The use of loot boxes has been compared to gambling due to its random nature, with the consequent risk of being conceived as an ordinary activity implemented in the daily routine. One of the factors contributing to these gambling behaviors is exposure to gambling advertisements. It is essential to protect children and adolescents from prejudicial advertising, since due to their psycho-evolutionary development, advertising makes them impressionable and suggestible. Currently, there is scarcely any research on the influence of advertising on underage buyers of loot boxes. Knowledge in this regard is important to adequately address efforts to protect minors from the potential impact of gambling and its advertising. Thus, this study aims to examine how understanding advertising intent in loot box advertising moderates the relationship between the recognition of loot box advertising and the problematic usage of loot boxes in a sample of adolescents. The present study used a cross-sectional design, and the sample is composed by 451 adolescents (85.8 % male) that played videogames and purchased loot boxes in the last 12 months. Results indicated that understanding advertising intent played a moderating role in the relationship between advertising recognition and Problematic Use of Loot Boxes, strengthening it positively. The findings showed that when there was a low degree of understanding advertising intent, the former relationship was not significant. However, with a high level of understanding advertising intent the relationship between advertising recognition and Problematic Use of Loot Boxes was significant and strengthened. This means that knowing how ads try persuading the player affects how adverts are linked to PULB. Specifically, if adolescents understand that ads are trying to sell them loot boxes, this knowledge makes the relationship between seeing ads and having PULB stronger. These results are of interest for advertising literacy strategies.

BACKGROUND: Hangzhou Public Places Smoking Control Regulations (2019) have been gradually adopted, which explicitly stipulate that smoking is strictly prohibited in the outdoor areas of educational and healthcare institutions for minors. However, there are few studies reporting the exposure to secondhand smoke (SHS) in outdoor public places for minors in the urban area of Hangzhou City.
METHODS: We aimed to assess the exposure to SHS in public spaces frequented by minors using on-site observations and questionnaires. In this cross-sectional study, the area was divided into core and non-core areas based on the spatial distribution and development process of the city. The core areas included the West Lake commercial district, extending to the Qiantang River, while non-core areas were located beyond this radius. Using stratified random sampling, 30 public places in each area were selected as observation sites. On-site observations measured SHS exposure and smoking control, and questionnaires were administered to 6 individuals at each site. The results were compared between the two investigation methods.
RESULTS: Among the 57 valid observation points, 24.6% (14/57) did not display any no-smoking signs. Outdoor SHS exposure rate from on-site observation P1 (observing someone smoking or smelling tobacco smoke), on-site observation P2 (observing someone smoking or smelling tobacco smoke or seeing cigarette butts) and questionnaire survey P3, were 59.6% (95% CI: 45.7-72.2), 91.1% (95% CI: 79.7-96.7) and 41.0% (95% CI: 35.5-46.7), respectively.
CONCLUSIONS: The outdoor SHS exposure in areas frequented by minors in the urban district of Hangzhou City remains high, coupled with a lack of awareness of SHS risks among underage individuals. Therefore, controlling outdoor SHS exposure in these key areas is a critical public health issue in Hangzhou, requiring further tobacco control efforts. On-site observation is an important and supplementary research method to investigate outdoor SHS exposure, especially to describe the SHS exposure of focus areas.

BACKGROUND: Increases in migration patterns in the recent years have led to a continuously growing number of unaccompanied foreign minors (UFMs) entering Italy. As part of processing and integration, age assessment is performed by pediatricians upon request of regulatory bodies. Updated guidelines for age estimation procedures were published in 2020 in order to prioritize the well-being of the minors and the accuracy of the assessment. Nonetheless, literature suggests that the recently established multidisciplinary approach has not yet been widely adopted by physicians.
METHODS: A cross-sectional exploratory survey was distributed to pediatricians in Italy in order to gauge their range of experience with UFMs and age assessment protocols.
RESULTS: In total 344 pediatricians participated in the survey, originating from varied regions in Italy. Out of pediatricians who reported conducting age assessment procedures (38.9%), only a small fraction (14.2%) confirmed being knowledgeable about the methodology. Instead, a significant portion (28.8% and 56.4%) either had partial awareness or lacked knowledge of these procedures. These responses significantly differed when comparing hospital and outpatient pediatricians or according to their geographical area of work (p <0.05).
CONCLUSIONS: Survey responses suggest that a gap in awareness and experience regarding a multidisciplinary approach to age estimations still exists, likely in part due to a lack of resources, especially at the regional level. In the future, efforts towards the education of professionals and mobilization of resources for investment in the field will be crucial for the improvement of work with UFMs and other migrant populations.

