Search Results (888)

Background/Objectives: Osteosarcoma (OS) is the most common malignant bone tumor in children and adolescents; the survival rate is as low as 24%. Accurate prediction of clinical outcomes remains a challenge due to tumor heterogeneity and the complexity of pediatric cases. This study aims to improve predictions of progressive disease, therapy response, relapse, and survival in pediatric OS using MRI-based radiomics and machine learning methods. Methods: Pre-treatment contrast-enhanced coronal T1-weighted MR scans were collected from 63 pediatric OS patients, with an additional nine external cases used for validation. Three strategies were considered for target region segmentation (whole-tumor, tumor sampling, and bone/soft tissue) and used for MRI-based radiomics. These were then combined with clinical features to predict OS clinical outcomes. Results: The mean age of OS patients was 11.8 ± 3.5 years. Most tumors were located in the femur (65%). Osteoblastic subtype was the most common histological classification (79%). The majority of OS patients (79%) did not have evidence of metastasis at diagnosis. Progressive disease occurred in 27% of patients, 59% of patients showed adequate therapy response, 25% experienced relapse after therapy, and 30% died from OS. Classification models based on bone/soft tissue segmentation generally performed the best, with certain clinical features improving performance, especially for therapy response and mortality. The top performing classifier in each outcome achieved 0.94–1.0 validation ROC AUC and 0.63–1.0 testing ROC AUC, while those without radiomic features (RFs) generally performed suboptimally. Conclusions: This study demonstrates the strong predictive capabilities of MRI-based radiomics and multi-region segmentations for predicting clinical outcomes in pediatric OS. Full article

During the coronavirus 2019 pandemic, sports activities were restricted, raising concerns about their impact on the physical condition of adolescent athletes, which remained largely unquantified. This study was designed with two primary objectives: first, to precisely quantify and elucidate the differences in the physical condition of adolescent athletes before and after activity restrictions due to the pandemic; and second, to innovatively develop and validate a non-contact medical checkup application. Medical checks were conducted on 563 athletes designated for sports enhancement. Participants were junior high school students aged 13 to 15, and the sample consisted of 315 boys and 248 girls. Furthermore, we developed a smartphone application and compared self-checks using the application with in-person checks by orthopedic surgeons to determine the challenges associated with self-checks. Statistical tests were conducted to determine whether there were statistically significant differences in range of motion and flexibility parameters before and after the pandemic. Additionally, items with discrepancies between values self-entered by athletes using the smartphone application and values measured by specialists were detected, and application updates were performed. Student’s t-test was used for continuous variables, whereas the chi-square test was used for other variables. Following the coronavirus 2019 pandemic, athletes were stiffer than during the pre-pandemic period in terms of hip and shoulder joint rotation range of motion and heel–buttock distance. The dominant hip external rotation decreased from 53.8° to 46.8° (p = 0.0062); the non-dominant hip external rotation decreased from 53.5° to 48.0° (p = 0.0252); the dominant shoulder internal rotation decreased from 62.5° to 54.7° (p = 0.0042); external rotation decreased from 97.6° to 93.5° (p = 0.0282), and the heel–buttock distance increased from 4.0 cm to 10.4 cm (p < 0.0001). The heel–buttock distance and straight leg raising angle measurements differed between the self-check and face-to-face check. Although there are items that cannot be accurately evaluated by self-check, physical condition can be improved with less contact by first conducting a face-to-face evaluation under appropriate guidance and then conducting a self-check. These findings successfully address our primary objectives. Specifically, we demonstrated a significant decline in the physical condition of adolescent athletes following pandemic-related activity restrictions, thereby quantifying their impact. Furthermore, our developed non-contact medical checkup application proved to be a viable tool for monitoring physical condition with reduced contact, although careful consideration of measurable parameters is crucial. This study provides critical insights into the long-term effects of activity restrictions on young athletes and offers a practical solution for health monitoring during infectious disease outbreaks, highlighting the potential for hybrid checkup approaches. Full article

Background/Objectives: Sprinting is a fundamental locomotor skill and a key indicator of lower limb strength and anaerobic power in early childhood. The aim of the study was to examine possible differences in the step kinematic parameters and their contribution to sprint speed between children with different patterns of speed development. Methods: 65 prepubescent male and female track athletes (33 males and 32 females; 6.9 ± 0.8 years old) were examined in a maximal 15 m short sprint running test, where photocells measured time for each 5 m segment. At the last 5 m segment, step length, frequency, and velocity were evaluated via a video analysis method. The symmetry angle was calculated for the examined step kinematic parameters. Results: Based on the speed at the final 5 m segment of the test, two groups were identified, the maximum sprint phase (MAX) and the acceleration phase (ACC) group. Speed was significantly (p < 0.05) higher in ACC in the final 5 m segment, while there was a significant (p < 0.05) interrelationship between step length and frequency in ACC but not in MAX. No other differences were observed. Conclusions: The difference observed in the interrelationship between speed and step kinematic parameters between ACC and MAX highlights the importance of identifying the speed development pattern to apply individualized training stimuli for the optimization of training that can lead to better conditioning and wellbeing of children involved in sports with requirements for short-sprint actions. Full article

