Childhood History Research Articles

FRI292 Asymptomatic TSH Secreting Pituitary Macroadenoma

Abstract Disclosure: B. Gautam: None. M.S. Hossain: None. H. liao: None. K. Mandal: None. D.S. Rosenthal: None. S.C. Kumar: None. Introduction: TSH-producing adenoma is a rare disorder accounting for 0.5-2% of all pituitary adenomas with prevalence of 1-2 cases/million, often diagnosed at the stage of invasive macroadenoma hence challenging to manage. Case Presentation: A 36 years old male with no PMH referred to endocrine clinic for the evaluation of insomnia with abnormal thyroid panel for last 4 years. He denied skin or hair changes, diaphoresis, tremor, change in appetite, weight or bowel habits, cold/heat intolerance, palpitations, recent use of biotin or x-ray contrast exposure. Patient denied headache, visual or hearing impairment, galactorrhea, sexual dysfunction, change in facial appearance or size of gloves & shoes. Patient also denied childhood history of developmental delay, learning disability and family history of thyroid disorder. Unremarkable physical exam with normal vitals. Thyroid was normal without palpable nodule. No thyroid bruit. Normal visual field by confrontation. No tremors, gynecomastia or galactorrhea noted. Laboratory results showed normal CBC, CMP, TSH 5.2 (0.55-4.78 uIU/ml) with FT4 2.1 (0.8-1.8 ng/dl), FT3 5.4 (2.3-4.2 pg/ml), FT4 by dialysis 3.1 (0.9-2.2 ng/dl), FT3 by dialysis 433 pg/dl, Thyroglobulin ab <1 (<1 IU/ml), TPO ab 3 (<9 IU/ml), TSI <89 (<140%), TBII <1 (<2 IU/L), HAMA <6 (<74 ng/ml). Normal ACTH 17 (6-50 pg/ml), serum cortisol level 10.5 (5.2-22.4 ug/dl), prolactin 9.2 (2-18 ng/dl), GH 0.1 (<7.1 ng/ml), IGF-1 183 (53-331 ng/ml), LH 4.7 (1.5-9.3 mIU/ml), FSH 5.9 (1.6-8 mIU/ml), free testosterone 120 (35-155 pg/ml) and total testosterone 1100 (250-1100 ng/dl), SHBG 82 (10-50 nmol/L), alpha-subunit 0.8 (0.1-0.5 ng/ml) & alpha/TSH molar ratio 1.5. MRI brain with pituitary protocol showed an expansile round enhancing soft tissue mass filling the sellar cavity measuring 1.5 x 1.5 x 1.3 cm tenting the optic chiasm without cavernous sinus involvement. Patient was diagnosed with TSH secreting pituitary adenoma and referred to Neurosurgery. Patient had successful trans-sphenoidal adenectomy. Post-surgery TFTs: TSH 2.18 (0.55-4.78 uIU/ml), FT4 1.2 (0.8-1.8 ng/dl). Pathology report showed pituitary adenoma, IM stains positive for FSH, GH patchy and TSH (patchy and weak), negative for prolactin and ACTH. Rare tumor cells positive for LH Discussion: Our case highlights the importance of early diagnosis and appropriate treatment of TSH secreting adenoma to prevent complications such as hyperthyroidism, visual field defect and pan-hypopituitarism. Diagnosis in our case was particularly challenging as the patient was completely asymptomatic, therefore emphasize the importance of correlating TSH level with FT4 and early evaluation of central cause in the presence of biochemical evidence suggesting central thyroid disorder. Presentation: Friday, June 16, 2023

Happy Families?: Scottish Presbyterian Missionary Children’s Homes, 1900s–1950s

This article focuses on two residential institutions in Edinburgh – Home House and Cunningham House – established in the first half of the twentieth century by various branches of Scottish Presbyterianism, to cater for the children of their missionaries operating overseas. These homes served to mitigate the common Protestant practice of family separation, whereby children often returned to countries of origin for all or some of their education. These Scottish homes replicated other Protestant institutions for missionary children. At the same time, they were smaller and more intimate in scale, and Presbyterians played on this to accentuate the homes' role in providing a substitute family for the residents. It argues that the Edinburgh homes can be understood from two equally important vantage points, drawing on insights from the history of emotions and the history of childhood. On the one hand, adult narratives played up notions of happiness and domestic stability for the children. On the other hand, children's narratives indicate considerable emotional ambiguity and navigation. As such, Cunningham House and Home House acted as important sites of emotional management perceived and experienced variously by children and adults.

