Magnetic resonance and diffusion tensor imaging of the adolescent rabbit growth plate of the knee.

PURPOSE: To assess the ability of MRI-DTI to evaluate growth plate morphology and activity compared with that of histomorphometry and micro-CT in rabbits. METHODS: The hind limbs of female rabbits aged 16, 20, and 24 wk (n = 4 per age group) were studied using a 9.4T MRI scanner with a multi-gradient echo 3D sequence and DTI in 14 directions (b-value = 984 s/mm2 ). After MRI, the right and left hind limb were processed for histological analysis and micro-CT, respectively. The Wilcoxon signed-rank test was used to evaluate the height and volume of the growth plate. Intraclass correlation and Pearson correlation coefficient were used to evaluate the association between DTI metrics and age. RESULTS: The growth plate height and volume were similar for all modalities at each time point and age. Age was correlated with all tractography and DTI metrics in both the femur and tibia. A correlation was also observed between all the metrics at both sites. Tract number and volume declined with age; however, tract length did not show any changes. The fractional anisotropy color map showed lateral diffusion centrally in the growth plate and perpendicular diffusion in the hypertrophic zone, as verified by histology and micro-CT. CONCLUSION: MRI-DTI may be useful for evaluating the growth plates.

Randomised controlled trial showed long-term efficacy, immunogenicity and safety of varicella vaccines in Norwegian and Swedish children.

AIM: Several countries, such as Norway and Sweden, have not implemented universal varicella vaccination. We present data for Norway and Sweden that were generated by a paediatric multi-country Phase III study over a 10-year period. This assessed the efficacy, antibody persistence and safety of two varicella vaccines containing the same Oka strain. METHODS: This was an observer-blind, controlled trial conducted in 10 European countries. Children aged 12-22 months (n = 5803) were randomised 3:3:1 and vaccinated between 1 September 2005 and 10 May 2006. The two-dose group received two tetravalent measles-mumps-rubella-varicella vaccine doses. The one-dose group received one monovalent varicella vaccine dose after a measles-mumps-rubella vaccine dose. Control group participants received two measles-mumps-rubella vaccine doses. Main study outcomes were vaccine efficacy against confirmed varicella cases and incidence of adverse events. RESULTS: Vaccine efficacy in the two-dose group was ≥92.1% in both Norwegian and Swedish children compared to 72.3% in Norway and 58.0% in Sweden in the one-dose group. Incidences of adverse events and serious adverse events were similar in the Norwegian and Swedish study populations. CONCLUSION: Consistent with overall study results, high efficacy against varicella and acceptable safety profiles of the two varicella vaccines were observed in Norwegian and Swedish populations. These findings highlight the benefits of varicella vaccines, particularly when administered as a two-dose schedule.

A cross-sectional magnetic resonance imaging study of factors influencing growth plate closure in adolescents and young adults.

AIM: To assess growth plate fusion by magnetic resonance imaging (MRI) and evaluate the correlation with sex, age, pubertal development, physical activity and BMI. METHODS: Wrist, knee and ankle of 958 healthy subjects aged 14.0-21.5 years old were examined using MRI and graded by two radiologists. Correlations of growth plate fusion score with age, pubertal development, physical activity and BMI were assessed. RESULTS: Complete growth plate fusion occurred in 75%, 85%, 97%, 98%, 98% and 90%, 97%, 95%, 97%, 98% (radius, femur, proximal- and distal tibia and calcaneus) in 17-year-old females and 19-year-old males, respectively. Complete fusion occurs approximately 2 years earlier in girls than in boys. Pubertal development correlated with growth plate fusion score (ρ = 0.514-0.598 for the different growth plate sites) but regular physical activity did not. BMI also correlated with growth plate fusion (ρ = 0.186-0.384). Stratified logistic regression showed increased odds ratio (OR F: 2.65-8.71; M: 1.71-4.03) for growth plate fusion of obese or overweight subects versus normal-weight subjects. Inter-observer agreement was high (Κ = 0.87-0.94). CONCLUSION: Growth plate fusion can be assessed by MRI; occurs in an ascending order, from the foot to the wrist; and is significantly influenced by sex, pubertal development and BMI, but not by physical activity.

