Concerns over the mental health of children and young people (CYP) continue to grow as rates of poorer mental health increase globally. To gain an understanding of the complex array of determinants of CYP mental health, Bronfenbrenner's bioecological model can be used to provide a conceptual framework to organise and analyse evidence, which can then be used to inform mental health policy and interventions. This rapid review brings together the published evidence on the use of Bronfenbrenner's bioecological model to understand and address the mental health of CYP. We searched Web of Science and PsychINFO to identify published studies. We grouped studies based on the system levels (e.g., micro-, macro-) before exploring the ways in which 'interactions' between and within model levels were examined. Thirty-four studies were included, with all studies focusing on micro-level factors and most also considering factors affecting mental health at the individual level. The impact of factors at exo-, macro- and chrono- levels were much less frequently addressed. Among the 34 studies, quantitative, statistical modelling was used to explore interactions between variables within the micro-system in six studies and between variables at different levels in thirteen studies. More than half of the quantitative studies did not examine statistical interactions. Among the qualitative studies, presenting issues were often discussed which could reflect interactions between systems. Existing literature applying Bronfenbrenner's bioecological model to understating CYP's mental health outcomes has focused predominantly on individual and micro level factors. There is a need for research to consider all systems of the model.

Multi-level influences that impact upon adolescents’ health have been conceptualized within the framework of ecological models. This ecological model used data from a large cross-national study to demonstrate the influence of social determinants of health situated at different system levels. The Health Behaviour in School-aged Children (HBSC) is a World Health Organization collaborative cross-national study conducted every 4 years in 52 countries and regions across Europe and North America (http://www.hbsc.org). HBSC data was examined on a selection of health and wellbeing indicators, health-related measures, and developmental context, collected in the 2018/2019 wave, using the international research protocol and questionnaire. The sample included 39,247 students from the Mediterranean countries (Greece, Israel, Italy, Malta, Portugal, and Spain). The mean age of the participants students was 13.6 years (SD 1.6), 52.1% were girls. Using an ecological framework, the determinants of adolescent well-being were examined from the individual to the national level. 31% of the variance in life satisfaction was explained by the following factors: being a boy, younger, higher family affluence, fewer psychological symptoms, frequent physical activity, daily fruit and vegetables consumption, not drinking alcoholic beverages, high family support, positive relations with teachers and school friends, and not having been bullied. When the analysis was stratified by country, findings were varied, though more similarities than differences were found. In order to improve the health of the adolescent population, there is a need for more sustainable multisectoral public policies to take into account developmental life challenges, aiming to reduce health inequalities.

OBJECTIVES:To review and evaluate available literature on spectral computed tomography (SCT) bone mineral density (BMD) measurement in adult thoracolumbar vertebrae of unenhanced images compared to quantitative computed tomography (QCT), to understand its current clinical utility. KEY FINDINGS:Keyword searches in four databases identified four cross-sectional studies which acquired an SCT BMD measurement in thoracolumbar vertebrae and compared this respectively to QCT, which were then critically appraised using the AXIS tool for cross-sectional studies. 862 vertebrae were measured between T10-S1 in 368 patients. Three studies demonstrated a statistically significant correlation between SCT and QCT for the measurement of Hydroxyapatite (HAP) and calcium (r = 0.86-0.96). One study demonstrated a diagnostic accuracy of 96% using a receiver operating curve. CONCLUSIONS:SCT measurements of HAP and calcium in the lumbar vertebrae are comparable to QCT for patients with no additional pathology present. However, further research is required to evaluate diagnostic accuracy before clinical application. IMPLICATIONS FOR PRACTICE:SCT BMD measurement has the potential to be developed as a screening tool for osteoporosis within the fracture liaison service (FLS). This could aid in the identification of patients with osteoporosis and address the current treatment gap. Nonetheless, many factors must be considered for this application including staff training, radiation protection and patient engagement with the screening programme.

