Young Adult Age Group Research Articles

THE RELATIONSHIP BETWEEN MENTAL WORKLOAD AND WORK STRESS IN TEACHERS OF SCHOOLS OF DISABLED CHILDREN

A profession as a teacher of schools of disabled children (SLB) is one of the jobs that can cause work stress. Teachers at SLB need more patience, attention, and special skills than teachers in ordinary schools. The purpose of this study was to determine the relationship between mental workload and work stress on SLB teachers in Jombang. This study was an analytical observational study with a cross sectional design. The samples in this study were three out of nine SLBs in Jombang that were chosen through random sampling. The data collection was done by using a questionnaire filled by 33 respondents. The questionnaire included the Subjective Workload Assessment Technique (SWAT) questionnaire to measure mental workload, and The National Union of Teacher (NUT) Stress Survey to measure work stress on SLB teachers in Jombang. The results showed that there was a strong relationship between mental workload and work stress (p-value = 0.049 and r = 0.360). In conclusion, most SLB teachers in Jombang are female and are in the age group of young adults. The Background Education of SLB teachers mostly comes from non-Special Education (PLB) department and the majority of them were new and had been teaching for years. According to the result of this study, the mental workload of SLB teachers in Jombang was at a moderate level, and their work stress was in the low category. Mental workload is one of the factors that can cause work stress on SLB teachers in Jombang.Keywords: mental workload, SLB teachers, work stress

Percutaneous closure of perimembranous ventricular septal defects utilizing almost ideal Amplatzer Duct Occluder II: Why limitation in sizes?

The purpose of this study is to describe the special aspects of perimembranous ventricular septal defects (pmVSD) closure by utilizing Amplatzer Duct Occluder II (ADO II) devices with a rational request for bigger ADO-II sizes, based on our experience in transcatheter device closure of pmVSD. At our institution, placement of an ADO II device was used in 15 patients with pmVSD; the patients' age ranged between 6months and 20years. The indications for closure were CHF (n=4), hemodynamically significant shunt (n=7), tricuspid regurgitation (n=3), and high risk for infective endocarditis (n=2), respectively. The location of the VSD was infracristal in 13 patients, supracristal in 1, and a postsurgical Gerbode VSD in another one. Implantation of the device was successfully performed without embolization, any evidence of an AV block, or other conductance abnormalities during implantation and follow-up in the mean of 2.5years (range 2months-6.5years). Transcatheter closure of a pmVSD with ADO II is feasible in all pediatric and young adult age groups, by considering the device diameter limitations. The off-label use of ADO II implantation seems to be safe for VSDs closure up to 6mm of size and feasible for various locations including unusual morphology such as postsurgical Gerbode defect.

Vascular changes in fetal growth restriction: clinical relevance and future therapeutics.

Fetal growth restriction (FGR) affects about 5-10% pregnancies and is associated with poorer outcomes in the perinatal period. Additionally, long standing epidemiological data support its association with chronic diseases such as hypertension and diabetes. Cardiac and vascular adaptations in response to chronic hypoxemia due to utero-placental insufficiency are hallmarks of fetal adaptations. Investigators have attempted to identify these changes in the placenta at the microscopic and molecular level. The ex vivo dual perfusion model of the placenta enables the study of placental haemodynamics in growth-restricted pregnancies. Persistent arterial abnormalities (thickness and stiffness) noted on vascular ultrasound during fetal life through to the young-adult age group for those affected by FGR, seem to be a plausible link between in utero events and chronic circulatory diseases. Using these, this review reflects current thought on vascular maladaptive changes in the FGR cohorts and the role in investigating current and future therapeutics.

DRUG UTILIZATION PATTERN STUDY IN YOUNG ADULT PATIENTS OF CUTANEOUS ADVERSE DRUG REACTIONS

Objective: To evaluate prevalence of cutaneous adverse reactions in young adult age group using ADR notification form. To create awareness in hospitals and health sectors, to establish drug safety monitoring units for mother and child care.Methods: Individual case safety reports of 46 patients from various hospitals were analyzed using CDSCO forms. To tabulate data on drugs, doses, systems, ADRs and factors for causation of cutaneous ADRs. Results: Females are more prone compared to males due to pregnancy at young age with increased use of Iron combinations, antibiotics and antiepileptic’s in young adult age groups (20-30yrs) among cutaneous ADRs.Conclusion: We conclude the need for establishment of drug safety units with generic units for maternity sections and use of drugs in pre and post natal period, as pregnancy and adult age are risk factors for cutaneous adverse drug reactions. Every hospital structure needs special caution on drug lots of iron preparations, antibiotics, analgesics, antiepileptic’s to be used in Obstetrics and Gynecology departments.

