Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy

Lifetime Polyvictimization and Mental Health Outcomes in Women With vs Without Incarceration Histories: A Population-Based Latent Class Analysis

We use latent class analysis, a life course framework, and information on the type, frequency, and timing of trauma exposure to identify distinct polytrauma groups in a national sample of women (AddHealth). We compare the identified polytrauma groups and their associations with mental health in adulthood in women with and without incarceration histories. A unique group with polyvictimization (neglect, physical, sexual) exposure in childhood by a caregiver in women with incarceration histories was not identified in women without incarceration histories. We find evidence of distinct associations between polytrauma groups and mental health and possibly, criminal justice involvement, in adulthood.

Cerebral Haemodynamic Assessment Following Sport-related Concussion (Mild Traumatic Brain Injury) in Youth and Amateur Rugby Union Players

BACKGROUND

Using functional near-infrared spectroscopy (fNIRS) as an objective diagnostic tool, we aimed to (1) compare fNIRS measurements in adult and youth male rugby players against controls over a playing season, and 2) document the fNIRS changes that occur in concussed rugby players during the England Rugby Football Union Graduated Return-To-Play programme (GRTP). Sixty-seven participants (rugby = 41 (26 adults: 27.5 ± 4.4 years; 15 youth: 16.5 ± 0.6 years; control = 26 (11 adult: 30.5 ± 5.2 years; 15 youth: 16.9 ± 0.4 years) completed fNIRS assessments at pre, mid and end-season. Eight players (five youth, three adult) sustained concussions, and completed fNIRS and the Graded Symptom Checklist from the Sport Concussion Assessment Tool version 5 (SCAT5) assessment throughout the GRTP period. Mixed linear models were utilised to assess the effect of group and time on fNIRS measures of oxyhaemoglobin (∆O2Hb) and deoxyhaemoglobin (∆HHb) during performance tasks. Typical Error (TE) i.e., normal biological fluctuation and measurement error, was calculated to identify 'cut-off' thresholds for identifying effects of concussion.

RESULTS

There were significant differences in fNIRS indices over time in adult and youth groups (p < 0.05) but no significant differences between rugby and control groups (p > 0.05). Seven out of eight (87.5%) concussed players showed changes greater than TE during the GRTP period for both ∆O2Hb and ∆HHb during performance tasks and these players' ∆O2Hb profiles had not returned to within 'normal' levels within the GRTP period. All players' symptom severity and number returned to normal within the GRTP period.

CONCLUSION

Current GRTP protocols alone are problematic and there is a need for a more individualised approach to concussion management, utilising objective biomarker tools such as fNIRS.

Estimating sensor-space EEG connectivity PART 2: Identifying optimal artifact reduction techniques for functional connectivity in real data

OBJECTIVES

Electroencephalography (EEG) can be used to assess functional brain connectivity (FC). However, there is considerable variability in the methods used for FC measurement across different studies, which may contribute to heterogeneity in research outcomes. We aimed to assess how different EEG pre-processing steps impact EEG-FC measurement when applied to real EEG data.

METHODS

Using the BrainClinics.com open-source EEG data repository we investigated how different pre-processing steps impacted the ability to detect age-related differences in alpha band FC and the test-retest reliability of FC measures. The pre-processing steps tested included artifact reduction techniques (Independent Component Analysis (ICA), wavelet-enhanced ICA (wICA), and Multi-channel Wiener Filters (MWF)), different epoch lengths (epochs that were 2 s versus 6 s in length), and different re-referencing montages (the common average reference (CAR) versus current source density (CSD) re-referencing). We also assessed different FC metrics including imaginary coherence (iCOH), real magnitude squared coherence (rMSC), and weighted phase lag index (wPLI) metrics.

RESULTS

The best performing pipeline at detecting age-related differences in alpha FC and providing high test-retest reliability included artifact reduction by ICA or wICA, data re-referenced using the CSD method, and FC measured by rMSC.

CONCLUSION & SIGNIFICANCE

This paper presents evidence for an EEG pre-processing pipeline that provides good detection of meaningful effects and high test-retest reliability for sensor space EEG alpha frequency FC.

Juvenile sanctions for young adult offenders in the Netherlands: an opportunity for rehabilitation?

BACKGROUND

To improve rehabilitation and reduce recidivism, adolescent criminal law provides tailor-made sanctioning in which the emphasis is on the offender's development. This results in the possibility that juvenile sanctions, in which education, treatment and rehabilitation are central, can be applied to young adult offenders. It is unknown, however, whether there is a relationship between the developmental focus of adolescent criminal law and the rehabilitation of young adult offenders. Therefore, the aim of this study was to examine whether juvenile sanctions are efficacious in rehabilitating young adult offenders.

METHODS

A quasi-experimental design was used with judicial observational data. From a total of young adults (n = 671) sentenced with juvenile sanctions and young adults (n = 7.221) sentenced with adult sanctions different subsamples were composed. The subsamples were based on distinct starting conditions: (1) young adults engaged in education or employment, (2) young adults without education, income or on unemployment benefits, (3) young adults living independently, and (4) young adults living with parents or institutionalized. Rehabilitation was operationalized as changes or stability in education/employment status and housing conditions two years after the sanction was imposed. Binary logistic regression analyses were used to assess the associations.

RESULTS

Young adults who were engaged in education or employment before their conviction were more likely to maintain this status after a juvenile sanction (OR = 1.43, p < 0.05) than after an adult sanction. Young adults who were not engaged in education or employment had a lower chance (OR = 0.677, p < 0.05) of improving their status after a juvenile sanction than after an adult sanction. No significant differences were found for housing conditions.

CONCLUSIONS

By focusing on maintaining existing engagement in education and employment, juvenile sanctions align with the developmental needs of young adults and promote stability in their transition to mature societal roles. This study highlights the importance of reinforcing existing prosocial bonds and providing adequate support for those needing to establish new prosocial bonds.

Position and velocity controls in children and adults during a wrist tracking task

Children's motor control skills develop with age, but it is unclear when the development begins and ends. To identify those critical points, we conducted a wrist tracking task and examined position and velocity controls in children and adults. The task consisted of a visible circular orbit, a target rotating at a constant speed of 0.1 Hz, a tracer reflecting the real-time position of the wrist joint, and target-visible and -invisible subsections. We had three age groups for younger children (n = 16, 8.00 ± 0.82 years old, Group 1), older children (n = 13, 11.62 ± 0.65 years old, Group 2), and adults (n = 10, 23.50 ± 2.88 years old, Group 3). Absolute angular position difference Δθ and absolute angular velocity difference Δω between the target and tracer were computed to analyze the position and velocity control abilities. Statistical hypothesis tests on the control parameters revealed that the mean Δθ of Group 2 (4.06 ± 0.71 deg) was statistically smaller than Group 1 (6.17 ± 1.51 deg, p = 0.006) and equivalent to Group 3 (2.76 ± 0.51 deg, p = 0.074), whereas the mean Δω of Group 2 (19.82 ± 4.50 deg/s) was statistically similar to Group 1 (20.46 ± 2.88 deg/s, p = 0.999) but greater than Group 3 (12.85 ± 2.03 deg/s, p = 0.001). It indicated that the preteen children between 10 and 12 years old performed accurate position controls like the adults and yet exercised immature velocity controls. However, we noticed that velocity controls in the older children were actively developing since they managed to decrease Δω significantly during the target-invisible phase (17.44 ± 3.53 deg/s, p = 0.002), just like the adults did (11.77 ± 1.08 deg/s, p = 0.017). Therefore, we could also infer that preteen children between 10 and 12 are beginning to obtain feedforward abilities and internal models for the wrist tracking task.

Delayed focal seizures following gunshot wound to the head in a child with minimal initial sequelae

A 6 year old girl accidentally discovered a gun in her home and shot herself in her mouth. A bullet lodged in her right frontal lobe, but she remained neurologically intact with minimal symptoms. Her diagnosis was delayed due to the family leaving the emergency room for long wait times and later noticed over 72 hours from the injury at a dentist appointment. She was sent back to the emergency department, where head imaging revealed the injury to be inoperable. Six months later, the patient developed focal impaired awareness seizures. This was treated with oxcarbazepine, and patient responded well with no further spells. The case was highly unusual as the neurological symptoms were mild compared to the severity and the risk of initial intracranial injury. It emphasizes the frequently overlooked risk of leaving guns unsecured in households with children.

