Search Results (2,634)

This study examined Saudi adolescents’ digital use, experiences of cyberbullying, and willingness to seek help when facing online risks. Furthermore, the study examined how perceived online safety, preferred reporting sources, exposure to online safety education, and demographic characteristics are associated with resistance to help-seeking. A cross-sectional online survey was completed by 302 adolescents aged 11–17 years across Saudi Arabia. Descriptive statistics, one-way ANOVAs, and hierarchical multiple regression were used to explore patterns and predictors of resistance to help-seeking. Descriptively, the results showed near-universal smartphone access, high daily screen time, and that a substantial minority had experienced recent cyberbullying, including repeated victimization. Although most participants reported feeling safe online, many expressed uncertainty and endorsed self-reliant or avoidant responses, with over half agreeing they would “just ignore” cyberbullying. Parents were the most frequently identified reporting source, yet around one-fifth of adolescents said that they would not seek help from anyone. Regression analyses indicated that female gender, higher socioeconomic status, feeling less safe online, and receiving online safety education from multiple sources were associated with lower resistance to help-seeking, whereas greater cyberbullying exposure predicted higher resistance. Overall, the results highlight the need for multi-source, culturally grounded online safety education and strengthened reporting pathways across families, schools, and digital platforms to support Saudi adolescents who experience cyberbullying and related online harms. Full article

Background/Objectives: Advanced technologies in type 1 diabetes mellitus (T1DM) management have reshaped the strategies used to achieve optimal glucose control. Continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) systems are effective alternatives to multiple daily injections (MDI). This study aims to evaluate glycemic regulation in children and adolescents transitioning from MDI to insulin pumps and to raise awareness among patients and their families regarding the benefits of these systems. Methods: 50 pediatric patients with T1DM (24 males, 26 females; mean age 10.76 ± 3.2 years) were evaluated. Cycle 1 established MDI metrics 3 months pre-transition. In cycle 2, patients transitioned either to an AID system (Medtronic MiniMed 780G, (Northridge, CA, USA), 78%), or a non-automated system (Omnipod DASH, 22%). Data were assessed at 3 and 6 months post-initiation. Parameters assessed were glycosylated hemoglobin (HbA1c), time in range (TIR), time above range (TAR), time below range (TBR), glucose management indicator (GMI) and coefficient of variation (CV). Results: The cohort exhibited a statistically significant increase in TIR (p = 0.0038) with mean values of 70.9% at 3 months and 73.2% at 6 months. TAR significantly reduced (p = 0.033) to 26.5% and 24.3% at 3 and 6 months, respectively. Sub-analysis in the AID group revealed a marked increase in TIR (p = 0.0001) alongside significant reductions in TAR (p = 0.0009) and GMI (p = 0.03). Conclusions: Transitioning from MDI to insulin pump therapy, particularly AID systems, leads to modest but significant improvements in specific sensor metrics (TIR, TAR) in real-world clinical practice. The consistency of these results across age groups indicates that AID systems can successfully overcome pediatric and adolescent diabetes management challenges. Full article

Background/Objectives: Pediatric obesity is closely associated with metabolic syndrome (MetS), a condition linked to increased cardiometabolic risk. Early identification of high-risk individuals remains challenging. This study aimed to evaluate the diagnostic performance of selected anthropometric, metabolic dysfunction and insulin resistance indexes for identifying MetS in children and adolescents with obesity. Methods: In this retrospective, cross-sectional, single-center study, 758 children and adolescents with obesity (mean age 14.8 ± 2.1 years; 59.9% females) hospitalized for a body weight-reduction program were included. MetS was defined according to International Diabetes Federation criteria, in which central obesity is a mandatory diagnostic component. The triglyceride–glucose (TyG), TyG–waist circumference (TyG-WC), body adiposity index (BAI), fasting glucose-to-insulin ratio (FGIR), and quantitative insulin sensitivity check index (QUICKI) were calculated. Receiver operating characteristic curve analysis was used to assess their discriminative ability. Results: The prevalence of MetS was 27.8% and was significantly higher in males than females (34.9% vs. 23.1%, p < 0.0001). TyG and TyG-WC showed the best discriminative performance (AUC 0.75 and 0.76, respectively), although with only moderate sensitivity and specificity. FGIR and QUICKI demonstrated lower accuracy (AUC 0.64 and 0.63), whereas BAI showed no discriminative ability (AUC 0.48). These findings were consistent across sexes, although sex-specific differences in both MetS prevalence and optimal cut-off values were observed. Correlation analyses confirmed moderate associations between TyG-based indexes and MetS, whereas other indexes showed weaker relationships. Conclusions: In the present cohort of children and adolescents with obesity, TyG and TyG-WC showed the best performance in identifying MetS compared with the other evaluated indexes. However, their performance remained moderate, and the proposed cut-off values require validation in independent populations. These indexes may represent simple supportive screening and risk-stratification tools but should be used alongside comprehensive clinical assessment and established diagnostic criteria rather than as stand-alone diagnostic measures. Full article

