Young Adult Years Research Articles

DiaBetter Together: Clinical trial protocol for a strengths-based Peer Mentor intervention for young adults with type 1 diabetes transitioning to adult care

BackgroundType 1 diabetes (T1D) management is challenging for young adults, who are expected to transfer from the pediatric to adult T1D healthcare system while also managing typical developmental demands (e.g., social, financial, work/school, residential). Many young adults have extended gaps in care before following up in adult care, increasing risk for poor health outcomes. There are few evidence-based programs to support young adults with T1D to promote a timelier transition during this period. This paper reports on the design of DiaBetter Together, a randomized controlled trial to evaluate a 12-month Peer Mentor-delivered intervention compared to usual care among young adults with T1D during the transfer from pediatric to adult care. MethodsOne-hundred young adults (age 17–25) with T1D and 29 Peer Mentors enrolled in this randomized clinical trial. Peer Mentors are experienced, older young adults with T1D, trained by the study team to share transition experiences and strategies to successfully navigate the adult healthcare system, help young adults prepare for the first adult care visit, and use strengths-based support strategies to teach and model skills for managing T1D-related challenges. ResultsThe primary outcome of the trial is HbA1c, and secondary outcomes include time to adult care, engagement in diabetes self-management behaviors, and psychosocial well-being. ConclusionThe goal of this research is to evaluate a developmentally appropriate, supportive intervention that can improve T1D self-management and successful transfer of care during the difficult young adult years and promote optimal T1D health outcomes.

Pediatric and Adolescent Hodgkin Lymphoma: Paving the Way for Standards of Care and Shared Decision Making.

Hodgkin lymphoma (HL) is a treatable cancer with an incidence peak in adolescent and young adult years. Treatment strategies have been developed to balance the intensity of therapy needed to maintain disease-free survival while simultaneously preserving overall survival. Risk-based, response-adapted frontline therapy has long used a combination of chemotherapy and radiotherapy (RT). Successive clinical trials over the past three decades have safely reduced cumulative alkylator, anthracycline, and RT exposures for many patients. The advent of checkpoint inhibitors and the CD30-targeted antibody drug conjugate, brentuximab vedotin, has provided new options for de-escalation of conventional therapies associated with late effects in survivors treated at a young age. The ability to evaluate novel agents has been accelerated in collaborative trials inclusive of children and adolescents within the US National Clinical Trials Network and between the Children's Oncology Group and the EuroNet Pediatric Hodgkin Lymphoma Consortium. With numerous treatment options, patients with HL and their clinicians have an opportunity for shared decision making from diagnosis, through cancer treatment, and into survivorship. Given excellent survival outcomes, decisions about treatment in classic HL should be collaborative and attention to long-term survivorship needs should remain a high priority. Patient-reported outcomes remain an important tool to aid clinicians working with survivors to optimize health status and related quality of life for decades after HL therapy.

Cracks in the Self: A Poetry Collection Exploring Narcissism and Its Coping Mechanism in Youth

When a girl grows up with an authoritarian parent, the trauma causes her to develop narcissistic personality disorder (NPD) in her young adult years, disrupting her ability to form healthy relationships with her mother, friends, and especially herself. To escape any emotional discomfort, she turns to non-suicidal self-injury (NSSI) as a coping mechanism. This narrative poetry explores the progression of Renee's life from childhood to her struggle with NPD in young adulthood. It highlights how dangerous NPD is when Renee resorts to NSSI to deal with the negative reactions from others. This creative work underscores the seriousness of NPD since it may lead to a harmful coping mechanism called NSSI.

Electronic Cigarette Use and Anxiety Among College Students: "Trapped in That Cycle".

