Search Results (1,053)

Background: Thalassemia is an inherited hemoglobin disorder and is among the most prevalent genetic diseases worldwide. In adolescents, the physical consequences of thalassemia extend beyond physiological impairment and affect daily functioning, education, and body image. Objective: This research aimed to promote resilience and quality of life among adolescents with thalassemia, with the goal of increasing mean resilience and quality-of-life scores before and after participation. Methods: This cluster quasi-experimental study employed a two-group pretest–posttest design with a sample of 58 adolescents aged 12–17 years diagnosed with thalassemia. Participants were allocated to the experimental (n = 29) and control (n = 29) groups using a cluster-based approach at the district level. The intervention lasted 8 weeks. The assessment tools included the Pediatric Quality of Life Inventory and the Resilience Scale. Data were analyzed using descriptive statistics, including frequency distributions, percentages, means, standard deviations, t-tests, chi-square tests, and Fisher’s exact tests. Results: Baseline comparisons indicated no statistically significant differences in personal characteristics between the two groups (p > 0.05). Before the intervention, the mean resilience scores in both groups were low. The mean quality-of-life scores for the experimental and control groups were moderate. After participating in the resilience enhancement program, the experimental group showed statistically significant increases in both resilience and quality-of-life scores relative to pre-intervention levels (p < 0.001). Additionally, these post-intervention scores were significantly higher than those of the control group (p < 0.001). Conclusions: These findings indicate that the resilience enhancement program effectively improved resilience and enhanced the quality of life among adolescents living with thalassemia. Full article

Background: Posterior spinal fusion is the mainstay of treatment for Cobb angle over 50 degrees with satisfactory long-term results. In the surgical management of scoliosis, surgeons usually focus on the amount of coronal curvature correction because it can determine the surgical outcome. Nevertheless, there are many factors that contribute to patients’ satisfaction after surgery, and achieving shoulder balance is one of the most vital factors of a successful surgery. Our objective is to study the differences in managing idiopathic scoliosis with pedicle screws versus hybrid fixation with regard to shoulder imbalance postoperatively. Methods: Continuous variables were described using mean and standard deviation, whereas categorical variables were described using frequencies. The association between predictor independent variables with the analyzed outcomes were expressed as (beta coefficients) with their associated 95% confidence intervals. The Alpha significance level was considered at 0.050 level. Results: The mean angle of the clavicle measured a significant drop post-surgery compared to their pre-surgical measured mean clavicular angle, p-value < 0.001, and so did the coracoid height difference: p-value < 0.001. Furthermore, the participants had measured a significantly lower mean angle of the clavicle compared to their baseline; p-value = 0.029, regardless of their surgery type. The participants mean measured coracoid height difference score had correlated positively with their mean angle of the clavicle: beta coefficient = 1.654, p-value < 0.001; when the coracoid height difference increased, so did the mean angle of the clavicle. Conclusions: Posterior spinal fusion is effective in correcting coronal curvature and improving radiographic shoulder asymmetry in AIS. Significant improvements were observed in Cobb angle, clavicle angle, and coracoid height difference, with pedicle screw constructs providing superior curve correction. These findings reinforce the value of individualized surgical planning that considers coronal, sagittal, and cosmetic alignment goals. Full article

Background: Childhood cancer survivors commonly experience long-term treatment effects that impair physical function. Access to in-person physical fitness assessments is often limited by geographic, logistical, and resource constraints. Virtually supervised physical fitness assessments may offer a feasible alternative; however, evidence in this population remains limited. Methods: This study evaluated the feasibility of delivering virtually supervised physical fitness assessments via videoconference for children and adolescents aged 5–18 years following completion of cancer treatment. Assessments evaluated lower-body strength (30 s sit-to-stand), upper-body strength (30 s push-up), mobility (timed up-and-go), balance (single-leg balance), aerobic endurance (two-minute step), and flexibility (sit-and-reach). Pre-defined feasibility benchmarks included recruitment (≥15 participants within three months), assessment completion (≥85% of participants completing all six assessments), individual assessment completion (≥90% of planned assessments completed), technique fidelity (≥85% of assessments performed with correct technique), session duration (≥90% of sessions completed in ≤30 min), safety (no adverse events), and participant satisfaction (qualitative feedback). Results: Twenty-nine participants were enrolled, with 28 completing the virtual assessments. The sample (61% male) had a mean age of 9.8 ± 3.7 years (range 5–16), with acute lymphoblastic leukaemia the most common diagnosis (46%). Recruitment exceeded benchmarks (23 participants within three months). Assessment completion was 92.9% (26/28), individual assessment completion was 98.8% (166/168), and technique fidelity was 90.9%, with the lowest fidelity for push-ups (73.1%). Most sessions were completed within 30 min (92.9%; median 19.5 min, range 15–33). No adverse events occurred. Feedback indicated high satisfaction, highlighting convenience, engagement, and practicality. Conclusions: Virtually supervised physical fitness assessments were feasible, safe, and acceptable for childhood cancer survivors. These findings provide initial feasibility evidence to support further validation and implementation research before broader clinical application. Full article