Background/Objectives: Evidence for herbal ergogenic aids remains uncertain, and ashwagandha trials span heterogeneous performance domains. This review evaluated oral Withania somnifera supplementation on exercise performance and explored participant-, outcome-, formulation-, and supplementation-related moderators. Methods: PubMed, Web of Science, Cochrane Library, Embase, and SPORTDiscus-EBSCO were searched from inception to 1 April 2026. Eligible randomized controlled trials compared oral ashwagandha with placebo or control conditions and reported objective exercise-performance outcomes. Dependent effects were synthesized using restricted-maximum-likelihood three-level random-effects models; 95% prediction intervals, GRADE certainty ratings, subgroup analyses, and dose/duration meta-regressions were reported. Results: Thirteen trials involving 599 participants contributed 79 effect sizes. Samples were mainly young adults or athletes; reported ages included one 18–40-year trial and one late-adolescent athlete cohort aged 17.4 ± 1.7 years. Trial-level sex composition was four male-only, one female-only, three mixed-sex, and five incompletely reported cohorts. Ashwagandha improved overall exercise performance on average (Hedges’ g = 0.47, 95% CI [0.25, 0.69], p < 0.001; I² = 60%; 95% prediction interval [−0.40, 1.33]), but the prediction interval crossed zero. Exercise type was the clearest moderator (P_between = 0.006): evidence was most consistent for aerobic endurance (g = 0.54, 95% CI [0.22, 0.85], p = 0.002), whereas strength effects were positive but uncertain and power or muscular endurance evidence remained sparse. Dose analyses were hypothesis-generating; 500–600 mg/day was the most evidence-supported extract-dose range. Conclusions: Oral ashwagandha may improve selected exercise-performance outcomes, particularly aerobic endurance, but benefits are not uniform across contexts. Future trials should be preregistered, adequately powered, double-blind, formulation-standardized, sex-stratified, and include rigorous blinding checks, mechanistic endpoints, adverse-event monitoring, and sport-specific performance tests. Full article

Background/Objectives: Adolescent idiopathic scoliosis (AIS) is a multifactorial condition with an unclear etiology. Previous studies have reported associations of scoliosis with female sex, lower body mass index (BMI), and lower physical activity levels. This study examined factors associated with suspected scoliosis identified through school screening, with emphasis on BMI and sports participation. Methods: A cross-sectional study was conducted during the 2019/2020 school year and included 18,216 adolescents. Suspected scoliosis was identified using the forward bend test (FBT). Logistic regression analysis assessed associations between suspected scoliosis and sex, grade, BMI, participation in the seven most frequently reported sports, and training frequency. Results: Higher BMI (odds ratio (OR) = 0.91, p < 0.001), participation in soccer (OR = 0.64, p < 0.001), gymnastics (OR = 0.58, p = 0.05), martial arts (OR = 0.66, p = 0.02), and higher recreational training frequency (OR = 0.92, p < 0.001) were associated with lower odds of suspected scoliosis. Female sex (OR = 2.49, p < 0.001) and higher grade level (6th: OR = 1.54; 8th: OR = 2.98; p < 0.001) were associated with increased odds of suspected scoliosis. Conclusions: Suspected scoliosis identified through school screening was more frequently observed among females and adolescents with lower BMI. Participation in certain sports and greater recreational physical activity were associated with lower prevalence and odds of suspected scoliosis. These findings reflect screening-based associations and do not imply causal relationships. The results support the importance of school-based screening and consideration of body composition and physical activity patterns in the early identification of adolescents with suspected scoliosis. Full article

