Child maltreatment is a major public health concern, yet identification in emergency department settings remains challenging. Caregiver-focused approaches may help identify families at risk. We describe cases reported to a hospital-based Child Protection Team following caregiver emergency department visits in Japan.

We conducted a single-center retrospective observational study at an urban tertiary hospital. We included caregiver emergency department visits between January 2022 and December 2024 when the presenting adult was 18 years or older, the visit was reported to the Child Protection Team regarding at least one child under 18 years in that adult's care, and the team subsequently judged that involvement was required. We extracted medical record variables and used descriptive analyses.

We included 79 index caregivers and 101 emergency department visits. A documented history of mental health conditions was present in 53% of caregivers. Common diagnoses included drug intoxication, alcohol-related disorders, somatic symptom-related or dissociation-related diagnoses, injuries related to domestic violence, and self-inflicted injuries. Neglect was the most common reason for notification. Fifty-seven percent of caregivers had prior involvement with the Child Protection Team or the Council for Children Requiring Care and Support, and 30% required new registration or temporary child protection after the team review.

This study describes a selected group of caregiver emergency department visits that were reported to a hospital-based Child Protection Team and subsequently judged to require team involvement. Further studies with defined caregiver denominators and comparison groups are needed to evaluate caregiver-focused emergency department assessment pathways.

Arts-based programs have re-emerged as a focus of population mental health policy, with the World Health Organisation Healing Arts initiative and social prescribing programs across the UK, Australia, USA, and Canada signaling growing interest in scalable, accessible approaches to mental health prevention. With this growing trend there is an opportunity for seeking complementary scalable approaches implemented during childhood to prevent mental-ill health.

The aim of this study was to provide a broad overview of the nature of the relationships between participation in arts programs and mental health and wellbeing outcomes during middle childhood, with a specific emphasis on the mechanisms that may underlie this relationship. This review also aimed to identify program characteristics and the context in which this relationship exists.

This systematic review was performed according to PRISMA guidelines with a focus on studies examining the relationships between arts participation and mental health and wellbeing outcomes among children in the general population during the middle childhood years (6 to 12 years).

A total of 34 studies were included, made up of primarily quantitative studies. The evidence base reviewed suggests therapeutic approaches in non-clinical settings led by specialists over shorter periods of implementation (typically 4-10 weeks) shows preliminary signs of promise. Recreational programs showed inconsistent effects across outcome domains: some studies reported benefits to wellbeing and stress, while others reported no effect on internalising or externalising symptoms, with no consistent pattern across program features. Psychological and biological constructs were the most commonly identified mechanisms of change. The certainty of evidence across all mental health outcomes was rated as low or very low.

This first systematic review of arts-inclusive programs in middle childhood points to preliminary signs of promise, particularly for therapeutic approaches in non-clinical settings, although the certainty of evidence is low. Future research should focus on conducting high quality studies in school contexts with a focus on pedagogical design and facilitator expertise. This would address cost effectiveness for scaling at the general population level for prevention.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024581364.

Understanding the heterogeneity of suicide attempts (SA), and non-suicidal self-injury (NSSI) - e.g., impulsiveness of these behaviors, as in the length of time between participants' thought of engaging in the relevant self-injurious behavior and acting on the thought - is an important step towards personalized intervention. Although impulsivity has been extensively studied in relation to SA and NSSI, much less work has evaluated impulsivity in relation to impulsiveness of these behaviors. This study assessed whether trait and state-sensitive impulsivity were associated with impulsiveness of SA and NSSI, respectively, in an adolescent inpatient sample.

Adolescents (N = 146) were recruited from a psychiatric inpatient facility. Multiple regression models examined whether trait impulsivity via self-report (i.e., lack of premeditation, lack of perseverance, sensation-seeking, and negative urgency) and state-sensitive impulsivity via the stop-signal task (SST) were associated with impulsiveness of SA and NSSI, respectively.

Lack of premeditation was positively associated with impulsiveness of SA. Greater impulsivity, as reflected by worse impulse inhibition on the SST, was also positively related to impulsiveness of SA. Lack of premeditation and low sensation-seeking were associated with the impulsiveness of NSSI.

These findings suggest that aspects of trait and state-sensitive impulsivity are differentially associated with impulsiveness of SA and NSSI. Collectively, these findings support the view that despite phenotypic overlap between these forms of self-injurious behaviors, important distinctions exist in their underlying correlates. They also support impulsiveness of these behaviors as a meaningfully manifestation of their heterogeneity.

