Prevalence of suicide attempt, suicide ideation and self-harm at diagnosis in adolescents with eating disorders.

BACKGROUND: Data concerning the suicide prevalence of eating disorder (ED) subtypes and predictive factors are lacking in youth. This study aimed to examine suicide attempts (SA), suicide ideation (SI) and self-harm (SH) upon diagnosis in adolescents with EDs. METHODS: The prevalence of SA, SI and SH in ED subtypes was evaluated by retrospectively assessing the Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicidal ideation and Safety (HEEADSSS) instrument of adolescents diagnosed with an ED. Clinical predictors of SI in anorexia nervosa (AN) and atypical AN (AAN) were assessed. RESULTS: Among all participants (398), 41 (10.3%) reported SA, 126 (31.7%) SI and 60 (15.1%) SH. While SA did not differ statistically between ED subgroups (p = .123), they were two times more prevalent in the bulimia nervosa (BN) group (17.5%) than in the AN group (8.5%). In the BN group, SI was 2.3 times more prevalent than in the AN group (p = .001). The AN and ARFID groups exhibited substantially less SH (p = .036). Having a higher body mass index (BMI) was the only significant predictor of SI. CONCLUSIONS: This study demonstrates that adolescents with EDs are at an increased risk for suicidality, highlighting the need for close screening, particularly in those with BN, AN-BP and AN with a higher BMI.

Adolescents with eating disorders have higher rates of suicidality than the general population.Bulimia nervosa had the highest risk for a suicide attempt, suicide ideation and self-harm at diagnosis.A higher body mass index (BMI) percentage was associated with an increased risk of suicidality in the anorexia nervosa group.

The impact of the prolonged COVID-19 pandemic on adolescents with eating disorders: a follow-up study from Türkiye.

BACKGROUND: At the onset of the pandemic, we conducted a study on adolescents with eating disorders (EDs) and found no deterioration in ED symptoms. The objective of this subsequent study was to conduct a follow-up evaluation of the same cohort and investigate the consequences of the prolonged pandemic. METHODS: This longitudinal study was conducted one year after the first study between May 2021 and June 2021 with 37 adolescents aged 12-18 years (pre-existing EDs). The reassessment included an evaluation of sociodemographic and clinical characteristics, the impact of pandemic-related restrictions on ED behaviors, well-being, and quality of life. All the participants underwent a re-administration of the ED examination questionnaire (EDE-Q), Beck Depression Inventory, the State Anxiety Inventory for Children, and the Maudsley Obsessive Compulsive Inventory. RESULTS: No significant difference was observed in the EDE-Q scores or the ED examination questionnaire scores between the initial (T1) and subsequent (T2) study. The ED-related quality of life was seen to have slightly improved in the later stage. While depression (T1: 18, T2: 15, p=0.883) and obsession scores (T1: 11, T2: 14, p: 0.536) showed no disparity between the studies, anxiety scores (T1: 38, T2: 43, p:0.011) exhibited a significant increase. CONCLUSIONS: Consistent with the early phase, no exacerbation of ED symptoms in adolescents was observed during the later stages of the pandemic. Close clinical monitoring during the pandemic might have been protective against the deteriorating effects of the pandemic. During social isolation, it is important to monitor adolescents with EDs continously for depression and anxiety.

Binge eating symptomatology in adolescents with polycystic ovary syndrome.

Several factors may contribute to binge eating behaviors in PCOS. However, findings are contradictory and studies in the adolescence are limited. We aimed to evaluate the eating attitudes of adolescents with PCOS and the possible etiological factors underlying the association between PCOS and binge eating symptomology. Between 2019 and 2022, 46 newly diagnosed adolescents with PCOS and 56 controls matched for age and BMI z-score were included. The Eating Disorder Examination Questionnaire, Three Factor Eating Questionnaire-R18, and a questionnaire assessing postprandial reactive hypoglycemia symptom severity were given. Binge eating symptomology, in terms of over, uncontrolled, and emotional eating, were more prevalent in the PCOS group. Uncontrolled, emotional, and binge eating were positively correlated with postprandial reactive hypoglycemia symptom score. Overeating was also associated with clinical hyperandrogenism. Improving the disease outcome and reducing the future complications requires early recognition and management of emotional and uncontrolled eating behaviors in adolescents with PCOS.