Background/Objectives: Pubertal maturation encompasses hormonal, somatic, and metabolic alterations that may influence pulmonary function in children with asthma. We evaluated the correlates of pulmonary function in pediatric asthma using sex-stratified analyses of pubertal stage, BMI z-score, asthma control (ACQ-6), and HDL cholesterol levels on FEV1, FVC, and the FEV1/FVC ratio (% predicted, NHANES III). Methods: A cross-sectional study was conducted with 118 children and adolescents with asthma (74 males and 44 females). The Tanner stages were categorized as pre-/early (I–II), mid (III), and late (IV). No participant had reached Tanner stage V at recruitment, and the reference category was composed predominantly of Tanner II participants; therefore, the pubertal contrast reflected early- versus mid-/late-pubertal physiology rather than a strictly prepubertal-versus-pubertal comparison. We performed hierarchical linear regression with bias-corrected and accelerated bootstrap inference (5000 replicates) for each sex and for all participants combined, complemented by a formal sex × predictor interaction test. Results: Mid- and late puberty were independently associated with reduced FEV1% and FVC% (β −0.25 to −0.31), without affecting the FEV1/FVC ratio. Sex-stratified analyses were exploratory and identified apparently divergent predictor sets by sex: in males, the pubertal stage was significant in FEV1% and FVC% (β −0.30 to −0.42), whereas the BMI z-score diminished the FEV1/FVC ratio (β = −0.274). In females, FEV1% was associated with HDL-c (β = 0.463), BMI z-score (β = 0.429), and ACQ-6 score (β = −0.306); the female FEV1/FVC% model showed a substantial apparent effect (Cohen’s f² = 0.508), with ACQ-6 score and HDL-c as primary associated variables. The formal sex × predictor interaction test in the combined sample, however, did not reach statistical significance (ΔR² = 0.037; p = 0.178), indicating that the sex-differential patterns observed in the stratified models were not confirmed as effect modifications. Conclusions: Sex-stratified exploratory analyses in this pediatric asthma cohort identified apparently divergent patterns of associations in males and females; however, the formal interaction test was not statistically significant, indicating that these stratified differences were not confirmed and require validation in adequately powered prospective cohorts. These findings identify HDL-c, body composition, and symptom control as candidate correlates of pulmonary function, with potential sex-related differences warranting further investigation. Full article

Background/Objectives: Adolescence is a crucial stage of development, in which life skills are essential for promoting psychological well-being. Social and Emotional Learning (SEL) interventions aim to develop social–emotional and relational skills that foster resilience and adaptation. Short-term effects may be nonlinear and influenced by gender differences, with possible fluctuations in self-assessments due to increased social–emotional awareness (response shift). Methods: This action research study involved 179 preteens (ages 11–17) from educational settings in Aosta Valley. The SEL program consisted of three experiential sessions on key life skills, led by psychologists and psychiatrists and including group activities and role-playing. Quality of life was assessed before and after the intervention using the Q-LES-Q, which measures satisfaction and well-being in the areas of social relationships, physical health, academic performance, leisure activities, and subjective feelings. Subscale scores were calculated as the mean of the corresponding items. Results: The results revealed nonlinear patterns: a decline in satisfaction with social relationships, which may reflect a response shift. Males reported higher initial levels and greater perceived positive effects, while females reported lower post-intervention scores, likely due to greater self-reflection and self-criticism. Conclusions: The data highlight the complexity of the short-term effects of SEL interventions and the importance of considering developmental trajectories and gender differences when evaluating their effectiveness. Full article

