18th Birthday Research Articles

Treatment‐Related Acute Myeloid Leukemia in Children

Introduction: Although rare, acute myeloid leukemia (AML) in children and adolescents is the most frequent treatment-related malignancy in children and adolescents. Both, chemotherapy and irradiation, but also predisposing inherited syndromes might be involved in leukemogenesis. The overall prognosis is generally poor and curative treatment requires allogeneic stem cell transplantation (alloSCT) in almost all cases. Methods: In clinical trials or registries of the AML‐BFM Study group, between 1993 and 2018 145 children and adolescents (f=70; m=75) with tAML have been enrolled. T‐AML was defined according to the WHO 2016 classification. Patients were included if the initial malignancy occurred before their 18th birthday. Thirteen patients were excluded due to the lack of data concerning the primary malignancy. Whereas between 1993 and 2003, full AML-BFM treatment with double induction and two consolidation elements prior to SCT was recommended (AML-BFM 93 / AML-BFM 98), since 2004 only double induction and direct alloSCT have been applied. AlloSCT should be performed in 1st CR but also in case of no evidence of blasts (NEL), e.g. hematological regeneration was not required. Results: The median age was 10.6 years old and ranged from 1.4 to 26.6 years. The median percentage of BM blasts was 68% (range 11 ‐ 95%), the median WBC of 10,100/ μl (range 1,100 ‐ 201,000/μl) and hemoglobin 9.6 g/dl (range 6.5‐13.1 g/dl) According to the FAB classification, FAB M4/M5 (66%) was the largest group, followed by FAB M0/M1/ M2 (25%), FAB M6/M7 (6%) and others (6%). This corresponded to genetics: t(9;11) 32% and other MLL rearranged AML ((10;11); t(11;19), t(4;11); 15%, normal (n=13; 13%), or complex karyotype (n=10; 10%). Other patients had different findings such as n‐ras (n=8; 8%), trisomy 8 (n=5; 5%), t(8;21); 1%, inv(16), 2%, monosomy 7 (n=2; 2%), WT1 (n=4;4%) or NPM1, c‐kit, CEBPαdm, FLT3‐ITD (n=1 each). Twenty-eight different primary malignancies were reported, the median interval between primary malignancy and tAML was 2.6 years (range 1.3 to 22 years). Acute lymphoblastic leukemia (n=37, 28%) was the most frequent primary malignancy, however in total tAML occurred in 47% of the patients following solid tumors (n=68; Ewing-sarcoma n=11, 8%, osteosarcoma n=12; 9%, neuroblastoma n=13, 10%, rhambomyosarcoma n=7; 5%, nephroblastoma n=5; 4%), in 40% following systemic malignancies (ALL, non-Hodgkin lymphoma n=7; 7%, Hodgkin-lymphoma (n=6, 4%) and in 13% following brain tumors (medulloblastoma n=6, 4%; others n=8, 9%).The 5yrs‐overall survival (OS) rate of the complete cohort was 28 ± 4%, increasing from 19 ± 5% (n=70 1993‐2003) to 34±7% (n=41, 2004‐2011) up to 45±9% (n=34 2012‐2018; p log rank <0.03). The OS is similar for solid tumors (28±6%) and systemic malignancies (37±6%) but inferior for patients with a previous brain tumor (6±6%; p<0.002). Early death was recorded in 20/145 patients (14%). Children with tAML, who achieved CR (47%) or at least no evidence of leukemia (NEL; 39%) had an OS 60±7% and 32±11%, respectively. By contrast, 10 out of 11 patients with persistence blasts at time of alloSCT died. Conclusions: T‐AML in pediatric patients is still associated with a poor prognosis due to poor response, increased toxicities and unfavorable genetic aberrations. T-AML following brain tumors as 1st malignancy showed the worst prognosis. The reduction to two treatment elements prior to alloSCT and proceeding to SCT without CR might contribute to the improvement of survival. Disclosures Reinhardt: BlueBirdBio: Membership on an entity's Board of Directors or advisory committees; CLS Behring: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees; CElgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees; Roche: Research Funding.

Do autistic patients change healthcare services utilisation through the transition age? An Italian longitudinal retrospective study

ObjectivesThis paper aims to provide an estimate of the prevalence rate of autism spectrum disorder (ASD) in 8-year-olds in 2017 based on administrative databases and to investigate the change in...