Problematic video gaming is negatively associated with bone mineral density in adolescents.

Adolescent bone health may be negatively impacted by problematic video gaming (PVG) due to factors such as prolonged screen time, poor sleep quality, and increased depression. Although sedentary behaviors have been linked to decreased bone mass, there is limited research on how PVG impacts bone health. We aimed to evaluate the association between PVG and bone mineral density (BMD) in adolescents by comparing the BMD z-scores of adolescents with and without PVG and by identifying PVG-related risk factors that may affect low BMD scores. This cross-sectional study took place between May 2019 and August 2021 with 110 adolescents who played video games for at least two hours per day. Data on screen time, game genre, tobacco, alcohol, caffeine consumption, and vigorous physical activity status were recorded. PVG was assessed using the Internet Gaming Disorder-Short Form (IGDS9-SF), with scores ≤ 16 comprising the control group and > 16 the PVG group. Sleep quality was assessed by Pittsburgh Sleep Quality Index, and depression was evaluated by Children's Depression Inventory. Dual-energy X-ray absorptiometry measurements of femoral neck and lumbar spine BMD were compared between the two groups. The mean age of the participants was 14.2 ± 1.8 years, and 86.4% were males. The PVG group exhibited lower femoral neck z-scores (p = 0.013) and a higher proportion of adolescents with low femoral neck BMD risk (27.8% vs 9.7%, p = 0.041). Lumber spine z-scores did not differ (p = 0.271). Despite poorer depressive symptoms and sleep quality in the PVG group, they were not associated with low BMD risk (OR 1.02, 95% CI 0.97-1.08, p = 0.398 and OR 1.00, 95% CI 0.87-1.18, p = 0.972, respectively). Among all PVG-related risk factors, video game time (aOR = 1.22, 95% CI = 1.06-1.41, p = 0.006) and vigorous physical activity amount (aOR = 2.86, 95% CI = 0.93-8.76, p = 0.080) showed the strongest associations with femoral neck z-scores.  Conclusion: The results of this study, showing a negative association between PVG and femoral neck BMD in adolescents, underscore the importance evaluating, monitoring, and supporting lower extremity bone health in adolescents with PVG. What is Known: • Adolescents with problematic video gaming are at risk for depression, impaired sleep; sedentary lifestyle; consumption of tobacco, alcohol, and drugs; and high caffeine intake. • These risk factors might lead to compromised bone health. What is New: • Problematic video gaming is associated with the low femoral neck bone mineral density risk in adolescents. • Extended video game time and reduced physical activity are found to be the primary risk factors.

Menstrual characteristics of atypical anorexia nervosa.

OBJECTIVE: While menstrual irregularities are acknowledged in restrictive-type eating disorders (EDs), the menstrual characteristics specific to atypical anorexia nervosa (AAN) remain inadequately defined. This study aims to compare the menstrual features of anorexia nervosa (AN) and AAN. METHOD: Adolescents diagnosed with AN or AAN who exhibited secondary amenorrhoea at presentation and had their menstrual cycles restored during follow-up were eligible for this study. Clinical and menstrual data at admission and during follow-up were obtained from patient files, and compared between the AN and AAN cohorts. RESULTS: The study included a total of 77 patients (38 with AN and 39 with AAN). The extent of weight loss and the disease duration until the onset of amenorrhoea were comparable in the two groups. However, the duration of illness and the time since the last menstrual period at admission were shorter in the AAN group. Moreover, amenorrhoea manifested at a higher body mass index, and the return of menses occurred more rapidly with less weight gain in the AAN group after the onset of clinical follow-up. Additionally, the AAN group exhibited a shorter overall duration of amenorrhoea. CONCLUSIONS: This study highlights the significance of recognising amenorrhoea in restrictive disorders, even when individuals maintain a normal weight. The faster return of menstrual cycles and shorter duration of amenorrhoea observed in adolescents with AAN emphasise the significance of early diagnosis and prompt initiation of treatment. Regardless of the patient's presenting complaint and weight status, obtaining a comprehensive ED history is essential when addressing concerns regarding amenorrhoea or menstrual irregularities.