Depression, anxiety, and suicidal ideation in young adults 5 years after undergoing bariatric surgery as adolescents.

PURPOSE: Metabolic and bariatric surgery (MBS) is increasingly used in adolescents. The aim was to explore symptoms of depression and anxiety in young adults over 5 years' follow-up after undergoing MBS. METHODS: Beck Depression Inventory-2 and the Beck Anxiety Inventory were used to assess symptoms of depression and anxiety in 62 patients 1, 2, and 5 years after having Roux-en-Y gastric bypass at 13-18 years of age. Mental health, eating-related problems, and weight outcomes were tested for association with suicidal ideation at the 5-year follow-up. RESULTS: At the 5-year follow-up, the mean score for depression was 11.4 (± 12.4), indicating minimal symptoms of depression. The mean score for anxiety was 12.82 (± 11.50), indicating mild anxiety symptoms. Still, several participants reported moderate or severe symptoms of depression (26%) and anxiety (32%). Women reported more symptoms than men (P = 0.03 and 0.04). No significant changes were found in self-reported symptoms of depression and anxiety between the 1-year and the 5-year follow-up (P = 0.367 and 0.934). Suicidal ideation was reported by 16% at the 5-year follow-up. Participants reporting suicidal ideation had lost significantly less excess weight than participants without suicidal ideation (P = 0.009). CONCLUSION: Five years after adolescent MBS, a substantial minority still struggles with mental health issues, and women are more burdened than men. Our results indicate an association between less optimal weight loss and suicidal ideation 5 years after MBS. The findings emphasize the importance of offering long-term follow-up and mental health treatment several years after MBS. LEVEL OF EVIDENCE: Level III, cohort study. CLINICAL TRIAL REGISTRATION: The study is registered with ClinicalTrials.gov (NCT00289705). First posted February 10, 2006.

Binge eating and other eating-related problems in adolescents undergoing gastric bypass: results from a Swedish nationwide study (AMOS).

Bariatric surgery is established as a treatment option for adolescents with severe obesity. Little is known about binge eating (BE) and other eating-related problems in adolescents undergoing bariatric surgery. BE, emotional eating, uncontrolled eating, and cognitive restraint were assessed at baseline, and one and two years after gastric bypass using questionnaires in 82 adolescents (mean age 16.9 years, 67% girls). BE was assessed with the Binge Eating Scale (BES) and other eating-related problems with the Three Factor Eating Questionnaire. Change in eating-related problems over time, along with the relationship between eating behaviors and other aspects of mental health and weight outcome, were analyzed. At baseline, 37% of the adolescents reported BE (defined as a BES score >17). Two years after gastric bypass, adolescents reported less problems related to BE, emotional eating, and uncontrolled eating. Improvements were moderate to large. Adolescents reporting BE at baseline also reported more general mental health and psychosocial weight-related problems before and/or two years after surgery, compared to adolescents with no BE. After surgery adolescents with BE before surgery reported more suicidal ideation than those with no BE at baseline. None of the eating-related problems assessed at baseline was associated with weight outcome after surgery. More binge eating, emotional eating, and uncontrolled eating two years after surgery were associated with less weight loss. In conclusion, eating-related problems were substantially reduced in adolescents after undergoing gastric bypass. However, pre-operative BE seem to be associated with general mental health problems before and two years after surgery, including suicidal ideation. Pre-operative eating-related problems did not affect weight outcome, and our results support existing guidance that BE should not be considered an exclusion criterion for bariatric surgery in adolescents.

Perceived child eating behaviours and maternal migrant background.

