Assessing whether an individual has reached the legal age of 18 is a complex, multifactorial process that requires the application of reliable, standardized, and reproducible methods. Among the various approaches, the assessment of third molar eruption has recently emerged as a useful preliminary tool for estimating whether an individual has reached the age of majority. This study aims to evaluate the accuracy of the Gambier et al. scoring system for legal age estimation based on third molar eruption in a sample of Lebanese subadult individuals. A retrospective analysis was conducted on 537 orthopantomograms (OPGs), comprising 298 males and 239 females, aged between 15 and 24 years. An increase in mean chronological age was observed with the progression of third molar eruption stages (1-3) and phases (A-D) in both sexes. Only in limited cases has a strong relationship been found between phase D and the probability that an individual is 18 years of age or older. In this Lebanese sample, phase D, which corresponds to complete emergence in the occlusal plane, was not always associated with individuals being 18 years or older: the 11.9% of males and females in this phase is above the legal age threshold. This technique may serve only as a preliminary tool for estimating the probable age of alleged minors of Lebanese origin, particularly in the context of migrant populations and child marriage contexts. Its application is recommended in accordance with the minimum age principle, as minimum age thresholds have been established for each stage and phase of third molar eruption. This method, however, ought to be applied only in combination with other internationally validated dental age estimation methods, thereby safeguarding against potential ethical implications associated with legal age assessment.
Stefano De Luca, Siddharth Paladugu, Sudheer Babu Balla et al.
INTRODUCTION: The purpose of this study is to examine the effectiveness and acceptability of a positive psychology-based psychoeducation program on the psychological states, future expectations, and coping styles of adolescents affected by the 2023 earthquake in Türkiye. METHODS: A single-group, pretest-posttest design was adopted. A four-session psychoeducation program was delivered to 74 students in one of the high schools in a village affected by the earthquake. The Brief Symptom Inventory (BSI), Future Expectations Scale for Adolescents (FESA), and Coping Scale for Adolescents (KIDCOPE) were used to assess the intervention outcomes. Additionally, interviews were used to assess the intervention's acceptability and perceived impact. RESULTS: There was a statistically significant decrease in the total BSI score and all sub-dimensions after the intervention (p < 0.001). While there was no significant difference between the KIDCOPE general scores (p = 0.599), significant improvements were recorded in the active coping (p = 0.031) and negative coping (p = 0.003) sub-dimensions. Additionally, there was an increase in FESA scores, with a statistically significant difference, especially in the marriage and family sub-dimension. Students perceived the interventions as impactful, interactive, timely, and culturally relevant. They suggested including their families in the intervention and reducing the group size to allow more interaction. CONCLUSION: Mental health interventions targeting children and adolescents should not only focus on reducing negative symptoms but also on nurturing positive mental health traits. Additionally, families should be included in the interventions as they play a vital role in adolescents' emotional and social well-being.
Veysel Kaplan, Mehmet Emin Düken, Abanoub Riad et al.
INTRODUCTION: Disorders of sex development (DSD) include congenital disorders with incongruence among phenotype, genotype, and gonadal sex. The psychological aspects and response of the parents of a child with DSD towards this issue are crucial, as they are considered the fundamental care providers for their child. Hence, their perceptions affect the overall clinical and social care. We hypothesise that parents having children with DSD face marked challenges, not only social, but also psychological, such as anxiety and depression. Also, their quality of life may be negatively affected. This study evaluates the psychological impact of having a child with DSD on his/her parents to be able to provide proper counselling and support for them. METHODS: A cross-sectional analytical study was conducted, including 44 parents whose children were under the age of 13 years and were diagnosed with DSD, whether they were operated upon or not. Their responses on sociodemographics, depression, anxiety, quality-of-life (QoL), views on marriage, and religious aspects were collected and analysed, alongside the effect of their child's condition on them. RESULTS/FINDINGS: Twenty-eight (63.6%) of children presented to medical care during the neonatal period. Similarly, 63.6% had congenital adrenal hyperplasia (CAH), either male or female. Genotypically, 43.2% had a 46,XX genotype, and 56.8% had a non-46,XX genotype. Thirty-four (77.3%) underwent genital surgery. All patients with ambiguous genitalia underwent surgery. The most affected QoL aspects were the economic, affective, and physical aspects: About thirty percent (29.6%) of the parents suffered from depression, and 61.4% had anxiety. Parents of children who underwent surgery also had a significant decrease in quality of life from the physical, affective, social, and ego perspectives (p-values <0.05). Genital surgery and family income were significantly associated with both decreased QoL and anxiety scores (p-values <0.05). Eighteen (40.9%) reported that psychological stability is the most important consequence and determinant of surgery. DISCUSSION: Differences in sex development (DSD) impact familial psychological health. Parents of children with DSD suffer high levels of anxiety and depression related to their condition and score low on various QoL aspects. Social pressures, legalities of registration, financial inheritance, and religious perspectives may affect attitudes toward surgery. CONCLUSION: Families of children with DSD have low QoL scores regarding the economic, psychological, and physical domains, with highly significant levels of emotional burden. Psychological stability, fertility, and sexual health prospects are their main concerns towards and around surgery. Professional counselling and education are needed throughout care, with the reassurance of consistent future availability. LEVEL OF EVIDENCE: III. TYPE OF STUDY: Cross-sectional.