Geospatial correlates of early marriage and union formation in Ghana.

The practice of early marriage, although acknowledged as a human rights violation, continues to occur in many countries. Different studies have identified the associated factors in many developing countries. However, these factors often assume no geographical variation in these factors within countries. Again, cultural practices and beliefs which strongly influence the acceptance and practices of early marriage vary geographically. In addition, geographic clusters of high rates of early marriage and union formation are also unknown. Thus, area specific correlates of early child marriage are required for the development of location specific policies to aid the eradication of early child marriage. Using data from the 2010 Ghana Population and Housing Census, this study examines the extent of geospatial clustering in early marriage amongst girls and their spatially-varying associated factors at the district level. The findings reveal strong clustering of high early marriage amongst districts in the Upper West, Northern and Volta regions. Nationally, 6.96% (CI = 6.83, 7.08) of girls are married or in union before their 18th birthday. The estimates range from 2.7% in the Jaman North district in Brong Ahafo region to 19.0% in the Gushiegu district in Northern region. Economic factors were observed as important spatially-varying associated factors. The findings suggest that targeted interventions are required in the effort to eradicate the practice in Ghana.

Multiple-Partner Fertility and Cohort Change in the Prevalence of Half-Siblings.

The transformation of the American family under the second demographic transition has created more opportunities for parents to have children with multiple partners, but data limitations have hampered prevalence estimates of multiple-partner fertility from the perspective of children. This study uses nationally representative data from the 1979 and 1997 cohorts of the National Longitudinal Surveys of Youth to examine cohort change in children's exposure to multiple-partner fertility. We find that one in five children in the 1979 cohort had at least one half-sibling by their 18th birthday, and the prevalence grew to more than one in four children by the 1997 cohort. A strong educational gradient in exposure to half-siblings persists across both cohorts, but large racial/ethnic disparities have narrowed over time. Using demographic decomposition techniques, we find that change in the racial/ethnic and socioeconomic composition of the U.S. population cannot explain the growth in exposure to half-siblings. We conclude by discussing the shifting patterns of fertility and family formation associated with sibling complexity and considering the implications for child development and social stratification.

Risk of childhood psychiatric disorders in children of refugee parents with post-traumatic stress disorder: a nationwide, register-based, cohort study

Children of refugees are often exposed to the consequences of parental post-traumatic stress disorder (PTSD), potentially leaving them vulnerable to intergenerational transmission of psychopathology. The present study aimed to determine whether parental PTSD is associated with childhood psychiatric morbidity among children of refugees. This study is a two-generation nationwide cohort study using the Danish Immigration Services database. We followed up children younger than 18 years with at least one refugee parent until psychiatric contact, end of the study, their 18th birthday, emigration, or death. We excluded children if their parents were diagnosed only with psychiatric diagnoses other than PTSD or if they had received a psychiatric contact before parental PTSD diagnosis. Information on parental PTSD and offspring psychiatric morbidity was obtained from the Danish Psychiatric Central Research Register. We used Cox proportional hazards regression models to assess the risk of psychiatric contacts among children of refugees with PTSD compared with children of refugees with no psychiatric diagnosis. Between Jan 1, 1995, and Dec 31, 2015, 102 010 refugees obtained residency permission in Denmark and 62 239 biological children of refugees were born in Denmark before Dec 31, 2015. 51 793 were eligible and included in the study (median follow-up 7·15 years [IQR 3·37-11·78]); of these, 1307 (2·5%) children had a psychiatric contact. 7486 (14·5%) children of refugees were exposed to parental PTSD. Parental PTSD significantly increased the risk of psychiatric contact in offspring (hazard ratio 1·49 [95% CI 1·17-1·89] for paternal PTSD, p=0·0011; 1·55 [1·20-2·01] for maternal PTSD, p=0·00084) after adjustment for sociodemographic variables. Children of refugees exposed to parental PTSD are at increased risk of psychiatric morbidity. Targeted screening and interventions are necessary to prevent psychiatric morbidity and ensure access to adequate care. Section for Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital Hvidovre.