Childhood contact with social services and self-harm and suicidal ideation in young adulthood: A population-wide cohort study in Northern Ireland

ObjectivesChildhood contact with social services is associated with adult suicide risk, but little is known about self-harm and suicidal ideation, which are recognised predictors of suicide. This study compares self-harm (SH) and suicidal ideation (SI) in young adults with childhood history of social services contact to unexposed peers.
 MethodA longitudinal, population-wide study of all children born 1985-1993 in Northern Ireland (NI) linking primary care registrations to social services data (1985-2015) and a national registry capturing all SH and SI presentations to the 12 Emergency Departments in NI (2012-2015). Multilevel logistic regression models estimated the association between level of contact with social services in childhood (no contact; referred but assessed as not in need (NIN); child in need (CIN); and child in care (CIC)) and SH, SI and any SH/SI, accounting for confounders and the amount of variation attributable to clustering by Health and Social Care Trust.
 ResultsThe cohort comprised 253,495 individuals (ages 18-30 years) alive and registered with a general practitioner during follow-up. Of the cohort, 4,026 presented with SH and 1,669 with SI. Individuals with a childhood history of social services contact comprised 10.8% of the cohort (2.9% NIN; 6.5% CIN; and 1.4% CIC) yet accounted for 40.9% of SH/SI cases. Likelihood of SH, SI, and any SH/SI increased stepwise with level of contact with social services. After full adjustment, young adults deemed NIN in childhood were three times more likely to present with SH/SI (OR 3.45 [95% CI 3.07-3.88]), former CIN five times more likely (OR 5.33 [95% CI 4.97-5.74]), and former CIC ten times more likely (OR 10.49 [95% CI 9.45-11.66]), relative to those with no contact.
 ConclusionAdults with a childhood history of social services contact, including those assessed as not in need, account for a disproportionate number of self-harm and suicidal ideation cases. Timely and targeted interventions aimed at this population have the potential to reduce the burden of self-harm and suicide

Experiences of peripartum depressive symptoms among Chinese middle-class migrant women in the Netherlands: a qualitative study of migrant motherhood

BackgroundA low educational level and poor economic status have repeatedly been identified as the main risk factors of peripartum depression among migrant women in existing studies. However, there is limited knowledge about a group of highly educated and middle-class migrant women, and how this group of migrant women deals with those risks and which protective factors facilitate a successful transition into motherhood in the host country. This study aims to shed light on the multifaceted psychosocial challenges during the peripartum period for Chinese migrant women in their relationships with intimate partners, mothers, and mothers-in-law.MethodsIn this qualitative study, semi-structured in-depth interviews were conducted digitally with 46 pregnant and postpartum middle-class Chinese migrant women with peripartum depressive symptoms in the Netherlands. The interview data were analyzed using content analysis.ResultsThe multifaceted psychosocial challenges for women with peripartum depressive symptoms were classified into three key categories: the ambivalence towards different mothering values, perceived inadequate and mismatching social support and adverse childhood experiences.ConclusionWell-educated middle-class Chinese migrant women with peripartum depressive symptoms faced challenges in the transition into motherhood due to the unmet self-expectations regarding the pursuit of a good quality of life and a happy motherhood. The nurturing intimate relationships and adequate social support in the host country have mitigated recollections of their adverse childhood experiences. Future prevention programs and postpartum care should consider the contextual specificity based on the childhood history. International mental health research should pay more attention to the growing and potentially vulnerable group of well-educated middle-class migrant women.

"Playes Print the Letter": American Child(hoods) as Archival Present/ce

Abstract: Drawing attention to the "similar motivations of nostalgia, desire, fantasy, and power" that bind childhood and archival studies together, Karen Sánchez-Eppler observes that "[t]he questions of politics and power at stake in archival work and in Childhood Studies are often one and the same." In this article, I expand Sánchez-Eppler's already complex directory by adding temporality to it. Pausing in the middle to examine a number of letters that children sent to the juvenile periodical St. Nicholas in the 1890s, I engage with the notion of time as a productive means to comprehend and ultimately work to counter the relative dearth of authorial, intentional, and dedicated archives of childhood—what historians of childhood have long identified as one of the main challenges for writing the history of children and youth. As I argue in this paper, to engage with time in the study of children and childhoods past begins with making the case for childhood as both a temporary and a temporal category and examining what this dual temporality means and does to archiving childhood.

