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Carvalho M, Branquinho C, Moraes B, Cerqueira A, Tomé G, Noronha C, Gaspar T, Rodrigues N, de Matos MG. Positive Youth Development, Mental Stress and Life Satisfaction in Middle School and High School Students in Portugal: Outcomes on Stress, Anxiety and Depression. CHILDREN (BASEL, SWITZERLAND) 2024; 11:681. [PMID: 38929260 PMCID: PMC11202279 DOI: 10.3390/children11060681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
The relation between positive youth development and stress, anxiety and depression was studied considering the mediator role of psychological symptoms and life satisfaction. A total of 3109 students included in the "Psychological Health and Well-being" study of the School Observatory participated, including 1618 females and 1491 males aged between 11 and 18 years old (M = 14.45; SD = 1.88), belonging to different school groups in different regions of the country. Adolescents with higher stress, depression and anxiety levels reported lower levels of competence, confidence and connection, as well as more psychological symptoms and lower life satisfaction. The results also showed that adolescents with higher levels of competence, confidence and connection reported less psychological symptoms and more life satisfaction. Two separate mediation analyses were performed to analyse the role of mental distress and life satisfaction on the relationship between positive youth development indicators and stress, anxiety and depression. These analyses confirmed the predicted relationships and partial mediations between mental distress and life satisfaction. These results should be taken into account in public policies concerning young people's health and education that should involve both targeted and indicated prevention strategies, including school and community-based interventions, in order to be effective.
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Affiliation(s)
- Marina Carvalho
- ISAMB/Environmental Health/Medical School, University of Lisbon, 1649-004 Lisboa, Portugal; (M.C.); (C.B.); (B.M.); (A.C.); (G.T.); (C.N.); (T.G.)
- Centro Hospitalar Universitário do Algarve, 8500-338 Portimão, Portugal
- Instituto Superior Manuel Teixeira Gomes, 8500-656 Portimão, Portugal
| | - Cátia Branquinho
- ISAMB/Environmental Health/Medical School, University of Lisbon, 1649-004 Lisboa, Portugal; (M.C.); (C.B.); (B.M.); (A.C.); (G.T.); (C.N.); (T.G.)
- Católica Research Centre for Psychological, Family and Social Well-Being, Faculdade de Ciências Humanas, University Católica Portuguesa, 1649-023 Lisbon, Portugal
| | - Barbara Moraes
- ISAMB/Environmental Health/Medical School, University of Lisbon, 1649-004 Lisboa, Portugal; (M.C.); (C.B.); (B.M.); (A.C.); (G.T.); (C.N.); (T.G.)
| | - Ana Cerqueira
- ISAMB/Environmental Health/Medical School, University of Lisbon, 1649-004 Lisboa, Portugal; (M.C.); (C.B.); (B.M.); (A.C.); (G.T.); (C.N.); (T.G.)
- Católica Research Centre for Psychological, Family and Social Well-Being, Faculdade de Ciências Humanas, University Católica Portuguesa, 1649-023 Lisbon, Portugal
| | - Gina Tomé
- ISAMB/Environmental Health/Medical School, University of Lisbon, 1649-004 Lisboa, Portugal; (M.C.); (C.B.); (B.M.); (A.C.); (G.T.); (C.N.); (T.G.)
| | - Catarina Noronha
- ISAMB/Environmental Health/Medical School, University of Lisbon, 1649-004 Lisboa, Portugal; (M.C.); (C.B.); (B.M.); (A.C.); (G.T.); (C.N.); (T.G.)
| | - Tânia Gaspar
- ISAMB/Environmental Health/Medical School, University of Lisbon, 1649-004 Lisboa, Portugal; (M.C.); (C.B.); (B.M.); (A.C.); (G.T.); (C.N.); (T.G.)
- Life Sciences Department, University Centre of Lisboa, University Lusófona de Humanidades e Tecnologias, 1749-024 Lisboa, Portugal
| | - Nuno Rodrigues
- Direção Geral de Estatísticas da Educação e Ciência, 1200-774 Lisboa, Portugal;
| | - Margarida Gaspar de Matos
- ISAMB/Environmental Health/Medical School, University of Lisbon, 1649-004 Lisboa, Portugal; (M.C.); (C.B.); (B.M.); (A.C.); (G.T.); (C.N.); (T.G.)
