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Purpose: To compare risk of problematic internet use (PIU) and importance of digital media interactions for transgender and cisgender adolescents. Methods: A nationally representative group of adolescents took an online survey that included a measure of PIU (Problematic and Risky Internet Use Screening Scale-3 [PRIUSS-3]) and technology interactions (Adolescent Digital Technology Interactions and Importance scale). We compared mean scores for these scales and their subscales and rates of positive screens for PIU for transgender and cisgender adolescents. Results: Of 4575 adolescents participating, 53 (1.2%) were transgender, nonbinary, and gender-diverse (TNG) adolescents. TNG adolescents had higher PRIUSS-3 scores and higher mean scores for importance of technology to explore identity/go outside their offline environment. Conclusions: TNG adolescents report higher PIU risk, which may relate to differences in technology importance for this group. [ABSTRACT FROM AUTHOR]

Rates of adolescent mood disorders and adolescent smartphone use have risen in parallel, leading some to suggest that smartphone use might have detrimental effects on adolescents' moods. Alternatively, it is possible that adolescents turn to smartphone use when experiencing negative mood. Past experimental study suggests that certain smartphone activities can reduce adolescents' negative moods or induce more positive moods, but little is known about the effects of real-world smartphone use, which can involve many different activities. A sample of N = 253 adolescents participated in an Ecological Momentary Assessment (EMA) procedure, which assessed which smartphone activities they were engaged in at random moments throughout the day. This procedure also prompted adolescents to rate their moods before and during smartphone use. Adolescents reported mood improvements during almost all smartphone activities and did not report that moods became more negative during any smartphone activity. Mood improvements were the largest when adolescents said they were listening to music, podcasts, or audiobooks. This may suggest some adolescent smartphone use is driven by a desire to alleviate negative mood. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to assess the level of moral courage among nurses in China, and to explore related influential factors, to help nursing managers take measures to improve nurses' moral courage. Design: A cross‐sectional study. Methods: The data adopted a convenient sampling method. From September to December 2021, 583 nurses from five hospitals in Fujian Province completed the Chinese version of the Nurses' Moral Courage Scale (NMCS). Data were analysed using descriptive statistics, chi‐square test, T‐test, Pearson correlation analysis and multiple regression analysis. Results: The Chinese nurses perceived themselves, on average, as morally courageous. The mean NMCS score was 3.64 ± 0.692. The six factors showed statistically significant correlations (p < 0.05) with moral courage. Regression analysis showed that the main factors influencing nurses' moral courage were active learning of ethics knowledge and nursing was a career goal. Conclusion: This study provides the self‐evaluation level and related influencing factors of Chinese nurses' moral courage. There is no doubt that nurses still need strong moral courage to face unknown ethical problems and challenges in the future. Nursing managers should pay attention to the cultivation of nurses' moral courage, using various forms of educational activities to help nurses alleviate moral problems and improve their moral courage, to maintain patients' access to high‐quality nursing. [ABSTRACT FROM AUTHOR]

Simple Summary: Diffuse midline glioma, H3 K27-altered are central nervous system tumors that primarily affect the pediatric population. Currently, there are no curative therapies, with several completed and on-going clinical trials exploring many different therapeutic options. In this systematic review, we utilized individual participant data from published clinical trials to assess the effect of treatment options, molecular makeup and clinical characteristics on overall survival. These findings are intended to provide guidance for future interventions along with indicate the need to continue to assess results from clinical trials as they become available at a larger scale. Diffuse midline glioma (DMG), H3 K27-altered are highly aggressive, incurable central nervous system (CNS) tumors. The current standard palliative treatment is radiotherapy, with most children succumbing to the disease in less than one year from the time of diagnosis. Over the past decade, there have been significant advancements in our understanding of these heterogeneous tumors at the molecular level. As a result, most of the newer clinical trials offered utilize more targeted approaches with information derived from the tumor biopsy. In this systematic review, we used individual participant data from seven recent clinical trials published over the past five years that met our inclusion and exclusion criteria to analyze factors that influence overall survival (OS). We found that the most prominent genetic alterations H3.3 (H3F3A) and TP53 were associated with worse OS and that ACVR had a protective effect. In addition, re-irradiation was the only statistically significant treatment modality that showed any survival benefit. Our findings highlight some important characteristics of DMG, H3 K27-altered and their effects on OS along with the importance of continuing to review clinical trial data to improve our therapies for these fatal tumors. [ABSTRACT FROM AUTHOR]

