Journal of Adolescent Health最新文献

Purpose: Transitioning from pediatric to adult care is critical for young adults with sickle cell disease. While the transfer typically occurs at age 18, some pediatric providers continue care into adulthood. This study evaluates whether remaining in pediatric care versus transferring to adult care affects health outcomes. We hypothesized that those who remain in pediatric care after age 18 would experience fewer acute health-care events and better outcomes than those who transfer to adult care.

Methods: A retrospective cohort study was conducted at HEMORIO, a blood center in Rio de Janeiro, Brazil. Health-care utilization (outpatient visits, emergency department visits, hospitalizations), hydroxyurea use, care abandonment, and mortality were compared among young adults with sickle cell disease aged 18-23 under pediatric or adult care. Wilcoxon rank sum tests and Fisher's exact tests were used for statistical analysis.

Results: Among 472 eligible patients (50% female, 71% Hb SS or Hb Sβ0 thalassemia), 81 (17%) remained in pediatric care, while 391 (83%) transferred to adult care. After age 18, patients in pediatric care had fewer emergency visits and hospitalizations compared to those in adult care. Transferred patients showed increased emergency visits and hospitalizations relative to their adolescent period, whereas those remaining in pediatric care experienced reduced rates of these events.

Discussion: Transitioning to adult care is associated with increased adverse outcomes despite more frequent ambulatory visits. Enhancing transition programs to improve adult care integration and engagement is essential to address these disparities.

Purpose: To investigate the association between physical activity (PA) and neurodegeneration biomarkers from adolescence to adulthood by examining tau protein and neurofilament light chain (NfL) levels in blood samples.

Methods: The study analyzed data from adolescents aged 12-19 years who participated in Waves I (1994-1996) and V (2016-2018) of the Add Health study over a span of 22 years. It assessed PA through self-reported questionnaires. Neurodegeneration measures at Wave V used venous blood collected via phlebotomy. Samples were analyzed using single-molecule array (Simoa) technology on a Quanterix HD-1 analyzer, using digital enzyme-linked immunosorbent assay to quantify NfL and tau proteins from serum and plasma samples.

Results: In the present study, 3,182 individuals participated, with females comprising 61% of the sample. Participants adhering to the PA guidelines in both waves reported lower levels of NfL (-0.583 pg/mL, 95% bias-corrected and accelerated (BCa) confidence interval (CI): -1.235 to -0.068) and tau protein levels (-0.244 pg/mL, 95% BCa CI: -0.405 to -0.078). Adjusted analyses confirmed significant lower levels of tau protein (-0.210 pg/mL, 95% BCa CI: -0.350 to -0.072) for Wave I adherents and even lower levels in NfL (-0.421 pg/mL, 95% BCa CI: -0.929 to -0.007) and tau protein levels (-0.229 pg/mL, 95% BCa CI: -0.412 to -0.053) for active participants in both waves.

Discussion: Our findings suggest that consistent engagement in PA may reduce certain neurodegenerative biomarkers, potentially influencing neurological health outcomes.

Purpose: Post-COVID condition (PCC) emerged following the 2020 coronavirus pandemic and required rapid service development to manage affected patients. This evaluation describes the demographics, medical background, management and six-month outcomes of children and young people with PCC-related symptoms referred to one specialist tertiary service between June 2020 and August 2022.

Methods: Data were retrospectively collected from referral information and medical notes.

Results: 176 patients (61% female) aged 6-18 years were referred, with a mean 8.2 PCC-related symptoms impacting on functioning (97%) and school attendance (86%). 10% patients had an autistic spectrum disorder diagnosis, above the ∼2% national prevalence, while rates of atopy and mental health were similar to national prevalence. 59% patients were managed in specialist tertiary clinics by clinicians with input from allied health professionals. At 6 month review, 40/73 patients reported improvement in their daily functioning, with 30/73 reporting no change and 3/73 reporting functional deterioration. School attendance increased over 6 months for 43/67 patients, with 12/67 reporting no change and 4/67 reporting reduced school attendance.

Discussion: Patients referred for PCC-related specialist input have significant functional impairment and challenges accessing education. More than half of those seen in specialist clinics showed functional improvement and increased school attendance over 6 months, while a subgroup had persistent symptoms. This suggests that the service model is beneficial for this complex patient group overall, although needs to be resourced for longer input for some. Further work is needed to understand the variability in presentation and symptom course.