INTRODUCTION: Parenting interventions have shown promise in improving mental well-being for parents and children and strengthening family relationships. Parenting for lifelong health (PLH) is an open-access, evidence-informed programme that aims to improve positive parenting practices, reduce family violence and promote mental health, particularly in low-resource settings. This study will evaluate the implementation and (cost-)effectiveness of an adapted version of the PLH for Parents and Teens programme. It will focus on supporting positive parenting, communication, mental health and well-being of adolescents and their caregivers in North Macedonia and Moldova. METHODS AND ANALYSIS: This multicountry hybrid type 1 effectiveness-implementation randomised waitlist-controlled trial will recruit 660 adolescents aged 10-14 years and their caregivers through schools, Youth Clinics and community partner organisations, including vulnerable and linguistically diverse families. The intervention group will receive the adapted PLH programme with assessments conducted postintervention and at 6-month follow-up. The waitlist control group will receive the adapted PLH programme after completion of the intervention group's 6-month post-baseline assessment. Primary outcomes include adolescent emotional problems, family functioning, parenting practices, adolescent and caregiver quality of life. Secondary outcomes assess a range of mental well-being, family and other psychosocial outcomes. Other prespecified outcomes include implementation and cost outcomes. Primary analyses will compare intervention and waitlist control groups at postintervention and 6-month follow-up using intention-to-treat, baseline-adjusted linear mixed models. A within-trial economic evaluation will include cost-utility analysis and cost-effectiveness analysis. A macroeconomic analysis will assess broader economic impacts using public financing and budget impact analysis. The study uses a mixed-methods process evaluation, and integrates qualitative data, budget impact analysis and simulation modelling to inform scale-up considerations. ETHICS AND DISSEMINATION: The study has received ethical approval from all relevant sites. Results will be disseminated through peer-reviewed publications, scientific conferences and webinars, newsletters, social media and open-access platforms, alongside engagement with researchers, clinicians, policymakers and the public. The Family-Focused Adolescent & Lifelong Health Promotion project uses a targeted communication and dissemination strategy for families, implementers and policy stakeholders to promote the adoption and scale-up of evidence-informed, open-access parenting interventions for adolescents and caregivers in low-resource settings. Dissemination focuses primarily on North Macedonia and Moldova while also engaging actors across the wider Eastern European region. TRIAL REGISTRATION NUMBER: NCT07240571.
Janina Mueller, Swetha Sampathkumar, Dennis Wienand et al.