Electronic cigarette use is the most prevalent form of tobacco among young college adults between 18 and 25 years old. In addition, during the young adult years, mental health issues surface, such as anxiety. As a result of these factors, it is imperative to describe the experience of electronic cigarettes among college students to better understand the cycle of addiction among electronic cigarette users. This study aims to explore and describe the experience of electronic cigarette use among college students who report feelings of anxiety. A qualitative descriptive study design with the Roy Adaptation Model as the theoretical framework was used to describe the experience. The setting was at one medium-sized private university on the east coast of the United States. Twenty participants met the study inclusion criteria of traditional undergraduate students aged 18-25 years. Data were collected using a demographic questionnaire, a smoking status questionnaire, a self-report feelings of anxiety questionnaire, and a semistructured interview guide. Data analysis synthesized three themes: the perfect storm, the power of ripping the nic, and trapped in that cycle. It was found through interviews that feelings of anxiety and the vape culture, along with the college experience, led to the powerful draw to electronic cigarette use among this population. This study reflects findings that the college life experience, the vape culture, and the feelings of anxiety contribute to electronic cigarette use and, finally, lead to intense addiction.

A Case Study Exploration of Authentic Leadership Development in Kenya.

In complex and challenging times many people seek for hope and encouragement from those who have influence. Authentic leadership style has been found to resonate as a positive form of leadership. This case study explores the development journey of three authentic leaders in Nairobi, Kenya. The selected leaders for the study had been rated highly on a 360 authentic leadership assessment as part of a leadership training course. The data consisted of information from the assessment reports and one semi-structured interview with each of the leaders and an observational session with one of the leaders in a management team meeting. Analysis of the data revealed that; 1.) Authentic leaders do not have a clear definition of their leadership, they are clear on what they do and how they do it and why they do, and in their description of these themes it clearly matches the literature definition of authentic leadership. 2.) Authentic leaders live and work by deeply held values that in fact seem like ‘a matter of fact way of life’, influenced by a positive interpretation of very critical and somewhat challenging times in their childhood. 3). They have a clear sense of purpose, they discern what needs to be done and persist at it till they achieve desired results. 4) Authentic leaders have deep respect for people and are passionate about developing people around them; they replicate their values, convictions and way of work within those they lead by leading an open, honest and very relational life. 4.) All the three leaders interviewed went through a process we shall call ‘formation’ in their late teen /young adult years.

Changing Trends in Sickle Cell Disease-Related Mortality in the United States over Four Decades

