Changes in health-related quality of life during transition to adult healthcare: an international prospective cohort study.

OBJECTIVE: To study changes in health-related quality of life (HRQoL) in adolescents and young adults (AYAs) with chronic medical conditions across the transfer to adult healthcare and associations of HRQoL with transition readiness and experience of care. METHODS: Participants in this international (Finland, Australia) prospective cohort study were recruited in the year prior to transfer to adult health services and studied 12 months later. In addition to two HRQoL scales (Pediatric Quality of Life inventory (PedsQL), 16D), the Am I ON TRAC for Adult Care Questionnaire and Adolescent Friendly Hospital Survey measured transition readiness and experience of care and categorised by quartile. Data were compared before and after transfer to adult healthcare. RESULTS: In total, 512 AYAs completed the first survey (0-12 months before transfer of care) and 336 AYAs completed it 1 year later (retention rate 66%, mean ages 17.8 and 18.9 years, respectively). Mean total PedsQL scores (76.5 vs 78.3) showed no significant change, although the social and educational subdomains improved after transfer of care. The mean single-index 16D score remained the same, but in Finland, distress increased and the ability to interact with friends decreased after transfer. AYAs within the best quartiles of experience of care and transition readiness had better HRQoL than AYAs within the worst quartiles. CONCLUSIONS: Overall HRQoL of AYAs remained unchanged across the transfer to adult healthcare. Recognising and supporting AYAs with unsatisfactory experience of care and poor transition readiness could improve overall HRQoL during the transition process. TRIAL REGISTRATION NUMBER: NCT04631965.

Smartphone use and well-being of adolescent girls: a population-based study.

BACKGROUND AND OBJECTIVES: Recent studies have reported an increasing incidence of anxiety among adolescent girls, and associated this with self-reported social media use. This study aimed to measure smartphone and social media use objectively and to evaluate its associations with measures of mental health and well-being. METHODS: In autumn 2022, we recruited a cohort of 1164 first-year female students from 21 socioeconomically diverse high schools. Students responded to an online survey comprising validated questionnaires (Bergen Social Media Addiction Scale (BSMAS), Generalised Anxiety Disorder-7, and Body Appreciation Scale 2) and visual analogue scales of current health, mood, tiredness, and loneliness. We also requested that they attach screenshots depicting their smartphone use. RESULTS: Among participants (mean age 16.3 years), 16% (n=183) had possible social media addiction and 37% (n=371) exceeded the cut-off for possible anxiety disorders. The BSMAS scores were associated with higher anxiety (r=0.380) and poorer body image (r=-0.268), poorer health (r=-0.252), lower mood (r=-0.261), greater tiredness (r=0.347), and greater loneliness (r=0.226) (p<0.001 for all). Among the 564 adolescents (48%) who sent screenshots of their smartphone use, average daily use was 5.8 hours (SD 2.2), including 3.9 hours (SD 2.0) of social media. Participants who sent screenshots had a higher grade point average than participants without screenshot data, but similar BSMAS and well-being measures. CONCLUSIONS: Consistent with other studies, we found social media addiction was common among adolescent girls and was associated with poorer mental health and well-being. Measures should be taken to protect adolescents from the potential harmful effects of social media use.

Associations of excessive internet use, sleep duration and physical activity with school absences: a cross-sectional, population-based study of adolescents in years 8 and 9.