Infant food allergy phenotypes and association with lung function deficits and asthma at age 6 years: a population-based, prospective cohort study in Australia.

Food allergy is considered a precursor to asthma in the context of the atopic march, but the relationship between infant food allergy phenotypes and lung function and asthma in childhood is unclear. We aimed to examine the association between food sensitisation and challenge-confirmed food allergy in infancy, as well as persistent and resolved food allergy up to age 6 years, and the risk of lung function deficits and asthma at age 6 years. The longitudinal, population-based HealthNuts cohort study in Melbourne, VIC, Australia, recruited 5276 infants children aged 1 year who attended council-run immunisation sessions between Sept 28, 2007, and Aug 5, 2011. At age 1 year, all children completed skin prick testing to four food allergens (egg, peanut, sesame, and either shrimp or cow's milk) and an oral food challenge (egg, peanut, and sesame) at the Royal Children's Hospital in Melbourne. Parents completed questionnaires about their infant's allergy history, demographic characteristics, and environmental exposures. At age 6 years, children were invited for a health assessment that included skin prick testing for ten foods (milk, egg, peanut, wheat, sesame, soy, shrimp, cashew, almond, and hazelnut) and eight aeroallergens (alternaria, cladasporum, house dust mite, cat hair, dog hair, bermuda grass, rye grass, and birch mix), oral food challenges, and lung function testing by spirometry. Questionnaires completed by parents (different to those completed at age 1 year) captured the child's allergy and respiratory history and demographics. We investigated associations between food allergy phenotypes (food-sensitised tolerance or food allergy; and ever, transient, persistent, or late-onset food allergy), lung function spirometry measures (forced expiratory volume in 1 sec [FEV1] and forced vital capacity [FVC] z-scores, FEV1/FVC ratio, forced expiratory flow at 25% and 75% of the pulmonary volume [FEF25-75%], and bronchodilator responsiveness), and asthma using regression methods. Only children with complete data on the exposure, outcome, and confounders were included in models. Infants without food sensitisation or food allergy at age 1 year and 6 years served as the reference group. Of 5276 participants, 3233 completed the health assessment at age 6 years and were included in this analysis. Food allergy, but not food-sensitised tolerance, at age 1 year was associated with reduced FEV1 and FVC (aβ -0·19 [95% CI -0·32 to -0·06] and -0·17 [-0·31 to -0·04], respectively) at age 6 years. Transient egg allergy was associated with reduced FEV1 and FVC compared with never having egg allergy (-0·18 [95% CI -0·33 to -0·03] and -0·15 [-0·31 to 0·00], respectively), whereas persistent egg allergy was not (FEV1 -0·09 [-0·48 to 0·31]; FVC -0·20 [-0·62 to 0·21]). Transient peanut allergy was associated with reduced FEV1 and FVC (FEV1 aβ -0·37 [-0·79 to 0·04] and FVC aβ -0·55 [-0·98 to -0·12]), in addition to persistent peanut allergy (FEV1 aβ -0·30 [-0·54 to -0·06] and FVC aβ-0·30 [-0·55 to -0·05]), and late-onset peanut allergy (FEV1 aβ -0·62 [-1·06 to -0·18] and FVC aβ-0·49 [-0·96 to -0·03]). Estimates suggested that food-sensitised tolerance and food allergy were associated with reduced FEF25-75%, although some estimates were imprecise. Food allergy phenotypes were not associated with an FEV1/FVC ratio. Late-onset peanut allergy was the only allergy phenotype that was possibly associated with increased risk of bronchodilator responsiveness (2·95 [95% CI 0·77 to 11·38]). 430 (13·7%) of 3135 children were diagnosed with asthma before age 6 years (95% CI 12·5-15·0). Both food-sensitised tolerance and food allergy at age 1 year were associated with increased asthma risk at age 6 years (adjusted odds ratio 1·97 [95% CI 1·23 to 3·15] and 3·69 [2·81 to 4·85], respectively). Persistent and late-onset peanut allergy were associated with higher asthma risk (3·87 [2·39 to 6·26] and 5·06 [2·15 to 11·90], respectively). Food allergy in infancy, whether it resolves or not, is associated with lung function deficits and asthma at age 6 years. Follow-up studies of interventions to prevent food allergy present an opportunity to examine whether preventing these food allergies improves respiratory health. National Health & Medical Research Council of Australia, Ilhan Food Allergy Foundation, AnaphylaxiStop, the Charles and Sylvia Viertel Medical Research Foundation, the Victorian Government's Operational Infrastructure Support Program.