(1) Background: Student burnout, widely regarded as a form of “hidden dropout” among adolescents, is associated with lower educational quality and mental health. Grounded in the Study Demands–Resources (SD–R) and Conservation of Resources (COR) theories, this study investigates the relationship between school-based resources, family dynamics, and personal resources by examining how teacher emotional support is associated with burnout through family cohesion and meaning in life; (2) Methods: a moderated mediation model was tested using a sample of 1224 adolescents (Mage = 14.27, SD = 1.72; 48% female); (3) Results: Analysis revealed that: 1. Teacher emotional support significantly and negatively predicted student burnout (β = −0.28, p < 0.001). 2. Family cohesion partially mediated this relationship, accounting for 36% of the total effect. 3. Meaning in life significantly moderated both the direct path and the second half of the mediation pathway (family cohesion → burnout). Notably, meaning in life was associated with a stronger negative association between teacher emotional support and student burnout, but a weaker negative association between family cohesion and student burnout, a pattern consistent with differential resource utilization; (4) Conclusions: These findings suggest a differentiated pattern of resource interplay: school-based emotional resources may connect to family-based relational resources, and the protective role of each external resource may be further moderated by adolescents’ internal meaning systems. These findings highlight the agentic role of adolescents in resource management and point to the value of multi-system interventions. Full article

Background: Childhood obesity can cause changes in respiratory mechanics, particularly in the peripheral airways. This study aimed to evaluate impulse oscillometry (IOS) parameters in obese children and to investigate the relationship between small airway function and metabolic indicators. Methods: A total of 135 children and adolescents (56.3% female) were included in the study. Seventy participants were obese, and 65 were in the normal-weight control group. IOS parameters (R5, R20, R5–R20, X5, X20, AX, Fres) were compared between the two groups. Obese participants were further divided into subgroups based on HOMA-IR levels, with and without metabolic disorders. The relationships between IOS parameters and body mass index z-score, HOMA-IR, and HbA1c were evaluated using correlation analysis. Results: The R5 value was significantly higher in the obese group compared to the control group (p = 0.01). The R20 parameter and R5–R20 parameter were markedly increased in the obese group (p = 0.03 and p < 0.001, respectively). The AX value was also significantly higher in the obese group (p = 0.02). No significant differences were found between the groups in terms of X5, X20, and Fres (p > 0.05). In the metabolic sub-analysis of the obese group, IOS parameters did not differ according to metabolic status. However, a weak positive correlation was found between HOMA-IR and R5–R20 (r = 0.257, p = 0.031) and AX (r = 0.290, p = 0.015). A moderate positive relationship was found between BMI z-score and R5–R20 (r = 0.424, p < 0.001) and AX (r = 0.383, p = 0.01). Conclusions: Small airway dysfunction was detected in obese children. The findings suggest that mechanical factors may be more dominant than metabolic factors in peripheral airway involvement. Full article

Background/Objectives: Adolescence is a critical period for the adoption of health-risk behaviors and the development of non-communicable diseases (NCDs). Schools represent a strategic setting for health promotion interventions; however, Italian studies simultaneously assessing NCD-prevention knowledge and lifestyle behaviors in the same adolescent population remain scarce. The study aimed to evaluate improvements in knowledge regarding nutrition and other lifestyle-related behaviors among Italian adolescents following a school-based educational intervention. Secondary objectives included describing lifestyle behaviors within the study population and exploring participants’ evaluation of the intervention. Methods: A quasi-experimental pre-post study was conducted between March and May 2025 in five lower secondary schools. A total of 410 adolescents aged 11–16 years were enrolled through a two-stage cluster sampling procedure. The intervention, lasting approximately two hours, was delivered by a trained nurse-researcher and addressed four health domains: nutrition, physical activity, screen exposure, and substance use. Results: Following the intervention, a measurable increase in overall knowledge scores (mean increase: +3.9 points) was observed, with 88.9% of participants showing improvement. The largest improvements were observed in nutrition-related knowledge and awareness of passive smoking harms. Despite these gains, unhealthy behaviors remained prevalent, including low adherence to physical activity recommendations (36.1%), suboptimal dietary quality (39.9%), and high screen exposure. A linear regression model identified five independent determinants of higher knowledge improvement: older age, female gender, higher screen exposure, having at least one employed parent, and lower pre-intervention test scores. The intervention was positively evaluated, with high levels of satisfaction, clarity, and perceived usefulness. Conclusions: Nevertheless, the persistent gap between knowledge and behavior underscores the need to integrate motivational and environmental components, gender-sensitive approaches, and longitudinal evaluations to foster sustainable, healthy choices and contribute to NCD prevention. Full article