BACKGROUND: Internet use has increased and sleep and physical activity (PA) have decreased in recent years among adolescents. Besides sleep and PA, another determinant of future health for adolescents is education. Our aim was to evaluate the associations of excessive internet use (EIU), short sleep duration and low PA with both unexcused absences and medical absences during lower secondary school. METHODS: The School Health Promotion study is a national survey of adolescents conducted biennially in Finland. We used data collected in 2019, when EIU was assessed for the first time. Cumulative odds ratio analysis was conducted with unexcused absences and medical absences as outcome variables. Besides EIU, sleep duration and PA, the associations of maternal education and parental relations were assessed. RESULTS: The mean age of the 86 270 participants was 15.3 years. Girls scored higher than boys on EIU. In all, 34.7% of participants slept less than 8 hours per night during the school week, and 34.3% reported low PA (ie, less than 3 days per week with minimum 1 hour of PA per day). EIU, short sleep and low PA were associated with both unexcused absences and medical absences from school. Longer sleep during weekends showed no association with absences, but good parental relations had the strongest protective association with both unexcused and medical absences. CONCLUSIONS: EIU, short sleep duration and low PA were associated with both unexcused and medical absences from school. This has important implications for both the promotion of general health and the support offered to students with alarming school absences.

Prenatal, newborn and childhood factors and the timing of puberty in boys and girls.

BACKGROUND: Our aim was to determine if prenatal factors, gestational age, birth weight and length, and childhood body mass index (BMI) are associated with the timing of puberty. METHODS: Our population-based study comprised 4826 girls and 5112 boys born between 1997 and 2002. Multiple linear regression modeled the relationships between the maternal and child predictors and the age at peak height velocity (PHV). RESULTS: Maternal smoking throughout pregnancy was associated with earlier age at PHV (-1.8 months in girls, 95%CI = -3.2 to -0.3, p = 0.015 and -1.7 months in boys, 95%CI = -3.1 to -0.3, p = 0.016). Older gestational age predicted later age at PHV in boys. One SDS increase in birth weight led to 1.7 months later age at PHV in girls (95%CI = 1.2 to 2.2, p < 0.001) and 0.8 months in boys (95%CI = 0.2 to 1.3, p = 0.005). At the age of 9 years, each increment of BMI by 1 kg/m2 was associated with 1.7 months (95%CI = -1.9 to -1.6, p < 0.001) and 1.3 months (95%CI = -1.4 to -1.1, p < 0.001) earlier age at PHV in girls and boys, respectively. CONCLUSIONS: Fetal exposure to smoking can potentially exert enduring effects on pubertal timing. Birth weight and childhood nutritional status are significant determinants of pubertal timing in both sexes. IMPACT: Maternal smoking was associated with earlier timing of puberty and greater birth weight with later timing of puberty in both girls and boys. Most previous studies have focused on girls and used surveys to assess pubertal development, but we studied both sexes and used the same objective measure (age at peak height velocity) for the timing of puberty. Our study increases knowledge especially regarding factors associated with the timing of puberty among boys.

Girls referred for amenorrhea: analysis of a patient series from a specialist center.

Objective: Among adolescents, amenorrhea is a common reason for medical consultation. Despite the variety of underlying etiologies, the prevalence of the causes is incompletely understood. This study aimed to assess the demographic and etiological factors among patients with amenorrhea treated in a single specialist unit of adolescent gynecology. Design: Retrospective register study. Methods: Medical records of 438 girls evaluated for primary or secondary amenorrhea in a single tertiary care center between 2015 and 2019 were retrospectively reviewed. In all, 423 patients-171 with primary amenorrhea and 252 with secondary amenorrhea-were included in the study. Data on underlying conditions, anthropometric variables, and selected hormonal markers were analyzed. Results: Functional hypogonadotropic hypogonadism was the most frequent reason for primary (56%) and secondary (78%) amenorrhea. It was mostly explained by lifestyle-related functional hypothalamic amenorrhea caused by disordered eating, intense exercise, energy deficiency, psychological stress, and their combinations. Conclusion: Menstrual pattern is a significant indicator of overall health and well-being among adolescent girls and young women. Functional reasons behind primary and secondary amenorrhea are important to recognize. Treatment often requires long-term lifestyle modifications. The frequency of functional causes also implies that most amenorrhea cases are preventable.

Health-related quality of life and self-reported health status in adolescents with chronic health conditions before transfer of care to adult health care: an international cohort study.

