Large Population Of Adolescents Research Articles

Effectiveness of Peer-Led Intervention on KAP Related to Sexual Reproductive and Mental Health Issues among Adolescents in Low Resource Settings India: A Comparative Study among Participants and Non-Participants

Background: India being the country with largest adolescent population in the world, needs a special focus on the health services as the status of an adolescent determines the health status in his/her adulthood. Some of the major issues faced by the adolescents include: mental health problems, early pregnancy and childbirth, (HIV/STI) and other infectious diseases, violence, injuries and malnutrition. The present study aims to understand the effectiveness of peer-led intervention on knowledge, attitude and practices related to sexual reproductive and mental health issues in adolescents among participants and non-participants. The study was carried out to improve the health-seeking behaviour of adolescents on sexual reproductive and mental health issues in low resource setting across four states in India. Methods: The study adopted a cross-sectional survey which was conducted on 400 adolescents from each of the four districts namely Bangalore, Khagaria-Bihar, Khed-Pune and Sahinganj-Jharkhand. A comparative analysis was conducted between the participants and the non-participants of the intervention to understand the effectiveness of the intervention on the KAP related to sexual reproductive and mental health of adolescents. Results: The study shows that the participants from Karnataka and Maharashtra had better knowledge in emergency contraception, HIV awareness, use of contraceptives and consumption of IFA’s than the non-participants; both the participants and the non-participants showed a positive behaviour in help-seeking in case of psychological challenges. Conclusion: The peer-led approach was found to be an effective strategy for learning, sharing and monitoring adolescent sexual reproductive and mental health.

Adapting an evidence-based positive youth development intervention to prevent sexual and teen dating violence.

Adapting evidence-based interventions (EBIs) guided by implementation science frameworks is a promising way to accelerate the translation of effective violence prevention in schools. School-based interventions offer an opportunity to reduce the risk of multiple forms of violence, including sexual violence (SV) and teen dating violence (TDV). EBIs in schools reach large populations of adolescents, including those underserved in other settings. Although specific SV/TDV prevention programs exist, evaluations indicate limited effectiveness over time. We adapted systematically the Youth Empowerment Solutions (YES) violence-prevention EBI using key adaptation steps described in implementation science frameworks to expand the scope of YES to integrate an SV/TDV focus and meet the needs of local youth. In the formative project year, the team adapted YES to integrate SV/TDV content informed by key steps outlined in frameworks including ADAPT-ITT, research-tested intervention programs, and map of the adaptation process. These steps include: (a) assess school and student needs, (b) identify, select an EBI, (c) consult with experts with knowledge in the new topic area (SV/TDV), (d) collaborate with community partners and stakeholders, (e) identify areas for adaptation while maintaining fidelity to core elements, (f) train staff, (g) pilot test adapted materials, (h) implement, and (i) evaluate. We developed the YES for Healthy Relationships (YES-HR), a school-based prevention program that retained core elements of YES, including content related to mastery, adult resources, leadership skills, and community engagement, while integrating SV/TDV-specific content (e.g., consent). Implementation science adaptation frameworks are useful in guiding the systematic adaptation of existing EBIs to meet the needs of youth.

Online Social anxiety Cognitive therapy for Adolescents (OSCA): protocol for a randomised controlled trial