BACKGROUND: Psychiatric emergency assessment of minors can be a complex process, especially for professional staff who are not specifically trained in handling child and adolescent emergency patients. As minors cannot usually express their feelings and experiences as well as adults, it is difficult to form an accurate picture of their condition and to determine what kind of emergency care is needed, for instance whether or not a psychiatric emergency admission is necessary. We lack insight in what professionals at emergency departments need to adequately assess these minors and their families. The aim of this study was to explore staff members\' experiences with assessing minors and explore recommendations for improving their ability to provide appropriate support.
METHODS: Guided by a topic list with open-ended questions, we conducted 11 semi-structured interviews with staff working at psychiatric emergency services. Thematic analysis enabled us to identify five main themes: (1) young age and the crucial role of parents; (2) professionals\' feelings, especially uncertainty; (3) psychiatric emergency admissions and the alternatives to them; (4) regional differences in organization and tasks; and (5) options for improving care.
RESULTS: The staff interviewed all agreed that it was often complicated and time consuming to take full responsibility when assessing minors with serious and urgent psychiatric problems. Most found it difficult to determine which behaviors were and were not age-appropriate, and how to handle systemic problems during the assessment. When assessing minors and their families in crisis, this led to uncertainty. Professionals were especially insecure when assessing children under age 12 and their families, feeling they lacked the appropriate knowledge and routine.
CONCLUSIONS: Customized expertise development and improved regional embedding of the psychiatric emergency service in the child and adolescent services will reduce professionals\' uncertainty and improve psychiatric emergency care for minors.

To fully respond to the provisions of the Judicial Authority relating to the care of minors and/or young adults subjected to judicial measures and affected by mental suffering and/or substance abuse, also with a view to a possible provision of placement in a therapeutic community, the UOSD \"Protection of the Health of Adults and Minors in the Penal Area\" - ASL Salerno has ensured operations through the establishment of a dedicated multidisciplinary team, made up of a psychiatrist, psychologist and social worker, as required by DGRC 567/2018, or as the only interface with the Judicial Authority in reference to healthcare. This article aims to describe the birth of the EMM (Equipe Multidisciplinare Minori), and of the methods used to take care of minors and/or young adult offenders affected by mental suffering and/or substance abuse. The article examines a sample of 207 minors, relating to the years 2018-2022, to highlight the most critical areas.

To understand the potential exposure to tobacco smoke in Washoe County (Reno/Sparks), Nevada casinos by measuring air quality in smoking areas relative to non-smoking/non-gaming areas in which minors may be present. To act as a pilot study in community-based health research and policy campaigns by evaluating low-cost air monitors to measure personal secondhand smoke (SHS) exposure. We used customized mobile apps, AtmoTube PRO Air Monitors, and hand clickers to measure the timing and minute-by-minute levels of PM2.5 (a tobacco smoke marker). The app was used to record the number of smokers, minors, and total patrons associated with ~10-minute sequential time periods in standardized casino locations, including outdoor areas, slots, tables, restaurants, bars/lounges, arcades, among others. Between April and May 2022, we successfully visited 14 casinos and 18 distinct types of indoor casino locations. We found high PM2.5 peaks in casino locations even with zero, or a low percentage of, observed active smokers, including in both gaming/non-gaming areas. Indoor areas, regardless of smoking/non-smoking areas, consistently had higher PM2.5 levels than outdoor background levels. Indoor locations had median PM2.5 levels up to 18 times higher than the lowest outdoor background levels. Minors were present throughout all casino locations, and thus were likely exposed to elevated PM2.5 levels. Potential PM2.5 exposures due to smoking can be high regardless of ventilation systems. Small proportions of smokers in a location can lead to high levels of exposure. Establishing comprehensive smoke-free casinos is the only way to protect against SHS harms.

