Cohort Of Adolescents Research Articles

Cognitive predictors of mental health trajectories are mediated by inferior frontal and occipital development during adolescence.

Laboratory studies show brain maturation involves synaptic pruning and cognitive development. Human studies suggest links between early cognitive performance and later mental health, but inconsistencies remain. It is unclear if specific brain regions mediate this relationship, and the molecular underpinnings are not well understood. Here, our longitudinal analyses in both the Adolescent Brain Cognitive Development and IMAGEN cohorts establish inverted U-shaped relationships between baseline executive function and subsequent symptom trajectories in the high-symptom individuals, whose externalizing (n = 963) or internalizing (n = 1762) symptoms exceed a clinical threshold at any point during the follow-up period, but not in the control group (n = 4291). Volumetric changes in the left lateral occipital cortex (LOC) mediated the relationship with externalizing symptoms (outwardly directed behaviors such as aggression), while changes in the right LOC and pars triangularis mediated the relationship with internalizing symptoms (inwardly directed emotional problems such as anxiety). Transcriptomic and genomic findings highlighted synaptic biology and particularly the gene ADCY1, which is implicated in synaptic pruning, as underlying both moderate executive function and its associated brain mediators. Notably, preadolescent cognitive performance predicts late-onset externalizing symptoms and remitting internalizing symptoms with high accuracies (area under the curve: 0.87 and 0.79). Our findings highlight the predictive value of cognitive performance for adolescent mental health trajectories, and indicate how this is mediated by specific brain regions, and underpinned by particular molecular pathways.

Comparison of scenarios in the trajectory of body mass index among adolescents monitored in primary health care: the VigiNUTRI Brazil study

We compared the BMI-for-age (BMI/A) trajectory of Brazilian adolescents monitored in the primary health care (PHC) setting based on a simulated scenario. We used a real-life cohort of adolescents monitored by the Food and Nutrition Surveillance System (Sisvan) between 2008 and 2018. The LMS method was employed to estimate the simulated BMI/A evolution curve, assuming that the adolescents maintained the conditions observed during their first assessment (simulation curve). This curve was compared with that of the real-world cohort (Sisvan curve). Both curves were compared to the World Health Organization (WHO) reference cutoff. The difference in the BMI/A trajectory between the two curves was evaluated using linear mixed-effects models. When the participants started adolescence, their BMI/A was above the reference range. The Sisvan curve revealed that girls had a BMI/A that was higher than the simulated value at age 19 (p < 0.001) and that exceeded the WHO reference cutoff value; this finding was particularly pronounced in the southern region (Sisvan: 23.89 kg/m2; simulation: 23.57 kg/m2; WHO: 21.4 kg/m2). The BMI of boys decreased after age 13 (p < 0.001) but remained higher than the reference value. Monitoring nutritional status in the PHC setting may have been more effective at controlling excess weight in boys, emphasizing the importance of improving care.

A cohort study on the association between blood pressure trajectories and variability in adolescence and subsequent target organ damage