BackgroundAdolescent social anxiety disorder (SAD) is common, impairing and persistent. There is a need to intervene early to avert its long-term consequences. Cognitive Therapy for SAD is the leading treatment for adults and shows promise for adolescents. However, given the scale of the problem of adolescent SAD and the limited availability of psychological therapists in child and adolescent mental health services, there is a substantial gap in service provision. Delivering therapy via the Internet may provide part of the solution to this problem. An Internet version of adult Cognitive Therapy for SAD has been developed, with outcomes similar to face-to-face therapy. We have recently adapted this treatment for use with adolescents with SAD. Here, we describe a randomised controlled trial designed to test the efficacy of Internet Cognitive Therapy for adolescent SAD compared to waitlist.Methods/designForty adolescents aged 14–18 years with a diagnosis of SAD will be recruited via schools. Participants will be randomly allocated to Internet Cognitive Therapy or to waitlist. All participants will be assessed three times during the study—at baseline (pretreatment/wait), midtreatment/wait (week 8) and posttreatment/wait (week 15). Participants in the experimental arm will also complete weekly measures as part of the online program and they will be assessed at 3 and 6 months. Postwait, participants in the waitlist arm will be offered Internet Cognitive Therapy, and weekly and posttreatment data will also be collected for them. The trial aims to test whether Internet Cognitive Therapy is superior to waitlist in reducing social anxiety symptoms and in reducing the proportion of adolescents meeting criteria for SAD. Other outcomes of interest include depression and general anxiety symptoms. Acceptability of the online treatment will also be evaluated.DiscussionThis randomised controlled trial will provide preliminary evidence on whether this intervention, requiring relatively low levels of therapist input, is safe and clinically effective. If this is shown to be the case, Internet Cognitive Therapy for adolescents has the potential to provide a service to the large population of adolescents with untreated SAD.Trial registrationISRCTN Registry, ISRCTN15079139. Version 1 registered on 06/02/2019.

Particulate matter air pollution and blood glucose in children and adolescents: A cross-sectional study in China.

The health effects of particulate matter (PM) air pollution on glucose metabolism have been rarely examined in children and adolescents. We aimed to investigate the associations between long-term PM exposure and blood glucose and prevalence of impaired fasting glucose in a large population of Chinese children and adolescents. In 2013, a total of 11,814 children and adolescents aged 7 to 18 years were recruited from seven provinces/municipalities in China. Fasting blood sample was taken for the measurement of blood glucose. Satellite-based spatial-temporal models were used to estimate exposure to ambient submicrometer particles (PM1), fine particles (PM2.5) and thoracic particles (PM10). Cross-sectional analyses were performed using mixed-effects multivariable linear and logistic regression models. After adjustment for a range of covariates, every 10 μg/m3 increment in PM1, PM2.5 and PM10 concentrations was associated with 0.160 [95% confidence interval (CI): 0.039, 0.280], 0.150 (95% CI: 0.044, 0.256) and 0.079 (95% CI: -0.009, 0.167) mmol/L higher blood glucose levels, respectively. PM exposure was also associated with higher prevalence of impaired fasting glucose, but the associations did not reach statistical significance [odds ratio per 10 μg/m3 increment in PM1, PM2.5 and PM10: 1.30 (95% CI: 0.86,1.96), 1.20 (95% CI: 0.85,1.69) and 1.08 (95% CI: 0.83,1.41)]. We found that long-term exposure to PM air pollution was associated with increased levels of blood glucose in children and adolescents. The associations were more evident for PM1 and PM2.5.

Community intervention to prevent adolescent health behavior problems: Evaluation of communities that care in Australia.

A major challenge for health psychologists is to ensure the implementation of evidence-based interventions to improve population health. To reduce high rates of adolescent alcohol use and related health problems, trials of the Communities That Care (CTC) prevention process were implemented in Australia beginning in 2001. The process assists communities to strategically plan and monitor implementation of evidence-based preventative interventions. This article reports an evaluation of the effects in the first four Australian communities that completed the process. Trends were examined based on self-report surveys completed by 41,328 adolescents (average age 13.5 years, 51.7% female) across 109 municipal localities between 1999 and 2015. Multilevel modeling compared the 5 localities where the 4 coalitions completed the CTC process with the remaining 104 localities for trends in adolescent reports of lifetime alcohol, tobacco, and cannabis use and past year antisocial behavior. Relative to Australian trends, adolescents in CTC localities reported significantly steeper annual reductions in any lifetime alcohol (Adjusted odds ratio [AOR] = 0.94, 95% confidence intervals [CI] = [0.93, 0.95]), tobacco (AOR = 0.97, CI [0.96, 0.99]), cannabis use (AOR = 0.96, CI [0.93, 0.98]) and antisocial behavior (unstandardized regression coefficient [B] = -0.001, CI [-0.002, 0.000]). Implementation of the CTC process in Australia was associated with more rapid community reductions in adolescent health behavior problems. Supporting community coalitions to adopt evidence-based interventions appears a feasible means for health psychologists to improve the health of large adolescent populations and prevent related chronic health problems in later life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exposure to ambient particulate matter air pollution, blood pressure and hypertension in children and adolescents: A national cross-sectional study in China