Patterns of maxillofacial fractures in Hofuf, Saudi Arabia: A 10-year retrospective case series

ObjectivesThis retrospective study was performed to analyze the incidence, etiology, and types of maxillofacial fractures in a major city in Eastern Province, Saudi Arabia. Materials and methodsThe medical records of all patients treated in the operating rooms for maxillofacial fractures by the Oral and Maxillofacial Surgery Department at King Fahad Hospital, Hofuf, Al-Ahsa, Saudi Arabia, between January 1, 2007, and December 31, 2016, were reviewed. A total of 270 patients with complete records were included. The data extracted included the age, gender, nationality, causes of injury, and patterns of maxillofacial fractures involved. ResultsAmong the 270 patients, 241 (89.3%) were males, and 29 (10.7%) were females. The young adult (19–44 years) age group was the most affected (65.6%). Road traffic accidents (63.3%) were found to be the most frequent causes of maxillofacial fractures; falls were the second most common (15.9%). The rate of mandibular (54.6%) fractures was higher than that of mid-facial (45.4%) fractures. Among the mandibular fractures, the most common type was the parasymphyseal fracture (24.6%). Zygomatic fractures were the most common (48.6%) of midface fractures. ConclusionsSimilar to reports of other studies in different regions of Saudi Arabia, Al-Ahsa showed that road traffic accidents were the most predominant etiology of maxillofacial fractures affecting most frequently males of young adult age group. These findings emphasize the need for better education of road safety and enforcement of traffic laws, especially for the most affected age group.

Influenza in New Zealand Before 1918: A Preliminary Report

In the present article, I aimed to test the hypothesis that possible fatal immunological reactions to the A/H1N1 virus of the 1918 "Spanish" influenza pandemic were the result of previous exposure to the A/H3N8 virus of the 1890-1892 "Russian" influenza pandemic. Using newspapers and official death records to reconstruct mortality peaks from influenza and excess pneumonia deaths in New Zealand before 1918 enabled comparisons with peaks of influenza mortality by age in 1918 from individual death records. For males, mortality peaks in the 1885, 1890-1892, 1894, and 1898 influenza outbreaks appeared to match those from the 1918 pandemic. For females, peaks of deaths in 1918 corresponded to those from the influenza outbreaks of 1887 and 1890-1892. The highest mortality rates for both sexes were among those 28-32 years of age. Although they lend strong support to the hypothesis of fatal immunological reactions derived from early exposure to a different influenza virus, the results from this study also raise more questions: Given that the A/H1N1 virus of 1918 was exceptionally virulent, why did so few children 5-15 years of age die from it? Influenza normally kills only the very young and the very old. In addition, why did twice as many European males as females die in the young-adult age groups, whereas Māori males and females died at almost identical rates?

FreeStyle Libre™ Use for Self-Management of Diabetes in Teenagers and Young Adults