The Child Eating Behaviour Questionnaire (CEBQ) is a well-established instrument in the study of obesity-related eating behaviours among children. However, research using the CEBQ in multicultural samples is limited. This study aims to identify and examine differences in child eating behaviours as reported by Swedish-born and non-Swedish-born mothers living in Sweden. Mothers (n = 1310, 74 countries of origin, mean age 36.5 years, 63.6% with higher education, 29.2% with overweight or obesity) of children aged 3-8 years (mean age 4.8 years, 18.1% with overweight or obesity) completed the CEBQ. Responses were analysed using CEBQ subscales Food Responsiveness, Emotional Overeating, Enjoyment of Food, and Desire to Drink, clustering into Food Approach, and subscales Satiety Responsiveness, Slowness in Eating, Emotional Undereating, and Food Fussiness, clustering into Food Avoidance. Data were compared across seven regional groups, divided by maternal place of birth: (1) Sweden (n = 941), (2) Nordic and Western Europe (n = 68), (3) Eastern and Southern Europe (n = 97), (4) the Middle East and North Africa (n = 110), (5) East, South and Southeast Asia (n = 52), (6) Sub-Saharan Africa (n = 16), and (7) Central and South America (n = 26). Crude, partly and fully adjusted linear regression models controlled for child's age, gender and weight status, and mother's education, weight status and concern about child weight. The moderation effect of maternal concern about child weight was examined through interaction analyses. Results showed that while Food Approach and Food Avoidance behaviours were associated with maternal migrant background, associations for Food Fussiness were limited. Notably, mothers born in the Middle East and North Africa reported higher frequencies of both Food Approach (except for Enjoyment of Food) and Food Avoidance. The study highlights the importance of examining how regionally-specific maternal migrant background affects mothers' perceptions of child eating behaviours.

Controlling feeding practices and maternal migrant background: an analysis of a multicultural sample.

OBJECTIVE: Parental feeding practices shape children's relationships with food and eating. Feeding is embedded socioculturally in values and attitudes related to food and parenting. However, few studies have examined associations between parental feeding practices and migrant background. DESIGN: Cross-sectional study. Parental feeding practices (restriction, pressure to eat, monitoring) were assessed using the Child Feeding Questionnaire. Differences were explored in four sub-samples grouped by maternal place of birth: Sweden, Nordic/Western Europe, Eastern/Southern Europe and countries outside Europe. Crude, partly and fully adjusted linear regression models were created. Potential confounding variables included child's age, gender and weight status, and mother's age, weight status, education and concern about child weight. SETTING: Malmö and Stockholm, Sweden. SUBJECTS: Mothers (n 1325, representing seventy-three countries; mean age 36·5 years; 28·1 % of non-Swedish background; 30·7 % with overweight/obesity; 62·8 % with university education) of pre-school children (mean age 4·8 years; 50·8 % boys; 18·6 % with overweight/obesity). RESULTS: Non-Swedish-born mothers, whether European-born or non-European-born, were more likely to use restriction. Swedish-born mothers and Nordic/Western European-born mothers reported lower levels of pressure to eat compared with mothers born in Eastern/Southern Europe and mothers born outside Europe. Differences in monitoring were small. Among the potential confounding variables, child weight status and concern about child weight were highly influential. Concern about child weight accounted for some of the effect of maternal origin on restriction. CONCLUSIONS: Non-European-born mothers were more concerned about children being overweight and more likely to report controlling feeding practices. Future research should examine acculturative and structural factors underlying differences in feeding.

Associations between maternal sense of coherence and controlling feeding practices: The importance of resilience and support in families of preschoolers.

Sense of Coherence (SOC) measures an individual's positive, or salutogenic, orientation toward her/his capacities, environment, future, and life. SOC comprises three factors: comprehensibility (the sense of one's own life as ordered and understandable); manageability (the perception of available resources and skills to manage stressors); and meaningfulness (the overall sense that life is filled with meaning and purpose). In numerous studies, SOC has been associated with resilience to stress. However, associations between parental SOC and controlling feeding practices have yet to be studied. This study examines the validity of the SOC 13-item, 3-factor questionnaire, associations between SOC and maternal and child characteristics, and associations between SOC and use of pressuring or restrictive feeding, among mothers of 4-year-olds. 565 mothers (23.5% of foreign origin, 30.3% with overweight/obesity) recruited via the Swedish population registry (response rate: 65%), completed the SOC-13, the Child Feeding Questionnaire (CFQ), and a background questionnaire. The validity of SOC-13 was examined using confirmatory factor analysis; associations with background characteristics and feeding practices were tested with structural equation modeling. SOC-13 validity testing showed acceptable fit (TLI = 0.93, CFI = 0.94, RMSEA = 0.06, SRMR = 0.04) after allowing one pair of error terms to correlate. The Cronbach's alpha for meaningfulness was 0.73, comprehensibility 0.76, and manageability 0.75. SOC increased with mothers' Swedish background and education, and decreased with higher BMI. Child gender, age, and BMI, were not associated with SOC. Lower SOC was associated with controlling practices and with concern about child weight and eating. The associations between SOC and feeding suggest that SOC-related parameters could inform childhood obesity research, and that prevention should address the socioeconomic barriers that parents face in building resilience to stress.