Background/Objectives: Schools may represent an ideal setting for increasing vaccine literacy and uptake. This quasi-experimental study took place between February and June 2025 with the aim of assessing the feasibility and effectiveness of a school-based educational intervention about vaccination among Italian adolescents. Methods: The European Commission’s e-Bug methodology was used to enhance vaccine knowledge in a sample of students attending four randomly chosen middle schools from Southern Italy. Pre and post-intervention vaccination knowledge was assessed through a questionnaire and compared through the Wilcoxon signed-rank test. Regression models were used to identify predictors of intervention-related outcomes. Results: A total of 262 students (mean age 12.3 ± 0.7 years, 52.3% female) participated in the study. A significant increase in vaccination knowledge score was registered from pre (5.6 ± 1.43) to post-intervention (6.79 ± 1.77). A significant improvement was found to be related to a lower number of cohabitants (OR = 0.61; 95% CI = 0.45–0.82), a lower score in the pre-test (OR = 0.60; 95% CI = 0.47–0.77), having considered the information provided completely clear (OR = 1.98; 95% CI = 1.05–3.74), and being willing to participate in similar future interventions (OR = 2.23; 95% CI = 1.12–4.42). Conclusions: These results show the effectiveness of school-based education strategies in increasing vaccine literacy within the targeted adolescent population. Similar interventions can be useful to increase compliance with vaccination in this age class. Randomized controlled studies are needed to confirm these findings. Full article

Background: Prenatal vitamin D exposure has been proposed as a potential determinant of immune development and subsequent allergic disease risk in offspring; however, long-term cohort data remain inconsistent. Methods: We analyzed data from the KLOTHO birth cohort, including 98 adolescents with available allergic outcome assessment. A maternal–neonatal sub-cohort of mother–child pairs with available maternal and neonatal serum total 25-hydroxyvitamin D₃ [25(OH)D] measurements at delivery was used for vitamin D analyses. Allergic outcomes included asthma, allergic rhinitis, and eczema in offspring. Associations were evaluated using descriptive statistics, Spearman correlation analyses, and logistic regression models. Results: Maternal 25(OH)D concentrations were not significantly associated with asthma (ρ = 0.075, p = 0.652), allergic rhinitis (ρ = 0.100, p = 0.556), or eczema (ρ = 0.131, p = 0.426). In crude logistic regression models, vitamin D concentrations were not associated with asthma (odds ratio (OR) per 10 nmol/L: 1.07, 95% confidence interval (CI): 0.78–1.48, p = 0.67), allergic rhinitis (OR: 1.05, 95% CI: 0.76–1.45, p = 0.77), or eczema (OR: 1.17, 95% CI: 0.86–1.60, p = 0.31). Adjusted models including maternal age, pre-pregnancy body mass index (BMI), season of delivery, and ultraviolet exposure yielded similar non-significant findings, although analyses were limited by a reduced complete-case sample size. Conclusions: In this prospective cohort with follow-up into early adolescence, vitamin D status at delivery was not associated with asthma, allergic rhinitis, or eczema in offspring. These findings support a lack of statistically significant association; however, potential non-linear relationships should be interpreted cautiously, given the modest sample size. Full article

