BACKGROUND: Sextortion - the threatened dissemination of explicit, intimate, or embarrassing images of a sexual nature without consent for the purpose of acquiring money, more images, or something else - has emerged as a critical public safety and public health concern for youth in recent years. OBJECTIVE: The current study explores the extent of sextortion among youth, as well as its relationship to suicidality. PARTICIPANTS/SETTING: Respondents were from a national US sample of 3416 English- or Spanish-speaking middle and high school students aged 13 to 17 (Mage = 15.0 years; 50.7% female; 63.5% White/Caucasian). METHODS: A cross-sectional design was utilized. Adolescents completed an anonymous online survey with questions about their experience with sextortion and suicidal thoughts and behaviors. RESULTS: Approximately 15% of youth in the sample had been the target of sextortion. Multivariate logistic regression analyses revealed a statistically significant relationship between experience with sextortion and suicidality. Results also indicated that the relationship between the victim and the offender (whether the offender was known offline or not) did not have an impact on suicidality. CONCLUSIONS: More research is necessary to better understand the underlying causes of sextortion, as well as effective ways to prevent and respond to it. One possible avenue for prevention could involve educating youth and their caregivers about the risks associated with sexting (such as sextortion), including the potential deleterious mental health outcomes when the experience turns negative.
Children today, in 2026, are growing up in a world that feels busy, fast and sometimes overwhelming. This raises questions: is the world too chaotic, are children and young people not resilient enough or could it be that our support systems have not kept up with the 'chaos'? Our current world is characterised by rapid technological change, algorithmically amplified social pressures, evolving global uncertainties translating into new reasons for worry and anxiety, and increased prevalence of mental health problems in children and young people globally. They are online at school, at home and all but constantly in the world around them. A modern resilience agenda must therefore prioritise safety-by-design online, neurodiversity-affirming educational and digital environments and expanded care capacity, supported by learning health systems that iterate quickly as conditions change. Our big picture systems and infrastructures have not kept pace and evolved at speed alongside digital advances and AI-driven environments. Consideration must be given to how digital and AI-enabled mental health tools can mitigate service gaps when demand exceeds workforce capacity, while emphasising and ensuring ethical, inclusive, accessible and developmentally attuned design. Modernising systemic supports is essential for cultivating youth resilience and mental health in an increasingly complex digital world.
This perspective provides policymakers, advocates and researchers with a description of proposed and enacted policies that assist consumers in identifying products with nonsugar sweeteners (NSSs) and/or reduce NSS exposure. Consumption of NSSs is associated with multiple chronic diseases. NSS exposure is increasing as food and beverage manufacturers replace added sugars with NSSs. We conducted a narrative review to identify public policies addressing NSSs, focusing on the United States while also considering the international context. A policy scan identified relevant polices through: 1) review of a United States sweetened beverage policy database, 2) systematic searches of 5 online United States policy databases and PubMed, 3) review of a World Health Organization food policy database, 4) survey of NSS policy experts, and 5) review of policies known to the research team. Searches were conducted between November 2024 and February 2025. We describe a selected subset of identified policies in more detail as illustrative examples based on adequacy of NSS definition, impact, feasibility, equity, and comprehensiveness (extent of products included). We identified 416 proposed or enacted policies and classified them into 9 groups: bans and restrictions on NSS use (n = 26), excise taxes (n = 106), sales taxes (n = 67), food package labels and disclosures (n = 47), healthy retail (n = 2), procurement and nutrition standards (n = 71), Supplemental Nutrition Assistance Program benefit restrictions (n = 54), Special Supplemental Nutrition Program for Women, Infants, and Children nutrition standards (n = 7), restaurant healthy default beverages (n = 34), and marketing restrictions (n = 2). Innovative policy options included banning NSSs in products sold to minors, prohibiting misleading sweetener labeling, closing United States Food and Drug Administration approval loopholes permitting the use of NSSs that may lack adequate and transparent safety data, and restricting NSS advertising on public transportation. We conclude that many options for reducing potential harms from NSSs are available. Public policies with the greatest potential impact are bans or restrictions on use, excise taxes, and front-of-package warnings and disclosures.
