This Viewpoint explores the Make America Healthy Again Commission’s framework for early childhood and out-of-school programs for increasing physical activity and improving nutrition options among US youths.
Importance The respiratory syncytial virus (RSV) bivalent prefusion F protein vaccine (RSVpreF) administered during pregnancy has demonstrated efficacy in protecting infants against early-life RSV disease in the pivotal clinical trial. Objective To conduct a systematic review and meta-analysis to synthesize real-world evidence on the effectiveness of RSVpreF in preventing RSV-associated lower respiratory tract infection (LRTI) in infants. Data Sources PubMed, Scopus, and Europe PMC were searched from January 1, 2020, through January 30, 2026. Study Selection A total of 1144 studies were initially identified. Eligible were nonrandomized studies reporting the effectiveness of RSVpreF vaccine in pregnancy in the prevention of RSV-associated LRTI in infants. Data Extraction and Synthesis All studies were screened independently by 2 reviewers. Data were extracted on RSV-associated outcomes among infants born to women who received RSVpreF vaccination during pregnancy and infants born to unvaccinated women. Main Outcomes and Measures The primary outcome was RSV-associated LRTI hospitalization. Odds ratios (ORs) were pooled using random-effects meta-analysis with the Hartung-Knapp adjustment and Sidik-Jonkman estimator. Vaccine effectiveness against RSV-associated LRTI hospitalization was calculated as (1 − OR) × 100% and assessed in infants from birth to age 3 months and from birth to 6 months, separately. The limited available data precluded meta-analysis of effectiveness against the secondary outcomes of RSV-associated emergency department visits, intensive care unit admissions, and death. Results A total of 7 studies were included, comprising 7112 infants, of whom 2684 were born to vaccinated mothers. The studies collected data from January 2024 through April 2025 from Argentina, the UK, and the US. Pooled vaccine effectiveness against RSV-associated LRTI hospitalization was 82% (95% CI, 81%-82%; 3 studies, 4397 participants; I 2 = 0%) in infants from birth to 3 months and 78% (95% CI, 70%-84%; 6 studies, 3008 participants; I 2 = 18.7%) in infants from birth to 6 months, when mothers were vaccinated 14 days or more before delivery. Conclusions and Relevance The results of this systematic review and meta-analysis suggest that postimplementation data support the effectiveness of RSVpreF in pregnancy for the prevention of RSV-associated LRTI hospitalization during the first 6 months of life. The results support the introduction of RSVpreF into routine antenatal immunization programs.
This study examines trends in preclinical and clinical obesity among US adolescents.
Importance Clesrovimab is a long-acting monoclonal antibody approved for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in neonates and infants who are born during or entering their first RSV season; data concerning clesrovimab from a second RSV season among children who remain at risk for severe disease are needed. Objective To evaluate the safety and tolerability of clesrovimab (105 mg) vs palivizumab in RSV season 1 in infants at increased risk for severe RSV disease. Key secondary objectives include describing the safety of 210 mg of clesrovimab in RSV season 2 in children who remain at increased risk for severe RSV disease, clesrovimab pharmacokinetics, and the incidence of RSV-associated disease. Design, Setting, and Participants SMART (MK-1654-007) was a randomized, partially masked, palivizumab-controlled, phase 3 clinical trial, conducted at 110 sites in 27 countries and territories between November 30, 2021, and November 20, 2025. The population constituted palivizumab-eligible infants, including those with prematurity, chronic lung disease of prematurity, or hemodynamically significant congenital heart disease. Interventions Participants, randomized 1:1 and stratified by region and condition, received clesrovimab (105 mg) on day 1 followed by placebo on day 28 or monthly palivizumab (15 mg/kg) up to 5 doses (1 dose per month). Eligible infants received open-label clesrovimab (210 mg) before their second RSV season. Main Outcomes and Measures The primary outcome was the observed proportions of participants experiencing adverse events (AEs) after clesrovimab or palivizumab in season 1. Results Overall, 997 infants (500 [50.2%] male; median age, 2.6 [range, 0.0-12.0] months) received clesrovimab, 105 mg (n = 498) or palivizumab (n = 499) in season 1; 276 received clesrovimab, 210 mg open-label in season 2. In season 1, the proportions of participants experiencing AEs were comparable between treatment groups. In season 2, clesrovimab, 210 mg was well tolerated. Incidence rates of RSV-associated medically attended lower respiratory infection (MALRI) were comparable between clesrovimab and palivizumab (3.2% [95% CI, 1.8%-5.2%] and 3.4% [95% CI, 2.0%-5.6%], respectively) through day 150 in season 1; total RSV-associated MALRI incidence through day 180 after a 210-mg dose in season 2 was 7.3% (95% CI, 4.4%-11.4%). Conclusions and Relevance In this randomized clinical trial, clesrovimab was well tolerated in infants at increased risk for severe RSV disease through 2 RSV seasons. These findings support the use of clesrovimab in children who remain at risk for severe RSV disease in their second RSV season. Trial Registration ClinicalTrials.gov Identifier: NCT04938830