Background: Management of skeletal Class III malocclusion of maxillary origin in late adolescence remains challenging, as conventional tooth-borne orthopedic approaches show reduced effectiveness at advanced stages of skeletal maturation. Minimally invasive, bone-anchored alternatives supported by digital workflows may improve clinical feasibility and patient acceptance. Objective: To describe a digitally guided clinical protocol combining a hybrid maxillary expander and supragingival mandibular miniplates, and to explore skeletal and dentoalveolar outcomes in late adolescents. Methods: This retrospective pilot clinical study included ten late adolescents (mean age 16.0 ± 1.3 years; range 13.8–17.7) in advanced skeletal maturation stages (CS4–CS6) with skeletal Class III malocclusion of maxillary origin. Treatment consisted of a hybrid maxillary expander anchored to palatal miniscrews and custom supragingival mandibular miniplates, placed using a fully digital workflow. Maxillary protraction was performed using a modified Alt-RAMEC protocol followed by continuous intermaxillary elastic traction for 12 months. Pre- and post-treatment cephalometric analyses were conducted. Results: A significant increase in SNA was observed (mean +6.1°, p < 0.001), indicating forward maxillary displacement. The Wits appraisal improved by 3.3 mm (p = 0.007), and the SeMax increased by 2.9 mm (p = 0.0013). No significant changes were found in the SNB or mandibular plane angle. Dentoalveolar effects were limited. Conclusions: Within the limitations of this pilot clinical study, the proposed digitally guided protocol demonstrated clinically relevant maxillary advancement with minimal dentoalveolar side effects and preserved vertical control. This relatively minimally invasive approach compared to conventional subgingival miniplates and orthognathic surgery may represent a feasible treatment option for selected late adolescent patients. Further controlled studies are required to confirm these findings. Full article

Background: Gross movement skills (GMS) development is important for long-term physical activity participation. Despite this, the influence maturation has on GMS is understudied. The purpose of this pilot study was to evaluate the effect of maturation and sex on GMS in adolescents and identify numbers for a definitive study. Methods: We recruited seventy-one athletes (21 male, 50 female) from 8 to 17 years of age. Height, sitting height, and body mass were measured, and biological age (indexed as years from peak height velocity [PHV]) was predicted. Athletes were classified into three maturational categories: pre-PHV, peri-PHV, and post-PHV. The Test of Gross Motor Development-2 was used to assess GMS. Differences in overall GMS, locomotor skill, and object control skills were evaluated using ANCOVA controlling for height, weight, sex, physical activity, and sport specialization. Results: We found that GMS scores were greater for athletes post-PHV (83.62 ± 6.09) when compared to athletes peri-PHV (74.25 ± 12.92; p = 0.01). There were no differences between the pre-PHV and post-PHV groups (p = 0.13). Between sexes, males had greater GMS scores than females within each maturational category (p < 0.05). Conclusion: Our pilot study is inconclusive but suggests that factors such as sex, exposure to different GMS, and time spent practicing GMS may influence GMS performance to a greater extent than maturation. However, these findings are underpowered; a sample of 154 would be required for a definitive study. Full article

We examined how sociodemographic, parental, and temporal factors are associated with parent-reported reasons for seeking consultation in a child and adolescent psychotherapeutic clinic. Data were derived from a large retrospective sample of more than 3000 cases collected between 2011 and 2023. Multivariable binary logistic regression analyses assessed the independent effects of age, gender, living arrangements, migration background, parental education, parental age at childbirth, parental separation or bereavement, and pandemic-related periods. School-aged children and adolescents were more likely than younger children to present with learning difficulties, depression, anxiety, mobbing and media addiction. Female patients showed lower odds of consultations related to learning difficulties, aggression, behavioral addiction, attention deficit/hyperactivity, but higher odds of depression, psychosomatic symptoms, anxiety, eating disorders and sleeping disorders. Parental separation increased the likelihood of consultations related to problematic social behavior within the family, delinquency and trauma and grief. Consultations for attention deficit/hyperactivity concerns were more frequent in the post-pandemic period compared to pre-pandemic. The findings highlight that sociodemographic, familial, and temporal factors are systematically associated with distinct patterns of parent-reported help-seeking patterns in child and adolescent psychotherapeutic care. Full article

