Performance of the FreeStyle Libre Flash Glucose Monitoring System during an Oral Glucose Tolerance Test and Exercise in Healthy Adolescents.

This study's aim was to assess FreeStyle Libre Flash glucose monitoring (FGM) performance during an oral glucose tolerance test (OGTT) and treadmill exercise in healthy adolescents. This should advance the feasibility and utility of user-friendly technologies for metabolic assessments in adolescents. Seventeen healthy adolescents (nine girls aged 12.8 ± 0.9 years) performed an OGTT and submaximal and maximal treadmill exercise tests in a laboratory setting. The scanned interstitial fluid glucose concentration ([ISFG]) obtained by FGM was compared against finger-prick capillary plasma glucose concentration ([CPG]) at 0 (pre-OGTT), -15, -30, -60, -120 min post-OGTT, pre-, mid-, post- submaximal exercise, and pre- and post- maximal exercise. Overall mean absolute relative difference (MARD) was 13.1 ± 8.5%, and 68% (n = 113) of the paired glucose data met the ISO 15197:2013 criteria. For clinical accuracy, 84% and 16% of FGM readings were within zones A and B in the Consensus Error Grid (CEG), respectively, which met the ISO 15197:2013 criteria of having at least 99% of results within these zones. Scanned [ISFG] were statistically lower than [CPG] at 15 (-1.16 mmol∙L-1, p < 0.001) and 30 min (-0.74 mmol∙L-1, p = 0.041) post-OGTT. Yet, post-OGTT glycaemic responses assessed by total and incremental areas under the curve (AUCs) were not significantly different, with trivial to small effect sizes (p ≥ 0.084, d = 0.14-0.45). Further, [ISFGs] were not different from [CPGs] during submaximal and maximal exercise tests (interaction p ≥ 0.614). FGM can be a feasible alternative to reflect postprandial glycaemia (AUCs) in healthy adolescents who may not endure repeated finger pricks.

Primary Hypertension with Target Organ Damage among Apparently Healthy Secondary School Students in Osogbo, South-Western Nigeria.

INTRODUCTION: In recent times, there has been an increase in the frequency of hypertension among young people which is contributing globally to the increase in cardiovascular morbidity and mortality in adults. OBJECTIVE: The aim of this study was therefore to determine the prevalence of primary hypertension and its risk factors among apparently healthy secondary school students in Osogbo, southwestern Nigeria. METHODS: A school-based cross-sectional study of a total of 404 secondary school students in Osogbo city. Following informed parental consents of all the students involved in the study, blood pressure (BP) measurements were taken at 2 different visits by auscultation after a negative urine dip stick test result (thus excluding haematuria or proteinuria) in every subject before each BP was measured. RESULTS: The overall prevalence of hypertension and prehypertension in this study was 3.5% (n = 14) and 6.2% (n = 25), respectively. Obesity, consumption of extra - uncooked salt, high parental education and attendance of privately-owned secondary schools were identified risk factors associated with elevated BP. Seven (29%) of 24 subjects with hypertension had features of left ventricular hypertrophy (an evidence of target organ damage) on echocardiography and electrocardiography. All subjects with elevated BP had normal renal scan. CONCLUSION: Hypertension with features of target organ damage exists among adolescents. No known primary aetiologies were found among the hypertensive adolescents in the study and thus they were all deemed to have essential hypertension.

