Burden Of Disease In Adolescents Research Articles

The relationship between community violence and mental health symptoms in adolescents: protocol for a systematic review

Background: Mental health diseases are responsible for 16% of the global burden of disease in adolescents. Identifying the main determinants of these disorders in this age group can direct public and political efforts aimed at their prevention. Two previous meta-analyses showed a moderate and positive effect between exposure to community violence and mental health symptoms; however, there are still significant gaps to be addressed. Objectives: To evaluate whether adolescents’ exposure to a higher degree of community violence is associated with a higher risk of internalizing mental health symptoms and to investigate whether degrees of community violence events (victimization, witnesses and heard about) is associated with a higher risk of internalizing mental health outcomes (depression, anxiety and postraumatic stress disorder). Methods: A systematic review, research question and inclusion and exclusion criteria were developed according to the PEO format. The population consists of adolescents aged 10 to 24 years, the exposition involves individuals who were exposed to community violence, the comparison is adolescents who were not exposed or who were exposed to community violence to a smaller degree, and the outcome consists of internalizing mental health symptoms. Selection, extraction and quality assessment are being performed independently by two researchers. Results: A narrative synthesis will be presented. If possible, a meta-analysis will be performed with subgroup analyses of age, sex, degree of community violence and race. Publication bias will be assessed using funnel plots. This protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) - CRD 42019124740.

Prevalence of anxiety disorders and its associated factors among adolescents in Arpookara Panchayat

Background: Adolescents (10 -19 years) constitute 1.3 billion in the world today. According to WHO mental health issues constitute 13% of the global burden of disease in adolescents of which anxiety disorders are the most common. Objective was to estimate the prevalence of anxiety disorders among adolescents using SCARED tool, to find the association of selected factors with anxiety disorders. Methods: A cross sectional study was conducted among 590 adolescents in Arpookara Panchayat. A semi-structured pretested questionnaire was used for collecting sociodemographic details. Anxiety disorder was assessed using Screen for Child Anxiety Related Emotional Disorder (SCARED) tool. Data was coded and entered in Microsoft excel and analysed using IBM SPSS software version 20 Results: The mean age of the study participants was 15.04 with SD ±3.013. Prevalence of anxiety disorders using SCARED tool was found to be 21.4%. Factors found to have statistically significant association with anxiety on univariate analysis were female gender (p=0.001), mother’s education more than high school level (p=0.036), time spent with father (p=0.001), time spent with mother(p=0.001), inadequate sleep (p=0.001) and family history of mental illness(p=0.043). On binary logistic regression following factors with p<0.05 were found to be independent predictors of anxiety-female gender (OR=2.037), mother’s education more than high school level (OR=1.469) adequate time spent with father (OR=0.713), inadequate sleep (OR=14.726), family history of mental illness (OR=3.521) Conclusions: More than one fifth of adolescents are having anxiety disorders. There should be efforts for early diagnosis and prompt treatment of anxiety disorders among adolescents.

Review of the India Adolescent Health Strategy in the context of disease burden among adolescents