The challenges of caring for diabetes in teenagers and young adults are well known. We analyzed two research studies (IMPACT and SELFY) that evaluated FreeStyle LibreTM Flash Glucose Monitoring System as a replacement for self-monitoring of blood glucose (SMBG), looking specifically at outcomes in patients aged 13-24 years. IMPACT enrolled 241 patients with well controlled type 1 diabetes (T1DM), HbA1c 6.74±0.56% (50.1±6.1 mmol/mol), age 43.7±13.9 years (mean±SD) into a 6 month European RCT (23 sites). The control group (n=121) used SMBG and the intervention group used FreeStyle Libre for self-management. Of the 241 patients, 19 were aged 18-24 years. SELFY enrolled 76 young people aged 10.3±4.0 years (mean±SD), baseline HbA1c 7.9±1.0% (62.9±11.1 mmol/mol) into a 10 week single arm European study (10 sites). The study consisted of 2 weeks baseline masked (blinded) wear, followed by 8 weeks open use. Of the 76 patients, 25 were aged 13-17 years. IMPACT study results at 6 months showed no significant interaction of age with treatment group for the primary endpoint of time in hypoglycemia <70 mg/dL. For the younger adults, time in range (TIR) (70-180 mg/dL) significantly increased by 2.9±0.89 hours/day (mean±SE); p=0.0055. Time in hyperglycemia (>180 mg/dL) also significantly improved with a reduction of 2.40±0.834 hours/day (mean±SE); p=0.0113. Intervention group patients scanned the sensor on average 11.3 times daily. Teenagers in the SELFY study significantly improved the primary endpoint of TIR (70-180 mg/dL) by 1.2±2.5 hours/day (mean±SD), p=0.0254. HbA1c also significantly improved, -0.7±0.6%, p<0.0001. Time in hyperglycemia (>180 mg/dL) significantly reduced by -1.7±2.9 hours/day, p=0.0093, no statistically significant changes were observed in hypoglycemia (time<55 mg/dL, baseline 0.7±1.0 hours/day). Scan frequency of FreeStyle Libre was on average 9.7 times daily. The IMPACT and SELFY studies both demonstrated improvements in glycemic control in the teenager and young adult age groups. Disclosure F. Campbell: Research Support; Self; Abbott. Consultant; Self; Eli Lilly and Company, Novo Nordisk A/S, Johnson & Johnson Diabetes Institute, LLC., Sanofi, Medtronic, Roche Diabetes Care Health and Digital Solutions. J. Bolinder: Advisory Panel; Self; Abbott. Speaker's Bureau; Self; Abbott. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S, Eli Lilly and Company.

Characteristics of Adults' Use of Facebook and the Potential Impact on Health Behavior: Secondary Data Analysis.

BackgroundSocial influences are a primary factor in the adoption of health behaviors. Social media platforms, such as Facebook, disseminate information, raise awareness, and provide motivation and support for positive health behaviors. Facebook has evolved rapidly and is now a part of many individuals' daily routine. The high degree of individual engagement and low attrition rate of this platform necessitate consideration for a potentially positive impact on health behavior.ObjectiveThe aim of this paper is to investigate the use of Facebook by adults. Knowledge is limited to the unique characteristics of Facebook users, including time spent on Facebook by adults of various age groups. Characteristics of Facebook users are important to understand to direct efforts to engage adults in future health behavior interventions.MethodsInstitutional Review Board approval was obtained for this secondary analysis of existing de-identified survey data collected for the Pew Research Center. The sample included adults age 18-65 years and above. Binomial logistic regression was performed for the model of age group and Facebook use, controlling for other demographics. A multinomial logistic regression model was used for the variable of time spent on Facebook. Based on the regression models, we computed and reported the marginal effects on Facebook use and time spent of adults age groups, including age groups 18-29, 30-49, 50-64, and 65 and over. We discuss these findings in the context of the implications for promoting positive health behaviors.ResultsThe demographics of the final sample (N=730) included adults age 18-65 years and above (mean 48.2 yrs, SD 18.3 yrs). The majority of the participants were female (372/730, 50.9%), white (591/730, 80.9%) and non-Hispanic (671/730, 91.9%). Bivariate analysis indicated that Facebook users and nonusers differed significantly by age group (χ2=76.71, P<.001) and sex (χ2=9.04, P=.003). Among subjects aged 50 and above, the predicted probability was 66% for spending the same amount of time, 10% with increased time, and 24% with decreased time.ConclusionsThe key findings of this study were Facebook use among midlife and older adults was more likely to stay the same over time, compared to the other age groups. Interestingly, the young adult age group 18-29 years was more likely to decrease their time on Facebook over time. Specifically, younger females were most likely to decrease time spent on Facebook. In general, male participants were most likely to spend the same amount of time on Facebook. These findings have implications for future health intervention research, and ultimately, for translation to the clinic setting to improve health outcomes.

Age dependency of primary tumor sites and metastases in patients with Ewing sarcoma.