A Strategy for Optimization of Self-Care in the Treatment of Children and Young People After Liver Transplantation: A Qualitative Study

BACKGROUND

To optimize self-care in the treatment of children and young people (CYP) after liver transplantation, intervention by healthcare professionals is necessary for both the CYP and their parents. Increasing evidence supports a comprehensive intervention strategy with dedicated individual time, but data on specific ways of involvement are limited. We explored specific and structured intervention strategies within the healthcare system in Japan to optimize self-care in treatment for CYP after liver transplantation by describing the best practices discussed by healthcare providers.

METHODS

We conducted semi-structured interviews with six RN clinical transplant coordinators from six different facilities in Japan. We inquired about their collaborative interventions with other healthcare professionals for CYP after liver transplantation. Each interview was audio-recorded, and anonymized transcripts were qualitatively coded and analyzed.

RESULTS

Our findings revealed interventions to optimize self-care in CYP after liver transplantation, involving three core categories: invest in future young people, grounding autonomy from the start, employ a patient-centered approach to optimizing self-care in CYP after liver transplant, and optimize the environment as an enabling factor for self-care through CYP stage.

CONCLUSIONS

This study emphasizes a holistic approach to optimizing self-care in CYP after liver transplantation by integrating normative development with transplant therapy demands. It focuses on two key age groups: early childhood and adolescence, within a life course perspective.

Effects of active breaks on educational achievement in children with and without ADHD: study protocol and rationale of the Break4Brain project

The Break4Brain project aims to elucidate the effects of both acute and chronic physical activity (PA) on educational achievement in children with and without Attention Deficit Hyperactivity Disorder (ADHD). This study will be conducted in two phases: a cross-over design followed by a hybrid type 1 implementation-effectiveness trial, which includes both a cluster randomized controlled trial (RCT) and a qualitative study. In phase I, 60 children aged 10-12, with 30 each from ADHD and non-ADHD groups, will participate in a laboratory-based study over 4 days within 1 month. They will participate in three counterbalanced experimental conditions: (i) PA with cognitive engagement, (ii) PA without cognitive engagement, and (iii) a cognitively engaging control. This phase will assess acute changes in brain function, academic performance, working memory, inhibitory control, and sustained attention. Phase II will involve 600 children aged 10-12, randomly assigned to either a video-based PA program or a control group (300 children per group) in an 8-week cluster RCT. This phase will also incorporate a qualitative approach to explore the implementation context through pre- and post-intervention semi-structured interviews with teachers and school staff, and questionnaires for students. The outcomes of interest in this phase will include working memory, cognitive flexibility, selective attention, and academic performance. For the cross-over study, we hypothesize that PA conditions will enhance the studied outcomes compared to the control condition. In the RCT, we anticipate that the 8-week active breaks program will result in significant improvements in the selected outcomes compared to the control group. This study is expected to make pioneering contributions by including novel variables and focusing on the ADHD population. Furthermore, if the cluster RCT proves effective, it could offer a practical and cost-effective resource for integrating active breaks into daily school routines.

Global research in schizophrenia and serotonin: a bibliometric analysis

Background

Schizophrenia is a chronic mental illness that affects millions of individuals worldwide. The etiological origin of schizophrenia is heterogeneous, but it has been shown to be associated with dysfunction in serotonin activity, serotonin receptors, and serotonin metabolism in the brain. Bibliometric analysis is a tool used to scrutinise and analyse research activities and evidence in a specific research area. No existing bibliometric analyses have considered both serotonin and schizophrenia.

Methods

We conducted a bibliometric analysis including 12,027 studies related to the schizophrenia-serotonin link published from the inception of the study to 2023 and available in the Scopus database. We used VOSviewer software to identify global trends, analyse the author and editors keywords, the most cited articles and author, as well as the most productive institutes and journals publishing research on schizophrenia-serotonin link.

Results

Most publications related to the link between schizophrenia and serotonin are focused on adult humans and examine topics such as antipsychotic agents, depression, and serotonin uptake inhibitors. The Journal of Clinical Psychiatry has published the most papers on the schizophrenia-serotonin relationship. Among nations, the United States is the leader in publications. King's College London is the institution with the highest number of publications, and H. Y. Meltzer is the most influential author. Growing trends in schizophrenia-serotonin research are personalised medicine, alternative medicine, transcranial magnetic stimulation, artificial intelligence, nervous system inflammation, brain-gut axis, and the gut microbiome.

Conclusion

Since 1950, there have been several fluctuations in the number of published studies related to schizophrenia and serotonin. We believe that the development of novel medications and treatments for schizophrenia will be increased in the future, as well as research into genetic risks, psychological factors, and cranial neuroimaging components. Future schizophrenia and serotonin research is likely to focus on personalised medicine, alternative therapies, novel pathogenesis of schizophrenia, and the use of emerging technologies such as artificial intelligence.

Electrophysiological responses of audiovisual integration from infancy to adulthood

Our ability to merge information from different senses into a unified percept is a crucial perceptual process for efficient interaction with our multisensory environment. Yet, the developmental process underlying how the brain implements multisensory integration (MSI) remains poorly known. This cross-sectional study aims to characterize the developmental patterns of audiovisual events in 131 individuals aged from 3 months to 30 years. Electroencephalography (EEG) was recorded during a passive task, including simple auditory, visual, and audiovisual stimuli. In addition to examining age-related variations in MSI responses, we investigated Event-Related Potentials (ERPs) linked with auditory and visual stimulation alone. This was done to depict the typical developmental trajectory of unisensory processing from infancy to adulthood within our sample and to contextualize the maturation effects of MSI in relation to unisensory development. Comparing the neural response to audiovisual stimuli to the sum of the unisensory responses revealed signs of MSI in the ERPs, more specifically between the P2 and N2 components (P2 effect). Furthermore, adult-like MSI responses emerge relatively late in the development, around 8 years old. The automatic integration of simple audiovisual stimuli is a long developmental process that emerges during childhood and continues to mature during adolescence with ERP latencies decreasing with age.

A comparison of the characteristics of accidental substance-related acute toxicity deaths in Canada across life stages, 2016-2017

The acute toxicity (sometimes called "overdose" or "poisoning") crisis has affected Canadians across all stages of life, including youth, adults and older adults. Our biological risks and exposures to substances change as we age. Based on a national chart review study of coroner and medical examiner data on acute toxicity deaths in 2016 and 2017, this analysis compares the burden of deaths and circumstances of death, locations of acute toxicity event and death, health history and substances contributing to death of people, by sex and life stage.

An overview of the efficacy and safety of brexpiprazole for the treatment of schizophrenia in adolescents

INTRODUCTION

The onset of psychotic symptoms occurs prior to age 19 in 39% of the patients with schizophrenia. There are limited approved treatment options for adolescents with schizophrenia. Brexpiprazole was approved by the United States Food and Drug Administration (FDA) for treatment of schizophrenia in adolescents in 2022.

AREAS COVERED

Extrapolation of adult data to youth and use of pharmacologic modeling coupled with open long-term safety data were used by the FDA to approve brexpiprazole for adolescent schizophrenia. They were all reviewed herein.

EXPERT OPINION

D2 receptor partial agonist antipsychotic agents are preferred in the early phase of treatment of psychotic disorders. Approval of brexpiprazole in adolescent schizophrenia provides an additional option. Brexpiprazole was approved by the FDA on the basis of extrapolation of adult data without controlled trials in adolescents. This reduces placebo exposure in young people. Two previous agents (asenapine and ziprasidone) approved for adult schizophrenia failed to separate from placebo in adolescent schizophrenia studies; this partially undermines the process of extrapolation. For brexpiprazole, the paucity of data in adolescents relegates it to a second-line agent. More research on brexpiprazole is needed to delineate its relative role in the management of adolescent schizophrenia.

The association between intolerance of uncertainty and academic burnout among university students: the role of self-regulatory fatigue and self-compassion

Introduction

Increased uncertainty is a major feature of the current society that poses significant challenges to university students' mental health and academics. However, current research has not paid sufficient attention to this issue, and no study has explored the underlying mechanisms between intolerance of uncertainty and academic burnout among university students.

Methods

This study examined the association between uncertainty intolerance and academic burnout among university students and the role of self-regulatory fatigue and self-compassion in light of the theory of limited resources. Convenience sampling was used to survey 1,022 Chinese university students.

Results

The findings demonstrated that intolerance of uncertainty significantly influenced university students' academic burnout with self-regulatory fatigue serving as a key mediator. Additionally, self-compassion can effectively moderate the effects of intolerance of uncertainty on self-regulatory fatigue and academic burnout.