Objective: To investigate the relationship between blood pressure trajectories and blood pressure variability with the risk of target organ damage in Chinese population from childhood to middle age. Methods: This study is a population-based, long-term follow-up cohort study. Participants who had their blood pressure measured at least 5 times in the Hanzhong Adolescent hypertension cohort from 1987 to 2023 were included in this study. Group-based trajectory modeling was used to identify different systolic and diastolic blood pressure trajectories, and the subjects were divided into low-increasing group, moderate-increasing group and high-increasing group according to blood pressure trajectories. Blood pressure variability was assessed using standard deviation (SD), variability independent of the mean (VIM), and average real variability (ARV). Target organ damage was evaluated during the final follow-up in 2023 (middle age). Logistic regression models were used to analyze the relationship between blood pressure trajectories and blood pressure variability with the risk of target organ damage. Results: A total of 2 447 subjects were included, with a median age of 48 years, of whom 1 373 were male (56.1%). Based on systolic blood pressure, 868 were in the low-increasing group, 1 238 in the moderate-increasing group, and 341 in the high-increasing group. For diastolic blood pressure, the distribution was 894, 1 263 and 290, respectively. Compared with the low-increasing group of systolic blood pressure, the moderate-increasing group (arteriosclerosis: OR=4.14, 95%CI 2.96-5.79; proteinuria: OR=2.06, 95%CI 1.38-3.07; left ventricular hypertrophy: OR=1.68, 95%CI 1.00-2.82) and high-increasing group (arterial stiffness: OR=15.44, 95%CI 10.14-23.50; proteinuria: OR=5.80, 95%CI 3.63-9.29; left ventricular hypertrophy: OR=2.93, 95%CI 1.55-5.53) had a higher risk of target organ damage (all P<0.005). The moderate-increasing group of diastolic blood pressure had a higher incidence of arterial stiffness (OR=3.72, 95%CI 2.69-5.12) and proteinuria (OR=1.67, 95%CI 1.15-2.42) than the low-increasing group (all P<0.005), while the high-increasing group had a significantly higher risk of all type of target organ damage compared to the low-increasing group (arterial stiffness: OR=10.84, 95%CI 7.08-16.61; proteinuria: OR=3.72, 95%CI 2.31-5.99; left ventricular hypertrophy: OR=2.38, 95%CI 1.23-4.59; all P<0.005). Additionally, higher systolic blood pressure variability was associated with an increased incidence of arterial stiffness (SD: OR=2.25, 95%CI 1.96-2.57; VIM: OR=1.64, 95%CI 1.45-1.86; ARV: OR=1.70, 95%CI 1.50-1.93) and proteinuria (SD: OR=1.65, 95%CI 1.44-1.89; VIM: OR=1.41, 95%CI 1.22-1.63; ARV: OR=1.45, 95%CI 1.26-1.67; all P<0.005). The results for diastolic blood pressure variability indicators were similar to those for systolic blood pressure. Conclusion: Early-life blood pressure trajectories are predictive of target organ damage risk in middle age. Higher blood pressure variability is related to an increased risk of arterial stiffness and proteinuria, but was less associated with left ventricular hypertrophy. Focusing on the risk of high blood pressure early in life can help prevent the occurrence of target organ damage in middle age.

Carotid-Femoral Pulse Wave Velocity in Children in South Africa: Reference Values for the Vicorder Device.

Atherosclerosis often starts in childhood, tracking to adulthood. In children, early vascular disease can be detected as arterial stiffness. Carotid-femoral pulse wave velocity is considered the non-invasive gold standard method for measuring arterial stiffness and widely accepted for use in children. We define pulse wave velocity (PWV) reference values for African children, in a cohort of children and adolescents living in Cape Town, South Africa, using the oscillometric Vicorder device, and considering the anatomical pathway in growing children. Three hundred and twenty four children (6-16 years old) were followed annually at Tygerberg Hospital, from March 2014 to March 2020, yielding 959 longitudinal PWV measurements. Centile curves for males and females by age and height were constructed using the Lamda-Mu-Sigma (LMS) method. Our study demonstrates that African children have a relatively flat PWV throughout childhood and early adolescence, from 7 to 14 years of age, and between 120 and 170 cm standing height. These gender-specific percentiles for age and height will allow accurate surveillance of arterial elasticity in African children over time. The identification of children at high risk is important given the long-term health implications and the effectiveness of early intervention to prevent progression to cardiovascular disease.

Grocery intervention and DNA-based assessment to improve diet quality in pediatric obesity: a pilot randomized controlled study.

We assessed the impact of a food-provisioning intervention on diet quality in children with obesity. Participants (n = 33, aged 6-11 years) were randomly assigned to either usual care (intensive health behavior and lifestyle treatment) or intervention (usual care + food provisioning; high-fiber, low-dairy diet) for 4 weeks. The primary outcome was a change in child diet quality at Week 4. Secondary outcomes were changes in weight, food insecurity, gut microbiome composition (16S ribosomal RNA), and dietary intake, measured via an objective DNA-based biomarker (i.e., FoodSeq). Genomic dietary data were analyzed against a larger pediatric adolescent obesity cohort (n = 195, aged 10-18 years) from similar households. Intervention demonstrated changes across all assessed diet components and was more effective than usual care in increasing whole grain (β = 0.20, 95% CI: 0.05 to 0.34; p = 0.013) and fiber (β = 2.52, 95% CI: 1.28 to 3.76; p < 0.001) and decreasing dairy (β = -1.31, 95% CI: -2.02 to -0.60; p = 0.001). FoodSeq results, highly concordant with grocery orders (adjusted R2 = 0.65; p < 0.001), indicated a dietary shift toward low-energy-density plant taxa in the intervention relative to a prior survey of diet in a related cohort (β = 8.64, 95% CI: 5.18 to 12.14; p < 0.001). No significant changes were observed in microbiome, weight, or food insecurity. Our study supports the potential of dietitian-guided food provisioning for improving diet quality in children with obesity and demonstrates an objective genomic approach for evaluating dietary shifts.

