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Rapid demographic, epidemiological, and nutritional transitons have brought a pressing need to track progress in adolescent health. Here, we present country-level estimates of 12 headline indicators from the Lancet Commission on adolescent health and wellbeing, from 1990 to 2016. Indicators included those of health outcomes (disability-adjusted life-years [DALYs] due to communicable, maternal, and nutritional diseases; injuries; and non-communicable diseases); health risks (tobacco smoking, binge drinking, overweight, and anaemia); and social determinants of health (adolescent fertility; completion of secondary education; not in education, employment, or training [NEET]; child marriage; and demand for contraception satisfied with modern methods). We drew data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, International Labour Organisation, household surveys, and the Barro-Lee education dataset. From 1990 to 2016, remarkable shifts in adolescent health occurred. A decrease in disease burden in many countries has been offset by population growth in countries with the poorest adolescent health profiles. Compared with 1990, an additional 250 million adolescents were living in multi-burden countries in 2016, where they face a heavy and complex burden of disease. The rapidity of nutritional transition is evident from the 324·1 million (18%) of 1·8 billion adolescents globally who were overweight or obese in 2016, an increase of 176·9 million compared with 1990, and the 430·7 million (24%) who had anaemia in 2016, an increase of 74·2 million compared with 1990. Child marriage remains common, with an estimated 66 million women aged 20–24 years married before age 18 years. Although gender-parity in secondary school completion exists globally, prevalence of NEET remains high for young women in multi-burden countries, suggesting few opportunities to enter the workforce in these settings. Although disease burden has fallen in many settings, demographic shifts have heightened global inequalities. Global disease burden has changed little since 1990 and the prevalence of many adolescent health risks have increased. Health, education, and legal systems have not kept pace with shifting adolescent needs and demographic changes. Gender inequity remains a powerful driver of poor adolescent health in many countries. Australian National Health and Medical Research Council, and the Bill & Melinda Gates Foundation.

Functional impairments (adaptive, behavioral, educational) are common after preschool traumatic brain injury (TBI). In comparison with cognitive outcome, functional outcomes have received limited attention, with little evidence to determine whether these difficulties persist in the long term. The aim of this study was to examine functional outcomes at 10 years post-injury and identify predictors of outcome. The study compared children with a diagnosis of TBI (n=40) to a healthy age-, gender-, and socioeconomic status (SES)-matched control group (n=19) at 10 years post-injury. Outcomes and predictors of functional skills were investigated. Poorer adaptive skills were evident for those with more severe injury. Behavioral difficulties were present regardless of injury severity. Post-injury, arithmetic skills were the most compromised in the longer term. Pre-injury status, interventions accessed, and acute intellectual function were significant predictors of outcome. These results highlight the importance of monitoring functional skills in the long term, especially for those children presenting with risk factors.

Children with traumatic brain injury (TBI) are at risk for social impairment, but research has yet to document the trajectory of these skills post-injury and factors that may predict social problems. This study addressed these gaps in knowledge, reporting on findings from a prospective, longitudinal follow-up study that investigated social outcomes post-injury and explored factors contributing to these outcomes at two years post-injury. The sample included 113 children, 74 with TBI and 39 typically developing (TD) controls. TBI participants were recruited on presentation to the hospital. Parents rated pre-injury function at that time, and all children underwent magnetic resonance imaging (MRI). Participants were followed up at two years post-injury. Outcomes were social adjustment, social participation, social relationships, and social cognition. Predictors of social outcomes examined included brain lesion characteristics, child cognition (6 months post-TBI), and behavior and environmental factors (pre-injury and two years). Reduced social adjustment (p = 0.011) and social participation (p < 0.001) were evident in children with TBI compared with TD controls. Poor social adjustment was predicted by externalizing behavior problems and younger age at injury. Reduced social participation was linked to internalizing behavior problems. Greater lesion volume, lower socioeconomic status, and family burden contributed to poorer social relationships, whereas age at injury predicted social cognition. Within the TBI group, 23% of children exhibited social impairments. Younger age at injury, greater pre-injury, and current behavior problems and family dysfunction, and poorer intelligence quotient (IQ), processing speed, and empathy were linked to impairment. Further follow-up is required to track social recovery and the influences of cognition, brain, and environment over time.