Parental feeding practices and associations with child weight status. Swedish validation of the Child Feeding Questionnaire finds parents of 4-year-olds less restrictive.

The Child Feeding Questionnaire (CFQ) assesses parental feeding attitudes, beliefs and practices concerned with child feeding and obesity proneness. The questionnaire has been developed in the U.S., and validation studies in other countries are limited. The aim of this study was to examine the psychometric properties of the CFQ in Sweden and the associations between parenting practices and children's weight status. Based on records from the Swedish population register, all mothers of 4-year-olds (n = 3007) from the third largest city in Sweden, Malmö, were contacted by mail. Those who returned the CFQ together with a background questionnaire (n = 876) received the CFQ again to enable test-retest evaluation; 564 mothers completed the CFQ twice. We used confirmatory factor analysis to test whether the original 7-factor model was supported. Good fit (CFI = 0.94, TLI = 0.95, RMSEA = 0.04, SRMR = 0.05) was obtained after minor modifications such as dropping 2 items on restriction and adding 3 error covariances. The internal reliability and the 2-week test-retest reliability were good. The scores on restriction were the lowest ever reported. When the influence of parenting practices on child BMI (dependent variable) was examined in a structural equation model (SEM), child BMI had a positive association with restriction and a negative association with pressure to eat. Restriction was positively influenced by concern about child weight. The second SEM treated parenting practices as dependent variables. Parental foreign origin and child BMI had direct effects on restriction, while pressure to eat was also influenced by parental education. While the results of the study support the usefulness of the CFQ in Sweden, carefully designed cross-cultural comparisons are needed to explain why the levels of restrictive feeding in Swedish families are the lowest reported.

Allergic Diseases and Childhood Obesity: A Detrimental Link?

Several epidemiological studies have described childhood obesity as a risk factor for atopic disease, particularly asthma. At the same time, this association seems to be more conflicting for allergic rhinitis, atopic dermatitis, and chronic urticaria. This article aims to deepen the possibility of a relationship between childhood obesity and allergic diseases. As regards asthma, the mechanical and inflammatory effects of obesity can lead to its development. In addition, excess adiposity is associated with increased production of inflammatory cytokines and adipokines, leading to low-grade systemic inflammation and an increased risk of asthma exacerbations. Allergic rhinitis, atopic dermatitis, food allergies, and chronic urticaria also seem to be related to this state of chronic low-grade systemic inflammation typical of obese children. Vitamin D deficiency appears to play a role in allergic rhinitis, while dyslipidemia and skin barrier defects could explain the link between obesity and atopic dermatitis. Starting from this evidence, it becomes of fundamental importance to act on body weight control to achieve general and allergic health, disentangling the detrimental link between obesity allergic diseases and childhood obesity. Further studies on the association between adiposity and atopy are needed, confirming the biologically active role of fat tissue in the development of allergic diseases and exploring the possibility of new therapeutic strategies.

DTI assessment of the maturing growth plate of the knee in adolescents and young adults.

PURPOSE: To assess the growth plates of the knee in a healthy population of young adults and adolescents using DTI, and to correlate the findings with chronological age and skeletal maturation. METHODS: A prospective, cross-sectional study to assess the tibial and femoral growth plates with DTI in 155 healthy volunteers aged between 14.0 and 21 years old. Echo-planar DTI with 15 directions and b value of 0 and 600 s/mm2 was performed on a 3 T whole-body scanner. RESULTS: A relationship was observed between chronological age and most DTI metrics (fractional anisotropy, mean diffusivity, and radial diffusivity), tract length and volume. (No significant relationship could be seen for axonal diffusivity and tract length.) Subdivision according to skeletal maturation showed the greatest tract lengths and volumes seen in stage 4b and not 4a. The intra-observer agreement was significant (P = 0.01) for all the measured variables, but agreement varied (femur 0.53 - 0.98; tibia 0.58 - 0.98). Spearman's correlation showed a significant correlation for age (P = 0.05; P = 0.01) as well as for the fractional anisotropy value within all variables in both femur and tibia. Tract number and volume had a similar correlation with most variables, especially the DTI metrics, and would seem to be interchangeable. CONCLUSION: The current study indicates that DTI metrics could be a tool to assess the skeletal maturation process of the growth plate and its activity. Tractography seems promising to assess the activity of the growth plate in a younger population but must be used with caution in the more mature growth plate.