Introduction: Sickle cell disease (SCD) causes significant morbidity and early mortality. The Cooperative Study of Sickle Cell Disease estimated median life expectancy for individuals with SCD at 42 years for males and 48 years for females in the early 1990s. However, this calculation was made prior to now standards-of-care in SCD, including routine transcranial doppler screening, pneumococcal prophylaxis, and the introduction of the primary disease-modifying therapy hydroxyurea and the widespread use of chronic blood transfusion. Over the last thirty years, with expanded access to disease modifying therapies, increased evidence exists for the preservation of organ function and less frequent acute vaso-occlusive pain. It remains unclear whether the introduction of these therapies has affected overall SCD-related mortality or the specific causes of death of those with SCD in the United States, particularly in the last decade when the use of hydroxyurea has expanded most significantly. Methods: We used the US mortality statistics for 1979-2020 available publicly through the CDC WONDER database (http://wonder.cdc.gov), which is a compilation of county, state, and national-level mortality statistics derived from death certificates, including age category at death, sex, race, ethnicity, year of death, underlying cause of death, and additional contributing causes using ICD-9 codes for 1979-1998 (282.6 sickle cell anemia- all SCD genotypes were included under one code in ICD-9) and ICD-10 codes for 1999-2020 (D57.0 sickle cell anemia with crisis; D57.1 sickle cell anemia without crisis; D57.2 double heterozygous sickling disorders; D57.8 other sickle cell disorders). We searched the SCD ICD-10 codes listed as underlying cause of death by five-year age groups for Black individuals and all ethnicities, (from Hamideh and Alvarez, Pediatric Blood and Cancer 2013) and compared the crude death rates overall and for each age group to those of 1999-2009. We also searched using the SCD ICD-10 codes included in “the multiple causes of death” to determine the 15 most common ICD categories of death in each 10-year period. Results: For the period 2010-2020, 5272 Black (Hispanic & non-Hispanic) individuals died in the United States with the underlying cause of death listed as one of the ICD-10 SCD codes (see Figure 1A for a map of the crude mortality rate distribution). The crude mortality rate was 1.1 per 100,000 Black individuals, which was significantly lower than the period 1999-2009 (crude rate 1.2 per 100,000, p < 0.0001) (Figure 1B). Of note, similar to prior trends, there is a significant increase in mortality rate in the 15-19 year age group versus 20-24 years (0.9 per 100,000 to 1.4 per 100,000, p < 0.0001) corresponding with the age of transition to adult centers. The mean age at death for all genotypes for 2010-2020 was 43 years (females: 44 years, males: 41 years) versus 39 years for 1999-2009 (females: 40 years, males: 38 years). For the period 2010-2020, 61% of cases listed SCD as the primary cause of death without specificity or proximal cause; for the other 39% of cases when an underlying cause of death was noted, cardiovascular disease was the most common (28%), followed by accidents (7%), cerebrovascular disease (7%), malignancy (6%), septicemia (4.8%), and renal disease (3.8%). The fifteen most common causes of death accounted for 90% of underlying causes of death listed in the SCD population. Conclusion: The sickle cell disease-related mortality rate has significantly declined over the last 40 years, including in the period 1999-2020, corresponding with the introduction of disease modifying therapies, improved SCD care, and decreased infant mortality. This overall improvement, however, provides contrast to the enduring sharp increase in mortality in the young adult years. This demonstrates the critical need to improve the transition process from pediatric to adult care and to emphasize the need for additional support for young adults after they transition to adult SCD care.

Descriptive epidemiology of sickle cell disease in Tennessee: population-based estimates from 2008 to 2019

IntroductionThe Sickle Cell Data Collection Program (SCDC) is a multi-state initiative utilizing multiple data sources to estimate population prevalence of Sickle Cell Disease (SCD) with the goal of improving quality of life and health outcomes among those affected. SCDC in Tennessee operates as a multi-site, interdisciplinary team using multiple sources of data to learn more about SCD in Tennessee.MethodsThis analysis characterizes the number, demographics, and proximity to specialty care of individuals living with SCD in Tennessee who have been covered by Medicaid or identified by newborn screening. We compared demographic patterns of individuals with SCD living in rural areas with those living in urban areas, as well as those living in counties contributing more than 50 individuals to the cohort, respectively, to demographic patterns of individuals with SCD in the rest of the state, using Chi-Square or Fisher’s exact tests.ResultsFindings show that overall, 66.1% of all SCD patients identified through newborn screening were residents of Davidson and Shelby counties at the time of birth, and 81.8% of those identified through Medicaid claims lived in Davidson, Hamilton, Knox, Madison, Montgomery, Rutherford, or Shelby County. In total, 8.6% of the cohort lived in rural settings and 91.4% in urban settings. Of the 95 counties in Tennessee, 75 (78.9%) had at least 1 to 40 residents with SCD, yet of these 75 counties, less than half had a hematology/oncology trained provider practicing within them.DiscussionThis analysis brings us closer to understanding how many people with SCD live in rural areas of Tennessee and the challenges they face in seeking the care needed to adequately manage their disease. Acute healthcare utilization remains highest in the young adulthood years. This analysis provides insight into how healthcare utilization patterns among individuals with SCD vary by age group and over time.

Gender and Family Financial Support in the Transition to Adulthood1

This study examines gender differences in the financial support young adults receive from their families and in the associations between adult role occupancy and financial assistance. Drawing on data from the Transition to Adulthood Supplement of the Panel Study of Income Dynamics between 2005 and 2015, this study analyzes patterns of receiving any family financial support among 17–27 year olds and explores the types of expenses for which young adults receive assistance (e.g., tuition). Findings indicate that young women are more likely to receive familial financial assistance in the young adult years, especially for tuition, and that associations between adult social role occupancy and assistance involve both similarities and differences for young men and women. Key differences include that young women are substantially less likely to receive assistance in the form of personal loans from family, and that their partnering and parenting roles are associated with assistance with rent or a mortgage in opposing ways compared to young men's. The study contributes to a deeper understanding of the ways family relationships and young adult pathways to independence are gendered.