Survival Kits for Babies: Baby Box Books and Infant Temporality in Finnish Maternity Packages

Maternity packages, introduced in 1938 by the Finnish state to counteract declining birth rates and infant mortality, have reached all newborns regardless of income or social status from 1949 onwards. The box is a unique phenomenon internationally and a significant part of the Finnish history of childhood as its contents mirror contemporaneous views on childhood. In 1982, a baby book was added to the box. Research has, however, kept focusing on the social aspects of the box, ignoring the baby books. In this article, we make up for the lack of scholarly interest in the baby box books by studying how they depict temporal normativity. Drawing on queer temporal studies (Halberstam 2005; Freeman 2010), we introduce the terms infant temporality/ baby time to discuss the interplay of aesthetics and normative timelines. We claim that these books use bodily tempo, rhythm, movement, as well as sensory and tactile aspects to depict non-normative timelines, understood as infant temporality. Drawing on Hartmut Rosa (2019), we argue that the interplay between adult caregiver and infant encouraged by these books aims to achieve resonance, understood as presence and connection. In contrast to adult acceleration, we claim that these books, as part of their unique hybrid aesthetics, present infant temporality as deceleration. Reaching a vast number of Finnish families yearly, the baby box books provide a strong temporal discourse while promoting a resonant reproductive time. However, we find that while the books studied deviate from adult temporal normativity, infant temporality is still included in a normative reproductive timeline, sanctioned by the Finnish state. Hereby, the baby box books expose temporal complexities of our era.

Oral 41 - Long-term medical and functional outcomes in adults with a childhood history of vesico-ureteric reflux

Oral 41 - Long-term medical and functional outcomes in adults with a childhood history of vesico-ureteric reflux

Risk factors of suicidal spectrum behaviors in adults and adolescents with attention-deficit / hyperactivity disorder – a systematic review

IntroductionAdolescents and adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of suicidal spectrum behaviors (SSBs). However, there is limited knowledge about risk factors triggering SSBs in this group of people.ObjectiveTo explore published literature concerning factors that may increase the risk of SSBs in adults and adolescents with ADHD.MethodsA systematic literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on 22nd of February 2022 using the Ovid MEDLINE and Web of Science databases. Three categories of search terms were used: (1) self-harm, self-injury, self-mutilation, suicide, self-poisoning; (2) adults, adolescents; and (3) attention-deficit hyperactivity disorder/ADHD. Studies with data concerning mediating factors of SSBs in relation to a clinical diagnosis of ADHD in participants above 16 years of age were included.ResultsThe literature search identified 604 articles, of which 40 were included in the final study selection. Factors found to increase the likelihood of SSBs included ADHD symptom severity and persistence, female gender, family history of ADHD, childhood and parental influences, and social functioning. Even when adjusting for psychiatric comorbidities, most studies showed that adults and adolescents with ADHD have an elevated risk of SSBs.ConclusionThis systematic review has documented that several demographic and clinical features are associated with an increased risk of SSBs in adolescents and adults with ADHD. Notably, ADHD emerges as an independent risk factor for SSBs. This information ought to have clinical implications in terms of screening and suicide prevention strategies. Further longitudinal studies are needed to investigate the outcome of preventive strategies in individuals along the full spectrum of ADHD symptom severity.

Childhood maltreatment predicts maternal sensitivity to distress: Negative attributions during the transition to parenthood.