Background: Moral courage is a recognized virtue. In the context of the COVID-19 pandemic, the master's students of nursing (MSNs) in China have shown tenacious moral courage. Objective: This study elaborates on the moral courage of Chinese MSNs through their experiences of volunteering during the pandemic. Research Design: Descriptive qualitative, interview-based. Participants and Research Context: Participants were nursing postgraduate students who participated in the prevention and control of the COVID-19 pandemic selected by purposeful sampling. The sample size was determined by data saturation, which was reached with 10 participants. Data were analyzed using a deductive method of content analysis. Because of the isolation policy, telephone interviews were adopted. Ethical considerations: After obtaining the approval of the ethical institution of the author's school (No. 138, 30 August 2021), verbal consent was obtained before the interview with the participants. All data were processed anonymously and confidentially. In addition, we recruited participants through MSNs' counselors, and obtained their phone numbers with their permission. Results: Data analysis resulted in 15 subcategories that were subsequently grouped into 3 major categories including proceed without hesitation, the outcome of practicing moral courage, and develop and maintain moral courage. Conclusion: This qualitative study is based on the special background of the COVID-19 pandemic, and the MSNs in China have shown tenacious moral courage in the work of epidemic prevention and control. Five factors led them to take action without hesitation, and six possible outcomes followed. Lastly, this study provides some suggestions for nurses and nursing students to enhance their moral courage. To better develop and support moral courage in the future, it is necessary to use different methods and multidisciplinary approaches to study moral courage. [ABSTRACT FROM AUTHOR]

Adolescents' digital technology use is nearly ubiquitous and has been associated with health benefits and risks, including risks of depression. The Adolescents' Digital Technology Interactions and Importance (ADTI) scale provides a novel approach to measuring how adolescents prioritize their technology use. The purpose of this study was to investigate the relationship between adolescents' technology interactions and mental health measures, including depression and mental well-being. This cross-sectional online survey study recruited adolescents aged 12–18 years using Qualtrics panels. Survey measures included the ADTI and assessments of depression and well-being. Analyses included the Kruskal–Wallis test and multivariate logistic regression analyses. The 4,592 participants had a mean age of 15.6 years (SD = 1.68), 46.4 percent were female, 66.9 percent were Caucasian, and 74.5 percent lived in a household with an income above the poverty line. The median ADTI total score was 48 (range 18–90), 23.0 percent (n = 1,055) of participants were categorized for at risk for depression and 54.8 percent (n = 2,477) of participants were categorized as high mental well-being. Participants with higher ADTI total scores were more likely to be at risk for depression (odds ratio [OR] = 1.059, 95 percent confidence interval [CI]: 1.054–1.064). Furthermore, participants with a higher ADTI total score were more likely to have a higher mental well-being (OR = 1.015, 95 percent CI: 1.012–1.019). We found that ADTI total scores were significantly higher both among adolescents who screened positive for depression and among adolescents with higher mental well-being. This intriguing finding suggests that it is possible that digital technology use intensifies either the positive or the negative mental states that adolescents bring to their online environment. [ABSTRACT FROM AUTHOR]