Although evidence suggests adiposity as a modifiable risk factor for postmenopausal breast cancer (BC), its association with premenopausal BC remains uncertain. This potential differential relationship for menopausal status has been insufficiently investigated in the Moroccan population due to limited data. This study aims to assess the relationship between various indicators of adiposity and the risk of BC among Moroccan women by menopausal status. A multicenter case-control study was conducted in Morocco between December 2019 and August 2023, including 1400 incident BC cases and 1400 matched controls. Detailed measures of adiposity and self-reported measures from different life stages were collected. Unconditional logistic regression analyses were conducted to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between body size indicators and the risk of BC, adjusting for a range of known risk factors for BC. Higher waist circumference (WC) and hip circumference (HC) were associated with an increased risk of BC in both pre- (p-trend < 0.001 for both WC and HC) and post-menopausal women (p-trend < 0.001 for WC, 0.002 for HC). Current body mass index (BMI) ≥30 kg/m² increased the risk of postmenopausal BC (p-trend = 0.012). Among postmenopausal women, higher weight at age 20 was positively associated with BC risk (p-trend < 0.001), while, weight at age 30 was significantly associated with increased BC risk in both pre- (p-trend = 0.008) and post-menopausal women (p-trend = 0.028). Interestingly, weight gain since age 20 was inversely associated with BC risk in postmenopausal women in the adjusted model (p-trend = 0.006). Young-adult BMI observed a significant increased trend with BC risk in both pre- (p-trend = 0.008) and post-menopausal women (p-trend < 0.001). In premenopausal women, larger body shape during childhood and early adulthood was positively associated with BC risk (p-trend = 0.01 and = 0.011, respectively). In postmenopausal women, larger childhood and adolescent body silhouettes were also associated with increased BC risk (p-trend = 0.045 and 0.047, respectively). These results suggest that anthropometric factors may have different associations with pre- and post-menopausal BC among Moroccan women. This underscores the importance of conducting large prospective studies to better understand these findings and explore their links to different molecular subtypes of BC. Full article

Background: Despite decades of high childhood vaccination coverage, pertussis has re-emerged in the Autonomous Province of Vojvodina (AP Vojvodina), Serbia. We aimed to describe the temporal, seasonal, and age-specific patterns of pertussis in AP Vojvodina and to analyze trends by vaccination status in order to highlight changes in epidemiology and potential gaps in vaccine-induced protection. Methods: We retrospectively analyzed 2796 pertussis cases reported between January 1997 and December 2024, examining temporal, seasonal, and age-specific trends, stratifying by vaccination status across four consecutive periods (1997–2003, 2004–2010, 2011–2017, and 2018–2024). Results: Throughout the 28-year period, after low and sporadic cases in the pre-2012 period, a dramatic rise was observed in 2014, 2017, and 2018, culminating in the highest annual number of reported cases in 2024 (1011 cases). Throughout this period, primary vaccination coverage with the DTwP/DTaP three-dose series ranged between 91% and 98%, while first booster coverage gradually declined from 98% in the early 2000s to 83% in 2024. Regarding seasonality, a sharp increase in cases began in 2012, peaking in November 2023 (>350 cases) and early 2024 (312 in January, 268 in February), with a seasonal shift from summer peaks in the 2011–2017 period to higher incidence rates during colder months more recently. Adolescents aged 10–14 years had the highest cumulative incidence (1149.4/100,000), followed by infants under 12 months (978.5/100,000), despite the latter representing fewer absolute cases. The proportion of pertussis in fully vaccinated individuals rose from 6.3% (1997–2003) to 49.7% (2018–2024). Conclusions: These findings suggest that booster immunization in adolescence and routine maternal vaccination during pregnancy could reduce transmission, particularly to infants. Enhanced surveillance and updated immunization policies are critical to mitigating future pertussis outbreaks. Full article