BACKGROUND: Heath-related quality of life (HRQoL) is lower in adolescents with chronic health conditions compared to healthy peers. While there is evidence of some differences according to the underlying condition and gender, differences by measure and country are poorly understood. In this study we focus on the differences in HRQoL in adolescents with various chronic medical conditions in the year before transfer of care to adult health services. We also study the associations of two different HRQoL measurements to each other and to self-reported health. METHODS: We recruited 538 adolescents from New Children`s Hospital, Helsinki, Finland, and the Royal Children`s Hospital, Melbourne, Australia in 2017-2020. We used two validated HRQoL measurement instruments, Pediatric Quality of Life Inventory (PedsQL) and 16D, and a visual analog scale (VAS) for self-reported health status. RESULTS: In total, 512 adolescents (50.4% female, mean age 17.8 [SD 1.2] years), completed the survey measures. Higher HRQoL was reported in males than females in both countries (PedsQL 79.4 vs. 74.1; 16D 0.888 vs. 0.846), and in adolescents from Finland than Australia (80.6 vs. 72.2 and 0.905 vs. 0.825, p < 0.001 for all). Adolescents with diabetes, rheumatological, nephrological conditions and/or organ transplants had higher HRQoL than adolescents with neurological conditions or other disease syndromes (p < 0.001). PedsQL and 16D scores showed a strong correlation to each other (Spearman correlation coefficient r = 0.81). Using the 7-point VAS (1-7), 52% (248 of 479) considered their health status to be good (6-7) and 10% (48 of 479) rated it poor (1-2). Better self-reported health was associated with higher HRQoL. CONCLUSIONS: The HRQoL of transition aged adolescents varies between genders, diagnostic groups, and countries of residence. The association between self-reported health and HRQoL suggests that brief assessment using the VAS could identify adolescents who may benefit from in-depth HRQoL evaluation. TRIAL REGISTRATION: Trial registration name The Bridge and registration number NCT04631965 ( https://clinicaltrials.gov/ct2/show/NCT04631965 ).

Transition readiness and anxiety among adolescents with a chronic condition and their parents: A cross-sectional international study.

AIMS: To evaluate associations of age, transition readiness and anxiety in adolescents with chronic conditions and to compare perceptions of adolescents and their parents regarding health self-management and transition readiness. DESIGN: Cross-sectional international study, reported following STROBE guidelines. METHODS: Adolescents and young adults (N = 512, mean age 17.7) with a chronic medical condition and their parents (N = 322) from Finland and Australia. Data were collected through surveys (between September 2017 and December 2020). Adolescents reported the duration of their condition. Age at survey was defined by the response date of the questionnaires. Validated questionnaires were used to measure transition readiness (Am I ON TRAC? for Adult Care) and anxiety related to transition of care (State-Trait Anxiety Inventory short form). Perceptions of health self-management and transition readiness were compared in adolescent/parent dyads. Associations were explored using Spearman's correlation. RESULTS: Duration of condition and age at survey correlated weakly with transition readiness knowledge and behaviour. Higher transition readiness knowledge scores correlated with higher behaviour scores. Higher transition readiness behaviour scores were associated with lower levels of anxiety. Adolescents were less anxious than their parents and adolescents and parents mostly agreed about health self-management and transition readiness. CONCLUSION: Transition readiness should be determined by an assessment of knowledge, self-management and psychosocial skills instead of age alone. Further research should address how well transition readiness predicts positive health outcomes after the transfer of care. IMPLICATIONS FOR PATIENT CARE: Transition readiness and self-management skills should be formally assessed because positive feedback may decrease the anxiety of both adolescents and their parents regarding the transfer of care. REPORTING METHOD: We have adhered to the STROBE statement, using STROBE checklist for cross-sectional studies. PATIENT OR PUBLIC INVOLVEMENT STATEMENT: No patient or public involvement. TRIAL AND PROTOCOL REGISTRATION: ClinicalTrials.org NCT04631965.

