Complications In Adolescents Research Articles

DNA methylation signatures of youth-onset type 2 diabetes and exposure to maternal diabetes

ObjectiveYouth-onset type 2 diabetes (T2D) is physiologically distinct from adult-onset, but it is not clear how the two diseases differ at a molecular level. In utero exposure to maternal type 2 diabetes (T2D) is known to be a specific risk factor for youth-onset T2D. DNA methylation (DNAm) changes associated with T2D but which differ between youth- and adult-onset might delineate the impacts of T2D development at different ages and could also determine the contribution of exposure to in utero diabetes.MethodsWe performed an epigenome-wide analysis of DNAm on whole blood from 218 youth with T2D and 77 normoglycemic controls from the iCARE (improving renal Complications in Adolescents with type 2 diabetes through REsearch) cohort. Associations were tested using multiple linear regression models while adjusting for maternal diabetes, sex, age, BMI, smoking status, second-hand smoking exposure, cell-type proportions and genetic ancestry.ResultsWe identified 3830 differentially methylated sites associated with youth T2D onset, of which 3794 were moderately (adjusted p-value < 0.05 and effect size estimate > 0.01) associated and 36 were strongly (adjusted p-value < 0.05 and effect size estimate > 0.05) associated. A total of 3725 of these sites were not previously reported in the EWAS Atlas as associated with T2D, adult obesity or youth obesity. Moreover, three CpGs associated with youth-onset T2D in the PFKFB3 gene were also associated with maternal T2D exposure (FDR < 0.05 and effect size > 0.01). This is the first study to link PFKFB3 and T2D in youth.ConclusionOur findings support that T2D in youth has different impacts on DNAm than adult-onset, and suggests that changes in DNAm could provide an important link between in utero exposure to maternal diabetes and the onset of T2D.

Impact of chlorpyrifos exposure on lung function in Egyptian adolescent agriculture workers

Chlorpyrifos (CPF) is a widely used organophosphate insecticide that has been linked to detrimental health effects that range from neurological impacts to respiratory disease. The objective of this study was to assess respiratory symptoms associated with CPF exposure throughout the application season. Urine samples were collected from Egyptian adolescent applicators (n = 206) and non-applicators (n = 72) to assess 3,5,6-trichloro-2-pyridinol (TCPy), a biomarker for CPF exposure, along with spirometry measures to determine lung ventilatory function. Samples were collected over 7 months in 2016. Logistic regression was used to model the odds of reporting wheeze symptoms based on urinary TCPy concentrations while controlling for age and smoking in the household. Ordinal multinomial logistic regression was used to model the percent reference for forced expiratory volume in one second (rFEV1) based on urinary TCPy concentration (µg/g creatinine). Wheezing increased with increasing pesticide exposure (OR = 1.74 (1.32 − 2.31)). There was no statistically significant relationship between rFEV1 and TCPy concentration. Efforts to reduce pesticide exposure should be implemented to prevent the potential onset or exacerbation of any linked respiratory complications in adolescents.

122. Surgical Management and Postoperative Complications in Adolescents with Pathology Proven Endometriosis

122. Surgical Management and Postoperative Complications in Adolescents with Pathology Proven Endometriosis

Musculoskeletal Pain Description in Adolescence with Internet Addiction: Community Engagement in Senior High School

Background: Some bad postures resulting from bad habits that had lasted since childhood, especially posture while accessing internet using gadget, might lead to some complications in adolescence. Aim: In this community engagement program, we tried to explore internet addiction and musculoskeletal pain proportions in some students. Material and methods: This is a cross-sectional study conducted in a senior high school at Jonggol, West Java, in February 2023. Students were gathered to have an education class about good posture. Before the education session, we asked the students to explore whether they had internet addiction and musculoskeletal pain by filling out the Indonesian Internet Addiction Diagnostic Questionnaire and Cornell Musculoskeletal Discomfort Questionnaire. Results: Thirty-nine students were involved in this study. As many as 19 (48.7%) students have an internet addiction. More than 50% of the addicted students often have moderate-severe pain in their neck, back and right wrist and reported that the pain interferes with their daily activities. Conclusions: Almost half of students attending posture education class had internet addiction and musculoskeletal pain. A further study with a larger sample size needs to be conducted to show the correlation between internet addiction and musculoskeletal pain in adolescence and other factors that correlate with them.