Executive functions (EFs) are key cognitive processes for behaviour. However, there is little information about interaction with the dimensions of health-related quality of life (HRQoL), therefore the objective of this study was to analyse the association between lifestyle habits (physical activity and screen time), sleep, HRQoL and EFs in children and adolescents. Specifically, this study aimed to identify the extent to which perceived well-being dimensions are associated with EFs and to determine the potential mediating role of HRQoL in the relationships between lifestyle habits and these cognitive domains, examining whether these direct and indirect pathways remain robust after adjusting for gender and age. A total of 943 children and adolescents (51.3% female) aged 10–17 years participated. Lifestyle parameters (PA Krece Plus, sleep duration and KIDSCREEN-10 questionnaire) and EFs (CogniFit neurocognitive assessment battery) were evaluated. The analysis of the individual KIDSCREEN-10 items revealed that perception of school performance presented the most consistent association with EFs, being positively related to attention (b = 16.39, p = 0.018), cognitive flexibility (b = 30.65, p = 0.005), inhibition (b = 24.66, p = 0.022), and working Memory (b = 42.33, p < 0.001). Furthermore, parental fairness reported a significant association for three out of four domains: attention (b = 13.89, p = 0.006), flexibility (b = 22.93, p = 0.003), and working Memory (b = 25.42, p < 0.001). Having enough time for self was also significantly related to attention performance (b = 12.60, p = 0.026). Regarding lifestyle habits, the composite lifestyle index (PA + ST) showed the most consistent positive association across all cognitive domains, while sleep duration was inversely associated with attention, cognitive flexibility, and working Memory. The mediation analysis revealed that global HRQoL significantly mediated the relationship between lifestyle habits and executive functions, accounting for 9.55% of the total effect on attention, 5.45% on cognitive flexibility, and 4.14% on working memory, whereas no mediation was observed for inhibition. In conclusion personal time, parental fairness, and school adjustment were positively associated with EFs. HRQoL and physical activity levels also showed consistent links with all EFs, whereas sleep duration was inversely related. Furthermore, mediation analysis revealed that global HRQoL acts as a critical indirect pathway, explaining a significant proportion of the lifestyle habits’ total effect on attention, cognitive flexibility, and working memory. Overall, these findings highlight the multifactorial and interrelated mechanisms shaping executive functioning in children and adolescents. Full article

Ovarian tissue cryopreservation (OTC) has emerged as the only viable fertility preservation strategy for prepubertal girls and adolescent cancer patients facing gonadotoxic treatments. While OTC has transitioned from an experimental procedure to an established clinical practice, the functional longevity of transplanted grafts remains limited by massive follicle depletion. This review synthesizes recent technological advances in OTC for female children, with a particular focus on the underlying molecular mechanisms and innovative protective strategies. We systematically evaluate pre-cryopreservation assessments, surgical harvesting techniques such as medulla-sparing biopsies, and the comparative efficacy of slow freezing versus vitrification in preserving stromal and follicular integrity. Central to this discussion are the molecular drivers of post-transplantation injury, including ischemia–reperfusion-induced oxidative stress and the iatrogenic over-activation of the PI3K/Akt/mTOR signaling pathway, which leads to follicular “burnout.” Furthermore, we explore targeted pharmacological interventions, such as the dual-drug application of VEGFA and rapamycin, alongside emerging bioengineering frontiers including decellularized extracellular matrix scaffolds and 3D-printed bioprosthetic ovaries. Clinical outcomes are also summarized, highlighting high rates of endocrine recovery (~95%) and promising live birth rates (~28%), predominantly through natural conception. By integrating deep molecular insights with advanced tissue engineering, this review provides a comprehensive framework for optimizing long-term fertility restoration and improving the quality of survivorship for young female cancer survivors. Full article