The application of conceptual thinking which uses a bioecological framework to underpin the work of a new World Health Organisation Collaborating Centre in Sustainable Child and Adolescent Health and Wellbeing is the focus of this paper. The rationale on which the work of the centre is based is the recognition that improvements in child and adolescent health and wellbeing will be enhanced and accelerated where research and public health action is placed in a more explicit conceptual framework. The case made is for a coherent approach, foundational to collecting, organising and synthesising research evidence and effectively impacting policy and practice, in a systematic and interdisciplinary way. All the work conducted under the auspices of the new centre is informed and shaped by this thinking, enabling the creation of explicit linkages between projects and systematically building understanding of the complex set of health determinants operating through different mechanisms and at different system levels. This approach may be applied to other research centres seeking an integrated and consistent direction to their work and therefore the paper should resonate beyond the WHO Collaborating Centre.

Objectives: The fluoroscopy environment poses a potential occupational radiation exposure risk to theatre personnel. Risks can be mitigated with effective application of radiation protection knowledge and methods. This review aimed to determine the link between orthopaedic surgeon's knowledge and the use of appropriate safety methods when using fluoroscopy.Key Findings: A keyword search of three databases discovered six articles, totalling 2209 orthopaedic surgeons, who completed surveys to assess knowledge on various aspects of radiation safety and training. Participants had varying levels of experience. Moreover 1981 participants always wore a lead gown (89 %), while only 1052 participants wore thyroid protection (47 %). 449 participants (20 %) received some form of training.Conclusion: Although surveys asked a range of questions it appeared that there was low knowledge of the ALARP principles. Usage of protective equipment is a legal requirement and thus was observed throughout, however, there were a number of incidences of disregarding some protective measures. Although there appeared to be limited knowledge surrounding radiation protection measures and lack of training provided, no clear link was demonstrated between compliance with protective methods and knowledge of the risks. Implications for practice: Formal and continuous training should be provided for the enhancement of knowledge to ensure the safety of all staff and help prevent the long-term effects of ionising radiation when using fluoroscopy.(c) 2023 The Authors. Published by Elsevier Ltd on behalf of The College of Radiographers. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

BACKGROUND Adolescent mental health (AMH) needs in England have increased dramatically and needs exceed treatment availability. This study undertook a comparative assessment of the health and economic return on investment (ROI) of interventions to prevent and treat mental disorders among adolescents (10-19 years) and examined intervention affordability and readiness. METHODS Interventions were identified following a review of published and grey literature. A Markov model followed a simulated adolescent cohort to estimate implementation costs and health, education, and economic benefits. Intervention affordability was assessed, comparing annual cost per adolescent with NHS England per capita spending, and an expert panel assessed intervention readiness using a validated framework. RESULTS Over 10- and 80-year horizons, interventions to treat mild anxiety and mild depression were most cost-effective, with the highest individual lifetime ROI (GBP 5822 GBP 1 and GBP 257: GBP 1). Preventing anxiety and depression was most affordable and 'implementation ready' and offered the highest health and economic benefits. A priority package (anxiety and depression prevention; mild anxiety and mild depression treatment) would avert 5 million disability-adjusted life-years (DALYS) and achieve an ROI of GBP 15: GBP 1 over 10 years or 11.5 million DALYs (ROI of GBP 55: GBP 1) over 80 years. CONCLUSION The economic benefits from preventing and treating common adolescent mental disorders equivalent to 25% of NHS England's annual spending in 2021 over 10 years and 91% over 80 years. Preventing and early treatment for anxiety and depression had the highest ROIs and strong implementation readiness.

Citation: Cosma A, Martin G, Walsh SD, Chzhen Y and Currie C (2024) Editorial: Contemporary perspectives in adolescent mental health. Front. Psychol. 15:1376940. doi: 10.3389/fpsyg.2024.1376940

In the absence of suitable indicators of adolescent socioeconomic status, the Family Affluence Scale (FAS) was first developed in Scotland 25 years ago. Since then, it has been adapted for use in the Health Behaviour in School-Aged Children (HBSC) Study to research inequalities in adolescent health in Europe and North America. FAS has also been used as an indicator of adolescent socioeconomic status in research studies outside of HBSC, worldwide. There has been a need for FAS to evolve and change its component items over time in order to take into account social and technological changes influencing the families of adolescents. This paper uniquely charts the development of FAS describing the methodological work carried out to validate the measure internationally and over time. It also presents an overview of the body of evidence on adolescent health inequalities produced over years from the HBSC Study and other research studies. Interviews conducted with policy stakeholders reveal that the evidence from FAS-related HBSC work has influenced their strategic work to raise awareness of inequalities and make the case for action to address these. Finally, the future of FAS is discussed with respect to its continual evolution in the context of technological, environmental and social change.