Childbirth occurring at high-risk maternal ages (≤18 years or ≥40 years) remains an important public health concern in Bangladesh and is influenced by a range of socio-demographic and behavioral factors. We conducted a cross-sectional secondary analysis of 15,386 ever married women from the BDHS 2022 dataset. After cleaning and removing duplicates and missing values, data were split into training 80 percent and testing 20 percent sets. Three feature selection methods Lasso with 12 features, Chi Square with 13 features, and Boruta with 10 features were applied. Machine learning models including non-ensemble models CART, SVM, KNN, Naive Bayes and ensemble models Random Forest, GBM, AdaBoost, XGB were trained using 10-fold stratified cross validation with SMOTE applied to balance classes. Model performance was evaluated using accuracy, precision, recall, F1 score, Area Under the Receiver Operating Characteristic Curve (AUROC), and Area Under the Precision-Recall Curve (AUPRC).. Among the evaluated machine learning models, CART achieved the best overall performance for the Lasso-selected features (Accuracy = 0.77, F1-score = 0.69, AUROC = 0.74, AUPRC = 0.54), while GBM performed best for the Chi-square-selected features (Accuracy = 0.80, F1-score = 0.71, AUROC = 0.79, AUPRC = 0.64) and Boruta-selected features (Accuracy = 0.75, F1-score = 0.64, AUROC = 0.69). Overall, the GBM model with Chi-square-selected features demonstrated the strongest predictive performance, achieving the highest AUROC (0.79) and F1-score (0.71). Key predictors of high-risk age at childbirth included maternal age, early marriage, current contraceptive use, husband occupation, number of children, husband age and education, respondent age, and regional disparities. Findings were consistent with prior South Asian and LMIC studies while highlighting the added relevance of partner education and media exposure. Machine learning approaches identified the most influential socio demographic and behavioral determinants of high-risk age at childbirth in Bangladesh. The results provide an evidence-based framework to guide policymakers in designing interventions such as delaying age at first birth, expanding female education, and targeting high risk districts to improve maternal and child health outcomes.
A T M Ahsanul Kyum Siam, Tanzila Tanjim Tusra, Md Abul Hossain
Over the past decade, Bangladesh has experienced substantial demographic change alongside increasing climate-related disruption. This study examines the links between extreme climatic events and fertility among married Bangladeshi women of childbearing age who already have children, focusing on how cyclones and floods relate to fertility behaviour in cyclone- and flood-prone villages. A mixed-methods design was used, drawing on 544 household surveys, 74 in-depth interviews with women, 10 focus group discussions with men, and 8 key informant interviews. Comparing two ecologically distinct sites allowed examination of how communities experience and respond to different hazards. The findings indicate divergent fertility patterns by hazard type. In the cyclone-prone site, physical destruction, displacement, and disrupted health-care access were associated with lower fertility. In the flood-prone site, recurrent inundation, reliance on children's labour, and constrained contraceptive access were associated with higher fertility. Socio-demographic factors, including education, age at marriage, and contraceptive access, were also strongly associated with fertility behaviour. Households in the cyclone-prone area showed greater livelihood vulnerability and lower fertility, whereas those in the flood-prone area showed higher fertility alongside elevated child mortality and a marked preference for sons, who were perceived as better able to assist in disaster recovery. These results suggest that extreme climatic events are associated with differentiated fertility responses, shaped by socio-demographic context, and point to the value of integrating reproductive health services into disaster risk reduction. The study highlights the intersection of climate change, socio-demographic factors, and reproductive health and offers evidence on how hazard-type conditions fertility responses, with implications for climate adaptation and population health policy in climate-vulnerable regions such as Bangladesh.
BACKGROUND: Globally and in Bangladesh, high-risk fertility behavior (HRFB) continues to be a significant public health issue, contributing to negative health outcomes for both mothers and children. Therefore, this study aimed to evaluate the trends, prevalence, determinants, and socio-economic inequalities associated with HRFB among presently married women of reproductive age by utilizing data from the Bangladesh Demographic and Health Survey (BDHS). METHODS: We analyzed data from 19,060 currently married women aged 15-49 years. HRFB was defined as the presence of any of the following: maternal age (<18 or >34 years), short birth intervals (<24 months), or high birth order (≥4). Two outcome variables were constructed: a binary indicator for any HRFB (yes/no) and a three-category variable indicating no, single, or multiple HRFBs. Bivariate analysis was conducted to determine the prevalence of HRFB, and multilevel mixed-effects logistic and multinomial regression models were applied to identify determinants, accounting for the complex survey design. Socio-economic inequalities were examined using concentration indices and concentration curves. RESULTS: Overall, 58% of women experienced at least one HRFB, with 33% exhibiting a single HRFB and 25% multiple HRFBs. Women who married after age 18 years, had higher education, were exposed to media, or had educated husbands were significantly less likely to experience HRFB. Higher odds of HRFB were associated with rural residence, lower household wealth, and regions such as Mymensingh, Barishal, and Chattogram. Significant inequalities were observed, with HRFB disproportionately concentrated among women with lower wealth (CIX = -0.427, p < 0.001) and no education (CIX = -0.268, p < 0.001). CONCLUSION: In Bangladesh, HRFB remains prevalent and is unevenly distributed across socio-economic and geographic groups. Targeted interventions aimed at delaying early marriage, improving educational attainment for women and their partners, expanding mass media outreach, and increasing access to reproductive healthcare- especially among disadvantaged and rural populations- are essential for reducing HRFB and improving maternal health outcomes.