The influence of growth hormone on pediatric body composition: A systematic review.

Background: Growth hormone (GH) affects metabolism and regulates growth in childhood. The most prominent feature of GH deficiency (GHD) in children is diminished height velocity that eventually leads to short stature. In adult-onset GHD, lean body mass (LBM) is reduced, and visceral fat mass (FM) increased. Beneficial effects of GH treatment on body composition in adults with GHD, including an increase in muscle mass and a decrease in FM, are well established. Relatively few studies have investigated the effects of GH treatment on the body composition of pediatric patients with idiopathic or hypothalamic-pituitary disease-associated GH deficiency. This systematic review aimed to summarize available evidence relating to the effects of GH treatment on body composition in children with GHD. Methods: The PubMed, Science Direct, Cochrane Trials, and Embase databases, were searched with keywords including "GH", "body composition", "children", and "growth hormone" for English-language articles, published between January 1999 and March 2021. Two reviewers independently evaluated the search results and identified studies for inclusion based on the following criteria: participants had a confirmed diagnosis of GHD (as defined in each study); participants were pediatric patients who were receiving GH or had stopped GH treatment, regardless of whether they were pre- or post-pubertal; the intervention was recombinant human GH (rhGH; somatropin); and outcomes included changes in body composition during or after stopping GH therapy. Data extracted from each study included study quality, study sample characteristics, study interventions, and body composition. Data on fat-free mass and LBM were combined into a single category of LBM. Results: Sixteen studies reporting changes in body composition (i.e., FM and LBM) associated with GH treatment in children with GHD were identified and included in the review. Collectively, these studies demonstrated that FM decreased, and LBM increased in response to GH replacement therapy. Conclusion: Despite study limitations (i.e., potential effects of diet and physical activity were not considered), we concluded that a periodic body composition assessment is required to ensure that a satisfactory body composition is achieved during GH replacement therapy in children with GHD.

Vitamin D and Osteogenesis Imperfecta in Pediatrics.

Osteogenesis Imperfecta (OI) is a heterogeneous group of inherited skeletal dysplasias characterized by bone fragility. The study of bone metabolism, in these disease, is problematic in terms of clinical and genetic variability. The aims of our study were to evaluate the importance of Vitamin D levels in OI bone metabolism, reviewing studies performed on this topic and providing advice reflecting our experience using vitamin D supplementation. A comprehensive review on all English-language articles was conducted in order to analyze the influence of vitamin D in OI bone metabolism in pediatric patients. Reviewing the studies, contradictory data were found on the relationship between 25OH vitamin D levels and bone parameters in OI, and in several studies the baseline levels of 25OH D were below the threshold value of 75 nmol/L. In conclusion, according to the literature and to our experience, we highlight the importance of adequate vitamin D supplementation in children with OI.

