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.

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.

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.

Psychological burden of asthma in adolescents and their parents.

INTRODUCTION: Asthma, a common chronic disease in adolescents is impacted by factors affecting quality of life. This study aimed to determine the psychosocial factors of adolescents with asthma and their parents. METHODS: The study included 122 adolescents with asthma, 82 healthy controls, and their parents who completed the Asthma Control Test (ACT), Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Brief Symptom Inventory (BSI). RESULTS: The mean age was 14.2 ± 1.9 years. ACT score was high and depression was low in patients with good treatment compliance. As the age of the first asthma symptoms/diagnosis increased, somatization, anxiety, hostility and general psychopathology scores increased, as did the somatization score of parents. Parental anxiety score was not related with adolescent BSI scores in the controls but in the study group when it was higher, the anxiety, depression, somatization, and general psychopathology scores were higher. PAQLQ showed that anxiety, negative self-esteem, somatization, depression, and general psychopathology were higher in patients concerned about asthma. Depression and somatization scores were higher in the parents of patients who perceived that "Treatment does not contribute to asthma control." Somatization scores were higher among parents of patients who noted: "Asthma will not pass in the long-term" and "I cannot control asthma." CONCLUSION: Higher scores of asthma patients who were anxious about the disease and families who were despondent about treatment demonstrate that health care providers should spend more time informing patients and caregivers. Increasing patient treatment compliance during early adolescence will lessen the psychological burden of the disease.

Rapid refeeding does not worsen anxiety in adolescents with anorexia nervosa: a pilot study.

The study aimed to describe the progression of state anxiety in adolescents with anorexia nervosa (AN) hospitalized on a high calorie refeeding (HCR) protocol. Participants, 12-21 years, admitted for malnutrition due to AN were placed on a HCR protocol in which calories were advanced by 300 kcal/day. The State-Trait Anxiety Inventory for Children (STAIC) was given to participants within 24 hours of hospitalization and the state anxiety component of the STAIC was administered daily immediately before and after breakfast until discharge. Of 22 patients enrolled, 86% were female, mean age was 14.9 ± 2.0 years, and 95% had AN-restrictive type. The median state and trait anxiety scores at time of admission were 37.0 (28-55) and 35.5 (23-51), respectively. There was no significant difference in median pre-meal state anxiety from hospital day 1 to 6 (34.0(26-55) vs. 38.5(25-55), p-value = 0.079) or in median post-meal state anxiety from hospital day 1 to 6 (35.5(29-56) vs. 37(24-56), p-value = 0.484). Similarly, we found minimal correlation between change in caloric intake and change in pre-meal S-anxiety (Spearman correlation coefficient = -0.032) or post-meal S-anxiety (Spearman correlation = 0.032). While this was a small sample observing anxiety over one week, we found no evidence that state anxiety increased with advancing calories, providing additional support for the use of more rapid refeeding protocols.

Predictors of bone mineral density in adolescents with atypical anorexia nervosa.

INTRODUCTION: We aimed to evaluate the bone mineral density (BMD) z scores of adolescents with atypical anorexia nervosa (AAN) and investigate the potential predictors of low BMD risk. MATERIALS AND METHODS: Potential factors that might have an effect on the femoral neck and lumbar spine dual energy X-ray absorptiometry data of adolescents (11-18 years) with AAN were retrospectively evaluated. RESULTS: Among adolescents with AAN, 13 (34.2%) had a z score lower than - 1 and 25 (65.8%) had a z score equal or greater than - 1. When adolescents with a BMD score lower and higher than - 1 were compared, normal BMD group had a significantly higher mean lifetime maximum BMI (p = 0.0035). Similarly previous overweight history was significantly higher in the normal BMD group (p = 0.005). A positive correlation was found between femoral neck (p = 0.002, r: 0.546) and lumbar spine (p: 0.002, r: 0.505) z scores and lifetime maximum BMI. There was also a positive correlation between lumbar spine BMD scores and BMI at admission (p = 0.001, r: 0.540). Lumbar spine z scores and amenorrhea duration were negatively correlated (p: 0.002, r: - 10.867). CONCLUSION: In the adolescent period similar to AN, AAN cases are also at risk for disordered bone health. In adolescents with AAN, BMI prior to the illness was estimated to be the significant parameter for the risk of low BMD. Special attention should be paid to the bone health of adolescents with AAN, especially for those who do not have a previous overweight history.