Psychosocial deficits, such as emotional, behavioral and social problems, reflect the most common and disabling consequences of pediatric traumatic brain injury (TBI). Their causes and recovery likely differ from physical and cognitive skills, due to disruption to developing brain networks and the influence of the child's environment. Despite increasing recognition of post-injury behavioral and social problems, there exists a paucity of research regarding the incidence of social impairment, and factors predicting risk and resilience in the social domain over time since injury. Using a prospective, longitudinal design, and a bio-psychosocial framework, we studied children with TBI ( = 107) at baseline (pre-injury function), 6 months, 1 and 2-years post-injury. We assessed intellectual ability, attention/executive function, social cognition, social communication and socio-emotional function. Children underwent structural magnetic resonance imaging (MRI) at 2-8 weeks post-injury. Parents rated their child's socio-emotional function and their own mental health, family function and perceived burden. We distinguished five social recovery profiles, characterized by a complex interplay between environment and pre- and post-TBI factors, with injury factors playing a lesser role. Resilience in social competence was linked to intact family and parent function, intact pre-injury adaptive abilities, post-TBI cognition and social participation. Vulnerability in the social domain was related to poor pre- and post-injury adaptive abilities, greater behavioral concerns, and poorer pre- and post-injury parent health and family function. We identified five distinct social recovery trajectories post-child-TBI, each characterized by a unique biopsychosocial profile, highlighting the importance of comprehensive social assessment and understanding of factors contributing to social impairment, to target resources and interventions to children at highest risk.

To determine whether spotters with medical training and experience in managing concussion have higher inter-rater reliability and accuracy than non-medical personnel when identifying video signs associated with concussion in Australian football. Retrospective cohort study. Video clips were collected of all impacts potentially resulting in concussion during 2012 and 2013 Australian Football League (AFL) seasons. Raters were divided into medical doctors and a non-medical group comprising allied health practitioners (physiotherapists) and non-medical/non-allied health personnel (performance analysts). Raters assessed 102 randomly selected videos for signs of concussion. The inter-rater reliability was calculated. Sensitivity, specificity, positive and negative predictive values were calculated by comparing the rater responses to the consensus opinion from two highly experienced clinicians with expertise in concussion. No statistically significant difference in inter-rater reliability was observed between the medical doctors and the non-medical group. Both groups demonstrated good to excellent agreement for slow to get up, clutching at head/face and facial injury. Both groups displayed intra-class coefficient >0.55 for no protective action-floppy, loss of responsiveness, and motor incoordination, and displayed lowest agreement for no protective action-tonic posturing, impact seizure and blank/vacant look. No statistically significant difference was found between the groups for sensitivity, specificity, positive and negative predictive values for correctly classifying video signs compared to the expert consensus opinion. After completing sufficient standardised training and testing, medical and non-medical personnel demonstrate comparable reliability in identifying video signs of concussion in professional Australian football and may be suitable for the role of video spotter.

To investigate the incidence and the game circumstances of concussion in the professional female (AFLW) and male (AFL) competitions of Australian Football, to identify potential targets for risk reduction. Retrospective cohort. Concussion data were obtained from the AFL injury database, which included all concussions sustained by AFL (Male) players from 2015 to 18 and AFLW (Female) players from 2017 to 19. Concussions were diagnosed by experienced clinicians utilising standardised concussion assessment tools and injury definitions, as well as video review. Video footage was analysed to determine the circumstances each concussion occurred, which included the action and the contact-point of impact. The incidence of concussion was higher in the AFLW (Female) compared to the AFL (Male) (IRR = 2.12, 95 %CI 1.54 to 2.92). Video footage was available for 194/252 (77 %) concussions in the AFL and 35/44 (80 %) concussions in the AFLW. Male players were most frequently concussed during marking contests (28 %) with primary impact from the upper limb (22 %) or the shoulder (19 %). Conversely, being bumped (23 %) or tackled (20 %) were the main actions associated with concussion in female players, with the head (29 %) or the ground (23 %) the most common contact-points of impact. In elite Australian Football a higher incidence of concussion was demonstrated in female compared to male players. The mechanisms associated with concussion were also found to differ between male and female competitions, suggesting that different injury prevention interventions may be beneficial. In particular, a review of tackling and bumping skills training and education in the AFLW may reduce the risk of concussion.

Abstract BACKGROUND Persistent postconcussive symptoms (PCS) are poorly understood in children. Research has been limited by an assumption that children with concussion are a homogenous group. OBJECTIVE To identify (i) distinctive postconcussive recovery trajectories in children and (ii) injury-related and psychosocial factors associated with these trajectories. METHODS This study is part of a larger prospective, longitudinal study. Parents of 169 children (5-18 yr) reported their child's PCS over 3 mo following concussion. PCS above baseline levels formed the primary outcome. Injury-related, demographic, and preinjury information, and child and parent mental health were assessed for association with trajectory groups. Data were analyzed using group-based trajectory modeling, multinomial logistic regression, and chi-squared tests. RESULTS We identified 5 postconcussive recovery trajectories from acute to 3 mo postinjury. (1) Low Acute Recovered (26.6%): consistently low PCS; (2) Slow to Recover (13.6%): elevated symptoms gradually reducing; (3) High Acute Recovered (29.6%): initially elevated symptoms reducing quickly to baseline; (4) Moderate Persistent (18.3%): consistent, moderate levels of PCS; (5) Severe Persistent (11.8%): persisting high PCS. Higher levels of child internalizing behaviors and greater parental distress were associated with membership to the Severe Persistent group, relative to the Low Acute Recovered group. CONCLUSION This study indicates variability in postconcussive recovery according to 5 differential trajectories, with groups distinguished by the number of reported symptoms, levels of child internalizing behavior problems, and parental psychological distress. Identification of differential recovery trajectories may allow for targeted early intervention for children at risk of poorer outcomes. Graphical Abstract Graphical Abstract