The median age of patients with Ewing sarcoma (EwS) at diagnosis is around 14-15 years. Older age is associated with a worse outcome. The correlation of age at diagnosis on sites of disease has not been fully described. The goal of this study was to evaluate the differences in sites of primary tumor and metastatic tumor involvement according to age groups. EwS data from the Gesellschaft für Pädiatrische Onkologie und Hämatology (GPOH) database of the Cooperative Ewing Sarcoma Study (CESS) 81/86 and the European Intergroup Cooperative Ewing's Sarcoma Study EICESS 92 and the EUROpean Ewing tumor Working Initiative of National Groups-99-Protocol (EURO-E.W.I.N.G.-99) study were analyzed. Patient and tumor characteristics were evaluated statistically using chi square tests. The study population included 2,635 patients with bone EwS. Sites of primary and metastatic tumors differed according to the age groups of young children (0-9 years), early adolescence (10-14 years), late adolescence (15-19 years), young adults (20-24 years), and adults (more than 24 years). Young children demonstrated the most striking differences in site of disease with a lower proportion of pelvic primary and axial tumors. They presented less often with metastatic disease at diagnosis. Site of primary and metastatic tumor involvement in EwS differs according to patient age. The biological and developmental etiology for these differences requires further investigations.

Sexual Dimorphism among the Kathmandu University Students Assessed by Anthropometric Studies

Objectives: To observe the sexual dimorphism among the young adult age group ranging from 18-21 years, of Kathmandu University students by measuring craniofacial circumference and canthal distances.&#x0D; Rationale of the study: These data could be useful for establishing the craniofacial standards and adds an implementation on plastic surgery, crime detection as well as in the industrial field.&#x0D; Method: 300 clinically normal students of Kathmandu University aged between 18-21 years were examined for the study. Fronto-occipital circumference, outer and inner canthal distances were measured. All the parameters were compared between males and females.&#x0D; Result: The cranial circumference as well as the inner and outer canthal distance in males was found to be significantly higher as compared to the females.&#x0D; Conclusion: The results concluded that sexual dimorphism remarkably exists in young adults of Kathmandu University students.

Gender Differentials in the Prevalence of Overweight and Obesity in India

Introduction: With global gender disparities in the prevalence of overweight and obesity, the majority of the studies do not explain why these gender disparities exist. Physical activity, cultural values, biological factors (such as menopause), and urbanization have been the most common explanations regarding gender disparities in overweight and obesity. However, rarely have studies gone beyond general explanations. Aims: In this study, an attempt has been made to assess the differentials and determinants of gender gap in the prevalence of overweight/obesity in India and across its states by different socioeconomic and demographic factors. Data and Methods: National Family Health Survey 2015-16 data and NFHS -3 (2005-06) data of 15-49 years old women and 15-54 years old men, were utilized to analyze gender gap in the recent scenario and over the time. Results and Conclusion: The prevalence of overweight/ obesity has increased significantly among men and women. At the same time, the difference in the prevalence of overweight/ obesity among men and women has declined over time. Earlier, women were predominantly more overweight/obese compared to men; however, overweight/ obesity prevalence has increased more swiftly among men than among women in the last decade.A rapid increase was observed in the prevalence of overweight/ obesity among men in the younger adult age groups. Irrespective of age, the gender gap in overweight/ obesity rose with education. The gender gap was also the highest among the castes other than SCs and STs. Muslims were found to have a higher gender gap compared to Hindus and others. Wealth quintiles had a positive relationship with the gender gap. The gender gap in the prevalence of overweight/ obesity prevalence increased among respondents of the richest wealth quintile. The pattern of higher gender gap in overweight and obesity was also observed among people who were working, living in nuclear families and living in low fertility states in both urban and rural areas. we found that food habits do not reflect any consistent pattern of the risk of overweight/ obesity among men and women, which may be due to complex and non-uniform food patterns across the Indian states.