Objective: Although individual-level social determinants of health (SDH) are known to influence 30-day readmission risk, contextual-level associations with readmission are poorly understood among children. This study explores associations between neighborhood disadvantage measured by Area Deprivation Index (ADI) and pediatric 30-day readmissions. Methods: This retrospective cohort study included discharges of patients aged < 20 years from Maryland's 2013–2016 all-payer dataset. The ADI, which quantifies 17 indicators of neighborhood socioeconomic disadvantage within census block groups, is used as a proxy for contextual-level SDH. Readmissions were identified with the 30-day Pediatric All-Condition Readmissions measure. Associations between ADI and readmission were identified with generalized estimating equations adjusted for patient demographics and clinical severity (Chronic Condition Indicator [CCI], Pediatric Medical Complexity Algorithm [PMCA], Index Hospital All Patients Refined Diagnosis Related Groups [APR-DRG]), and hospital discharge volume. Results: Discharges (n = 138,998) were mostly female (52.7%), publicly insured (55.1%), urban-dwelling (93.0%), with low clinical severity levels (0–1 CCIs [82.3%], minor APR-DRG severity [48.4%]). Overall readmission rate was 4.0%. Compared to the least disadvantaged ADI quartile, readmissions for the most disadvantaged quartile were significantly more likely (aOR 1.19, 95% CI 1.09–1.30). After adjustment, readmissions were associated with public insurance and indicators of medical complexity (higher number of CCIs, complex-chronic disease PMCA, and APR-DRG severity). Conclusion: In this all-payer, statewide sample, living in the most socioeconomically disadvantaged neighborhoods independently predicted pediatric readmission. While the relative magnitude of neighborhood disadvantage was modest compared to medical complexity, disadvantage is modifiable and thus represents an important consideration for prevention and risk stratification efforts. [ABSTRACT FROM AUTHOR]

Objective. Delays in skeletal maturity are related to bone mass and fracture risk in children, but the factors that determine it are unknown. We aimed to identify the association between insulin-like growth factor-1 (IGF-1) and skeletal maturation before and after growth hormone (GH) treatment. Methods. In this retrospective cohort study, we observed 783 short children and adolescents, 229 of whom received GH therapy. Skeletal maturation was assessed based on the difference between bone age (BA) and chronological age (CA) (noted as BA-CA). Anthropometric data and laboratory values were measured, and BA was evaluated using the Greulich and Pyle method. Results. The delayed BA group was defined as BA ‐ CA < − 2 SD (n = 457), and the occurrence rate of BA delay was 58.37%. A nonlinear relationship was observed between the IGF-1 standard deviation score (IGF-1 SDS) and BA-CA before and after GH therapy. Before GH therapy, there was a significant positive association between the IGF-1 SDS and BA-CA when the IGF-1 level was greater than -2 SDS (β 0.17, 95% CI 0.08, 027; P < 0.001). However, we did not observe a significant relationship between the IGF-1 SDS and BA-CA when the IGF-1 level was lower than -2 SDS (β 0.07, 95% CI -0.12, 0.26; P = 0.454). After GH therapy, there was a significant positive association between the IGF-1 SDS and BA-CA when the IGF-1 level was lower than 2 SDS (β 0.20, 95% CI 0.12, 028; P < 0.001). However, we did not observe a significant relationship between the IGF-1 SDS and BA-CA when the IGF-1 level was greater than 2 SDS (β -0.03, 95% CI -0.33, 0.27; P = 0.866). Conclusion. BA is more delayed in short children and adolescents. There is a nonlinear relationship between IGF-1 and BA maturation in short children before and after GH treatment. These findings suggest that a low level of IGF-1 may contribute to BA delay in short children and adolescents. [ABSTRACT FROM AUTHOR]