Changes in adipose tissue distribution and relation to cardiometabolic risk factors after Roux-en-Y gastric bypass in adolescents.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) among adolescents with obesity results in significant weight loss; however, depot-specific changes have been understudied. OBJECTIVE: We hypothesized that visceral adipose tissue (VAT) reduction in adolescents undergoing RYGB would be greater than other depots and associated with improvement in cardiometabolic risk factors. SETTING: Three specialized treatment centers in Sweden. METHODS: Fifty-nine adolescents underwent dual x-ray absorptiometry before surgery and at 1, 2, and 5 years after RYGB. Changes in body composition in multiple depots (total fat, lean body, gynoid fat, android fat, subcutaneous adipose tissue, and VAT) and cardiometabolic risk factors were assessed using multiple linear regression analysis and generalized estimating equations adjusting for age, sex, and baseline risk factor levels. Data are presented as percent change (95% CI) with regression models showing slopes and estimated P values. RESULTS: At 1 year post-RYGB, a significant reduction was observed across all body composition measures (P < .001) with the greatest reduction observed in VAT (-65.1% [-68.7, -61.8]). From year 1 to 5 years post-RYGB, a regain was observed in all depots except lean body mass (1.2% [.3, 2.7], P = .105). A sex-specific difference in overall trajectories was only observed in lean body mass with males consistently having higher mean levels. Change in VAT at 1 year correlated with change in triglycerides (slope: .21 mg/dL/kg, P = .034) and fasting plasma insulin (slope: 44 pmol/L/kg, P = .027). CONCLUSIONS: Adiposity measures all decreased after RYGB but poorly predicted change in cardiometabolic risk. Despite significant reductions at 1 year, a steady regain was observed out to 5 years, with values still well below baseline. Further research should consider control group comparison and extended follow-up.

Long-term changes in dietary intake and its association with eating-related problems after gastric bypass in adolescents.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery is an established, effective treatment for severe adolescent obesity. Long-term dietary intake and the relationship to eating-related problems are scarcely evaluated in this population. OBJECTIVES: Assess changes in dietary intake in adolescents after RYGB and explore associations between dietary intake and eating-related problems. SETTING: Multicenter study in Swedish university hospitals. METHOD: Diet history, binge eating scale (BES), and Three-Factor Eating Questionnaire were assessed preoperatively and 1, 2, and 5 years after RYGB in 85 adolescents (67% female) aged 16.5 ± 1.2 years with a body mass index (BMI) of 45.5 ± 6.0 kg/m2 and compared with control individuals at 5 years. RESULTS: Five-year BMI change was -28.6% ± 12.7% versus +9.9% ± 18.9% in RYGB patients versus control individuals (P < .001). Through 5 years, RYGB adolescents reported reduced energy intake, portion size of cooked meals at dinner, and milk/yoghurt consumption (P < .01). The BES scores were 9.3 ± 8.3 versus 13.4 ± 10.5 in RYGB patients versus control individuals (P = .04). Association between BES score and energy intake was stronger in control individuals (r = .27 versus r = .62 in RYGB patients versus control individuals, P < .001). At 5 years, lower energy intake was associated with greater BMI loss in all adolescents (r = .33, P < .001). Higher scores in BES and uncontrolled and emotional eating were associated with higher energy intake, cooked meals, candies/chocolates, cakes/cookies, desserts, and sugary drinks (r > .23, P < .04) and lower intake of fruits/berries (r = -.32, P = .044). A higher score in cognitive restraint was associated with a higher intake of cereals and fruits/berries (r > .22, P < .05) and a lower intake of sugary drinks (r = -.24, P < .03). CONCLUSION: To support optimization of long-term outcomes in adolescent RYGB patients, it is important to provide management strategies to reduce energy intake. Monitoring eating-related problems could identify potential individuals at risk of poor weight loss and to initiate treatment interventions.

Persistence of hSBA titers elicited by the meningococcal serogroup B vaccine menB-FHbp for up to 4 years after a 2- or 3-dose primary series and immunogenicity, safety, and tolerability of a booster dose through 26 months.

