Office of Adolescent Health

IntroductionThe scope of medical education has expanded to familiarize trainees with the impact of social determinants/drivers of health (SDoH) on health outcomes. However, few experiential learning curricula engage trainees in reducing health-related social needs. The Family Lifestyle Program Patient Navigator Initiative was developed as a novel experiential curriculum for training health equity–minded medical students in food insecurity (FI).MethodsStudent volunteers were recruited from local schools with entry points across all academic years. Student navigators completed training to develop skills to engage families referred from their medical home for FI- or diet-related chronic conditions. Training combined small-group, case-based, and didactic sessions on cultural humility, trauma-informed care, and management strategies for FI, with an emphasis on local and federal resources. Following training, navigators contacted families and provided individualized resource lists. Program evaluation included qualitative/quantitative data collection from participating students and families.ResultsBetween 2021 and 2024, 76 students were trained, 1,355 patient referrals were made, and 640 families were provided resources. A subset of 22 navigators completed pre- and postparticipation surveys, showing a significant increase in confidence in communicating with families experiencing FI and identifying appropriate local resources. Student interviews demonstrated themes around improved communication skills, empathy, and interpersonal enrichment.DiscussionThis initiative demonstrates a feasible experiential learning opportunity for medical students. As health care systems increasingly recognize the influence of SDoH on health outcomes, curricula that incorporate hands-on engagement with public health and social needs are essential for cultivating the knowledge, attitudes, and behaviors required of future clinicians.

Routine adolescent health check-ups can support healthy development and well-being, but evidence on the feasibility, acceptability and effectiveness of contextually relevant comprehensive check-ups in low- and middle-income settings is limited. We conducted a hybrid implementation-effectiveness study incorporating a mixed-methods pre-post design of Y-Check, a comprehensive health check-up intervention in Zimbabwe, as part of a multicountry study developed and coordinated by the World Health Organization. Eligible participants were 10-19-year-old adolescents attending school or community venues. We used self-administered digital questionnaires, provider-led clinical tests and nurse reviews to screen for 25 conditions/behaviors. We provided health promotion, on-site care and referral to relevant providers. From October 2022 to September 2023, 2,097 adolescents were enrolled, of whom 1,843 (87.9%) were seen at 6 months. The primary outcome of appropriate care and/or referral(s) for all identified issues was achieved for 70.8% (95% confidence interval: 68.7-72.9%) of 1,865 participants with at least one issue. At follow-up, there were improvements in nutrition, health-related quality of life, self-esteem, behaviors and educational outcomes. The intervention was feasible and largely acceptable. Uptake of referral services varied by issue. Y-Check cost US$47 per participant. Through Y-Check, we identified untreated conditions and risk behaviors and successfully treated and linked adolescents to services. Here we provide evidence on the potential of the intervention to positively impact health and well-being.

To diagnose newborn infants with congenital cytomegalovirus (cCMV) related sensorineural hearing loss (SNHL) within the critical four-week window for initiating antiviral treatment, we aimed to determine the number needed to test (NNT) for cCMV among newborn infants failing the neonatal hearing screening. A population-based multicenter cohort study included newborn infants in East Denmark who failed two hearing screening tests and underwent saliva CMV screening between November 2021 and May 2024. The NNT was calculated as the inverse of the absolute detection rate of cCMV-related SNHL in this cohort. A total of 484 infants with hearing screening failure were tested for cCMV. Of these, 27 (5.6%) were CMV positive in saliva and 7 (1.5%) were confirmed to have cCMV in urine, blood, or dried blood spots. Six (85.7%) of 7 infants with cCMV and initial hearing screening failure had normal hearing at follow-up, leaving 1 (0.2%) of 484 with cCMV-related SNHL and an NNT of 484 (95% CI 87-20 000). In our setting, targeted screening for cCMV resulted in a high NNT of almost 500 to identify one newborn infant with cCMV-related SNHL, reflecting a low incidence of cCMV-related SNHL and a high risk of false-positive hearing screening.

Abstract How does internal representation held in visual working memory (VWM), known as the attentional template, guide attention? A longstanding debate concerns whether only one (Single-Item-Template theory) or multiple (Multiple-Item-Template theory) items serve as attentional templates simultaneously. Here we propose a Rhythmic-Item-Template hypothesis, successfully reconciling these seemingly contradictory theories. Using the classical VWM-guided attention task, we found that two VWM items alternately dominate behavioral guidance in theta-rhythmic (4–8 Hz), with anti-correlated activation states in time, and more importantly, this rhythmic oscillation was not driven by the retro-cue processing. Neural recordings revealed that occipital alpha-oscillation (8–14 Hz) governed item-specific prioritization and its amplitude closely tracked subjects’ behavioral guidance, while frontal theta-oscillations phase-led and coupled with occipital alpha-oscillations during the item transition. Our Rhythmic-Item-Template results not only resolve previous Single-Item-Template versus Multiple-Item-Template debate but also advance our understanding of how distributed brain rhythms coordinate flexible resource allocation in multi-item memory systems.

