A 15-year-old female presented with exertional chest pain and near-syncope. Imaging revealed a large left sinus of Valsalva aneurysm compressing the left coronary artery. She underwent successful surgical repair. Intraoperative and pathologic findings confirmed Takayasu arteritis. This case highlights a rare aetiology of cardiac chest pain in adolescents and underscores the importance of evaluating for an underlying vasculitis when a sinus of Valsalva aneurysm is identified.

Individuals with mental health difficulties (MHD) have a substantial reduction in life expectancy compared to the general population. It is increasingly recognised that mental health services need to improve physical healthcare as a priority. Sexual health, including consideration of high-risk sexual behaviours, medication side effects, and challenges in romantic relationships, is a further important but under-recognised aspect of overall health. We discuss some of the current issues relating to physical and sexual health, with a particular focus on youth with MHD and how we might implement holistic care in Ireland. Prioritising the resourcing of these issues could facilitate the implementation of a Shared Model of Care as recommended in Ireland’s National Mental Health Policy, Sharing the Vision.

This population-based cross-sectional study investigated the complex interplay of factors influencing high ultra-processed food (UPF) consumption among Brazilian adolescents using a hierarchical socio-ecological model. Data from 100 028 adolescents (13–17 years) enrolled in public and private schools nationwide were collected via self-administered questionnaires from the 2019 National School Health Survey. High UPF consumption was defined as ≥ 7 subgroups consumed on the previous day based on the NOVA classification. Poisson regression adjusted for complex sampling and hierarchical structure identified prevalence ratios (PR) for associated factors. High UPF consumption was significantly associated with younger age (PR = 1·22; 95 % CI 1·11, 1·34), regular breakfast consumption (PR = 1·32; 95 % CI 1·23, 1·42), regular screen time during meals (PR = 1·36; 95 % CI 1·27, 1·45), frequent UPF purchases at and around school (PR for canteen: 1·57; 95 % CI 1·43, 1·72; street vendors: 1·71; 95 % CI 1·55, 1·89), higher maternal education (PR 1·23, 95 % CI 1·12, 1·36) and lower parental supervision (PR 1·34, 95 % CI 1·11, 1·62). Living in the South (PR 1·50, 95 % CI 1·34, 1·69), Southeast (PR 1·30, 95 % CI 1·17, 1·44) and Midwest regions (PR 1·21, 95 % CI 1·09, 1·34) also correlated with higher consumption. Conversely, high body satisfaction and attending private school showed an inverse association. These findings underscore the intricate, multilevel influences on UPF consumption among Brazilian adolescents. Integrated interventions, spanning schools, family environments and public policies are crucial for promoting healthier eating habits and preventing obesity in this vulnerable population.

Non-suicidal self-injury (NSSI) among adolescents severely jeopardizes their well-being and has emerged as a significant global public health challenge. However, research on the trends in NSSI among adolescents remains scarce. This study sought to uncover the evolving patterns in the severity of NSSI among adolescents and the factors that influence these patterns. The Deliberate Self-Harm Inventory was employed to measure the severity of NSSI among adolescents. Relevant studies were retrieved from both Chinese databases (CNKI, Wanfang, and VIP) and English databases (Web of Science, PubMed, Scopus, ProQuest, and Wiley). A total of 70 articles (71 studies; N = 96,382) were included in this review. The data spanned from 2007 to 2023. The analysis revealed the following: (1) Although the severity of NSSI showed a small to moderate upward trend from 2007 to 2023, this increase did not reach statistical significance. (2) No significant differences in trends were observed among Asia, Europe, and the America. (3) Adolescents with clinical samples exhibited a more pronounced upward trajectory in NSSI severity compared to those with non-clinical samples. (4) Social development indicators (GDP per capita, Human Development Index, and Internet penetration rate) and social well-being (happiness index) exhibited significant positive correlations with NSSI among adolescents. Conversely, lower social equity (higher Gini coefficient) was associated with reduced NSSI among adolescents. This study elucidated the changing trends in NSSI among adolescents and offered novel insights for the early prevention and individualized intervention of NSSI among adolescents.

A burgeoning body of evidence suggests a higher prevalence of nonsuicidal self-injury (NSSI) behaviors among adolescents. This study aimed to examine the comorbid internalizing symptoms and suicidal behaviors, along with associations between dissociative experiences and suicide risk in adolescents attending a psychiatric outpatient unit in Ankara, Türkiye. The study included 81 adolescents aged 12–18 years, who engaged in NSSI and sought treatment at a psychiatric outpatient clinic. Psychiatric evaluations were conducted through semi-structured clinical interviews. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, and suicide risk was measured using the Suicide Probability Scale. Additionally, internalizing symptoms and dissociative experiences were evaluated using the Revised Children’s Anxiety and Depression Scale-Child Version and the Adolescent Dissociative Experiences Scale, respectively. Moderate to high correlations were found among suicide risk, dissociation, NSSI severity, anxiety and internalizing scores. Mediation analysis revealed that NSSI significantly mediated the relationship between dissociation and suicide risk. These findings indicate that assessing both dissociation and NSSI could provide valuable insights into comprehending and addressing adolescent suicide, thereby facilitating the development of targeted interventions to mitigate the effects of dissociative experiences.