BackgroundAir pollution has been associated with elevated blood pressure in adults. However, epidemiological evidence from children and adolescents is limited. We investigated the associations between long-term exposure to particulate matter (PM) air pollution and blood pressure in a large population of children and adolescents. MethodsA cross-sectional analysis was performed in a nationally representative sample consisting of 43,745 children and adolescents aged 7 to 18 years in seven provinces in China. Exposure to ambient fine particles (PM2.5) and thoracic particles (PM10) was estimated using spatiotemporal models based on satellite remote sensing, meteorological data and land use information. Mixed-effects (two-level) linear and logistic regression models were used to investigate the associations between PM exposure and systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension. ResultsAfter adjustment for a wide range of covariates, every 10 μg/m3 increment in PM2.5 and PM10 concentration was associated with 1.46 [95% confidence interval (CI): 0.05, 2.88] and 1.36 (95% CI: 0.34, 2.39) mmHg increases in SBP, respectively. PM10 was also associated with higher prevalence of hypertension [odds ratio per 10 μg/m3 increment: 1.45 (95% CI: 1.07, 1.95)]. ConclusionsLong-term exposure to ambient PM air pollution was associated with increased blood pressure and higher prevalence of hypertension in children and adolescents. Our findings support air pollution reduction strategies as a prevention measure of childhood hypertension, a well-recognized risk factor of future cardiovascular health.

Characterization of chronic urticaria and associated conditions in a large population of adolescents

Although chronic spontaneous urticaria (CSU) affects all age groups, data regarding CSU in adolescents is scarce. To characterize the epidemiology, demographics, and comorbidities associated with CSU in a large, cross-sectional nationwide population of adolescents. Medical records of 16-year-old candidate conscripts to the Israeli Defense Forces were reviewed. Data were collected on the prevalence and severity of CSU, as well as the demographics, medical comorbidities, medication use, and blood test results of affected individuals. Medical records of 1,108,833 consecutive 16-year-old adolescents were reviewed. A total of 6617 (0.6%) adolescents received CSU diagnoses. CSU was increased in female conscripts (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.07-1.19, P<.001) and adolescents with higher socioeconomic scores (OR 1.92, 95% CI 1.56-2.32, P<.001). Individuals with CSU were significantly more likely to have allergic diseases, including food allergy (OR 7.31, 95% CI 6.13-8.72), allergic rhinitis (OR 2.9, 95% CI 2.71-3.11), atopic dermatitis (OR 2.35, 95% CI 2.03-2.72), and asthma (OR 1.46, CI 1.35-1.57). Our work provides an account of CSU in a large cohort of adolescents. We found a strong link between CSU and atopic diseases. Further investigation is needed to decipher the mechanism underlying this observed association.

Is rasterstereography a valid noninvasive method for the screening of juvenile and adolescent idiopathic scoliosis?