Liver transplantation using pediatric and technical variant grafts presents unique challenges due to graft size, vascular anomalies, and ischemia-reperfusion injury. Static cold storage has been the standard preservation method, but machine perfusion is emerging as a superior technique for improving graft function and posttransplant outcomes. This review addresses the role of machine perfusion in preserving pediatric and technical variant grafts with a focus on feasibility and impact on graft viability and early allograft function. Clinical and experimental studies of hypothermic and normothermic machine perfusion were reviewed for pediatric and technical variant grafts. Key parameters, perfusion dynamics, biochemical markers, and outcomes were investigated and suggested that machine perfusion enhances graft quality. In addition, the feasibility and potential of liver splitting during machine perfusion along with technical considerations is being addressed. Machine perfusion represents a transformative approach for pediatric and technical variant grafts, improving preservation quality and posttransplant outcomes while minimizing adverse events especially primary graft nonfunction. Currently, only normothermic machine perfusion enables viability assessment, offering a potential for expanding the donor pool. Due to the low number of pediatric liver transplantation and utilization of technical variant grafts, multicenter studies are required to define protocols and selection criteria for individual grafts, and establish machine perfusion as a standard practice in pediatric liver transplantation.

A major complication of type 1 diabetes is diabetic kidney disease (DKD). Albuminuria and impaired glomerular filtration rate are the main characteristics of DKD. Neutrophil gelatinase-associated lipocalin (NGAL) levels may rise even in the early stages of DKD, even in patients with normoalbuminuria. We present the first systematic review and meta-analysis examining the prognostic role of NGAL exclusively in pediatric patients with type 1 diabetes. A search through major databases was carried out until September 24, 2024, investigating the prognostic role of NGAL in kidney injury in pediatric patients with type 1 diabetes. A p<0.05 was considered statistically significant. A study quality assessment was conducted using the Newcastle-Ottawa Scale. The standardized mean difference in urinary NGAL (uNGAL) levels between the type 1 diabetes group and healthy controls was statistically significant (SMD=0.63, 95%CI [0.36,0.90]). A moderate positive relationship between uNGAL and ACR was identified (r=0.53, 95% CI [0.31-0.70]). The uNGAL revealed a high overall diagnostic accuracy (AUC=0.881). Urinary NGAL appears to be a valuable biomarker for early detection and understanding of DKD in individuals with type 1 diabetes. Future clinical studies should prioritize assessing the accuracy of NGAL in identifying kidney injury in pediatric patients with type 1 diabetes and the association of NGAL with traditional biomarkers in groups with similar characteristics.

Adolescents and young adults (AYA) face distinct barriers when accessing care for opioid use disorder (OUD). Our objective was to compare characteristics of young adults to older adults seeking buprenorphine via telehealth and examines retention in care. This retrospective cohort study compares young adults (ages 18-29) to older callers (age 30 and above) prescribed buprenorphine via a health system-based telehealth bridge clinic, CareConnect, in Philadelphia, Pennsylvania from 2021 to 2023. We compared patient and treatment characteristics using χ2 tests. Interactions between the age groups and independent variables were analyzed. Significant interactions were retained. Multivariable logistic regression evaluated factors associated with buprenorphine retention. Of the 1023 telehealth callers, 152 (15%) were young adults. The majority identified as male (60%) and were enrolled in Medicaid (74%). Of the sample, 45% identified as White, 36% identified as Black, and 12% identified as Hispanic. Young adult callers were more likely to identify as Hispanic than older callers (19% vs. 11%, P<0.03) and more likely to report incarceration in the last 1 month (17% vs. 9%, P<0.03). There were no significant differences in buprenorphine retention between younger and older adults. Lack of insurance among all adults was associated with lower odds of retention in buprenorphine treatment than insured patients (aOR=0.4, 95% CI=0.2-0.6). Young adults who identified as Black had lower odds of buprenorphine retention(aOR=0.3, 95% CI=0.1-0.8). Our study highlights the importance of insurance coverage to support continued buprenorphine treatment engagement. This analysis also underscores the need for interventions to mitigate OUD treatment disparities among minoritized young.

The rise of social media has raised concerns about its addictive potential and impairments in mental health and cognitive functions, including distortions in time processing. Emerging evidence suggests social media addicts tend to misestimate the amount of time spent using social media, hinting at possible problems with their cognitive time-processing. This study aimed to investigate the impact of social media addiction on basic time perception using controlled experimental paradigms. Forty participants scoring ≥24 on the Bergen Social Media Addiction Scale with ≥5 hr daily usage were recruited, alongside 40 controls. After excluding individuals craving, fear of missing out for social media, or test anxiety during experiment, final samples included 36 addicts and 37 controls. Time reproduction (motor timing) and bisection (perceptual timing) tasks were administered, distinguishing subsecond (<1 s) and suprasecond (>1 s) intervals. Tasks used neutral gray stimuli to avoid social media cues and included pretask rest to control physiological arousal. Social media addicts exhibited significant deficits in suprasecond bisection task, demonstrated by lower subjective equality points (1,430.69 vs. 1,549.32 ms) and higher Weber ratios (0.41 vs. 0.29), indicating both time overestimation and reduced time sensitivity. No significant group differences were observed in reproduction tasks or in subsecond bisection task. These findings establish that social media addiction selectively impairs suprasecond perceptual timing, characterized by overestimation and diminished sensitivity. These findings establish a novel cognitive deficit linked to addictive social media use, with potential clinical implications for intervention strategies targeting distorted time processing.