Intelligence Plus Character

When you walk into the Character Lab office, the very first thing you'll see are the words of Martin Luther King, Jr.: “Intelligence plus character—that is the goal of true education.” The quote comes from an essay King published in the Morehouse College campus newspaper around his 18th birthday. King opens his argument with an observation: “I too often find that most college men have a misconception of the purpose of education.” A common mistake, he says, is in seeing only one of two aims. The more obvious goal of education is “to become more efficient,” particularly in “thinking logically and scientifically.” Today, we might say we send our kids to school to become critical thinkers. “Education must enable one to sift and weigh evidence, to discern the true from the false, the real from the unreal, and the facts from the fiction.” Another—perhaps less obvious—goal is to cultivate character: “But education which stops with efficiency may prove the greatest menace to society,” King wrote. “The most dangerous criminal may be the man gifted with reason, but with no morals.”

The incidence of cancer and mortality in paediatric onset inflammatory bowel disease in Denmark and Finland during a 23-year period: a population-based study.

Recent studies report increased risks of both cancer and mortality in paediatric onset inflammatory bowel disease (pIBD) but the reproducibility of this is unknown. To estimate the risk of cancer and mortality in the Danish and Finnish pIBD population in a 23-year period compared to the general population. The pIBD population was defined as individuals registered in the national patient registries with a diagnosis of Crohn's disease (CD), ulcerative colitis (UC) or IBD-unclassified before their 18th birthday from 1992 to 2014. This cohort was cross referenced with the national cancer and mortality registries identifying all pIBD patients who subsequently developed cancer and/ or died and followed up to the end of 2014. Risk estimates are presented as standardised incidence ratios calculated based on incidence figures from the populations. Six thousand six hundred and eight-nine patients with pIBD were identified (median age at follow-up 22.3 years; median follow-up: 9.6years [interquartile range: 4.8-16.0]). Seventy-two subsequently developed cancer and 65 died. The standardised incidence ratio of cancer in general was 2.6 (95% CI: 1.8-3.7) and 2.5 (95% CI: 1.8-3.4) in CD and UC, respectively. The standardised mortality ratios were 2.2 (95% CI: 1.4-3.4) and 3.7 (95% CI: 2.7-5.0) in CD and UC, respectively. The leading causes for mortality were cancer, suicide and infections. We found an increased risk of cancer and mortality in pIBD. This underlines the importance of cancer surveillance programs and assessment of mental health in the standard of care in adolescent pIBD patients.

“He is suitable for her, of course he is our relative”: a qualitative exploration of the drivers and implications of child marriage in Gezira State, Sudan

IntroductionChild marriage is a fundamental development challenge for women and girls, with significant negative health and social outcomes. Sudan has a high rate of child marriage, with 34% of women...

Multiple sclerosis: effect of beta interferon treatment on survival.

Worldwide, the beta interferons remain the most commonly prescribed disease-modifying drugs for multiple sclerosis. However, it is unclear if they alter survival. We investigated the association between beta interferon and mortality in the 'real-world' setting. This was a multi-centre population-based observational study of patients with relapsing-onset multiple sclerosis who were initially registered at a clinic in British Columbia, Canada (1980-2004) or Rennes, France (1976-2013). Data on this cohort were accessed from the clinical multiple sclerosis databases and from individually linked health administrative data; all data were collected prospectively. Participants were followed from the latter of their first multiple sclerosis clinic visit, 18th birthday or 1 January 1996; until death, emigration or 31 December 2013. Only those who were naïve to disease-modifying therapy and immunosuppressant treatment of multiple sclerosis at the start of their follow-up were included in the analysis. A nested case-control approach was used. Up to 20 controls, matched to cases (deaths) by country, sex, age ± 5 years, year and disability level at study entry, were randomly selected from the cohort by incidence density sampling. The associations between all-cause mortality and at least 6 months beta interferon exposure, and also cumulative exposure ('low', 6 months to 3 years; and 'high', >3 years), were estimated by conditional logistic regression adjusting for treatment with other disease-modifying therapies and age in years. Further analyses included separate analyses by sex and country, additional adjustment for comorbidity burden in the Canadian cohort, and estimation of the association between beta interferon and multiple sclerosis-related death in both countries. Among 5989 participants (75% female) with a mean age of 42 (standard deviation, SD 11) years at study entry, there were 742 deaths (70% female) and the mean age at death was 61 (SD 13) years. Of these cases, 649 were matched to between one and 20 controls. Results of the conditional logistic regression analyses are expressed as adjusted odds ratios with 95% confidence intervals. The odds of beta interferon exposure were 32% lower among cases than controls (0.68; 0.53-0.89). Increased survival was associated with >3 years beta interferon exposure (0.44; 0.30-0.66), but not between 6 months and 3 years exposure (1.00; 0.73-1.38). Findings were similar within sex and country, and for multiple sclerosis-related death. Beta interferon treatment was associated with a lower mortality risk among people with relapsing-onset multiple sclerosis. Findings were consistent between two geographically distinct regions in North America and Europe.