The Impact of North Carolina Medicaid Expansion on Young Adults, Infant/Maternal Health, and Caregiver Well-being.

Access to health insurance for the people who give birth to, care for, educate, and nurture children will improve the health and well-being of these individuals and the children in their care. This article highlights how expanded coverage can improve the health and well-being of children in North Carolina starting before birth, through their young adult years, and beyond.

Lifetime Burden of Psychological Symptoms, Disorders, and Suicide Due to Cancer in Childhood, Adolescent, and Young Adult Years

A cancer diagnosis and treatment may result in highly traumatic periods with lasting psychological consequences for children, adolescent, and young adult patients with cancer (CYACs). Early identification and management may prevent long-term psychological morbidity and suicide. To analyze risk, severity, and risk factors for depression, anxiety, psychotic disorders, and suicide in CYACs and noncancer comparators. Literature search of PubMed, MEDLINE, Embase, PsycINFO, CINAHL, and PubMed Central from January 1, 2000, to November 18, 2022. Full-length articles in peer-reviewed journals that measured and reported risk and/or severity of depression, anxiety, psychotic disorders, and suicide mortality in CYACs and a noncancer comparator group. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed with prospective PROSPERO registration. Risk ratios (RRs) were used for dichotomous outcomes, and standardized mean differences (SMDs) were used for continuous outcomes. SMDs were defined as follows: 0.2, small; 0.5, medium; and 0.8, large. Sources of heterogeneity and risk factors were investigated using sensitivity, subgroup, and meta-regression analyses. From 7319 records, 52 studies were included. Meta-analyses revealed that CYACs were at increased lifetime risk of severe symptoms or a disorder of depression (RR, 1.57; 95% CI, 1.29-1.92), anxiety (RR, 1.29; 95% CI, 1.14-1.47), and psychotic disorders (RR, 1.56; 95% CI, 1.36-1.80) relative to both matched controls and their siblings. Overall suicide mortality was not significantly elevated (RR, 1.63; 95% CI, 0.78-3.40). The mean severity of depression was found to be elevated in CYACs receiving treatment (SMD, 0.44; 95% CI, 0.13-0.74) and long-term survivors (SMD, 0.18; 95% CI, 0.02-0.33). The mean severity of anxiety was found to be elevated only during treatment (SMD, 0.16; 95% CI, 0.03-0.20). Findings of this systematic review and meta-analysis suggest that CYACs may experience lasting psychological burden long into survivorship. Timely identification, preventive efforts, and psycho-oncological intervention for psychological comorbidity are recommended.

Factors affecting wellbeing of young adults: A study of Gujrat city, Punjab, Pakistan

ABSTRACT Wellbeing is a fundamental, broad, and multifaceted construct that deals with individual’s health, potential, productivity, social connections, ability to contribute, gain pleasure from doing a good job, recognize themselves by others, grappling, mastering, further utilizing new skills and acquaintances, they value independence, and also the ability to shape their own destinies. Wellbeing emphasizes on developing a person, especially adolescents or young adults as whole, and encompassing different dimensions as social, psychological, physical, economic, and spiritual wellbeing. The years of young adulthood are critical, exciting, and stressful as a continuous process of growing and changing is taking place. Major biological, social, and cognitive changes occur during the period between puberty and young adulthood, which largely stimulate the most important shift in personal capacities, communal affiliation, facilitating to develop and work out societal identities and discover their self-sufficiency. Young adults in Pakistan constitute a major chunk in the national population (63%), and unfortunately produce poor contribution in development and face a multiplicity of challenges. Keeping in consideration the said scenario, an in-depth evaluation is carried out to check the impacts of various factors on overall wellbeing of young adults. Primary data were collected from 18–25-year-old adolescents (male and female) through random sampling. Finding of the study reveals that factors such as family attitude, peer group, adaptability, and leisure time activity have significant impacts on dimensions of overall wellbeing. Furthermore, the relationship among variables is positively significant and has direct and mediating impacts on overall wellbeing of young adults.