Comparison of Metabolic Risk Factors Based on the Type of Physical Activity in Korean Adolescents: Results from a Nationwide Population-Based Survey.

Physical activity (PA) is associated with a favorable metabolic risk profile in adults. However, its role in adolescents remains unclear. In this study, using data (2019-2021) from the 8th Korea National Health and Nutrition Examination Survey, we investigated the optimal exercise type for preventing metabolic complications in adolescents. A total of 1,222 eligible adolescent participants (12-18-year-old) were divided into four groups as follows: aerobic exercise (AE), resistance exercise (RE), combined aerobic and resistance exercise (CE), and no exercise (NE). Daily PA was assessed using the international PA questionnaire. Blood samples were collected to measure lipid, glucose, and insulin levels. Additionally, the homeostasis model assessment for insulin resistance (HOMA-IR) and triglyceride-glucose (TyG) indices were measured. Multivariate regression analysis was used to compare the metabolic risk factors across the PA groups before and after propensity score matching (PSM) adjustment for confounding variables. The CE group exhibited improved fasting glucose levels, lower TyG index, reduced white blood cell count, and higher high-density lipoprotein (HDL) cholesterol levels than the NE group. The RE group exhibited lower mean blood pressure, triglyceride, fasting insulin, HOMA-IR, TyG index and a reduced risk of metabolic syndrome than the NE group. The AE group had higher total and HDL cholesterol levels. In detailed comparison of the AE and RE groups, the RE group consistently exhibited favorable metabolic parameters, including lower blood pressure and total and low-density cholesterol levels, which persisted after PSM. These findings highlight the positive effects of PA on cardiovascular risk factors in adolescents. Thus, RE may have a more favorable metabolic effect than AE. Further studies are needed to validate the benefits of exercise according to the exercise type.

Factors Affecting Quality of Life in Adolescents Living With Type 2 Diabetes: A Substudy of the Improving Renal Complications in Adolescents With Type 2 Diabetes Through REsearch (iCARE) Cohort

ObjectivesType 2 diabetes (T2D) disproportionately impacts adolescents living in challenging socioeconomic conditions. However, the impacts of T2D on quality of life (QOL) in this context are unknown. Our aim in this study was to evaluate QOL and identify its biological, psychological, and social determinants among adolescents living with and without T2D from similar sociodemographic backgrounds. Relationships between glycemic stability, early complications, and treatments of T2D and QOL were also examined. MethodsNinety-two adolescents with T2D and 59 at-risk controls were included from the Improving Renal Complications in Adolescents With Type 2 Diabetes Through Research (iCARE) cohort. The main outcome was QOL (Pediatric QOL Inventory [PedsQL]). Biological covariates included age, sex, body mass index z score, glycated hemoglobin, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio. Psychological factors included perceived stress (14-item Perceived Stress Scale) and mental distress (6-item Kessler scale). Social factors included food security (Household Food Security Survey Module) and income quintile. Multivariate linear regression analyses were used to identify factors associated with QOL between adolescents with and without T2D, and within the T2D cohort. ResultsMean total QOL scores among adolescents with T2D were lower than in controls (67.0±14.8 vs 71.7±16.2, p=0.04). Age, sex, and percent Indigenous ethnicity were not significantly different between groups. Mean duration of T2D was 2.3±2.0 years. In the multivariate analysis, QOL was not associated with diabetes status, but negative associations were seen between mental distress (β=−1.46, p<0.001) and food insecurity QOL (β=−6.26, p=0.037). No differences were seen between biological factors and QOL in either analysis. ConclusionsSignificant factors associated with decreased QOL in adolescents living with T2D include mental distress and food insecurity, indicating areas for targeted intervention.