Persistent post-concussion symptoms (PPCS) affect 35% of children and adolescents with concussion. This study aimed to characterise sleep patterns in children and adolescents with PPCS and explore the effect of sleep disturbance on clinical concussion outcomes.

A prospective longitudinal study was conducted in participants with PPCS (n = 20, aged 11-18 years) presenting to a tertiary referral clinic. Participants completed a battery of concussion assessments at their initial consultation and at 4 weeks follow-up to assess and monitor symptom burden, cognition, balance, mental health, and exercise tolerance. The Insomnia Severity Index (ISI) was used to identify participants with post-concussion clinical insomnia (PCCI). Wrist actigraphy was used to objectively characterise sleep patterns, including total sleep time, sleep latency, wake after sleep onset and sleep efficiency, over a 14-day period. Participants were followed until they were recovered from concussion.

Forty-five percent of participants with PPCS also had PCCI. Objective mean ± SD sleep parameters of participants were: total sleep time 452.1 ± 53.8 min, sleep latency 32.2 ± 16.3 min, wake after sleep onset 76.9 ± 21.4 min, and sleep efficiency 85.9 ± 3.7%. Mood disturbance was a significant predictor of sleep disturbance at the 4-week follow-up (P = 0.01). Recovery time was three times greater for participants with PCCI than those with no PCCI (median (interquartile range): 150 (91-247) vs 47 (30-58) days, P = 0.04).

Sleep disturbance is significantly associated with poorer mental health and prolonged recovery time in children and adolescents with PPCS.

Gangliosides are sialylated glycosphingolipids highly enriched in the central nervous system, where they regulate membrane signaling, metabolism, neurogenesis, and immune responses. This Review integrates recent advances across distinct experimental and clinical domains. First, recent studies demonstrate that the monosialoganglioside GM1 enhances astrocyte-neuron metabolic coupling via the astrocyte-neuron lactate shuttle, thereby supporting neuronal bioenergetics and resilience. Complementary mechanistic work shows that specific gangliosides regulate adult neurogenesis through developmentally controlled epigenetic and transcriptional programs. In Huntington's disease models, preclinical evidence indicates that GM1 and related gangliosides attenuate microglia-mediated inflammatory responses and promote proteostasis through extracellular vesicle-dependent clearance of misfolded proteins. Finally, clinical evidence from acute spinal cord injury demonstrates that GM1 administration accelerates neurological recovery, underscoring its translational relevance. Together, these findings position gangliosides as multi-target modulators of neural repair and inflammation, and highlight their potential for therapeutic development.

Chronic fatigue syndrome (CFS) is a widespread and debilitating disorder that profoundly impacts the physical and mental health of patients. In traditional Chinese medicine (TCM), spleen-kidney yang deficiency is recognized as the most prevalent syndrome associated with CFS. Moxibustion is commonly employed to mitigate fatigue and address yang deficiency; however, conventional moxa box moxibustion has demonstrated limited clinical efficacy in practice. Considering the intrinsic benefits of Jianqiao ancient moxibustion in terms of its herbal formula and treatment coverage, this randomized controlled superiority trial aims to compare the clinical efficacy of Jianqiao ancient moxibustion with that of moxa box moxibustion in patients with CFS who exhibit a spleen-kidney yang deficiency pattern.

This single-center, single-blind randomized controlled superiority trial will enroll 90 eligible patients diagnosed with CFS exhibiting a spleen-kidney yang deficiency pattern. Participants will be randomly assigned in a 1:1 ratio to receive either Jianqiao ancient moxibustion or moxa box moxibustion, with each group receiving standardized interventions as outlined in the trial protocol. Each 60-min treatment session will be administered three times per week for 4 consecutive weeks. A follow-up assessment will be conducted at week 16. The primary outcome measure will be the Fatigue Scale-14. Secondary outcome measures will include the Spleen-Kidney Yang Deficiency Symptom Scale, the Self-Rating Anxiety Scale, the Self-Rating Depression Scale, and infrared thermal imaging. All evaluations will be performed at baseline, immediately post-intervention at week 4, and during follow-up at week 16.