Maternal death in women with epilepsy

ObjectiveTo determine the maternal mortality in women with epilepsy.MethodsThis was a matched case-control study of pregnant women in Denmark who were born in Denmark between January 1, 1962, and December 31, 1994, and who were alive on their 18th birthday. We defined maternal mortality as deaths in pregnancy and the first 42 days after termination of pregnancy. Cases were pregnancies in women with a diagnosis of epilepsy before the termination of pregnancy. Data were analyzed with a conditional logistic model. For comparison, we estimated the mortality in women of childbearing age (18–50 years) diagnosed with epilepsy regardless of pregnancy status using a Poisson model.ResultsWe identified 2,105,084 pregnancies, including 11,976 (0.57%) pregnancies in which the mother was diagnosed with epilepsy. Of the 176 maternal deaths in this cohort, 5 women had a diagnosis of epilepsy. The mortality associated with an epilepsy diagnosis was >5 times higher compared to the mortality in women without this diagnosis (odds ratio 5.57, 95% confidence interval 2.23–13.9, p < 0.001).Conclusions and RelevanceMaternal mortality in women with epilepsy in Denmark was lower than what has previously been reported from United States and the United Kingdom. However, the maternal mortality in women with epilepsy was considerably higher compared to women without epilepsy. Further studies should address whether improving epilepsy care in women with epilepsy could reduce the rate of maternal deaths.

Measuring the impact of transition on children aging out of child protective services

IntroductionOn their 18th birthday children in custody of provincial Child and Family Services (CFS) age out, and are adults in control of their own care. An additional extended transitional services program was introduced several years ago to address gaps in the provicion of, and access to, adult social services during this change.&#x0D; Objectives and ApproachUsing linked population based data from the Manitoba Population Research Data Repository, children in the custody of CFS who turned 18 during a 10 year study period were compared to children not in custody. For those in custody of CFS, we also compared individuals who participated in the extended transitional care services to those who opted out. Outcomes included use of health services and prescription drugs, social assistance, involvment with the justice system, living in social housing, and mental health outcomes. For most outcomes, the two year period prior to the 18th birthday and the two year period after were measured.&#x0D; ResultsDuring the study period, 4656 children in care of CFS turned 18 while in custody. There were 2811 permanent wards, of which 1663 participated in the extended transitional services program. An additional 1845 non-permanent wards also turned 18 during the study period. Permanent wards were much more likely to be long term wards (greater than six years, ~65\%) compared non permanent wards (~17\%). Opioid prescription rates more than doubled in the two years after their 18th birthday and were about 6 times greater than prescription rates for those not in care of CFS. Criminal accusation rates did not change after their 18th birthday, were about equal for permanent and non-permanent wards. For the majority of outcomes, the transitional services program appeared to have little impact.&#x0D; Conclusion/ImplicationsCompared to children not in care of CFS, rates of most outcomes were considerably higher for wards. Not all outcomes demonstrated a significant change over the transition period. By linking data from so many different government departments, extra attention can be focused on areas likely to have the greatest impact.