A nuanced understanding of the health needs of adolescents in the context of the India Adolescent Health Strategy (IAHS) is needed to inform policy interventions for improving the health and well-being of adolescents in India. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we identified the top ten causes of years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) disaggregated by sex and age group (10-14 and 15-19 years) for India and its states in 2019. To inform the IAHS of refinement or expansion in focus needed to improve adolescent health in India, we reviewed the extent to which the top 10 causes of disease burden are addressed in the IAHS, and the availability of and age- and sex-disaggregation in the service utilisation data for adolescents captured in the Adolescent Friendly Health Clinic monitoring information system (AFHC MIS) and Health Management Information System (HMIS). We also reviewed the availability of and age-and sex-disaggregation in the data capture at the population level for the IAHS outcome indicators in the data sources identified in the IAHS operational framework. Females in the 10-14 and 15-19 years age groups suffered 6.75 million and 9.25 million DALYs, respectively, 39.1% and 44.2% of which were YLLs; the corresponding DALYs for males were 6.71 million and 9.65 million (42.3% and 41.1% YLLs), respectively. Within the 6 thematic areas of the IAHS, most strategies and indicators identified are for sexual and reproductive health followed by nutrition, and broadly these conditions accounted for YLDs and not YLLs in adolescents. Significant gaps in the IAHS in comparison to the disease burden for fatal diseases and conditions were seen across injuries, communicable diseases, and non-communicable diseases. Injuries accounted for 65.9% and 45.3% of YLLs in males and females aged 15-19 years, and 40.8% in males aged 10-14 years. Specifically, road injuries (15.3%, 95% UI 11.0-18.0) and self-harm (11.3%, 95% UI 8.7-14.2) accounted for most of the injury deaths in 15-19 years whereas drowning (7.7% 95% UI 5.8-9.6) and road injuries (6.9%, 95% UI 4.7-8.6) accounted for the most injury deaths in 10-14 years males. However, only self-harm and gender-based violence are specifically addressed in the IAHS with non-specific interventions for other injuries. Diarrhoea, lower respiratory infections, malaria, encephalitis, tuberculosis, typhoid, cirrhosis, and hepatitis are the other disease conditions accounting for YLLs and DALYs in adolescents but these are neither addressed in the IAHS nor in service provision under the AFHC MIS. There is no age- or sex-disaggregation in the cause of death data captured in the HMIS to allow an understanding of mortality in adolescents. For the IAHS outcome indicators at the population level, data capture for the 10-14 years irrespective of sex was largely missing from the population surveys and none of the surveys captured data for either females or males aged 15-19 years for physical inactivity and mental health indicators. The considerable differences seen in the IAHS thematic focus as compared with the leading causes of fatal and non-fatal disease burden in adolescents in India, and in the availability of population-level data to monitor the outcome indicators of the IAHS can pose substantial limitations for improving adolescent health in India. The findings in this paper can be utilized by decision makers to refine action aimed at improving adolescent health and well-being. Bill & Melinda Gates Foundation.

Assessing perspectives of disease burden and clinically meaningful changes using the Spinal Muscular Atrophy Health Index in adolescents and young adults

Spinal muscular atrophy (SMA) treatment may increase survival and improve physical function among adolescents and young adults. Validated patient-reported outcome measures are needed to understand which treatment benefits are clinically meaningful and to develop targeted resources for this population. To date, use of the SMA Health Index (SMA-HI) in pediatric and young adult populations has been limited. Here, we report results from a survey of adolescents and young adults with SMA to quantifiably understand individuals' perceptions of disease burden. Participants aged 12-25 y with a self-reported diagnosis of SMA completed an online survey containing demographic questions and the SMA-HI, a patient-reported outcome measure that assesses individuals' perceptions of disease burden in 15 symptomatic areas. Eighty-eight participants completed the survey. Total SMA-HI scores and SMA-HI subscale scores including shoulder and arm function; back, chest, and abdominal function; activity participation; hand and finger strength; swallowing function; gastrointestinal function; respiratory function; mobility and ambulation, and total disease burden were significantly higher (greater disease burden) in patients with poorer motor function and severe SMA. SMA-HI total and subscale scores were generally lower in adolescents (12-17 y old) versus adults (18-25 y old), suggesting a possible progression of symptomatic disease burden over time. This study demonstrates the utility of the SMA-HI for measuring clinically relevant disease burden in adolescents and young adults with SMA. This study demonstrates how disease burden varies by age, SMA type, and other demographics.

Community violence and internalizing mental health symptoms in adolescents: A systematic review.

PurposesMental disorders are responsible for 16% of the global burden of disease in adolescents. This review focuses on one contextual factor called community violence that can contribute to the development of mental disordersObjectiveTo evaluate the impact of community violence on internalizing mental health symptoms in adolescents, to investigate whether different proximity to community violence (witness or victim) is associated with different risks and to identify whether gender, age, and race moderate this association.Methodssystematic review of observational studies. The population includes adolescents (10-24 years), exposition involves individuals exposed to community violence and outcomes consist of internalizing mental health symptoms. Selection, extraction and quality assessment were performed independently by two researchers.ResultsA total of 2987 works were identified; after selection and extraction, 42 works remained. Higher exposure to community violence was positively associated with internalizing mental health symptoms. Being a witnessing is less harmful for mental health than being a victim. Age and race did not appear in the results as modifiers, but male gender and family support appear to be protective factors in some studies.ConclusionThis review confirms the positive relationship between community violence and internalizing mental health symptoms in adolescents and provides relevant information that can direct public efforts to build policies in the prevention of both problems.

Negative Symptom Domains Are Associated With Verbal Learning in Adolescents With Early Onset Psychosis.