Arrested development: relative school entry age and arrests during the teenage and young adult years

ABSTRACT A large literature documents that there are significant academic and non-academic differences between the youngest and oldest students in a school cohort. This paper investigates if being the youngest in a cohort has any impact on an individual's propensity to commit crime by utilizing a data set that contains over 4 million arrest records spanning a 20-year period in California. While I find no persistent effect on the probability of arrest, the youngest students in a cohort have a higher risk of arrest for certain offenses at age 14, corresponding to the age when they would transition to high school.

Chiari I malformation management in patients with heritable connective tissue disorders

BackgroundChiari malformation type I (CMI) is relatively common neurosurgical condition typically treated with posterior fossa decompression. However, the management of CMI in patients with heritable connective tissue disorders (CTDs), such as Ehlers-Danlos Syndrome, Marfan Syndrome, or Osteogenesis Imperfecta, involves a unique set of perioperative challenges. ObjectiveThis study aims to define the demographic information, comorbidities, and perioperative course of patients with concomitant CMI and CTD. MethodsPatients with CMI admitted for surgical decompression from 2008 to 2015 were captured using the National Inpatient Sample (NIS). Information was collected based on ICD-9 codes. Descriptive and regression analyses were performed in SPSS (version 26). Results38,169 CMI patients, 353 of whom had CTD (0.92%), were identified. CMI patients with CTD were more likely to be female (p < 0.001) and present during teenage (p = 0.033) or young adult years (p < 0.001). They had more chronic issues (p < 0.001): systemic comorbidities include postural orthostatic tachycardia syndrome, cardiac dysrhythmias, and gastroparesis (all p < 0.001). CNS comorbidities include migraine, tethered spinal cord, and epilepsy (all p < 0.001). They have increased joint instability (both p < 0.001), as well as craniocervical instability (CCI). More posterior cervical fusion surgeries and application of cervical halo devices were seen during the same inpatient stay (both p < 0.001). ConclusionsPatients with concurrent CTD and CMI were more likely to present with complex Chiari and associated CCI. They were also younger, more often female, and had more systemic, CNS, and joint abnormalities. As such, preoperative recognition of an underlying CTD is imperative to achieve optimal outcomes in this patient population.

Eating and Body Image Disturbances in Adolescence and Substance Use Throughout Young Adulthood: Findings from the Australian Temperament Project

Abstract We investigated whether eating and body image disturbances in mid-adolescence were associated with substance use in young adulthood. Participants (n = 1566) completed the drive for thinness, bulimic behavior, and body dissatisfaction subscales from the Eating Disorder Inventory during adolescence (15–16 years), and reported frequencies of substance use (tobacco, cannabis, binge drinking, other illicit substances) across young adulthood (19–20, 23–24, and 27–28 years). Adolescent body dissatisfaction was associated with a 10% increase in the rate of binge drinking and tobacco smoking, with effects being of similar magnitude in men and women, and across young adulthood. The association between bulimic behavior and tobacco smoking was strongest in the earlier years of young adulthood (19–20 years). Relationships between cannabis use, bulimic behavior, and body dissatisfaction were evident in men only. Findings highlight important targets for prevention programs, as well as focused monitoring efforts to identify individuals at risk of later substance use.