The epilepsy transition care gap in young adults with childhood-onset epilepsy

IntroductionA substantial proportion of young adults with childhood-onset epilepsy may require ongoing long-term epilepsy care as adults. ObjectiveThe objective of the study was to assess the extent to which epilepsy transition discussions occurred in adolescents with childhood-onset epilepsy prior to the age of attaining majority (prior to their 18th birthday) in a community-based cohort of individuals with childhood-onset epilepsy followed longitudinally. MethodsThe Connecticut Study of Epilepsy is a prospective, community-based study of newly diagnosed childhood-onset epilepsy with 613 children (onset < 16 years old; year recruited: 1993–97). During the final exit interview, 308 young adults ≥18 years old (or parent-proxies) were asked, “Before you turned 18 years old, did your doctors or other epilepsy care providers talk with you about how your epilepsy care needs might change as you get older?” (‘transition discussion’). We examined whether or not sociodemographic and clinical characteristics were associated with epilepsy transition discussions. ResultsFor young adults with childhood-onset epilepsy (N = 308; mean age: 24 years, SD = 4.0; mean age of epilepsy onset: 5.4 years, SD = 3.7), only 15% responded “Yes” to having had a “transition discussion”. Of those with “active epilepsy” (N = 130; seizure-free < 5 years or on an antiseizure medication within 2 years of their 18th birthday) upon attaining the age of majority (18 years), 40/130 (~31%) young adults had “transition” discussions, compared with 7/178 (4%) of those with “inactive epilepsy” (p < 0.0001). Self- (N = 95 active epilepsy) and proxy-reports (N = 35 active epilepsy) of “transition” discussions were comparable (31%). Having a transition discussion was associated with neurodevelopmental comorbidity and type of epilepsy care provider at time of last contact (p < 0.05). Having a “transition” discussion was not associated with gender, race/ethnicity, high school graduation, parent insurance, epilepsy syndrome, psychiatric disorder, or intellectual disability (intelligence quotient [IQ] < 70) for those with “active epilepsy”. In assessing transfer of care, we found that only 50% of cases (who had active epilepsy at transition) were being seen by an adult or general neurologist at the time of the exit interview. ConclusionsOnly one-third of young adults with active epilepsy at transition in this community-based study reported having epilepsy care transition discussions with healthcare providers before the age of 18 years. Identifying barriers to successful delivery of effective epilepsy transition care is critical to remediating treatment care gaps and building effective future care models.

THE SOCIAL INFLUENCE OF SOCIAL MEDIA ON YOUNG PEOPLE'S DECISIONS: TRNC-NICOSIA EXAMPLE

The youngsters, who are the most important stones of the social structure, are a very important group in terms of political participation. Especially voters who have just completed their 18th birthday and will vote for the first time makes political parties and candidates' agenda busy. Because the mass that we can call the vote or not yet ossified is mostly composed of young people. This becomes even more important because population density is at a level that will determine the outcome of the election in the societies formed by young people. Political campaigners at this point are working on decision making mechanisms of young people, trying to direct them to vote and to influence their final decisions. Social media tools such as Twitter and Facebook are among the tools that political actors use to reach young voters during the election process. In this study, it is aimed to show how important and preliminary the activities conducted on the internet and the social media tools on young people 's voting decisions and the tendency of young people to vote. In line with this aim, a questionnaire was applied to six different provinces of the Turkish Republic of Northern Cyprus, through a face-to-face interview, from the universe of young people between the ages of 18 and 29, determined from the number of official voters, In addition, face-to-face in-depth interviews were conducted with the interview group, which was also formed as a random sample.

Maura Lynch: fistula fighter and nun

When Maura Lynch entered the order of the Medical Missionaries of Mary two days before her 18th birthday, she was hoping to spend her life serving poor populations in Africa....

From pipelines to pathways: the Memorial experience in educating doctors for rural generalist practice.