Adolescence and Nursing, Together for the Promotion of Healthy Nutritional Habits

Unhealthy eating habits during adolescence increase the risk of developing chronic diseases in the future. The lack of knowledge about nutrition among adolescents is a problem that must be urgently addressed. In the Tulcán canton, the existence of nutritional diseases among adolescents from different areas has been confirmed. The objective of this research is to propose nursing strategies to reduce nutritional complications in adolescents from the Tulcán canton. A diagnosis was made regarding adolescents' knowledge of nutritional complications in the canton. A mixed methodology was used in the research, which was non-experimental with a cross-sectional design, action-oriented, descriptive, bibliographic, field-based, and applied. The theoretical methods employed were inductive-deductive, analytical-synthetic, and historical-logical. The empirical method used was scientific observation. The study population consisted of 75 adolescents attending the Tulcán Sur Health Center. A survey was used to obtain information. Among the results, it stands out that more than 45% had no knowledge of nutritional diseases; 53% practiced inadequate eating habits, at inappropriate times, without engaging in physical activity. Strategies related to Education, Promotion, Prevention, and Evaluation were taken into account. Addressing these challenges from a comprehensive perspective, promoting policies and programs that foster the availability, accessibility, and affordability of healthy foods, as well as nutritional education and the promotion of healthy lifestyles from adolescence, benefits the well-being of the Ecuadorian population.Keywords: Adolescence, nutrition, healthy habits

Are corticosteroids safe in adolescent and adult patients with infectious mononucleosis? A retrospective cohort study

Background and aimThe use of systemic corticosteroids during Epstein-Barr virus (EBV)-induced infectious mononucleosis is a controversial but widespread practice. We aimed to investigate the frequency of complications in adolescents and adults with infectious mononucleosis in relation to the use of corticosteroids. MethodsWe reviewed the clinical records of 396 patients admitted to the hospital with infectious mononucleosis (52.0% male; median age, 19 years; range, 15–87 years), with a focus on both short-term (infectious and non-infectious) and long-term (hematological malignancies) complications in relation to corticosteroid use. ResultsA total of 155 (38.6%) patients received corticosteroids at some point during infectious mononucleosis. Corticosteroid use was significantly (P≤0.002) associated with sore throat, lymphadenopathy, leukocytosis, and with antibiotics use (mainly indicated after suspicion of tonsillar bacterial superinfection). Overall, 139/155 (89.7%) patients who were treated with corticosteroids also received antibiotics either before or during hospitalization, compared with 168/241 (69.7%) patients who did not. The frequency of short-term severe complications, either infectious (peritonsillar–parapharyngeal abscess or bacteremia) or non-infectious (splenic rupture, severe thrombocytopenia, myopericarditis, or lymphocytic meningitis) were similar in patients receiving and not receiving corticosteroids. After a median of 15 years of follow-up, only one Hodgkin's lymphoma was diagnosed, in a patient who was not treated with corticosteroids during infectious mononucleosis. ConclusionsThe use of systemic corticosteroids during EBV-induced infectious mononucleosis is generally safe, at least with concomitant antibiotic therapy. However, this should not encourage the use of corticosteroids in this context, given that their efficacy has yet to be demonstrated.

Risk factors and timing of complication presentation following primary hypospadias repair in adolescents.