Discussion

These results indicated that the depletion of cognitive resources brought about by uncertainty in the current highly uncertain social environment may be one of the key pathways to academic burnout among university students. Furthermore, current research provides insights into how to mitigate the negative effects of uncertainty on university students.

The Relationship between Adolescent Dating Violence and Risky Health Behavioral Outcomes

Dating violence is a serious public health issue among adolescents due to the detrimental short- and long-term consequences. The purpose of this study is to examine the relationship between adolescent dating violence (ADV) and adverse health behavioral outcomes related to substance abuse, mental health, and select risky health behaviors such as feeling unsafe, school performance, and inadequate sleep within the state of Florida. This study used data from the 2015 Youth Risk Behavior Survey (YRBS). The high school students represented a weighted total of 542,818 (n = 4301). Logistic regression analyses, stratified by gender, examined the relationship between ADV and health risk behaviors after adjusting for race and grade. Proportions of ADV were as follows: 3.1% of students reported being abused both physically and sexually; 3.4% reported being abused only physically; 3.9% reported being abused only sexually; and 89.6% were uninvolved. ADV was associated with almost all the health risk behavior outcomes studied, with a few exceptions. Experiencing both kinds of abuse held the highest odds ratio among the four mutually exclusive categories of ADV. The findings from this study could be helpful in identifying youths who demonstrate warning signs of ADV abuse and thus could provide opportunities for targeted preventive interventions.

Morphogenetic theory of mental and cognitive disorders: the role of neurotrophic and guidance molecules

Mental illness and cognitive disorders represent a serious problem for the modern society. Many studies indicate that mental disorders are polygenic and that impaired brain development may lay the ground for their manifestation. Neural tissue development is a complex and multistage process that involves a large number of distant and contact molecules. In this review, we have considered the key steps of brain morphogenesis, and the major molecule families involved in these process. The review provides many indications of the important contribution of the brain development process and correct functioning of certain genes to human mental health. To our knowledge, this comprehensive review is one of the first in this field. We suppose that this review may be useful to novice researchers and clinicians wishing to navigate the field.

Stand up to better pay attention, sit down to better subtract: a new perspective on the advantage of cognitive-motor interactions

The Stroop task and subtraction rely on the different cognitive processes and cerebral regions, but both these cognitive functions interact with posture. The study of cognitive-motor interactions falls under the concept of sharing resources, implying that resources for processing are limited. Researchers try to understand this interaction by constructing dual task (DT) paradigms. None have investigated the Stroop and subtraction tasks in three inherently simple postures in two groups of young adults. This study aimed to test whether a given posture benefits a given cognitive function when cognitive and postural tasks are not overly demanding and are underpinned by common cerebral structures. This study presents the results of 60 healthy young adults performing a subtraction task in three postures (sitting, standing, and walking) and 57 healthy young adults performing the Stroop task in the same three postures. Our results showed that performance at the Stroop task, in terms of number of correct answers and interference, are better while standing or even walking compared to sitting while subtraction is better sitting compared to standing and walking. Moreover, static postural parameters did not vary when in DT compared to single task. This means that there was no additional cost on posture when achieving the cognitive activity simultaneously. The absence of impact of the DT on postural parameters in static postures and the changes in the gait pace when walking suggest that cognitive tasks can be achieved in various postures, without being too costly on posture.

Sex differences in development of functional connections in the face processing network

BACKGROUND AND PURPOSE

Understanding sex differences in typical development of the face processing network is important for elucidating disruptions during atypical development in sex-linked developmental disorders like autism spectrum disorder. Based on prior sex difference studies in other cognitive domains, this study examined whether females show increased integration of core and extended face regions with age for face viewing, while males would show increased segregation.

METHODS

This study used a cross-sectional design with typically developing children and adults (n = 133) and a functional MRI face localizer task. Psychophysiological interaction (PPI) analysis examined functional connectivity between canonical and extended face processing network regions with age, with greater segregation indexed by decreased core-extended region connectivity with age and greater integration indexed by increased core-extended region connectivity with age.

RESULTS

PPI analysis confirmed increased segregation for males-right fusiform face area (FFA) coupling to right inferior frontal gyrus (IFG) opercular when viewing faces and left amygdala when viewing objects decreased with age. Females showed increased integration with age (increased coupling of the right FFA to right IFG opercular region and right occipital face area [OFA] to right IFG orbital when viewing faces and objects, respectively) and increased segregation (decreased coupling with age of the right OFA with IFG opercular region when viewing faces).

CONCLUSIONS

Development of core and extended face processing network connectivity follows sexually dimorphic paths. These differential changes mostly occur across childhood and adolescence, with males experiencing segregation and females both segregation and integration changes in connectivity.

INSIDER: Interpretable sparse matrix decomposition for RNA expression data analysis

RNA sequencing (RNA-Seq) is widely used to capture transcriptome dynamics across tissues, biological entities, and conditions. Currently, few or no methods can handle multiple biological variables (e.g., tissues/ phenotypes) and their interactions simultaneously, while also achieving dimension reduction (DR). We propose INSIDER, a general and flexible statistical framework based on matrix factorization, which is freely available at https://github.com/kai0511/insider. INSIDER decomposes variation from different biological variables and their interactions into a shared low-rank latent space. Particularly, it introduces the elastic net penalty to induce sparsity while considering the grouping effects of genes. It can achieve DR of high-dimensional data (of > = 3 dimensions), as opposed to conventional methods (e.g., PCA/NMF) which generally only handle 2D data (e.g., sample × expression). Besides, it enables computing 'adjusted' expression profiles for specific biological variables while controlling variation from other variables. INSIDER is computationally efficient and accommodates missing data. INSIDER also performed similarly or outperformed a close competing method, SDA, as shown in simulations and can handle complex missing data in RNA-Seq data. Moreover, unlike SDA, it can be used when the data cannot be structured into a tensor. Lastly, we demonstrate its usefulness via real data analysis, including clustering donors for disease subtyping, revealing neuro-development trajectory using the BrainSpan data, and uncovering biological processes contributing to variables of interest (e.g., disease status and tissue) and their interactions.

Physical fitness is related to concentration performance in adolescents

The aim of this study was to test the relationship between physical fitness and attention in a sample of adolescents. The hypothesis was that the overall fitness as well as its single components (speed, endurance, strength, coordination, and flexibility) would be positively related to participants' performance in a test of attention. Participants were adolescent students (N = 140) aged 15 to 18 years. Physical fitness was measured with the German Motor Test. Attention was assessed with the d2-Test of Attention. Overall, physical fitness explained 26% of the variance in the attentional test performance. Endurance, strength, coordination, and flexibility were all positively linked to participants' attention, whereas speed was unrelated to attention. Endurance and flexibility better predicted how fast participants processed the test items, while strength and coordination better predicted the accuracy with which the participants detected the targets. Better physical fitness seems to be an advantage for adolescents' cognitive performance.

Validation of the Attention, Memory, and Frontal-Executive Abilities Screening Test (AMFAST) in children, adolescents, and young adults with complex medical conditions

The objective of this study was to validate the Attention, Memory, and Frontal-Executive Abilities Screening Test (AMFAST) in a sample of children, adolescents, and young adults with complex medical conditions characterized by frontal-subcortical dysfunction. Toward this goal, we first report on scoring corrections to the AMFAST for younger participants (ages 8-10), thereby expanding its use beyond the age range (i.e., ages 11+) that we had validated in our previous study. We then examined the diagnostic utility of the AMFAST at identifying different levels of neurocognitive dysfunction in a clinical sample of 61 children, adolescents, and young adults (ages 8-20) with complex medical conditions who also underwent comprehensive neuropsychological testing. We identified two AMFAST cutoff scores; one that optimally distinguished participants with significant neurocognitive dysfunction from non-impaired participants and another that differentiated participants with more subtle, mild neurocognitive dysfunction from non-impaired participants. These findings demonstrate that the AMFAST is a highly effective screening test that can be used to identify varying levels of frontal-subcortical deficits in younger patient populations.

Adolescent and caregiver preferences for juvenile idiopathic arthritis treatment: a discrete-choice experiment

BACKGROUND

This study aimed to elicit and quantify preferences for treatments for juvenile idiopathic arthritis (JIA).

METHODS

We conducted a discrete-choice experiment among adolescents with JIA in the United States (US) (n = 197) and United Kingdom (UK) (n = 100) and caregivers of children with JIA in the US (n = 207) and UK (n = 200). In a series of questions, respondents chose between experimentally designed profiles for hypothetical JIA treatments that varied in efficacy (symptom control; time until next flare-up), side effects (stomachache, nausea, and vomiting; headaches), mode and frequency of administration, and the need for combination therapy. Using a random-parameters logit model, we estimated preference weights for these attributes, from which we derived their conditional relative importance.