Gestational weight gain (GWG) and birth weight (BW) have a multifactorial etiology, which makes identifying the most influential determinants difficult. The association between variants of the FTO and LEPR genes has been explored as contributing factors to obesity in various age groups; however, their role in GWG and BW in adolescent mothers and their offspring is uncertain. To determine whether the presence of polymorphisms rs9939609 (FTO) and rs1137101 (LEPR) is associated with gestational weight gain and newborn weight in a cohort of adolescent mothers. Methods: A prospective cohort study of 305 mother-child dyads was conducted between 2020 and 2024. Genotyping of the single nucleotide variants (SNVs) rs9939609 of the FTO gene and rs1137101 of the LEPR gene was performed using real-time PCR and high-resolution melting analysis (qPCR-HRM), using maternal peripheral blood and umbilical cord blood samples. GWG, BW, energy intake, and other perinatal data were recorded and classified. Genetic data from 305 mother–offspring dyads were analyzed. The median maternal age was 16 years, and 71.4% had a normal pre-pregnancy body mass index (BMI). The most frequent genotypes were TT for FTO rs9939609 and AG for LEPR rs1137101. In both groups, the genotypic distribution significantly deviated from Hardy–Weinberg equilibrium (p < 0.0001). The AA genotype of FTO was associated with a higher probability of excessive gestational weight gain (GWG) after adjustment for pre-pregnancy BMI and dietary and sociodemographic factors. High protein and lipid intake increased the risk of excessive GWG, whereas adequate intake of carbohydrates and legumes showed a protective effect. An initial significant association was identified between the LEPR rs1137101 variant (AA allele) and low birth weight (LBW); however, this association was lost after adjustment for confounding factors. The FTO rs9939609 variant was significantly associated with GWG. On the other hand, the LEPR rs1137101 variant in the offspring showed an association with BW categorized by percentiles (in crude analysis), while the FTO variant showed no relationship with birth weight. Full article

Background/Objective: Myopia has become a prominent public health issue in China, significantly impacting the visual health of children and adolescents. The condition is characterized by a high incidence rate, increasing prevalence, and a trend toward earlier onset, highlighting the critical need for early and accurate diagnosis. Current clinical diagnostic methods primarily depend on subjective evaluations by optometrists and the use of isolated parameters, leading to inefficiencies and inconsistent outcomes. Moreover, there remains a lack of diagnostic tools that can effectively integrate multi-parameter analysis while ensuring robust data privacy protection. This study aims to develop an artificial intelligence (AI) diagnostic model that achieves objective, accurate, and safe diagnosis of myopia in children without cycloplegia through multi-parameter fusion and to enable local deployment. The proposed model is intended to be a reliable tool for clinical applications and large-scale screening projects, while ensuring strong protection of patient privacy. Methods: We built a transparent, rule-driven AI framework using clinical guidelines. Key ocular parameters—visual acuity, spherical equivalent, axial length, corneal curvature, and axial ratio—were encoded as logical rules in Python and incorporated via instruction fine-tuning. The model was trained and validated on retrospective clinical data (70% training, 15% validation, 15% test) using five algorithms: gradient boosting, logistic regression, random forest, SVM, and XGBoost. Performance was evaluated using accuracy, precision, recall, F1 score, and mean AUC across classes. Results: The model classifies refractive status into five categories: hyperopia, pre-myopia, mild, moderate, and high myopia. All five different algorithms demonstrated excellent diagnostic and classification performance. Gradient boosting achieved the best overall performance, with an accuracy of 98.67%, an F1 score of 98.67%, and a mean AUC of 0.957—outperforming all other models. Conclusions: This study successfully developed an artificial intelligence-based myopia diagnosis system for children under non-dilated pupil conditions. The system is interpretable and privacy-preserving, and has excellent diagnostic and classification performance, making it suitable for clinical decision support and large-scale screening applications. It has great potential to promote the development of early intervention, precision prevention, and control strategies for childhood myopia. Full article

Background: This study examined the predictive effect of parental marital satisfaction on suicidal behaviors among preadolescents and adolescents in China, with positive youth development (PYD) attributes as a mediator. Methods: A total of 3665 matched pairs of students (aged 9–19, 51.3% boys) and their parents completed questionnaires, with parental marital satisfaction reported by parents and suicidal behaviors (ideation, plan, and attempt) and PYD attributes reported by students. Results: The prevalence of overall suicidal behavior was 15.5% in this sample, with a higher prevalence observed among those with lower parental education levels. Hierarchical regression and structural equation modeling analyses revealed that: (1) after controlling for socio-demographic variables, parental marital satisfaction negatively predicted suicidal behaviors; (2) PYD attributes negatively predicted suicidal behaviors, accounting for the largest proportion of variance (ΔR² range = 0.036–0.102); (3) parental marital satisfaction was positively correlated with PYD attributes; and (4) PYD attributes partially mediated the predictive relationship between parental marital satisfaction and suicidal behavior, with a significant indirect effect (β = −0.06) accounting for 56.6% of the total effect. Conclusions: This study illuminates protective pathways through which a positive family environment cultivates individual competencies, ultimately contributing to reduced suicidal behavior. Full article