In many high-income countries, the proportion of adolescents who smoke, drink, or engage in other risk be-haviours has declined markedly over the past 25 years. We illustrate this behavioural shift by collating and presenting previously published data (1990-2019) on smoking, alcohol use, cannabis use, early sexual initiation and juvenile crime in Australia, England, the Netherlands, New Zealand, and the USA, also providing European averages where comparable data are available. Then we explore empirical evidence for and against hypothesised causes of these declines. Specifically, we explore whether the declines across risk behaviours can be considered 1) a 'unitary trend' caused by common underlying drivers; 2) separate trends with behaviour-specific causes; or 3) the result of a 'cascade' effect, with declines in one risk behaviour causing declines in others. We find the unitary trend hypothesis has theoretical and empirical support, and there is international evidence that decreasing unstructured face-to-face time with friends is a common underlying driver. Additionally, evidence suggests that behaviour-specific factors have played a role in the decline of tobacco smoking (e.g. decreasing adolescent approval of smoking, increasing strength of tobacco control policies) and drinking (e.g. more restrictive parental rules and attitudes toward adolescent drinking, decreasing ease of access to alcohol). Finally, declining tobacco and alcohol use may have suppressed adolescent cannabis use (and perhaps other risk be-haviours), but evidence for such a cascade is equivocal. We conclude that the causal factors behind the great decline in adolescent risk behaviours are multiple. While broad contextual changes appear to have reduced the opportunities for risk behaviours in general, behaviour-specific factors have also played an important role in smoking and drinking declines, and 'knock-on' effect from these behavioural domains to others are possible. Many hypothesised explanations remain to be tested empirically.

Introduction: The diagnosis of renal cell carcinoma (RCC) is increasing due to incidental findings with more frequent use of cross-sectional imaging. Therefore improvements to diagnostic and follow up imaging techniques is necessary. MRI diffusion weighted imaging (DWI) is a recognised method of measuring the diffusion of water within lesions using the apparent diffusion coefficient (ADC), and may have a role in monitoring the efficacy of cryotherapy ablation of RCC. Methods: A retrospective cohort study of 50 patients was approved to investigate if the ADC value can determine the success of cryotherapy ablation treatment for RCC. DWI was performed at a single centre using 1.5 T MRI before and after cryotherapy ablation to the RCC. The control group was considered as the unaffected kidney. The ADC value of the RCC tumour and normal kidney tissue prior to and after cryotherapy ablation was measured, and compared to the result of the MRI. Results: A statistically significant change in the ADC values was observed, pre ablation (1.562 x 10mm2/ sec) to the post ablation (1.126 x 103mm2/sec), p < 0.0005. There was no statistical significance in any of the other outcomes measured. Conclusion: Although a change of ADC value occurred this is likely due to cryotherapy ablation causing coagulative necrosis at the site, and does not determine the success of the cryotherapy ablation. This can be considered a feasibility study for future research. Implications for practice: DWI is a quick addition to routine protocols, does not require intravenous gadolinium based contrast agent, and provides qualitative and quantitative data. Further research is required to establish the role of ADC for treatment monitoring. (c) 2023 The Author(s). Published by Elsevier Ltd on behalf of The College of Radiographers. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