PS-C08-11: RELATIONSHIP OF AMBULATORY WAKE SYSTOLIC BLOOD PRESSURE AND COGNITIVE FUNCTIONING IN CHILDREN AND ADOLESCENTS: THE SHIP-AHOY STUDY

Objective: 24-Hour Ambulatory blood pressure monitoring (ABPM) has been shown to be associated with cognitive functioning in both adults and children with hypertension. Few studies have examined this relationship in youth with normal to mildly elevated blood pressure (BP). We aimed to address this gap in the literature by examining the relationship between average wake systolic BP and targeted cognitive abilities in children and adolescents with normal to mildly elevated BP. Design: Cross-sectional cohort study across six academic centers in the United States. Methods: Participants were part of the SHIP AHOY Project examining target organ damage in children and adolescents with normal to mildly elevated BP. Patients were recruited from pediatric nephrology and/or cardiology clinics and had BP levels &gt; 75th percentile to &gt; 95th percentile). Ascertainment was designed to balance BMI across this BP range by actively recruiting normotensive subjects with obesity. Exclusion criteria included stage 2 hypertension, use of antihypertensive or lipid-lowering medication in the past 6 months, diabetes mellitus (type 1 or 2), kidney disease, or other chronic medical conditions. The primary exposure for this study was average wake Systolic BP. Cognitive variables included the Test of Nonverbal Intelligence, Woodcock-Johnson-V Verbal Attention, and Conners Continuous Performance Test-3 Errors of Omission and Errors of Commission. Preliminary analyses comprised the use of unadjusted linear regressions for the entire sample, with follow-up analyses planned to include key covariates for any significant findings. Results: We recruited 397 adolescents, ages 11–19 years (M∼15.5 yrs.), who comprised approximately 60% males and 53% white. About 25% of the participants had caregivers with a high school degree or less. About 40% of the sample had elevated BP (&gt; 90th percentile). There was a significant relationship between wake average systolic BP and Verbal Attention (p &lt; .009); and wake average systolic BP and Errors of Commission (p &lt; .026). All findings were in the expected direction with higher average wake BP being related to lower performance on the attention-related variables. SBP and Errors of Omission approached significance (p &lt; .07), while Nonverbal IQ was nonsignificant (p &lt; .34). Conclusions: Higher average wake BP, even in adolescents with BP below the hypertensive range, is associated with lower performance on tests of attention regulation and response inhibition. These findings suggest that efforts to minimize associated neurocognitive dysfunction in the late adolescence and young adult years should begin before the presence of hypertension.

Does cognitive reserve or brain maintenance explain heterogeneity in episodic memory trajectories in late middle age?

AbstractBackgroundAging‐related episodic memory (EM) decline and Alzheimer’s disease (AD)‐related brain changes begin in late middle age around age 60. However, rate and severity of cognitive decline do not consistently correspond to the extent of neuropathological changes, suggesting a high degree of heterogeneity in EM trajectories. We tested if brain maintenance (BM; relative absence of changes in neural resources as a determinant of preserved cognition) and/or cognitive reserve (CR; a property of the brain that allows for sustained cognitive performance in the face of age‐related changes and brain insult or disease) explain individual differences and heterogeneity in EM in late middle age.MethodParticipants were 1604 men from the Vietnam Era Twin Study of Aging. A practice effect‐adjusted composite EM score based on six measures was calculated at three time points with mean ages of 56, 62, and 68. Young adult general cognitive ability (GCA) and lifetime years of education were used as proxy measures of CR. BM was assessed as relative change (from age 56 to 68) in cortical thickness and surface area in a bilateral cortical signature of AD regions‐of‐interest (N = 321). We used linear mixed effect modeling.ResultOn average, there was a significant decline in EM from age 56 to 68 (p&lt;0.001). Education (p = 0.042) and young adult GCA (p&lt;0.001) were positively related to EM, but there were no significant effects of education or GCA on the rate of EM change (all p’s≥0.316). Relative brain changes were not related to EM (all p’s≥0.067) and there were no significant interactions of CR proxies and brain changes on EM (all p’s≥0.379).ConclusionHigher education and higher young adult GCA were related to better EM performance across late middle age – with a stronger contribution of GCA compared to education – but EM change did not differ as a function of these proxy CR measures. Our results did not support effects of BM or CR on EM change in late middle age but rather reflected baseline differences in memory in those with low versus high education/cognitive ability. Whether differential change occurs at later ages or with increased AD pathology remains to be determined.