Importance:Adolescents are increasingly using generative artificial intelligence (AI) as an anonymous emotional support system, yet the association between affective use and mental health remains poorly understood. Objective:To examine the association between affective generative AI use and emotional problems among a large, diverse sample of youth. Design, Setting, and Participants:This cross-sectional study evaluates Ontario Health and Peer Relations Study data (May 2025 through March 2026) among students in grades 4 through 12 across 4 school boards in Ontario, Canada. Data were analyzed in May 2026. Exposures:Affective AI use (emotional support or advice) and functional AI use (school-related tasks). Main Outcomes and Measures:Emotional problems were assessed via the Ontario Child Health Study Emotional Behavioral Scales using a validated clinical threshold. Covariates included mattering, loneliness, and demographic characteristics. Results:The final analytic sample consisted of 39 761 students (mean [SD] age, 12.8 [2.4] years; 19 291 [48.5%] girls). A total of 8408 participants (21.1%) reported using AI for affective purposes. Female students, gender-diverse students, and students who were Black, Indigenous, or of other racial and ethnic groups besides White were more likely to have used AI for affective purposes compared with boys and White students, respectively. Additionally, students who were older and students who reported using AI for school reported incrementally higher affective AI use. In unadjusted models, affective AI use was associated with significantly higher emotional problem scores (mean [SD] score, 1.04 [0.54] with use vs 0.67 [0.51] without use; B = 0.37 [95% CI, 0.36 to 0.39]) and were twice as likely to have clinical emotional problems (57.7% vs 29.2%; prevalence ratio, 1.98 [95% CI, 1.91 to 2.04]). In fully adjusted models, affective AI use remained associated with emotional problems (B = 0.14 [95% CI, 0.13 to 0.15]), whereas functional AI use showed a modest dose-response association with emotional problems (ranging from B = 0.01 [95% CI, 0.00 to 0.02] with rare use to B = 0.04 [95% CI, 0.02 to 0.05] with a lot of use). A significant interaction between affective AI use and gender identity was observed, which was attenuated for gender-diverse students compared with boys (B = -0.07 [95% CI, -0.12 to -0.03]) and girls (B = -0.08 [95% CI, -0.13 to -0.03]). No significant interaction was observed between affective AI use and school level. Conclusions and Relevance:This cross-sectional study suggests that seeking emotional support from generative AI is a unique marker of psychological distress in children and adolescents, independent of mattering or loneliness. Clinical frameworks and digital literacy programs should distinguish between functional AI assistance and the use of algorithmic interfaces as a digital refuge for emotional needs.
Importance:In February 2025, Australia introduced maternal vaccination with bivalent respiratory syncytial virus prefusion F protein-based vaccine (RSVpreF) in the National Immunization Program for pregnant individuals from 28 weeks' gestation as the primary, year-round strategy to prevent RSV disease in infants 6 months of age or younger. Objective:To estimate effectiveness of RSVpreF vaccination during pregnancy against infant RSV hospitalization in Australia. Design, Setting, and Participants:This retrospective case-control study with a test-negative design was conducted in 9 hospitals across Australia with year-round respiratory testing for acute respiratory illness (ARI) among infants born from 28 weeks' gestation and hospitalized with ARI at 6 months of age or younger, March 1, 2025, through February 28, 2026. Data were analyzed March 2026 through May 2026. Exposure:Maternal RSVpreF vaccination administered from 28 weeks' gestation and 14 days or more before delivery. Main Outcomes and Measures:Maternal RSVpreF effectiveness was evaluated against hospitalization for RSV lower respiratory tract disease (RSV-LRTD, primary objective), severe RSV-LRTD, and RSV-ARI. Logistic regression with confounder adjustment was used to calculate vaccine effectiveness (VE) as (1 - adjusted odds ratio) × 100%. Results:Of 1012 infants hospitalized with ARI, 655 had LRTD, with 114 of 386 case infants (30%) and 171 of 269 control infants (64%) born to RSVpreF-vaccinated mothers (median [IQR] gestational age at vaccination, 31 weeks [29-33]). Median (IQR) maternal age at delivery was 32 years (29-35). Median (IQR) age of infants hospitalized for LRTD was 52 days (30-89); 495 of 655 (76%) were aged 3 months or younger. VE against RSV-LRTD hospitalization was 77.8% (95% CI, 66.4%-85.3%) among infants from birth through 6 months of age, 80.2% (95% CI, 71.1%-86.5%) among infants from birth through 3 months of age, 86.3% (95% CI, 79.0%-91.1%) among infants from birth through 2 months of age, and 68.2% (95% CI, 42.2%-82.5%) among infants older than 2 months through 4 months of age. Comparable VE among infants aged 6 months or younger was observed for severe RSV-LRTD (80.4%; 95% CI, 54.4%-91.6%) and RSV-ARI (80.8%; 95% CI, 70.4%-87.6%) hospitalization, with similar age-specific trends. VE was consistent across stratifications by gestational age at vaccination, vaccination to delivery time interval, and proximal administration with other vaccines during pregnancy. Descriptively, among all infants hospitalized with ARI, 161 of 499 (32%) born to RSVpreF-unvaccinated mothers had severe LRTD, while 87 of 513 (17%) born to RSVpreF-vaccinated mothers had severe LRTD. Conclusions and Relevance:Findings in this case-control study demonstrate high year-round effectiveness of RSVpreF vaccination against RSV-associated hospitalization in infants 6 months of age or younger in the first year following introduction in Australia, with the highest VE observed in the earliest age intervals. Future analyses with larger sample sizes will evaluate VE among additional subgroups.