Purpose: To review parental pre-pregnancy and pregnancy exposures in relation to pediatric cancer (diagnosis before age 20). Methods: We conducted literature searches using Ovid Medline and Scopus to find primary research studies, review articles, and meta-analyses published from 2014 to 17 March 2021. Results: Strong evidence links increased risk of childhood cancer with maternal diabetes, age, and alcohol and coffee consumption during pregnancy. Both paternal and maternal cigarette smoking before and during pregnancy are associated with childhood cancers. Diethylstilbestrol (DES) exposure in utero has long been known to be causally associated with increased risk of vaginal/cervical cancers in adolescent girls. More recent evidence implicates in utero DES exposure to testicular cancer in young men and possible intergenerational effects on ovarian cancer in the granddaughters of women exposed to DES during pregnancy. There is strong evidence that childhood cancer risk is also associated with both high and very low birth weight and with gestational age. Evidence is also strong for the protective effects of maternal vitamin consumption and a healthy diet during pregnancy. Unlike early studies, those reviewed here show no association between in utero exposure to medical ionizing radiation, which may be explained by reductions over time in radiation doses, avoidance of radiation during pregnancy, and/or by inadequate statistical power to detect small increases in risk, rather than a lack of causal association. Evidence is mixed or conflicting for an association between childhood cancer and maternal obesity, birth order, cesarean/instrumental delivery, and prenatal exposure to diagnostic medical radiation. Evidence is weak or absent for associations between childhood cancer and multiple gestations or assisted reproductive therapies, as well as prenatal exposure to hormones other than DES, and medications. Full article

Suicide is a growing public health concern in Brazil, with significant increases in mortality rates over the last decade and disparities among vulnerable populations. This study aimed to systematically synthesize the recent literature reviews on suicidality and suicide prevention in Brazil, providing an overview of key findings, research gaps, and implications for future studies. This systematic review of reviews follows a pre-registered PROSPERO protocol (CRD42024561892). Searches across five databases (MEDLINE, Scopus, CINAHL, SciELO and LILACS) identified 10 eligible reviews, published between 2019 and 2024, including systematic, integrative, narrative reviews, and meta-analyses. The reviews examined populations such as Indigenous peoples, adolescents, university students, older adults, and healthcare professionals. Findings showed that the risk of suicidal behavior was associated with mental health conditions, social vulnerability, and limited access to mental health services. Particularly high suicide rates were observed among Indigenous populations and adolescents. Across reviews, a lack of interventional studies, limited geographical coverage, and the inadequate training of health professionals were recurrent themes. This review highlights the urgent need for culturally sensitive suicide prevention strategies, greater research investment in underserved populations, and improved healthcare training and coordination. These findings aim to support the development of more effective national suicide prevention policies. Full article

Background/Objectives: Social worry may appear in preadolescence, causing it to persist in the future, such that adolescents become more avoidant of situations in which they are evaluated by others. Many previous studies have shown that approximately 4% of preadolescent children suffer from high levels of social worry, which may lead to other problems in the future. It is important to take necessary precautions to explore this worry and take the necessary measures to address it. This study aimed to do so by extracting the psychometric properties of the Social Worries Questionnaire (SWQ) for preadolescence in Arab countries. Methods: The sample consisted of 269 children aged 8–12 years. The SWQ, Spence Child Anxiety Scale (SCAS), Child Abuse Self-Reporting Scale (CASRS-12), and Arabic version of the Children’s Depression Inventory (AVCDI) were administered via various social media. Results: Confirmatory factor analysis was used, and the one-factor model showed that the scale consists of 14 items. The results also indicated evidence of discriminant validity, and that the internal consistency was acceptable. For reliability, the test–retest results showed that the value was appropriate. Conclusions: This scale could be valuable in detecting worry in preadolescent children and providing them with therapeutic and psychological services. Full article

Background: Art therapy is increasingly recognized as a valuable complementary intervention for individuals with eating disorders (EDs), who frequently experience comorbid anxiety and difficulties with emotional regulation. However, few studies have examined its short-term effects on state and trait anxiety within structured clinical settings. Methods: This pilot study involved 19 adolescent females (mean age 17.7 ± 2.1 years) diagnosed with anorexia nervosa (AN) or bulimia nervosa (BN) and admitted to the Mariconda Regional Residence for Eating Disorders (ASL Salerno, Italy) in residential or semi-residential treatment. Participants completed a structured six-week cycle of weekly textile-based art therapy sessions, designed to promote emotional expression and body reconnection. State and trait anxiety levels were assessed pre- and post-session using the State-Trait Anxiety Inventory (STAI). Repeated-measures ANOVA was used to analyze state anxiety changes; a linear mixed-effects model was applied to trait anxiety. Results: State anxiety significantly decreased immediately after sessions (p = 0.002). A significant main effect of session (p = 0.01) and a time × session interaction (p = 0.025) indicated variability across sessions. Trait anxiety showed a non-significant trend toward reduction (p = 0.11); however, reductions were significant at sessions 4 (p = 0.015), 5 (p < 0.001), and 6 (p = 0.005). Conclusions: Art therapy may offer immediate reductions in state anxiety and may contribute to a longer-term reduction in trait anxiety with 4–6 sessions. These findings support integrating creative interventions within multidisciplinary ED treatment programs. Future research with larger samples and control groups is needed to confirm and expand upon these preliminary results. Full article