Childhood maltreatment is a predictor of subsequent parenting behaviors; however, the mechanisms explaining this association have been understudied. The present study examined the indirect effect of childhood maltreatment on maternal sensitivity to distress via (a) emotion regulation difficulties, (b) negative attributions about infant crying, (c) minimizing attributions about infant crying, and (d) situational attributions about infant crying. The sample included 259 primiparous mothers (131 Black and 128 White) and their 6-month-old infants (52% female). Mothers retrospectively reported on their childhood history of maltreatment when their infants were about 2 years old. Emotion regulation difficulties and causal attributions about infant crying were assessed prenatally. Maternal sensitivity to distress was rated during three distress-eliciting tasks when children were 6 months old. Results from the structural equation model demonstrated that maternal childhood maltreatment was significantly positively associated with negative attributions about infant crying but not with emotion regulation difficulties, minimizing attributions, or situational attributions about crying. Furthermore, negative attributions about crying were associated with lower sensitivity to distress, and there was an indirect effect of childhood maltreatment on sensitivity to distress via negative attributions about infant distress. These effects were significant above and beyond the effects of coherence of mind, concurrent depressive symptoms, infant affect, maternal age, race, education, marital status, and income-to-needs ratio. The results suggest that altering negative attributions about infant crying may be an important area to intervene during the prenatal period to reduce continuity in maladaptive parenting across generations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Developmental Feeding Stages and Their Impact on Child Feeding Behavior.

Previous research has shown that critical periods of feeding skills development exist and feeding problems can arise in children due to delays in attaining feeding developmental milestones. This study aims to delineate the transitional process of feeding development in healthy children and children with gastrointestinal diseases (GIDs) and to examine the relationship between feeding milestones and the appearance of later feeding problems. A cross-sectional case-control study among 711 healthy Greek children and 119 children with GID, aged 2-7 years. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale and "self-reported" questionnaires assessing child's feeding history. Differences in feeding behavior of preschoolers between the 2 groups were found concerning the time of introduction of complementary (pureed), lumpy, and table foods as well as finger feeding and regular cup-drinking. Age-specific milestones as proposed by guidelines were not reached. Late introduction of complementary and lumpy foods (>6 months and >9 months, respectively) as well as finger feeding (>9 months) were predictive of more problematic feeding behaviors later on. The trajectory of feeding development, including less studied feeding milestones, both in healthy children and children with GIDs, indicates that there are discrepancies between current feeding practices and infant feeding guidelines, and a tendency to delay the acquisition of all assessed feeding milestones.

Parental experiences and opinions regarding the management of acute otitis media in Finland-a comparative questionnaire between 2006 and 2019.

Treatment guidelines for acute otitis media (AOM) have changed over the past 20 years. Watchful waiting is often recommended as an option for antibiotic treatment and the use of proper pain medication is emphasised. To study parental experiences and opinions regarding the management of AOM and compare our findings with our previous questionnaire submitted in 2006. We sent an online survey link through day-care centres and Facebook parental groups in Turku area. Children <4 years of age attending day care were included in the analysis. We asked about the child's history of AOM, parental opinions about AOM treatment, and antibiotic resistance. Results of 2019 were compared with those of 2006. Altogether 84% (320/381) and 83% (568/681) of children had had at least 1 episode of AOM in 2019 and 2006, respectively. In 2019, more children had been treated without antibiotics (30% vs. 13%, P < 0.001) and fewer parents thought that antibiotics are necessary for the treatment of AOM (70% vs. 85%, P < 0.001) compared with 2006. The use and knowledge of painkillers had increased over the past 13 years. Painkillers had been given at least once to 93% (296/320) of children in 2019 and 80% (441/552) of children in 2006 (P < 0.001). Today, more parents accept watchful waiting as a treatment option for AOM and give painkillers to their children, which indicates that the education about optimal management of AOM has reached parents.

System management and compensatory parenting: Educational involvement after maternal incarceration

AbstractResearch has demonstrated that paternal incarceration is associated with lower levels of educational involvement among fathers and primary caregivers, but little is known regarding caregiver educational involvement when mothers have been incarcerated. In this study, we present the first analysis of variation in school‐ and home‐based educational involvement by maternal incarceration history, pairing survey and interview data to connect macro‐level group differences with micro‐level narratives of mothers’ involvement in their children's education. Our survey data demonstrate that children of ever‐incarcerated mothers experience increased school‐based educational involvement by their primary caregivers, regardless of whether the caregiver is the mother herself. Our interview data point to compensatory parenting as a key motivating factor in educational involvement, wherein a caregiver endeavors to “make up for” the child's history of maternal incarceration. Findings add to the literature demonstrating maternal incarceration as a distinct experience from both paternal incarceration and material disadvantage alone, and they suggest the need to explore the role of schools as potential points of productive institutional involvement for mothers with an incarceration history.