On a collision course: fatal motorcycle and bicycle accidents of adolescents in Finland from 2008 to 2019.

BACKGROUND: Transport injuries are a major cause of mortality among adolescents. Our aim was to evaluate the circumstances and trauma associated with fatal accidents involving adolescents and two-wheeled vehicles. METHODS: We analyzed retrospective data from the Finnish Crash Data Institute from 2008 to 2019 involving 10- to 24-year-old victims of fatal traffic accidents who were injured while riding a bicycle, moped or motorcycle. We collected data on patient characteristics, accident circumstances and possible treatment. These fatalities were compared with national mortality rates among the respective age groups. RESULTS: We identified 147 fatalities over the 12-year period involving 20 bicycle, 50 moped and 77 motorcycle riders. Most accidents involved males (n = 121, 82%). Less than half of vehicles were in good condition (46%); motorized vehicles were often illegally tuned (37%) or had tire problems (31%). Most of the accidents were collisions with another vehicle (n = 99, 67%) or other objects (n = 35, 24%). In 94% of cases, the Injury Severity Score was >25. Head injury was the most common cause of death (62%). Among 15-year-olds, every fifth death was due to accidents on two-wheeled vehicles. CONCLUSIONS: Fatal transport accidents among adolescents comprise several elements that should be incorporated into driver's education and in case of minors, also communicated to parents. These include the condition of the vehicle, proper helmet use and effects of speed on both control of the vehicle and the consequences of a possible collision.

Eating behaviours, menstrual history and the athletic career: a retrospective survey from adolescence to adulthood in female endurance athletes.

Aim: To evaluate differences in menstrual and pubertal history and trends in eating behaviours among women with and without a competitive sports background. Additionally, we investigated if menstrual history and eating behaviours are associated with sports career-related factors. Methods: This retrospective study was conducted on 100 women with a competitive endurance sports background and their age-matched, gender-matched and municipality-matched controls (n=98). Data were collected using a questionnaire using previously validated instruments. Generalised estimating equations were used to calculate associations of menstrual history and eating behaviours with outcome variables (career length, participation level, injury-related harms and career termination due to injury). Results: Athletes reported higher rates of delayed puberty and menstrual dysfunction than controls. No differences between the groups were observed in the Eating Disorder Examination Questionnaire short form (EDE-QS) scores at any age. Previous disordered eating (DE) was associated with current DE in both groups. Among athletes, higher EDE-QS scores during the sports career were associated with a shorter career (B=-0.15, 95% CI -0.26 to -0.05). Secondary amenorrhoea was associated with lower participation level (OR 0.51, 95% CI 0.27 to 0.95), injury-related harms during the career (OR 4.00, 95% CI 1.88 to 8.48) and career termination due to injury (OR 1.89, 95% CI 1.02 to 3.51). Conclusion: The findings indicate that DE behaviours and menstrual dysfunction, specifically secondary amenorrhoea, have a disadvantageous relationship with a sports career in women competing in endurance sports. DE during the sports career is associated with DE after the career.

Disease control and psychiatric comorbidity among adolescents with chronic medical conditions: a single-centre retrospective study.

BACKGROUND: To investigate disease control, psychiatric comorbidity, substance use and their possible associations in adolescents with chronic medical conditions before transfer to adult healthcare. METHODS: We collected clinical data from the year preceding transfer of care and psychiatric data from the records of the paediatric hospital in Helsinki, Finland (population base 1.7 million). Participants were grouped into three disease and/or adherence control categories (good, some evidence of concern, poor) based on clinical data from the medical records of the year preceding the transfer of care. Participants completed the Adolescent's Substance Use Measurement Questionnaire before transfer of care and were divided into four risk subgroups accordingly. RESULTS: In total, 253 adolescents (mean age 17.3 years, SD 1.2) from six paediatric subspecialties participated in this study. Disease control and/or adherence were rated as good in 28% (n=70), moderate in 42% (n=105) and poor in 30% (n=76) in the year before participants transferred to adult health services. A quarter of participants had at least one psychiatric diagnosis during adolescence. Adolescents with concomitant psychiatric diagnoses more often had poor disease control of their chronic medical condition than adolescents with only a medical condition (44% vs 26%; n=25 of 59 vs 51 of 194, respectively). More than half of adolescents (56%) were abstinent or used substances infrequently; 10% (n=26) reported hazardous substance use. CONCLUSIONS: Psychiatric comorbidity in adolescents with chronic medical conditions is common. Its negative association with disease control and possible substance use should be considered in the transition process to adult health services.