An Assessment of the Quality of YouTube Videos as a Resource for Adolescents Experiencing Abnormal Uterine Bleeding.

STUDY OBJECTIVE: YouTube, the largest accessible media-sharing platform, has become an important tool for pursuing health-related information. Adolescents may find it challenging to seek counseling or access adolescent-friendly services for menstruation-related problems, so YouTube may be a useful resource. The aim of this study was to examine the reliability, quality, and accuracy of YouTube videos concerning abnormal uterine bleeding in adolescents. METHODS: A YouTube search using the key words "adolescent, teens, heavy period, abnormal uterine bleeding, heavy menstrual bleeding" yielded 109 videos. Video features (duration, time since upload, likes, views, comments), sources of upload, and content were recorded. All the videos were reviewed by 2 adolescent medicine specialists and scored using the Journal of the American Medical Association, the 5-point modified DISCERN tool, and the Global Quality Scale. RESULTS: Fifty-eight videos met the inclusion criteria. Most (62.1%) were created by non-professionals, and a significant portion (81%) contained general descriptions. On the basis of the DISCERN classification, 50% exhibited poor quality. Similarly, the Journal of the American Medical Association assessment indicated that only 36.2% satisfied the requirements for good quality. The videos uploaded by professionals exhibited notably superior quality in comparison with those uploaded by non-professionals. Additionally, higher-quality videos were longer (P = .040) and more recent (P = .011). CONCLUSION: Mot YouTube videos about adolescent abnormal uterine bleeding provide low-quality information. We believe that increasing the number of videos tailored by health care providers specializing in adolescent gynecology to address the specific physical and psychosocial needs of adolescents with menstrual problems would be beneficial.

Suicidal ideation and attempts among adolescents from a tertiary hospital in Turkey: A comparative study of pre and postpandemic periods.

AIM: This study aims to compare changes in rates of suicidal ideation (SI) and attempts (SA) among adolescents during pre, mid and later periods of the pandemic. MATERIAL AND METHOD: This study included adolescents who presented to the adolescent medicine clinic in Turkey between March-May 2019 (prepandemic = T0), March-May 2021(mid period of the pandemic = T1) and March-May 2022 (late period year of the pandemic = T2). SI and SA data were assessed through the electronic hospital records of the "HEEADSSS" inventory. RESULTS: The charts of 2113 adolescents were evaluated. The rates of both SI (p = .015) and SA (p = .026) were determined to be higher during the pandemic (T1+T2) compared to the pre-pandemic period, with a 1.4-fold increase in SI and a 1.5-fold increase in SA. The rates of SI did not differ according to gender, (p = .090). In contrast, SA rate was significantly higher in females (7.3%) than males (3.6%) (p = .001). CONCLUSION: This study reveals an increase in SI and SA among adolescents during the first 2 years of the pandemic. In challenging times, health professionals should prioritize the identification and treatment of mental health issues, including screening for depression and suicide risk.

Tamoxifen Treatment for Pubertal Gynecomastia: When to Start and How Long to Continue.

Introduction: Pubertal gynecomastia is a common clinical condition among male adolescents, and in most cases, it regresses spontaneously. However, tamoxifen treatment is recommended in selected cases. We aimed to evaluate the indications, safety, and efficacy of tamoxifen treatment in adolescents with pubertal gynecomastia. Methods: The data of 83 adolescents with pubertal gynecomastia who were treated with tamoxifen between 2006 and 2018 were evaluated retrospectively. The clinical and laboratory data, initial complaint, tamoxifen treatment indication, duration, and dose were recorded along with the treatment outcome. Results: The gynecomastia disc diameter's monthly reduction rate was significantly higher in adolescents with an initial disc diameter ≥3 cm. The significant reduction of the disc started after the fourth month of tamoxifen treatment and continued to significantly reduce, extending to the sixth month. Conclusion: Tamoxifen treatment in pubertal gynecomastia was found to be effective and safe. One of the current indications for tamoxifen treatment is having a disc size ≥4 cm, and the recommended treatment duration is 4-6 months. However, this study suggests that treatment should be continued for at least 6 months to achieve the optimal effect. In addition, we recommend that the disc diameter threshold for starting tamoxifen needs to be ≥3 cm.