James W Krieger, Jennie N Davis, Shu Wen Ng et al.
There is a critical lack of exploration into the firsthand experiences of autistic children in the psychological literature. We sought to address this using baseline data from a wider mixed-methods study. A total of 136 autistic children (mean age = 10.35) completed an online questionnaire. Questions explored children's understanding of autism, their feelings about being autistic in different contexts and challenges experienced. Quantitative data revealed limited autism knowledge and understanding for some. Challenges included talking about being autistic and self-advocating for needs, especially with non-family members. Children generally recognised both strengths and challenges of being autistic, although concerns about feeling/being different were widespread, and masking common. Strikingly, although most children felt positive about being autistic at home, significantly fewer felt this to be true when around peers or teachers. Using reflexive thematic analysis, four main themes were developed: (1) overwhelming experiences, (2) unsafe people, (3) sanctuary and (4) autistic identity. Overall, the children felt safest at home with family and/or with autistic/neurodivergent/understanding friends, but most unsafe at school with their teachers and neurotypical peers, where victimisation was rife. These findings offer valuable insights into the lives of autistic children, and demand we explore how places of education can be transformed into safe spaces for autistic children.Lay abstractAutistic children are rarely asked directly about their own experiences. In this study, 136 autistic children (ages 8-14) shared their views through an online questionnaire. They were asked what being autistic means to them, how they feel about it and what challenges they face in different environments. Many said they knew little about autism, and most did not have the words to talk about being autistic or feel safe doing so. Talking was especially difficult outside the family; while over 60% felt comfortable with family, only 16.5% felt this way with other people. Children also told us how overwhelming everyday life can be. Noisy, crowded or unpredictable environments often caused distress or shutdown. Many described how strong emotions, especially anxiety, build up in these moments. Some lost the ability to speak, and tasks like decision-making or emotional regulation became especially hard and exhausting. School was often named as a major source of overwhelm. Children showed deep insight into the people around them. They were highly attuned to whether others, for example, friends, family, teachers or professionals, felt safe or unsafe. Feeling unsafe often meant being misunderstood, ignored or bullied. School peers were commonly described as sources of victimisation, and teachers as making children feel unsafe by not listening or misunderstanding their needs. When children did not trust those around them, they masked their autistic traits to avoid judgement. This came at a cost: many described exhaustion, loneliness or feeling like they had to hide who they really are. By contrast, home and trusted relationships, especially with neurodivergent family or friends, offered sanctuary. Children felt freer to be themselves, ask for what they need and talk about autism. Emergent positive autistic identities were evident in some children. These findings show autistic children are thoughtful, perceptive and deeply affected by their environments while simultaneously shining a bright light on the challenges growing up autistic in a neurotypical world. Their voices offer vital insights and a call to make schools and services safer, more respectful spaces.
Sinéad L Mullally, Alice E Wood, Cherice C Edwards et al.
BACKGROUND: Little has been published surrounding the safety and utility of deep implant reuse in children. Pediatric orthopaedic surgeons report reuse of deep implants in specific settings-namely during medical outreach trips outside of North America and Europe. Evaluation of existing literature demonstrates lack of clarity as to appropriate reprocessing, monitoring, and reporting practices for deep implant reuse. METHODS: Existing literature was reviewed, and a Pediatric Orthopaedic Society of North America (POSNA) membership survey of 34 questions was conducted online. RESULTS: Surveyed POSNA members indicated they reuse deep implants predominantly outside of North American centers, but many members expressed willingness to expand this practice if knowledge and infrastructure were bolstered to support it. CONCLUSIONS: The results of this literature review and survey indicate potential to expand deep implant reuse with potential benefits to health access, equity, cost, and the environment. Doing so, however, should be predicated on the results of further research and infrastructure to enable practice change and implementation safely and equitably. KEY CONCEPTS: (1)A survey of Pediatric Orthopaedic Society of North America members indicates widespread interest in expanding knowledge about deep implant reuse, particularly as it relates to safety and indications.(2)Deep implant reuse has the potential to reduce waste and cost while expanding access to needed implants in low-resource settings.(3)Currently, a lack of outcomes and complications data, limitations in implant-tracking programs, medicolegal constraints, manufacturer single-use designations, patient perceptions, and limited infrastructure and funding for reprocessing programs limit capacity for implant reuse across most settings.(4)Surgeons utilizing reprocessed implants should disclose this as well as how they ensure reused implant integrity and sterility with patients during informed-consent discussions.(5)Collaboration between pediatric orthopaedic surgeons across diverse geographies including low-, middle-, and high-income settings are needed to determine the optimal indications for and practices related to safety and quality assurance in deep orthopaedic implant reuse. National and international societies have a key role to play in enabling outcome sharing and knowledge on this topic. LEVEL OF EVIDENCE: IV.