Aim of the study was to verify the accuracy of rasterstereography (RST), as radiation-free alternative to plain radiography (RAD) in the monitoring of spine deformity and scoliosis progression in juvenile and adolescent subjects with idiopathic scoliosis. 192 subjects underwent RST (by Formetric 4D device) and low-dose RAD (EOS Imaging, France) in the same session. A sub-group of 30 subjects, selected for conservative treatment with corrective bracing, was assessed at 6-months follow-up. The Cobb angles (CA) obtained by the 3D spine reconstruction from RAD were compared with those provided by RST. Thoracic kyphosis (TK) and lumbar lordosis (LL) were compared as well. RST provided lower CA compared to RAD (15° vs. 33°, mean values). The average difference in measuring CA was 18°, and the correlation coefficient was 0.55. Comparable TK was observed, whereas LL resulted underestimated by RST compared to RAD (34° vs. 43°, average values). The within-subjects correlation, measuring the accuracy of RST in monitoring the scoliosis progression, was 0.3. Accuracy of RST in identifying increased or decreased CA was 67%. Sensitivity and specificity were 64% and 69%. RST demonstrated moderate accuracy in measuring the scoliosis degree and low accuracy in monitoring the curve progression. Accordingly, it cannot be considered as a valid alternative to radiographic evaluation. However, since demonstrated capable of revealing the presence of spine deformity, it could be in principle considered for the early screening in large adolescent populations, but after accounting for a cost-benefit analysis with respect to other traditional approaches. These slides can be retrieved under Electronic Supplementary Material.

Spiritual belief and its link with potentially addictive behaviors in a youth sample in Switzerland.

Earlier studies suggested a positive impact of spirituality on addictive disorders, but this effect has rarely been studied in a large adolescent and young adult population. To examine the association between spiritual beliefs (general belief, the supporting role of spiritual belief, the critical role of spiritual belief) and potentially addictive behaviors (tobacco, alcohol, cannabis and other illegal drugs, excessive Internet use and gambling). Data were collected using online self-report questionnaires among a sample of 5179 adolescents and young adults aged 15-24 years in post-mandatory education in Switzerland. Statistical analysis at bivariate and multivariate level was performed. At the bivariate level, spiritual beliefs were linked to a lower risk of tobacco smoking, alcohol misuse and cannabis use as well as an increased risk of Internet overuse and gambling. However, at the multivariate level, controlling for age, gender, language and place of birth, significant associations were found only for alcohol misuse, Internet overuse and gambling. The study provides evidence that spiritual belief could protect youth from the risk of alcohol misuse but could also increase the risk of excessive Internet use and gambling. The role of spiritual beliefs in preventing or motivating these problematic behaviors is of great interest for adolescent health care providers and should be considered in the light of the separation-individuation process and transition from adolescence to adulthood.

Back pain in adolescents with spinal deformities

Back pain prevalence ranges from 7 to 58% of subjects aged between 13 and 15, equally distributed in males and females. Back pain is thought to be associated with spinal deformities but no studies investigated the prevalence of back pain in different spinal deformities like, spondylolisthesis, Scheuermann disease, hyperkyphosis, scoliosis. To document the prevalence of back pain, in all its forms in a large population of adolescents with spine deformities and to investigate the association of back pain and different spine pathologies. All the patients visited in 2010–2015 were asked for pain at first clinical evaluation by a single expert physician. PAINGroup and NOPAINGroup were formed. Pain description was then classified into 4 subtypes (localized or generalized, limiting or occasional). Inclusion criteria: age between 10 and 18, spine deformity diagnosis, Exclusion criteria: secondary deformities and other associated pathologies. Descriptive statistics. t -test to check the difference in the two groups considered for SRS-22 score, age and BMI. Chi 2 test to check the association between the presence of pain and diagnosis and pain subtypes; sports activities and previous treatment with brace. In total, 702 patients were included (males n = 468), mean age 13.3 ± 1.92. Subjects’ diagnosis: adolescent idiopathic scoliosis ( n = 387; 55.1%), sagittal unbalance (idiopathic) ( n = 134; 19.1%) Scheuermann deformities ( n = 67; 9.55%); all other diagnosis ( n = 114; 16.2%). In AIS 32% referred pain, 55% in sagittal unbalanced patients and 52% in Scheuermann disease. Only Scheuermann disease predispose to pain (Chi 2 = 10.2, Fisher exact test = 0.002), Sagittal unbalance is slightly associated to pain with Chi 2 = 3.65, Fisher exact test = 0.05. BMI, age, sports and brace were not associated with SRS-22. This is the first study investigating the epidemiology of different type of back pain in a large adolescents population with spinal deformities, Scheuermann deformity resulted associated to pain.