This report describes the community context, concept and mission of The Faculty of Medicine at Memorial University of Newfoundland (Memorial), Canada, and its 'pathways to rural practice' approach, which includes influences at the pre-medical school, medical school experience, postgraduate residency training, and physician practice levels. Memorial's pathways to practice helped Memorial to fulfill its social accountability mandate to populate the province with highly skilled rural generalist practitioners. Programs/interventions/initiatives: The 'pathways to rural practice' include initiatives in four stages: (1) before admission to medical school; (2) during undergraduate medical training (medical degree (MD) program); (3) during postgraduate vocational residency training; and (4) after postgraduate vocational residency training. Memorial's Learners & Locations (L&L) database tracks students through these stages. The Aboriginal initiative - the MedQuest program and the admissions process that considers geographic or minority representation in terms of those selecting candidates and the candidates themselves - occurs before the student is admitted. Once a student starts Memorial's MD program, the student has ample opportunities to have rural-based experiences through pre-clerkship and clerkship, of which some take place exclusively outside of St. John's tertiary hospitals. Memorial's postgraduate (PG) Family Medicine (FM) residency (vocational) training program allows for deeper community integration and longer periods of training within the same community, which increases the likelihood of a physician choosing rural family medicine. After postgraduate training, rural physicians were given many opportunities for professional development as well as faculty development opportunities. Each of the programs and initiatives were assessed through geospatial rurality analysis of administrative data collected upon entry into and during the MD program and PG training (L&L). Among Memorial MD-graduating classes of 2011-2020, 56% spent the majority of their lives before their 18th birthday in a rural location and 44% in an urban location. As of September 2016, 23 Memorial MD students self-identified as Aboriginal, of which 2 (9%) were from an urban location and 20 (91%) were from rural locations. For Year 3 Family Medicine, graduating classes 2011 to 2019, 89% of placement weeks took place in rural communities and 8% took place in rural towns. For Memorial MD graduating classes 2011-2013 who completed Memorial Family Medicine vocational training residencies, (N=49), 100% completed some rural training. For these 49 residents (vocational trainees), the average amount of time spent in rural areas was 52 weeks out of a total average FM training time of 95 weeks. For Family Medicine residencies from July 2011 to October 2016, 29% of all placement weeks took place in rural communities and 21% of all placement weeks took place in rural towns. For 2016-2017 first-year residents, 53% of the first year training is completed in rural locations, reflecting an even greater rural experiential learning focus. Memorial's pathways approach has allowed for the comprehensive training of rural generalists for Newfoundland and Labrador and the rest of Canada and may be applicable to other settings. More challenges remain, requiring ongoing collaboration with governments, medical associations, health authorities, communities, and their physicians to help achieve reliable and feasible healthcare delivery for those living in rural and remote areas.

Child marriage and associated outcomes in northern Ghana: a cross-sectional study

BackgroundChild marriage is a human rights violation disproportionately affecting girls in lower- and middle-income countries and has serious public health implications. In Ghana, one in five girls marry before their 18th birthday and one in 20 girls is married before her 15th birthday. This paper uses a unique dataset from Northern Ghana to examine the association between child marriage and adverse outcomes for women among a uniquely vulnerable population.MethodsBaseline data from on ongoing impact evaluation of a government-run cash transfer programme was used. The sample consisted of 1349 ever-married women aged 20–29 years from 2497 households in the Northern and Upper East regions of Ghana. We estimated a series of ordinary least squares (OLS) and logistic regression models to examine associations of child marriage with health, fertility, contraception, child mortality, social support, stress and agency outcomes among women, controlling for individual characteristics and household-level factors.ResultsChild marriage in this sample was associated with increased odds of poorer health, as measured by difficulties in daily activities (OR = 2.08; CI 1.28–3.38 among women 20–24 years and OR = 1.58; CI 1.19–2.12 among women 20–29 years), increased odds of child mortality among first-born children (OR = 2.03; CI 1.09–3.77 among women 20–24 years) and lower odds of believing that one’s life is determined by their own actions (OR = 0.42; CI 0.25–0.72 among women 20–24 years and OR = 0.54; CI 0.39–0.75 among women 20–29 years). Conversely, child marriage was associated with lower levels of reported stress (regression coefficient = − 1.18; CI -1.84–-0.51 among women 20–29 years).ConclusionsChild marriage is common in Northern Ghana and is associated with poor health, increased child mortality, and low agency among women in this sample of extremely poor households. While not much is known about effective measures to combat child marriage in the context of Ghana, programmes that address key drivers of early marriage such as economic insecurity and school enrolment at the secondary level, should be examined with respect to their effectiveness at reducing early marriage.Trial registration: Registered in the Registry for International Development Impact Evaluations (RIDIE) on 01 July 2015, with number RIDIE-STUDY-ID-55942496d53af.