RESULTS

On average, respondents preferred greater symptom control; greater time until the next flare-up; less stomachache, nausea, and vomiting; and fewer headaches. However, adolescents and caregivers in the US were generally indifferent across varying modes and frequencies of administration. UK adolescents and caregivers preferred tablets, syrup, or injections to intravenous infusions. US and UK adolescents were indifferent between treatment with monotherapy or combination therapy; caregivers in the UK preferred treatment with combination therapy to monotherapy. Subgroup analysis showed preference heterogeneity across characteristics including gender, treatment experience, and symptom experience in both adolescents and caregivers.

CONCLUSIONS

Improved symptom control, prolonged time to next flare-up, and avoidance of adverse events such as headache, stomachache, nausea, and vomiting are desirable characteristics of treatment regimens for adolescents with JIA and their caregivers.

Abdominal Pain in Inflammatory Bowel Disease: An Evidence-Based, Multidisciplinary Review

Abdominal pain is one of the most common and impactful symptoms associated with inflammatory bowel disease (IBD), including both Crohn's disease and ulcerative colitis. A great deal of research has been undertaken over the past several years to improve our understanding and to optimize management of this issue. Unfortunately, there is still significant confusion about the underlying pathophysiology of abdominal pain in these conditions and the evidence underlying treatment options in this context. There is also a relative paucity of comprehensive reviews on this topic, including those that simultaneously evaluate pharmacological and nonpharmacological therapeutic options. In this review, our multidisciplinary team examines evidence for various currently available medical, surgical, and other analgesic options to manage abdominal pain in IBD.

Relationship between gamer profiles, gaming behavior, sociodemographic characteristics, and big five personality traits among French law students

BACKGROUND

Over the past 10 years, gamer profiles have been developed to understand the reason underlying players' intrinsic motivation. While the research undertaken has led to the creation of distinct models (e.g., BrainHex and Hexad typologies), there is a lack of studies on the prevalence of these profiles among a specific population and the association between the target population's profiles and their personality traits, gaming behavior, and sociodemographic characteristics.

METHODS

Thus, the present study aimed to (a) establish the gamer profiles of French undergraduate law students, (b) examine the relationships between the participants' profiles and their personality traits, gaming behavior, and sociodemographic characteristics, with a view to the development of serious games specifically intended for this population. In total, 753 French undergraduate students participated in the study, completing an online questionnaire. Data were analyzed using Latent Profile Analysis (LPA), chi-square, and ANOVA.

RESULTS

The main findings show that among participants, the two most prevalent gamers' profiles are Mastermind (45%) and Seeker (22.7%); followed by three less represented archetypes: Conqueror (12.9%), Daredevil (9.7%), and Achiever (9.7%). These archetypes are associated with the participants' Big Five personality traits. Specifically, Daredevils, Masterminds, and Seekers have high mean scores on Extraversion (p < .001); Achievers and Seekers have high mean scores on Agreeableness (p < .001); Seekers and Achievers have high mean scores on Neuroticism (p < .001); and Seekers, Masterminds, and Achievers have high mean scores on Openness (p < .001). The unveiled profiles are also significantly associated with the participants' gaming behavior including their playing frequency (p < .001), game types (p = .031), and sociodemographic characteristics (p < .001). For example, Masterminds are more likely to be female than the other four profiles (p < .001), while Conquerors and Daredevils are more likely to have a low socio-economic status compared to those with intermediate and high socio-economic status (p = .49).

CONCLUSION

These findings can be used to design serious/educational games tailored to the studied population.

Motor function in early onset schizophrenia-A 2-year follow-up study

AIM

Motor symptoms primarily assessed by clinical rating are documented across the schizophrenia spectrum, but no studies have examined the longitudinal course of these symptoms in adolescents using tests that control for the natural maturational process. The aim is therefore to compare fine and gross motor function using age-adjusted tests in adolescents with schizophrenia and controls across a 2-year period, and examine if clinical correlates contribute to changes in motor function in adolescents with schizophrenia.

METHOD

Motor function assessed by two age-adjusted tests was compared in 25 adolescents with schizophrenia and age- and sex-matched controls over a 2-year period using t-tests, Cohen's D and χ2 tests. Linear mixed models with a random intercept at patient level were used to assess changes between baseline and follow-up. The latter approach was adopted to assess the association between changes and potential predictors as age, sex, complications during labour/delivery, childhood motor function, symptoms severity, executive function and antipsychotics.

RESULT

All measures of motor function but one significantly differentiated adolescents with schizophrenia from controls with large effect sizes at 2-year follow-up. The overall scores did not change during follow-up, whereas two resembling motor areas of the tests significantly improved in adolescents with schizophrenia. The severity of schizophrenia, sex and IQ revealed association with the changes.

CONCLUSION

The finding of both stability and improvements from diagnosis to follow-up in adolescents with schizophrenia and the differences between adolescents with and without schizophrenia argue in favour of the neurodevelopment hypothesis and highlights the need for assessing motor function.

Real-world effectiveness of repeated intravenous ketamine infusions for treatment-resistant depression in transitional age youth

BACKGROUND

Ketamine is an emerging treatment for treatment-resistant depression (TRD) associated with rapid and robust improvements in depressive symptoms and suicidality. However, the efficacy and safety of ketamine in transitional age youth (TAY; age 18-25) populations remains understudied.

METHODS

In this retrospective analysis, TAY patients (n = 52) receiving ketamine for TRD were matched for sex, primary diagnosis, baseline depression severity, and treatment resistance with a general adult (GA) sample (age 30-60). Patients received four ketamine infusions over 2 weeks (0.5-0.75 mg/kg over 40 min). The primary outcome was the change in Quick Inventory of Depressive Symptomatology Self-Report 16-item (QIDS-SR16) over time. Secondary outcomes were changes in QIDS-SR16 suicidal ideation (SI) item, anxiety (Generalized Anxiety Disorder 7-item (GAD-7)), and adverse effects (ClinicalTrials.gov: NCT04209296).

RESULTS

A significant main effect of infusions on reduction of total QIDS-SR16 (p < 0.001), QIDS-SR16 SI (p < 0.001), and GAD-7 (p < 0.001) scores was observed in the TAY group with moderate effect sizes, indicative of clinically significant improvements in depression, anxiety, and suicidality. There were no significant differences between TAY and GA groups on these measures over time, suggesting comparable improvements in both groups. Safety and tolerability outcomes were comparable between groups with only mild, transient adverse effects observed.

CONCLUSION

Ketamine was associated with comparable clinical benefits, safety, and tolerability in a TAY sample as compared to a matched GA TRD sample.

Pilot study protocol of a randomized controlled trial for the potential effects of creatine monohydrate on persistent post-concussive symptoms

Background

Mild traumatic brain injury or concussion is a global public concern, with an estimated annual incidence between 48 million and 96 million worldwide. It is a socioeconomical problem, and almost one-third of individuals with concussion suffer from severe persistent post-concussive symptoms (PPCS), with an increased risk of unemployment or terminating their studies. To date, no single treatment is available with guaranteed success. Creatine monohydrate (CrM) has shown potential as a treatment for post-concussive symptoms, having a positive impact on cognitive function, chronic fatigue, depression, and anxiety. The aim of this study is to examine the effect of CrM on PPCS assessed using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ).

Methods

The study is designed as a double-blinded randomised controlled trial. Study participants are found through neurological outpatient clinics in Denmark or through social media. They will be between 25 and 35 years of age, will have suffered from PPCS for 6-12 months prior to inclusion, and will have no comorbidities. The participants will be randomly allocated to either an intervention group (INT), placebo group (PLA), or control group (CG). Baseline data will be collected immediately after inclusion, and the study period will be 7 weeks. Follow-up data will be collected 1 week after the end of the study period. The primary outcome of the study is changes in RPQ score. Changes in weight and training status will be adjusted for as potential confounders.

Ethics and dissemination

This protocol is approved by the National Committee on Health Research (97508) and by the Danish Data Protection Agency 11.651. The investigators intend to submit their study findings for publication in peer-reviewed journals and disseminate the findings via presentation at academic meetings/conferences.Clinical Trial registration: NCT05562232, registered September 30, 2022.