Repair potential of a bulk-fill resin composite: Effect of different surface-treatment protocols.

This study evaluated the effect of different surface-treatment protocols on the repair bond strength of a bulk-fill resin composite. One-hundred and forty specimens (Filtek Bulk-fill) were created (5 mm diameter, 4 mm depth) and allocated to one of 14 groups according to surface treatment (no treatment, tribochemical silica coating, sandblasting with aluminum oxide), adhesive application (no adhesive, total-etch, self-etch), and type of repair resin (bulk-fill, universal resin) (n = 10 per group). Twenty specimens were selected for measuring the cohesive strengths of non-aged resin composites and used as reference. Other specimens were thermocycled. Shear bond-strength testing was performed. Data were analyzed using linear regression of bond strength as a function of the surface treatment, type of adhesive and whether or not adhesive was applied, and type of repair resin. The failure modes were analyzed using logistic regression of failure mode (cohesive failure vs. other types, or adhesive failure vs. other types) on the type of surface treatment, adhesive application, and repair resin used. Surface treatment, regardless of whether this was tribochemical silica coating (mean difference = 5.44 MPa; 95% CI = 4.77-6.11) or sandblasting with aluminum oxide (mean difference = 4.22 MPa; 95% CI = 3.55-4.88), resulted in higher shear bond strength than no treatment. Application of adhesive resulted in a substantial and statistically significant decrease of shear bond strength (by 8.77 MPa, for self-etch and by 7.26 MPa for total-etch) relative to no adhesive. Conversely, the type of repair resin did not influence the shear bond strength to any appreciable extent.

Impact of Pacemakers and Implantable Cardioverter Defibrillators on the Psychosocial Functioning of Paediatric Patients.

Although implanted cardiac devices improve patients' physical health, long-term psychosocial effects especially in the paediatric population are still unknown. The aim of this study was to evaluate the psychosocial effects of cardiac devices in a paediatric population.Pediatric Quality of Life Questionnaire (PedsQoL) was used to evaluate life quality, Connor-Davidson Resilience Scale was used to evaluate resilience and Brief Symptom Inventory was used to evaluate psychiatric symptoms in a paediatric population with cardiac devices.Seventy-one patients were enrolled in the study. Fifty of them (70.5%) had a cardiac pacemaker and 21 of them (29.5%) had implantable cardioverter defibrillator. When compared to the control group both implantable cardioverter defibrillator and pacemaker using patients had lower quality of life (79.5 ± 12.4 versus 86.7 ± 12.1, p = 0.001) but no difference was observed in resilience and psychological pathologies. Age, gender, family size, and education level had no effect on quality of life. Implantable cardioverter defibrillator bearing patients had higher levels of anxiety than pacemaker patients (0.58 versus 0.30 p = 0.045), and implantable cardioverter defibrillator patients who had received shock in the last year had higher levels of somatisation than the group that did not receive device shock (0.17 versus 0.44 p = 0.022).In conclusion study showed that cardiac devices have negative effects on the psychosocial health of children. Cardiologist working with these patients should be aware of these pathologies and monitor not only physical health but also psychosocial health too.

Is Ramadan fasting correlated with disordered eating behaviours in adolescents?