Background/Objectives: Oxylipins, a family of oxygenated natural products derived from polyunsaturated fatty acids (PUFAs), play crucial roles in various physiological processes. Evaluating their levels in vivo helps to reveal their roles in health and disease. Because of the numerous isomers of oxylipins, it is essential to develop efficient and precise analytical methods for their identification and quantification. The objective of this study is to establish a quantitative method for oxylipin analysis and its application to the assessment of oxylipins in children’s plasma, with potential implications for diagnostic use in pediatric populations. Methods: A liquid chromatography–electrospray ionization–tandem mass spectrometry method was developed to quantify 64 oxylipins and four precursor PUFAs within 36 min. The limits of quantification ranged from 0.25 to 50 pg, with most analytes showing recoveries and matrix effects between 85 and 110% and between 90 and 110%, respectively. Intra- and inter-day precision values were within 15%. The established method was applied to plasma samples from children aged 9–12 years (boys = 181; girls = 161) in Hokkaido, Japan, to assess the relation between plasma oxylipin and PUFA levels and age, sex, and body mass index. Results: There was no significant correlation between oxylipin levels and age, sex, or body mass index. However, among the PUFAs, boys had higher eicosapentaenoic acid and arachidonic acid levels than those of girls, with a significant increase in eicosapentaenoic acid levels in the overweight group compared with those in the underweight group. Conclusions: We successfully developed a simple and highly selective method for the analysis of oxylipins in preadolescent children’s plasma samples. Thus, this study provides a foundation for broader application of the developed method to different biological samples in future studies. Full article

This paper examines the importance of ‘education outside the classroom’ (EOtC) in an Australian secondary school. The primary aim was to develop a sense of belonging, build resilience, and enhance wellbeing in female students. This study investigated two cohorts of Year 9 students (aged 14–15 yrs) who participated in a four-week residential EOtC pilot program. The first cohort (Wave 1; N = 58) undertook the program alongside (N = 39) boys. The second cohort was single-sex girls (Wave 2; N = 28). A mixed-methods research design was implemented to inform experiences of students, parents, and staff and to triangulate inferences drawn from the data. Quantitative data was gained from pre- and post-program surveys with students and parents, whilst qualitative data was gathered from student focus groups, staff, and parents through semi-structured interviews to assess more nuanced impacts. School belonging was measured using the PISA six-item scale. Academic buoyancy was quantified using the four-item Academic Buoyancy Scale. Self-efficacy, peer relations, and resilience were evaluated by employing the 34-item Adolescent Girls’ Resilience Scale. The findings revealed significant improvements in students’ sense of belonging, including higher levels of school belonging than reported Australia-wide averages for 15-year-olds. Despite students’ mean academic buoyancy scores being more than a point lower than reported baseline scores for Australian high school students, it was promising to see a modest increase following the EOtC program. In conclusion, EOtC is a potent vehicle for developing a sense of belonging, enhancing resilience, and equipping students to deal with academic challenges. Full article

Background: Skipping breakfast, a prevalent issue among children and adolescents, has been reported to be associated with academic performance and long-term health. However, less attention has been given to the types of breakfast foods consumed. Therefore, our study aims to investigate the association between breakfast variety and dietary knowledge, attitude, and practice (KAP) among preadolescents. Methods: The study included 1449 students in grades 4–6 from Zhongshan city, Guangdong province. Data were collected through face-to-face field investigation using a validated questionnaire. The questionnaire encompassed sociodemographic characteristics, as well as dietary KAP. Results: Among all participants, 1315 reported consuming breakfast daily. Dietary diversity varied significantly: 8.8% consumed only 1 type of food, 52.9% consumed 2–4 types, and 38.3% consumed ≥5 types. Students who consumed a greater variety of breakfast foods exhibited more favorable dietary and lifestyle patterns. Specifically, those who consumed ≥5 types of food showed statistically significant associations with healthier practices, including reduced intake of sugary beverages and night snacks, stronger adherence to dietary guidelines, more positive attitudes toward improving eating habits, longer sleep durations, increased participation in meal preparation, greater dish variety in meals, and higher engagement in daily physical activity. Conclusions: Breakfast variety was associated with KAP, particularly when breakfast types ≥ 5, providing more sufficient and favorable evidence for breakfast consumption. Full article