Effect of Pediatric Obesity Treatment on Long-Term Health

Data regarding the long-term impact of treating childhood obesity on the risk of obesity-related events, including premature mortality, are limited. To evaluate the long-term effect of different responses to pediatric obesity treatment on critical health outcomes in young adulthood. The study included a dynamic prospective cohort of children and adolescents with obesity within The Swedish Childhood Obesity Treatment Register (BORIS) and general population comparators, linked with national registers. Baseline data were collected between 1996 and 2019. Formal analyses for this study was conducted in 2023. Outcomes were assessed from individuals aged 18 to 30 years (2005 to 2020). Participants included children and adolescents aged 6 to 17 years receiving at least 1 year of obesity treatment. General population comparators were matched on a ratio of 1:5 on sex, year of birth, and geographical area. Pediatric obesity treatment response was based on changes in body mass index standard deviation score and categorized as poor, intermediate, and good response and obesity remission. Obesity-related events included type 2 diabetes (T2D), dyslipidemia, hypertension, depression or anxiety, and weight-loss bariatric surgery. Additionally, mortality was assessed. Of 6713 individuals (3777 male [56%] and 2936 female [44%]), the median age at obesity treatment initiation was 12.1 (quartile 1; quartile 3: 10.1; 14.3) years and treatment duration was 3.0 (1.8; 4.9) years. For T2D, hypertension, dyslipidemia, weight-loss bariatric surgery, and depression or anxiety outcomes, unadjusted incidence rates tended to decrease with better treatment response and the lowest estimate was observed among general population comparators. Compared with poor response, obesity remission or a good response in obesity treatment was associated with reduced risk of mortality (adjusted hazard ratio [HR], 0.12; 95% CI, 0.03-0.46). Good response was also associated with lower risk of TD2 (HR, 0.42; 95% CI, 0.23-0.77), dyslipidemia (HR, 0.31; 95% CI, 0.13-0.75), and bariatric surgery (HR, 0.42; 95% CI, 0.30-0.58). Obesity remission showed similar reduced risk, but also a reduced risk of hypertension (HR, 0.40; 95% CI, 0.24-0.65). Treatment response was not associated with depression or anxiety. In this study, beneficial pediatric obesity treatment response yielded enduring health benefits, markedly lowering future morbidity and mortality risks in young adulthood.

Factors protecting against progression of myopia in school students exposed to societal change in Vietnam: a 3-year cohort study

ObjectivesTo elucidate the incidence of myopia, progression of refractive error, axial length (AL) elongation and factors associated with myopia in secondary school students in Vietnam.DesignProspective cohort study.SettingsHue Healthy Adolescent Cohort...

Associations of behavioral, motivational, and socioeconomic factors with BMI among children and adolescents.

Higher weight represents a significant health concern in youth and may be influenced by socioeconomic and behavioral factors. We investigated the relationship between BMI and parental education, nutritional health, eating culture, organized and non-organized physical activity (PA), motives for PA (weight loss/maintenance, enjoyment), and screen-time in children and adolescents. 677 2- to 11-year-olds (young-age-group) and 464 12- to 20-year-olds (old-age-group) from Leipzig, a city in Germany, participated. We applied multivariate linear regression analyses to assess associations. BMI-SDS was negatively associated with parental education (young-age-group: b = -0.25, p < 0.001, old-age-group: b = -0.27, p = 0.02), non-organized PA (young-age-group: b = -0.23, p = 0.029), and PA enjoyment (young-age-group: b = -0.05, p = 0.01, old-age-group: b = -0.05, p = 0.038), but negatively with media use during dinner (old-age-group: b = 0.53, p < 0.001), PA for weight loss/maintenance (young-age-group: b = 0.15, p < 0.001, old-age-group: b = 0.12, p < 0.001), and screen-time (young-age-group: b = 0.11, p = 0.009, old-age-group: b = 0.09, p = 0.001). Significant interactions with age, sex and parental education were observed. A lower BMI in children is associated with high parental education, screen-free eating, higher participation in non-organized PA and lower screen-time. While measures of motivation were limited and thus findings should be interpreted with caution, intrinsic motivation for PA is associated with lower BMI whereas extrinsic motivation for PA is associated with higher BMI. In a German cohort of children and adolescents, lower BMI is associated with high parental education, less screen time, more participation in non-organized physical activity and less media use during dinner. Intrinsic and extrinsic motives for physical activity are directly linked to the weight status of children and adolescents. These associations are particularly strong in families with low/medium formal education.

Associations between Neighborhood Environment and Prenatal Alcohol and Tobacco Exposure.

