence in female adolescents decreased faster than that in male. However, there was an increasing trend in the incidence of extensively drug-resistant TB (EAPC = 11.23, 95% CI: 8.22-14.33) and multidrug-resistant TB without extensive drug resistance (EAPC = 3.28, 95% CI: 1.73-4.86). South Africa had the highest increase in TB incidence (EAPC = 3.51, 95% CI: 3.11-3.92). Global TB incidence, mortality, and DALYs in adolescents and young adults decreased from 1990 to 2019. However, the incidence of drug-resistant TB increased. TB remains a threat in adolescents and young adults worldwide, especially in low- and middle-income countries.

High mortality in adolescents and young adults with perinatally-acquired HIV in Thailand during the transition to adulthood

ABSTRACT Transitioning from pediatric to adult care remains a challenge for adolescents and young adults with perinatally-acquired HIV (AYA-PHIV). We assessed treatment outcomes and mortality among Thai AYA-PHIV. The study included AYA-PHIV who reached age 18–24 years who started antiretroviral treatment during childhood at five pediatric HIV clinics across Thailand. From November 2020–July 2021, data were gathered from a cohort database, medical records, and the Thai National AIDS Program. Of 811 eligible AYA-PHIV, 93% were alive; median age 22.3 years (IQR 20.6–23.7), treatment duration 16.1 years (IQR 13.4–18.0). Current HIV care was provided in adults (71%) and pediatric clinics (29%). Treatment regimens included non-nucleoside reverse transcriptase inhibitors (55%), protease inhibitors (36%), and integrase inhibitors (8%); 78% had HIV RNA <200 copies/ml. Of the 7.0% who died, median age at death was 20.8 years (IQR 20.6–22.1); 88% were AIDS-related death. Mortality after age 18 was 1.76 per 100-person years (95% confidence interval 1.36–2.28). Those with CD4 <200 cell/mm3 at age 15 had higher risk of mortality (adjusted hazard ratio 6.16, 95% CI 2.37–16.02). In conclusion, the high mortality among Thai AYA-PHIV indicated the need for better systems to support AYA-PHIV during the transition to adulthood.

Global trends in youth suicide from 1990 to 2020: an analysis of data from the WHO mortality database

Suicide is a serious but preventable public health concern at the global level, showing relevant geographical differences. This study aims to monitor global temporal and geographical patterns in suicide mortality in pre-adolescents, adolescents, and young adults (i.e., aged 10-24 years), from 1990 to 2020 or the most recent available year. Using the World Health Organisation mortality database, we conducted an analysis on a subset of 52 countries with valid and high-quality data. We computed age-standardised suicide rates (ASR) by sex, country, and calendar year, and performed a joinpoint regression analysis to identify significant changes in the temporal suicide trends over the studied period. High variability in suicide rates and trends was observed, with a male-to-female ratio of two to five. Between 1990 and 2020, most European countries reported declining suicide trends, with some exceptions. In particular, alarming trends emerged in the United Kingdom, with annual rises of 2.5% (95% CI: 1.6-3.5) since 2005 among males and 8.5% (95% CI: 4.7-12.6) since 2012 among females. The most favorable trends and lowest suicide rates were in Southern Europe, with 3.1/100,000 persons in Italy (2020) and 3.5/100,000 persons in Spain (2021) among males, and 0.9/100,000 persons in Italy (2020) and 1.1/100,000 persons in Romania (2019) among females. Conversely, the highest rates were in Central-Eastern Europe, with 10.2/100,000 males in the Russian Federation (2019) and 10.0/100,000 males in Poland (2002). Higher suicide rates and significant increases were reported in not European areas. The highest ASR was 15.5/100,000 males in the United States of America, with an annual increase of 3.8% (95% CI: 3.1-4.5) among males in 2009-2020 and 6.7% (95% CI: 5.6-7.8) among females in 2007-2017, followed by a levelling off. Temporal and geographical comparisons of suicide mortality should be interpreted with caution due to potential misclassification or under-reporting of suicide deaths in some countries. None.