This study aimed to examine the cross-sectional relationship between Ramadan fasting as a spiritual factor with prolonged hunger and disordered eating behaviors. The study was conducted in June 2016 (11th-29th days of Ramadan) and consisted of 238 fasting and 49 non-fasting adolescents. Risk of disordered eating was evaluated using the Eating Attitudes Test-26 (EAT-26) and Three Factor Eating Questionnaire-R18 (TFEQ-R18). Body image dissatisfaction was rated with Stunkard's Figure Rating Scale (FRS). Nutritional status was assessed using a 24-hour dietary recall. There was no significant difference between energy intake, EAT-26 and TFEQ-R18 scores (except the emotional eating sub-scores) between the groups. FRS revealed that the comparisons of their "ideal" and self were not significantly different between the groups whereas the gap between the figures they think healthy and closest to self was significantly higher amongst non-fasting adolescents. Two-hundred and two (97.5%) adolescents reported fasting for religious purposes whereas only 8 (3.4%) for losing weight. The EAT-26 total scores were in the pathological range in 39 (16.8%) adolescents who fasted for religious purposes. This study suggests that motivation of adolescents to fast during Ramadan was due to spiritual decisions rather than weight control or other factors and Ramadan fasting was not correlated with disordered eating behaviors or body image dissatisfaction.

The effects of parental and peer factors on psychiatric symptoms in adolescents with obesity.

PURPOSE: The aim of this study was to examine the relationships among psychiatric symptoms, effect of beliefs and attitudes of parents about obese people and victimization or bullying in obese adolescents. METHODS: The study group included 110 obese or overweight adolescents and 55 adolescents of normal weight as the control group. All adolescents completed the Brief Symptom Inventory (BSI) and Traditional Bullying Scale. The parents completed the Attitudes Toward Obese Persons (ATOP) Scale and Beliefs About Obese Persons (BAOP) Scale. RESULTS: The BSI subscale scores for depression were significantly higher in the study group. There was no significant relationship found between psychiatric symptoms of obese or overweight adolescents and the ATOP and BAOP scores of parents. When victims, bullies/victims, bullies and those not included in any group among obese or overweight adolescents were examined, psychiatric symptoms of victims and bullies/victims were significantly higher. CONCLUSIONS: The results of this study suggest that the clinical treatment of obesity is not just a matter of diet and exercise but additionally dealing with issues of depression and anxiety. A very satisfactory result of the study was that parents of obese or overweight adolescents did not show an increased weight bias. This study has also shown the association between negative social and psychological ramifications, as the study group was more likely to be the victims and perpetrators of bullying behaviors than their normal-weight peers. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Bladder and voiding dysfunction in adolescents with anorexia nervosa: a novel finding and potential causes.

PURPOSE: This study aimed to investigate the bladder capacity (BC) and bladder dynamics of adolescents with anorexia nervosa (AN). METHODS: The participants consisted of 15 adolescents newly diagnosed with AN according to the DSM 5 criteria and in the acute weight loss period who were questioned about the symptoms of lower urinary tract (LUT) dysfunction. Functional bladder capacity (FBC) and voided volume with uroflowmetry were measured for each subject; the larger volume of the two was chosen for the bladder capacity. Uroflowmetry was used to obtain uroflow curves for the participants whose patterns were labeled as pathologic if they were outside the bell-shape. RESULTS: Fourteen (93.3%) of the patients exhibited at least one of the LUT dysfunction symptoms (pathologic voiding symptom/urinary incontinence/pathologic uroflow pattern). BC was observed to increase in 86.6% (n = 13) of the patients. Eighty% of the patients (n = 12) showed pathological uroflow patterns. In patients with pathological uroflow patterns, which showed insufficiency of bladder contraction, assistance of abdominal muscles was needed during voiding. CONCLUSION: The novel findings presented in this study are the increase of BC in adolescents with AN, the presence of at least one type of voiding or bladder dysfunction, and the pathology of uroflow patterns of most patients show that the bladder dynamics is affected in AN. The most important contribution of this study to the literature is that impaired bladder dynamics was determined to be a medical complication of AN. LEVEL OF EVIDENCE: Case-control analytic study, Level III.

Bisphenol A and phthalate levels in adolescents with polycystic ovary syndrome.