Beliefs and Predictors of Negative Attitudes Toward Obesity Among Turkish Healthcare Professionals: Assessing the Bias with Sub-group Analysis.

AIM: This study aimed to examine Turkish healthcare professionals' beliefs and predictors of negative attitudes toward obesity and to investigate whether those beliefs and negative attitudes differ per their profession and sociodemographic and familial variables. METHOD: In this cross-sectional study, healthcare professionals (n = 495) working in four hospitals of Ankara completed a sociodemographic questionnaire and two self-report scales: the Attitudes Toward Obese Persons Scale and the Beliefs About Obese Persons Scale. Data were collected during May, 2018. RESULTS: Female healthcare professionals had significantly higher (p = 0.03) positive attitude scores than males, and nurses had significantly higher (p = 0.04) Beliefs About Obese Persons Scale scores than physicians, representing their belief that obesity is not under the control of the individual. The Attitudes Toward Obese Persons Scale scores of university hospital healthcare professionals were significantly higher (p = 0.00) than those of public hospital and private hospital healthcare professionals, and Attitudes Toward Obese Persons Scale scores of healthcare professionals who have a family member with a chronic disease were significantly higher (p = 0.027) than those who do not. CONCLUSION: The work experience, spending more time with a patient, and having a member of the family with a chronic illness lead to a more positive attitude toward people with obesity. This result emphasizes the importance of interventions that promote sensitive and empathic communication skills.

Assessing the Menstrual Cycle and Related Problems in Adolescents with a Genetic Syndrome Associated with Intellectual Disability.

STUDY OBJECTIVE: The aim of this study was to assess the experience and quality of life (QoL) related to menstruation in adolescents with a genetic syndrome accompanying intellectual disability (ID). METHODS: This prospective cross-sectional study was conducted on 49 adolescents with a genetic syndrome accompanied by ID, which was defined by the Wechsler Intelligence Scale for Children-Revised, and 50 unaffected controls. In a survey created by the authors, demographic information, menstrual history, and information regarding menstrual difficulties, school abstinence, dysmenorrhea, and premenstrual changes were collected. The Childhood Health Assessment Questionnaire was used to evaluate physical impairment, whereas the QoL scale was utilized to evaluate QoL in general and during menstruation. Data were collected from caregivers and additionally from the participants with mild ID, whereas in the control group, data were collected from the participants. RESULTS: Menstrual history was similar between the 2 groups. Menstruation-related school absenteeism was higher among the ID group (8% vs 40.5%, P < .001). Mothers reported that 73% of their daughters needed help with menstruation care. Social, school, psychosocial functioning, and total QoL scores during menstruation were significantly lower in the ID group when compared with the controls. A significant decrease in physical, emotional, social, psychosocial functioning, and total QoL score occurred during menstruation in the ID group. None of the mothers requested menstrual suppression. CONCLUSION: Although menstrual patterns in the 2 groups were similar, QoL decreased significantly while menstruating in the ID group. Despite a decrease in QoL, an increase in school absenteeism, and a high percentage of needing assistance while menstruating, none of the mothers requested menstrual suppression.

Radiopacity evaluation of different types of resin restorative materials using a digital radiography system.

OBJECTIVES: The aim of the study was to evaluate and compare the radiopacity of 20 current dental resin composites with digital radiography. METHODS: Ten specimens, 10-mm in diameter and 1-mm thickness, were prepared and radiographed using phosphor plates close to Al step wedges and tooth sections. The mean grey values (MGVs) were measured using an ImageJ software program and converted to equivalent Al thickness. Data were analyzed using one-way analysis of variance (ANOVA) and Tamhane post hoc test (p < 0.05). Correlation between mean radiopacity and filler content (wt% and vol%) of the tested materials was analyzed with linear regression analysis. RESULTS: The radiopacity of all composites ranged from 1.32 mm Al (Estellite Flow Quick) to 3.41 mm Al (Charisma Classic). All the tested materials, except four restorative materials, had a radiopacity equal or higher than the enamel (p < 0.05). Linear regression revealed low correlation between the radiopacity and filler content of the composite. CONCLUSION: Majority of the materials has appropriate radiopacity for dental restorations. There was great variation in radiopacity level, may clinically affect the diagnosis.