The Family Affluence Scale (FAS) is a widely used and validated instrument to measure adolescents’ socioeconomic status (SES). It is plausible that the COVID-19 pandemic and resulting social and economic changes have affected the capacity of the six-item FAS-III to measure adolescent SES, particularly the holiday and computer items. Using data from 247,503 adolescents from 16 European countries participating in the Health Behaviour in School-aged Children (HBSC) study before (2013/14 and 2017/18) and during (2021/22) the pandemic, the present study aims to fill this gap. Findings showed that although the internal consistency of the scale decreased during the pandemic, related to the functioning of the computer and especially the holiday item, it was still acceptable in all countries. Furthermore, measurement invariance analysis showed that during the pandemic the item thresholds of the computer and particularly the holiday item deviated from the thresholds of these items before the pandemic. However, all item factor loadings were comparable to the factor loadings before the pandemic. In addition, during the pandemic the computer and holiday item and their correlations with health-related outcomes were mostly still in the expected direction. Removing these items from the scale yielded comparable or decreased scale criterion validity as compared to the original FAS-III scale in most countries. These findings inform future research that although mean differences in family affluence levels before and during the pandemic should be interpreted with caution, it is a suitable tool to study (changes in) socioeconomic health inequalities among adolescents during the pandemic.

Adolescents’ interactions with animals are of increasing interest and their beneficial developmental outcomes are well known. However, negative interactions such as perpetrating cruelty toward animals during childhood and adolescence have been related with child abuse, domestic violence, and later interpersonal violence. Cruelty toward animals by adolescents has been reported predominately in criminal and clinical samples, and links have been made between animal cruelty and interpersonal violence. However, studies often lack a clear definition of animal cruelty and the animal involved. The present study addresses methodological shortcomings by providing a clear definition of the cruelty acts and the animals involved and the time frame within which cruelty acts have been taken place. Therefore, we investigated the prevalence of animal cruelty of 979 British adolescents (419 male, 497 female, Mage = 15.1 ± 1.57 years) by means of a survey questionnaire administered in school. Animal cruelty was investigated encompassing deliberate and nondeliberate cruelty acts, a clear definition of the target animals was included and a time frame was provided. Furthermore, acceptability of animal cruelty, engaging in antisocial behavior, and family affluence were investigated. Results show high reliabilities for the measures applied. Exploratory factor analysis reveals different types of animal cruelty. Gender differences were observed for deliberate and accidental cruelty acts, with boys reporting higher levels than girls. Younger adolescents reported higher accidental cruelty acts than older ones. Acceptance of animal cruelty played a significant role in predicting animal cruelty, together with antisocial behaviors and place of living. The present study shows for the first time the importance of distinguishing between different types of animal cruelty and defining the animals involved.

INTRODUCTION:Artificial intelligence (AI) has started to be increasingly adopted in medical imaging and radiotherapy clinical practice, however research, education and partnerships have not really caught up yet to facilitate a safe and effective transition. The aim of the document is to provide baseline guidance for radiographers working in the field of AI in education, research, clinical practice and stakeholder partnerships. The guideline is intended for use by the multi-professional clinical imaging and radiotherapy teams, including all staff, volunteers, students and learners. METHODS:The format mirrored similar publications from other SCoR working groups in the past. The recommendations have been subject to a rapid period of peer, professional and patient assessment and review. Feedback was sought from a range of SoR members and advisory groups, as well as from the SoR director of professional policy, as well as from external experts. Amendments were then made in line with feedback received and a final consensus was reached. RESULTS:AI is an innovative tool radiographers will need to engage with to ensure a safe and efficient clinical service in imaging and radiotherapy. Educational provisions will need to be proportionately adjusted by Higher Education Institutions (HEIs) to offer the necessary knowledge, skills and competences for diagnostic and therapeutic radiographers, to enable them to navigate a future where AI will be central to patient diagnosis and treatment pathways. Radiography-led research in AI should address key clinical challenges and enable radiographers co-design, implement and validate AI solutions. Partnerships are key in ensuring the contribution of radiographers is integrated into healthcare AI ecosystems for the benefit of the patients and service users. CONCLUSION:Radiography is starting to work towards a future with AI-enabled healthcare. This guidance offers some recommendations for different areas of radiography practice. There is a need to update our educational curricula, rethink our research priorities, forge new strong clinical-academic-industry partnerships to optimise clinical practice. Specific recommendations in relation to clinical practice, education, research and the forging of partnerships with key stakeholders are discussed, with potential impact on policy and practice in all these domains. These recommendations aim to serve as baseline guidance for UK radiographers. IMPLICATIONS FOR PRACTICE:This review offers the most up-to-date recommendations for clinical practitioners, researchers, academics and service users of clinical imaging and therapeutic radiography services. Radiography practice, education and research must gradually adjust to AI-enabled healthcare systems to ensure gains of AI technologies are maximised and challenges and risks are minimised. This guidance will need to be updated regularly given the fast-changing pace of AI development and innovation.