Reference values of left heart echocardiographic dimensions and mass in male peri-pubertal athletes.

Background Several articles have proposed reference values in healthy paediatric subjects, but none of them has evaluated a large population of healthy trained adolescents. Design The study purpose was to establish normal echocardiographic measurements of left heart (aortic root, left atrium and left ventricular dimensions and mass) in relation to age, weight, height, body mass index, body surface area and training hours in this specific population. Methods We retrospectively evaluated 2151 consecutive, healthy, peri-pubertal athletes (100% male, mean age 12.4 ± 1.4 years, range 8-18) referred to a single centre for pre-participation screening. All participants were young soccer athletes who trained for a mean of 7.2 ± 1.1 h per week. Results Left ventricular internal diameters, wall thickness, left ventricular mass, aortic root and left atrium diameters were significantly correlated to age, body surface area, height and weight ( p < 0.01). Age, height, weight and body surface area were found associated with chamber size, while body mass index and training hours were not. Inclusion of both age and body size parameters in the statistical models resulted in improved overall explained variance for diameters and left ventricular mass. Conclusion Equations, mean values and percentile charts for the different age groups may be useful as reference data in efficiently assessing left ventricular parameters in young athletes.

Symptomatic hallux valgus and dorsal bunion in adolescents with cerebral palsy: clinical and biomechanical factors.

The prevalence of severely symptomatic deformities of the first metatarsophalangeal (MTP) joint in adolescents with cerebral palsy (CP) requiring arthrodesis is unknown. Recent literature regarding these deformities is limited. We studied the presentation of severe, symptomatic deformities of the first ray in a large population of children and adolescents with CP and their association with gross motor function, CP subtype, and other musculoskeletal deformities. We identified 41 patients with CP and a symptomatic deformity of the first MTP joint, managed by arthrodesis, from a large population based database over a 21-year period. Information recorded included demographics, CP subtype, Gross Motor Function Classification System (GMFCS), clinical presentation, and radiological features. Adolescents with spastic diplegia, at GMFCS levels II and III, were the most common group to develop symptomatic hallux valgus. In contrast, non-ambulant adolescents, at GMFCS levels IV and V, with dystonia or mixed tone, more commonly had dorsal bunions. The type of first MTP joint deformity in patients with CP may be predicted by the type and distribution of movement disorder, and by GMFCS level. Specific patterns of associated musculoskeletal deformities may contribute to the development of these disorders and may provide a guide to surgical management. The prevalence of severe bunions requiring fusion surgery was 2%. The two types of bunion were hallux valgus and dorsal bunion. The type of bunion can be identified on both clinical and radiological grounds. The cerebral palsy subtype is predictive of the type of bunion.

Short form development for oral health patient-reported outcome evaluation in children and adolescents.

Children and adolescents are vulnerable to dental problems and oral diseases. This paper presents the development of two multi-item self-report scales for use in assessing oral health status of children and adolescents. Following the Patient-Reported Outcome Measurement Information System framework, survey questions were designed using a newly developed conceptual model. These items were administered to 334 children and adolescents (8-17years) along with concurrent dental exams. Exploratory and confirmatory factor analyses were conducted and the item response theory graded response model was used to estimate item parameters and oral health status scores and to identify short-form items. The items were selected by high level of information and wide coverage of different domains to assess Child Oral Health Status Index (COHSI) and treatment referral recommendations (RR). The long form consists of 28 items. The short-form includes 12 items (8 for COHSI and 7 for RR with 3 common items).The intra-class correlations between long form and short-form were 0.90 for COHSI and 0.87 for RR. The short-forms provide a possible solution for the longstanding challenge of oral health evaluation for large populations of children and adolescents. The calibrated long form provides the foundation for computer adaptive test administration. These oral health assessment toolkits can be used for oral health screening, surveillance program, policy planning, and research.