BACKGROUND: To demonstrate extended protection against meningococcal serogroup B (MenB) disease after MenB-FHbp (bivalent rLP2086) vaccination, this study evaluated immunopersistence through 26 months following MenB-FHbp boosting after 2 or 3 primary doses in adolescents. STUDY DESIGN: This phase 3, open-label study was an extension of 3 phase 2 studies with participants aged 11-18 years randomized to receive primary MenB-FHbp vaccination following 1 of 5 dosing schedules or control. A booster dose was administered 48 months after the primary series. Immunopersistence through 48 months after the last primary dose (persistence stage) and 26 months postbooster (booster stage) was determined by serum bactericidal assays using human complement (hSBAs) against 4 vaccine-heterologous test strains. Safety evaluations included adverse events (AEs) and local and systemic reactions. RESULTS: Overall, 698 and 304 subjects enrolled in the persistence and booster stages, respectively. hSBA titers declined in all groups during 12 months postprimary vaccination, then remained stable through 48 months. One month postbooster, 93.4-100.0% of subjects achieved hSBA titers ≥ lower limit of quantitation against each test strain; percentages at 12 and 26 months postbooster were higher than at similar time points following primary vaccination. Primary and booster MenB-FHbp vaccinations were well tolerated, with ≤ 12.5% of subjects reporting AEs during each stage. The most common local (reported by 84.4-93.8% of subjects) and systemic (68.8-76.6%) reactions to the booster were injection site pain and fatigue and headache, respectively; ≤ 3.7% of subjects reported severe systemic events. CONCLUSION: Protective hSBA titers initially declined but were retained by many subjects for 4 years irrespective of primary MenB-FHbp vaccination schedule. Boosting at 48 months after primary vaccination was safe, well tolerated, and induced immune responses indicative of immunological memory that persisted through 26 months. Booster vaccination during late adolescence may prolong protection against MenB disease.

Chronological Age Assessment in Young Individuals Using Bone Age Assessment Staging and Nonradiological Aspects: Machine Learning Multifactorial Approach.

BACKGROUND: Bone age assessment (BAA) is used in numerous pediatric clinical settings as well as in legal settings when entities need an estimate of chronological age (CA) when valid documents are lacking. The latter case presents itself as critical as the law is harsher for adults and granted rights along with imputability changes drastically if the individual is a minor. Traditional BAA methods have drawbacks such as exposure of minors to radiation, they do not consider factors that might affect the bone age, and they mostly focus on a single region. Given the critical scenarios in which BAA can affect the lives of young individuals, it is important to focus on the drawbacks of the traditional methods and investigate the potential of estimating CA through BAA. OBJECTIVE: This study aims to investigate CA estimation through BAA in young individuals aged 14-21 years with machine learning methods, addressing the drawbacks of research using magnetic resonance imaging (MRI), assessment of multiple regions of interest, and other factors that may affect the bone age. METHODS: MRI examinations of the radius, distal tibia, proximal tibia, distal femur, and calcaneus were performed on 465 men and 473 women (aged 14-21 years). Measures of weight and height were taken from the subjects, and a questionnaire was given for additional information (self-assessed Tanner Scale, physical activity level, parents' origin, and type of residence during upbringing). Two pediatric radiologists independently assessed the MRI images to evaluate their stage of bone development (blinded to age, gender, and each other). All the gathered information was used in training machine learning models for CA estimation and minor versus adult classification (threshold of 18 years). Different machine learning methods were investigated. RESULTS: The minor versus adult classification produced accuracies of 0.90 and 0.84 for male and female subjects, respectively, with high recalls for the classification of minors. The CA estimation for the 8 age groups (aged 14-21 years) achieved mean absolute errors of 0.95 years and 1.24 years for male and female subjects, respectively. However, for the latter, a lower error occurred only for the ages of 14 and 15 years. CONCLUSIONS: This study investigates CA estimation through BAA using machine learning methods in 2 ways: minor versus adult classification and CA estimation in 8 age groups (aged 14-21 years), while addressing the drawbacks in the research on BAA. The first achieved good results; however, for the second case, the BAA was not precise enough for the classification.

Comparison of reliability of magnetic resonance imaging using cartilage and T1-weighted sequences in the assessment of the closure of the growth plates at the knee.

BACKGROUND: Growth development is traditionally evaluated with plain radiographs of the hand and wrist to visualize bone structures using ionizing radiation. Meanwhile, MRI visualizes bone and cartilaginous tissue without radiation exposure. PURPOSE: To determine the state of growth plate closure of the knee in healthy adolescents and young adults and compare the reliability of staging using cartilage sequences and T1-weighted (T1W) sequence between pediatric and general radiologists. MATERIAL AND METHODS: A prospective, cross-sectional study of MRI of the knee with both cartilage and T1W sequences was performed in 395 male and female healthy subjects aged between 14.0 and 21.5 years old. The growth plate of the femur and the tibia were graded using a modified staging scale by two pediatric and two general radiologists. Femur and tibia were graded separately with both sequences. RESULTS: The intraclass correlation was overall excellent. The inter- and intra-observer agreement for pediatric radiologists on T1W was 82% (κ = 0.73) and 77% (κ = 0.65) for the femur and 90% (κ = 0.82) and 87% (κ = 0.75) for the tibia. The inter-observer agreement for general radiologists on T1W was 69% (κ = 0.56) for the femur and 56% (κ = 0.34) for the tibia. Cohen's kappa coefficient showed a higher inter- and intra-observer agreement for cartilage sequences than for T1W: 93% (κ = 0.86) and 89% (κ = 0.79) for the femur and 95% (κ = 0.90) and 91% (κ = 0.81) for the tibia. CONCLUSION: Cartilage sequences are more reliable than T1W sequence in the assessment of the growth plate in adolescents and young adults. Pediatric radiology experience is preferable.