PRE-ARTHRITIC HIP DISEASE: ISOLATED LABRAL PATHOLOGY IS A VALID DIAGNOSIS

Our understanding of pre-arthritic hip disease has evolved tremendously but challenges remain in categorizing diagnosis, which ultimately impacts choice of treatments and clinical outcomes. This study aims to report patient reported outcome measures (PROMs) comparing four different condition groups within hip preservation surgery by a group of fellowship-trained surgeons.From 2018 to 2021, 380 patients underwent hip preservation surgery at our center and were classified into five condition groups: dysplasia: 82 (21.6%), femoro-acetabular impingement (FAI): 173 (45.4%), isolated labral tear: 103 (27.1%), failed hip preservation: 20 (5.3%) and history of childhood disease/other: 2 (0.5%). International hip outcomes Tool 12 (IHOT-12), numeric pain score and patient-reported outcomes measurement information system (PROMIS) were collected pre-operatively and at 3 months and 1 year post-operatively, with 94% and 82% follow-up rate respectively.Arthroscopy (75.5%) was the most common procedure followed by peri-acetabular osteotomy (PAO) (22.4%) and surgical dislocation (2.1%). Re-operation rate were respectively 18.3% (15), 5.8% (10), 4.9% (5), 30% (6) and 0%. There were 36 re-operations in the cohort, 14 (39%) for unintended consequences of initial surgery, 10 (28%) for mal-correction leading to a repeat operation, 8 (22%) progression of arthritis, and 4 (11%) for incorrect initial diagnosis/intervention. Most common re-operations were hardware removal 31% (7 PAO, 3 surgical hip dislocation and 1 femoral de-rotational osteotomy), arthroscopy 31% (11) and arthroplasty 28% (10). All groups had significant improvements in their IHOT-12 as well as PROMIS physical and numerical pain scales, except those with failed hip preservation. Dysplasia group showed a slower recovery.Overall, this study demonstrated a clear relation between the condition groups, their respective intervention and the significant improvements in PROMs with isolated labral pathology being a valid diagnosis. Establishing tertiary referral centers for hip preservation and longer follow-up is needed to monitor the overall survivorship of these various procedures.

HOW ARE ADULTS WITH LEGG-CALVE-PERTHES DISEASE (LCPD) FUNCTIONING AFTER TOTAL HIP ARTHROPLASTY? RESULTS OF AN INTERNATIONAL WEB-BASED SURVEY

LCPD can cause femoral head deformity and osteoarthritis requiring total hip replacement (THR). Currently, there is little data on how patients are functioning after a THR from patients’ perspective. The purpose of this study was to collect a large patient-reported outcome data set on adults with LCPD, including those who had a THR, using a Web-survey method and to compare their outcomes to a normative population.An English REDCap-based survey was built and made available on a LCPD study group website. The survey included childhood and adult LCPD history, SF-36 Health Survey, and the Hip Disability and Osteoarthritis Outcome Score (HOOS). Statistical analysis included t-test and linear and proportional odds regressions.Of the 1182 participants who completed the survey, 261 participants (89 M, 172 F) had a THR. The mean age at survey was 44.6±12.4 years (range 20–79). The mean duration since THR was 7.2±8 years (median 4, range 0–43). Gender and age matched analysis showed that THR participants had significantly lower HOOS Quality-of-Life and Sports scores (p&lt;0.0001) for all age groups in comparison to a normative cohort. In women, the HOOS Symptoms, Daily Living, and Pain scores were also significantly lower in the &lt;55 age groups (p&lt;0.05). Similarly, SF-36 scores were significantly lower (p&lt;0.05) in female &lt;45 age groups in 5 out of 8 SF-36 scales. Overall, hip dysplasia and the number of years-from-THR were the main factors associated with worse SF-36 and HOOS scores. In comparison to the non-THR participants, THR participants had higher scores in some of the HOOS and SF-36 scales.LCPD participants with THR had significantly worse HOOS and SF-36 scores in most of the scales studied than a normative cohort, especially in women. There is significant disability even after a THR, warranting continued efforts to improve treatment and outcome.

