Variability In Young Adults Research Articles

P.032 The importance of transition clinics: A chart-review examining demographic, health, and social variables in young adults with epilepsy who were recently transitioned

Background: Research consistently shows that adolescents transitioning from pediatric to adult care struggle. Although data looking at young adults with epilepsy is limited, research suggests that these adults tend to have higher rates of depression and anxiety, lower rates of medication compliance, and lower education. Methods: To better understand this population and their struggles, a retrospective chart review of 58 patients transferred from pediatric to adult care was done. Results: 39.7% of participants were lost to follow-up; 12 were temporarily lost (average 1.3 years) and 11 were permanently lost. Twenty-three participants admitted to medication non-compliance, with fifteen having break-through seizures. Of the 45 patients that filled out mental health assessments at initial visit, 28.9% met the threshold for major depressive disorder, and 56.6% of patients had symptoms of anxiety. Data found that at one-year follow-up, 60% of these patients had similar or worsened depression scores, and 64% had similar or worsened anxiety scores. Conclusions: The findings of this study are concerning and highlight the need for greater education and support for these adolescents. Specifically, patients need more education on the importance of consistent follow-ups and consistently taking medication. Findings also suggest the importance of assessing and addressing mental health concerns.

Acute nasal breathing lowers diastolic blood pressure and increases parasympathetic contributions to heart rate variability in young adults.

There is growing interest in how breathing pace, pattern, and training (e.g., device-guided or -resisted breathing) affect cardiovascular health. It is unknown whether the route of breathing (nasal vs. oral) affects prognostic cardiovascular variables. Because nasal breathing can improve other physiological variables (e.g., airway dilation), we hypothesized that nasal compared with oral breathing would acutely lower blood pressure (BP) and improve heart rate variability (HRV) metrics. We tested 20 adults in this study [13 females/7 males; age: 18(1) years, median (IQR); body mass index: 23 ± 2 kg·m-2, means ± SD]. We compared variables between nasal- and oral-only breathing (random order, five min each) using paired, two-tailed t tests or Wilcoxon signed-rank paired tests with significance set to P < 0.05. We report the median (interquartile range) for diastolic BP and means ± SD for all other variables. We found that nasal breathing was associated with a lower mean BP (nasal: 84 ± 7 vs. oral: 86 ± 5 mmHg, P = 0.006, Cohen's d = 0.70) and diastolic BP [nasal: 68(8) vs. oral: 72(5) mmHg, P < 0.001, Rank-biserial correlation = 0.89] but not systolic BP (nasal: 116 ± 11 vs. oral: 117 ± 9 mmHg, P = 0.48, Cohen's d = 0.16) or heart rate (HR; nasal: 74 ± 10 vs. oral: 75 ± 8 beats·min-1, P = 0.90, Cohen's d = 0.03). We also found that nasal breathing was associated with a higher high-frequency (HF) contribution to HRV (nasal: 59 ± 19 vs. oral: 52 ± 21%, P = 0.04, Cohen's d = 0.50) and a lower low frequency-to-HF ratio at rest (nasal: 0.9 ± 0.8 vs. oral: 1.2 ± 0.9, P = 0.04, Cohen's d = 0.49). These data suggest that nasal compared with oral breathing acutely 1) lowers mean and diastolic BP, 2) does not affect systolic BP or heart rate, and 3) increases parasympathetic contributions to HRV.NEW & NOTEWORTHY There is growing interest in how breathing pace, pattern, and training (e.g., device-guided or -resisted breathing) affect prognostic cardiovascular variables. However, the potential effects of the breathing route on prognostic cardiovascular variables are unclear. These data suggest that nasal compared with oral breathing 1) lowers mean and diastolic blood pressure (BP), 2) does not affect systolic BP or heart rate (HR), and 3) increases parasympathetic contributions to heart rate variability (HRV). These data suggest that acute nasal breathing improves several prognostic cardiovascular variables.

An Examination of the Associations between Nutritional Composition, Social Jet Lag and Temporal Sleep Variability in Young Adults.