Viral DNAemia and DNA Virus Seropositivity and Mortality in Pediatric Sepsis

Sepsis is a leading cause of pediatric mortality. Little attention has been paid to the association between viral DNA and mortality in children and adolescents with sepsis. To assess the association of the presence of viral DNA with sepsis-related mortality in a large multicenter study. This cohort study compares pediatric patients with and without plasma cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus 1 (HSV-1), human herpesvirus 6 (HHV-6), parvovirus B19 (B19V), BK polyomavirus (BKPyV), human adenovirus (HAdV), and torque teno virus (TTV) DNAemia detected by quantitative real-time polymerase chain reaction or plasma IgG antibodies to CMV, EBV, HSV-1, or HHV-6. A total of 401 patients younger than 18 years with severe sepsis were enrolled from 9 pediatric intensive care units (PICUs) in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Data were collected from 2015 to 2018. Samples were assayed from 2019 to 2022. Data were analyzed from 2022 to 2023. Death while in the PICU. Among the 401 patients included in the analysis, the median age was 6 (IQR, 1-12) years, and 222 (55.4%) were male. One hundred fifty-four patients (38.4%) were previously healthy, 108 (26.9%) were immunocompromised, and 225 (56.1%) had documented infection(s) at enrollment. Forty-four patients (11.0%) died in the PICU. Viral DNAemia with at least 1 virus (excluding TTV) was detected in 191 patients (47.6%) overall, 63 of 108 patients (58.3%) who were immunocompromised, and 128 of 293 (43.7%) who were not immunocompromised at sepsis onset. After adjustment for age, Pediatric Risk of Mortality score, previously healthy status, and immunocompromised status at sepsis onset, CMV (adjusted odds ratio [AOR], 3.01 [95% CI, 1.36-6.45]; P = .007), HAdV (AOR, 3.50 [95% CI, 1.46-8.09]; P = .006), BKPyV (AOR. 3.02 [95% CI, 1.17-7.34]; P = .02), and HHV-6 (AOR, 2.62 [95% CI, 1.31-5.20]; P = .007) DNAemia were each associated with increased mortality. Two or more viruses were detected in 78 patients (19.5%), with mortality among 12 of 32 (37.5%) who were immunocompromised and 9 of 46 (19.6%) who were not immunocompromised at sepsis onset. Herpesvirus seropositivity was common (HSV-1, 82 of 246 [33.3%]; CMV, 107 of 254 [42.1%]; EBV, 152 of 251 [60.6%]; HHV-6, 253 if 257 [98.4%]). After additional adjustment for receipt of blood products in the PICU, EBV seropositivity was associated with increased mortality (AOR, 6.10 [95% CI, 1.00-118.61]; P = .049). The findings of this cohort study suggest that DNAemia for CMV, HAdV, BKPyV, and HHV-6 and EBV seropositivity were independently associated with increased sepsis mortality. Further investigation of the underlying biology of these viral DNA infections in children with sepsis is warranted to determine whether they only reflect mortality risk or contribute to mortality.

Experience of pediatric and adolescent rehabilitation in the department of rehabilitation of the regional children’s oncohematological center, Vladivostok

The development of modern treatment technologies in oncology has reduced the mortality of children and adolescents from malignant neoplasms and hematological diseases. As a result, the issue of organizing rehabilitation care has become urgent. In this article, we describe the experience of organizing and developing pediatric rehabilitation in the oncology/hematology profile in Primorsky Krai for the period from 1995 to 2022. Various medical, psychological, social, and environmental aspects are outlined along with rehabilitation technologies used. The effectiveness of rehabilitation and the peculiarities of its implementation in children with oncological and hematological diseases are shown. The expediency of carrying out stages of rehabilitation in the region of residence of patients is substantiated.

The patterns, trends and major risk factors of suicide among Indian adolescents – a scoping review

BackgroundAdolescence is an essential stage for the development of mental health, and suicide is among the leading cause of mortality for adolescents around the world. In India, the suicide rate among adolescents has been increasing in recent years. The scoping review was conducted to map the evidence and address gaps by examining the existing pattern, and trends, and identify the major risk factors of suicide among Indian adolescents.MethodsThe study was conducted as per the Arksey and O’Malley scoping review framework and the Joanna Briggs Institute Reviewers’ manual. The systematic search was performed using electronic databases such as PubMed, Google Scholar, EMBASE, and PsycINFO, by using specific keywords. After the screening, 35 articles were identified according to the inclusion criteria.ResultsThe evidence on the trends of suicide among adolescents showed that the suicide rate has shown an alarming increase in recent years. The evidence pattern showed that hanging and poisoning were the commonly selected methods used by adolescents. The most commonly reported risk factors were mental health problems (54.28%), negative or traumatic familiar issues (34.28%), academic stress (22.85%), social/lifestyle factors (20%), violence (22.85%), economic distresses (8.75%), relationship factor (8.75%).ConclusionBy synthesizing and summarising the patterns, trends, and key risk factors of suicide among Indian adolescents, this scoping review provides a broad understanding of the literature already in existence. In order to effectively tackle these issues, the finding highlights the urgent need for extensive and targeted suicide prevention measures.