#3295 RAPIDLY PROGRESSIVE AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE : RISK FACTORS FOR DISEASE SEVERITY DURING CHILDHOOD AND EARLY ADULTHOOD

Abstract Background and Aims Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease and is characterized by genetic complexity and phenotypic variability. The age of reaching kidney failure (KF) is variable and covers the complete age-spectrum. There is an unmet need for early biomarkers to differentiate between rapid and slow progressors. The PROPKD score identified hypertension before the age of 35 years as a risk factor for rapid kidney function decline. We aim to identify earlier risk factors for rapid disease progression by studying a population of ADPKD patients who reached kidney failure (KF) before the age of 40y. Method This multicentric retrospective study focusses on a unique population (n = 200) of ADPKD patients who reached KF before 40y. Kidney failure (KF) was defined as CKD5 or start of Kidney Replacement Therapy (KRT), whichever came first. Longitudinal data on childhood history, comorbidities and kidney function were collected. Life table and Proportional Hazards analysis were used to assess associations between clinical parameters and time to KF. Results Median age of ADPKD diagnosis was 22.3 (16.5 – 28.6) and median age of KF onset was 36.2 years (32.9-38.7 years). Fourty-seven patients were genotyped (23.5%) of which 38 patients (81.0%) were PKD1T and 8 (17.0%) were PKD1NTand only 1 patient (2.1%) was PKD2. Median age at first urological event was 27.0 (20.7 – 32.0) years. 71 patients (35.5%) had history of UTI's, 67 patients (33.5%) had hemorrhagic cysts on abdominal imaging, 66 patients (33.0%) presented with gross hematuria and 40 patients (25.0%) presented with kidney stones. There was a high prevalence of hypertension (N = 128, 64.0%). Four patients (N = 4/128, 3.1%) had a very early diagnosis of hypertension before the age of 10 years. Hypertension-onset before the age of 18 years correlated with a significantly faster progression (UV HR: 2.07 (1.32 – 3.25)). Conclusion This study describes a unique cohort of ADPKD patients with rapid disease progression. Hypertension at young age (&amp;lt;18) correlated with rapid disease progression, suggesting that ambulatory blood pressure in children might be useful to identify patients at risk for rapidly progressive ADPKD.

Fatal Rapunzel Syndrome: Gastric and Intestinal Trichobezoars in a Child With Trichotillomania.

We report a rare case of a young child, younger than10 years, who died of complications related to trichophagia and multiple gastrointestinal trichobezoars. One year before death, the child's clinical history yielded a diagnosis of iron deficiency anemia, believed to be related to poor diet, and alopecia areata, the etiology of which was unknown. Two weeks before death, the child presented with complaints of intermittent "flu-like" symptoms and vomiting. The child reported abdominal pain, anorexia, and fatigue on the night before death. The next morning, the child ate breakfast and was subsequently discovered unresponsive.On external examination, there were areas of thinning head hair. Postmortem computed tomography, magnetic resonance imaging, and internal examination revealed 3 distinct trichobezoars, occupying the stomach, jejunum, and ileum. This was complicated by small bowel obstructions and perforations due to the trichobezoars. The cause of death was peritonitis secondary to small bowel perforations due to small bowel obstruction with multiple trichobezoars. This is the first case report to demonstrate the utility of postmortem computed tomography and magnetic resonance imaging in characterizing the nature and extent of trichobezoars in a fatal case of Rapunzel syndrome.

The associations of heavy metals exposure in water sources to the risk of stunting cases

Stunting is a condition of failure in children-under-five's growth as a result of chronic malnutrition. Thus children become too short for their age, or a condition when a person is shorter than the height of other people (of the same age) in general. In Indonesia, the stunting rate has decreased from the previous year. However, the prevalence still exceeds the maximum stunting rate target set by WHO. Bandung regency is one of the priority areas for stunting prevention in Indonesia. The causes of stunting are quite complex, including the health characteristics of children under five, the sociodemographic factors, and the environmental factors, such as exposure to heavy metals. This study aims to analyze the relationship between environmental factors, especially the water media, and the incidence of stunting in the Bandung regency. The method used is a case-control study (retrospective), using a questionnaire, interviews, and testing of heavy metals in drinking water and clean water samples from children under five that is divided into 26 respondents for the case group and 25 respondents for the control group. The Mann-Whitney U test is conducted to see the relationship between the heavy metal concentration of Pb, Cd, and As and the incidence of stunting. The results show that the concentration of As and Cd in drinking water sources were suspected to be significantly related to the incidence of stunting in Bandung Regency (p-value = 0.008 and 0.024). The Chi-Square Test is also done to determine the significance of children's characteristics, sociodemographic and family history, and sanitation on the risk of stunting. It shows that the significance factors to the risk of stunting is mothers' lower education (p-value = 0.017), fathers' lower education (p-value = 0.003), and lower household income (p-value = 0.005).