While dietary intake has previously been related to various indices of poor sleep (e.g., short sleep duration, poor sleep quality), to date, few studies have examined chrononutrition from the perspectives of the relationship between dietary intake and social jet lag and temporal sleep variability. Moreover, recently it has been suggested that previous methods of measuring social jet lag have the potential to lead to large overestimations. Together, this precludes a clear understanding of the role of nutritional composition in the pathophysiology of poor sleep, via social jet lag and temporal sleep variability, or vice versa. The aim of the present study was to determine the relationships between nutrient intake and social jet lag (using a revised index, taking account of intention to sleep and sleep onset and offset difficulties), and temporal sleep variability. Using a cross-sectional survey, 657 healthy participants (mean age 26.7 ± 6.1 years), without sleep disorders, were recruited via an online platform and completed measures of weekly dietary intake, social jet lag, temporal sleep variability, stress/sleep reactivity and mood. Results showed limited associations between nutritional composition and social jet lag. However, levels of temporal sleep variability were predicted by consumption of polyunsaturated fats, sodium, chloride and total energy intake. The results suggest further examinations of specific nutrients are warranted in a first step to tailoring interventions to manage diet and temporal variabilities in sleep patterns.

Interrelationship about body composition on sleep quality, physical activity, and heart rate variability in young adults: a cross-sectional study

Interrelationship about body composition on sleep quality, physical activity, and heart rate variability in young adults: a cross-sectional study

A microintensive research study: The impact of yoga on posture, breathing, and psychosocial variables in young adults with cerebral palsy

Abstract The objective of the study was to demonstrate physical and psychosocial impact of yoga on adults with cerebral palsy (CP). This study was a pre–post intervention study involving 12 adults with CP selected with purposive sampling method. The participants received individualized interventions planned by a special yoga specialist for 10 months. Along with the Yoga intervention they underwent traditional physiotherapy sessions on a once-a-week basis. The participants were evaluated on the following parameters: breathing capacity, posture and physical measurements, and psychological impact. Breathing capacity was assessed using the calibrated spirometer where the maximum volume of air inspired was measured. Chest expansion measurements at rest and full inspiration were recorded at apex of axilla and at xiphoid process. The length of time of Om chanting was recorded in seconds. Physical assessments were done by measuring height, weight, body mass index (BMI), and girth of arm and thighs and a postural assessment against a postural grid. The psychosocial impact was measured using the Depression Anxiety and Stress Scale 21 items (DASS-21). There was no significant effect on BMI (P = 0.404; paired t test). There was significant improvement in the vital capacity (P = 0.04; paired t test) three ball spirometer (P = 0.003; paired t test), Om chanting (P = 0.0001; paired t test), and chest expansion at axilla and xiphoid process (P = 0.0004 and 0.002, respectively; paired t test). DASS-21 scores also showed significant differences (anxiety, P = 0.02; stress, P = 0.07; and depression, P = 0.06). It can, therefore, be concluded that yoga intervention does not impact the physical parameters of young adults with CP. It shows a positive impact on the vital capacity parameters and it also has a positive psychological impact.

Association between maximal aerobic capacity and heart rate variability

Relevance. Сardiovascular status could be assessed by maximal aerobic capacity (VO2max) through direct analysis of the gases involved in pulmonary ventilation and monitoring fluctuations in intervals between beats over time as heart rate variability. The aim of the study was to investigate the relationship between VO2max and heart rate variability in young adults. Materials and Methods. A total of 100 young adults between the ages of 18 and 25 were included in observational study, who did not engage in any strenuous physical activity, 50 of whom were male and 50 of whom were female.There were measured Heart rate variability in the frequency domain; LF, HF, LF/HF, and time domain; SDNN, RMSSD, pNN 50, and VO2max were assessed using a treadmill test according to Graded Exercise Protocol. Results and Discussion. There was weak positive correlation of VO2max with LF ( r = 0.177) and weak negative correlation with HF ( r = -0.141). Male participants had a weak negative relationship between VO2 max and LF ( r = -0.075), whereas female respondents had a weak positive relationship(r = 0.286). There was weak negative correlation of VO2max with LF/HF ratio for male subjects but weak positive correlation ( r = -0.101) for female subjects. For male and female participants, there was a weak negative association of VO2max with SDNN ( r = -0.170) and ( r = -0.301), respectively. Male and female participants had a weak negative association of VO2max with RMSSD, with ( r = -0.154) and ( r = -0.284) respectively. Male and female participants had a slight negative association of VO2max with pNN 50, with ( r = -0.062) and ( r = -0.441) respectively. Conclusion. Significant variations were found in the time domain and frequency domain indices including HF and LF/HF ratio which represents the balance between sympathetic and parasympathetic responses.