Background/Objectives: This study aimed to examine the occurrence and risk factors for proximal junctional kyphosis (PJK) in relation to preoperative sagittal alignment, particularly the shape of thoracolumbar kyphosis (TLK) and the proportion of lumbar lordosis. Methods: We recruited 38 consecutive patients with adolescent idiopathic scoliosis (AIS) who underwent isolated posterior fusion. Participants were categorized according to the presence or absence of PJK at 1 year postoperatively (PJK+ or non-PJK) and by preoperative TLK status (positive or negative; pre-TLK+ or pre-TLK, respectively). We compared spinal parameters preoperatively, immediately postoperatively, and at 1 year postoperatively between groups. Results: Among the 38 participants, PJK occurred in 21 patients (55.3%). The PJK group had significantly larger preoperative TLK and LDI values and decreased postoperative TLK and LDI. Simple linear regression revealed a moderate positive correlation between ΔPJA and preoperative TLK as well as a fair positive correlation between ΔPJA and changes in TLK and LDI. The prevalence of PJK was high (83.3%) in the pre-TLK+ group (24 patients), and preoperative LDI was significantly larger compared with the pre-TLK group. However, TLK and LDI were significantly decreased after surgery in the pre-TLK+ group. Conclusions: Patients with Lenke-5C curvature who exhibit positive preoperative TLK are at a very high risk of developing PJK after isolated posterior surgery. Preoperative sagittal alignment should be considered when planning the extent of sagittal correction. Full article

Background/Objectives: Digital technologies have become increasingly integrated into the daily lives of children and adolescents, largely because their interactive and visually engaging design is particularly suited to the younger users. The COVID-19 pandemic further accelerated this trend, significantly lowering the average age of access to the digital devices. However, scientific consensus remains divided regarding the developmental impact of digital media use—particularly its cognitive, motor, and emotional consequences—depending on whether the use is passive or active. This review aims to explore these effects across developmental stages, focusing on both behavioral and neurobiological dimensions, and to identify emerging risks and protective factors associated with digital engagement. Methods: A PRISMA review was conducted on the impact of digital media use among pre-school children and adolescents. Behavioral, psychosocial, and neurobiological aspects were examined, with specific attention to epigenetic changes, techno-stress, digital overstimulation, and immersive technologies (e.g., virtual and augmented reality). Results: The findings suggest that passive digital consumption is more often associated with negative outcomes, such as impaired attention and emotional regulation, especially in younger children. Active and guided use may offer cognitive benefits. Neurobiological research indicates that chronic exposure to digital stimuli may affect stress regulation and neural development, possibly via epigenetic mechanisms. Effects vary across developmental stages and individual vulnerabilities. Conclusions: A nuanced understanding of digital engagement is essential. While certain technologies can support development, excessive or unguided use may pose risks. This review provides age-specific recommendations to foster balanced and healthy technology use in children and adolescents. Full article

Background: This literature review examines the prevalence and severity of depression and anxiety symptoms in adolescents following ACL injury, with a focus on gender-disaggregated data. Methods: An electronic search was conducted across databases, including Ovid MEDLINE (R), PUBMED, and the Cochrane Library, covering articles from 1964 to 13 February 2024. Primary search terms were “ACL,” “depression,” “anxiety,” and “adolescent,” expanded using medical subject headings (MeSH). Manual searches of the references supplemented the database search. Inclusion criteria included studies on depression or anxiety post-ACL injury in adolescents. The exclusion criteria were studies without adolescent participants or those focusing exclusively on one sex. Results: The search identified 62 studies, of which 5 were ultimately selected for comprehensive analysis. Four studies reported on depression using various scales, and three measured anxiety symptoms. No studies provided gender-disaggregated data. One study found no significant difference in depression scores between adolescent and adult patients. Another study noted that socioeconomic disadvantage correlated with increased depressive and anxiety symptoms post-surgery. An additional study highlighted a significant increase in depression scores from pre- to post-injury among ACL-injured participants compared to uninjured controls. Conclusions: Our understanding of the psychological consequences of ACL rupture on female adolescent patients is incomplete. Given the high incidence of ACL injuries in this patient group and their potential psychological vulnerability, improving the evidence base in this area could address a previously neglected aspect of care, with positive impacts on returning to sport and quality of life. Future studies of high methodological quality are needed to address this gap in the literature. Full article