Previous research is inconclusive as to whether having an immigration background acts as a risk factor for poor mental health in adolescents, and furthermore, what contribution the social context in which adolescents grow up may make. To address these questions, the current study uses an integrative resilience framework to investigate the association between immigration background and adolescent mental health, and the moderating role of social capital at the individual, the school, and the national level. The study uses data gathered from nationally representative samples of adolescents aged 11, 13, and 15 years ( N girls = 63,425 (52.1%); M age = 13.57, SD = 1.64) from 29 countries participating in the 2017/18 Health Behaviour in School-aged Children (HBSC) study. Data analysis reveals that first- and second-generation immigrants reported higher levels of life dissatisfaction and psychosomatic symptoms than their native peers, and that this association varied across schools and countries. In addition, social capital was found to moderate the association between immigration background and adolescent mental health. Individual-level social support from peers and family and national-level trust protected against poor mental health in adolescents with an immigration background, while the opposite was true for individual-level teacher support. Supportive teacher-student relationships were found to provide more protection against poor mental health for native adolescents than for immigrant adolescents. Our findings indicate the importance of taking an ecological approach to design interventions to reduce the negative effects of having an immigration background on adolescent mental health.

Purpose: Adolescents with higher socioeconomic status (SES) report better mental health. The strength of the association-the "social gradient in adolescent mental health"-varies across countries, with stronger associations in countries with greater income inequality. Country-level meritocratic beliefs (beliefs that people get what they deserve) may also strengthen the social gradient in adolescent mental health; higher SES may be more strongly linked to adolescent's perceptions of capability and respectful treatment. Methods: Using data from 11-15 year olds across 30 European countries participating in the 2013/ 2014 Health Behaviour in School-aged Children study (n = 131,101), multilevel regression models with cross-level interactions examined whether country-level meritocratic beliefs moderated the association between two individual-level indicators of SES, family affluence and perceived family wealth, and three indicators of adolescent mental health (life satisfaction, psychosomatic complaints, and aggressive behavior). Results: For family affluence, in some countries, there was a social gradient in adolescent mental health, but in others the social gradient was absent or reversed. For perceived family wealth, there was a social gradient in adolescent life satisfaction and psychosomatic complaints in all countries. Country-level meritocratic beliefs moderated associations between SES and both life satisfaction and psychosomatic complaints: in countries with stronger meritocratic beliefs associations with family affluence strengthened, while associations with perceived family wealth weakened. Conclusions: Country-level meritocratic beliefs moderate the associations between SES and adolescent mental health, with contrasting results for two different SES measures. Further understanding of the mechanisms connecting meritocratic beliefs, SES, and adolescent mental health is warranted. (C) 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc.

Purpose: Although previous research has established a positive association between national income inequality and socioeconomic inequalities in adolescent health, very little is known about the extent to which national-level wealth inequalities (i.e., accumulated financial resources) are associated with these inequalities in health. Therefore, this study examined the association between national wealth inequality and income inequality and socioeconomic inequality in adolescents' mental well-being at the aggregated level. Methods: Data were from 17 countries participating in three consecutive waves (2010, 2014, and 2018) of the cross-sectional Health Behaviour in School-aged Children study. We aggregated data on adolescents' life satisfaction, psychological and somatic symptoms, and socioeconomic status (SES) to produce a country-level slope index of inequality and combined it with country-level data on income inequality and wealth inequality (n = 244,771). Time series analyses were performed on a pooled sample of 48 country-year groups. Results: Higher levels of national wealth inequality were associated with fewer average psychological and somatic symptoms, while higher levels of national income inequality were associated with more psychological and somatic symptoms. No associations between either national wealth inequality or income inequality and life satisfaction were found. Smaller differences in somatic symptoms between higher and lower SES groups were found in countries with higher levels of national wealth inequality. In contrast, larger differences in psychological symptoms and life satisfaction (but not somatic symptoms) between higher and lower SES groups were found in countries with higher levels of national income inequality. Conclusions: Although both national wealth and income inequality are associated with socioeconomic inequalities in adolescent mental well-being at the aggregated level, associations are in opposite directions. Social policies aimed at a redistribution of income resources at the national level could decrease socioeconomic inequalities in adolescent mental well-being while further research is warranted to gain a better understanding of the role of national wealth inequality in socioeconomic inequalities in adolescent health. (C) 2020 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine.