The development of functional connectivity within the dorsal striatum from early childhood to adulthood

Dorsal striatum, principally comprising of caudate and putamen, is well-known to support motor function but also various higher-order cognitive functions. This is enabled by developing short- and long-range connections to distributed cortical regions throughout the life span, but few studies have examined developmental changes from young children to adults in the same cohort. Here we investigated the development of dorsal-striatal network in a large (n = 476), single-site sample of healthy subjects 3-42 years of age in three groups (children, adolescence, adults). The results showed that the connectivity within the striatum and to sensorimotor regions was established at an early stage of life and remained strong in adolescence, supporting that sensory-seeking behaviours and habit formation are important learning mechanisms during the developmental periods. This connectivity diminished with age, as many behaviours become more efficient and automated. Adolescence demonstrated a remarkable transition phase where the connectivity to dorsolateral prefrontal cortex emerged but connectivity to the dorsomedial prefrontal and posterior brain, which belong to the ventral attentional and default mode networks, was only seen in adults. This prolonged maturation in between-network integration may explain the behavioural characteristics of adolescents in that they exhibit elaborated cognitive performance but also demonstrate high risk-taking behaviours.

Indoor coal ash and school and social competency among children aged 6-14 years

BACKGROUND

A child's ability to succeed in social interactions and in a school setting are important for their development and growth. Exposure to environmental pollutants has been associated with poorer school performance and fewer social interaction in children. Fly ash, a waste product generated when burning coal for energy, is comprised of small glass spheres with neurotoxic heavy metal(loid)s found to be risk factors for learning and social problems in school.

OBJECTIVE

The purpose of this novel study was to assess the association of fly ash in children's homes with school and social competency.

METHODS

We recruited children aged 6-14 years old from communities located within 10 miles of two coal-burning power plants. In homes of the participants, fly ash was collected on polycarbonate filters using personal modular impactors. We measured school competency and social competency using the validated Child Behavioral Checklist. Using Tobit and linear regression we investigated the relationship of indoor fly ash with school and social competency.

RESULTS

Forty-three percent of children in the study had fly ash in their homes. In covariate-adjusted Tobit models, children with fly ash in their homes scored on average 2.63 (95% CI: -4.98, -0.28) points lower on the school competency scale than peers without ash in their homes. We did not observe that fly ash in homes was related with lower social competency.

SIGNIFICANCE

Results from this study suggest that children with fly ash in their homes had poorer performance in the school setting, compared to peers without fly ash in their homes. In the US, coal-fired power plants are being closed, however health concerns about pollution from coal ash storage facilities remains. Findings from this study can provide impetus for creating of public health policy and to highlight the need future research on children's exposure to fly ash.

IMPACT

Children's growth and development are impacted by their social interactions and ability to perform in school settings. Environmental pollutants may impact these essential elements of development. Millions of children are exposed to fly ash which is a waste product generated from burning coal. Fly ash, an environmental health threat throughout the world, is comprised of small glass spheres with trace concentrations of neurotoxic metal(loid)s. Findings from this research show that children with fly ash in their homes are significantly more likely to have poorer school performance than children without fly ash in their homes.

Effectiveness of a Personalized, Chess-Based Training Serious Video Game in the Treatment of Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial

BACKGROUND

Compared with traditional approaches, gaming strategies are promising interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). We developed a serious game, The Secret Trail of Moon (TSTM), for ADHD treatment.

OBJECTIVE

The main objective of this clinical trial was to demonstrate the effectiveness of an add-on, either TSTM or Therapeutic Chess (TC), in previously optimally drug-titrated, clinically stable patients with ADHD.

METHODS

This study is a prospective, unicentric, randomized clinical trial in clinically stable patients with ADHD, aged 12 to 22 years. The TSTM (n=35) and TC groups (n=34) performed 12 weekly sessions of their respective treatments. The control group (CG) patients (n=35) were called by phone every week, but they received no cognitive intervention. The primary end point was the change from baseline to end point in the parent "Behavior Rating Inventory of Executive Function-2" (BRIEF-2; patients' parents) in the per-protocol population (31 serious videogame: 24 TC and 34 CG).

RESULTS

Our study failed to probe clear-cut improvements in the global score of the BRIEF-2. However, the TC group showed improvements in measures of emotional control, emotional regulation, and inattention. The TSTM group showed improvements in measures of emotional regulation, inattention, and school context.

CONCLUSIONS

TSTM and TC did not improve executive function symptoms, but they improved ADHD symptomatology related to emotional regulation. Further studies with bigger samples are required to confirm these preliminary findings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04355065; https://clinicaltrials.gov/ct2/show/NCT04355065.

Omega-3 supplements in the prevention and treatment of youth depression and anxiety symptoms: A scoping review

INTRODUCTION

Omega-3 supplements may be efficacious in reducing symptoms of depression and anxiety in adults, particularly as an adjunct to antidepressant medication. However, research in young people is limited. Thus, this scoping review aimed to summarise existing evidence on the efficacy of omega-3 supplementation in treating depression and anxiety symptoms in young people aged 14-24. A secondary aim was to determine whether grey literature intended for the general public accurately reflects the evidence.

METHOD

Four databases (Cochrane CENTRAL, EmBASE, PsycINFO, PubMed) were searched from inception to 4th August 2021. Eligible peer-reviewed studies were empirical studies which examined the efficacy of omega-3 supplements in preventing/treating anxiety and/or depression symptoms in young people aged 14-24. Risk of bias was assessed for randomised studies using the Cochrane Risk of Bias Tool. Selected grey literature databases were also searched, with eligible sources assessed for quality. A stakeholder group including young people with lived experience of anxiety/depression, parents/carers and mental health professionals informed the research questions and data interpretation. Findings were summarised using narrative synthesis.

RESULTS

17 empirical studies (N = 1240 participants) meeting inclusion criteria were identified. Studies varied in treatment and participant characteristics. In general, the data did not support the view that omega-3 supplements were efficacious in improving symptoms of anxiety or depression in young people aged 14-24. In contrast, most grey literature sources recommended the use of omega-3 supplements in young people.

DISCUSSION

Evidence for efficacy of omega-3 supplementation in reducing symptoms of depression and anxiety in young people was inconclusive. More research is needed to identify potential mechanisms and moderators of the effect of omega-3 supplements on depression and anxiety symptoms in young people.

Expanding on Threat and Deprivation: Empirical Examination of Adversity Dimensions and Psychiatric Outcomes Among Emerging Adults

Dimensional models of adversity, whereby experiences lie along dimensions of threat and deprivation, are increasingly popular; however, their empirical validation is limited. In a sample of emerging adults (N=1,662; M age =20.72; 53% female; 72% Black), we conducted exploratory factor analyses using adversities derived from items probing family relationships and a validated assessment of traumatic events. Resulting factors were used to test associations with odds of lifetime diagnosis of a substance use disorder, other mental health disorders, and suicide attempt. Results supported a four-factor solution: threat (non-betrayal), emotional deprivation, sexual assault, and threat (betrayal). Threat (betrayal) summary scores were most strongly associated with increased odds of substance use and other disorders, whereas sexual assault was most strongly associated increased odds of lifetime suicide attempt. Findings provide some empirical support for categorizing adversity along dimensions of threat and deprivation. However, it also suggests the possibility of further divisions within these dimensions.

Brain structural co-development is associated with internalizing symptoms two years later in the ABCD cohort

Background and aims

About 1/3 of youth spend more than four hours/day engaged in screen media activity (SMA). This investigation utilized longitudinal brain imaging and mediation analyses to examine relationships among SMA, brain patterns, and internalizing problems.

Methods

Data from Adolescent Brain Cognitive Development (ABCD) participants with baseline and two-year follow-up structural imaging data that passed quality control (N = 5,166; 2,385 girls) were analyzed. Joint and Individual Variation Explained (JIVE) identified a brain co-development pattern among 221 brain features (i.e., differences in surface area, thickness, or cortical and subcortical gray-matter volume between baseline and two-year-follow-up data). Generalized linear mixed-effect models investigated associations between baseline SMA, structural co-development and internalizing and externalizing psychopathology at two-year follow-up.

Results

SMA at baseline was related to internalizing psychopathology at year 2 (β=0.020,SE=0.008,P=0.014) and a structural co-development pattern (β=0.015,SE=0.007,P=0.029), where the co-development pattern suggested that rates of change in gray-matter volumes of the brainstem, gray-matter volumes and/or cortical thickness measures of bilateral superior frontal, rostral middle frontal, inferior parietal, and inferior temporal regions were more similar than those in other regions. This component partially mediated the relationship between baseline SMA and future internalizing problems (indirect effect = 0.020, P-value = 0.043, proportion mediated: 2.24%).