Psychological strain and suicidal ideation in young university students during Covid-19 outbreak: the mediating roles of rumination and depression.

The link between psychological strain and suicidal ideation is well embedded in literature, however, the underlying mechanism is rarely explored. Therefore, this study aimed to examine the relationship between psychological strain, suicidal ideation, rumination, and depression among Pakistani young adults during the Covid-19 outbreak. In addition, it will also try to determine the mediating role of ruminative subtypes and depression in the relationship between psychological strain and suicidal ideation. The sample consists of 400 university students (83 males and 289 females) with the age range from 18 to 30 years (M = 22.25, SD = 2.40). Psychological strain scale, Suicidal Ideation Scale, Beck Depression Inventory, and Ruminative Response Scale were administered to the participants. Results indicated a significant and positive association between the study variables. Psychological strain positively influenced suicidal ideation both directly, and indirectly via brooding and depression. Both variables were found to be serially mediated by the brooding subtype of rumination and depression and not with the reflective subtype. Strain theory of suicide and response style theory also postulated important insights regarding the association of these variables in young adults, among which, strain is serially related to first brooding and then depression, which is eventually related to suicidal ideation. The present study makes a significant contribution to the literature by providing a unique conceptual and theoretical framework to identify suicide at the ideation level before it proceeds to behavior during this unprecedented time of the pandemic outbreak.

Potentiation of GABAergic synaptic transmission by diazepam acutely increases resting beat‐to‐beat blood pressure variability in young adults

IntroductionResting beat‐to‐beat blood pressure (BP) variability is a powerful predictor of cardiovascular events and end‐organ damage. Recent studies indicate that resting beat‐to‐beat BP variability possesses greater prognostic value when compared with traditional 24‐h ambulatory or home‐based BP monitoring. However, despite the well‐recognized clinical significance of resting beat‐to‐beat BP variability, its underlying mechanisms remain incompletely understood. The sympathetic nervous system is critical for BP regulation. Given that the sympathetic pre‐motor neurons are highly regulated by inhibitory GABAergic interneurons, it is reasonable to speculate that GABA receptors may contribute to the beat‐to‐beat BP variability. However, this hypothesis has not been tested experimentally before. Therefore, in this study, we tested the hypothesis that a potentiation of GABAergic synaptic transmission by diazepam would acutely increase resting beat‐to‐beat blood pressure variability in humans.MethodsIn 40 (17 females) young, normotensive adults, resting beat‐to‐beat BP (finger photoplethysmography) was continuously measured for 5‐10 min, 60 min after the oral administration of either diazepam (10 mg) or placebo. The experiments were conducted in a randomized, double‐blinded, placebo‐controlled and crossover design. Stroke volume was estimated from the BP waveform (ModelFlow) permitting the calculation of cardiac output (CO) and total peripheral resistance (TPR). Parameters of variability included the standard deviation, range, interquartile range (the difference between the 25th and 75th percentiles within‐subject), the coefficient of variation [(SD/mean) x 100], and the average real variability. Additionally, direct recordings of muscle sympathetic nerve activity (MSNA, microneurography) were obtained in a subset of subjects (n=13) and the gain of arterial baroreflex control of MSNA (sympathetic baroreflex) and heart rate (cardiac baroreflex), as well as signal‐averaged sympathetic transduction of blood pressure calculated.ResultsCompared to placebo, diazepam significantly increased the standard deviation of systolic (4.7 ± 1.4 vs. 5.7 ± 1.5 mmHg, P = 0.001), diastolic (3.8 ± 1.2 vs. 4.5 ± 1.2 mmHg, P = 0.007) and mean BP (3.8 ± 1.1 vs. 4.5 ± 1.1 mmHg, P = 0.002), as well as CO (469 ± 149 vs. 626 ± 259 ml/min, P &lt; 0.001) and TPR (1.0 ± 0.3 vs. 1.4 ± 0.6 mmHg/l/min, P &lt; 0.001). Similar results were found using all indices of variability. Furthermore, diazepam reduced resting MSNA burst frequency (placebo: 22 ± 6 bursts/min vs. diazepam: 18 ± 8 bursts/min, P = 0.025) without affecting cardiac or sympathetic baroreflex sensitivity. However, the peak increase in mean BP following a spontaneous burst of MSNA (i.e., sympathetic transduction) was accentuated after diazepam administration.ConclusionThis is the first study to indicate that GABAA receptors may play a role in resting beat‐to‐beat BP variability. These findings advance our current understanding of the neural network mechanisms contributing to the resting beat‐to‐beat BP variability in young adults.