Background: Cervical cancer remains a leading cause of cancer-related deaths among women in Nigeria. In 2023, the Government of Nigeria, with support from Gavi and partners, introduced the single-dose human papillomavirus (HPV) vaccine through a phased, school-based campaign. The first phase was launched in October 2023 across 16 states, followed by a second phase in May 2024 that expanded coverage to the remaining states and the Federal Capital Territory. This study evaluates the additional impact of a behavioral insights–informed digital intervention, comprising a social media campaign amplified by trained pharmacists serving as local influencers, implemented in 2025 to increase acceptance and uptake of HPV vaccination during routine immunization. Methods: A pre-test/post-test quasi-experimental design with a control group was implemented in three Nigerian states in 2025 to assess the additional impact of a behavioral insights–informed social media campaign designed to strengthen social approval for HPV vaccination, increase awareness of vaccination locations, and reinforce caregivers’ recognition of their adolescent daughters’ desire to be vaccinated. Messages were amplified by trained pharmacists who served as local influencers. Caregivers of adolescent girls aged 9–17 years were recruited online through targeted Facebook and Instagram advertisements during Nigeria’s transition from school-based HPV vaccination campaigns to routine immunization. Caregivers in treatment areas were exposed to geofenced social media advertisements on Facebook and Instagram and pharmacist counseling, while those in control areas were not. Logistic regression models using a difference-in-difference approach estimated the campaign’s effect on HPV vaccination, controlling for caregiver and adolescent characteristics. Additional statistical models assessed the campaign’s impact on caregivers’ motivation and ability—key drivers of behavior according to the Fogg Behavior Model. Results: HPV vaccination increased at a significantly higher rate in the treatment compared to the control area. The adjusted odds of an adolescent girl being vaccinated were 1.48 times higher in the treatment area at follow-up (95% CI: 1.14–1.92). Adjusted marginal effects indicated that exposure to the campaign increased the probability of vaccination by 8.9 percentage points relative to the control group. The rate at which caregivers’ motivation (aOR = 1.31, 95% CI: 1.00–1.70) and ability (knowing where to get vaccinated: aOR = 1.38, 95% CI: 1.07–1.79; ease of vaccination: aOR = 1.59, 95% CI: 1.22–2.06) increased was also higher in the treatment area. There was no relative increase in intervention versus control groups in factual knowledge regarding HPV vaccination. Conclusions: A behavioral insights–informed social media campaign in which pharmacists served as influencers was associated with higher HPV vaccine uptake during routine immunization. The higher rate of vaccination observed in intervention areas was associated with higher rates of caregiver motivation and ability but not with higher rates of caregiver knowledge. These findings are consistent with the potential of behavioral insights–informed digital campaigns to complement routine immunization efforts and improve vaccine uptake in low- and middle-income countries. Full article

Background/Objectives: Stuttering is a neurodevelopmental disorder of speech fluency. It emerges most commonly between 2 and 5 years old, often causing social exclusion and stigma. In Latin America, cultural misconceptions regarding its causes exacerbate these psychosocial challenges. This study validated a culturally adapted instrument for Chile to measure public attitudes toward stuttering. The instrument provides a psychometrically sound method to assess and address stigma within educational and community settings. Methods: A total of 756 Chilean adults (mean age = 36.7 years, SD = 15.8; 64% women, 36% men) were recruited using stratified probability sampling to reflect the national demographics. Ethical approval and informed consent were obtained. The subsection underwent rigorous cross-cultural adaptation (translation, expert review, cognitive debriefing n = 30, pre-testing n = 50). Analysis employed polychoric matrices, EFA, CFA with WLSMV, and multiple reliability/validity indices. Results: Joint analysis showed poor fit (CFI = 0.72, RMSEA = 0.12), confirming independence. Beliefs (14 items): three-factor CFA fit excellent (CFI = 0.993, RMSEA = 0.034); factors: competence/normality (α = 0.85), psychological causes (α = 0.78), and help/support (α = 0.72). Reactions (11 items): four-factor fit adequate (CFI = 0.97, RMSEA = 0.043); factors: distant concern (α = 0.82), personal concern (α = 0.79), media sources (α = 0.75), and formal sources (α = 0.77). Validity was supported; bifactor models favored multidimensionality. Conclusions: The adapted subsection is psychometrically robust and effectively captures Chilean-specific attitudes toward childhood stuttering. It provides a reliable tool for quantifying public stigma and misconceptions, particularly in educational and school contexts, thereby supporting the design of targeted school-based policies and interventions to reduce bullying, promote inclusion, and safeguard the psychosocial well-being of children and adolescents who stutter. Full article