Facial Distances and Possible Risk of High Blood Pressure: The Analyses of Young and Middle‐ Aged Adult Populations of Northern Nigeria

The objectives of the study were to determine the relationship between the facial distances and blood pressure across different age groups of young adults and middle‐aged population in males and females of northern Nigeria. Secondly, to determine the best facial predictors and discriminators of the blood pressure in the study population. Participants included 397 males and 159 females of northern of Nigeria with mean age of 25.37± 7.78 years. The facial distances were measured using direct anthropometry and blood pressure was determined using standard protocols. Pearson's correlation, step–wise multiple linear regression and receiver operating characteristic curve were employed to analyze the data. Measurements of blood pressure were in mmHg, age in years, bmi in kg/m2 and the remaining facial distances in mm. It was observed that no significant correlation between the facial distances and blood pressure (BP) in younger adult males and females except for lower facial height (LFH) and diastolic BP in males. Above the age of 30 years, significant correlation was noticed between the right ear width (EW), left EW, head length (HL) with both systolic and diastolic BP. The nasal length (NL) and nasal width (NW) correlated significantly with systolic and diastolic BP respectively in males only. For females, bizygomatic distance (BD) correlated only with systolic BP. The best predictors of systolic BP were left EW and HL in males and females respectively, while the best predictors of diastolic BP were left EW and right EW in males and females respectively. LFH was found to predict only the systolic blood pressure component in younger male adults. The best discriminating potential of facial distances with regard to abnormal blood pressure was only observed in the middle‐aged population. In both sexes right EW and left EW had more than 80% discriminating ability of abnormal BP (area under curve &gt; 0.80). However, head width (HW) and HL had more than 80% discriminating ability of abnormal BP in males and females respectively. In conclusion, a significant correlation was observed between the facial distances and BP in middle‐ aged adult population. The facial soft tissue gave best predictors and discriminator in both sexes.Support or Funding InformationNoneThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Preconception Counseling for Adolescents and Young Adults with Diabetes: a Literature Review of the Past 10Years.

Women with diabetes who have unplanned pregnancies and uncontrolled blood sugars are at a higher risk for maternal and fetal morbidities and mortalities. Preconception counseling (PC) has been shown to decrease the risks and improve health outcomes. From 2009 to 2017, the American Diabetes Association has recommended that preconception counseling be given at each clinic visit for all women with diabetes of childbearing age starting at puberty (prior to sexual debut). This article reports both national and international progress in PC efforts for adolescents and young adults (12-34years) with diabetes over the past decade. Twenty-eight publications were identified and included in this article (11 were research, 12 clinical guidelines, and 5 reviews). Despite recommendations to start PC at puberty, only four studies had interventions that targeted the adolescent and young adult age group. Three of them were associated with the same PC awareness program. Positive outcomes were reported in all of these studies. Greater family vigilance was observed in a long-term follow-up of a cohort of women who received PC as teens. Adolescents should receive awareness PC. More early PC interventions and cohort follow-up studies are needed among adolescents and young adults, using technology that appeals to this age group. Programs should be expanded to include other populations like males with diabetes and females from other cultures and religions that would require program modification.

Acute kidney injury epidemiology, risk factors, and outcomes in critically ill patients 16\u201325 years of age treated in an adult intensive care unit

BackgroundMost studies of acute kidney injury (AKI) have focused on older adults, and little is known about AKI in young adults (16–25 years) that are cared for in an adult intensive care unit (ICU). We analyzed data from a large single-center ICU database and defined AKI using the Kidney Disease Improving Global Outcomes criteria. We stratified patients 16–55 years of age into four age groups for comparison and used multivariable logistic regression to identify associations of potential susceptibilities and exposures with AKI and mortality.ResultsAKI developed in 52.6% (n = 8270) of the entire cohort and in 39.8% of the young adult age group (16–25 years). The AUCs for the age categories were similar at 0.754, 0.769, 0.772, and 0.770 for the 16–25-, 26–35-, 36–45-, and 45–55-year age groups, respectively. For the youngest age group, diabetes (OR 1.89; 95% CI 1.09–3.29), surgical reason for admission (OR 1.79; 95% CI 1.44–2.23), severity of illness (OR 1.02; 95% CI 1.02–1.03), hypotension (OR 1.13; 95% CI 1.04–1.24), and certain medications (vancomycin and calcineurin inhibitors) were all independently associated with AKI. AKI was a significant predictor for longer length of stay, ICU mortality, and mortality after discharge.ConclusionsAKI is a common event for young adults admitted to an adult tertiary care center ICU with an associated increased length of stay and risk of mortality. Potentially modifiable risk factors for AKI including medications were identified for all stratified age groups.