To evaluate the risk factors for postoperative complications in adolescents who undergo primary hypospadias repair and determine the time required for complication detection. Our study included patients classified as Tanner stages three to five who underwent primary hypospadias repairs at our hospital from January 2015 to August 2022. The patients' baseline information, clinical characteristics, postoperative complications, and time to complication detection were collected. Cox regression analysis, ROC curves, Kaplan-Meier survival analyses, and the Mann-Whitney U test were used. The study comprised 143 patients, with a median age of 12.58 years. Postoperative complications were experienced by 66 patients. The length of the urethral defect was identified as an independent risk factor for postoperative complications. The ROC curve analysis identified 3 cm as the optimal cutoff value for the length of the urethral defect. The median time to complication detection was 30.5 days (IQR 23 to 209.25). 89.4% of the complications were identified within the first year. Patients with a urethral defect of <3 cm experienced a significantly longer time for the detection of urethral fistula compared to those with a urethral defect of ≥3 cm (p = 0.047). Our data indicate that adolescents with a urethral defect ≥3 cm have a higher risk of postoperative complications. Although most complications were identified within the first year, conducting long-term follow-ups for adolescents is recommended to identify potential subsequent complications that may arise from persistent urethral alterations.

Determinants of Problems in Teenage Pregnancy

This study aims to determine the determinants or risk factors for pregnancy complications in adolescents. This type of research is quantitative analytical research with a case-control approach. The results of univariate analysis show that most respondents married at the age of 16-19 years (92%), and the remainder at the age of 12-15 years lived in rural areas (62%) and with their parents. (70). %), have low education (65.3%), have poor economic conditions (56%), and have anemia status (60%). The most frequently experienced pregnancy problems were constant vomiting and not wanting to eat (39.3%), while the least experienced were bleeding at the beginning or end of pregnancy and yellow eyes/skin (1.3% each). There are two variables related to teenage pregnancy problems, namely anemia status and knowledge about pregnancy. The most influential variable is anemia (p=0.000, OR: 3.995 (1.952-8.174). In conclusion, the impact of complications and deaths on women and children and the effect on future generations can be prevented.&#x0D; &#x0D; Keywords: Determinants, Teenage Pregnancy, Problems

Protein supplement consumption prevalence, habits and complications in adolescents

IntroductionThe consumption of nutritional and protein supplements by adolescents may have important consequences for their health. MethodsProspective observational study based on a survey of adolescents enrolled in 6 schools selected at random in the city of Seville. Our primary objective was to determine the actual consumption of dietary supplements in the adolescent population and quantifying their protein content. ResultsWe obtained a total of 263 valid responses that showed a prevalence of consumption of nutritional supplements of any kind of 19.01%, of which 56.0% (10.64% of the total) corresponded to adolescents that consumed protein supplements for a mean protein intake of 0.26 g/kg/day (SD, 0.18). The profile of consumers of any type of supplements differed from that of nonconsumers in age, use of long-term medication and weight loss or high-protein diets. The comparison of adolescents who consumed protein supplements versus nonprotein supplements only evinced a significant difference in the control of supplement consumption. Although most of these adolescents were not subject to external control, 25.92% of those who consumed protein supplements were monitored by a professional, compared to 7.38% of consumers of nonprotein supplements. In the group that consumed protein supplements, 85.18% of adolescents achieved the desired effect and 18.51% reported some form of negative effect. ConclusionsThe prevalence of protein supplement consumption among adolescents in our area is 10.64%, with consumption of amounts corresponding to 25% of the recommended daily allowance of protein. The profile of protein supplement consumers is very similar to that of nonprotein supplement consumers.

Trends in HOMA-IR values among South Korean adolescents from 2007–2010 to 2019–2020: a sex-, age-, and weight status-specific analysis