A study protocol for predictors of post-discharge mortality among children aged 5-14 years admitted to tertiary hospitals in Tanzania: A prospective observational cohort study.

Globally, millions of children and adolescents die every year from treatable and preventable causes. Sub-Saharan Africa accounted for 55% of deaths of children aged 5-14 years in 2017. Despite this high burden, minimal effort has been directed toward reducing mortality among older children and adolescents in comparison to under-fives. Mortality rates of children post-discharge vary between 1-18% in limited-resource countries and are reported to exceed in-hospital mortality. In Tanzania, there is limited data regarding post-discharge mortality and its predictors among children aged 5-14 years. This study aims to determine the post-discharge mortality rate and its predictors among children aged 5-14 years admitted to pediatric wards at MNH, MOI, and JKCI. This will be a prospective observational cohort study that will be conducted among children aged 5-14 years admitted to pediatric wards at Muhimbili National Hospital, Jakaya Kikwete Cardiac Institue, and Muhimbili Orthopedic Institue in Dar-Es-Salaam, Tanzania. Data will be collected using a structured questionnaire and will include socio-demographic characteristics, clinical factors, and patients' outcomes. Post-discharge follow-up will be done at months 1, 2, and 3 after discharge via phone call. Data will be analyzed using SPSS version 23. The association of demographic, social economic, and clinical factors with the outcome of all causes, 3 months post-discharge mortality will be determined by Cox regression, and survival rates will be displayed through Kaplan-Meier curves. This study will determine post-discharge mortality among children aged 5-14 years and its predictors in Tanzania. This information is expected to provide baseline data that will be useful for raising awareness of clinicians on how to prioritize and plan a proper follow-up of children following hospital discharge. These data may also be used to guide policy development to address and reduce the high burden of older children and adolescent mortality and may be used for future studies including those aiming to develop prediction models for post-discharge mortality among older children and adolescents.

The hidden severity of the COVID-19 pandemic in children and adolescents in Brazil: a territorial analysis of hospital mortality.

This article aims to describe the geographical distribution of hospital mortality from COVID-19 in children and adolescents during the 2020-2021 pandemic in Brazil. Ecological, census study (SIVEP GRIPE) with individuals up to 19 years of age, hospitalized with SARS due to COVID-19 or SARS not specified in Brazilian municipalities, stratified in two ways: 1) in the five macro-regions and 2) in three urban agglomerations: capital, municipalities of the metropolitan region and non-capital municipalities. There were 44 hospitalizations/100,000 inhabitants due to COVID-19 and 241/100,000 when including unspecified SARS (estimated underreporting of 81.8%). There were 1,888 deaths by COVID-19 and 4,471 deaths if added to unspecified SARS, estimating 57.8% of unreported deaths. Hospital mortality was 2.3 times higher in the macro-regions when considering only the cases of COVID-19, with the exception of the North and Center-West regions. Higher hospital mortality was also recorded in non-capital municipalities. The urban setting was associated with higher SARS hospital mortality during the COVID-19 pandemic in Brazil. Living in the North and Northeast macro-regions, and far from the capitals offered a higher risk of mortality for children and adolescents who required hospitalization.

Injury Mortality of Children and Adolescents Aged 0-19 Years - China, 2010-2021.