Importance:Emergency department (ED) pediatric readiness and pediatric inpatient services have changed over time in many hospitals, but the impact of these changes on pediatric outcomes is unclear. Objective:To evaluate pediatric mortality associated with changes to ED pediatric readiness and pediatric inpatient services over a 10-year period. Design, Setting, and Participants:This cohort study included data from January 1, 2012, through December 31, 2021, for 759 hospitals in 11 states that completed the 2013 and 2021 National Pediatric Readiness Program assessments. Participants were children aged 0 to 17 years who received care in an ED resulting in hospital admission, interhospital transfer, or death. Data analysis was performed from May 2025 to May 2026. Exposure:Changes in ED pediatric readiness and inpatient pediatric services, as measured through national assessments in 2013 and 2021. ED readiness change groups were characterized based on the weighted Pediatric Readiness Score (wPRS, range 0-100) associated with survival (wPRS ≥88 vs wPRS <88): sustained high readiness, gained, lost, or never had. Changes in pediatric inpatient services were defined as sustained, gained, lost, or never had. Main Outcomes and Measures:In-hospital mortality, including ED and inpatient deaths. Results:There were 2 416 030 children, including 337 167 who were injured (median [IQR] age, 10 [4-15] years; 4642 deaths [1.38%]) and 2 078 863 who were medically ill (median [IQR] age, 6 [1-14] years; 18 576 deaths [0.89%]). Of the 759 hospitals, the median (IQR) wPRS in 2013 vs 2021 was 71 (58-86) and 72 (62-88), respectively. Ninety-nine EDs (13.0%) had sustained high readiness, 85 (11.2%) gained readiness, 78 (10.3%) lost readiness, and 497 (65.5%) never had high readiness. For inpatient services, 225 hospitals (29.6%) sustained inpatient services, 36 (4.7%) gained services, 120 (15.8%) lost services, and 378 (49.8%) never had services. After risk adjustment, EDs that lost or never had high ED readiness were associated with 1727 (95% CI, 751-2646) and 3776 (95% CI, 2327-5143) excess deaths, respectively. Hospitals that lost or never had inpatient services were associated with 1657 (95% CI, 1214-2067) and 3745 (95% CI, 3127-4328) excess deaths, respectively. Conclusions and Relevance:This study found that the loss or persistent lack of high ED pediatric readiness and pediatric inpatient services were independently associated with excess mortality in children. Increasing ED readiness and adding inpatient services may augment pediatric survival in the US health care system.
Importance:Concerns about screen use and early language development are widespread, and prior research has reported mixed findings. Many studies have not distinguished baseline differences from developmental change, leaving uncertainty about whether screen use is associated with actual language development in early childhood. Objective:To examine associations between children's and parental screen use and children's language development from ages 5 to 7 years. Design, Setting, and Participants:This population-based prospective cohort study included children recruited through municipalities across Norway in 2023. Children were followed up annually for 3 waves. Data were analyzed from September 2025 to March 2026. Exposures:Parent-reported child daily screen time (weekday and weekend weighted average), child digital device ownership, maternal and paternal daily social media use, and primary parent smartphone screen time at the onset of the study. Main Outcomes and Measures:Receptive vocabulary and receptive grammar were assessed annually using the British Picture Vocabulary Scale and the Test for Reception of Grammar. Latent growth modeling was used to estimate baseline language levels and developmental trajectories from ages 5 to 7 years, adjusting for parental education and household income. Results:A total of 747 children (mean [SD] age, 4.9 [0.3] years; 360 of 718 female [50.1%]) were included in this study. Most screen use indicators were not associated with children's language growth. However, primary parent smartphone screen time was associated with slower growth in receptive vocabulary; each additional 1 hour per day was associated with 0.42 slower annual growth in receptive vocabulary raw score (95% CI, -0.66 to -0.18). Children who owned a digital device at age 4 to 5 years scored lower at baseline as follows: 5.13 points lower in receptive vocabulary (95% CI, -7.43 to -2.82) and 4.56 points lower in receptive grammar (95% CI, -7.56 to -1.55) compared with children who did not own a device. Conclusions and Relevance:In this cohort study, primary parent smartphone screen time was associated with slower growth in children's receptive vocabulary, whereas children's digital device ownership was associated with lower concurrent language performance. These findings highlight the importance of considering screen use within the broader family context when evaluating children's language development and are potentially informative for parents and clinicians.