The Naked World: A Tale with Verse by Irina Mashinski

Reviewed by: The Naked World: A Tale with Verse by Irina Mashinski Susan Blumberg-Kason Irina Mashinski The Naked World: A Tale with Verse Cheshire, Massachusetts. MadHat Press. 2022. 185 pages. IRINA MASHINSKI IS one of the most notable contemporary Russian American translators and poets. While she usually composes poetry in Russian, in her latest work she writes in English to examine her family's origins in the former Soviet Union and their exodus to the United States. In the preface, poet Ilya Kaminsky writes that Mashinski's memoir is "a magical book, a story of four generations of one family, told through poems." Mashinski, Kaminsky, and many others are labeled as Russian American writers, and their Judaism is often not mentioned or perhaps deemed unimportant by editors and publishers. Yet their experiences in the Soviet Union and the reasons they emigrated specifically transpired because of their Judaism. In the Soviet Union of Mashinksi's childhood and early adult years, Jews had special marks in their passports, were prohibited from certain professions, and were not promoted in the jobs they could find. Children were called slurs and often beaten up just because they were Jewish. Mashinski's memoir is magical, as Kaminsky writes, because she addresses her family's Judaism through a combination of interconnected poetry and short essays. The Soviet Union was formed to provide equality to all citizens, but it didn't take long for Stalin to become wary of a perceived growing threat from Jews in the government. Mashinski's family felt the effects of this distrust going back to her grandparents' young adult years, specifically in 1928 when her paternal grandfather, Alexander, was arrested and imprisoned just before the birth of Mashinski's [End Page 74] father, Victor. Alexander's brother-in-law, Sergei Gorny, had been the consul general in Turkey during the early years of the Soviet Union and was suddenly on the outs with Stalin. No family member was left untouched, and, because of this, Alexander was imprisoned for the first, but not last, time. Mashinski writes about her paternal grandparents and their family separation in the essays "Alexander and Alexandra, The First Arrest" and "Victor," followed by a poem, "Love": "… counts her beads of trifles, / slips of tongue, quick glances, / having tortured millions / of crumpled petals, anguishing / from encounters, for one year watching / from the four corners, having not uttered / even two words." Alexander would be arrested again twenty years later in 1948 and sent away for six years that time. Mashinksi was born in Moscow in 1958, half a century after Jews had moved beyond the Pale of Settlement or what is now Ukraine, Belarus, Lithuania, Moldova, and parts of Poland, Latvia, and Russia. Several million Jews were confined to this area from the late 1700s until the founding of the Soviet Union and murdered in pogroms en masse when economies declined or rulers felt the need to solidify their power. Another million Jews in Ukraine were shot to death in mass killings during World War II. Many Ashkenazi Jews around the world can trace their origins back to the Pale of Settlement, including Mashinski. In her prose essay "The Bronze Horseman, Natasha," Mashinski writes of her mother's exodus from Kiev in 1941 just before the city fell to the Nazis. Mashinski's mother, Natasha, was only nine years old when her mother, Ophelia, had the foresight to leave Kiev and head east for the Urals, away from Europe. Before they could flee, the Germans bombed their train. Ophelia acted quickly and put Natasha on a truck with relatives leaving the city. Thanks to her grandmother's quick thinking, Mashinski is here today. In reading this essay, I could not help but reflect on today's conflict in Kyiv, as it's known in Ukrainian, as families are torn apart—if they survive. And that the number-one Jewish target of aggression in this current conflict happens to be the president of Ukraine, which would have been unheard of twenty years ago. A number of former Soviet Jewish memoirs by authors like Yelena Lembersky (see WLT, May 2022, 22–25), Lev Golinkin, and Margarita Gokun Silver, among others, show how...