Endocrine disruptors have been proposed in the etiology of polycystic ovary syndrome (PCOS) as they have the potency to interfere with hormone-sensitivity systems. The aim of this study was to evaluate the levels of bisphenol A (BPA) and phtalates in adolescents with PCOS. Sixty-two girls with PCOS and 33 controls, age 12-18 years were enrolled in the study. The diagnosis of PCOS was made using modified Rotterdam criteria. Urinary BPA levels were measured using high-performance liquid chromatography. Di-(2-ethylhexyl)-phthalate (DEHP), the most commonly used phthalate and mono-(2-ethylhexyl)-phthalate (MEHP), its main metabolite were measured by using high-performance liquid chromatography. Adolescents with PCOS had markedly increased BPA levels (15.89 µg/g creatine ± 1.16) when compared with the control group (7.30 µg/g creatine ± 1.38) (p = .016). In adolescents with PCOS, BPA was significantly correlated with polycystic morphology on ultrasound but not with obesity androgen levels, or other metabolic parameters. Patients with PCOS (DEHP: 0.40 ppm ± 0.24, MEHP: 0.13 ppm ± 0.23) and controls (DEHP: 0.49 ppm ± 0.27, MEHP: 0.14 ppm ± 0.3) had similar serum phtalate concentrations (p = .7 and p = .3, respectively). Exposure to specific endocrine disruptors such as BPA could modify neuroendocrine, reproductive, and metabolic regulation favoring PCOS development in adolescents.

Emotion regulation, emotion recognition, and empathy in adolescents with anorexia nervosa.

PURPOSE: Emotional functions may play an important role in anorexia nervosa (AN). The onset of the disorder generally occurs during adolescence, which is a critical period of emotional development. However, most studies that evaluated emotional functions in AN were conducted in adult patients. The aim of this study was to evaluate emotion regulation, emotion recognition, and empathy skills in adolescent girls with AN by controlling for the effects of depression and anxiety symptoms, childhood traumatic experiences, and attachment security on emotional functions. METHODS: Thirty-two adolescent girls with AN and 32 healthy counterparts completed the Difficulties in Emotion Regulation Scale, the Reading the Mind in the Eyes Test, Toronto Alexithymia Scale-20, and the Child and Adolescent KA-SI Empathic Tendency Scale-Adolescent Form. RESULTS: The results revealed that adolescents with AN were found to have more difficulties in emotion regulation, higher alexithymic tendencies, and lower empathy skills compared with the control group. However, emotion recognition was not found to be significantly different between the two groups. These results were the same when controlling for the effects of depression and anxiety symptoms, childhood traumatic experiences, and attachment security except for empathy skills. Alexithymia and depressive symptoms were significantly related to emotion regulation difficulties in adolescents with AN. CONCLUSIONS: Considering the results, it seems that emotion regulation and alexithymia may play a crucial role in the development and maintenance of AN. Accordingly, it is necessary to focus on the improvement of these skills during the treatment of AN. Furthermore, interventions promoting these skills during adolescence may be preventive. LEVEL OF EVIDENCE: Level III, case-control study.

The Effects of Fresh Detox Juices on Color Stability and Roughness of Resin-Based Composites.

PURPOSE: To evaluate the effects of three fresh detox juices, including an orange, green, and red beverage, on the color stability and surface roughness of three anterior esthetic resin-based composites (RBCs). MATERIALS AND METHODS: Disk-shaped specimens were prepared with three different esthetic RBCs (Amaris, G-aenial Anterior, Clearfil Majesty ES-2) according to the manufacturers' instructions. Forty specimens were prepared for each RBC, and all specimens were stored in artificial saliva at 37°C for 24 hours. The initial color values and surface roughness measurements of the specimens were taken using a spectrophotometer and a profilometer. The specimens were then divided into 4 subgroups (n = 10). All specimens except the control specimens were immersed in their designated fresh detox juices (green, red, or orange) for 10 minutes twice a day. Color and surface roughness measurements were taken on day 15 and day 30, and the results were analyzed by one-way ANOVA and Tukey HSD test. The association between color change and surface roughness was evaluated by Spearman's Rank Correlation analysis. RESULTS: Color changes and surface roughness increased upon exposure to fresh detox juices for 15 and 30 days for all of the RBCs. All of the G-aenial and Amaris groups displayed color changes above the threshold of acceptability, whereas Clearfil Majesty ES-2 displayed a color change above the threshold of acceptability only after exposure to the red beverage for 30 days (ΔE > 3.7). With regard to surface roughness, Clearfil Majesty ES-2 outperformed the other RBCs (p < 0.001). According to Spearman's Rank Correlation analysis, there was no correlation between color change and surface roughness (p > 0.001). CONCLUSIONS: Exposure to the fresh detox juices used in this study led to similar color changes in the RBCs used in this study.