Health-related quality of life in boys with constitutional delay of growth and puberty.

Introduction: Constitutional delay of growth and puberty (CDGP) is the most common reason for delayed puberty in healthy male adolescents. The main indication for medical treatment for this condition is psychosocial burden. However, to the best of our knowledge, no previous study has addressed the impact of puberty-promoting treatment on health-related quality of life (HRQoL) among boys with CDGP. Methods: We investigated HRQoL in 22 boys with CDGP, who participated in a randomized controlled trial in four Finnish pediatric endocrinology outpatient clinics between 2013 and 2017. The boys were randomized to receive either aromatase inhibitor letrozole (2.5mg/day; n=11) or intramuscular testosterone (1mg/kg/every 4 weeks; n=11) for 6 months and followed up to 12 months. HRQoL was assessed with a generic self-assessment 16D© instrument developed and validated for adolescents aged 12 to 15 years. The 16D includes 16 dimensions (vitality, sight, breathing, distress, hearing, sleeping, eating, discomfort and symptoms, speech, physical appearance, school and hobbies, mobility, friends, mental function, excretion and depression). The results were compared with an age-matched reference population that included 163 boys from the Finnish capital-city area. The study protocol is registered to ClinicalTrials.gov (registration number: NCT01797718). Results: At baseline, the mean 16D score of the CDGP boys was similar to the age-matched reference population (0.95 vs 0.96, p=0.838). However, the physical appearance score (satisfaction with general appearance, height and weight) was significantly lower in the CDGP boys (0.75 vs 0.92, p=0.004) than their peers. Twelve months after treatment, Appearance had improved significantly (0.75 vs 0.87, p=0.004) and no HRQoL dimension was inferior compared to the age-matched reference population. Discussion: In terms of HRQoL, the main impact of delayed puberty was dissatisfaction with physical appearance. Puberty promoting therapy was associated with a positive change in perceived appearance, with no clear difference between low-dose testosterone and letrozole treatments.

Parent, teacher, and nurse concerns and school doctor actions: an observational study of general health checks.

OBJECTIVE: To evaluate the association between the concerns of parents, teachers, and nurses regarding each child's well-being and the school doctor actions conducted in routine general health checks. DESIGN: A blinded, observational study. Prior to the health check parents, teachers, and nurses completed questionnaires assessing their concerns. Doctors, blinded to the responses, routinely examined all children accompanied by parents and reported their actions after each health check. Multilevel logistic regression was used to analyse the association of the concerns with the actions. SETTING: 21 primary schools in four municipalities in Finland. PARTICIPANTS: Between August 2017 and August 2018, we randomly recruited 1341 children from grades 1 and 5, aged 7 and 11 years, respectively. OUTCOME MEASURES: Outcome measures were the respondents' concerns and the school doctor actions. The extent of concerns was assessed on a five-point Likert scale. Concern refers to 'Quite a lot or a great deal of concern' by at least one respondent. The school doctor actions included instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals, and referrals to specialised care. RESULTS: Altogether, respondents were concerned about 47.5% of children. The top three concerns comprised growth/and or physical symptoms (22.7%), emotions (16.2%), and concentration (15.1%). All concerns were associated with some type of school doctor action (ORs: 1.66-4.27, p≤0.05); but only concerns regarding growth and/or physical symptoms were associated with all actions. Almost all concerns were associated with referrals to other professionals (ORs: 1.80-4.52, p≤0.01); emotions had the strongest association OR 4.52 (95% CI 3.00 to 6.80, p<0.0001). CONCLUSIONS: Health checks by school doctors may lead to referrals of children to other professionals especially for children's psychosocial problems. This should be considered when developing the roles, training, and multiprofessional collaboration of school health care professionals. TRIAL REGISTRATION: NCT03178331.