Background: The growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis is critical for the regulation of children's growth and development. Serum IGF-1 concentrations are usually low in individuals with idiopathic short stature (ISS) despite normal endogenous GH levels, and the associated underlying factors are unknown. This study aimed to explore the relationship between IGF-1 and hemoglobin (Hb) in children with ISS. Methods: A cross-sectional analysis was performed including 178 children and adolescents with ISS who were enrolled from March 2013 to February 2019. The related clinical and biochemical parameters were evaluated for each patient. Univariate analysis, smooth curve fitting and multivariate piecewise linear regression were performed. Result: The mean levels of IGF-1 standard deviation scores (SDS) and Hb were − 0.99 (− 1.60 - -0.09) and 131.81 ± 9.36 g/L, respectively. Univariate analysis displayed a significant positive association between Hb and IGF-1 SDS (P < 0.001). After adjusting for potential confounding factors, the positive relationship between Hb and IGF-1 SDS remained (P = 0.001). Furthermore, there was an inflection point for Hb in the curve. In a multivariate piecewise linear regression model, IGF-1 SDS was significantly positively associated with Hb when Hb concentrations were lower than 145 g/L (B 0.05; 95% CI 0.02, 0.07; P < 0.001). However, IGF-1 SDS decreased with increasing Hb levels when Hb concentrations were greater than 145 g/L (B -0.15; 95% CI -0.23, − 0.06; P = 0.001). Conclusion: This study demonstrated that Hb is associated with IGF-1 in Chinese children and adolescents with ISS. The levels of IGF-1 increased with the elevation of Hb, but when the concentration of Hb exceeded a certain range, with the increase of Hb, IGF-1 decreased instead. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to examine the relationship between serum alanine aminotransferase (ALT) and growth hormone (GH) in children and adolescents with short stature. Methods. In this retrospective cohort study, 670 Chinese children and adolescents with short stature were included, and 253 of them received recombinant human GH (rhGH) therapy. Anthropometric and biochemical indicators were measured. GH peak levels were assessed after provocation tests with L-dopa and insulin. The subjects were divided into 3 groups according to the GH peak level. The association between the GH peak and ALT was analyzed. The change of ALT during rhGH therapy was assessed by a generalized additive mixed model. Results. Serum ALT and incidence of ALT elevation were both decreased across the GH tertiles (P = 0.002, 0.012, respectively). A univariate analysis showed that the GH peak was negatively associated with ALT (β: -0.12; 95%CI: -0.22, -0.02; P = 0.023). Furthermore, multiple linear stepwise regression analysis demonstrated that the GH peak was independently related to ALT after adjusting for other confounding variables (β: -0.12; 95%CI: -0.24, -0.00; P = 0.042). Besides, mean values of the change in ALT from baseline displayed that, during the early stages of rhGH treatment, serum ALT level indicated a temporary upward trend, but it subsequently gradually decreased (β: -0.16; 95%CI: -0.23, -0.09; P < 0.001). Conclusions. GH secretion level was strongly negatively correlated with ALT in short children and adolescents. And rhGH therapy could reduce ALT level over time. [ABSTRACT FROM AUTHOR]

Old Order Amish and Mennonites, or Plain populations, are a growing minority in North America with unique health care delivery and access challenges coupled with higher frequencies of genetic disorders. The objective of this study was to determine newborn screening use and attitudes from western Wisconsin Plain communities. A cross-sectional survey, with an overall response rate of 25 %, provided data representing 2010 children. In households with children (n = 297), the rate of newborn screening was 74 % and all children were screened in 40 % of these households. Lack of access to testing was the most common reason for not screening all children and parental age was inversely associated with testing. The majority of respondents reported some or more knowledge of screening, viewed screening as important, and had access to screening in their communities. Households with children who had never received newborn screening (26 %) reported lower frequencies of favorable responses in all categories compared to households that had at least one child screened. The difference in access to newborn screening was less marked between the groups compared to differences on knowledge and consideration of its importance. Moreover, 55 % of households who had never screened any of their children reported being unlikely or unsure of screening any future children. A focus on improving access to newborn screening alongside establishing approaches to change parental perceptions on the importance of newborn screening is necessary for increasing newborn screening in these Plain communities. [ABSTRACT FROM AUTHOR]