INTRODUCTION: Radiographers and other healthcare professionals are routinely exposed to ionising radiation (IR). Although acute effects are rare, long-term and reproductive risks associated with chronic low-dose exposure remain a concern. Existing literature highlights gaps in radiation protection knowledge and inconsistent safety practices, yet little is known about radiographers' perceptions. This study explores European radiographers' views on occupational IR risks to health and reproduction. METHODS: A cross-sectional online survey was distributed through professional networks and the European Federation of Radiographer Societies between March and July 2024. The survey assessed demographics, knowledge and perceptions of radiation protection, and concerns regarding health, fertility and offspring. Quantitative data were analysed using descriptive statistics, chi-squared tests and Spearman correlations, while qualitative free-text responses were examined using content analysis. RESULTS: A total of 629 respondents from 32 countries completed the survey. While 96% reported understanding occupational radiation risks and 93% felt able to protect themselves, concern remained: 30% were worried about health effects, 24% about fertility and 19% about their children's health. Younger participants and students expressed significantly greater concern about reproductive risks than older radiographers (p < 0.05). Qualitative comments highlighted barriers to consistent protection, including discomfort and limited availability of shielding, workflow pressures and uncertainty about long-term low-dose effects. CONCLUSION: European radiographers and students in this survey demonstrate strong awareness of radiation protection but retain notable concerns about reproductive and long-term risks. These findings indicate a need for continued, practice-oriented education and improved access to ergonomic, well-maintained protective equipment. IMPLICATIONS FOR PRACTICE: Clear communication of current standards, reliable access to shielding, and supportive policies for pregnant or planning radiographers may help reduce anxiety, particularly among younger staff, and strengthen safety culture across clinical settings.
OBJECTIVES: Sentinel hepatology events require robust prior experience to accurately diagnose and manage. Given the rarity of complex pediatric liver disease, gastroenterology (GI) fellows do not uniformly get exposure to these patients. We developed a simulation curriculum to ensure exposure to and improve confidence in diagnosis and management of these patients. METHODS: Using needs assessment data, a simulation experience was developed, including two clinical scenarios, each mimicking several days of case evolution. Learning objectives included effective communication of diagnostic and management plans to medical teams and families. Targeted didactics were completed between phases. At the conclusion of the experience, fellows scored their confidence levels across learning objectives compared to a retrospective baseline. To assess longitudinal confidence, two similar online clinical cases were disseminated 5 months later with repeat confidence scoring. RESULTS: Six of eight eligible fellows participated in the simulation experience. All participants reported that the curriculum was meaningful and decreased their anxiety caring for these patients. The collaborative structure fostered psychological safety and mitigated cognitive load. There was a statistically significant increase in self-assessed confidence for all learning objectives after the simulation. CONCLUSION: In the current training environment, it is difficult to attain autonomy in managing complex pediatric liver disease. This simulation is the first of its kind in pediatric GI to address diagnosis and management of complex chronic liver disease. The pilot was feasible, impactful, and could help standardize fellow training regardless of program size or transplant center designation, thereby impacting the care of children with liver disease.