Associating school doctor interventions with the benefit of the health check: an observational study.

BACKGROUND: The benefits of school doctor interventions conducted at routine general health checks remain insufficiently studied. This study explored the associations of school doctor interventions with the doctor-evaluated and parent-evaluated benefits of routine health checks. METHODS: Between August 2017 and August 2018, we recruited a random sample of 1341 children from grades 1 and 5 from 21 Finnish elementary schools in 4 municipalities. Doctors routinely examined all children, who were accompanied by parents. The doctor-reported interventions were categorised into six groups: instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals and referrals to specialised care. Doctors evaluated the benefit of the appointment using predetermined criteria, and parents provided their subjective perceptions of benefit. Interventions and reported benefit were compared using multilevel logistic regression. RESULTS: Doctors reported 52% and parents 87% of the appointments with interventions beneficial. All interventions were independently associated with doctor-evaluated benefit (ORs: 1.91-17.26). Receiving any intervention during the appointment was associated with parent-evaluated benefit (OR: 3.25, 95% CI 2.22 to 4.75). In analyses of different interventions, instructions and/or significant discussions (OR: 1.71, 95% CI 1.20 to 2.44), prescriptions (OR: 7.44, 95% CI 2.32 to 23.91) and laboratory tests and/or medical imaging (OR: 3.38, 95% CI 1.34 to 8.55) were associated with parent-evaluated benefit. Scheduled follow-up appointments and referrals to other professionals showed no significant association with parent-evaluated benefit. CONCLUSIONS: Doctors and parents valued the appointments with interventions. Parents especially appreciated immediate help and testing from the doctor. TRIAL REGISTRATION NUMBER: NCT03178331.

Timing of puberty and school performance: A population-based study.

Objective: To determine whether the timing of puberty associates with school performance. Methods: Growth data on 13,183 children born between 1997 and 2002, were collected from child health clinics and school healthcare and school performance data from school records. Age at peak height velocity (PHV) marked pubertal timing. The relationships between age at PHV and average grades in mathematics, native language, English, and physical education from school years 6 (end of elementary school; age 11-12 years), 7 (start of middle school; 12-13 years), and 9 (end of middle school; 14-15 years) were modeled using generalized estimating equations and linear mixed models, adjusted for the month of birth and annual income and education levels in school catchment areas. Results: The mean (SD) age at PHV was 13.54 (1.17) years in boys and 11.43 (1.18) years in girls. In girls, age at PHV was associated with grades in mathematics (ß=0.041-0.062, p<0.005) and physical education (ß=0.077-0.107, p<0.001) across the study years, and in school year 9, also with grades in English (ß=-0.047, 95%CI -0.072 to -0.021, p<0.001). Among boys, only the grades in physical education were related to age at PHV across the study years (ß=0.026-0.073, p<0.01) and in middle school the grades in mathematics decreased dramatically. Conclusions: In both sexes, the timing of puberty was associated with the grades in physical education, and in girls, with academic achievement. The decrease in boys' mathematics grades and sex difference in academic achievement were unexplained by the timing of puberty.

The perceptions of different professionals on school absenteeism and the role of school health care: A focus group study conducted in Finland.

