Untreated Adolescents Research Articles

Quality of Life in Adolescents Born Small for Gestational Age: Does Growth Hormone Make a Difference?

Background/Aims: To evaluate quality of life (QoL) in adolescents born SGA without spontaneous catch-up growth, treated with and without long-term growth hormone (GH) therapy. Additionally, to assess whether GH treatment has a positive effect on QoL, besides improving adult height and height SDS during childhood. Methods: Two groups of adolescents born SGA without spontaneous catch-up growth participated in the QoL evaluation; a GH-treated group (n = 44, mean GH duration: 8.8 (1.7) years) and an untreated group (n = 28), both mean age 15.8 (2.1) years. QoL was measured by self-reports of the TACQOL-S, a disorder-specific questionnaire, and the CHQ, a generic questionnaire. Results: The GH group scored significantly better health status and health-related QoL on several scales of the TACQOL-S. On all TACQOL-S scales the GH group scored better QoL than the untreated group, with effect sizes of moderate to large, not all differences reaching statistical significance. The generic CHQ did not reveal significant differences in QoL between the GH group and the untreated group. Conclusions: Firstly, adolescents born SGA, with a GH-induced improved height, had in many aspects a better QoL than untreated adolescents born SGA, according to the disorder-specific questionnaire. Secondly, we advise to use, in addition to a generic questionnaire, a disorder-specific questionnaire for measuring QoL in children treated for short stature, as the generic CHQ did not reveal such differences.

Occlusal status in orthodontically treated and untreated adolescents

Occlusal status in orthodontically treated and untreated adolescents

Cardiovascular Risk of Young Growth-Hormone-Deficient Adolescents

Objective: To determine whether postprandial lipids, coagulation factors and homocysteine levels are abnormal in young growth hormone (GH)-deficient (GHD) adolescents. Methods: Fifteen GHD adolescents on GH replacement were studied. Ten untreated GHD adolescents and 15 healthy subjects served as controls. Fasting lipids, lipoprotein(a), fibrinogen, plasminogen activator inhibitor-1, homocysteine, folate and vitamin B₁₂ levels were measured. Cholesterol and triglycerides were measured 4 h after a high fat meal. Results: Fasting and postprandial triglycerides and homocysteine levels of untreated GHD patients were increased compared to those of GH-treated GHD subjects and healthy controls; fibrinogen concentrations were elevated in both treated and untreated adolescents. Conclusions: GHD adolescents present an abnormal fasting and postprandial lipid profile. In addition, the increased fibrinogen and homocysteine levels are suggestive of the accumulation of cardiovascular risk factors early on in life.

Occlusal status in orthodontically treated and untreated adolescents

In order to evaluate the outcome of orthodontic care, all available 16-year-old adolescents (n = 138) living within the catchment area of one Finnish health center were invited for a clinical examination. A total of 126 adolescents participated, corresponding to 79% of the whole age cohort. Of these, 47% had been treated orthodontically, 2% were still wearing appliances, and 51% were untreated. In 80% of cases, a non-extraction treatment was carried out. All occlusions were evaluated using a recently developed occlusal morphology and functional index (OMFI) based on assessment of 6 morphological and 4 functional traits which are classified applying an acceptable-non-acceptable dichotomy. The occlusal status in untreated individuals was used as a second reference in comparisons between the treated and untreated occlusions. The morphological criteria for an acceptable occlusion were met by 42% of the participants and the functional criteria by 64%. Although the treated occlusions failed to meet the criteria of morphological acceptability more often than the untreated ones (73% vs 40%), the proportions of non-acceptable occlusions were fairly high among untreated occlusions. The main reasons for non-acceptability were the failure of the canine relationship, overbite, and protrusion movement to fulfill the criteria of acceptability. Only 19% of the adolescents had occlusions classified as acceptable, both morphologically and functionally. In the evaluated health center, the allocation of resources resulted in a high coverage of orthodontic care. However, our results indicate that the general occlusal status in the examined age cohort did not reach an optimal level.

Neuropsychological performance in DSM-IV ADHD subtypes: an exploratory study with untreated adolescents.