Discussion and conclusions

Greater youth engagement in SMA at ages 9-10 years statistically predicted higher levels of internalizing two years later. This association was mediated by cortical-brainstem circuitry, albeit with relatively small effect sizes. The findings may help delineate processes contributing to internalizing behaviors and assist in identifying individuals at greater risk for such problems.

Kratom (M. speciosa) exposure during adolescence caused long-lasting cognitive behavioural deficits associated with perturbated brain metabolism pathways in adult rats

Kratom (M. speciosa Korth) is an herbal plant native to Southeast Asia. The leaves have been widely used to alleviate pain and opioid withdrawal symptoms. However, the increasing trend of recreational use of kratom among youth is concerning because substance abuse may render the adolescent brain more susceptible to neuropathological processes, causing dramatic consequences that persist into adulthood. Therefore, the present study aimed to investigate the long-term effects of mitragynine, the main alkaloid and lyophilized kratom decoction (LKD) exposure during adolescence on cognitive behaviours and brain metabolite profiles in adult rats. Adolescent male Sprague-Dawley rats were given mitragynine (3, 10 or 30mg/kg) or LKD orally for 15 consecutive days during postnatal days 31-45 (PND31-45). Behavioural testing was performed during adulthood (PND70-84) and the brains were subjected to metabolomic analysis. The results show that a high dose of mitragynine impaired long-term object recognition memory. Social behaviour and spatial learning were not affected, but both mitragynine and LKD impaired reference memory. Brain metabolomic study revealed several altered metabolic pathways that may be involved in the cognitive behavioural effects of LKD and mitragynine exposure. These pathways include arachidonic acid, taurine and hypotaurine, pantothenate and CoA biosynthesis, and tryptophan metabolism, while the N-isovalerylglycine was identified as the potential biomarker. In summary, adolescent kratom exposure can cause long-lasting cognitive behavioural deficits and alter brain metabolite profiles that are still evident in adulthood. This finding also indicates that the adolescent brain is vulnerable to the impact of early kratom use.

Morphometric dis-similarity between cortical and subcortical areas underlies cognitive function and psychiatric symptomatology: a preadolescence study from ABCD

Preadolescence is a critical period characterized by dramatic morphological changes and accelerated cortico-subcortical development. Moreover, the coordinated development of cortical and subcortical regions underlies the emerging cognitive functions during this period. Deviations in this maturational coordination may underlie various psychiatric disorders that begin during preadolescence, but to date these deviations remain largely uncharted. We constructed a comprehensive whole-brain morphometric similarity network (MSN) from 17 neuroimaging modalities in a large preadolescence sample (N = 8908) from Adolescent Brain Cognitive Development (ABCD) study and investigated its association with 10 cognitive subscales and 27 psychiatric subscales or diagnoses. Based on the MSNs, each brain was clustered into five modules with distinct cytoarchitecture and evolutionary relevance. While morphometric correlation was positive within modules, it was negative between modules, especially between isocortical and paralimbic/subcortical modules; this developmental dissimilarity was genetically linked to synapse and neurogenesis. The cortico-subcortical dissimilarity becomes more pronounced longitudinally in healthy children, reflecting developmental differentiation of segregated cytoarchitectonic areas. Higher cortico-subcortical dissimilarity (between the isocortical and paralimbic/subcortical modules) were related to better cognitive performance. In comparison, children with poor modular differentiation between cortex and subcortex displayed higher burden of externalizing and internalizing symptoms. These results highlighted cortical-subcortical morphometric dissimilarity as a dynamic maturational marker of cognitive and psychiatric status during the preadolescent stage and provided insights into brain development.

Interindividual Variability in Mental Fatigue-Related Impairments in Endurance Performance: A Systematic Review and Multiple Meta-regression

BACKGROUND

The negative effect of mental fatigue (MF) on physical performance has recently been questioned. One reason behind this could lie in the interindividual differences in MF-susceptibility and the individual features influencing them. However, the range of individual differences in mental fatigue-susceptibility is not known, and there is no clear consensus on which individual features could be responsible for these differences.

OBJECTIVE

To give an overview of interindividual differences in the effects of MF on whole-body endurance performance, and individual features influencing this effect.

METHODS

The review was registered on the PROSPERO database (CRD42022293242). PubMed, Web of Science, SPORTDiscus and PsycINFO were searched until the 16th of June 2022 for studies detailing the effect of MF on dynamic maximal whole-body endurance performance. Studies needed to include healthy participants, describe at least one individual feature in participant characteristics, and apply at least one manipulation check. The Cochrane crossover risk of bias tool was used to assess risk of bias. The meta-analysis and regression were conducted in R.

RESULTS

Twenty-eight studies were included, with 23 added to the meta-analysis. Overall risk of bias of the included studies was high, with only three presenting an unclear or low rating. The meta-analysis shows the effect of MF on endurance performance was on average slightly negative (g = - 0.32, [95% CI - 0.46; - 0.18], p < 0.001). The multiple meta-regression showed no significant influences of the included features (i.e. age, sex, body mass index and physical fitness level) on MF-susceptibility.

CONCLUSIONS

The present review confirmed the negative impact of MF on endurance performance. However, no individual features influencing MF-susceptibility were identified. This can partially be explained by the multiple methodological limitations such as underreporting of participant characteristics, lack of standardization across studies, and the restricted inclusion of potentially relevant variables. Future research should include a rigorous description of multiple different individual features (e.g., performance level, diet, etc.) to further elucidate MF mechanisms.

Impairments to executive function in emerging adults with Huntington disease

BACKGROUND AND OBJECTIVES

The clinical diagnosis of Huntington disease (HD) is typically made once motor symptoms and chorea are evident. Recent reports highlight the onset of cognitive and psychiatric symptoms before motor manifestations. These findings support further investigations of cognitive function across the lifespan of HD sufferers.

METHODS

To assess cognitive symptoms in the developing brain, we administered assessments from the National Institutes of Health Toolbox Cognitive Battery, an age-appropriate cognitive assessment with population norms, to a cohort of children, adolescents and young adults with (gene-expanded; GE) and without (gene-not-expanded; GNE) the trinucleotide cytosine, adenine, guanine (CAG) expansion in the Huntingtin gene. These five assessments that focus on executive function are well validated and form a composite score, with population norms. We modelled these scores across age, and CAP score to estimate the slope of progression, comparing these results to motor symptoms.

RESULTS

We find significant deficits in the composite measure of executive function in GE compared with GNE participants. GE participant performance on working memory was significantly lower compared with GNE participants. Modelling these results over age suggests that these deficits occur as early as 18 years of age, long before motor manifestations of HD.

CONCLUSIONS

This work provides strong evidence that impairments in executive function occur as early as the second decade of life, well before anticipated motor onset. Future investigations should delineate whether these impairments in executive function are due to abnormalities in neurodevelopment or early sequelae of a neurodegenerative process.

Quantitative Survey on Prevalence of Prescription Pain Medications and Stimulants Use in Young Adults

Background

Prescription drug use including pain relievers and stimulants has been a growing problem in young adults and the issue has been a public health concern for years.

Methods

This Quantitative Cross-sectional study aimed to collect preliminary data regarding prescription opioid use, prescription stimulant drug use and overdose treatment knowledge in young adults between 18 and 24 years old in a southern New Jersey university through administering an online survey.

Results

Of the 1663 students who completed the survey, 33% reported using prescription pain relievers and 15% reported using prescription stimulant drugs. Stimulant drug users were found to be more likely to use prescription pain relievers (49%) as compared to non-stimulant users (30%). Furthermore, students with overdose treatment knowledge of opioids were more likely to report misuse of prescription drugs (15%) than students with less knowledge (8%).

Conclusions

This study reiterates the increasing usage of prescription drugs and stimulant use among college students. There is a need for effective education strategies to inform students about the prescription medication uses and misuse to reduce nonmedical use of prescription medications.