Influence of family history of hypertension on blood pressure and heart rate variability in young adults: a meta-analysis.

This meta-analysis evaluates the impact of family history of hypertension (FHH + ) on blood pressure (BP) and heart rate variability (HRV) in young adults. Observational studies that evaluated adults (aged between 18 and 40 years) of both sexes, are without cardiometabolic disease diagnosis, are published in English, and are reporting on the influence of FHH + (father, mother, or both) on BP and HRV were included. In June 2021, we made a search of the electronic database MEDLINE (accessed by PubMed). Random-effects models were used, and data are reported as standardized mean difference and 95% confidence limits. Thirty-eight studies with a total of 2025 individuals were included. Clinic systolic [3.13 mmHg (1.75-4.51)] and diastolic [2.85 mmHg (1.65-4.04)] BPs were higher ( P < 0.001) in individuals with an FHH + . Only 24-h systolic BP was higher [1.76 mmHg (0.05-3.47); P = 0.04] in individuals with an FHH + . As for HRV indices in time-domain, RMSSD: -7.00 ms (-10.75 to -3.26), SDNN: -13.93 ms (-23.56 to -4.30), and HF [-6.82 n. u. (-9.76 to -3.89)] were lower ( P < 0.05), and LF [4.78 ms (2.52-7.03)] and LF/HF ratio [0.32 (0.14-0.50)] were higher ( P < 0.001) in individuals with an FHH + . FHH + negatively impacts BP and HRV in young adults.

Potentiation of GABAergic synaptic transmission by diazepam acutely increases resting beat-to-beat blood pressure variability in young adults.

Resting beat-to-beat blood pressure variability is a powerful predictor of cardiovascular events and end-organ damage. However, its underlying mechanisms remain unknown. Herein, we tested the hypothesis that a potentiation of GABAergic synaptic transmission by diazepam would acutely increase resting beat-to-beat blood pressure variability. In 40 (17 females) young, normotensive subjects, resting beat-to-beat blood pressure (finger photoplethysmography) was continuously measured for 5-10 min, 60 min after the oral administration of either diazepam (10 mg) or placebo. The experiments were conducted in a randomized, double-blinded, and placebo-controlled design. Stroke volume was estimated from the blood pressure waveform (ModelFlow) permitting the calculation of cardiac output and total peripheral resistance. Direct recordings of muscle sympathetic nerve activity (MSNA, microneurography) were obtained in a subset of subjects (n = 13), and spontaneous cardiac and sympathetic baroreflex sensitivity were calculated. Compared with placebo, diazepam significantly increased the standard deviation of systolic blood pressure (4.7 ± 1.4 vs. 5.7 ± 1.5 mmHg, P = 0.001), diastolic blood pressure (3.8 ± 1.2 vs. 4.5 ± 1.2 mmHg, P = 0.007), and mean blood pressure (3.8 ± 1.1 vs. 4.5 ± 1.1 mmHg, P = 0.002), as well as cardiac output (469 ± 149 vs. 626 ± 259 mL/min, P < 0.001) and total peripheral resistance (1.0 ± 0.3 vs. 1.4 ± 0.6 mmHg/L/min, P < 0.001). Similar results were found using different indices of variability. Furthermore, diazepam reduced MSNA (placebo: 22 ± 6 vs. diazepam: 18 ± 8 bursts/min, P = 0.025) without affecting the arterial baroreflex control of heart rate (placebo: 18.6 ± 6.7 vs. diazepam: 18.8 ± 7.0 ms/mmHg, P = 0.87) and MSNA (placebo: -3.6 ± 1.2 vs. diazepam: -3.4 ± 1.5 bursts/100 Hb/mmHg, P = 0.55). Importantly, these findings were not impacted by biological sex. We conclude that GABAA receptors modulate resting beat-to-beat blood pressure variability in young adults.

Diurnal Salivary Cortisol in Relation to Body Composition and Heart Rate Variability in Young Adults.