Prenatal alcohol and tobacco exposure continue to impact a significant portion of the US population every year. Differences in neighborhood environment may be a contributing factor. The current study examines whether prenatal alcohol and tobacco exposure differ by neighborhood environment. We utilized neighborhood environment data linked to a US based, nationally representative cohort of adolescents (N = 8731 (47.2% female); Age: M = 118.6 months, SD = 7.4 months). Lower neighborhood deprivation, less air pollution, higher lead risk and perceived neighborhood safety were associated with prenatal alcohol exposure, while higher neighborhood deprivation and lower perceived neighborhood safety were associated with prenatal tobacco exposure. Neighborhood environments differ between prenatal alcohol exposed children and unexposed children, as well as between prenatal tobacco exposed children and unexposed children. Future research should consider the cumulative and interactive effects of prenatal exposure to alcohol and tobacco and neighborhood environment.

Relationships of eating behaviors with psychopathology, brain maturation and genetic risk for obesity in an adolescent cohort study

Unhealthy eating, a risk factor for eating disorders (EDs) and obesity, often coexists with emotional and behavioral problems; however, the underlying neurobiological mechanisms are poorly understood. Analyzing data from the longitudinal IMAGEN adolescent cohort, we investigated associations between eating behaviors, genetic predispositions for high body mass index (BMI) using polygenic scores (PGSs), and trajectories (ages 14–23 years) of ED-related psychopathology and brain maturation. Clustering analyses at age 23 years (N = 996) identified 3 eating groups: restrictive, emotional/uncontrolled and healthy eaters. BMI PGS, trajectories of ED symptoms, internalizing and externalizing problems, and brain maturation distinguished these groups. Decreasing volumes and thickness in several brain regions were less pronounced in restrictive and emotional/uncontrolled eaters. Smaller cerebellar volume reductions uniquely mediated the effects of BMI PGS on restrictive eating, whereas smaller volumetric reductions across multiple brain regions mediated the relationship between elevated externalizing problems and emotional/uncontrolled eating, independently of BMI. These findings shed light on distinct contributions of genetic risk, protracted brain maturation and behaviors in ED symptomatology.

Impact of Social Disadvantage on Medical and Functional Severity in Children With Cerebral Palsy.

Those with neurological disorders like cerebral palsy (CP) may experience an altered impact of social determinates of health on child functioning and well-being. We investigated the relationship between relative social advantage and medical and functional outcomes in a large cohort of children, adolescents and young adults with CP (n = 1269, aged 2-84 years). We extracted data from the Cerebral Palsy Research Registry and dichotomized a range of independent factors (income, ethnicity and race) into advantaged and disadvantaged/vulnerable and a range of medical and functional outcomes (gross motor, manual ability, behaviour, breathing, nutritional intake, hearing, seizures, language and vision) and computed odds ratios using logistic regression. We found significantly more gross and fine motor functional limitations for those with disadvantage in income (p = 0.002 and 0.006), marginalized race (p < 0.001 and 0.062) or ethnicity (p = 0.013 and 0.014). Ethnicity was further implicated in gestational age, whereas minority race played a role in more severe impairments in breathing, nutritional intake, language functioning and low birth weight status. We found evidence of more health and functional challenges for children with CP and social disadvantage in our cohort. Additional access to equitable resources may improve these imbalances and should be prioritized.

Sexual identity is associated with adverse childhood experiences (ACEs) in US early adolescents

ObjectiveTo determine disparities in adverse childhood experiences (ACEs) by sexual identity in a national cohort of early adolescents. MethodsWe analyzed cross-sectional data from year 2 of the Adolescent Brain Cognitive Development Study (N=10,934, 2018-2020, ages 10-14 years). Disparities in ACE score across lesbian, gay, or bisexual (LGB), not sure, and heterosexual adolescents were assessed using multinomial logistic regression analyses. Logistic regressions estimated the associations between sexual identity and each individual ACE. Analyses were adjusted for potential confounders. ResultsIn adjusted models, LGB adolescents had higher risk of experiencing 2, 3, or ≥4 ACEs (Relative Risk Ratios [RRR] =1.57, 95% CI 1.01-2.42), 3 (RR=1.78, 95% CI 1.100-2.88), or ≥4 ACEs (RRR=3.20, 95% CI 1.92-5.32), and not sure adolescents had a higher risk of having ≥4 ACEs (RRR=2.17, 95% CI 1.22-3.87), compared to heterosexual adolescents. LGB and not sure adolescents had higher risks of reporting emotional abuse (“yes” OR =4.21, 95% CI 1.84-9.61; “maybe” OR=6.20, 95% CI 2.91-13.19) and parent mental illness (“yes” OR=1.95, 95% CI 1.48-2.57; “maybe” OR=1.63, 95% CI 1.21-2.18) compared to heterosexual adolescents. ConclusionsLGB adolescents and those questioning their sexual identity were at greater risk of having higher ACE scores, with LGB adolescents experiencing the highest risk of experiencing ACEs. LGB adolescents also had higher odds of reporting emotional and parent mental illness. Recognizing this heightened risk of ACEs in early adolescence is critical for designing clinic and school-based interventions.