Prognostic significance of age within the adolescent and young adult acute ischemic stroke population after mechanical thrombectomy: insights from STAR.

Although younger adults have been shown to have better functional outcomes after mechanical thrombectomy (MT) for acute ischemic stroke (AIS), the significance of this relationship in the adolescent and young adult (AYA) population is not well defined given its undefined rarity. Correspondingly, the goal of this study was to determine the prognostic significance of age in this specific demographic following MT for large-vessel occlusions. A prospectively maintained international multi-institutional database, STAR (Stroke Thrombectomy and Aneurysm Registry), was reviewed for all patients aged 12-18 (adolescent) and 19-25 (young adult) years. Parameters were compared using chi-square and t-test analyses, and associations were interrogated using regression analyses. Of 7192 patients in the registry, 41 (0.6%) satisfied all criteria, with a mean age of 19.7 ± 3.3 years. The majority were male (59%) and young adults (61%) versus adolescents (39%). The median prestroke modified Rankin Scale (mRS) score was 0 (range 0-2). Strokes were most common in the anterior circulation (88%), with the middle cerebral artery being the most common vessel (59%). The mean onset-to-groin puncture and groin puncture-to-reperfusion times were 327 ± 229 and 52 ± 42 minutes, respectively. The mean number of passes was 2.2 ± 1.2, with 61% of the cohort achieving successful reperfusion. There were only 3 (7%) cases of reocclusion. The median mRS score at 90 days was 2 (range 0-6). Between the adolescent and young adult subgroups, the median mRS score at last follow-up was statistically lower in the adolescent subgroup (1 vs 2, p = 0.03), and older age was significantly associated with a higher mRS at 90 days (coefficient 0.33, p < 0.01). Although rare, MT for AIS in the AYA demographic is both safe and effective. Even within this relatively young demographic, age remains significantly associated with improved functional outcomes. The implication of age-dependent stroke outcomes after MT within the AYA demographic needs greater validation to develop effective age-specific protocols for long-term care across both pediatric and adult centers.

Pilonidal disease: A new look at an old disease

Pilonidal disease is a very common affliction that affects mainly young, hirsute, obese males during their young adult years of life. Previous etiological theories of this ailment centred on congenital causes. The current understanding is that pilonidal disease is an acquired affliction. Some patients, however, may have confounding hereditary tendencies to form pilonidal disease. There is a myriad of methods of treatment for chronic pilonidal disease. Such treatments vary from the creation of large skin flaps to simple instillation of chemicals into the sinuses. No single technique is favoured by every surgeon and each technique has its ardent supporters. The current favoured treatments however, are toward the use of the less invasive options compared to the large extensive flaps. Favoured options include minimally invasive techniques as well as simple lay open and marsupialisation. No proposed classification system for the assessment of severity of pilonidal disease has correlated disease severity with treatment options. Therefore, no classification system is in widespread use by the surgical community. Post-operative supportive management, especially in the early post-operative period, and laser hair epilation after the initial healing phase, have some usefulness in the overall treatment of pilonidal disease.

Exploring Depressive Symptoms and Cancer Worries in a High-Volume Cancer Genetics Clinic: What Are the Roles of Age and Cancer Diagnosis?

Limited research has explored depression and cancer worries (CWs) among adolescents and young adults with cancer (AYAs) seeking genetic counseling. This study evaluated depressive symptoms and CWs among five groups: AYAs, adolescents and young adults without cancer (AYAWOCs), older adults with cancer (OAs), older adults without cancer (OAWOCs), and older adults diagnosed with cancer in their adolescent and young adult years (OA/AYAs). A retrospective data analysis was performed on 6524 patients, which found that AYAs reported significantly higher depressive symptoms and CWs compared with all other groups except OA/AYAs. These findings suggest that the intersection between age and cancer diagnosis is related to depressive symptoms and CWs.