To explore neuropsychological performance in untreated Brazilian adolescents suffering from attention-deficit hyperactivity disorder (ADHD). We assessed 30 untreated adolescents with ADHD and 60 healthy control subjects, aged 12 to 16 years, using a neuropsychological battery including the Wisconsin Card-Sorting Test (WCST), the Stroop Test (ST), the Digit Span, and the Word Span. We found neuropsychological differences among the DSM-IV ADHD subtypes. Adolescents with the predominantly inattentive subtype (ADHD-I) performed more poorly than did control subjects on both the Digit Span and the ST. On both the Digit Span and the WCST, adolescents with the combined subtype (ADHD-C) presented significantly more impairments than did control subjects. Adolescents with the predominantly hyperactive-impulsive type (ADHD-HI) did not differ significantly from the control subjects in any measure assessed, but had a better performance than did those with ADHD-C on both the Digit Span and the WCST. In addition, adolescents with ADHD-HI performed better on the ST than did adolescents with ADHD-I. These findings suggest cognitive differences among ADHD subtypes, supporting the diagnostic distinction among them. Adolescents with ADHD-HI do not seem to have significant cognitive deficits.

Intensive family preservation services: an examination of critical service components

A treatment programme for child victims of sexual abuse within the family has been evaluated in terms of psychological and behavioural outcomes for the young people two years after beginning therapy. The Canadian programme was based on principles established by Giarretto in his Child Sexual Abuse Treatment Program (CSATP). Screening by child protection workers selected potential candidates. However, because of limited resources, referral of less than half of the originally screened families was made, even though they were judged suitable for participation. This made available an untreated comparison group (n = 30), similar in many ways to the treated families (n = 27). After two years the treated adolescents had largely recovered levels of self‐esteem obtained in normative samples, and depressive affect had diminished markedly, as had problem behaviours. By contrast, the untreated adolescents had retained low levels of self‐esteem, and high levels of depression. Negative behaviours (delinquency, running away from home, acts of deliberate self‐harm) had deteriorated after two years. This was linked both to further within‐family abuse (in a fifth), followed by a drift in some into street life. Despite its apparent success, the CSATP could not be continued because of lack of funding, and problems in maintaining a community development model for supporting a humanistic programme.

HIV-1 viral loads and CD4 levels in treated and untreated adolescents

HIV-1 viral loads and CD4 levels in treated and untreated adolescents

Serum lipids, lipoprotein Ip(a), and plasminogen activator inhibitor-1 in patients with Turner's syndrome before and during growth hormone and estrogen therapy

Objective: To evaluate whether girls with Turner's syndrome have an increased risk for cardiovascular disease due to alterations in their lipoprotein metabolism. Design: Controlled clinical study. Setting: Private academic hospital. Patient(s): Fifteen untreated girls with Turner's syndrome were studied initially; 11 of these patients were evaluated further while on therapy. Intervention(s): Serum lipids, lipoprotein lp(a), and plasminogen activator (PA) inhibitor-1 were measured before and during 6 months of either GH or estrogen (E) treatment. Main Outcome Measure(s): Serum lipids, lipoprotein lp(a), and PA inhibitor-1 (PAI-1). Result(s): Total and low-density lipoprotein (LDL) cholesterol, triglycerides, lipoprotein lp(a), and PA inhibitor-1 levels were normal in Turner's syndrome patients compared with age matched controls; HDL cholesterol was increased. During GH treatment, a significant decrease in total and LDL cholesterol was noted, whereas lipids, lipoprotein(a), and PA inhibitor-1 levels did not change with E therapy. Conclusion(s): The normal lipoproteins of untreated adolescents with Turner's syndrome, as well as the further decrease of total and LDL cholesterol during GH treatment, would seem to indicate that lipoproteins do not increase the cardiovascular risk of these girls.

Treatment of Acute Lymphoblastic Leukaemia in Adolescents and Adults

From Jan, 1970, to Dec, 1978, 86 previously untreated adolescents and adults with acute lymphoblastic leukaemia were treated in the University Hospitals at Leiden and Nijmegen. Remissions were induced with vincristine and prednisone. If necessary an anthracyclin derivate was added. 73 Patients (85%) achieved a complete remission. CNS leukaemia prophylaxis was given to 64 patients. Two different schedules were used. 35 patients received cranial irradiation with concomitantly intrathecal injections of methotrexate (I+M) after remission had been achieved, and 29 intrathecal methotrexate (M) alone given peridiocally during the remission induction and maintenance treatment. No CNS leukaemia prophylaxis was given to 9 patients (O). Relapses were confined to the CNS alone in 5 cases (group I+M: 1 case; group M: 1 case; group O: 3 cases), to the bone marrow in 40 cases, and to the bone marrow and CNS concurrently in 5 cases (group I+M: 4 cases; group M: no cases; group O: 1 case). A second remission was obtained in 28 patients (56%). The majority of these patients did not receive further CNS prophylaxis. A second relapse of the leukaemia was seen in the majority (23 patients). CNS involvement was found in 6 of these 23 patients. Prophylactic treatment of the CNS in adult acute lymphoblastic leukaemia is mandatory. In our group of patients both schedules of prophylaxis appeared equally effective in preventing CNS leukaemia.