To examine the recent trends in child injury mortality in China. Injury mortality data of 2010-2021 for children and adolescents aged 0-19 years were from the China Health Statistics Yearbook. Injury mortality disparities across urban vs. rural locations, gender, and age groups were scrutinized. Annual percent change (APC), average annual percent change (AAPC), and their 95% confidence intervals (95% CI) were estiamted usimg Joinpoint regression models. The age-standardized injury mortality significantly dropped from 21.87 to 9.41 per 100,000 population among children and youth aged 0-19 years during 2010-2021, with an AAPC of -6.7% (95% CI: -8.2%, -5.2%). The urban-rural disparity and gender gap in injury mortality reduced gradually. In 2021, drowning and road traffic crashes were the top two causes of child injury deaths, explaing 31.1% and 27.9% of total injury deaths, respectively. Suffocation accounted for 62.3% of injury deaths among infants younger than a year. Alarmingly, the suicide mortality rate rose from 2.16 to 3.42 per 100,000 population between 2010 and 2021 among teenagers aged 15-19 years. Subgroup analyses yielded similar results. During 2010-2021, the injury mortality decreased significantly among Chinese children and adolescents, and the responding urban-rural disparities narrowed.

A gravidade oculta da pandemia de COVID-19 em crianças e adolescentes no Brasil: uma análise territorial da mortalidade hospitalar

Abstract This article aims to describe the geographical distribution of hospital mortality from COVID-19 in children and adolescents during the 2020-2021 pandemic in Brazil. Ecological, census study (SIVEP GRIPE) with individuals up to 19 years of age, hospitalized with SARS due to COVID-19 or SARS not specified in Brazilian municipalities, stratified in two ways: 1) in the five macro-regions and 2) in three urban agglomerations: capital, municipalities of the metropolitan region and non-capital municipalities. There were 44 hospitalizations/100,000 inhabitants due to COVID-19 and 241/100,000 when including unspecified SARS (estimated underreporting of 81.8%). There were 1,888 deaths by COVID-19 and 4,471 deaths if added to unspecified SARS, estimating 57.8% of unreported deaths. Hospital mortality was 2.3 times higher in the macro-regions when considering only the cases of COVID-19, with the exception of the North and Center-West regions. Higher hospital mortality was also recorded in non-capital municipalities. The urban setting was associated with higher SARS hospital mortality during the COVID-19 pandemic in Brazil. Living in the North and Northeast macro-regions, and far from the capitals offered a higher risk of mortality for children and adolescents who required hospitalization.

Cancer mortality in childhood and adolescence: analysis of trends and spatial distribution in the 133 intermediate Brazilian regions grouped by macroregions.

To assess the magnitude, trend, and spatial patterns of childhood and adolescent cancer mortality between 1996 and 2017 in 133 Brazilian intermediate regions by using socioeconomic and healthcare services indicators. This is an ecological study for analyzing the trend of mortality from cancer in childhood and adolescence through time series. Data on deaths were extracted from the Brazilian Mortality Information System. Data on population were extracted from the 1991, 2000, and 2010 demographic censuses of the Brazilian Institute of Geography and Statistics, with interpolation for intercensal years. Time series were delineated for mortality by type of cancer in each intermediate region. Such regions were grouped by macroregions to present the results. The calculation and interpretation of mortality trends use the Prais-Winsten autoregression procedure. Mortality rates for all neoplasms were higher in the Northern region (7.79 deaths per 100 thousand population), while for leukemias, they were higher in the Southern region (1.61 deaths per 100 thousand population). In both regions, mortality was higher in boys and in the 0-4 age group. The trend was decreasing (annual percent change [APC] - -2.11 [95%CI: -3.14; - 1.30]) for all neoplasms in the Brazilian regions and stationary (APC - -0.43 [95%CI: -1.61; 2.12]) for leukemias in the analyzed period. The mortality rate for all neoplasms showed higher values in regions with smaller numbers of ICU beds in the public healthcare system.

Knowledge of reproductive rights and associated factors among Oda Bultum University students, eastern Ethiopia.