An Ontological, Anthropological, and Psychoanalytic Perspective on Physician Burnout

Post-industrialization, societies have evolved with profound changes in ways of life. However, it was not until just recently that the overall impact of its deleterious and pernicious effects has been widely recognized, studied, and accepted. In the last few years, increased rates of stress and burnout (BO) not only affect clinicians, personally, but health care systems across the nation. The understanding of BO in the realm of current nosological limitations lacks context and is often unrecognized given the stigma associated with mental illness. However, the emerging data regarding this syndrome is highly concerning. Its impact on professionals and leaders across various disciplines is puzzling and underscores the nature and extent of the problem. A search of PubMed, PsycINFO, Cochrane Library, and Google Scholar was conducted from the date of inception until June 2022 using the keywords Burnout", "Mental Health"," Physicians", "Addiction", "Health Care Workers", "Anthropology", "Psychopathology", Philosophy", "Wellness". The search resulted in the identification of 135 articles; 56 articles met the inclusion criteria for the review. Post-pandemic BO has reached distressing levels. BO remains poorly understood highly complex and has multifactorial etiology which is now included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. Besides being linked with known factors such as long work hours, administrative burdens, and a lack of control over one's work environment there are many confounders. It is a serious issue that can have negative consequences for both the physician and the patient, and therefore mitigation strategies are needed. The awareness of these unmanifested conflicts, mindfulness training, limiting addictive habits, and efforts toward wellness may provide some alternative solutions. Lastly, developing a coherent philosophy may be useful for distress tolerance, dealing with ambiguity related to the profession, and paving the way to a more meaningful life.

Brain responses in aggression-prone individuals: A systematic review and meta-analysis of functional magnetic resonance imaging (fMRI) studies of anger- and aggression-eliciting tasks

Reactive aggression in response to perceived threat or provocation is part of humans' adaptive behavioral repertoire. However, high levels of aggression can lead to the violation of social and legal norms. Understanding brain function in individuals with high levels of aggression as they process anger- and aggression-eliciting stimuli is critical for refining explanatory models of aggression and thereby improving interventions. Three neurobiological models of reactive aggression - the limbic hyperactivity, prefrontal hypoactivity, and dysregulated limbic-prefrontal connectivity models - have been proposed. However, these models are based on neuroimaging studies involving mainly non-aggressive individuals, leaving it unclear which model best describes brain function in those with a history of aggression. We conducted a systematic literature search (PubMed and Psycinfo) and Multilevel Kernel Density meta-analysis (MKDA) of nine functional magnetic resonance imaging (fMRI) studies (eight included in the between-group analysis [i.e., aggression vs. control groups], five in the within-group analysis). Studies examined brain responses to tasks putatively eliciting anger and aggression in individuals with a history of aggression alone and relative to controls. Individuals with a history of aggression exhibited greater activity in the superior temporal gyrus and in regions comprising the cognitive control and default mode networks (right posterior cingulate cortex, precentral gyrus, precuneus, right inferior frontal gyrus) during reactive aggression relative to baseline conditions. Compared to controls, individuals with a history of aggression exhibited increased activity in limbic regions (left hippocampus, left amygdala, left parahippocampal gyrus) and temporal regions (superior, middle, inferior temporal gyrus), and reduced activity in occipital regions (left occipital cortex, left calcarine cortex). These findings lend support to the limbic hyperactivity model in individuals with a history of aggression, and further indicate altered temporal and occipital activity in anger- and aggression-eliciting conditions involving face and speech processing.

Nutrition in school-age children: a rationale for revisiting priorities

Middle childhood and early adolescence have received disproportionately low levels of scientific attention relative to other life stages, especially as related to nutrition and health. This is partly due to the justified emphasis on the first 1000 days of life, and the idea that early deficits and consequences may not be fully reversible. In addition, these stages of life may superficially appear less "eventful" than infancy or late adolescence. Finally, there has been historical ambiguity and inconsistency in terminology, depending on whether viewing "childhood" through physiologic, social, legal, or other lenses. Nevertheless, this age bracket, which encompasses most of the primary education and basic schooling years for most individuals, is marked by significant changes, inflection points, and sexually driven divergence in somatic and brain growth and development trajectories. These constitute transformative changes, and thus middle childhood and early adolescence represents a major and last opportunity to influence long-term health and productivity. This review highlights the specificities of growth and development in school age, with a focus on middle childhood and early adolescence (5 years-15 years of age, for the purposes of this review), the role of nutrition, the short- and long-term consequences of inadequate nutrition, and the current global status of nutrition in this age group. Adequate attention and emphasis on nutrition in the school-age years is critical: (a) for maintaining an adequate course of somatic and cognitive development, (b) for taking advantage of this last major opportunity to correct deficits of undernutrition and "catch-up" to normal life course development, and (c) for addressing the nutritional inadequacies and mitigating the longer-term consequences of overnutrition. This review summarizes and provides a rationale for prioritizing nutrition in school-age children, and for the need to revisit priorities and focus on this part of the life cycle to maximize individuals' potential and their contribution to society.

Symptoms of problematic pornography use among help-seeking male adolescents: Latent profile and network analysis

BACKGROUND AND AIMS

Little data exist on exploring the subgroups and characteristics of problematic pornography use (PPU) in help-seeking adolescents. The aims of the study were to classify the subgroups among help-seeking male adolescents, explore their similarities and differences, and uncover their core symptoms.

METHODS

A total of 3,468 Chinese male adolescents (Mage = 16.64 years, SD = 1.24) who were distressed about their pornography use were recruited. The Problematic Pornography Consumption Scale, the Brief Pornography Screen Scale, and Moral Disapproval of Pornography Use were used to classify them. The General Health Questionnaire, the Pornography Craving Questionnaire, and the Sexual Compulsivity Scale were used to investigate participants' negative consequence related to their pornography use; and the Online Sexual Activity Questionnaire (OSAs) and time spent on pornography use every week were considered as quantitative indicators.

RESULTS

Help-seeking male adolescents could be divided into 3 profiles, namely, self-perceived problematic (SP, n = 755), impaired control (IC, n = 1,656), and problematic use groups (PPU, n = 1,057). Frequency of OSAs was important for the identification of SP individuals, while negative consequences were more effective in identifying individuals with objective dysregulated behavior. Salience and mood modification were shared by all groups; however, in addition to this, the SP and PPU groups also showed withdrawal symptoms.

DISCUSSION AND CONCLUSION

This study's results provide support for the presence of different profiles of help-seeking individuals and information on potential intervention targets among adolescents which is lacking in the literature.

Puberty Blockers for Children: Can They Consent?

Gender dysphoria is a persistent distress about one's assigned gender. Referrals regarding gender dysphoria have recently greatly increased, often of a form that is rapid in onset. The sex ratio has changed, most now being natal females. Mental health issues pre-date the dysphoria in most. Puberty blockers are offered in clinics to help the child avoid puberty. Puberty blockers have known serious side effects, with uncertainty about their long-term use. They do not improve mental health. Without medication, most will desist from the dysphoria in time. Yet over 90% of those treated with puberty blockers progress to cross-sex hormones and often surgery, with irreversible consequences. The brain is biologically and socially immature in childhood and unlikely to understand the long-term consequences of treatment. The prevailing culture to affirm the dysphoria is critically reviewed. It is concluded that children are unable to consent to the use of puberty blockers.

Brain volume abnormalities and clinical outcomes following paediatric traumatic brain injury

Long-term outcomes are difficult to predict after paediatric traumatic brain injury. The presence or absence of focal brain injuries often do not explain cognitive, emotional and behavioural disabilities that are common and disabling. In adults, traumatic brain injury produces progressive brain atrophy that can be accurately measured and is associated with cognitive decline. However, the effect of paediatric traumatic brain injury on brain volumes is more challenging to measure because of its interaction with normal brain development. Here we report a robust approach to the individualized estimation of brain volume following paediatric traumatic brain injury and investigate its relationship to clinical outcomes. We first used a large healthy control dataset (n > 1200, age 8-22) to describe the healthy development of white and grey matter regions through adolescence. Individual estimates of grey and white matter regional volume were then generated for a group of moderate/severe traumatic brain injury patients injured in childhood (n = 39, mean age 13.53 ± 1.76, median time since injury = 14 months, range 4-168 months) by comparing brain volumes in patients to age-matched controls. Patients were individually classified as having low or normal brain volume. Neuropsychological and neuropsychiatric outcomes were assessed using standardized testing and parent/carer assessments. Relative to head size, grey matter regions decreased in volume during normal adolescence development whereas white matter tracts increased in volume. Traumatic brain injury disrupted healthy brain development, producing reductions in both grey and white matter brain volumes after correcting for age. Of the 39 patients investigated, 11 (28%) had at least one white matter tract with reduced volume and seven (18%) at least one area of grey matter with reduced volume. Those classified as having low brain volume had slower processing speed compared to healthy controls, emotional impairments, higher levels of apathy, increased anger and learning difficulties. In contrast, the presence of focal brain injury and microbleeds were not associated with an increased risk of these clinical impairments. In summary, we show how brain volume abnormalities after paediatric traumatic brain injury can be robustly calculated from individual T1 MRI using a large normative dataset that allows the effects of healthy brain development to be controlled for. Using this approach, we show that volumetric abnormalities are common after moderate/severe traumatic brain injury in both grey and white matter regions, and are associated with higher levels of cognitive, emotional and behavioural abnormalities that are common after paediatric traumatic brain injury.