Longitudinal study of periodontal condition associated with orthodontic treatment in adolescents

Periodontal condition, plaque situation, and gingival status were studied longitudinally on five different occasions before, during, and after a full period of routine edgewise treatment in thirty-eight adolescents, 11 to 12 years old at the start. Extraction of permanent teeth was part of therapy in all cases. Thirty-nine matching persons who had not had any orthodontic treatment served as a reference group and were examined in an identical way. Loss of attachment was recorded with a periodontal probe on the mesial, distal, and facial surfaces of all permanent maxillary teeth except the second molars. A particular oral hygiene program was followed carefully by all orthodontic patients. The response of the preventive program was reflected in good or excellent oral hygiene and gingival condition throughout treatment. While no differences were registered during active therapy, after removal of the fixed appliances the orthodontic patients had significantly lower plaque scores and less gingivitis than the untreated persons. With regard to loss of attachment, there were no statistically significant differences between the two categories of patients at any of the five examinations. In fact, periodontal condition was excellent in both groups and the average loss of attachment was less than 0.1 mm. per surface. Although it was not possible with the methods used to demonstrate any statistically significant difference in periodontal condition between the treated and untreated adolescents shortly after band removal, the need for extended long-term studies is evident, as discussed. Such follow-ups are planned for both categories of patients in this study.

Treatment of Acute Lymphoblastic Leukemia in Adolescents and Adults: A Retrospective Study of 41 Patients (1970-1973)

During the period from January 1970 until December 1973, therapy was started in 41 previously untreated adolescents and adults with acute lymphoblastic leukemia. Induction therapy was started with vincristine and prednisone in all patients, resulting in complete remission in 19 and death due to infection during the first month in one case. After 3 wk on these two drugs, the addition of daunorubicin was required in the remaining 21 patients. Fifteen of these obtained remission, one died during induction therapy, and five patients were unresponsive to this therapy, as well as to all subsequent induction schemes. The overall remission rate was 83%. Significantly higher initial leukocyte counts were found in the group treated with vincristine, prednisone, and daunorubicin. Meningeal leukemia prophylaxis, by either periodic methotrexate injections given intrathecally or a combination of cranial irradiation and intrathecally administrated methotrexate, was administered in 29 therapy responders. The median duration of complete remission obtained with various maintenance therapy schemes was 13 mo. No differences were seen in the results obtained in patients between 14 and 20 yr of age and older patients. Twenty-two patients relapsed within 2-37 mo. Relapses were confined to the central nervous system in two cases, to the bone marrow in 18, and to the bone marrow and CNS simultaneously in two. A second remission was obtained in 17 cases (77%). The median survival time of the whole group was 27 mo, as compared with 32 mo for therapy responders and 7 mo for the nonresponders. The percentage and duration of remission and the survival time in our group of adolescents and adults were comparable to those currently being achieved in other centers, but not as good as those reported for children treated with the same protocols.

Treatment of acute lymphoblastic leukemia in adolescents and a-dults: A retrospective study of 41 patients (1970-1973)

During the period from January 1970 until December 1973, therapy was started in 41 previously untreated adolescents and adults with acute lymphoblastic leukemia. Induction therapy was started with vincristine and prednisone in all patients, resulting in complete remission in 19 and death due to infection during the first month in one case. After 3 wk on these two drugs, the addition of daunorubicin was required in the remaining 21 patients. Fifteen of these obtained remission, one died during induction therapy, and five patients were unresponsive to this therapy, as well as to all subsequent induction schemes. The overall remission rate was 83%. Significantly higher initial leukocyte counts were found in the group treated with vincristine, prednisone, and daunorubicin. Meningeal leukemia prophylaxis, by either periodic methotrexate injections given intrathecally or a combination of cranial irradiation and intrathecally administrated methotrexate, was administered in 29 therapy responders. The median duration of complete remission obtained with various maintenance therapy schemes was 13 mo. No differences were seen in the results obtained in patients between 14 and 20 yr of age and older patients. Twenty-two patients relapsed within 2–37 mo. Relapses were confined to the central nervous system in two cases, to the bone marrow in 18, and to the bone marrow and CNS simultaneously in two. A second remission was obtained in 17 cases (77%). The median survival time of the whole group was 27 mo, as compared with 32 mo for therapy responders and 7 mo for the nonresponders. The percentage and duration of remission and the survival time in our group of adolescents and adults were comparable to those currently being achieved in other centers, but not as good as those reported for children treated with the same protocol.