ObjectiveChronic stress has been related to impaired body composition (bone, muscle, adipose tissue), and disturbed autonomic nervous system (ANS), the latter regulated by hypothalamic–pituitary–adrenal (HPA) axis. Our objective was to investigate the relationship between salivary cortisol, body composition and heart rate variability (HRV—highly influenced by ANS), in a young student population.MethodsBody composition and HRV parameters were measured using two portable devices based on multi-frequency bioelectrical impedance and photoplethysmography. Body composition included measurement of bone, lean/muscle and adipose tissues. HRV included time domain and frequency domain indices. Salivary cortisol, immediately after awakening, 60 min post awakening and late night was collected and analyzed by ELISA.ResultsParticipants included n = 43 healthy university students (39 women, 4 men); 21.1 ± 1.3 years, BMI = 21.8 ± 3.4 kg/m2. Skeletal muscle was reduced in most of the participants, bone mass was at the lower normal range, while the fat tissue parameters were normal with only 7% participants being overweight. Cortisol and HRV parameters of sympathetic predominance (low frequency—LF and low frequency/high frequency ratio—LF/HF) were significantly associated with higher fat tissue parameters (fat mass—FM% and intramuscular adipose tissue—IMAT%) (p <0.001 and p = 0.035, respectively) and with lower skeletal muscle (p = 0.002) and bone mass (p = 0.025).ConclusionsThe results point to a role of cortisol and ANS in the control of all three body composition compartments, suggesting that the stress can result in adverse effects on body composition, even in young, apparently healthy individuals.

Physical activity influences heart rate variability in young adults, regardless of dextrose ingestion.

Cardiac autonomic modulation can be altered by carbohydrate ingestion. On the other hand, some of the protective effects of physical activity may be due to its impact on the autonomic nervous system. This cross-sectional study was conducted to evaluate whether physical activity level influences heart rate variability (HRV) under fasting and mainly, after dextrose ingestion. Healthy adults aged 18-40 years ( n = 92; 54.35 % women) were separated into nonactive ( n = 47) and active groups ( n = 45), based on the physical activity level determined by International Physical Activity Questionnaire (IPAQ) and then compared. There were no significant differences ( P > 0.05) for age, body mass, BMI, abdominal circumference, blood pressure, fasting glucose and blood glucose at 60 min after dextrose ingestion between groups. Body fat (%) was lower in the active group ( P = 0.02). The time-domain indices (RMSSD, SDNN and pNN50) were higher in the physically active group compared to the nonactive group (main effect of group, P < 0.01). The SDNN index was higher at 60 min after dextrose ingestion compared to fasting (main effect of time, P ≤ 0.01). However, no HRV indices showed significantly interaction effect (group x time; P > 0.05). The magnitude of HRV responses to glucose was not influenced by physical activity status. Young adults who met at least the minimum physical activity recommendations showed a higher cardiac autonomic modulation, regardless of dextrose ingestion.

Changes in quality of life, strength and heart rate variability after 4-weeks of supervised online burpees training during the covid-19 quarantine in healthy young adults

In order to maintain physical fitness during the COVID-19 quarantine, we designed a short-term intervention with one body-weight exercise – burpees. Thus, the aim of this study was to understand level of feasibility and potential benefits of our protocol to different variables in young adults during the COVID-19 quarantine. An online 4-week intervention was administered to 13 young adults (age 22.5±1.39 years, weight 71.8±10.1 kg). The main phase of each session consisted of burpees, a calisthenics body-weight exercises. The training was administered daily. Data regarding quality of life (QoL), body composition, posture, heart rate variability (HRV), cardiovascular health, and strength were collected before and after the intervention period. Participants’ QoL significantly increased after four weeks (p=.025). Also, participants’ strength improved, assessed by the push-up test (p=.017). Systolic blood pressure showed no difference between the pre- and post-measures, while a significant reduction was found in diastolic blood pressure. The HRV assessment showed increased mean RR (p=.005) and RMSSD (p=.014) and decreased mean HR (p=.004) (in the time-domain). For the frequency-domain variables, no significant difference was found. No significant changes were noted in body composition, posture, handgrip strength and countermovement squat jump height. Our preliminary results suggest that the 4-week daily online burpees intervention is a feasible method that could improve QoL, upper body strength and HRV in young adults. This non-time-consuming approach could be easily administered to promote healthy living and counteract physical inactivity during COVID-19 restrictions thanks to its feasibility, short duration, and low cost.