INTRODUCTION: Ces derniers temps, on a constaté une augmentation de la fréquence de l'hypertension chez les jeunes, ce qui contribue globalement à l'augmentation de la morbidité et de la mortalité cardiovasculaires chez les adultes. OBJECTIF: Le but de cette étude était donc de déterminer la prévalence de l'hypertension primaire et de ses facteurs de risque parmi des élèves du secondaire apparemment en bonne santé à Osogbo, sud-ouest du Nigeria. MÉTHODES: Étude transversale en milieu scolaire portant sur un total de 404 élèves du secondaire dans la ville d'Osogbo. Après avoir obtenu le parents informés de tous les élèves participant à l'étude, des mesures de l'étude, la pression artérielle a été mesurée par auscultation lors de 2 visites après un résultat négatif à la bandelette urinaire (excluant ainsi l'hématurie ou la protéinurie) chez chaque sujet avant que la TA ne soit mesurée. RÉSULTATS: La prévalence globale de l'hypertension et de la préhypertension dans cette étude était de 3,5% (n = 14) et de 6,2% (n = 25), respectivement. L'obésité, la consommation de sel extra-cuit, le haut niveau d'éducation des parents et la fréquentation d'écoles secondaires privées ont été identifiés comme des facteurs de risque associés à une tension artérielle élevée. Sept (29%) des 24 sujets hypertendus présentaient des caractéristiques d'hypertrophie du ventriculaire gauche (preuve d'une atteinte des organes cibles) à l'échocardiographie et à l'électrocardiographie. Tous les sujets présentant une PA élevée avaient une scintigraphie rénale normale. CONCLUSION: L'hypertension avec des caractéristiques d'atteinte des organes cibles existe chez les adolescents. Aucune étiologie primaire connue n'a été trouvée chez les adolescents hypertendus de l'étude et donc tous considérés comme souffrant d'hypertension essentielle. Mots clés: Hypertension primaire, dommages aux organes cibles, adolescents sains.

A Communication Model to Bridge Adolescent Patients, Caregivers, and Physicians in Transitions of Care.

A transition of care (TOC) process from pediatric to adult medicine ensures that adolescents receive ongoing care into young adulthood, a time of high risk for preventable morbidity and mortality. We explored patient, caregiver, and physician perspectives on ways to improve TOC communication with healthy adolescents. Two researchers conducted key informant interviews with healthy 12- to 18-year-old adolescents, their caregivers, and primary care physicians working in pediatric, internal, and family medicine. Data saturation was reached after interviewing 12 adolescents, 10 caregivers, and 36 physicians. Three themes were identified: perceptions of TOC; effective communication among the triad of adolescents, caregivers, and providers; and early communication about TOC preparation. From these themes, a model of communication was identified and adapted, outlining the communication skills and responsibilities for physicians and patients during TOC. Physicians must understand how to use strong, consistent, adolescent-centered communication to execute effective TOC.

Weekly variation in markers of cardiometabolic health - the possible effect of weekend behavior - a cross-sectional study.

BACKGROUND: Adolescents' health-related behavior varies from weekday to weekend. Only few studies, however, have examined to which degree such variation will affect markers of cardiometabolic health. Therefore, the primary aim of this study is to examine if markers of cardiometabolic health differ between different days of the week in adolescents. METHODS: This cross-sectional school-based study included up to 581 participants, 11-17 years old. Markers of metabolic health were insulin, glucose, triglyceride, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and blood pressure. Linear mixed regression modelling was used to examine the cardiometabolic profile across weekdays. RESULTS: Significant declining trends were observed across the week in adolescents' levels of cardiometabolic health markers. Lower levels of insulin (16.1%), glucose (2.6%) and triglyceride (24.7%) were observed on Fridays compared to Mondays (p ≤ 0.006). Gradual improvement in measurement profiles across weekdays was less apparent for HDL-C, LDL-C, systolic blood pressure and diastolic blood pressure (P ≥ 0.06). Analyses stratified by sex suggested a more noticeable pattern of gradual improvement across weekdays in boys than in girls. CONCLUSION: Significantly lower levels of insulin, glucose and triglyceride were observed in adolescents on Fridays compared to Mondays. However, when sex specific analyses were performed significant profile variations were only observed across the week in boys. More research is needed to better understand which behavioral factors in particular seem to influence weekly variation in markers of cardiometabolic health - especially since such variation potentially will have an impact on how assessments of markers of cardiometabolic health optimally should be planned, standardized and carried out, both in research and in medical practice.

Testicular asymmetry in healthy adolescent boys.