The prospective associations between problematic gaming and phubbing among Chinese adolescents: Insights from a cross-lagged panel network model

Background and aimsPrevious studies are limited in addressing the directionality of temporal relationships between problematic gaming and phubbing symptoms by exploring cross-sectional studies. Therefore, we estimated the longitudinal relationships between individual behavioral addictive symptoms including problematic gaming and phubbing in adolescence, and explored potential sex differences in these relationships. MethodsThis study included 3296 participants in Shandong Province, China. Data were collected from November 2021 (mean [SD] age: 15.17 [1.44] years) to May 2023 (mean [SD] age: 17.50 [1.18] years), with females comprising 54.5 % of the sample. Problematic gaming and phubbing were assessed using validated scales at each wave. We construct cross-sectional networks and cross-lagged panel networks (CLPN) to explore the contemptuous and temporal relationships between problematic gaming and phubbing. ResultsContemporaneous networks revealed significant differences in problematic gaming and phubbing networks between males and females. Additionally, temporal network analyses indicated that among male adolescents, feeling anxious when unable to play games was the most influential predictor of subsequent behavioral addictive symptoms. For female adolescents, fantasizing about gaming had the most significant associations with future addictive behaviors. The strongest bridge symptom linking problematic gaming and phubbing for both sexes was focusing on phones rather than engaging in conversation. Discussion and conclusionsThe study applied network modeling to panel data from a large, population-based cohort of adolescents, identifying unique longitudinal relationships between problematic gaming and phubbing across symptom domains. It provides valuable insights into the characterization of behavioral addictive symptoms among adolescents and the potential predictive relationships among these symptoms among different sexes, guiding sex-specific targeted interventions for adolescents.

Tracking the course of depressive and anxiety symptoms across adolescence (the CATS study): a population-based cohort study in Australia

Adolescent mental health appears to be in crisis, yet few studies have comprehensively charted the course of common mental disorders (CMDs; depression and anxiety) across this key life stage. We aimed to describe the course of CMD symptoms in adolescence by summarising annual prevalence, cumulative incidence, and course for depression and anxiety, both separately and as comorbid CMDs, by sex assigned at birth in a contemporary Australian cohort. The Child to Adult Transition Study (CATS) was established in 2012 to form a representative cohort of adolescents in Melbourne, VIC, Australia. 43 schools were recruited using a stratified sampling approach, and all 2289 students aged 8-9 years were invited to participate. 1239 (54·1%) students obtained parental written informed consent and were followed up annually from 2012 to 2019 for a total of ten waves. Data from waves 3-10 (ages 10 to 18 years) were used for the current study and analysed to describe the course of symptoms of CMDs across adolescence. Primary measures of interest were clinically relevant depressive symptoms, clinically relevant anxiety symptoms, and any CMD (clinically relevant depressive or anxiety symptoms) at waves 3-10. A secondary measure of interest was comorbid CMDs (concurrent reporting of clinically significant anxiety and depressive symptoms) at waves 3-10. Depressive symptoms in the past 2 weeks were self-reported using the 13-item validated Short Mood and Feelings Questionnaire (SMFQ) at each wave, with a threshold score of 12 or more indicating clinically relevant symptoms. Anxiety symptoms in the past two weeks were self-reported using an 8-item shortened version of the Spence Children's Anxiety Scale (SCAS) at each wave, with a threshold score of 11 or higher indicating clinically relevant symptoms. The course of CMDs was described using annual prevalence, cumulative incidence for depression and anxiety, separately and combined. Missing data were handled via multiple imputation. An author with lived experience was involved in the research and writing process. Of the 1239 adolescents who participated in the study, 667 (53·8%) were female and 572 (46·2%) were male. 769 (62·1%) of 1239 were classified as socioeconomically advantaged, 675 (66·4%) of the 1016 with available data had a mother whose highest level of education was vocational or tertiary, and 579 (70·7%) of the 819 participants with ethnicity data identified as Anglo-Celtic or European. Overall, incidence of any clinically significant CMD symptoms during adolescence was 74% (95% CI 70-77; 84% [81-88] for females and 61% [55-66] for males). Independently, incidences of clinically significant depressive symptoms and anxiety symptoms were 65% (62-68) and 58% (55-62), respectively. Incidence of comorbid CMD was 48% (45-52). The estimated mean ages of first report in adolescence for both sexes were 14·1 years (95% CI 13·9-14·4) and 13·6 years (3·3-13·9) for depressive and anxiety symptoms, respectively. Of those who reached the threshold score for any CMD between ages 10 and 18 years, over half had a chronic (three or more waves) course (depression 54% [49-60]; anxiety 52% [47-58]), and a third met criteria for full remission at any subsequent wave (depression 30% [25-35]; anxiety 33% [27-39]). Females were consistently estimated to have a worse course of adolescent CMDs compared with males (eg, 64% [58-70] of females had a chronic course of depressive symptoms vs 37% [26-48] of males). In this contemporary multi-wave cohort study, almost three-quarters of adolescents reported CMD symptoms. The likelihood of chronicity of CMD symptoms (ie, recurrence) was high. Universal responses are urgently required to address this considerable public health problem. National Health and Medical Research Council of Australia and the Royal Children's Hospital Foundation.