The Relationship of Diabetes Mellitus Risk with Well-Being, and Physical Activity among Young Adults

Background: The growing prevalence of diabetes mellitus poses a worldwide health risk for young adults. Objective: To investigate the risk of diabetes mellitus, well-being, and physical activity in university students. Materials and Methods: This cross-sectional study was conducted with 925 university students. Personal Information Form, Finnish Diabetes Risk Score - Type 2 Diabetes Risk Assessment Form, The Well Star Scale, and The international Physical Activity Questionnaire Short Form have been used in the study. Results: All the students were classified in a low-risk group for diabetes. Examining lifestyle behaviours among the students, 52.8% did not have regular and balanced dietary habits and 66% did not exercise regularly. In the study, increased levels of physical activity promoted overall scores for well-being. Increased physical activity decreased the risk of diabetes. Significant differences were found in terms of wellbeing, physical activity, and Finnish Diabetes Risk Score scores among students who had regular and balanced eating habits in comparison to those who did not (p&lt;0.05). Conclusion: The students’ levels of well-being have increased, and the risk of diabetes has reduced as their physical activity levels increase. On the contrary, those who did not exercise regularly and did not have a regular dietary habit have an increased risk of diabetes mellitus. There is a need for more studies investigating diabetes risk levels and related variables in young adults

Association between Levels of Urine Di-(2-ethylhexyl)phthalate Metabolites and Heart Rate Variability in Young Adults.

Phthalate exposure is associated with cardiovascular risk. Among the various phthalates, di-(2-ethylhexyl) phthalate (DEHP) is a deleterious plasticizer in our daily lives. This study investigated the association between DEHP exposure and the alteration of heart rate variability (HRV). During 2017–2019, we recruited 974 young adults to investigate the effects of living environments and dietary habits on cardiometabolic disorders in Taiwan. We quantitatively analyzed urinary metabolites of DHEP. A continuous electrocardiogram was recorded to obtain a 5-min ECG. Time-domain and frequency-domain HRV analyses were performed. Multiple linear regression showed that urinary oxidized DEHP metabolites MEHHP and MEOHP were associated with decreased HRV after controlling for associated cardiovascular risk factors. A higher MEHHP level was associated with a lower triangular interpolation of NN interval histogram (TINN), very low frequency (VLF), and low frequency/high frequency (LF/HF) ratio. A higher MEOHP level was associated with a decreased LF/HF ratio. In addition, trend analysis showed that higher MEHHP and MEOHP quantiles were significantly associated with a decreased LF/HF ratio. DEHP is a potentially harmful and invisible chemical. The urinary DEHP metabolites MEHHP and MEOHP are associated with decreased HRV, indicating an adverse effect on autonomic balance in young adults in Taiwan.

Factors associated with Health of the Nation Outcomes Scales (HoNOS) in an acute young adult psychiatric unit.

The transition from adolescence to adulthood is a highly vulnerable period for mental health concerns and is a key life-stage, fundamental to later health and quality of life. Scant research has investigated the health outcomes of young adults admitted to a specialised acute psychiatric unit for this cohort. Understanding health and functional outcomes for young adults admitted to a specialised acute mental health inpatient unit is beneficial in identifying treatment effectiveness and vulnerable groups. The study examines the relationship between demographic and clinical factors with admission, discharge and change in Health of the Nation Outcomes Scale (HoNOS) scores in patients admitted to an acute young adult psychiatric unit. The HoNOS was completed at admission and discharge for patients admitted to an acute young adult psychiatric unit in Australia. Descriptive statistics, paired t-tests, generalised estimating equations, independent samples t-tests and correlations were completed. Patients (N = 130) were aged between 18 and 25 years old (M = 21.26 years old, SD = 2.31). Patients were diagnosed with mood disorders (21.54%), substance abuse disorders (20.00%), personality disorders (19.23%), and psychotic disorders (17.69%). HoNOS scores across all subscales improved from admission to discharge, when controlling for confounding variables. Admission, discharge and change in HoNOS scores were associated with gender, country of birth, number of admissions, mental health act, diagnosis and socioeconomic status. This study is the first to explore HoNOS scores, demographic factors and clinical variables in young adults admitted to a specialised psychiatric inpatient unit for this age group. While further research is required, the findings identifies vulnerable subgroups (e.g., individuals with personality disorders, individuals with substance use, those admitted involuntarily, those readmitted) that may benefit from increased tailored support to foster more optimal health outcomes.

