Association Between High Serum Aspartate Transaminase to Alanine Transaminase Ratio and Probable HIV Dementia Among People Living With HIV on Dolutegravir-Based Antiretroviral Therapy: A Cross-Section

Over the first quarter of the 21st century, major gains in child survival and pediatric technology have changed the case mix of child health. The pediatric agenda is no longer defined only by whether children survive acute illness, but increasingly by whether they can develop, function, and thrive across home, school, digital, and community settings. Mental health problems now shape morbidity on a broad scale; digital routines influence sleep, mood, and learning; chronic health risks are appearing earlier in life; more children with disabilities and medical complexity are living longer at home; and environmental instability is becoming a pediatric care issue rather than a distant policy concern. Accordingly, pediatric nursing must prepare not only for disease management but also for longitudinal risk, family caregiving demands, and equitable access to both in-person and digital care [-]. Mental health problems among children and adolescents are no longer peripheral concerns but have become major drivers of both current and future morbidity. During the COVID-19 (coronavirus disease 2019) pandemic, symptoms of depression and anxiety increased substantially among children and adolescents worldwide, highlighting the vulnerability of youth mental health to large-scale social disruption []. For pediatric nursing, this shift underscores the need to recognize emotional distress as a core pediatric outcome because it affects treatment adherence, sleep, school participation, family functioning, and long-term developmental trajectories. The recent worsening of child and adolescent mental health is best understood as the cumulative result of interacting factors that have intensified over the past decade rather than as the consequence of a single, time-limited disruption. Pandemic-related school closures served as an acute trigger by removing daily structure, peer interaction, and access to school-based support while increasing loneliness and social isolation. However, these patterns largely reflect the acceleration of pre-existing trends in social disconnection and family stress. Loneliness has emerged as a particularly important contributor as childhood is increasingly characterized by reduced face-to-face interaction and weakened community networks. Evidence suggests that loneliness predicts both current and future depression and anxiety, with longer durations of loneliness associated with a greater risk of mental health problems. Family conflict, parental distress, and reduced emotional availability may also act as chronic stressors that contribute to children’s emotional difficulties. In addition, disruptions in school connectedness may weaken a critical source of social support, belonging, and emotional stability for children and adolescents. Collectively, these findings suggest that contemporary child mental health problems are cumulative and socially embedded, arising from the interaction of family, school, and community environments [,].