Background: Early-onset psychosis (EOP) is among the leading causes of disease burden in adolescents. Negative symptoms and cognitive deficits predicts poorer functional outcome. A better understanding of the association between negative symptoms and cognitive impairment may inform theories on underlying mechanisms and elucidate targets for development of new treatments. Two domains of negative symptoms have been described in adult patients with schizophrenia: apathy and diminished expression, however, the factorial structure of negative symptoms has not been investigated in EOP. We aimed to explore the factorial structure of negative symptoms and investigate associations between cognitive performance and negative symptom domains in adolescents with EOP. We hypothesized that (1) two negative symptom factors would be identifiable, and that (2) diminished expression would be more strongly associated with cognitive performance, similar to adult psychosis patients.Methods: Adolescent patients with non-affective EOP (n = 169) were included from three cohorts: Youth-TOP, Norway (n = 45), Early-Onset Study, Norway (n = 27) and Adolescent Schizophrenia Study, Mexico (n = 97). An exploratory factor analysis was performed to investigate the underlying structure of negative symptoms (measured with the Positive and Negative Syndrome Scale (PANSS)). Factor-models were further assessed using confirmatory factor analyses. Associations between negative symptom domains and six cognitive domains were assessed using multiple linear regression models controlling for age, sex and cohort. The neurocognitive domains from the MATRICS Consensus Cognitive Battery included: speed of processing, attention, working memory, verbal learning, visual learning, and reasoning and problem solving.Results: The exploratory factor analysis of PANSS negative symptoms suggested retaining only a single factor, but a forced two factor solution corroborated previously described factors of apathy and diminished expression in adult-onset schizophrenia. Results from confirmatory factor analysis indicated a better fit for the two-factor model than for the one-factor model. For both negative symptom domains, negative symptom scores were inversely associated with verbal learning scores.Conclusion: The results support the presence of two domains of negative symptoms in EOP; apathy and diminished expression. Future studies on negative symptoms in EOP should examine putative differential effects of these symptom domains. For both domains, negative symptom scores were significantly inversely associated with verbal learning.

Our teenagers: still a pending subject

Adolescents (ages 10-19) represent approximately 16% of the population in Mexico. This article identifies their main morbidity and mortality conditions, as well as current strategies and interventions to reduce preventable causes. Identify the main causes of morbidity, mortality, and disease burden in adolescents from 10 to 19 years of age, and current interventions to reduce mortality and improve adolescent health in the Mexican and international context. A descriptive-exploratory statistical analysis of primary sources was performed to identify the main causes of adolescent morbidity and mortality in Mexico. Through a structured literature search, current policies, and interventions to improve adolescent health were identified. Accidents are the second leading cause of death in adolescents aged 10 to 14 years and in the group of 15 to 19 years. Intentional injuries have increased in recent years, occupying the third cause of death in adolescents between 10 and 14 years old and the first cause of death among youngsters between 15 and 19 years old. The current health system urgently needs restructuring and reengineering, in which adolescent health and wellbeing intervention needs are considered.

Why the Anti-Meningococcal B Vaccination during Adolescence Should Be Implemented in Italy: An Overview of Available Evidence

Although meningococcal disease has a low incidence in Italy, it is a public health concern owing to its high lethality rate and high frequency of transitory and/or permanent sequelae among survivors. The highest incidence rates are recorded in infants, children and adolescents, and most of the cases are due to Neisseria meningitidis B. In Italy, anti-meningococcal B (anti-MenB) vaccination is free for infants but, despite the considerable disease burden in adolescents, no national recommendation to vaccinate in this age-group is currently available. The aim of this study was to assess the main available scientific evidence to support the Italian health authorities in implementing a program of free anti-MenB vaccination for adolescents. We conducted an overview of the scientific literature on epidemiology, disease burden, immunogenicity and safety of available vaccines, and economic evaluations of vaccination strategies. Each case of invasive meningococcal disease generates a considerable health burden (lethality rate: 9%; up to 60% of patients experience at least one sequela) in terms of impaired quality of life for survivors and high direct and indirect costs (the mean overall cost of acute phase for a single case amounts to about EUR 13,952; the costs for post-acute and the long-term phases may vary widely depending of the type of sequela, reaching an annual cost of about EUR 100,000 in cases of severe neurological damage). Furthermore, vaccination against meningococcus B in adolescence proved cost-effective. The study highlights the need to actively offer the anti-MenB vaccination during adolescence at a national level. This would make it possible to avoid premature deaths and reduce the high costs borne by the National Health Service and by society of supporting survivors who suffer temporary and/or permanent sequelae.