Peak retrograde flow a potential objective management tool to identify young adults with varicocele ‘at risk’ for a high sperm DNA fragmentation

Determining which patients are negatively affected by varicocele would enable clinicians to better select those men who would benefit most from surgery. Since conventional semen parameters, have been limited in their ability to evaluate the negative effects of varicocele on fertility, specialized laboratory tests have emerged. To identify clinical and ultrasound parameters (including PRF) which would negatively influence standard and functional semen variables in young adults with a varicocele. Prospective, cross-sectional observational study. Antwerp University Hospital, Belgium. Young volunteers between 16 and 26 years, Tanner 5, were recruited. Every participant had a scrotal ultrasound to calculate testicular volumes. If a varicocele was present, the grade, vein diameter, peak retrograde flow (PRF) in supine position and spontaneous reflux in standing position were measured. All participants provided a semen sample. Standard semen parameters were analyzed and sperm DNA fragmentation. Of all clinical and ultrasound parameters tested, PRF was an objective tool identifying young adults with a varicocele. PRF was highlighted by the prevalence of SDF, both in the total and vital fractions of the spermatozoa, providing opportunities to manage such 'at-risk' adolescents/young adults. Total SDF was significantly increased in grade 3 varicocele compared to grade 1 and 2 but no significant difference with vital SDF or standard descriptive semen parameters was seen. Total and vital SDF on the other hand were significantly increased when PRF was above 38.4cm/s. Standard semen analysis showed no difference with PRF as an independent predictor. Testicular atrophy index, varicocele vein diameter and spontaneous reflux revealed no significant differences in both the descriptive and functional semen variables. Descriptive semen parameters showed no significant difference between the non-varicocele controls and the varicocele group with low and high PRF. Increased PRF negatively influenced sperm quality via increased DNA fragmentation both in the total as in the vital fractions of the semen. Of all clinical and ultrasound parameters tested, PRF was an objective non-invasive tool to identify varicocele patients at risk for a high SDF.

Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes.

The purpose of this study was to describe objective sleep-wake characteristics and glycemia over 7-14 days in young adults with type 1 diabetes. In addition, person-level associations among objective sleep-wake characteristics (total sleep time, sleep variability, and sleep fragmentation index), daytime sleepiness, and glycemia (glycemic control and glucose variability) were examined. In this cross-sectional study, objective sleep-wake characteristics were measured via actigraphy and glucose variability via continuous glucose monitoring over 6-14 days. At baseline, participants completed the Psychomotor Vigilance Test, the Trail Making Test, and questionnaires on daytime sleepiness, sleep quality, and sleep disturbance including sleep diaries. Forty-six participants (mean age, 22.3 ± 3.2 years) wore a wrist actigraph and underwent continuous glucose monitoring concurrently for 6-14 days. Greater sleep variability was directly associated with greater glucose variability (mean of daily differences; r = .33, P = .036). Higher daytime sleepiness was directly associated with greater glucose variability (mean of daily differences; r = .50, P = .001). The association between sleep variability and glucose variability (mean of daily differences) was no longer significant when accounting for daytime sleepiness and controlling for type 1 diabetes duration (P > .05). A higher sleep fragmentation index was associated with greater glucose variability (B = 1.27, P = .010, pr2 = 0.40) after controlling for type 1 diabetes duration and accounting for higher daytime sleepiness. Sleep-wake variability, sleep fragmentation, daytime sleepiness, and the associations with glycemia are new dimensions to consider in young adults with type 1 diabetes. Sleep habits in this population may explain higher glucose variability, and optimizing sleep may improve overall diabetes management. Griggs S, Hickman RL Jr, Strohl KP, Redeker NS, Crawford SL, Grey M. Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes. J Clin Sleep Med. 2021;17(9):1865-1874.