PURPOSE OF THE STUDY: School absenteeism and school dropout jeopardize the future health and wellbeing of students. Reports on the participation of school health care in absenteeism reduction are infrequent, although physical and mental health problems are the most common causes of school absenteeism. Our aim was to explore what reasons different professionals working in schools recognize for absenteeism and which factors either promote or inhibit the inclusion of school health care in absenteeism reduction. MATERIALS AND METHODS: Data for this qualitative study was gathered from ten focus groups conducted in two municipalities in southern Finland. The groups included (vice) principals, special education/resource/subject teachers, guidance counselors, school social workers, school psychologists, school nurses, school doctors, and social workers working in child protective services. Data analysis was predominantly inductive but the categorization of our results was based on existing literature. RESULTS: Study participants identified student-, family-, and school-related reasons for absenteeism but societal reasons went unmentioned. A number of reasons promoting the inclusion of school health care in absenteeism reduction arose, such as expertise in health-related issues and the confidentiality associated with health care. Inclusion of school health care was hindered by differences in work culture and differing perceptions regarding the aims of school health care. CONCLUSION: Professionals working in schools were knowledgeable about the different causes of school absenteeism. Clarifying both the aims of school health care and the work culture of different professionals could facilitate the inclusion of school health care in absenteeism reduction.

Associations between study questionnaire-assessed need and school doctor-evaluated benefit of routine health checks: an observational study.

BACKGROUND: In Finland, school doctors examine all children at predetermined ages in addition to annual health checks by school nurses. This study explored the association of study questionnaire-assessed need for and school doctor-evaluated benefit of routine health checks conducted by doctors. METHODS: Between August 2017 and August 2018, we recruited a random sample of 1341 children in grades 1 and 5 (aged seven and eleven years, respectively) from 21 elementary schools in four Finnish municipalities. Children mainly studying in special education groups or whose parents needed an interpreter were excluded. School nurses performed their health check as usual. Parents, nurses, and teachers then completed study questionnaires that assessed the concerns of parents, school nurses, and teachers regarding each child's physical, mental and social health. Doctors, blinded to the responses, routinely examined all the children. The primary outcome measures were (1) the need for a health check based on the study questionnaires and (2) the benefit/harm of the appointment as estimated by the doctors according to predetermined criteria, and (3) the patient-reported experience measures (PREMs) of benefit/harm of the appointment as estimated by the parents and children. We compared the need for a health check with the doctor-evaluated benefit using multilevel logistic regression. RESULTS: The participation rate was 75.5 %. According to all questionnaires, 20-25 % of the 1013 children had no need for a health check. The doctors regarded 410 (40.6 %) and the parents 812 (83.4 %) of the appointments as being beneficial. Respondents rarely reported harm. The children who were classified as needing a health check more often benefitted from the health check (assessed by the doctor) than children with no need for one (OR 3.53; 95 % CI 2.41-5.17). CONCLUSIONS: The need for a health check is an important predictor of school-doctor evaluated benefit of the health check. This approach could allow school doctors to allocate time for the children who need them most. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier NCT03178331, registration June 6th 2017.

Bridge study protocol: an international, observational cohort study on the transition of healthcare for adolescents with chronic conditions.

INTRODUCTION: More than 10% of adolescents live with a chronic disease or disability that requires regular medical follow-up as they mature into adulthood. During the first 2 years after adolescents with chronic conditions are transferred to adult hospitals, non-adherence rates approach 70% and emergency visits and hospitalisation rates significantly increase. The purpose of the Bridge study is to prospectively examine associations of transition readiness and care experiences with transition success: young patients' health, health-related quality of life (HRQoL) and adherence to medical appointments as well as costs of care. In addition, we will track patients' growing independence and educational and employment pathways during the transition process. METHODS AND ANALYSIS: Bridge is an international, prospective, observational cohort study. Study participants are adolescents with a chronic health condition or disability and their parents/guardians who attended the New Children's Hospital in Helsinki, Finland, or the Royal Children's Hospital (RCH) in Melbourne, Australia. Baseline assessment took place approximately 6 months prior to the transfer of care and follow-up data will be collected 1 year and 2 years after the transfer of care. Data will be collected from patients' hospital records and from questionnaires completed by the patient and their parent/guardian at each time point. The primary outcomes of this study are adherence to medical appointments, clinical health status and HRQoL and costs of care. Secondary outcome measures are educational and employment outcomes. ETHICS AND DISSEMINATION: The Ethics Committee for Women's and Children's Health and Psychiatry at the Helsinki University Hospital (HUS/1547/2017) and the RCH Human Research Ethics Committee (38035) have approved the Bridge study protocol. Results will be published in international peer-reviewed journals and summaries will be provided to the funders of the study as well as patients and their parents/guardians. TRIAL REGISTRATION NUMBER: NCT04631965.