The Effect of In-Office Bleaching with Different Concentrations of Hydrogen Peroxide on Enamel Color, Roughness, and Color Stability.

The aim of this study is to evaluate the effectiveness of in-office bleaching in esthetic dentistry on the roughness and color stability of the enamel surface, using different concentrations of hydrogen peroxide (HP). Fifty human incisors were randomly divided into 5 groups (n = 10). No bleaching was performed in the control group. For these groups, concentrations of 40% HP with fluoride (F), 35% HP with calcium (Ca), 25% HP with nano-hydroxyapatite (nHA) and 18% HP with nHA were used for bleaching in the test groups. Surface roughness was assessed at baseline after bleaching occurred. Color measurements were first obtained at baseline, then after the first and second sessions of bleaching, and, finally, after the staining protocol. Scanning electron microscopy and atomic force microscopy were performed. Statistical analysis was conducted with a one-way ANOVA, followed by a post hoc Tukey's test and a paired-samples t-test (p < 0.05). All the bleaching gels used exhibited a similar color change (p > 0.05). Bleaching gels containing 18% HP with nHA and that containing 35% HP with Ca caused less surface roughness of the enamel. Of these concentrations, 25% HP with nHA caused the most surface roughness and no significant difference was observed, compared with 40% HP with F. The highest coloration after bleaching was observed in 40% HP with F and 25% HP with nHA. The lowest coloration was obtained in 35% HP with Ca and 18% HP with nHA but no significant difference was observed between them and the control group. A concentration above 18% HP does not increase the bleaching effectiveness. The results show that 18% HP with nHA and 35% HP with Ca resulted in the least increase in enamel surface roughness when compared to high-concentrate HP; however, it also prevented recoloration after bleaching.

Eating disorder visits increase among adolescents during the COVID-19 pandemic.

AIM: The study aimed to assess changes in adolescent visits due to eating disorders (EDs) during the pandemic. METHOD: A retrospective evaluation of adolescents diagnosed with an ED during two periods: June 2019-February 2020 (pre-pandemic) and June 2021-February 2022 (during the pandemic) at an adolescent medicine clinic in Tukey was conducted. The number of patients diagnosed with an ED between these dates was compared with the number of overall attended outpatient appointments. Baseline data for patients with Anorexia Nervosa (AN) and the requirement of hospitalization for all cases were compared. RESULTS: Of the 3708 visits in the pre-pandemic period 46 (1.2%) were diagnosed with an ED. This was 69 (2.2%) of 3149 visits during the pandemic which was statistically significant (p = 0.003). The percentage of males to females changed from 2.2% to 11.6% (p = 0.065). Distribution of the type of ED did not change (p = 0.280), although the percentage of atypical AN increased from 6.5% to 17.4%. Mean age, BMI, calorie intake and hospital admissions did not significantly change. CONCLUSION: Our findings support the increase in adolescent EDs during COVID-19. Particular attention should be given to males and Atypical AN cases.

Adolescent male soccer players have higher growth rates and risk of injury is associated with biological maturity.