- Católica Research Centre for Psychological, Family and Social Well-Being, Faculdade de Ciências Humanas, University Católica Portuguesa, 1649-023 Lisbon, Portugal
- Applied Psychology Research Centre Capabilities and Inclusion, Instituto Superior de Psicologia Aplicada, 1140-041 Lisboa, Portugal
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Pajek J, Mancini K, Murray M. COVID-19 and children's behavioral health: An overview. Curr Probl Pediatr Adolesc Health Care 2023; 53:101491. [PMID: 38040607 DOI: 10.1016/j.cppeds.2023.101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
The paper reviews the impact of the COVID-19 pandemic on children's and adolescents' well-being. A trauma-informed framework is employed to discuss the emerging evidence of notable changes in youth's psychological, developmental, academic, and social well-being since the start of the COVID-19 pandemic. Children and adolescents have been uniquely affected based on their age at the start of the pandemic. Despite multiple resiliency factors, COVID-19 and its ramifications have had an adverse effect on youth in general and have exacerbated preexisting racial and socioeconomic disparities. This review concludes with recommendations for child health clinicians.
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Affiliation(s)
- Julie Pajek
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
| | - Kathryn Mancini
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Marsheena Murray
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
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Goralski JL, Hoppe JE, Mall MA, McColley SA, McKone E, Ramsey B, Rayment JH, Robinson P, Stehling F, Taylor-Cousar JL, Tullis E, Ahluwalia N, Chin A, Chu C, Lu M, Niu T, Weinstock T, Ratjen F, Rosenfeld M. Phase 3 Open-Label Clinical Trial of Elexacaftor/Tezacaftor/Ivacaftor in Children Aged 2-5 Years with Cystic Fibrosis and at Least One F508del Allele. Am J Respir Crit Care Med 2023; 208:59-67. [PMID: 36921081 PMCID: PMC10870849 DOI: 10.1164/rccm.202301-0084oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
Rationale: Elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) has been shown to be safe and effective in people with cystic fibrosis (CF) aged ⩾6 years with at least one F508del-CFTR allele but has not been studied in younger children. Objectives: To evaluate the safety, pharmacokinetics, pharmacodynamics, and efficacy of ELX/TEZ/IVA in children with CF aged 2-5 years. Methods: In this phase 3, open-label, two-part study (parts A and B), children weighing <14 kg (on Day 1) received ELX 80 mg once daily (qd), TEZ 40 mg qd, and IVA 60 mg each morning and 59.5 mg each evening; children weighing ⩾14 kg received ELX 100 mg qd, TEZ 50 mg qd, and IVA 75 mg every 12 hours. Measurements and Main Results: The primary endpoints for part A (15-d treatment period) were pharmacokinetics and safety and tolerability. For part B (24-wk treatment period), the primary endpoint was safety and tolerability; secondary endpoints included pharmacokinetics and absolute changes from baseline in sweat chloride concentration and lung clearance index2.5 (LCI2.5, defined as the number of lung turnovers required to reduce the end tidal N2 concentration to 2.5% of its starting value) through Week 24. Analysis of pharmacokinetic data from 18 children enrolled in part A confirmed the appropriateness of the part B dosing regimen. In part B, 75 children (F508del/minimal function genotypes, n = 52; F508del/F508del genotype, n = 23) were enrolled and dosed. Seventy-four children (98.7%) had adverse events, which were all mild (62.7%) or moderate (36.0%) in severity. The most common adverse events were cough, fever, and rhinorrhea. Decreases in sweat chloride concentration (-57.9 mmol/L; 95% confidence interval [CI], -61.3 to -54.6; n = 69) and LCI2.5 (-0.83 U; 95% CI, -1.01 to -0.66; n = 50) were observed from baseline through Week 24. Mean body mass index was within the normal range at baseline and remained stable at Week 24. Conclusions: In this open-label study in children 2-5 years of age, ELX/TEZ/IVA treatment was generally safe and well tolerated, with a safety profile consistent with that observed in older age groups, and led to clinically meaningful reductions in sweat chloride concentration and LCI2.5. Clinical trial registered with www.clinicaltrials.gov (NCT04537793).