PurposeIntersectionality theory highlights the importance of the interplay of multiple social group memberships in shaping individual mental well-being. This article investigates elements of adolescent mental well-being (life dissatisfaction and psychosomatic complaints) from an intersectional perspective. It tests mental well-being consequences of membership in combinations of multiple social groups and examines to what extent such intersectional effects depend on the national context (immigration and integration policies, national-level income, and gender equality).MethodsUsing Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy, we assessed the role of the national context in shaping the interplay between immigration background, socioeconomic status, and gender, using data from 33 countries from the 2017/2018 Health Behaviour in School-aged Children survey.ResultsWe found no uniform intersectionality effects across all countries. However, when allowing the interplay to vary by national context, results did point toward some intersectional effects. Some aggravated negative effects were found for members of multiple disadvantaged social groups in countries with low levels of income equality and restrictive migration policies, whereas enhanced positive effects were found for members of multiple advantaged groups in these countries. Similarly, mitigated negative effects of membership in multiple disadvantaged groups were shown in countries with higher levels of income equality and more inclusive migration policies, whereas mitigated positive effects were found for multiply advantaged individuals. Although for national-level gender equality results pointed in a similar direction, girls' scores were counterintuitive. High national-level gender equality disproportionately benefitted groups of disadvantaged boys, whereas advantaged girls were doing worse than expected, and reversed effects were found for countries with low gender equality.ConclusionsTo fully understand social inequalities in adolescent mental well-being, the interplay between individual-level and national-level indicators must be explored.

This paper extracts, organises and summarises findings on adolescent mental health from a major international population study of young people using a scoping review methodology and applying a bio-ecological framework. Population data has been collected from more than 1.5 million adolescents over 37 years by the Health Behaviour in School-Aged Children: WHO Cross-National (HBSC) Study. The paper reviews the contribution that this long standing study has made to our understanding of the individual, developmental, social, economic, cultural determinants of adolescent mental health by organising the findings of 104 empirical papers that met inclusion criteria, into individual, microsystem, mesosystem and macrosystem levels of the framework. Of these selected papers, 68 were based on national data and the other 36 were based on international data, from varying numbers of countries. Each paper was allocated to a system level in the bio-ecological framework according to the level of its primary focus. The majority (51 papers) investigate individual level determinants. A further 28 concentrate primarily on the microsystem level, 6 on the mesosystem level, and 29 on the macrosystem level. The paper identifies where there is evidence on the determinants of mental health, summarises what we have learned, and highlights research gaps. Implications for the future development of this population health study are discussed in terms of how it may continue to illuminate our understanding of adolescent mental health in a changing world and where new directions are required.

Positive sexual and reproductive health (SRH) in adolescence is fundamental to a good quality of life. SRH is critical to general health and wellbeing of adolescents and is likely to contribute not only to the health and well-being of individuals, but also of families, communities and nations. It is also vital to consider the wider social, cultural, economic and political contexts within which adolescents live their lives and experience their SRH in order to understand the risks for poor SRH and what policies, practices and services can be put in place to optimise SRH. There is still an incomplete understanding of the complexity of factors that impinge on adolescent SRH and how these interact to shape outcomes in various contexts and environments within which adolescents are living. This paper applies a bio-ecological systems framework for organising existing evidence on determinants operating at different levels, from individual up to macro-level factors, and demonstrates that this approach also helps to identify gaps in knowledge. Furthermore, it is argued that such framing can inform the design of interventions, programmes and policy to improve and protect adolescent SRH.