OBJECTIVES: To assess the presence of testicular asymmetry and the currently used threshold values in varicocoele management in a healthy adolescent population. SUBJECTS AND METHODS: We conducted an observational cross-sectional study from April 2015 until December 2016 in which we recruited 539 adolescent boys aged 11-16 years. A clinical examination including testicular size measurement by ultrasonography was performed. Testicular volume (TV) was calculated using the Lambert formula (length × width × height × 0.71). The Testicular Atrophy Index (TAI) was calculated using the formula [(TV right - TV left)/largest TV] × 100. The data for all statistical analyses were stratified for Tanner stage for genital development (TSG) and pubic hair (TSP). Non-parametric tests were used to assess the difference between right and left TV, and the prevalence of a smaller left testis for the entire population, and between each TSG and TSP. Parametric tests were used to determine the difference in mean TAI between each TSG and TSP, and to compare the mean TAI to a test value of 0. RESULTS: Of the 539 recruited boys, we excluded 194 due to a current or past pathology, including varicocoeles, influencing normal (testicular) growth or due to incomplete data. Most boys were in the second Tanner stage, followed by the third Tanner stage. The mean (sd) age of the entire population was 13.33 (1.25) years. Of the 345 included participants the mean (sd) left TV was 7.67 (5.63) mL and right TV was 7.97 (5.90) mL. The mean (sd) TAI was 2.85 (17.00)%. In all, 203 (58.84%) boys had a smaller left testis and 142 (41.16%) had a smaller right testis. In all, 51 boys (14.78%) had a TAI >20%, 45 (13.04%) had a TV difference (TVD) of >2 mL with a deficit in left TV, and 69 (20.00)% had a TAI >20% or a TVD of >2 mL with a deficit in left TV. Related-samples Wilcoxon signed-rank test showed a significant difference in mean left and right TV for the entire population, and more specifically for TSG3 (P < 0.001) and TSP3 (P = 0.004). A one-sample t-test showed a significant difference in the mean TAI vs the test value of 0 for the entire population (P = 0.002), and more specifically for TSG3 (P < 0.001) and TSP3 (P = 0.003). CONCLUSION: Testicular asymmetry, with a smaller left testis, was seen in a considerable number of healthy adolescents. One out of five adolescents had a smaller left testis and met one of the threshold values currently used in varicocoele management. Therefore, in left-sided unilateral inguinoscrotal pathology, a smaller ipsilateral testis in combination with a TAI of >20% and/or TVD of >2 mL requires careful interpretation and serial measurements of TV should always be performed. Furthermore, this study provides reference values for TV, TVD and TAI according to TSG and TSP for a healthy adolescent population.

The effects of fatty fish intake on adolescents' nutritional status and associations with attention performance: results from the FINS-TEENS randomized controlled trial.

BACKGROUND: Adolescence involves changes in dietary habits that may induce imbalances in the intake of different nutrients. Fish is an important dietary source of omega-3 (n-3) long-chain polyunsaturated fatty acids (LCPUFAs), vitamin D, several minerals and high-quality protein. By using secondary outcomes and exploratory analyses, the aims of this paper were to evaluate if nutritional biomarkers (red blood cell fatty acids, serum (s)-25(OH)D, s-ferritin and urinary iodine concentration (UIC)) were altered during a dietary intervention, and if they mediated previously reported changes in attention performance. In addition, to examine the status of the biomarkers and explore associations between dietary pattern, biomarkers and attention performance cross-sectionally at baseline. METHODS: The Fish Intervention Studies-TEENS (FINS-TEENS) was a three-armed intervention trial, including adolescents from eight secondary schools (n = 415; age: 14-15y) in Bergen, Norway. Participants were individually randomized to receive either fish meals, meat meals or n-3 LCPUFA supplements, three times a week for a total of 12 weeks. Blood and urine samples were collected pre and post intervention and attention performance was assessed with the d2 test of attention. Analyses of covariance (ANCOVA) assessed differences between groups in changes of biomarkers and linear mixed models were applied in analyses of attention performance and biomarkers. The trial is registered in ClinicalTrials.gov (NCT02350322). RESULTS: At baseline, the mean omega-3 index was 5.8 ± 1.3% and deficient status were identified for s-25(OH)D (54%), s-ferritin (10%) and UIC (40%). The intervention resulted in an increase in DHA and the omega-3 index which was larger in the supplement group compared to the fish and meat group (P < 0.01), and in the fish group compared to the meat group (P < 0.01). No differences between the groups were observed for changes in 25(OH)D, s-ferritin or UIC. None of the biomarkers mediated performance in the d2 test. The intake of fatty fish and a healthy dietary pattern was associated with scores in processing speed at baseline. CONCLUSIONS: These results show that Norwegian adolescents have insufficient status of important nutrients, which may be improved with fatty fish consumption or n-3 LCPUFA supplements. However, nutritional status was not associated with scores in the d2 test of attention.