Changes in acute viral hepatitis epidemiology in the Turkish adult population: A multicenter study.

The present study aimed to determine the changes in the epidemiology of hepatitis in recent years in an adult Turkish population. Overall, 852 patients with acute viral hepatitis from 17 centers were included in this study. Their sociodemographic characteristics, clinical courses, treatments, and laboratory findings were retrospectively analyzed. The most commonly found microorganisms were the hepatitis B virus (55.2%) and hepatitis A virus (37.6%), and the types of acute viral hepatitis differed significantly according to the age group (p≤0.001). The most frequently reported symptom was fatigue (73.7%), and the most common complications were cholecystitis (0.4%) and fulminant hepatitis (0.4%). The median hospital stay was 9 days (range 1-373). In total, 40.8% patients with acute hepatitis B virus developed immunity. In Turkey, there are significantly large adolescent and adult populations susceptible to acute viral hepatitis. Therefore, larger vaccination programs covering these age groups should be implemented.

4.47 Patient Characteristics and Patterns of Care Prior to Schizophrenia Diagnosis in a Large Commercially-Insured Population of Adolescents and Young Adults in the United States

Schizophrenia, often diagnosed in adolescence, is associated with substantial health care resource utilization (HCRU) and costs. Little is known about patterns of care before diagnosis. We describe clinical and demographic characteristics and HCRU of adolescent patients with and without schizophrenia over a five-year pre-diagnosis period.

Insulin resistance, serum uric acid and metabolic syndrome are linked to cardiovascular dysfunction in pediatric obesity.

Childhood obesity is associated with cardiovascular abnormalities but little is known on the potential correlation between early cardiovascular and metabolic alterations. Aims of this study were 1) to evaluate early cardiovascular abnormalities in a large population of obese children and adolescents compared with a normal weight counterpart, 2) to investigate their potential association with insulin resistance (IR), serum uric acid (sUA) and metabolic syndrome (MetS). This was a single-center case-control study. Eighty obese (OB) subjects (6-16years) and 20 normal weight (NW) matched controls were consecutively recruited. In the whole population we performed an anthropometric and a cardiovascular assessment. OB patients also underwent an OGTT and biochemical evaluations. OB children showed greater left atrial (LA) and ventricular (LV) dimensions and mass and higher carotid artery intima-media thickness (CIMT), compared with NW controls. The BMI z-score, waist circumference, IR and sUA were positively related with LA and LV dimensions and mass. OB subjects with MetS (46.3%) showed greater LA diameter (p=0.001) and LV area (p=0.01) and volume (p=0.04) compared with OB children without MetS. LA diameter and LV dimensions and mass were significantly dependent on the number of criteria for MetS. Mets, sUA and IR were significant predictors of left heart dimensions and mass in obese children. Obesity and MetS are associated with abnormal cardiovascular response during childhood. Hyperuricemia can be an early marker of cardiovascular dysfunction and the routine determination of circulating levels of sUA should be implemented during risk stratification among pediatric age.

Adolescent health in the Eastern Mediterranean Region: findings from the global burden of disease 2015 study

ObjectivesThe 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10–24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs.MethodsUsing data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants.ResultsCommunicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communicable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally, many EMR countries had high rates of adolescent pregnancy and unmet need for contraception.ConclusionsEven with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR.

Cardiac anomalies and associated comorbidities in a large adolescent population.