643 Rest Activity Rhythms, Symptom Burden, and Glucose Variability in Young Adults with Type 1 Diabetes

Abstract Introduction Circadian alignment is an important element in individual health, and one behavioral marker, rest-activity rhythm (RAR), may influence disease management in young adults with type 1 diabetes (T1D). Thus, in this descriptive study, we examined whether circadian rhythm is correlated with symptoms (emotional and diabetes distress, and diabetes physical symptom burden) and glucose variability in young adults with T1D. Methods Using convenience sampling, young adults with T1D underwent concurrent actigraphy and continuous glucose monitoring for 6–14 days to generate the following RAR parameters: (MESOR, amplitude, acrophase, and circadian quotient) and glucose variability indices (coefficient of variation and time in range). Participants completed the 8-item Epworth Sleepiness Scale, 8-item PROMIS v1.0 Emotional Distress Scale, 17-item Diabetes Distress Scale, and 34-item Diabetes Symptom Checklist-Revised. Cosinor analysis was used to compute the RAR parameters and linear regression modeling procedures were performed to determine the associations among the study variables. Results The sample included 46 young adults (mean age 22.3±3.2; 32.6% male; 84.8% non-Hispanic White, A1C mean 7.2±1.1%, BMI 27.0±4.4 kg/m2). A more robust rhythm (higher amplitude) was associated with a lower diabetes symptom burden (ß=-0.31, p=.035). A higher circadian quotient was associated with less daytime sleepiness (ß=-0.41, p=.004). All associations between the RAR parameters and symptom measures remained statistically significant (p&amp;lt;.05) after adjustment for sex and BMI. The associations between the RAR parameters and glucose variability indices were not significant. Conclusion RAR was associated with daytime sleepiness, as well as symptom burden in young adults with T1D even after consideration of sex and BMI. Future investigators should clarify the causality of these associations and the potential for improving the strength and stability of RAR in the mitigation of daytime sleepiness and symptoms. Support (if any) This research is or was partially supported by grants from the American Academy of Sleep Medicine (220-BS-19), National Institute of Nursing Research (K99NR018886 &amp; T32NR0008346), Sigma Theta Tau International, and Dexcom provided continuous glucose monitors (G4) free of charge for participants who did not have a device.

Heart Rate Variability in Young Adults with Persisting Post‐Concussion Symptoms

Objective Recovery following a concussion generally occurs within 7 to 10 days. However, between 10 to 50% of adults experience persistent post-concussion symptoms (PPCS). Alterations in cardiac autonomic function, which may lead to heart rate (HR) dysregulation, could explain some of those persisting symptoms. Our aim was to examine short-term resting heart rate variability (HRV), commonly used as an indicator of cardiac autonomic balance, in a group of subjects with PPCS. Hypothesis HRV parameters associated with cardiac vagal tone will be lower, while parameters associated with cardiac sympathetic activity (SYMP) will be higher in subjects with PPCS when compared to controls. Methods HRV was quantified in individuals experiencing PPCS for more than 4 wks [n=9 (5M/4F); 25 ± 6 y; body mass index (BMI): 25 ± 4 kg/m2] compared to matched healthy controls [n=18 (10M/8F); 27 ± 5 y; BMI: 23 ± 3 kg/m2]. Electrical activity of the heart was recorded continuously for 5 min in resting supine position (3-lead ECG). Signals were reviewed for artifacts and processed using Ensemble-R software (Elucimed, Wellington, NZ). Time-domain analysis of HRV provided the square root of the mean squared differences of successive NN intervals (RMSSD), and the number of interval differences, between successive intervals, greater than 50ms (pNN50). Using spectral power analysis, relative low frequency (LF) power, relative high frequency (HF) power and LF/HF ratio were obtained. RMSSD, pNN50 and relative HF power are generally associated with cardiac vagal tone, whilst relative LF power and LF/HF ratio reflect a mix of cardiac SYMP and vagal activity. Results Mean LF/HF ratio was elevated in PPCS compared to controls (2.4 ± 1.9 vs. 0.9 ± 0.5; p=0.020), owing mainly to a lower relative HF power (28.1 ± 15.8 % vs. 48.5 ± 15.8 %; p=0.004), whilst relative LF power did not differ between groups (p=0.053). There were no significant differences in RMSSD and PNN50 between groups. Conclusion As hypothesized, LF/HF ratio was increased. This shift in cardiac autonomic balance appears to result from a reduction in cardiac vagal tone in young adults with PPCS when assessed in the frequency domain.