It is hypothesized that Jianqiao ancient moxibustion will be more effective than moxa box moxibustion in alleviating symptoms in patients with CFS who have spleen-kidney yang deficiency. Furthermore, this study will employ infrared thermal imaging to assess alterations in the thermal characteristics of the Sanjiao and Governor Vessel both prior to and following moxibustion. This methodology may help elucidate the mechanisms underlying moxibustion's modulation of yang-qi distribution in patients with CFS.

https://www.chictr.org.cn/showproj.html?proj=193045.

Attention-deficit/hyperactivity disorder (ADHD) in preschool-aged children presents a significant developmental and public health challenge globally. In Thailand, early identification and intervention are constrained by diagnostic uncertainty, limited standardized care, and cultural misalignment with Western-based treatment models. Although parent management training (PMT) is the recommended first-line non-pharmacological intervention for early-onset ADHD, its effectiveness and adaptability in collectivist, resource-limited contexts remain underexplored. This study aimed to evaluate the efficacy of a culturally adapted, group-based PMT program for Thai caregivers of preschoolers at risk for ADHD, with the goal of reducing symptoms and enhancing positive parenting compared to standard educational materials.

This single-blind randomized controlled trial (RCT) enrolled caregivers of preschool children aged 3-5 years identified as being at risk for ADHD using the Thai ADHD Screening Scales (THASS). Participants were randomly assigned to either a culturally adapted group-based PMT intervention or an educational materials control condition. Outcomes were assessed at baseline, 2 weeks, and 6 weeks using standardized caregiver-reported measures. Primary efficacy analyses were conducted using generalized estimating equations (GEE) to account for correlations between repeated outcome measurements over time.

The intervention group demonstrated significant reductions in ADHD symptoms (Cohen's d>1.2; P<0.001), with sustained improvements across hyperactivity-impulsivity and inattention domains through 6 weeks. Positive parenting scores improved at 2 weeks (d=0.74), though gains were partially reduced at 6 weeks. No adverse events occurred, and retention was 100%, indicating strong acceptability of the intervention model.

This study provides the first controlled evidence for a culturally adapted, group-based PMT intervention in Southeast Asia. Its feasibility, brevity, and alignment with cultural values support its potential as a scalable early intervention model in low-resource, collectivist settings.

Thai Clinical Trials Registry (TCTR20260202021).

Picky eating is common among children with autism spectrum disorder (ASD). However, the specific effects of different levels of picky eating on nutritional status, dietary diversity, and eating behaviors in preschool-aged children with ASD remain unclear. This study aimed to compare these aspects between children with low versus high levels of picky eating.

A cross-sectional study design was employed, enrolling 130 children with ASD aged 3 to 6 years who met the DSM-5 diagnostic criteria [Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-V)]. Trained personnel measured each child's height and weight using standardized instruments. Validated dietary diversity scores and preschool eating behavior scales were used to assess dietary diversity and nutrient intake and eating behaviors. energy and macronutrient intake were quantified through three non-consecutive 24-hour dietary recalls. Children were divided into a low picky eating group and a high picky eating group based on the degree of picky eating for comparative analysis.

There were no statistically significant differences in height and weight indicators between the two groups, with most children falling within the normal range of growth and development. However, distinct differences were observed in nutrient intake and eating behaviors: children in the low picky eating group showed significantly higher total dietary diversity scores (P<0.05). Regarding nutrient intake, children in the low picky eating group exhibited higher intake levels of total energy, polyunsaturated fatty acids, and dietary fiber compared to those in the high picky eating group; in specific food categories, intake of starchy tubers, fruits, nuts, and legumes was also significantly higher. Regarding eating behaviors, children in the low picky eating group showed lower scores for picky eating and problematic eating behaviors, whereas exhibited heightened satiety responsiveness, with all differences reaching statistical significance (P<0.05).

The degree of picky eating is a key factor influencing dietary quality and eating behaviors in preschool-age children with ASD. Low levels of picky eating are associated with more comprehensive nutrient intake, richer dietary diversity, and more favorable eating behavior patterns. Early identification and intervention targeting picky eating behavior are of significant importance for improving the nutritional status of children with ASD.

There is a relative scarcity of studies focusing on fat infiltration in the supraspinatus muscle using musculoskeletal ultrasound (MSK US). This study aimed to investigate the clinical application value of MSK US in assessing fat infiltration of the supraspinatus muscle in patients with supraspinatus tendon tears.