Temporal changes in the incidence of treated psychiatric and neurodevelopmental disorders during adolescence: an analysis of two national Finnish birth cohorts

Comprehensive overviews of the temporal changes in treated psychiatric and neurodevelopmental disorders during adolescence are scarce. We reviewed data from two national cohorts, 10 years apart, to establish the change in use of specialised services for psychiatric and neurodevelopmental diagnoses in Finland. We compared the nationwide register-based incidence of psychiatric and neurodevelopmental diagnoses between the 12th birthday and 18th birthday of adolescents born in Finland in 1987 and 1997. Adolescents who emigrated or died before their 12th birthday and those with missing covariate data were excluded, as were those who, when aged 11 years, had lived in a municipality belonging to a hospital district with obviously incomplete data reports during any follow-up years in our study. Our primary outcomes were time to incident specialised service use for any psychiatric or neurodevelopmental disorder and for 17 specific diagnostic classes. We also investigated whether adolescents who died by suicide had accessed specialised services before their deaths. The cumulative incidence of psychiatric or neurodevelopmental disorders increased from 9·8 in the 1987 cohort to 14·9 in the 1997 cohort (difference 5·2 percentage points [95% CI 4·8-5·5]) among girls, and from 6·2 in the 1987 cohort to 8·8 in the 1997 (2·6 percentage points [2·4-2·9]) among boys. The hazard ratio for the overall relative increase in neurodevelopment and psychiatric disorders in the 1997 cohort compared with the 1987 cohort was 1·6 (95% CI 1·5-1·8) among girls and 1·5 (1·4-1·6) among boys. Of the studied diagnostic classes, we noted significant (ie, p<0·001) relative increases for ten of 17 diagnoses among girls and 11 among boys. Of the adolescents who died by suicide before age 18, only five of 16 in the 1987 cohort and two of 12 in the 1997 cohort had used specialised services in the 6 months before their death. The large absolute rise in service use for psychiatric or neurodevelopmental disorders points to the need to deliver effective treatment to a rapidly increased patient population, whereas the relative increase in specific diagnoses should inform clinical practice. Despite increasing service use, identification of adolescents at risk of suicide remains a major public health priority. Academy of Finland, Brain and Behavior Research Foundation, Finnish Medical Foundation.

Does Voter Preregistration Increase Youth Participation?

Abstract Young people are systematically underrepresented in the electoral process. Reformers have attempted to design policies and campaign strategies that reduce this inequality, but most of these efforts have proven ineffective. One relatively new and increasingly popular reform allows young people to preregister at the age of 16 or 17, making them automatically registered on their 18th birthday. I estimate the effect of preregistration by combining individual-level administrative data with a differences-in-differences design that accounts for cohort effects as well as idiosyncratic differences across each state election. On average, preregistration appears to increase youth turnout by about two percentage points—a modest effect notably below previous estimates in the literature.

Childhood onset inflammatory bowel disease and risk of cancer: a Swedish nationwide cohort study 1964-2014

Objective To assess risk of cancer in patients with childhood onset inflammatory bowel disease in childhood and adulthood.Design Cohort study with matched general population reference individuals using multivariable Cox regression...

Is initiating tanning bed use as a minor associated with increased risky tanning behaviors and burning? An exploratory study.

Tanning bed use is most common among youth and young adults, and is associated with an increased risk of skin cancer. Recently, numerous states have adopted restrictions on minors' access to tanning beds; however, little has been reported on how such policies may impact tanning behaviors and burning. The purpose of this study was to examine the associations between age of indoor tanning initiation and risky tanning behaviors and burning. Female students (n=567) attending a large southeastern public university completed a questionnaire (spring of 2015) assessing tanning bed use history, including age of initiation. The analytic sample was limited to participants reporting past year indoor tanning (n=134). Multivariable logistic regression was used to compare the odds of risky tanning behaviors and burning among those initiating indoor tanning before and after their 18th birthday. Participants initiating indoor tanning as a minor had significantly (ps<0.05) greater odds of using a tanning bed 10 or more times in the previous year, typically indoor tanning for ≥10min, ever indoor tanning without wearing goggles, and ever fallen asleep inside a tanning bed. Further, those that initiated as a minor had significantly greater odds of ever burning from indoor tanning (p<0.05). Indoor tanning initiation as a minor was associated with several risky tanning behaviors and burning. Youth access restrictions may help reduce the harms caused by tanning beds.