Reproductive rights are an essential element of public health interventions to reduce adolescent and youth mortality and morbidity. A lack of knowledge about sexual and reproductive health is an important barrier that contributes to a variety of health and social issues. This study assessed the knowledge of reproductive rights among Oda Bultum University students, eastern Ethiopia. An institution-based cross-sectional study was carried out among 727 students from December 1 to 30, 2020. Participants were selected using a multistage sampling technique. Data were collected using a self-administered, pre-tested, and structured questionnaire. Data were entered into EpiData version 4.1 and analyzed using SPSS version 27. The study employed both bivariable and multivariable logistic regression analysis to determine the variables associated with knowledge regarding reproductive rights. The significance and degree of strength were declared at a p-value < 0.05 using an adjusted odds ratio with a 95% confidence interval. The overall knowledge of reproductive rights among university students was 47.2% (95% CI: 43.3%, 50.9%). Male gender (AOR = 2.11, 95% CI: 1.50, 2.97), urban residence (AOR = 1.62, 95% CI: 1.16, 2.28), formal maternal education (AOR = 2.26, 95% CI: 1.62, 3.17), participation in a sexual and reproductive health club (AOR = 2.67, 95% CI: 1.74, 4.10), utilization of sexual and reproductive health services (AOR = 6.29, 95% CI: 4.22, 9.36), and discussion about sexual and reproductive health issues (AOR = 1.60, 95% CI: 1.11, 2.30) were the factors that improved the knowledge of reproductive rights. Almost half of the university students know about reproductive rights. Various factors identified were associated with the knowledge of reproductive rights among university students, including gender, residence, parental education level, engagement in sexual and reproductive health clubs, utilization of sexual and reproductive health services, and discussions about sexual and reproductive issues. Healthcare professionals at all levels should concentrate on offering excellent services related to reproductive health and establishing programs for specific education and counseling on reproductive rights for all well-behaved students.

АНАЛИЗ ОРГАНИЗАЦИИ ОКАЗАНИЯ МЕДИЦИНСКОЙ ПОМОЩИ ДЕТЯМ, ПРОЖИВАЮЩИМ В СЕЛЬСКОЙ МЕСТНОСТИ ОРЕНБУРГСКОЙ ОБЛАСТИ

In order to understand how the situation in rural health care is changing as a result of the processes taking place within the framework of the Healthcare project, it is necessary to periodically analyze the situation in the provision of medical care to residents of rural areas. The purpose of the study: to assess the organization of medical care for children living in rural areas of the Orenburg region. Materials and methods. An assessment of the organization of medical care for children in rural areas in the Orenburg region was carried out for the period 2016–2020. A retrospective study was conducted using the methods of statistical and epidemiological analysis. Data provided by the state budgetary healthcare institution of the Orenburg region "Medical Information and Analytical Center" (MIAC). Results. A decrease in the population of the Orenburg region in rural areas, a decrease in the number of outpatient clinics, medical outpatient clinics and FAPs have been established. There was an increase in the capacity of polyclinics by 5.8% (from 196.8 to 213.9); decrease in the indicator of provision with pediatric and infectious beds (44.0%; 9.5%); the provision of pediatricians (per 10,000 population) decreased by 11.6% (2016 - 18.1; 2020 - 16.0). The incidence of children (0-14 years old), adolescents (15-17 years old) decreased respectively by 17.6% (in cities - by 14.5%, in districts - by 15.9%) and 20.2% (in cities - by 10.7%, in districts - by 30.9%). Infant mortality (per 1000 live births) decreased by 50% (from 6.5‰ in 2016 to 3.7‰ in 2020). In rural areas, infant mortality was on average 40% higher than in urban areas. Conclusions. Structural changes in rural healthcare are associated with a reduction in the rural population and optimization of healthcare. A positive trend in morbidity was revealed, a decrease in the mortality of children and adolescents in rural areas, but there is an increase in the incidence of certain classes of diseases, there are differences in the mortality rates of children and adolescents in rural areas from the urban population.

Adolescence Substance Use Prevention Strategies: A Review of Key Interventions

The rise in the prevalence of substance use among adolescents has triggered researchers for more studies on substance use and intervention strategies. The aim of the review is to provide a synthesis of effective preventive strategies in the face of multiple and variant literature on adolescent substance use data. A Google Scholar, and PUBMED academic literature published in English from 2012 to 2022 were included. A Google search of Keywords for the search were adolescent, substance use and preventive strategies. The described principles of prevention science provide examples of efficacious preventive interventions. It describes challenges and potential solutions necessary to take efficacious prevention policies and programs. It tends to scale and conclude with recommendations on how to reduce the burden of adolescent substance use mortality and morbidity worldwide through preventive interventions. Effective strategies share common goals with strengthening ‘protective factors,’ such as well-developed social skills, strong family bonds, attachment, active involvement, community, and religious organizations, while reducing ‘risk factors’ that increase vulnerability to substance use. In conclusion, several strategies are positive and effective, while some lack acceptable evidence for interventions. These attributes can help resource-constrained nations mount effective control measures against substance use. Keywords: Adolescence; Intervention; Substance Use; Strategies.