Association Between the Treatment Modality of Pediatric Subcondylar Fractures and Functional Outcomes at the Six-Month Follow-Up: A Retrospective Pilot Study.

The choice of treatment for subcondylar fractures in children and adolescents remains a controversial issue. The aim of this study was to evaluate the association between the treatment modality of subcondylar fractures and functional outcomes at the six-month follow-up. This retrospective study examined a cohort of children and adolescents with unilateral or bilateral subcondylar fractures treated at a level 1 trauma center over a five-year period. Radiological assessments of ramal height shortening (RHS) and subcondylar fracture angulation (SFA) were conducted using cone beam computed tomography. A total of 28 patients met the inclusion criteria, which required participants to be 18 years of age or younger, have a follow-up period of at least six months, and present with an initial SFA of less than 45°. Subcondylar fractures were classified into three categories: Class I (RHS <2 mm and/or SFA <10°), Class II (RHS ≥2 mm and ≤15 mm and/or SFA ≥10° and ≤35°), and Class III (RHS >15 mm and/or SFA >35°). Functional outcomes, including maximal mouth opening, lateral movements, and protrusive movements, were assessed at the six-month follow-up. Reference values specific to children and adolescents were applied to distinguish between normal and limited mandibular motion. The relationship between treatment modality and functional outcomes was analyzed using logistic regression, with adjustments made for age, sex, and fracture classification. Results: Twenty-eight patients (67.9% male; mean age 14.0±4.0 years) met the inclusion criteria. Of these, 53.6% (n=15) were treated with open reduction and internal fixation, while 46.4% (n=13) underwent closed reduction. The choice of treatment modality significantly influenced patient prognosis. Closed reduction was strongly associated with improved functional outcomes, specifically in the vertical range of movement (odds ratio (OR)=16.4; P=0.047), lateral range of movement (OR=18.7; P=0.044), and overall combined functional outcomes of vertical, lateral, and protrusive movements (OR=10.9; P=0.028). This preliminary study suggests a correlation between treatment modality and functional outcomes at the six-month follow-up. Open reduction and internal fixation of subcondylar fractures in children and adolescents may carry a higher risk of poor functional outcomes. The findings support closed reduction as the preferred approach for Class I-III cases with subcondylar fracture fragments angulated between 0° and 45°.

The Risk of Hospital Admission for an Acute-Onset Psychiatric Disorder in Adolescents and Adults Treated with Isotretinoin: A French, Nationwide, Population-Based, Case-Time-Control Study

Introduction: Oral isotretinoin is the only effective treatment for severe acne without an alternative. Isotretinoin has been linked to the occurrence of acute psychiatric disorders outside suicidal behaviors. There are few large-scale epidemiological studies in this area, and the putative associations are unclear. Our objective was to determine whether adolescents and young adults have an elevated risk of acute-onset psychiatric disorder requiring hospital treatment within 2 months of starting isotretinoin treatment. Methods: Our data source was the French national health insurance database (Système National des Données de Santé, SNDS), 2010–2015. We performed a case-time-control study nested in an exhaustive, nationwide cohort of all French adolescents and young adults aged 10–25 years treated with isotretinoin. The outcome was an acute-onset psychiatric disorder requiring hospitalization (including anxiety, depressive, mood, adjustment, and psychotic disorders). A conditional logistic model was used to estimate odds ratios (ORs) with their 95% confidence interval (CI) for acute psychiatric events. Results: 2,284 acute-onset psychiatric disorder requiring hospitalization were recorded for the study population of 262,786 patients. Among the patients with at least one psychiatric event, 88 had started taking isotretinoin in the risk period (0–2 months before the date of the event), versus 81 in the reference period (2–4 months before the event). A comparison with the 383 and 355 time-trend matched controls who started taking isotretinoin in the risk and reference periods, respectively, yielded a case-time-control OR (95% CI) of 1.01 (0.72–1.41). Conclusion: Psychiatric events managed outside the hospital system were not recorded. Our findings are reassuring for clinicians concerning the risk of severe acute-onset psychiatric events after isotretinoin initiation.