Purpose: To examine the associations between adverse childhood experiences (ACEs) scores from routine screenings in pediatric checkups and timing of puberty in a diverse cohort of adolescents.

Methods: A retrospective cohort study of 52,573 pediatric members of Kaiser Permanente Northern California, an integrated healthcare delivery system. Exposure was the total ACEs score, determined using caregiver- and self-reported scores across all well-child visits, and categorized into 0, 1-3, 4-6, or 7-10 ACEs. Outcomes were age at menarche and pubertal onset, using physician-assessed Sexual Maturity Ratings.

Results: Girls with ACEs had a substantially higher risk of earlier menarche and pubertal onset compared to those without ACEs. There were no associations between ACEs and boys' pubertal timing.

Discussion: These results highlight the importance of screening for ACEs in a clinical setting to address adolescents' psychological well-being and healthy lifestyle habits, which in turn may prevent adverse health outcomes associated with early puberty.

Purpose: To explore how trans youth with pregnancy capacity think through and understand the associations between pregnancy, contraception methods, and dysphoria.

Methods: We conducted 8 asynchronous online focus groups (n = 152) between 2020 and 2021 with trans youth assigned female at birth, and thus presumed capable of pregnancy, aged 14-18, who were living in the United States. Data were analyzed using a qualitative thematic approach informed by interpretive description.

Results: Some youth participants were unequivocal in their belief that both pregnancy and contraception would give rise to gender-related distress, which affected how they framed the acceptability of pregnancy and various methods for its prevention. Others had more dynamic understandings of dysphoria, recognizing that it is not inevitable or uniformly experienced. Still others posited that dysphoria that does occur can be managed considering the individual's priority goal or desire - whether to become a gestational parent or to prevent pregnancy. Participants discussed the importance of accessing sexual and reproductive healthcare, even if doing so requires them to navigate terrains of potential dysphoria, including dysphoria that is provoked by having to access gendered spaces and services and due to the use of gendered language.

Discussion: Youth participants had varied, nuanced understandings of dysphoria and its potential impact on their conception, pregnancy, and contraception experiences. Many did not hold prescriptive views that dysphoria is a defining aspect of their lives as trans people. Findings suggest strategies for the delivery of gender-affirming, youth-friendly sexual and reproductive healthcare that attends to dysphoria-as-distress when it occurs.

Purpose: Adverse childhood experience (ACE) exposure and poor mental health are closely intertwined. In 2020, the prevalence of both began precipitously increasing among adolescents. We explored associations of individual and cumulative ACE exposure with cost and COVID-19 pandemic-related unmet health needs to assess ACEs as risk markers for broader structural adversity.

Methods: We conducted a nationally representative analysis of 5,536 adolescents (weighted N = 20,294,070) aged 13-17 years using the 2019 and 2021 National Health Interview Survey. Outcomes included mental health symptoms, preventive care access, cost and COVID-19-related unmet needs, and health care use. We estimated associations with lifetime exposure to 4 ACEs using marginal effects from multivariable logistic regressions.

Results: Millions of adolescents were exposed to parental incarceration (7.8%, N = 1,407,670), neighborhood violence (6.9%, N = 1,567,483), a guardian with serious mental illness (10.3%, N = 2,088,957), and/or a guardian with alcohol or drug problems (11.4%, N = 2,304,953). Overall, 77.7% (N = 15,758,023), 13.2% (N = 2,671,342), and 9.2% (N = 1,864,704) were exposed to 0, 1, and 2+ of these ACEs. In adjusted models, compared with exposure to 0 ACEs, exposure to 1 or 2+ ACEs was positively associated with anxiety and depression symptom frequency, urgent care and emergency department use, trouble paying medical bills, delayed and forgone mental health care due to cost, and delayed and forgone care due to the COVID-19 pandemic.

Discussion: Adolescents exposed to ACEs experienced mutually reinforcing disadvantages: a worse mental health symptom burden, yet greater barriers to accessing needed medical and mental health care. ACEs must be reconceptualized as markers of structural-rather than individual-adversity and addressed through structural and policy interventions.