BACKGROUND: The objective of this study was to ascertain disparities in growth and maturation between male adolescents engaged in soccer and their non-athletic counterparts, as well as to examine the injury features specific to young soccer players. METHODS: A total of 206 soccer players between the ages of 11-16 years, and 208 non-athletic peers were enrolled. Height, weight, body mass index (BMI), annual growth rate, and skeletal age evaluated using a left handwrist x-ray were determined. Biological and sexual maturation were evaluated using skinfold thickness, body composition, and Tanner stages. The game positions, initial age for playing soccer, the number of games per/ week, the number of sports injuries, date of injury, duration for return to activity, the site, nature, mechanism, and rate of injury were recorded for soccer players. Using an injury card, the characteristics of soccer player injuries were recorded. RESULTS: The mean age of the participants was 13.6 ± 1.5 years. There was no difference in the growth rates between the groups at the ages of 11.0, 12.0, and 15.0 but at the ages of 13.0 and 14.0 years growth rates were higher in the soccer group. The soccer players were taller than the controls. For all Tanner stages, soccer players had a lower BMI and total body fat percentage, as well as a faster growth rate. Injuries occurred at a rate of 39.3% per year among soccer players. The most common being toe injuries, and playing soccer increased the risk of multiple injuries. Additionally, injuries occurred more frequently in soccer players who were taller, heavier, with higher total body fat and/or higher growth rate, and most commonly occurred during Tanner stage 4. Futhermore, Tanner stage 4 had a higher incidence of two or more injuries than the other stages. CONCLUSIONS: Adolescent male soccer players have higher growth rates than their non-athletic peers, and their biological maturity status is associated with an increased risk of injury.

Pregabalin abuse in adolescence: a case series.

BACKGROUND: Pregabalin is an inhibitor of gamma-aminobutyric acid (GABA) and can be abused, especially by polydrug abuser adults. Drug abuse is one of the many risky behaviors that can be seen during adolescence. Here, three adolescents with pregabalin abuse were described. CASE: These adolescents abused pregabalin to cope with their depressive and anxiety symptoms, become tranquilized, boost other drug effects, and reduce withdrawal symptoms. Therefore, the risk factors should be assessed while pregabalin is prescribed to adolescents. CONCLUSIONS: The cases were reported in order to increase awareness concerning the abuse risk of pregabalin among adolescents.

Social Connectedness Matters: Depression and Anxiety in Transgender Youth During the COVID-19 Pandemic.

BACKGROUND: Gender-affirming and supportive relations for transgender youth are considered protective in terms of mental health. AIM: To describe how transgender youth perceived changes in their gender expression, in the course of the gender-affirming path, and the effect of social connectedness and social support on depression and anxiety during the pandemic. METHODS: In this cross-sectional study, transgender youth completed an online survey developed to evaluate the perceived changes in gender expression and affirmation path that occurred during COVID-19 and the age-stratified lockdown. Furthermore, we aimed to investigate the effect of social connectedness and social support on depression and anxiety in this population during the pandemic. The participants completed the following scales: Social Connectedness Scale Revised (SCS-R), Multidimensional Scale of Perceived Social Support (MSPSS), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI). The effect of lockdown on life conditions, gender expression, social and medical gender-affirming path, social connectedness, social support, depression, and anxiety levels were examined. Linear regression analyses were performed to evaluate the relationships between BDI and STAI scores and other variables. OUTCOMES: The relationship between the levels of perceived social connectedness, and social support, the pandemic-related changes in living conditions and depression and anxiety scores were calculated. RESULTS: A total of 49 transgender youth with a mean age of 20.53 ± 1.86 years were enrolled. Participants reporting discomfort at the place they live and who had difficulties concerning gender expression and affirmation had higher depression and anxiety scores and perceived lower social support from their family. Social connectedness score was a significant negative predictor of depression severity, whereas social connectedness and social support were both significant negative predictors of anxiety severity. CLINICAL IMPLICATIONS: Our results show increased adversity for transgender youth when connectedness with supportive people is diminished. During the COVID-19 pandemic, social connectedness and social support perceived by transgender youth are associated with better mental health. STRENGTHS AND LIMITATIONS: This is one of the first studies to evaluate the changes that occurred during the COVID-19 pandemic in transgender youth with relation to social support and connectedness, during an age-stratified lockdown. The main limitations were the small study size, skewed gender ratio and that the study sample came from a single gender clinic. CONCLUSION: As social connectedness and social support are significant predictors of depression and anxiety severity, special attention is needed to increase contact and support for transgender youth during the pandemic. Tüzün Z, Basar K, Akgül S. Social Connectedness Matters: Depression and Anxiety in Transgender Youth During the COVID-19 Pandemic. J Sex Med 2022;19:650-660.