Effectiveness of the primary Bacillus Calmette-Guérin vaccine against the risk of Mycobacterium tuberculosis infection and tuberculosis disease: a meta-analysis of individual-participant data

Tuberculosis vaccine trials using disease as the primary endpoint are large, time consuming, and expensive. An earlier immunological measure of the protection against disease would accelerate tuberculosis vaccine development. We aimed to assess whether the effectiveness of the Bacillus Calmette-Guérin (BCG) vaccine for preventionof Mycobacterium tuberculosis infection was consistent with that for prevention of tuberculosis disease. We conducted an individual participant data (IPD) meta-analysis on experimental and observational longitudinal studies before April 6, 2018, identified through systematic reviews, known to us through expert knowledge in the field, reporting on BCG vaccination status, Mtuberculosis infection test (QuantiFERON IFN-γ release assay [IGRA] and tuberculin skin test [TST]), and tuberculosis incidence. Cohort studies were included only for countries with a mandatory neonatal BCG vaccination policy. Exclusion criteria were previous or current tuberculosis disease, HIV infection, tuberculosis preventive treatment usage, and for household contacts, a positive baseline IGRA or TST test and young children aged 0-2 years; for randomised controlled trials, TST results within 2years after random assignation were excluded. We contacted the investigators of the identified studies to provide IPD. We compared the protective efficacy of the BCG vaccine against Mtuberculosis infection with that against tuberculosis disease using mixed-effects, multivariable proportional hazards modelling, by study type, Mtuberculosis infection test (IGRA and TST), cutoff for defining test positivity, age, sex, and latitude. We identified 79studies eligible for full screening and of these, IPD datasets from 14studies were included in our analysis: 11household contact studies (29 147participants), two adolescent cohort studies (11 368participants), and one randomised controlled trial (2963 participants). Among 28 188participants we found no protection by the BCG vaccine against TST conversion regardless of cutoff in any type of study. Among 1491household contacts, but not among 5644adolescents, the BCG vaccine protected against QuantiFERON conversion at the primary cutoff of 0·7IU/mL or more with the adjusted hazard ratio (0·65, 95% CI 0·51-0·82) being consistent with that for protection against disease (0·68, 0·18-2·59). Protection against QuantiFERON conversion at cutoff of 0·35IU/mL or more (0·64,0·51-0·81) was similar. Protection from the BCG vaccination against Mtuberculosis infection, measured as QuantiFERON conversion, is inconsistent across different groups. Among groups with recent household exposure, QuantiFERON conversion is consistent with protection against disease and could be evaluated as a proxy for disease in tuberculosis vaccine trials. We found that TST lacks value for prevention in phase 2b proof-of-concept trials. Bill & Melinda Gates Foundation.

Engaging adolescents and young adults in decisions about return of genomic research results: study protocol for a mixed-methods longitudinal clinical trial protocol

BackgroundTo protect minors’ future autonomy, professional organizations have historically discouraged returning predictive adult-onset genetic test results and carrier status to children. Recent clinical guidance diverges from this norm, suggesting that when minors have genomic sequencing performed for clinical purposes, parents and children should have the opportunity to learn secondary findings, including for some adult-onset conditions. While parents can currently opt in or out of receiving their child’s secondary findings, the American Society of Human Genetics Workgroup on Pediatric Genetic and Genomic Testing suggests including adolescents in the decision-making process. However, it is not clear what factors young people consider when given the opportunity to learn genetic findings for themselves. In this manuscript, we report on the methods for a clinical trial that examines adolescents’, young adults’, and their parents’ decisions about learning genomic information for the adolescent or young adult.MethodsWe are enrolling assenting (ages 13–17) adolescents and consenting (ages 18–21) young adults in a prospective genomic screening study to assess the choices they make about receiving individual genomic results. Participants use an online tool to indicate whether they want to learn their personal genetic risk for specific preventable, treatable, and adult-onset conditions, as well as carrier status for autosomal recessive conditions. We are examining (1) how choices differ between adolescent and young adult cohorts (as well as between adolescents/young adults and parents) and (2) decisional conflict and stability across study timepoints. Results are returned based on participants’ choices. Qualitative interviews with a subset of participants explore decisional stability, adolescent/young adult engagement with parents in decision-making, and the impact of learning pathogenic/likely pathogenic and autosomal recessive carrier results.DiscussionThis study explores decision making and decision stability between adolescents and parents (where applicable), as well as the ethical implications and impact of return of clinical-grade genetic research results to adolescents and young adults. The results of this study will contribute empirical evidence to support best practices and guidance on engaging young people in genomic research studies and clinical care that offer return of results.Trial registrationClinicalTrials.gov Identifier: NCT04481061. Registered 22 July 2020.