To determine the prevalence, secular trends and associations of heart disease in a large unscreened, otherwise basically healthy, adolescent population. Cross-sectional study of the cardiac status of 113,694 adolescents from the northern district of Israel, who completed the profiling process between the ages of 16 and 19, including all essential measures over a 22-year period. Results of imaging were categorized as either isolated valvar or structural abnormalities, and their clinically significant subgroups defined prospectively. The findings were correlated with the socio-demographic and anthropometric data and non-cardiac health conditions. Of those sent for echocardiography, 1257 (0.93% of the total population) had isolated valvar disease and 216 (0.19%) had structural abnormalities, with 20% of both groups considered significant. Females had lower prevalence of heart disease. There was peak prevalence in the second 5-year period. Tall subjects or a past history of rheumatic fever had more valvar abnormalities. Thin subjects or those with skeletal anomalies had more structural abnormalities. Significant valvar and structural anomalies were more common in subjects with learning disorders, endocrine disorders and diabetes mellitus. Fewer valvar abnormalities were diagnosed in obese subjects. Heart disease was more common in those with non-solid tumors. Appreciable numbers of potentially healthy adolescents were found to have heart disease. There appeared to be an association with body size, skeletal abnormalities and relatively common medical disorders, the cause of which remains to be determined in prospective studies that could change the way common adolescent disease should be followed.

The relationship between hyperthyrotropinemia and metabolic and cardiovascular risk factors in a large group of overweight and obese children and adolescents.

Mild TSH elevations are frequently observed in obese patients, in the absence of any detectable thyroid disease. Our objective is to evaluate the relationship between the raised TSH levels and the biochemical and clinical consequences of obesity. This is a retrospective cross-sectional study of a large population of obese children and adolescents. We evaluated 833 subjects (340 m, 493 f), aged 14.4±2.5 (range 5.2-18.5) years, height SDS 0.27±1.04 (-3.49-4.35), and BMI SDS 2.94±0.59 (1.60-4.68). Body composition, free T4, TSH, anti-TPO antibodies, anti-TG antibodies, inflammation markers (total WBC and the subtypes, ultrasensitive C-reactive protein), and metabolic parameters [AST, ALT, γGT, ALP, glycaemia, insulin, total cholesterol (TC), HDL-cholesterol (HDL-C), and LDL-cholesterol (LDL-C), triglycerides (TG)] were measured, and oral disposition index (ODI) and cardiovascular risk factors (TC/HDL-C and TG/HDL-C) were calculated. After exclusion of the subjects showing anti-thyroid antibodies, the remaining 779 (325 m, 454 f) were then subdivided into two subgroups according to a TSH value below (group A) or above (group B) 4.5mU/L. Clinical characteristics and hematological markers of patients with and without positive anti-thyroid antibodies were similar, with the exception of higher TSH levels in the latter group. Using analysis of covariance, the subjects of group B had significantly higher values of TC (170.3±28.7 vs 163.3±32.9mg/dL; p<0.05), systolic (125.8±13.5 vs 124.5±13.1mm/Hg), and diastolic blood pressure (79.2±8.0 vs 77.9±8.2mm/Hg) than subjects of group A. No difference was observed in body composition, ODI, and the cardiovascular risk factors between these two groups. TSH elevation in overweight and obese children and adolescents, being associated with a higher TC and blood pressure, might negatively influence the cardiac status. Longitudinal studies are requested, however, to confirm this hypothesis and, therefore, to conclude whether a substitutive treatment with l-thyroxine is really needed in these patients.

Contextual determinants of adolescent mortality in South Africa.

South Africa has a large adolescent population (approximately 20% of the total population). The survival and development of these individuals are a priority among parents and the government. In an effort to better understand the factors contributing to adolescent mortality in South Africa, this study examined the effect of household and community factors on adolescent death. The study used data from Census 2001. Multilevel modelling was used to study the impact of community and household factors on adolescent mortality. A multivariate binary logistic 2-level model was developed. Odds ratios were produced and, statistically significant values (p<0.05) were discussed. There were 41,261 reported adolescent deaths from census data. This study found that having a few household assets, six or more people living in a residence, and high racial diversity is associated with increased odds of adolescent mortality in South Africa in 2001. Socio-economic status of the household and racial diversity within communities is likely to increase adolescent mortality in South Africa. However, there is need to examine the role of other community characteristics, such as number of schools, health facilities and employment opportunities in order to create a holistic profile of the contextual determinants of adolescent mortality in the country.