Thoracic sagittal plane variations between patients with thoracic adolescent idiopathic scoliosis and healthy adolescents.

PURPOSE: To analyze the sagittal thoracic parameters of different types of progressive thoracic adolescent idiopathic scoliosis (AIS) patients and compare them with healthy adolescents. METHODS: 115 AIS patients with main thoracic curves (Cobb: 59.4 ± 12.7) were prospectively compared with 116 healthy adolescents. The AIS and control (C) groups were homogeneous in terms of age and gender. Standing sagittal radiographs were analyzed for differences in T5-T12 kyphosis, T5-T8 and T9-T12 segmental kyphosis, the change between these two angles, and the double rib contour sign. Statistical analyses were performed using the χ 2, one-way ANOVA, Mann-Whitney U and Student's t tests. RESULTS: The sagittal parameters of Lenke 1 curves did not differ from healthy adolescents (T5-T8: 17.1 ± 10 vs C: 16 ± 7; T9-T12: 6.3 ± 7 vs C: 7.9 ± 5; T5-T12: 23.9 ± 14 vs C: 23.9 ± 8). Compared with the controls, Lenke type 3 curves were globally more hypokyphotic (T5-T12: 18.9 ± 12 vs C: 23.9 ± 8, P = 0.027) due to a "lordosis" of the lower thoracic segment (T9-T12: 0.9 ± 10 vs C: 7.9 ± 5, P = 0.001). Type 2 curves tended to exhibit more pronounced upper thoracic kyphosis (T5-T8: 20.7 ± 12 vs C: 16 ± 7). Both types 2 and 3 require a marked TK changes in the transition between the upper and lower thoracic segments to compensate for global (T5-T12) kyphosis. CONCLUSIONS: In this 2D analysis of moderate AIS, Lenke 1 curves exhibited normal thoracic sagittal parameters, which brings into question the effect of lordosis on the development of single thoracic curves. Lenke 3 curves exhibited lower thoracic segmental hypokyphosis, and the type 2 showed upper segmental hyperkyphosis. These results should be considered when planning a surgical strategy.

Comparison of Some Anthropometric Parameters and Blood Pressure between Adolescents with Down Syndrome and Healthy Ones.

Background: Most of the people with Down syndrome have short stature compared to general population. There is also a high prevalence of overweight and obesity, mainly in the adolescence and in the adult life. The aim of this study was to compare some anthropometric parameters, heart rate and blood pressure of children with Down syndrome and those with normal development. Down syndrome is among the most commonly classified categories of mental sub normality, with the incidence at birth being around 1: 700 and 1: 750 in live births in most countries worldwide, with the risk of increasing with mother's age. Methods: The sample consisted of 82 children, 32 with Down syndrome and 50 healthy children, male, aged 14-15 yr from the population of Kosovo in 2022. There were no health problems present in the healthy children. Results: About 53% of children with Down syndrome have normal body mass, 15.62% are overweight, and 21.8 are obese. In terms of blood pressure, Down syndrome children have higher systolic pressure (121.94mm/hg), sd ±21.69 than healthy children (111.18mm/hg, sd ±10.88). Conclusion: Children with Down syndrome had significantly higher body mass index, heart rate, and systolic pressure at rest compared to healthy children. However, after short physical activity, healthy children exhibited greater diastolic pressure than children with Down syndrome.

Anxiety in Older Adolescents at the Time of COVID-19.