BACKGROUND: One of the most serious medical conditions in children is choking. It is a critical pediatric emergency caused by foreign objects obstructing the airway, posing a serious threat to children's lives and representing a significant public health concern. Parental readiness and proper reaction are crucial to solving choking incidents in children. OBJECTIVE: To investigate parental readiness and reaction toward choking in children in Saudi Arabia. METHODS: This cross-sectional study was conducted in Saudi Arabia with a sample of 530 participants. The study employed an online survey to gather data from parents of children aged 0-6 years. The survey aimed to evaluate various factors, including knowledge and awareness regarding choking in children, parental practices, readiness, and reactions toward choking in children. RESULTS: Among 530 participants, over half (57.9%) had a good overall knowledge level about choking in children. The majority reported that children aged 1-5 years (73.8%) are most at risk for choking. In identifying choking hazards, parents showed high awareness, with 82.8% correctly identifying small pieces as dangerous. When asked about their immediate response to a choking incident, 70.2% reported they would attempt appropriate first aid measures. CONCLUSION: While most parents showed a basic understanding of choking risks, such as the dangers posed by small objects and the importance of supervision during eating, there remain notable gaps that could compromise child safety. Health campaigns teaching first aid and cardiopulmonary resuscitation for parents are essential to help parents treat choking conditions in children and potentially save lives.
Sultan Alwehaibi, Meshal Alzakari, Faisal Alzkari et al.
BACKGROUND: Nalbuphine is synthetic agonist-antagonist opioid compound. Allergic reactions to nalbuphine hydrochloride are exceedingly rare. We present a case of hypersensitivity reaction to nalbuphine in a pre-adolescent patient. CASE PRESENTATION: A male patient, aged 11 years, underwent general anesthesia for the correction of congenital strephexopodia. Nalbuphine hydrochloride was administered as part of the postoperative analgesia regimen. However, the patient subsequently developed an allergic reaction characterized by pulmonary edema, wheezing, tachycardia and cutaneous rash. Prompt initiation of anti-allergic therapy resulted in significant clinical improvement. The patient was subsequently transferred to the general ward following complete resolution of symptoms. CONCLUSIONS: This case report highlights a hypersensitivity reaction to nalbuphine in pre-adolescent patient, manifesting with both cutaneous and respiratory symptoms. To improve the safety profile of nalbuphine in pre-adolescent populations, further research is necessary to elucidate the underlying mechanisms of such adverse reactions.
BACKGROUND: The population of children with medical complexity (CMC) is increasing globally. Caregivers must provide highly individualized care, and there may be "information asymmetry" between families and support providers. Infrastructure disruptions during disasters, such as power outages and communication failures, threaten the survival of CMC. This study aimed to estimate the independent effect (after adjusting for daily confounding factors) of requiring advanced respiratory support (ARS) on three types of disaster-related anxiety. METHODS: A cross-sectional online survey was conducted from August to October 2025, targeting caregivers of CMC via a nationwide support network in Japan. Participants were categorized into an ARS group (requiring invasive/non-invasive ventilation, high-flow nasal cannula, or frequent suctioning) and a non-ARS group. Anxiety was assessed across three domains: (1) accurate transmission of information to medical professionals met for the first time, (2) transmission of information in situations where communication methods are unavailable, and (3) continuity of care during power outages. With ARS as the primary independent variable, binomial logistic regression was performed to calculate adjusted odds ratios (AOR), controlling for covariates, including caregiver and child ages, evacuation method difficulty, and daily information-sharing satisfaction. RESULTS: Data from 279 caregivers were analyzed (child mean age: 9.5 ± 7.0 years). Binomial logistic regression showed that requiring ARS had a significant independent effect on anxiety about the accurate transmission of information to medical professionals met for the first time (AOR: 2.60; 95% confidence interval [CI]: 1.13-5.99; p = 0.025) and continuity of care during power outages (AOR: 5.87; 95% CI: 2.99-11.52; p < 0.001), but not for situations where communication methods were unavailable. CONCLUSIONS: Caregivers of CMC requiring ARS experience significantly greater anxiety during disasters, caregivers of CMC requiring ARS experience significantly greater anxiety about communicating information to medical professionals and continuity of care. To ensure CMC safety, transitioning to digital personal health records to complement oral and paper-based methods should be considered. Bridging these information gaps may reduce caregiver anxiety and facilitate rapid triage during emergencies.