Background: Most individuals develop smoking habits in adolescence, highlighting the need for a smoking prevention program targeted at this age group. The use of “Implementation Intentions” (If-Then plans) about how to refuse a cigarette combined with anti-smoking messages has been shown to be effective in the UK. However, there is a scarcity of data regarding school-based smoking prevention interventions among adolescents available to countries with high tobacco consumption rates, like Greece. Objectives: To describe the cultural adaptation procedure and the evaluation protocol for the school-based “Implementation Intentions” program aimed at reducing tobacco use susceptibility among Greek adolescents aged 13–16 in school settings. Methods: The present study is part of the EU-funded FRESHAIR4Life Program. We will use a mixed-methods approach with a pre- and post-intervention design in six conveniently selected secondary schools in Heraklion, Crete, Greece, to measure the intervention’s Reach, Effectiveness, Adoption, Implementation, and Maintenance using the RE-AIM framework. The study plans to involve three Master Trainers (MTs), 20–25 school teachers (to be trained by the MTs), and approximately 480 students. Participating schools will receive the “Implementation Intentions” intervention, which is based on a goal-setting technique where individuals commit to perform a particular behavior when a specific context arises. The study will consist of five sequential phases: Phase I involves training three Master Trainers (MTs) using the International Primary Care Respiratory Group (IPCRG’s) Teach-the-Teacher (TtT) curriculum, specifically focused on the implementation of our intervention. In Phase II, workshops will be held to co-create and culturally adapt the intervention. Phase III will involve teachers trained by MTs on delivering the intervention. In Phase IV, teachers will deliver the intervention among students in their schools. Data will be collected pre- and post-intervention through surveys, session logs, fidelity observations, feedback forms, and follow-up interviews or focus groups (Phase V). Quantitative data will be analyzed descriptively and by using paired t-tests and multiple linear regression analyses, while qualitative data will undergo thematic analysis. Discussion: The study protocol’s potential benefits extend beyond educating Greek adolescents on the risks associated with smoking. Active participation will empower and motivate young people to make informed, healthy choices. We expect the results could help create more effective, context-specific interventions, support policy changes aimed at decreasing the prevalence of adolescent smoking in Crete, Greece, and potentially be used by other countries as well. Full article

Background/Objectives: This study evaluates the efficacy of hypoglossal nerve stimulation as an alternative intervention for pediatric patients with obstructive sleep apnea (OSA) unresponsive to standard therapies and examines the uniformity of therapeutic outcomes across different patient cohorts. Methods: An extensive systematic search was performed across four principal databases (PubMed, EMBASE, Cochrane Library, and Web of Science) utilizing keywords associated with pediatric OSA and hypoglossal nerve stimulation, encompassing studies up to July 2025 that provided objective polysomnographic metrics (e.g., apnea-hypopnea index [AHI] values) to enable the quantitative assessment of pre- and post-intervention effects in children. The primary outcome measured was the ratio of means (ROM), determined from pre–post data in single-group studies, with summary estimates obtained using the fixed-effects model. Results: The systematic review included nine eligible studies with a total of 140 pediatric subjects, the majority of whom were adolescents with Down syndrome. AHI meta-analysis outcomes indicated a marked improvement in OSA severity, yielding an overall ROM of 0.57 [95% confidence interval: 0.49–0.65]. The therapeutic benefit demonstrated a high degree of uniformity across cohorts, as indicated by minimal statistical heterogeneity (I² = 16%, p = 0.30). Funnel plot assessment showed no statistically significant evidence of systematic publication bias. Conclusions: Current evidence suggests that hypoglossal nerve stimulation therapy is a safe, effective, and valuable alternative for pediatric OSA patients who do not respond to conventional therapies. Full article