Unintentional injuries and violence among adolescents aged 12–15 years in 68 low-income and middle-income countries: a secondary analysis of data from the Global School-Based Student Health Survey

Injuries and violence account for a substantial proportion of the global burden of disease in adolescents, especially among low-income and middle-income countries (LMICs). We aimed to compare the prevalence of unintentional injuries and violence among young adolescents in LMICs. We did a secondary analysis of data from the Global School-based Student Health Survey (GSHS) for adolescents aged 12-15 years from LMICs collected between 2009 and 2015. Survey data was collected using a standardised questionnaire. We used survey data to calculate the overall prevalence of serious injuries and violence (eg, physical attack, physical fighting) and bullying per country. We did a random-effects meta-analysis to calculate pooled overall and regional estimates. We also did subgroup analyses stratified by sex, age (12-13 years vs 14-15 years), and time period (2009-11 vs 2012-15). Logistic regression models adjusted for sex, weights, stratum, and primary sampling unit were used to analyse the differences in prevalence of serious injuries, violence, and bullying. We included data from 68 LMICs, including 164 633 young adolescents (77 707 [47·2%] boys; 86 926 [52·8%] girls). The overall prevalence of physical attack, physical fighting, and serious injuries during the past 12 months were 35·6% (95% CI 30·7-40·5), 36·4% (29·9-42·9), and 42·9% (39·0-46·9), respectively. Prevalence varied by WHO region and was higher among boys than girls for injuries (47·8% vs 37·5%, p=0·00094), physical attack (41·0% vs 29·4%, p=0·001), and physical fighting (45·5% vs 26·9%, p<0·0001). Fractures (22·6%, 95% CI 19·1-26·1) and cuts (21·8%, 16·8-26·8) were the most common types of serious injury, and falling was the main cause of these injuries (33·1%, 30·2-35·9). The overall prevalence of bullying at least once in the past 30 days was 34·4% (27·1-41·7), irrespective of age and sex. The most common types of bullying were physical (18·3%, 13·7-23·0), verbal-sexual (13·2%, 10·2-16·2), and racial-ethnic (11·6%, 9·2-14·0). The prevalence of unintentional injuries and violence remain high among young adolescents in LMICs. These countries should prioritise the development of anti-violence and anti-injury programmes to improve health in their young adolescent populations. National Natural Science Foundation of China, National Key R&D Program of China, Natural Science Foundation of Zhejiang Province, Sanming Project of Medicine in Shenzhen, K.C. Wong Magna Fund in Ningbo University, and Ningbo Scientific Innovation Team for Environmental Hazardous Factor Control and Prevention.

\u201cIt is like a mind attack\u201d: stress and coping among urban school-going adolescents in India

BackgroundMental health problems are leading contributors to the global disease burden in adolescents. This study aims to highlight (1) salient context-specific factors that influence stress and coping among school-going adolescents across two urban sites in India; and (2) potential targets for preventing mental health difficulties.MethodsFocus group discussions were undertaken with a large sample of 191 school-going adolescent boys and girls aged 11–17 years (mean = 14 years), recruited from low- and middle-income communities in the predominantly urban states of Goa and Delhi. Framework analysis was used to identify themes related to causes of stress, stress reactions, impacts and coping strategies.ResultsProximal social environments (home, school, peers and neighborhood) played a major role in causing stress in adolescents’ daily lives. Salient social stressors included academic pressure, difficulties in romantic relationships, negotiating parental and peer influences, and exposure to violence and other threats to personal safety. Additionally, girls highlighted stress from having to conform to normative gender roles and in managing the risk of sexual harassment, especially in Delhi. Anger, rumination and loss of concentration were commonly experienced stress reactions. Adolescents primarily used emotion-focused coping strategies (e.g., distraction, escape-avoidance, emotional support seeking). Problem-focused coping (e.g., instrumental support seeking) was less common. Examples of harmful coping (e.g., substance use) were also reported.ConclusionsThe development of culturally sensitive and age-appropriate psychosocial interventions for distressed adolescents should attend to the challenges posed by home, school, peer and neighborhood environments. Enhancements to problem- and emotion-focused strategies are needed in order to bolster adolescents’ repertoire of adaptive coping skills in stressful social environments.