Background/ObjectivesAn increase in obesity prevalence may lead to an increase in the HOMA-IR value. This study aimed to investigate changes in age- and sex-specific homeostasis model assessment of insulin resistance (HOMA-IR) values among South Korean adolescents, using data from the Korean National Health and Nutrition Examination Survey (KNHANES) IV, V, and VIII conducted between 2007–2010 and 2019–2020.Subjects/MethodsOverall, 4621 adolescents aged 10–18 years were evaluated, including 3473 from the 2007–2010 dataset and 1148 from the 2019–2020 dataset. The mean HOMA-IR values and percentile curves were evaluated by age, sex, and weight status.ResultsThe mean HOMA-IR values peaked at puberty in both sexes and further increased during puberty in the 2019–2020 dataset (boys 5.21, 95% confidence interval [CI] 4.16–6.26; girls 5.21, 95% CI 3.09–7.33) compared with the 2007–2010 dataset (boys 3.25, 95% CI 3.04–3.47; girls 3.58, 95% CI 3.31–3.85). Both groups (with normal-weight and overweight/obesity) exhibited a peak HOMA-IR value during puberty in both sexes and both datasets, although the group with overweight/obesity had a higher and wider peak age range. While the mean HOMA-IR values did not change in adolescents with normal-weight, they increased during puberty and post-puberty in boys with overweight/obesity.ConclusionsHOMA-IR values should be interpreted considering sex, weight status, and pubertal stages. In particular, during the pubertal period, insulin resistance (IR) can coexist not only due to weight-related factors but also as a result of the distinct hormonal changes characteristic of puberty. Over the 10-year period, the mean HOMA-IR values increased in the group with overweight/obesity during puberty and post-puberty, highlighting the need for active intervention to prevent metabolic complications in adolescents with overweight/obesity.

Caregiver perceptions of the pediatric medical home model to address the health services needs of youth in foster care

BackgroundChildren in foster care demonstrate higher rates of physical health difficulties and lower rates of engagement in preventative health services than the general population. This pattern places foster youth at heightened risk for long-term health complications in adolescence and adulthood. Interventions for children in foster care are needed to decrease barriers to health services, increase continuity of care, and ameliorate negative long-term outcomes. Pediatric Medical Home (PMH) models may be a viable solution, but little guidance exists on the adaptation of these models for vulnerable youth. ObjectiveThe current project utilized a qualitative approach to evaluate the perceived utility of PMHs as a health care delivery system for youth in foster care. Method: Face-to-face semi-structured interviews were conducted with 40 parents of children in foster care who had received PMH services within the past year. ResultsQualitative themes demonstrated overall positive perceptions of the PMH model, with numerous advantages related to foster-care specialization that sustained caregiver engagement. Participant themes aligned with several of the major characteristics of PMHs, most specifically with continuity of care, and highlighted additional needs specific to families with child welfare involvement. ConclusionsFindings address the utility of medical homes for parents and youth with child welfare involvement and can inform future efforts on enhancing interprofessional health interventions for children with histories of maltreatment.

Features of the cytokine profile in adolescents with microvascular complications of type 1 diabetes mellitus

Despite advances of modern medical science, the consequences associated with management of complications in type 1 diabetes mellitus (DM1) in children and adolescents represent a serious problem. Common development of microvascular diabetic complications (retinopathy, neuropathy, kidney damage) still remains a sufficient obstacle for achieving high quality of life and social adaptation in the young patients, thus promoting studies of immune mechanisms involved in genesis of microvasculature damage under the conditions of dysmetabolic abnormalities associated with DM1. Our goal was to assess the role of altered cytokine balance in blood serum in development of microangiopathies in adolescents with DM1.140 adolescent patients with type 1 diabetes aged 14-18 years were examined being divided in 2 groups: group I included the patients with glycated hemoglobin (HbA1c) level of &gt; 9.0% (n = 65), and group II which included adolescents with HbA1C level of ≤ 9.0% (n = 75). Each group was divided into subgroups: Ia (n = 50) and IIa (n = 38) included adolescents with diabetic retinopathy, nephropathy or neuropathy, whereas groups Ib (n = 15) and IIb (n = 37) were without microvascular complications. The control group consisted of 36 adolescents with normal body weight, without carbohydrate metabolic disorders, and family history of diabetes mellitus. Determination of TNFα, IL-1β, VCAM-1, fractalkine levels in blood serum was performed by enzyme immunoassay using test systems “RayBiotech” (USA), “BIOSCIENCE” (USA).Development of microangiopathies in adolescents with different glycemic control is associated with increased serum concentration of the factors involved in neoangiogenesis and vascular wall remodeling, i.e., TNFα, IL-1β, VCAM-1, compared with control group (p &lt; 0.05), and a statistically significant decrease in fractalkine level in adolescent patients with either complicated, or uncomplicated DM1. The study allowed us to suggest that occurrence of microvascular complications in adolescents with DM1 is associated with impaired immune response tending for altered cytokine balance towards Th1 type, enhanced intercellular interactions, imbalance of bioregulatory molecules, contributing to development of inflammatory immunoregulatory state. The revealed patterns of laboratory markers, along with assessment of metabolic indices, will enable personalized approaches to early diagnostics of microvascular complications in adolescents with DM1 and prevent their further progression.