This study used a Cross-Lagged Panel Network model to examine prospective longitudinal associations among dimensions of adolescent mental health and differences in these associations across gender and grade levels. A total of 3610 Chinese adolescents completed the Middle School Student Mental Health Scale at two time points, with an interval of approximately six months between assessments. In the overall network, interpersonal sensitivity had the strongest out-expected influence, indicating the strongest outgoing predictive associations with other mental health dimensions. Depression ranked second and showed a significant bidirectional prospective association with interpersonal sensitivity. Emotional instability had the strongest in-expected influence, suggesting that it was the dimension most strongly predicted by other domains. Subgroup analyses revealed that interpersonal sensitivity showed the strongest outgoing predictive associations in the male network, whereas depression played this role in the female network. In the junior high school network, depression showed the strongest outgoing predictive associations, whereas interpersonal sensitivity was the most central predictive domain in the senior high school network. These findings may inform gender- and grade-sensitive screening and monitoring strategies and provide preliminary evidence for future intervention research. Full article

Background: High-intensity interval training (HIIT) is increasingly implemented in school-based physical education, yet little is known about how exercise intensity changes across repeated sessions and whether such trajectories are associated with physiological adaptations in adolescents. Methods: This study, conducted within the PEER-HEART project (ClinicalTrials.gov: NCT06431230), included 145 adolescents from the experimental arms of a broader school-based trial, stratified by sex and training modality: male HIPT (n = 24), male HIIT (n = 45), female HIPT (n = 46), and female HIIT (n = 30). The 8-week intervention was delivered twice weekly, and exercise intensity was monitored during 16 sessions using heart rate sensors. Intensity trajectories were examined using visual trajectory plots and slope-based statistical analyses, and pre-to-post changes in body fat percentage, systolic and diastolic blood pressure, and predicted VO₂max were analyzed. Results: Visual analyses indicated sex- and modality-specific intensity patterns, with the female HIIT group showing the most dynamic trajectory. Mean changes ranged from −0.63 ± 2.37% to −1.54 ± 2.66% for body fat, from −2.73 ± 5.28 to −5.37 ± 4.32 mmHg for systolic blood pressure, from −0.22 ± 5.00 to −2.62 ± 6.25 mmHg for diastolic blood pressure, and from 0.41 ± 3.25 to 3.81 ± 4.67 mL/kg/min for predicted VO₂max across subgroups. Although most delta values showed no significant main effects, a sex × modality interaction was observed for body fat percentage, and a main effect of sex was observed for predicted VO₂max. Greater intensity progression was associated with larger reductions in diastolic blood pressure in the female HIIT (β = −708.0, p < 0.001, R² = 0.39) and male HIIT groups (β = −377.0, p = 0.014, R² = 0.13) and with greater improvements in predicted VO₂max in the female HIPT (β = 154.0, p = 0.029, R² = 0.104) and male HIIT groups (β = 315.0, p = 0.029, R² = 0.106). Conclusions: Individual intensity trajectories may help explain variability in physiological responses to school-based interval training and may provide additional insight beyond group-level comparisons alone. Full article

Background: Problematic social media use (PSMU) has been increasingly conceptualized as a form of behavioral addiction, characterized by loss of control and continued engagement despite negative consequences. Adolescents with psychiatric disorders may represent a particularly vulnerable group, yet clinical evidence remains limited. This study examined the prevalence of PSMU in help-seeking adolescents and investigated how psychological vulnerabilities influence social media (SM) engagement, platform selection, and content preferences. Methods: A cross-sectional study was conducted on 265 adolescents (12–18 years) undergoing psychiatric evaluation. Participants completed validated measures of PSMU (Social Media Disorder Scale-9) and perceived stress, along with items assessing screen time, platform usage, engagement style (active vs. passive), and content preferences. Diagnostic data were retrieved from clinical assessments. Results: PSMU prevalence was 14.4%, rising to 19.2% among adolescents with internalizing disorders. Female and gender-diverse adolescents showed significantly higher PSMU scores. PSMU was associated with greater screen time (OR = 2.41) and nearly threefold higher odds of intensive TikTok use. Overall, SM engagement was predominantly passive, particularly among adolescents with depressive disorders, while those with neurodevelopmental disorders more frequently engaged actively. Higher stress levels were linked to greater SM use, especially on TikTok and Instagram. Conclusions: PSMU appeared to be relatively prevalent among adolescents receiving psychiatric care, particularly those with mood and anxiety disorders and high stress levels. Findings highlight the importance of assessing PSMU in these groups of adolescents and analyzing qualitative patterns of SM engagement to identify at-risk youth and inform targeted clinical interventions. Full article