This qualitative study examined the impact of extended family networks on women's autonomy in household decision-making in relation to marriage, reproduction, mobility, social visits, household expenses, and living arrangements. Based on interviews with 24 married women aged 15-49 years in Kurla, Maharashtra, the findings indicate that women's autonomy was not solely influenced by household structure, but was negotiated within the context of intergenerational hierarchies, gender norms, and socioeconomic conditions. The influence of extended kin on women's decision-making in joint families was evident in various domains, including marriage, child and maternal health, and mobility. In contrast, the influence of kinship in nuclear households manifested through subtle expectations and indirect interventions in financial and living arrangement decisions. Economic participation and education can enhance decision-making; however, agency remains shaped by class, position, and family ties. Rather than guaranteeing emancipation, the nuclearisation of family structures likely reconfigures the influence of extended kin, with relational ties continuing to shape decision-making across domains. Addressing gender equity in patrilocal societies requires contextual, family-centred approaches that account for kin, gender, and power interactions.
Climate change is an escalating global crisis that disproportionately threatens the health and rights of children and adolescents, with girls facing particularly heightened vulnerability. Increasing temperatures, extreme weather events, food and water insecurity, and exposure to environmental toxins directly and indirectly affect sexual and reproductive health. These impacts include altered timing of menarche, worsened dysmenorrhea, increased risks of subfertility and pregnancy complications, and reduced access to essential reproductive health services. Broader climate-related instability further contributes to malnutrition, disruption of education, child marriage, displacement, and gender-based violence, compounding longstanding gender, socioeconomic, and geographic inequities. FIGIJ affirms climate change as a health emergency and aligns itself with international efforts calling for urgent, coordinated action. FIGIJ supports the development of strong coalitions between governments, health care systems, and communities to amplify the health care sector's voice in global and regional climate advocacy. Protecting the next generation requires coordinated efforts, effective collaboration, and an ongoing commitment to supporting a healthier, more resilient and equitable future.
Marnie Slonim, Judith Simms-Cendan, Angela Aguilar et al.
BACKGROUND: There are no evaluated family-based mental health and psychosocial support (MHPSS) interventions for adolescents in Southwest Asia (known as the Middle East), and few whole-family interventions in low- and middle-income countries, despite consistent evidence for the impact of family support on mental health and well-being. This study aims to evaluate the effectiveness of a brief family systemic mental health intervention, deliverable by non-specialists in mental health. METHODS: We conducted an assessor-blind type I hybrid effectiveness-implementation multi-site randomized controlled trial comparing the locally developed family intervention to a waitlist control group for randomly allocated families residing in North Lebanon and Beqa'a governorates. Eligible families presented with medium-to-high risk for child protection concerns (abuse, neglect, child labor, early marriage) and had at least one adolescent aged 12-17 who demonstrated psychological distress. Outcomes at the family, caregiver, and adolescent level were measured pre- and post-intervention, and at 3-month follow-up. RESULTS: Intent-to-treat analyses found a significant between-group effect of the intervention on adolescent-reported family functioning, caregiver mental health, and parenting. No change was found for adolescent psychological distress. Further analyses found effects on adolescent well-being for those who completed the intervention, and that father attendance was associated with better outcomes for adolescent well-being in the intervention group. No other significant moderators were found. At the 3-month follow-up for the intervention condition, family functioning and caregiver well-being significantly dropped from endline. CONCLUSIONS: The study demonstrates mixed results for a non-specialist-delivered family-systemic intervention developed in the context of humanitarian crises in Lebanon. While the intervention did not result in benefits in adolescent-reported symptoms of psychological distress, the intervention group did show greater improvements than the control group on a number of other outcomes, showing the potential impact of working with the wider family system to support adolescents in humanitarian settings.
Tania Bosqui, Felicity L Brown, Sally Farah et al.