5-year mental health and eating pattern outcomes following bariatric surgery in adolescents: a prospective cohort study.

BACKGROUND: Mental health problems are prevalent among adolescents with severe obesity, but long-term mental health outcomes after adolescent bariatric surgery are not well known. We aimed to assess mental health outcomes over 5 years of follow-up after Roux-en-Y gastric bypass surgery in adolescents who participated in the Adolescent Morbid Obesity Surgery (AMOS) study. METHODS: This was a non-randomised matched-control study in adolescents aged 13-18 years who had a BMI of 40 kg/m2 or higher, or 35 kg/m2 or higher in addition to obesity-related comorbidity; who had previously undergone failed comprehensive conservative treatment; and were of pubertal Tanner stage III or higher, with height growth velocity beyond peak. A contemporary control group, matched for BMI, age, and sex, who underwent conventional obesity treatment, was obtained from the Swedish Childhood Obesity Treatment Register. Data on dispensed psychiatric drugs and specialist treatment for mental disorders were retrieved from national registers with complete coverage. In the surgical group only, questionnaires were used to assess self-esteem (Rosenberg Self-Esteem [RSE] score), mood (Mood Adjective Checklist [MACL]), and eating patterns (Binge Eating Scale [BES] and Three-Factor Eating Questionnaire-R21 [TFEQ]). This study is registered with ClinicalTrials.gov (NCT00289705). FINDINGS: Between April 10, 2006, and May 20, 2009, 81 adolescents (53 [65%] female) underwent Roux-en-Y gastric bypass surgery, and 80 control participants received conventional treatment. The proportion of participants prescribed psychiatric drugs did not differ between groups in the years before study inclusion (pre-baseline; absolute risk difference 5% [95% CI -7 to 16], p=0·4263) or after intervention (10% [-6 to 24], p=0·2175). Treatment for mental and behavioural disorders did not differ between groups before baseline (2% [-10 to 14], p=0·7135); however, adolescents in the surgical group had more specialised psychiatric treatment in the 5 years after obesity treatment than did the control group (15% [1 to 28], p=0·0410). There were few patients who discontinued psychiatric treatment post-surgery (three [4%] receiving psychiatric drug treatment and six [7%] receiving specialised care for a mental disorder before surgery). In the surgical group, self-esteem (RSE score) was improved after 5 years (mixed model mean 21·6 [95% CI 19·9 to 23·4]) relative to baseline (18·9 [17·4 to 20·4], p=0·0059), but overall mood (MACL score) was not (2·8 [2·7 to 2·9] at 5 years vs 2·7 [2·6 to 2·8] at baseline, p=0·0737). Binge eating was improved at 5 years (9·3 [7·4 to 11·2]) relative to baseline (15·0 [13·5 to 16·5], p<0·0001). Relative changes in BMI were not associated with the presence or absence of binge eating at baseline. INTERPRETATION: Mental health problems persist in adolescents 5 years after bariatric surgery despite substantial weight loss. Although bariatric surgery can improve many aspects of health, alleviation of mental health problems should not be expected, and a multidisciplinary bariatric team should offer long-term mental health support after surgery. FUNDING: Swedish Research Council, VINNOVA, Västra Götalandsregionen, ALF VG-region, Region Stockholm, Swedish Child Diabetes Foundation, Swedish Heart and Lung Foundation, Tore Nilsson's Foundation, SUS Foundations and Donations, Capio Research Foundation, and Mary von Sydow's Foundation.