Corona Virus Disease-19 (COVID-19) is a catastrophic health risk, with psychological, emotional, social, and relational implications. From the early stages of the virus spread, the elderly population was identified as the most vulnerable, and health authorities have rightly focused on this frailer population. Conversely, less attention was given to the emotional and psychological dimensions of children and adolescents. Moreover, even though they were the subjects whose lives and health were at low risk, they, nevertheless, had to face a reality full of anxiety, fears, and uncertainties. The current study investigated the state of anxiety and emotional awareness in a sample of healthy older adolescents, 84 females and 64 males, aged 17 to 19, during the pandemic lockdown, using the Self-Rating Anxiety Scale and the Italian Emotion Awareness Questionnaire. An unexpected anxious phenomenology was found, affecting anxiety and the ideo-affective domain, while somatic symptomatology appeared to be less severe. The highest anxiety symptoms were breathing difficulties. These findings supported the hypothesis that the COVID-19 pandemic may be a risk condition for an increased state of anxiety in older adolescents and suggested the need to provide (1) an effective, empathic communication system with direct participation of older adolescents, (2) a psychological counseling service for the stress management of adolescents.

Exercise Caution: Questions to Ask Adolescents Who May Exercise Too Hard.

When the primary goal of exercise is to compensate for food intake and to alter body shape and weight, it is considered compulsive and may be harmful. Compulsive exercise (CE) is important in the pathogenesis of eating disorders (EDs). Many healthy adolescents engage in CE too, and this may indicate a risk for EDs. Our aim was to learn more about ED risk factors tied to CE and to try to isolate questions to ask in order to probe for high ED risk in adolescents engaging in CE. Using two well-established instruments (the Structural Analysis of Social Behavior and the Eating Disorders Examination Questionnaire), we studied associations between ED variables and CE in healthy adolescent boys and girls. We examined gender-specific items to generate the best possible fit for each gender. Individuals with CE displayed significantly greater ED pathology and more self-criticism, and this pattern was stronger in girls than in boys. Risk factors for ED among individuals with CE differed slightly for boys and girls. We put forward a set of gender-specific questions that may be helpful when probing for ED risk among adolescents engaging in CE.

Improving vaccine-related pain, distress or fear in healthy children and adolescents-a systematic search of patient-focused interventions.

OBJECTIVE: The WHO recently highlighted the need for research into potential interventions that can be used to mitigate pain during mass vaccinations, in addition to interventions specific for adolescents. The current review examines the literature on potential interventions that can be used during mass vaccination settings in healthy individuals between the ages of 4 and 15 years old. METHODS: Criteria for inclusion were: 1)participants between the ages of 4-15 years, 2)interventions that were patient-focused, 3)vaccinations in healthy individuals, 4)outcome measures to include self-reported pain, fear or distress. RESULTS: Twenty-seven articles were identified with a total of 31 interventions. Eleven interventions used injection-site specific interventions, 17 used patient-led interventions and three used a combination of both site-specific and patient-led interventions. CONCLUSION: Interventions using coolant and vibration together, as well as a combination of site-specific and patient-led interventions, showed the most consistent effects in reducing self-reported pain, fear or distress.

Assessment of anxiety in adolescents involved in a study abroad program: a prospective study.

Objective The aim of the study was to measure the effects on levels of anxiety in healthy teenagers caused by a temporary change of country and school during a study abroad program. Methods In a prospective study we gathered the data from six anxiety level related tests on high school participants in a study abroad program (age 15-17, n = 364, M 172, F 192). These volunteer participants were divided into two separate groups: with self-reported elevated levels of anxiety (n = 111; YES-group) and with self-reported normal levels of anxiety (n = 253; NO-group). Two control groups of schoolchildren drawn from two local schools were used for comparison (n = 100 each). Three tests were subjective, i.e. self-fill-out tests. The next three tests were objective psychological or neurophysiological tests designed to estimate reflex control, concentration and a feeling for the passage of time. Results The initial mean anxiety level score among the 364 participants was 41.5 ± 16.7 (min 16, max 80) on 5-110 scale. For the YES-group the score was 56.5 ± 15.9, and for the NO-group the score was 34.7 ± 17.4 (p = 0.05). The retesting after they had been in the same place for 7 weeks revealed that the mean anxiety level score of the participants decreased to 37.4 ± 16.9 (min 15, max 72). For the YES-group the score significantly decreased to 39.3 ± 15.5, and for the NO-group the score slightly elevated to 36.7 ± 16.4 producing similar results for both groups (p = 0.81). Conclusion A temporary change of country and school at first results in a rise in anxiety levels in about one third of participants. However, after an extended stay it falls to normal levels.