US data from the National Health and Nutrition Examination Survey estimates that the prevalence of obesity among US adolescents (ages 12–19) has reached 22.9% of the paediatric population, with nearly 9% meeting criteria for severe obesity (body mass index ≥120% of the 95th percentile or ≥35 kg/m2). These alarming figures underscore the cumulative impact of paediatric obesity, including established associations with impaired cardiometabolic health. The study “Cardiac Geometry Alterations Following Bariatric Surgery in Severely Obese Adolescents: A One-Year Follow-Up Study of a Randomized Controlled Trial” advances this understanding by comparing lifestyle intervention alone versus lifestyle therapy in combination with the application of bariatric surgery (e.g. laparoscopic adjustable gastric banding). As the first prospective randomised trial to assess cardiac geometric and following adolescent metabolic and bariatric surgical intervention, the findings demonstrate significant improvements in cardiac geometry among surgical participants, suggesting partial reversal of obesity-related cardiac remodelling. While these short-term results are encouraging, durability remains uncertain given the study’s small sample size and previous reports of significant weight regain and higher-than-expected complication rates following gastric banding. Considerations for future investigational designs should incorporate an expanded age range with regards to overall eligibility as well as bariatric procedures other than the gastric band, that offer long-term weight loss (i.e., vertical sleeve gastrectomy and gastric bypass). Longer-term and comprehensive follow-up will be critical to delineate the longitudinal cardiometabolic outcomes of surgical versus medical interventions for severe adolescent obesity.

Autistic adolescents are at higher risk of self-harm, suicidal behaviours, and emotion dysregulation compared with their non-autistic peers. Dialectical behaviour therapy (DBT) is an evidence-based treatment for self-harm and suicidal behaviour with emerging literature of the application of DBT for autistic populations. Despite this, no qualitative research has investigated the experiences of autistic adolescents of standard DBT. Therefore, this study aimed to explore autistic adolescents’ experiences of non-adapted DBT. Ten adolescents who had or were seeking an autism diagnosis, and were in a DBT programme, completed semi-structured interviews. Qualitative data from the interviews were analysed using reflexive thematic analysis. Themes were generated for each objective. Objective 1 included themes about the lived experience of autistic adolescents accessing DBT, including: ‘The impact of invalidation’, ‘Fostering acceptance and understanding’, ‘What does autism mean to me?’, and ‘Autism and mental health difficulties’. The themes regarding Objective 2 were about the experiences of the various modes of DBT and were organised by each client-facing mode. Objective 3 included themes highlighting the experience of utilising DBT skills in daily life, which included: ‘Barriers to skills use’, ‘Supporting skills use’, and ‘Skills practice or masking?’. Finally, Objective 4 included themes regarding the recommendations participants had for optimising DBT for autistic people: ‘Improving written materials’ and ‘General accessibility advice’. These findings suggest for DBT therapists to embody cultural humility, curiosity, validation, and flexibility when building neuro-affirmative competencies for supporting autistic individuals. Results are discussed in relation to the application and acceptability of DBT for this group.

Key learning aims

1. (1) Recent publications (e.g. Keenan et al., 2023) have explored the experience of autistic adults accessing DBT and highlighted the need for clinicians to work collaboratively with clients and make reasonable adjustments to improve autistic adults’ understanding and adherence to DBT.

2. (2) To date, no qualitative studies have explored the experience of autistic adolescents accessing the Rathus and Miller (2015) Adolescent DBT model. The current study explores the views of autistic adolescents on how autism is discussed and considered by clinicians when supporting them to access different components of DBT when describing the strengths and barriers they experience.

3. (3) Adopting a bottom-up approach, we identify key themes from adolescents’ perspectives on how to support them to access and engage with different DBT components, ranging from making environmental adaptations to meet individual sensory needs to improve accessibility, to providing more opportunities for personalised learning using neuro-affirmative examples that can improve generalisability of skills in everyday life. We provide recommendations for clinicians to consider on ways of adapting the process and content of DBT to increase accessibility and engagement for autistic adolescents in treatment.

Few studies have examined the effects of early-life nutrition interventions on adolescent physical activity (PA). We aimed to examine the long-term effects of small-quantity lipid-based nutrient supplements (SQ-LNS) on adolescent PA and sedentary behaviour (SB) and to describe current adolescent PA and SB levels in this cohort. In the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana trial, 1320 mothers were enrolled and randomly assigned to one of three conditions: (1) daily iron and folic acid during pregnancy and placebo (calcium) from birth to 6 months postpartum (IFA), (2) multiple micronutrient supplements during pregnancy to 6 months postpartum (MMN) or (3) SQ-LNS during pregnancy to 6 months postpartum (LNS). Infants from mothers in the LNS group received SQ-LNS designed for children from 6 to 18 months. We recruited 11–13-year-old adolescents of mothers enrolled in the iLiNS-DYAD-G trial for a 7-d PA and SB assessment using accelerometers (n 305) and self-reported PA and SB (n 508). We compared the LNS with non-LNS (IFA+MMN) groups using ANCOVA models for the following outcomes: mean vector magnitude counts per minute, PAQ-C score and percentage of time in SB, light PA and moderate-to-vigorous PA (MVPA). There were no significant differences between the LNS and non-LNS groups in any PA outcome in minimally or fully adjusted models. Only approximately 50 % of adolescents met the PA recommendation of 60 min/d MVPA, with males more active than females; however, there is room for improvement. SQ-LNS in early life does not appear to have a sustained impact on PA or SB.