Resilience to Maltreatment in Early Adulthood Does Not Predict Low Allostatic Load at Midlife.

Although childhood maltreatment is associated with a host of poor health and social outcomes in adulthood, many individuals manifest resilience. We tested competing predictions about whether achieving positive psychosocial outcomes in young adulthood would be differentially predictive of allostatic load at midlife for those with and without a childhood history of maltreatment. The sample included 808 individuals, 57% of whom had court-documented records of childhood abuse or neglect between 1967 and 1971, and demographically matched controls without those histories. Participants provided information on socioeconomic, mental health, and behavioral outcomes in interviews conducted between 1989 and 1995 (mean age = 29.2 years). Indicators of allostatic load were measured between 2003 and 2005 (mean age = 41.2 years). The relationship between positive life outcomes in young adulthood and allostatic load in middle adulthood varied depending on childhood maltreatment status (b = .16, 95% CI: .03; .28); for adults who did not experience childhood maltreatment, more positive life outcomes predicted lower allostatic load (b = -.12, 95% CI: -.23; -.01), whereas the relationship was not significant for adults with a childhood history of maltreatment (b = .04, 95% CI: -.06; .13). There were no differences in the results predicting allostatic load for African-American and White respondents. Childhood maltreatment may have enduring effects on physiological functioning that are manifest in elevated allostatic load scores in middle age. Alternatively, resilience to maltreatment-as manifest in positive functioning in socioeconomic and behavioral domains-may not be sufficiently stable over adulthood to buffer individuals from the physiological consequences of stressful environments.

Introducing the Neuroplastic Narrative: a non-pathologizing biological foundation for trauma-informed and adverse childhood experience aware approaches.

Most people accessing mental health services have adverse childhood experiences (ACEs) and/or histories of complex trauma. In recognition of this, there are calls to move away from medical model approaches and move toward trauma-informed approaches which privilege the impact of life experience over underlying pathology in the etiology of emotional and psychological suffering. Trauma-informed approaches lack a biological narrative linking trauma and adversity to later suffering. In its absence, this suffering is diagnosed and treated as a mental illness. This study articulates the Neuroplastic Narrative, a neuroecological theory that fills this gap, conceptualizing emotional and psychological suffering as the cost of surviving and adapting to the impinging environments of trauma and adversity. The Neuroplastic Narrative privileges lived experience and recognizes that our experiences become embedded in our biology through evolved mechanisms that ultimately act to preserve survival in the service of reproduction. Neuroplasticity refers to the capacity of neural systems to adapt and change. Our many evolved neuroplastic mechanisms including epigenetics, neurogenesis, synaptic plasticity, and white matter plasticity allow us to learn from, and adapt to, past experiences. This learning and adaption in turn allows us to better anticipate and physiologically prepare for future experiences that (nature assumes) are likely to occur, based on past experiences. However, neuroplastic mechanisms cannot discriminate between experiences; they function to embed experience regardless of the quality of that experience, generating vicious or virtuous cycles of psychobiological anticipation, to help us survive or thrive in futures that resemble our privileged or traumatic pasts. The etiology of suffering that arises from this process is not a pathology (a healthy brain is a brain that can adapt to experience) but is the evolutionary cost of surviving traumatizing environments. Misidentifying this suffering as a pathology and responding with diagnosis and medication is not trauma-informed and may cause iatrogenic harm, in part through perpetuating stigma and exacerbating the shame which attends complex trauma and ACEs. As an alternative, this study introduces the Neuroplastic Narrative, which is situated within an evolutionary framework. The Neuroplastic Narrative complements both Life History and Attachment Theory and provides a non-pathologizing, biological foundation for trauma-informed and Adverse Childhood Experience aware approaches.