Increased P-wave dispersion a risk for atrial fibrillation in adolescents with anorexia nervosa.

Studies have shown that a prolonged P-wave dispersion is a risk factor for the development of atrial fibrillation. The aim of this study was to evaluate P-wave dispersion in adolescents with anorexia nervosa at diagnosis. We evaluated electrocardiographic findings, particularly the P-wave dispersion, at initial assessment in 47 adolescents with anorexia nervosa. Comparison of P-wave dispersion between adolescents with anorexia nervosa and controls showed a statistically significant higher P-wave dispersion in patients with anorexia nervosa (72 ± 16.3 msec) when compared to the control group (43.8 ± 9.5 msec). Percent of body weight lost, lower body mass index, and higher weight loss rate in the patients with anorexia nervosa had no effect on P-wave dispersion. Due to the fact that anorexia nervosa has a high mortality rate we believe that cardiac pathologies such as atrial fibrillation must also be considered in the medical evaluation.

Fasting during Ramadan: a religious factor as a possible trigger or exacerbator for eating disorders in adolescents.

Culture-based contributors play a role in eating disorders (EDs). Here, we present one such factor that may play a role in triggering ED's in adolescents: Fasting during the holy period of Ramadan. Ramadan is the Islamic month of fasting, in which participating Muslims refrain from eating, drinking, and smoking, which starts from dawn lasting until sunset. For the past 2 years, we have noticed an increase in patients with disordered eating patterns that have applied to Hacettepe University, Division of Adolescent Medicine during or shortly after Ramadan. We document six of these patients, three of which were diagnosed with an ED and three that did not meet full criteria. We argue that the possible effects of a drastic change in ones diet such as that which occurs during Ramadan, play an important role in triggering ED's in adolescents with a predisposition or may exacerbate an eating pathology.

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.

Prevalence of premenstrual syndrome in adolescent girls.

BACKGROUND: Premenstrual syndrome (PMS) is characterized by physical, cognitive, emotional, and behavioral symptoms that appear during the luteal phase of the menstrual cycle, disappear after menstruation, and are recurrent in every cycle. PMS significantly affects the social and academic lives of adolescents, and historically, it has been neglected by healthcare professionals. We aimed to evaluate the current point prevalence of PMS in Turkish adolescents presented to a tertiary adolescent medicine clinic. MATERIAL AND METHOD: Adolescent girls between the ages of 12 and 18 and who had regular menstrual cycles for at least three months without any mental or chronic illness were assessed. A clinic information form and the 'Premenstrual Syndrome Scale' (PMSS) questionnaire were completed. Those with a PMSS total score of more than 50% of the total score (>110 out of 220) were classified as PMS (+). Those classified as PMS were further classified as mild-moderate (score: 110-150) and severe (>150). RESULTS: The study included 417 adolescents. The point prevalence of PMS was found to be 61.2% (n:255). Of those with PMS, 49.4% had mild-moderate and 50.6% had severe PMS. The mean PMSS score was 154.56 ± 30.43 in the PMS group and 76.17 ± 20.65 in the non-PMS group (p<0.001). The mean age was 15.41 ± 1.3 years in the PMS group and 14.88 ± 1.35 years in the non-PMS group (p=0.029). None of the youth in our study applied to our clinic due to any premenstrual complaints. CONCLUSION: PMS is frequently observed in youth, as indicated by our study. Adolescents have little awareness of PMS and their need for healthcare services. During the evaluation of adolescents, it is important for health care providers to acquire knowledge regarding the features of menstrual cycles and conduct a comprehensive psychosocial assessment.