Neuroanatomical Correlates of Perceived Stress Controllability in Adolescents and Emerging Adults

Stressful life events predict changes in brain structure and increases in psychopathology, but not everyone is equally affected by life stress. The learned helplessness theory posits that perceiving life stressors as uncontrollable leads to depression. Evidence supports this theory for youth, but the impact of perceived control diverges based on stressor type: perceived lack of control over dependent (self-generated) stressors is associated with greater depression symptoms when controlling for the frequency of stress exposure, but perceived control over independent (non-self-generated) stressors is not. However, it is unknown how perceived control over these stressor types is associated with brain structure. We tested whether perceived lack of control over dependent and independent life stressors, controlling for stressor exposure, is associated with gray matter (GM) in a priori regions of interest (ROIs; mPFC, hippocampus, amygdala) and across the cortex in a sample of 108 adolescents and emerging adults ages 14-22. There were no associations across the full sample between perceived control over either stressor type and GM in the ROIs. However, less perceived control over dependent stressors was associated with greater amygdala gray matter volume in female youth and greater medial prefrontal cortex thickness in male youth. Furthermore, whole-cortex analyses revealed less perceived control over dependent stressors was associated with greater GM thickness in cortical regions involved in cognitive and emotional regulation. Thus, appraisals of control have distinct associations with brain morphology while controlling for stressor frequency, highlighting the importance of differentiating between these aspects of the stress experience in future research.

Functional Connectivity Stability: A Signature of Neurocognitive Development and Psychiatric Problems in Children

Brain functional connectivity has been shown to provide a type of fingerprint for adult subjects. However, most studies tend to focus on the connectivity strength rather than its stability across scans. In this study, we performed for the first time a large-scale analysis of within-individual stability of functional connectivity (FC) using 9071 children from the Adolescent Brain Cognitive Development database. Functional network connectivity (FNC) was extracted via a fully automated independent component analysis framework. We found that children's FNC is robust and stable with high similarity across scans and serves as a fingerprint that can identify an individual child from a large group. The robustness of this finding is supported by replicating the identification in the two-year follow-up session and between longitudinal sessions. More interestingly, we discovered that the within-individual FNC stability was predictive of cognitive performance and psychiatric problems in children, with higher FNC stability correlating with better cognitive performance and fewer dimensional psychopathology. The overall results indicate that the FNC of children also shows reliable within-individual stability, acting as a fingerprint for distinguishing participants, regardless of significant growth and development in the children's brain. FC stability can be a valuable imaging marker to predict early cognitive and psychiatric behaviors in children. Clinical Relevance---The stability of functional connectivity can be used to identify children from a large group and to draw inferences on early-age cognitive and psychiatric behaviors.

Responding to neurodiversity in the courtroom: A brief evaluation of environmental accommodations to increase procedural fairness

Recent research has highlighted that a high prevalence of young adults who have various forms of neurodivergence come into contact with the criminal justice system. Currently, many courts are not designed to respond to neurological differences often seen in young people who engage with them. The aim of this study was to identify ways to make locality courts more accessible, engaging, and ultimately more responsive to neurodivergence. A panel of neurodivergence specialists reviewed the general district courtroom environment of a new specialised young adult list court in Aotearoa New Zealand to identify potential barriers to accessibility and to highlight areas for improvement. The methodology involved naturalistic observation of a typical morning in the courtroom. We identified a series of recommendations with the potential to improve the court experience and increase access to justice for neurodivergent young adults. This study identified specific need for neurodiversity education and screening within the court environment.

Dispelling a Myth: Reevaluating the Predictive Validity of Rape Myth Acceptance for Likelihood of Engaging in Sexual Violence

Sexual violence prevention on college campuses has received significant recent attention. A prevalent intervention paradigm has centered around re-educating young people around consent and reduce endorsement of "rape myths," based on the correlation between rape myths and sexual violence incidents. Yet many of these programs have not measurably reduced sexual assaults. We evaluated the predictive value of a rape myth measure, as compared with other predictors (criminal history, childhood victimization, aggressive tendencies, substance use, and empathy), in predicting self-reported acts of forcible and incapacitated sexual assault in college-age men (N = 304) from 45 U.S. states. Across three logistic regression model pairs, rape myths were weakly associated with violence when considered as sole predictors. However, this predictive power dissipated when other predictors were included. Comprehensive models accounted significantly better for variability in outcomes; with criminal history demonstrating consistent predictive effects. Based on these findings, we recommend further research into prevention programming based on other predictors of violence.

Views and experiences of young people, their parents/carers and healthcare professionals of the advance care planning process: A summary of the findings from a qualitative study

BACKGROUND

Advance care planning for young people is relatively new in the UK. There is a lack of understanding about the engagement of young people in their own planning process, optimal timing of discussions and the facilitators and barriers to the engagement of young people.

AIM

To explore the views and experiences of young people, their parents/carers and HCPs of the advance care planning process.

DESIGN

A qualitative study, using semi-structured interviews with young people, their parents/carers and healthcare professionals across four case series. Data were analysed using thematic analysis.

PARTICIPANTS

Fifteen participants were interviewed: young people (n = 2), parents/carers (n = 5) and healthcare professionals (n = 8).

RESULTS

Three themes were identified from the findings. Key findings related to barriers and facilitators of engaging young people in their own care planning were apparent in the following areas: misperception of terms; hierarchies of power in relationships; and a flexible and innovative organisational structure and culture.

CONCLUSION

Participants expressed a variety of views and experiences of advance care planning. Advance care planning was thought to be best initiated by a consultant when the young person is in their mid-teens, their condition is stable, and before they transition to adult care. Engagement was also considered to be facilitated by appropriate communication, developing relationships prior to initiating advance care planning, and written support for everyone involved in the process. These factors were supported by training and education for healthcare professionals and a flexible and innovative structure and cultures of organisations.

Are Extended Reality Interventions Effective in Helping Autistic Children to Enhance Their Social Skills? A Systematic Review

Autistic children’s social skills do not always align with those of their neurotypical peers and research suggests that this can negatively impact quality of life. This review aimed to assess the effectiveness of extended reality (XR) interventions in helping autistic children to enhance their social skills. Five electronic databases were systematically searched and seventeen studies were identified. The majority targeted social-emotional reciprocity and were of relatively low quality. There was insufficient evidence to determine whether effects were generalisable, sustained or important to autistic people. Research in this field is in its infancy and evidence of effectiveness should be viewed with caution. Future studies should aim for high-quality, theory-driven research, and involve autistic people to ensure meaningful outcomes.

PROSPERO ID: CRD42021229442

Neurocognitive functioning and symptoms across levels of collision and contact in male high school athletes

OBJECTIVE

We sought to determine whether male collision sport athletes perform worse on computerised neurocognitive assessments and report higher symptom burdens than athletes in contact (but not collision) sports and athletes in non-contact sports.

METHODS

This cross-sectional study used data collected by the Massachusetts Concussion Management Coalition on high school boys who underwent computerised neurocognitive testing between 2009 and 2018. We divided sports participation in three different sport types: (1) collision, (2) contact, non-collision and (3) non-contact. Our outcomes included the four computerised neurocognitive composite scores (verbal memory, visual memory, visual motor speed and reaction time) and the total symptom score. The independent variable was sport type (collision, contact, non-contact), adjusted for age, concussion history and comorbidities.

RESULTS

Of the 92 979 athletes (age: 15.59±2.08 years) included in our study, collision sport athletes performed minimally but significantly worse than other athletes on neurocognitive composite scores (verbal memory: β=-1.64, 95% CI -1.85 to -1.44; visual memory: β=-1.87, 95% CI -2.14 to -1.60; visual motor speed: β=-2.12, 95% CI -2.26 to -1.97; reaction time: β=0.02, 95% CI 0.02 to 0.02). Collision and contact sport athletes also had slightly but significantly lower total symptom scores (collision: 3.99±7.17; contact: 3.78±6.81; non-contact: 4.32±7.51, p<0.001, η2=0.001) than non-contact sport athletes.

CONCLUSION

There are minimal observed differences in performance on neurocognitive assessments between collision sport, contact sport and non-contact sport athletes. The repetitive subconcussive head impacts associated with collision sport participation do not appear to negatively affect self-reported symptoms or neurocognitive functioning in current youth athletes.