OBJECTIVE: This study aims to analyze the clinical epidemiology, diagnostic and treatment characteristics of minor patients with maxillofacial fracture and provide a reference for the prevention and treatment.
METHODS: The clinical data of minor patients with maxillofacial fracture in Departmentof Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, from January 1, 2015 to December 31, 2020 were retrospectively studied and statistically analyzed in terms of age, gender, etiology, anatomic sites and treatment modalities.
RESULTS: The mean age of the patients was (10.65±5.15) years, and the male-to-female ratio was 1.91∶1. High fall was the primary cause of maxillofacial fractures in minors aged 0-6 years. Traffic accident injuries were the main cause of maxillofacial fractures in minors aged 7-12 and 13-17 years. About 65.13% of the midface and 83.08% non-condylar fractures were mainly treated by surgery, and condylar fractures were treated conservatively in 74.73% and by surgical treatment in 25.27%.
CONCLUSIONS: The etiology of maxillofacial fractures in minors differs at different ages, so prevention strategies should be adjusted according to age. Surgical treatment has become the preferred treatment modality for midface and non-condylar fractures. Conservative treatment is still the main treatment method for condylar fractures, but the proportion of surgical treatment increases.
目的: 分析近年来未成年人颌面部骨折的临床流行病学和诊治特点，为其防治提供参考依据。方法: 回顾性研究2015年1月1日—2020年12月31日四川大学华西口腔医院创伤整形外科的未成年颌面部骨折患者的临床资料，统计分析其年龄、性别、致病因素、骨折部位、治疗方式和效果。结果: 患者平均年龄为（10.65±5.15）岁，男女比为1.91∶1。高坠伤是0~6岁患者的首要致伤原因，对7~12岁和13~17岁患者，交通事故伤则成为首要致伤原因。面中部骨折和面下部非髁突骨折手术治疗占比为65.13%和83.08%，髁突骨折保守治疗占比74.73%，手术治疗占比25.27%。结论: 不同年龄阶段的未成年人颌面部骨折致伤原因存在差异，因此需要根据未成年人所处的年龄阶段调整其预防策略。手术治疗是面中部骨折和面下部非髁突骨折的主要治疗方式，髁突骨折仍以保守治疗为主要治疗方式，但手术治疗占比呈增长趋势。.

Video slot machines (VSM) are considered a particularly harmful gambling format; however, scant data is available on their use among underage Italian individuals. Two surveys were conducted in 2018 and 2022 involving 7,959 underage high school students (57.8% female) in Pavia, Northern Italy. We estimated adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI) for lifetime experience and current regular (at least monthly) use of VSM, according to family, educational and behavioral factors. Overall, participants reporting lifetime VSM experience were 13.2% (95% CI: 12.5 - 13.9), 15.2% (95% CI: 14.0-16.4%) in 2018, and 12.0% (95% CI: 11.1-13.0%) in 2022. Current regular VSM users were 1.4% (95% CI: 1.1-1.7) in total, 1.2% (95% CI: 0.8-1.6%) in 2018 and 1.5% (95% CI: 1.1-1.8%) in 2022. VSM lifetime experience and current regular use were significantly more frequent in males (aORs: 1.55 and 4.81, respectively), students who failed a year (aORs: 2.07 and 3.44), or with daily gambling parents/siblings (aORs: 2.83 and 4.86). Lifetime use of alcohol, tobacco, or illicit substances was significantly directly associated with lifetime VSM use (aORs between 2.64 and 4.75); monthly alcohol, tobacco, or illicit substances use was significantly directly associated with current regular VSM use (aORs between 4.47 and 18.21). Sexting and voluntary self-injury were significantly more frequent among VSM lifetime/current regular users. VSM use, which is directly associated with other risky behaviors, may be pervasive among Italian minors. Such public health concern calls for legislative enforcements and integrated multidisciplinary health promotion and prevention strategies.

OBJECTIVE: The Emergency Medical Treatment and Labor Act (EMTALA) is intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (EDs). EMTALA requirements pertain to patients of all ages presenting to dedicated EDs regardless of whether facilities have dedicated pediatric specialty services. This study aims to describe EMTALA-related civil monetary penalty (CMP) settlements involving minors.
METHODS: Descriptions of all EMTALA-related CMPs occurring between 2002 and 2023 were obtained from the Office of the Inspector General web site and reviewed for involvement of minors (<18 years of age) using keywords in settlement summaries. Characteristics of settlements involving minors were described and compared with settlements not involving minors.
RESULTS: Of 260 EMTALA-related CMPs, 38 (14.6%) involved minors. Most involved failure to provide a medical screening exam (MSE) (86.8%) and/or stabilizing treatment (52.6%). Seven (18.4%) involved pregnant minors. Eleven (28.9%) involved ED staff directing a patient (or guardian) to another facility, typically by private vehicle, and another involved 2 patients referred to on-campus outpatient clinics without an MSE.
CONCLUSIONS: One in 7 CMPs related to EMTALA violations involved minors, and 1 in 5 of these minors was pregnant. One-third of CMPs involving minors included ED staff directing patients to proceed to another facility or on-campus clinic without MSE or stabilization. Findings suggest a need for providers to understand EMTALA-specific requirements for appropriate MSE, stabilization, and transfer, and for EDs at hospitals with limited pediatric services to implement policies for the evaluation of minors and protocols for transfer when indicated.

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