Therapeutic approaches to hematological malignancies in adolescents and young adults

Hematological malignancies (HM) comprise the major proportion of the cancer incidence and mortality in the adolescent and young adult (AYA) age group. Even though age-related differences in tumor biology have been reported in HM, further biological studies are warranted for elucidating age-related differences in AYAs. Hemato-oncologists and pediatric oncologists frequently follow various treatment strategies for HM, as the treatment strategy that is more suitable for this age group remains unclear. Recently, the involvement of pediatric oncologists has increased because the advantage of pediatric-type treatment has been demonstrated in acute lymphoblastic leukemia (ALL) and the significance of long-term follow-up has been clarified. However, for HM, except for ALL, the pediatric- and adult-type therapy that is more suitable for AYAs remains unclear. This review aimed to describe the challenges in the context of major HM affecting the AYA age group (acute leukemia and lymphoma). For assessing the outcome of AYAs with HM, we need to consider not only the treatment strategy but also other factors such as differences in aging and tumor biology. Furthermore, it is imperative to develop a therapy that resolves psychosocial problems peculiar to AYAs.

Harm Perceptions of Menthol and Nonmenthol Cigarettes Differ by Brand, Race/Ethnicity, and Gender in US Adult Smokers: Results from PATH Wave 1.

Harm perceptions of menthol cigarettes may contribute to their appeal and use. African-Americans, women, and younger smokers disproportionately use menthol cigarettes, and may misperceive harm of menthol cigarettes. Data were from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. Weighted analyses of current adult smokers (18 and older) were used to estimate the correlates of menthol smoking among all cigarette brands and separately for the top three cigarette brands (Newport, Camel, and Marlboro). Adjusted models examined the main effect of menthol smoking on harm perceptions of one's own brand of cigarette and interactions with race/ethnicity, age, and gender. Menthol cigarettes were used by nearly 40% of current smokers, although the prevalence of menthol smoking differed across the top three brands (94% Newport, 46% Camel, and 18% Marlboro). Among menthol smokers, 80% perceived their cigarette as equally harmful, 14% perceived their brand as more harmful, and 7% perceived their brand as less harmful. In adjusted models, menthol smokers were more likely than nonmenthol smokers to misperceive their own brand as more harmful than other brands (compared to no difference in harm). Race and gender emerged as moderators of the association between menthol brand preference and harm perceptions. In adjusted analyses, menthol smokers were more likely than nonmenthol smokers to perceive their brand as more harmful than other brands, with differences by sub-groups who disproportionately use menthol. Menthol cigarettes have been historically marketed with messages conveying lower harm than other cigarettes. Little is known about how contemporary adult menthol smokers perceive the harm of their usual brand, and potential differences by race, gender, and young adult versus older adult age group. After adjusting for other factors, menthol smokers were more likely than nonmenthol smokers to perceive their cigarette brand as more harmful than other brands. Further, the association between menthol smoking and harm perceptions differed by race and gender, but not by age group (young adult vs. older adult). This type of large-scale study identifies critical links between menthol smoking and harm perceptions among vulnerable smokers that will inform regulatory actions designed to decrease smoking-related harm.

Analysis of the tonsillar microbiome in young adults with sore throat reveals a high relative abundance of Fusobacterium necrophorum with low diversity.