Background Diagnosis of life threatening childhood illness or injury can lead to significant distress reactions in parents, with many experiencing clinically significant levels of post-traumatic stress symptoms. These symptoms can have long-term adverse impacts on parent mental health, family functioning, and the adjustment of the ill child. Independent studies have found such reactions in several different illness groups. However, very little research has systematically compared the prevalence, impact and trajectories over time of post-traumatic stress symptoms in parents across different childhood illness groups with an acute life threat. The current study seeks to map the course of post-traumatic stress reactions in parents of children with various life threatening illnesses over an 18 month period, and identify factors that predict successful adaptation in families. Method/Design The current study described is of a prospective, longitudinal design. The sample included parents of children admitted to four major hospital departments at the Royal Children’s Hospital, Melbourne, Australia, for a life threatening illness or injury. Eligible parents were those who were caregivers of children aged 0-to 18-years admitted to the Oncology, Cardiology, Neurology and Pediatric Intensive Care Unit. Parents were recruited acutely, and completed self-report questionnaires at four time-points: within the first 4 weeks (T1:); then at 4 months (T2); 7 months (T3); and 19 months (T4) after admission. Questionnaires assessed parent and child mental health and wellbeing, and a number of risk and reliance factors such child illness factors, parent demographic factors, and psychosocial factors. Discussion This study is one of the first to document the trajectory of post-traumatic stress responses in parents of very ill children, across illness groups. Given that it will also identify risk and resilience factors, and map the course of parent outcomes over an 18 monthperiod, it has the potential to inform novel strategies for intervention.

Pediatric concussion is a major public health concern. Despite the prevalence of behavior problems following concussion and their potential role in prolonged symptoms, little is known about how child and adolescent behavior may impact post-concussion recovery. We sought to examine change in behavioral and emotional functioning in a sample of children ages 5 to <18 years with concussion. This study reports on data collected as part of a larger single-site prospective longitudinal cohort study. Participants were recruited from the Emergency Department (ED) of a tertiary children's hospital and completed the Child Behavior Checklist (CBCL) at 2 weeks (acute; T2) and 3 months (post-acute; T4) post-injury. Children with concussion (n = 231) showed a significant reduction in internalizing (p < 0.001, d = 0.27), externalizing (p < 0.001, d = 0.23), and total behavior problems (p < 0.001, d = 0.36) at 3 months compared with 2 weeks post-injury. Multiple regression models found a significant interaction between age and sex with higher rates of internalizing (p = 0.048, ηp 2 = 0.02) and total (p = 0.040, ηp 2 = 0.02) behavior problems as age increased in females. The results show that pediatric concussion is associated with temporary behavioral disturbances that are likely to improve considerably in the months following injury. Nonetheless, as age increases, females may be at increased risk for experiencing ongoing internalizing problems several months after concussion and may require targeted clinical intervention.

Children with traumatic brain injury (TBI) are at risk for social impairment. This study aimed to examine social function at 6 months post-TBI and to explore the contribution of injury, cognitive, and environmental influences. The sample included 136 children, 93 survivors of TBI, and 43 healthy controls. TBI participants were recruited on admission and underwent magnetic resonance imaging scan within 8 weeks of injury and behavioral assessment at 6 months post-injury. Healthy controls underwent magnetic resonance imaging scans and behavioral assessment on recruitment. Assessment included parent and child questionnaires tapping social outcome and child-direct testing of cognitive abilities important for social competence (communication, attention/executive function, social cognition). Injury characteristics and environmental measures were collected. At 6-months post-injury, social problems were evident, but not global. Social participation appeared most vulnerable, with more severe injuries leading to greater problems. Greater injury severity and poorer communication skills were associated with poorer social adjustment and social participation, with the impact of family function also significant. Processing speed, younger age, and male gender also contributed to social outcomes. Further follow-up is required to track the recovery of social skills and the changing influences of cognition, brain, and environment over time. (JINS, 2013, 19, 1–12)