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Affiliation(s)
| | - Jordana E. Hoppe
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Marcus A. Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
- German Center for Lung Research, Associated Partner, Berlin, Germany
| | - Susanna A. McColley
- Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Bonnie Ramsey
- Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan H. Rayment
- University of British Columbia and British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Phil Robinson
- The Royal Children’s Hospital, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Florian Stehling
- Children’s Hospital, University of Duisburg-Essen, Essen, Germany
| | | | - Elizabeth Tullis
- St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Anna Chin
- Vertex Pharmaceuticals Inc., Boston, Massachusetts; and
| | - Chenghao Chu
- Vertex Pharmaceuticals Inc., Boston, Massachusetts; and
| | - Mengdi Lu
- Vertex Pharmaceuticals Inc., Boston, Massachusetts; and
| | - Tao Niu
- Vertex Pharmaceuticals Inc., Boston, Massachusetts; and
| | | | | | - Margaret Rosenfeld
- Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Wainwright C, McColley SA, McNally P, Powers M, Ratjen F, Rayment JH, Retsch-Bogart G, Roesch E, Ahluwalia N, Chin A, Chu C, Lu M, Menon P, Waltz D, Weinstock T, Zelazoski L, Davies JC. Long-Term Safety and Efficacy of Elexacaftor/Tezacaftor/Ivacaftor in Children Aged ⩾6 Years with Cystic Fibrosis and at Least One F508del Allele: A Phase 3, Open-Label Clinical Trial. Am J Respir Crit Care Med 2023; 208:68-78. [PMID: 37154609 PMCID: PMC10870850 DOI: 10.1164/rccm.202301-0021oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
Rationale: A 24-week, phase 3, open-label study showed elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) was safe and efficacious in children aged 6-11 years with cystic fibrosis (CF) and one or more F508del-CFTR alleles. Objectives: To assess long-term safety and efficacy of ELX/TEZ/IVA in children who completed the pivotal 24-week phase 3 trial. Methods: In this phase 3, two-part (part A and part B), open-label extension study, children aged ⩾6 years with CF heterozygous for F508del and a minimal function CFTR mutation (F/MF genotypes) or homozygous for F508del (F/F genotype) who completed the 24-week parent study received ELX/TEZ/IVA based on weight. Children weighing <30 kg received ELX 100 mg once daily/TEZ 50 mg once daily/IVA 75 mg every 12 hours, whereas children weighing ⩾30 kg received ELX 200 mg once daily/TEZ 100 mg once daily/IVA 150 mg every 12 hours (adult dose). The 96-week analysis of part A of this extension study is reported here. Measurements and Main Results: Sixty-four children (F/MF genotypes, n = 36; F/F genotype, n = 28) were enrolled and received one or more doses of ELX/TEZ/IVA. Mean (SD) period of exposure to ELX/TEZ/IVA was 93.9 (11.1) weeks. The primary endpoint was safety and tolerability. Adverse events and serious adverse events were consistent with common manifestations of CF disease. Overall, exposure-adjusted rates of adverse events and serious adverse events (407.74 and 4.72 events per 100 patient-years) were lower than in the parent study (987.04 and 8.68 events per 100 patient-years). One child (1.6%) had an adverse event of aggression that was moderate in severity and resolved after study drug discontinuation. From parent study baseline at Week 96 of this extension study, the mean percent predicted FEV1 increased (11.2 [95% confidence interval (CI), 8.3 to 14.2] percentage points), sweat chloride concentration decreased (-62.3 [95% CI, -65.9 to -58.8] mmol/L), Cystic Fibrosis Questionnaire-Revised respiratory domain score increased (13.3 [95% CI, 11.4 to 15.1] points), and lung clearance index 2.5 decreased (-2.00 [95% CI, -2.45 to -1.55] units). Increases in growth parameters were also observed. The estimated pulmonary exacerbation rate per 48 weeks was 0.04. The annualized rate of change in percent predicted FEV1 was 0.51 (95% CI, -0.73 to 1.75) percentage points per year. Conclusions: ELX/TEZ/IVA continued to be generally safe and well tolerated in children aged ⩾6 years through an additional 96 weeks of treatment. Improvements in lung function, respiratory symptoms, and CFTR function observed in the parent study were maintained. These results demonstrate the favorable long-term safety profile and durable clinical benefits of ELX/TEZ/IVA in this pediatric population. Clinical trial registered with www.clinicaltrials.gov (NCT04183790).