Unintentional Injury and Violence Among Adolescents in Low- and Middle-Income Countries

Background: Injuries and violence account for a substantial proportion of the burden of disease in adolescents globally, especially among low- and middle-income countries (LMICs), and prevention is still a public health priority. We compared unintentional injuries and violence among young adolescents in LMICs using data from the Global School-based Student Health Surveys (GSHS). Methods: This study analyzed the GSHS data for adolescents aged 12-15 years from 68 LMICs. Data were collected between 2009 and 2015 using a standardized questionnaire. This report focuses on four survey questions that assessed the frequency of injuries and violence-related variables (physical attack, physical fighting, and bullying), and we also used questions on the types and causes of injuries or bullying. The weighted prevalence and 95% confidential intervals (95% CIs) were calculated for each country, as were the overall and regional prevalence estimates. Findings: A total of 164,633 young adolescents (47·2% boys) were included in this study. The overall prevalence of injuries, physical attack, and physical fighting during the past 12 months were 42·9% (95% CI 39·0- 46·9), 35·6% (95% CI 30·7-40·5), and 36·4% (95% CI 29·9-42·9), respectively. These prevalence varied among regions, with significantly higher prevalence of physical attack, physical fight, and bullying among the African and Western Pacific regions generally than the Americas and Southeast Asia regions. Prevalence rates were higher among boys than girls for injuries (47.9% vs. 37·6, p<0·001), physical attack (41·0% vs. 29·4%, p=0·001), and physical fighting (45·5% vs. 26·9%, p<0·001). The overall prevalence of bullying occurring at least once during the past 30 days was 34·4% (95% CI 27·1-41·7), irrespective of age and sex. Among those adolescents suffering injuries, the most common type of serious injuries included fractures (22·6%, 19·1-26·1) and cuts (21·8%, 16·8- 26·8), and causes were mainly falls (33·1%, 30·2-35·9). The most common types of bullying were physical (18·3%, 13·7-23·0), verbal (13·2%, 10·2- 16·2), and racial (11·6%, 9·2-14). Significantly decreased trends in the prevalence rates across time were observed for injuries from physical attack and bullying (p-values <0·001). Interpretation: Despite an apparent decrease, the prevalence of violence and unintentional injuries among young adolescents in LMICs remains high. These high rates require LMICs to prioritize anti-violence and anti-injury programs to achieve improvements in population health. Funding Statement: This study received funding from the National Natural Science Foundation of China (81602853), National Key R&D Program of China (2017YFC1310902), Natural Science Foundation of Zhejiang Province (LY17H260002), K.C. Wong Magna Fund in Ningbo University, China Postdoctoral Science Foundation funded project (156458), Jiangsu Postdoctoral Science Foundation funded project (1601121B), and Ningbo Scientific Innovation Team for Environmental Hazardous Factor Control and Prevention (2016C51001). Declaration of Interests: The authors confirm that this article content has no conflict of interest. Ethics Approval Statement: All GSHS surveys were approved in each country by both a national government administration, most often the Ministry of Health or Education, and an institutional review board or ethics committee. Verbal or written consent was also obtained from the participants and their parents.

Can the Early Introduction of Palliative Care Alleviate the Disease Burden in Adolescents and Young Adults With Cancer?

As a result of oncology research and technology, great improvements in cancer treatment and survival have occurred in the past 2 decades. However, adolescents and young adults (AYAs) who received a diagnosis of cancer have not witnessed the same improvements in survival as children or older adults. Adolescent and young adult oncology is an emerging field that focuses on the physical and psychosocial treatment of patients between the ages of 15 and 39 years. Adolescent and young adult oncology patients experience high burden of psychological distress, in addition to physical symptoms, which affect their quality of life. Cancer is the leading disease-related cause of death in AYAs; it is imperative that healthcare professionals work to improve the high morbidity and mortality within this age group. Adolescent and young adult oncology patients would benefit from earlier implementation of palliative care. Incorporating palliative care alongside early cancer treatment regimens is beneficial in helping to relieve psychosocial and symptom burden, increase quality of life, and identify the patient's goals of care throughout the treatment process. Initiating palliative care at the beginning of treatment helps build therapeutic relationships between the patient and caregiver. When there are changes in goals of care, having an established relationship with palliative care eases the transition between active disease treatment and end-of-life care. Despite research indicating benefits to patients and increased growth of clinical and academic palliative care programs, many barriers still exist in incorporating palliative care alongside standard oncology care. Palliative care is not routinely incorporated into AYA oncology despite the high symptom burden and unique psychosocial needs of this population. This literature review discusses unique challenges that AYAs face throughout the diagnosis of cancer, identifies the unmet needs of this population, and advocates for an earlier introduction of palliative care throughout the treatment process.