Integrative analysis reveals novel associations between DNA methylation and the serum metabolome of adolescents with type 2 diabetes: A cross-sectional study.

ObjectiveRates of type 2 diabetes (T2D) among adolescents are on the rise. Epigenetic changes could be associated with the metabolic alterations in adolescents with T2D.MethodsWe performed a cross sectional integrated analysis of DNA methylation data from peripheral blood mononuclear cells with serum metabolomic data from First Nation adolescents with T2D and controls participating in the Improving Renal Complications in Adolescents with type 2 diabetes through Research (iCARE) cohort study, to explore the molecular changes in adolescents with T2D.ResultsOur analysis showed that 43 serum metabolites and 36 differentially methylated regions (DMR) were associated with T2D. Several DMRs were located near the transcriptional start site of genes with established roles in metabolic disease and associated with altered serum metabolites (e.g. glucose, leucine, and gamma-glutamylisoleucine). These included the free fatty acid receptor-1 (FFAR1), upstream transcription factor-2 (USF2), and tumor necrosis factor-related protein-9 (C1QTNF9), among others.ConclusionsWe identified DMRs and metabolites that merit further investigation to determine their significance in controlling gene expression and metabolism which could define T2D risk in adolescents.

53-OR: Diabetes Stigma and Clinical Outcomes in Adolescents and Young Adults: The SEARCH for Diabetes in Youth Study

We examined the association between diabetes stigma and glycemic control, treatment regimen, and acute and chronic complications in adolescents and young adults (AYAs) with type 1 (T1D) and type 2 diabetes (T2D) in the SEARCH for Diabetes in Youth Study, 2016-2019. A 5-question survey assessed frequency of perceived stigma experience, from which we created a total stigma score. We used multivariable linear modeling, stratified by T1D and T2D, to examine the association of diabetes stigma with clinical factors, adjusting for sociodemographic, clinic site, duration of diabetes, health insurance type, treatment regimen, and HbA1c. Of 16respondents, 78% had T1D, 56% were female, and 48% were non-Hispanic White. Mean (SD) age at study visit was 21.7 (5.1) years (range - 24.9 years) . Mean (SD) HbA1c was 9.2% (2.3) . Higher stigma scores were associated with female sex and higher HbA1c (both p &amp;lt;0.01, table) . No statistically significant association between stigma score and insulin pump or continuous glucose monitor use was observed. In participants with T2D, higher stigma scores were associated with insulin use (p = 0.04) . Independent of HbA1c, higher stigma scores were associated with acute complications for AYAs with T1D and chronic complications for AYAs with T1D and T2D (table) . Diabetes stigma in AYAs is associated with worse diabetes outcomes and therefore is important to address in diabetes care. Disclosure K.B.Eitel: None. E.T.Jensen: Consultant; Regeneron Pharmaceuticals Inc. A.D.Liese: None. S.M.Marcovina: None. E.J.Mayer-davis: None. K.Reynolds: Research Support; Amgen Inc., Merck &amp; Co., Inc., Novartis Pharmaceuticals Corporation. C.Pihoker: None. A.J.Roberts: None. R.Dagostino: Consultant; Aetion, Inc., AstraZeneca, Biogen, Bristol-Myers Squibb Company, Daiichi Sankyo, Merck &amp; Co., Inc. R.A.Bell: None. A.Bellatorre: None. C.E.Barrett: None. A.Cristello: None. D.Dabelea: None. L.M.Dolan: None. Funding The SEARCH for Diabetes in Youth Cohort Study (1R01DK127208-01, 1UC4DK108173) is funded by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases and supported by the Centers for Disease Control and Prevention.