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Affiliation(s)
- Claire Wainwright
- Queensland Children’s Hospital, South Brisbane, Queensland, Australia
- Child Health Research Centre, University of Queensland, South Brisbane, Queensland, Australia
| | - Susanna A. McColley
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paul McNally
- Children’s Health Ireland, Dublin, Ireland
- Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | | | | | - Erica Roesch
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Neil Ahluwalia
- Vertex Pharmaceuticals Incorporated, Boston, Massachusetts
| | - Anna Chin
- Vertex Pharmaceuticals Incorporated, Boston, Massachusetts
| | - Chenghao Chu
- Vertex Pharmaceuticals Incorporated, Boston, Massachusetts
| | - Mengdi Lu
- Vertex Pharmaceuticals Incorporated, Boston, Massachusetts
| | - Prema Menon
- Vertex Pharmaceuticals Incorporated, Boston, Massachusetts
| | - David Waltz
- Vertex Pharmaceuticals Incorporated, Boston, Massachusetts
| | | | | | - Jane C. Davies
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
- Royal Brompton Hospital, Part of Guy’s and St. Thomas’ NHS Trust, London, United Kingdom
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Lawrence PJ, Skripkauskaite S, Shum A, Waite P, Dodd H. Changes in UK pre-schooler's mental health symptoms over the first year of the COVID-19 pandemic: Data from Co-SPYCE study. JCPP ADVANCES 2023; 3:e12163. [PMID: 37753148 PMCID: PMC10519734 DOI: 10.1002/jcv2.12163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/24/2023] [Indexed: 09/28/2023] Open
Abstract
Background The COVID-19 pandemic caused significant disruption to the lives of children and their families. Pre-school children may have been particularly vulnerable to the effects of the pandemic, with the closure of childcare facilities, playgrounds, playcentres and parent and toddler groups limiting their opportunities for social interaction at a crucial stage of development. Additionally, for parents working from home, caring for pre-school aged children who require high levels of support and care, was likely challenging. We conducted an intensive longitudinal, but not nationally representative, study to examine trajectories of pre-schoolers' mental symptoms in the United Kingdom during the first year of the COVID-19 pandemic. Methods UK-based parents and carers (n = 1520) of pre-school-aged children (2-4 years) completed monthly online surveys about their pre-schoolers' mental health between April 2020 and March 2021. The survey examined changes in children's emotional symptoms, conduct problems and hyperactivity/inattention. Results In our final mixed-effects models, our predictors (fixed effects) accounted for 5% of the variance in each of conduct problems, emotional symptoms and hyperactivity/inattention symptoms scores, and the combined random and fixed effects accounted for between 64% and 73% of the variance. Pre-schoolers' emotional problems and hyperactivity/inattention symptoms declined from April through summer 2020 and then increased again during the autumn and winter 2020/2021 as lockdowns were re-introduced. Pre-schoolers who attended childcare showed greater decline in symptom severity than those who did not. Older children, compared to younger, showed greater lability of emotion symptom severity. Attending childcare predicted lower symptom severity across all three domains of conduct problems, emotional symptoms, and hyperactivity/inattention, while the opposite pattern was observed for children whose parent had a mental health problem. Conclusions Our findings reinforce the importance of examining pre-schoolers' mental health in the context of micro and macro-level factors. Interventions focussing on family factors such as parent mental health, as well as continued provision of childcare, may have most potential to mitigate the impact of COVID-19 on young children's mental health.
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Affiliation(s)
- Peter J. Lawrence
- Centre for Innovation in Mental HealthSchool of PsychologyUniversity of SouthamptonSouthamptonUK
| | - Simona Skripkauskaite
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Adrienne Shum
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Polly Waite
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Helen Dodd
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
- Children and Young People's Mental Health Research CollaborationExeter Medical SchoolUniversity of ExeterExeterUK
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Li Y, Jia W, Yan N, Hua Y, Han T, Yang J, Ma L, Ma L. Associations between chronic stress and hair cortisol in children: A systematic review and meta-analysis. J Affect Disord 2023; 329:438-447. [PMID: 36868386 DOI: 10.1016/j.jad.2023.02.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES This review systematically examined the associations between chronic stress and hair cortisol concentration (HCC) in children, and the potential modification effects of type, measurement period and scales of chronic stress, child age and sex, hair length and HCC measurement method, characteristics of study site, and congruence between time periods measured for chronic stress and HCC. METHODS Pubmed, Wed of Science, and APA PsycINFO were systematically searched for articles examining the association between chronic stress and HCC. RESULTS Thirteen studies from five countries with 1,455 participants were included in the systematic review and nine studies were included in the meta-analysis. Meta-analysis revealed that chronic stress was associated with HCC (pooled-r = 0.09, 95 % CI: 0.03, 0.16). Stratified analyses revealed that type, measurement time and scales of chronic stress, hair length and measurement method of HCC, and the congruence between time periods measured for chronic stress and HCC modified such correlations. The positive correlations between chronic stress and HCC were significant for studies measuring chronic stress as stressful life events, assessing chronic stress within the past six months, extracting HCC from 1 cm, 3 cm, or 6 cm of hair, measuring HCC by LC-MS/MS, or having congruence between time periods measured for chronic stress and HCC. The potential modifying effects of sex and country developmental status could not be concluded due to the limited number of studies included. CONCLUSIONS Chronic stress was positively correlated with HCC, varying by characteristics and measurements of chronic stress and HCC. HCC could be a biomarker for chronic stress among children.
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Affiliation(s)
- Ying Li
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wanru Jia
- Department of Disease Prevention and Control, Xi 'an Children's Hospital, Xi'an, China
| | - Na Yan
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, China
| | - Yiming Hua
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tuo Han
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Juan Yang
- Department of Cell Biology and Genetics, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Lu Ma
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, China.
| | - Le Ma
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, China.
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Trauma-Informed Care for Hospitalized Adolescents. CURRENT PEDIATRICS REPORTS 2022; 10:45-54. [PMID: 35280451 PMCID: PMC8900961 DOI: 10.1007/s40124-022-00262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 10/25/2022]
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