Injuries, Violence, and Bullying Among Middle School Students in Oman.

Injuries account for a substantial proportion of the burden of disease in adolescents globally. This paper describes injury rates and associated exposures, and risk behaviors in Oman's 2010 Global School-based Student Health Survey (GSHS). This study used complex samples analysis to examine nationally-representative data from 1 606 students in grades eight, nine, and 10 who participated in the 2010 Oman GSHS. In total, 34.0% of the students reported having at least one injury in the past year that caused at least one full day abscence from usual activities or required medical treatment. The most common injury type reported was a broken bone or dislocated joint. The most common injury cause was falling. Additionally, 38.4% of the students reported being bullied in the past month, 38.8% reported being physically attacked in the past year, and 47.6% reported being in physical fights. Both injured boys and girls reported experiencing significantly more bullying, fights, and attacks (odds ratio > 2) than their non-injured classmates, even though only 9.6% of injured students reported that their most serious injury in the past year was the result of an assault, and students reporting assaults did not have significantly higher odds of exposure to these types of peer violence. More than half of the bullied students reported that the most frequent type of peer victimization they experienced was being made fun of with sexual jokes, comments, or gestures. Sexual bullying was the most common type of bullying reported by girls and boys. Promoting healthier peer relationships may help to reduce injuries in this age group as well as reducing the harmful effects of bullying.

Adolescent vaccines: Need special focus in India

WHO defines adolescence age between 10 to 19 years. In India, there are 243 million adolescents which constitute 21 per cent of the total population. The global burden of disease in adolescents (2011) reports that the total number of disability adjusted life years (DALYs) worldwide among adolescents were 230 million which constitutes 15.5% of total DALYs. The immunization is one of the most important, most beneficial and cost-effective disease prevention measures that can be provided for adolescents. The adolescent vaccination protects most of the world's adolescents from a number of infectious diseases that previously claimed millions of lives each year. In India, thousands of adolescents die and thousands are hospitalized every year due to communicable diseases that could have been prevented by vaccination. Main aims of adolescent vaccinations are: to boost immunity status that is waning after completion of primary immunization or absence of “natural” boosting due exposure to the particular disease. The recommendations for the immunization of adolescents are to improve vaccination coverage among them. The adolescent vaccinations also help in accelerate disease control or elimination effort. Improvement in adolescent immunization coverage in India, will require strengthening of health care delivery system and also require significant improvements in the health care functionaries ability and willingness to provide and deliver vaccines to adolescents.

Prédire le trouble bipolaire : que pouvons-nous apprendre des études prospectives de cohortes ?

Bipolar disorder (BD) is a life course illness; and there is increasing awareness of the many personal, social and economic consequences of the illness in older adults. However, it is important to emphasize that BD usually begins in late adolescence or early adulthood and 75 % cases have a first episode in this age period. This early onset and the associated level of disability mean that BD is the 4th leading cause of global disease burden in adolescents and young adults. Internationally, mental health services are increasingly striving to diagnose and treat BD as early as possible to try to prevent poor outcomes. In addition, researchers are using methods employed previously in psychosis studies as these may help us to recognise the earliest manifestations of BD. If it is possible to identify sub-threshold and 'ultra high risk' syndromes for BD, this might lead to new interventions that could target the prevention of first episodes of mania. One approach to understanding these risk syndromes is to examine prospective community cohort studies and BD offspring studies.This paper reviews prospective cohort studies that identify robust risk factors in early illness onset, which was defined as age at onset of BD between 15-25 years.We found that although > 50 % of individuals who developed BD had developed a putative BD prodrome prior to 14 years of age, this usually began with non-specific symptoms that overlap with similar presentations for those who later develop psychosis or severe depression. However, there are some features that seem to better identify groups with a BD "at-risk" syndrome. This syndrome is frequently composed of several factors such as mood lability, depressive episodes, prior anxiety, sleep and/or conduct disorders, attention and concentration impairment, altered energy patterns, and a family history of mania and/or depression. The course of these early predictors suggests the precursor syndromes are composed of mini-clusters of symptoms many of which are episodic and change over time. During the early phases of BD, most of the affective disturbances reported were depressive in polarity and started during adolescence, there were few manic or mixed or psychotic episodes with an onset before puberty. The pathogenesis of BD demonstrates a gradual progression from non-specific to more specific symptoms and then to frank BD features.Prospective community and offspring BD cohort studies are approaches that together can help us understand the evolution of BD and allow us to define the developmental pathways. Further, identifying subjects with BD "at-risk" syndrome using a clinical staging model may allow benign interventions to be used as first-line treatment - such as neuroprotective agents like essential fatty acids; second line treatments, with a less benign risk to benefit ratio should be reserved for severe or resistant cases.