Admixture of Liposomal Bupivacaine and Bupivacaine Hydrochloride for Peripheral Nerve Blocks in Adolescents Undergoing Orthopedic Surgery: An Observational Cohort Study.

Background/Objectives: In 2021, the Food and Drug Administration approved liposomal bupivacaine injectable suspension for single-dose infiltration in patients ≥ 6 years of age. Liposomal bupivacaine and bupivacaine hydrochloride admixtures may also be administered off-label for pediatric regional anesthesia including peripheral nerve blocks (PNBs). This single-injection, long-acting technique is not well described in pediatrics but may have benefits over traditional continuous catheter-based systems. The purpose of this investigation was to examine an adolescent cohort who received liposomal bupivacaine/bupivacaine hydrochloride PNBs for orthopedic surgery. Methods: Patient, surgical, anesthetic, block characteristics, and post-anesthesia care unit (PACU) outcomes were retrospectively reviewed from February 2020 to June 2024. From February to December 2022, a short follow-up survey was conducted to assess post-discharge patient-reported outcomes. Results: There were 524 liposomal bupivacaine/bupivacaine hydrochloride PNBs (106 upper-extremity and 418 lower-extremity) performed in 374 patients with a mean (standard deviation, range) age of 16 (1.2, 11-17) years. Two unilateral PNBs were performed in 150 (40%) patients to ensure an adequate sensory neural blockade. The interscalene (n = 81, 15%) and adductor canal (n = 140, 27%) blocks were the most common upper- and lower-extremity PNBs, respectively. Intraoperatively, the majority of the cohort (n = 258, 69%) underwent monitored anesthesia care (MAC). No patient required conversion from MAC to general anesthesia due to pain. In PACU, 288 (77%) patients reported no pain. Mild and moderate pain were reported by 56 (15%) and 30 (8%) patients, respectively. No patients developed local anesthetic toxicity. The survey results (n = 66) indicate that the majority of patients (96%) were satisfied with block analgesia postoperatively. Conclusion: Liposomal bupivacaine/bupivacaine hydrochloride PNBs were used successfully in adolescents undergoing a variety of orthopedic surgeries.

Firearm Injury Risk Prediction Among Children Transported by 9-1-1 Emergency Medical Services: A Machine Learning Analysis.

Among children transported by ambulance across the United States, we used machine learning models to develop a risk prediction tool for firearm injury using basic demographic information and home ZIP code matched to publicly available data sources. We included children and adolescents 0-17 years transported by ambulance to acute care hospitals in 47 states from January 1, 2014 through December 31, 2022. We used 96 predictors, including basic demographic information and neighborhood measures matched to home ZIP code from 5 data sources: EMS records, American Community Survey, Child Opportunity Index, County Health Rankings, and Social Vulnerability Index. We separated children into 0-10 years (preadolescent) and 11-17 years (adolescent) cohorts and used machine learning to develop high-specificity risk prediction models for each age group to minimize false positives. There were 6,191,909 children transported by ambulance, including 21,625 (0.35%) with firearm injuries. Among children 0-10 years (n = 3,149,430 children, 2,840 [0.09%] with firearm injuries), the model had 95.1% specificity, 22.4% sensitivity, area under the curve 0.761, and positive predictive value 0.41% for identifying children with firearm injuries. Among adolescents 11-17 years (n = 3,042,479 children, 18,785 [0.62%] with firearm injuries), the model had 94.8% specificity, 39.0% sensitivity, area under the curve 0.818, and positive predictive value 4.47% for identifying patients with firearm injury. There were 7 high-yield predictors among children and 3 predictors among adolescents, with little overlap. Among pediatric patients transported by ambulance, basic demographic information and neighborhood measures can identify children and adolescents at elevated risk of firearm injuries, which may guide focused injury prevention resources and interventions.