Fusobacterium necrophorum (Fn), a gram-negative anaerobe, is increasingly implicated as an etiologic agent in older adolescents and young adults with sore throat. Inadequately treated Fn pharyngitis may result in suppurative complications such as peritonsillar abscess and Lemierre’s syndrome. Data from the literature suggest that the incidence of life-threating complications in these age groups from Fn pharyngitis (Lemierre’s syndrome) in the United States exceeds those associated with group A beta-hemolytic streptococcal (GAS) pharyngitis (acute rheumatic fever). Using real-time PCR, we previously reported about a 10% prevalence of Fn in asymptomatic medical students and about 20% in students complaining of sore throat at a university student health clinic (p = 0.009). In this study, a comprehensive microbiome analysis of the same study samples confirms that Fn pharyngitis was more common than GAS pharyngitis. Eighteen patients were found to have Fn OTU values exceeding an arbitrary cutoff value of 0.1, i.e. greater than 10% of total sequences, with five subjects reaching values above 0.7. By contrast only 9 patients had GAS OTU values greater than 0.1 and none exceeded 0.6. When the data were analyzed using five separate assessments of alpha diversity, in each case for Fn there were statistically significant differences between Fn positive_high (OTU abundance > 0.1) vs control, Fn positive_high vs Fn negative (OTU abundance = 0), Fn positive_high vs Fn positive_low (OTU abundance > 0 and < 0.1). When the data were analyzed using three beta diversity indexes (Bray-Curtis, weighted unifrac, and unweighted unifrac), there were statistically significant differences between Fn positive_high (OTU abundance ≥ 0.1) vs control for all three. Statistically significant differences remained if we chose somewhat different OTU abundance cutoffs of 0.05 or 0.15. We conclude that Fn appears to play a dominant role in bacterial pharyngitis in the older adolescent and young adult age groups and that the development of a productive mucosal infection with Fn is linked to a significant decrease in the diversity of the associated tonsillar microbiome.

Epidemiology of Traumatic Spinal Injury: A 15-Year Retrospective Study of 1092 Cases

Background: Spinal trauma is a well‑documented problem in developed countries but literature has been mute on this problem in developing counties. The purpose of this study was to elucidate epidemiological characteristics of spine trauma in our center over a 15-year period. Methods: All consecutive patients with acute spinal trauma who were admitted in our center from March 2003 to March 2018 were included. The analysis was focused on patient-related demographic characteristics, cause and mechanism of injury, level and type of injury, neurological deficit, associated injuries, management and outcome. All of the statistical calculations were performed using the Statistical Package for Social Sciences (SPSS). Statistical analyses were conducted using the Student t-test and nonparametric tests (Mann-Whitney U-test, Kruskal-Wallis test). Values for p<0.05 were regarded as statistically significant and all confidence intervals were expressed at 95%. Results: A total of 1,092 patients with acute traumatic spinal injuries were managed in our trauma center. There were 74.3% males and 25.7% females with mean age 34.5 years. Young adults (age group: 18-39 years) were more affected with 58.9%. The leading mechanism of injury was compression with 39.2%. The most common cause of accident was motor vehicle collision accident (58.5%) followed by high-energy falls (32.6%). Six hundred eighty-seven patients (62.8%) had spinal cord injury, with 14.4% complete tetraplegia and 7.7% complete paraplegia. Overall, the use of operative treatment (64.8%) exceeded that of conservative treatment (35.2%). Conclusion: This study’s unique feature of delineating variables with statistical significance trending toward better management provides useful data to guide future researches, benchmarking, public health policy, and efficient resource allocation for the management of spine trauma.

Current Healthcare Utilization Patterns and Most Common Reasons for Admission Amongst Patients with Sickle Cell Disease