AB0736 Quality of life measures and psychiatric symptoms in adolescents with SLE and FMF

BackgroundAdolescents with chronic illnesses are faced with a significant burden of the disease due to the illness and its treatment. There are wide spread physical, psychosocial and economical effects of...

Burden of disease in adolescents and young people in Spain

ObjectiveThis article analyses the burden of disease in adolescents and young people in Spain in 2008. Materials and methodsA cross-sectional population-based study. We estimated disability-adjusted life years (DALYs) by sex and cause for subjects aged 15-29 years. Data sources were used: (1) National death records by age, sex and cause; (2) population data (both in July 2008); and (3) estimates of the disability pattern for European countries with very low mortality. ResultsIn 2008, adolescents and young people lost 786,479 DALYs (414,346 in males). Non-communicable diseases generated 661,282 DALYs (84% of the total). The main specific causes of disease burden were: unipolar depression (16% of DALYs), alcohol use disorders (11%), migraine (9%), bipolar disorder (7%), schizophrenia (6%), road traffic accidents (5%) and drug addiction disorders (5%). ConclusionsThe burden of disease expressed in DALYs can define the loss of health in adolescents and young people. At these ages, health promotion and protection are essential to prevent the onset of disease in adulthood.

Carga de enfermedad en adolescentes y jóvenes en España

This article analyses the burden of disease in adolescents and young people in Spain in 2008.A cross-sectional population-based study. We estimated disability-adjusted life years (DALYs) by sex and cause for subjects aged 15-29 years. Data sources were used: 1) National death records by age, sex and cause; 2) Population data (both in July 2008); and 3) Estimates of the disability pattern for European countries with very low mortality.In 2008, adolescents and young people lost 786,479 DALYs (414,346 in males). Non-communicable diseases generated 661,282 DALYs (84% of the total). The main specific causes of disease burden were: unipolar depression (16% of DALYs), alcohol use disorders (11%), migraine (9%), bipolar disorder (7%), schizophrenia (6%), road traffic accidents (5%) and drug addiction disorders (5%).The burden of disease expressed in DALYs can define the loss of health in adolescents and young people. At these ages, health promotion and protection are essential to prevent the onset of disease in adulthood.

Neisseria meningitidis: epidemiology, treatment and prevention in adolescents

Neisseria meningitidis has been recognized as a cause of serious disease for centuries, but changing epidemiology and advances in treatment and prevention strategies mandate that providers be aware of ongoing developments with regard to this infection. Given the high burden of disease in adolescents, it is important for clinicians to be familiar with current recommendations regarding N. meningitidis. Adolescents and young adults continue to have the second highest incidence of disease from N. meningitidis. New diagnostic techniques, including polymerase chain reaction, have shown promise for enhancing detection of meningococcal infection in selected scenarios. Whereas most isolates of meningococcus remain penicillin-susceptible, fluoroquinolone resistance has now been documented in the US for the first time. Routine immunization using the meningococcal conjugate vaccine continues to be recommended, despite ongoing concern about a possible association between vaccination and Guillain-Barré syndrome. Active research is ongoing to develop a serogroup B vaccine and meningococcal vaccines that are immunogenic in infants and toddlers. Given the increased incidence of meningococcal infection among adolescents and the substantial morbidity and mortality associated with invasive disease, adolescent health providers must be familiar with current antibiotic treatment and prophylaxis guidelines and ongoing developments regarding meningococcal vaccination.