Tract Based Spatial Statistic Reveals No Differences in White Matter Microstructural Organization between Carriers and Non-Carriers of the APOE ɛ4 and ɛ2 Alleles in Young Healthy Adolescents.

The apolipoprotein E (APOE) ɛ4 allele is the best established genetic risk factor for Alzheimer's disease (AD) and has been previously associated with alterations in structural gray matter and changes in functional brain activity in healthy middle-aged individuals and older non-demented subjects. In order to determine the neural mechanism by which APOE polymorphisms affect white matter (WM) structure, we investigated the diffusion characteristics of WM tracts in carriers and non-carriers of the APOE ɛ4 and ɛ2 alleles using an unbiased whole brain analysis technique (Tract Based Spatial Statistics) in a healthy young adolescent (14 years) cohort. A large sample of healthy young adolescents (n = 575) were selected from the European neuroimaging-genetics IMAGEN study with available APOE status and accompanying diffusion imaging data. MR Diffusion data was acquired on 3T systems using 32 diffusion-weighted (DW) directions and 4 non-DW volumes (b-value = 1,300 s/mm² and isotropic resolution of 2.4×2.4×2.4  mm). No significant differences in WM structure were found in diffusion indices between carriers and non-carriers of the APOE ɛ4 and ɛ2 alleles, and dose-dependent effects of these variants were not established, suggesting that differences in WM structure are not modulated by the APOE polymorphism. In conclusion, our results suggest that microstructural properties of WM structure are not associated with the APOE ɛ4 and ɛ2 alleles in young adolescence, suggesting that the neural effects of these variants are not evident in 14-year-olds and may only develop later in life.

No differences in hippocampal volume between carriers and non-carriers of the ApoE ε4 and ε2 alleles in young healthy adolescents.

Alleles of the apolipoprotein E (ApoE) gene are known to modulate the genetic risk for developing late-onset Alzheimer's disease (AD) and have been associated with hippocampal volume differences in AD. However, the effect of these alleles on hippocampal volume in younger subjects has yet to be clearly established. Using a large cohort of more than 1,400 adolescents, this study found no hippocampal volume or hippocampal asymmetry differences between carriers and non-carriers of the ApoE ε4 or ε2 alleles, nor dose-dependent effects of either allele, suggesting that regionally specific effects of these polymorphisms may only become apparent in later life.

Uso de las redes sociales como estrategia de promoción de alimentación saludable en adolescentes / Using a social media network as a strategy to promote healthy eating in adolescents

Con el aumento de las enfermedades crónicas no transmisibles y los estilos de vida poco saludables se hace relevante elaborar estrategias de promoción en salud dirigidas desde la infancia hasta la adolescencia. El uso de las Tecnologías de la Información y Comunicaciones (TICs) en adolescentes es masivo, debido a que estos invierten altas horas tanto en telefonía móvil (smartphones), redes sociales, y en aplicaciones de diversa indole, la buena utilizacion de las TICS pudiese por tanto contribuir a mejoras en el estado de salud. El objetivo del presente estudio es analizar el uso de las redes sociales como estrategia de alimentación saludable en adolescentes, utilizando como apoyo los mensajes de las Guía Alimentarias Basadas en los alimentos (GABAS). Se presenta como resultado el aprendizaje significativo de las GABAS basado en el analisis cualitativo de los resultados del uso de la estrategia implementada(AU)

With the increase in chronic noncommunicable diseases and unhealthy lifestyles, it is important to develop health promotion strategies directed from childhood to adolescence. The use of Information and Communication Technologies (ICTs) in adolescents is massive, because they invest high hours in both mobile telephony (smartphones), social networks, and in applications of diverse nature, the good use of ICT could therefore contribute to improvements in health status. The objective of this study is to analyze the use of social networks as a strategy of healthy eating in adolescents, using the messages of the Food-Based Food Guide (GABAS) as support. The significant learning of the GABAS is presented as a result based on the qualitative analysis of the results of the use of the implemented strategy(AU)