Background: Sickle cell disease (SCD) is an inherited condition affecting over 100,000 individuals in the United States with increasing prevalence, with annual healthcare costs of approximately $488 million dollars. Peak rates of healthcare utilization occur in the young adult population, with the highest mortality risk when transitioning to adult care. This has prompted increased efforts to improve the transition process from pediatric to adult care, in addition to optimizing overall care for SCD patients. The impact of these efforts on current healthcare utilization, including reasons for hospitalization, has yet to be explored. This study sought to explore current rates of healthcare utilization in SCD patients, measured by inpatient hospitalizations, as well as the most common reasons for hospitalization to inform continued efforts to improve outcomes in the SCD population.Methods: Data was obtained from the Healthcare Cost Utilization Project (HCUP) State Inpatient Database (SID) for New York from 2005-2014. All patients with a principal or secondary ICD-9-CM diagnosis of any genotype of SCD (282.41, 282.42, 282.60-282.64, 282.68 or 282.69) were identified. Patients with anemia or other hemoglobinopathies not due to sickle cell were excluded. The encrypted identifier was used to identify all hospitalizations in SCD patients (including those not coded for SCD), and analyze outcomes at a patient-level. Utilization outcomes examined were (1) total number of patient encounters and (2) 30-day and (3) 90-day readmissions following the index hospitalization. To examine reasons for hospitalization, variables for common conditions were created using standard ICD-9-CM diagnosis codes found in the Elixhauser Comorbidity algorithm, a tool used to predict hospital resource use and in-hospital mortality, in addition to acute or chronic conditions associated with SCD. Descriptive statistics and univariate analyses were performed using SAS Enterprise Guide version 7.1. This project was determined to be exempt from Institutional Review Board oversight per the Washington University Human Research Protection Office.Results: A total of 19,729 patients had at least one hospitalization from 2005-2014 coded for SCD, with a total of 140,779 hospitalizations. The SCD population was 57.6% female and the primary insurance type was Medicaid (49.9%). The mean age at index hospitalization was 26.5 years (SD 19.3, range 0-104) and the mean length of stay was 5.5 days (SD 11.4). At the time of the index hospitalization SCD patients aged18-30 years made up 29% of the population (Table 1). The largest percentage of all hospitalizations also occurred among patients in this age group (33.3% of total encounters). Hospitalization rates per 10 person-years of observation were similar among patients aged 10-17 years (13.2), 18-30 years (13.8), 31-45 years (12.9) and 46-64 years (13.3). Both 30-day and 90-day readmissions after the index hospitalization were highest in the 18-30 year age group (33.9% and 31.1%, respectively, Table 2). The most commonly coded diagnoses were pneumonia (23.3%), vaso-occlusive crisis (22.9%) and respiratory infection (20.1%, Table 3). The most commonly coded principal diagnosis was vaso-occlusive crisis (11.7%). Diagnoses associated with the respiratory system accounted for the largest category of hospitalization reasons, including: pneumonia (23.3%), respiratory infection (20.1%), asthma (14.5%), respiratory failure (11.0%) and chronic lung disease (14.6%). (Table 3)Conclusion: Analysis of 10 years of inpatient data shows that overall rates of hospitalizations in SCD patients have decreased as compared to those previously reported in the literature. Rates per person years were similar across most age groups, but 30-day readmission, a frequently used quality metric, was highest in the young adult age group. This suggests an improvement in utilization patterns, but also reiterates the need for targeted efforts towards improved care in the young adult group. Hospitalizations were frequently due to vaso-occlusive episodes, and a large number of hospitalizations were due to complications of the pulmonary system, both infectious and non-infectious. Directed efforts towards optimizing pulmonary health and aggressive treatment of respiratory infections may further decrease the utilization burden and hasten the improvement of outcomes in the SCD population. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

GAIT DEFICITS UNDER DUAL - TASK CONDITIONS IN THE CONCUSSED ADOLESCENT AND YOUNG ATHLETE POPULATION: A SYSTEMATIC REVIEW.

There are no current sport concussion assessments that capture the effects of dual-task conditions on gait. Multiple studies have evaluated changes, but none have comprehensively examined literature related to the adolescent and young adult population.Purpose: The purpose of this systematic review is to synthesize documented changes in gait under dual-task conditions in adolescents and young adults after sustaining a concussion.Study Design: Systematic Review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was consulted to guide this systematic review. Six databases were searched: Cinahl, ProQuest, PubMed, Scopus, SPORTdiscus, and Web of Science. Concussion, gait, and dual-task, along with their synonymous terms were the search terms used. Inclusion criteria consisted of adolescent and young adult age groups, acute concussion, dual-tasking, and matched controls. Quality assessment was performed using The Joanna Briggs Institute Critical Appraisal Checklist for Case Control Studies. Ten full-text articles were selected for inclusion. Concussed individuals demonstrated longer stride times with shorter stride lengths, increased mediolateral displacement with corresponding increases in sagittal and frontal plane peak velocity, and decreased sagittal plane Center of Mass (COM) and Center of Pressure (COP) displacement. The majority of included studies demonstrated moderate to large effect sizes in these gait characteristics. Concussed individuals demonstrated decreased gait stability while ambulating with a dual-task condition. Though statistically significant differences between concussed individuals and matched controls lasted only 72 hours, concussed individuals demonstrated continued improvements in gait for up to two months post-injury, which has the potential to affect an athlete's ability to perform. Further research is needed to determine if a gait examination with a dual-task condition is a realistic, reliable, and valid measure to be included in return to sport testing. 2a.