Difficulty with Oral Health Complications in Adolescents with Developmental Disability and Obesity.

Developmental disabilities (DDs), obesity, and dental caries are highly prevalent health conditions among adolescents. Evidence indicates that a significant proportion of adolescents with DDs are obese, and those with obesity and dental caries share common risk factors. In this first-ever US-based cross-sectional national study, we assessed the likelihood of adolescents with DDs and obesity experiencing chronic difficulty with decayed teeth, toothaches, bleeding gums, and eating and swallowing due to a health condition among adolescents with DDs and obesity compared to adolescents with no DDs or obesity. For this secondary data analysis study, we used data of 68,942 adolescents aged 10 to 17 y from the 2016 through 2019 National Survey of Children's Health. Weighted descriptive and bivariate analyses were conducted. Four multiple logistic regression models predicting chronic difficulty in the past 12 mo with decayed teeth, toothaches, bleeding gums, and eating and swallowing due to a health condition were conducted, controlling for other variables. The adjusted odds ratio (aOR) of experiencing chronic difficulty in the past 12 mo for adolescents with no DDs or obesity was significantly lower for decayed teeth (aOR, 0.64; 95% confidence interval [CI], 0.51-0.80; P < 0.0001), toothaches (aOR, 0.43; 95% CI, 0.30-0.60; P < 0.0001), bleeding gums (aOR, 0.48; 95% CI, 0.33-0.70; P < 0.0001), and eating or swallowing due to a health condition (aOR, 0.34; 95% CI, 0.20-0.57; P < 0.0001) compared to adolescents with both DDs and obesity. Results from this study indicate that DD adolescents with obesity have more/greater impending oral health needs than adolescents with no DDs or obesity. Results of this study highlight the high oral health needs and the chronic difficulty adolescents with developmental disabilities and obesity experience compared to adolescents without developmental disabilities and obesity. Targeted oral health policies and interventions that will promote oral health among this high-risk group are recommended.

Effect of metformin as an add-on therapy on neuregulin-4 levels and vascular-related complications in adolescents with type 1 diabetes: A randomized controlled trial

BackgroundInflammation is closely associated with atherosclerosis and plays a crucial role in the development of cardiovascular disease. Metformin sensitizes body cells to insulin, which may cause a reduction of atherogenic lipid fractions. Low neuregulin-4 (Nrg-4) levels, an adipokine, are linked to obesity, insulin resistance, impaired glucose tolerance and type 2 diabetes. ObjectivesWe assessed the effect of oral supplementation with metformin on glycemic control, neuregulin-4 levels and carotid intima media thickness (CIMT) as a marker for subclinical atherosclerosis in adolescents with type 1 diabetes mellitus (T1DM) and microvascular complications. MethodsThis randomized placebo-controlled trial included 80 type 1 diabetic patients with microvascular complications who were randomly divided to receive either 24 weeks of metformin 500 mg/day or matching placebo. Fasting blood glucose (FBG), HbA1c, C-reactive protein (CRP), urinary albumin creatinine ratio (UACR), lipid profile, Nrg-4 and CIMT were assessed at baseline and study end. ResultsBoth groups were well-matched as regards baseline clinical and laboratory data (p greater than 0.05). After 24-weeks, metformin therapy for the intervention group resulted in a significant decrease of HbA1c, CRP, UACR, total cholesterol and CIMT while Nrg-4 levels were increased compared with baseline levels (p < 0.001) and with placebo group(p < 0.001). Baseline Nrg-4 levels were negatively correlated to FBG, HbA1c, total cholesterol, CRP and CIMT. Metformin was well-tolerated. ConclusionsOral metformin supplementation once daily for 24 weeks as an adjuvant therapy to intensive insulin in pediatric T1DM was safe and effective in improving glycemic control, dyslipidemia and Nrg-4 levels; hence, it decreased inflammation, microvascular complications and subclinical atherosclerosis.