We conducted a retrospective analysis of 154 patients diagnosed with supraspinatus tendon tears by arthroscopy. All patients underwent semi-quantitative grading of supraspinatus muscle fat infiltration using MSK US, complemented by shear wave elastography (SWE). Magnetic resonance imaging (MRI) served as the gold standard. Diagnostic performance metrics were calculated for MSK US in detecting fat infiltration, and Kappa consistency analysis was assessed between MSK US and MRI findings. Additionally, Spearman correlation analysis was performed to evaluate the relationship between the degree of fat infiltration quantified by MSK US and the extent of supraspinatus tendon tear as determined arthroscopically.

Arthroscopic results revealed full-thickness tears in 50 patients (32.47%, 50/154), and partial tears in 104 patients (67.53%, 104/154). In terms of tear grades by arthroscopy, 22 cases were Grade I (14.29%, 22/154), 38 were Grade II (24.68%, 38/154), and 94 were Grade III (61.04%, 94/154). The SWE measurements demonstrated significantly lower shear wave velocity in the affected supraspinatus muscle (2.52±0.56 cm/s) compared with the healthy side (3.03±0.64 cm/s; t=7.42, P<0.001). Using MRI as a reference standard, MSK US achieved a sensitivity of 94.90%, specificity of 82.14%, positive predictive value of 90.29%, negative predictive value of 90.20%, accuracy rate of 90.26%, and an area under the receiver operating characteristic (ROC) curve of 0.89. A statistically significant positive correlation was observed between the degree of supraspinatus muscle fat infiltration assessed by MSK US and the extent of supraspinatus tendon tear determined arthroscopically (rs=0.47, P<0.001).

The fat infiltration in the supraspinatus muscle, as assessed by MSK US, demonstrated moderate consistency with MRI diagnoses, underscoring its high clinical value. A strong association was observed between supraspinatus muscle fat infiltration and the severity of supraspinatus tendon tears. Specifically, higher-grade tendon tears were significantly correlated with greater degrees of fat infiltration within the supraspinatus muscle.

Ultrasound-guided needle-knife release of the transverse carpal ligament (TCL) has the potential to treat mild-to-moderate carpal tunnel syndrome (CTS). This study aimed to compare the clinical efficacy and safety of ultrasound-guided needle-knife release of the TCL with those of glucocorticoid injection therapy.

A total of 27 patients with mild or moderate CTS, involving 32 carpal tunnels, were enrolled between September 2025 and January 2026. They were randomly assigned to either the ultrasound-guided needle-knife therapy group (Group T, 17 carpal tunnels) or the ultrasound-guided glucocorticoid injection group (Group C, 15 carpal tunnels). Functional scores, Numerical Rating Scale (NRS) numbness and pain scores, Boston carpal tunnel questionnaire (BCTQ) scale scores, and 36-Item Short Form Health Survey (SF-36) scale scores were recorded and compared between groups at baseline, 1 month, and 3 months post-treatment. Clinical efficacy rates were assessed using the Kelly criteria.

Compared with baseline, at 1 and 3 months post-treatment, Group T showed a significant improvement in carpal tunnel function scores (P=0.011, P<0.001); a significant reduction in NRS pain scores (P=0.006, P<0.001); the NRS numbness score decreased significantly (P<0.001), with better results observed at 3 months post-treatment compared to 1 month post-treatment (P=0.014); and the Symptom Severity Scale (SSS) score of BCTQ scale decreased significantly (P=0.0179, P<0.001); the physical functioning (PF), bodily pain (BP), role physical (RP), general health (GH), role emotional (RE), and social functioning (SF) scores of SF-36 scale all increased significantly (P<0.05). Compared with baseline, in Group T, the Functional Status Scale (FSS) score of the BCTQ scale decreased significantly by 3 months after treatment (P=0.028), and the vitality (VT) and mental health (MH) scores of the SF-36 scale both increased significantly (P<0.05). Group C showed improvement in the aforementioned scores at both 1 and 3 months post-treatment compared to baseline, but the magnitude was smaller than that of Group T and did not differ significantly from baseline (P>0.05). Furthermore, the efficacy at 3 months post-treatment in the corticosteroid injection group was almost indistinguishable from that at 1 month, indicating poorer long-term efficacy. According to the Kelly criteria, the overall response rate was higher in Group T than in Group C. There were significant differences between Group T and Group C in terms of carpal tunnel function, Visual Analog Scale (VAS), NRS, BCTQ, and SF-36 scores (P<0.05).

Ultrasound-guided needle-knife release of the TCL demonstrated superior efficacy compared to glucocorticoid injection.