Health-Related Quality of Life after Adolescent Fractures of the Femoral Shaft Stabilized by a Lateral Entry Femoral Nail.

(1) Background: In adolescents, fractures of the femoral shaft that are not suitable for elastic-stable-intramedullary-nailing (ESIN), are challenging. We aimed to evaluate the health-related quality of life (HRQoL) and complications in adolescents treated with intramedullary rodding using the adolescent lateral trochanteric entry femoral nail (ALFN), and to assess if HRQoL was associated with additional injuries. (2) Methods: We followed-up on 15 adolescents with a diaphyseal femoral fracture who were treated with an ALFN from 2004 to 2017. Patients were asked to fill in a questionnaire that includes the iHOT, Peds-QL, and the Pedi-IKDC. (3) Results: The ALFN was used as a primary method of fixation in 13 patients, and as a fixation for failed ESIN in two cases. All 15 fractures healed radiographically. One distal locking screw broke. After a mean follow-up of 2.8 years, the mean iHOT-12 was 14.0 (SD 15.4), PedsQL-function was 85.7 (SD 19.3), PedsQL-social-score was 86.2 (SD 12.5), and the mean Pedi-IKDC was 77.2 (SD 11.3). In patients where the femoral fracture was an isolated injury, the HRQoL-scores were consistently higher compared with patients who sustained additional injures. (4) Conclusions: Treating diaphyseal fractures in adolescents with an ALFN resulted in good radiographic outcomes in all our cases. HRQoL, as measured by the iHOT, PedsQL, and Pedi-IKDC, was good to excellent; but it was consistently inferior in patients with additional injuries. These results suggest that the ALFN is a good alternative when patients are not suitable for ESIN, and that the HRQoL of adolescents who were treated with an ALFN is mainly influenced by the presence of additional injures, and less by the fracture of the femur itself.

Risk factors for nephropathy in persons with type 1 diabetes: a population-based study

AimsAlbuminuria is strongly associated with risk of renal dysfunction, cardiovascular disease and mortality. However, clinical guidelines diverge, and evidence is sparse on what risk factor levels regarding blood pressure, blood lipids and BMI are needed to prevent albuminuria in adolescents and young adults with type 1 diabetes.MethodsA total of 9347 children and adults with type 1 diabetes [mean age 15.3 years and mean diabetes duration 1.4 years at start of follow-up] from The Swedish National Diabetes Registry were followed from first registration until end of 2017. Levels for risk factors for a risk increase in nephropathy were evaluated, and the gradient of risk per 1 SD (standard deviation) was estimated to compare the impact of each risk factor.ResultsDuring the follow-up period, 8610 (92.1%) remained normoalbuminuric, 737 (7.9%) individuals developed micro- or macroalbuminuria at any time period of whom 132 (17.9% of 737) individuals developed macroalbuminuria. Blood pressure ≥ 140/80 mmHg was associated with increased risk of albuminuria (p ≤ 0.0001), as were triglycerides ≥ 1.0 mmol/L (p = 0.039), total cholesterol ≥ 5.0 mmol/L (p = 0.0003), HDL < 1.0 mmol/L (p = 0.013), LDL 3.5– < 4.0 mmol/L (p = 0.020), and BMI ≥ 30 kg/m2 (p = 0.033). HbA1c was the strongest risk factor for any albuminuria estimated by the measure gradient of risk per 1 SD, followed by diastolic blood pressure, triglycerides, systolic blood pressure, cholesterol and LDL. In patients with HbA1c > 65 mmol/mol (> 8.1%), blood pressure > 140/70 mmHg was associated with increased risk of albuminuria.ConclusionsPreventing renal complications in adolescents and young adults with type 1 diabetes need avoidance at relatively high levels of blood pressure, blood lipids and BMI, whereas very tight control is not associated with further risk reduction. For patients with long-term poor glycaemic control, stricter blood pressure control is advocated.