Expression of fibrosis-related genes in liver allografts: Association with histology and long-term outcome after pediatric liver transplantation.

BACKGROUND: Unexplained graft fibrosis and inflammation are common after pediatric liver transplantation (LT). OBJECTIVE: We investigated the graft expression of fibrogenic genes and correlated the findings with transplant histopathology and outcome. METHODS: Liver biopsies from 29 recipients were obtained at a median of 13.1 (IQR: 5.0-18.4) years after pediatric LT. Control samples were from six liver-healthy subjects. Hepatic expression of 40 fibrosis-related genes was correlated to histological findings: normal histology, fibrosis with no inflammation, and fibrosis with inflammation. Liver function was evaluated after a subsequent follow-up of 9.0 years (IQR: 8.0-9.4). RESULTS: Patients with fibrosis and no inflammation had significantly increased gene expression of profibrotic TGF-ß3 (1.17 vs. 1.02 p = .005), CTGF (1.64 vs. 0.66 p = .014), PDGF-α (1.79 vs. 0.98 p = .049), PDGF -ß (0.99 vs. 0.76 p = .006), integrin-subunit-ß1 (1.19 vs. 1.02 p = .045), α-SMA (1.12 vs. 0.58 p = .013), type I collagen (0.82 vs. 0.53 p = .005) and antifibrotic decorin (1.15 vs. 0.99 p = .045) compared to patients with normal histology. mRNA expression of VEGF A (0.84 vs. 1.06 p = .049) was lower. Only a few of the studied genes were upregulated in patients with both fibrosis and inflammation. The gene expression levels showed no association with later graft outcome. CONCLUSIONS: Altered hepatic expression of fibrosis-related genes is associated with graft fibrosis without concurrent inflammation.

Patients with psychiatric diagnoses have lower quality of life than other patients with juvenile rheumatic disease: a prospective study.

OBJECTIVES: Transition of adolescents with chronic diseases from paediatric healthcare to adult care requires attention to maintain optimal treatment results. We examined changes in health-related quality of life (HRQoL) and disease activity among JIA patients with or without concomitant psychiatric diagnoses after transfer to an adult clinic. METHODS: We prospectively followed 106 consecutive patients who were transferred from the New Children's Hospital to the Helsinki University Hospital Rheumatology outpatient clinic between April 2015 and August 2019 and who had at least one follow-up visit. HRQoL was measured using 15D, a generic instrument. RESULTS: The patients' median age at transfer was 16 years and disease duration 4.0 years. Patients were followed for a median of 1.8 years. Disease activity and overall HRQoL remained stable, but distress (dimension 13 of 15D) increased during follow up (P=0.03). At baseline, patients with at least one psychiatric diagnosis had lower overall 15D scores [mean 0.89 (s.d. 0.14) vs 0.95 (s.d. 0.05), P <0.01] and higher disease activity [DAS28mean 1.88 (s.d. 0.66) vs 1.61 (s.d. 0.31), P = 0.01] than patients without psychiatric diagnoses. The difference in overall 15D persisted over the study period. CONCLUSION: Transition-phase JIA patients with psychiatric diagnoses had lower HRQoL than other JIA patients. Despite reduced disease activity and pain, HRQoL of patients with psychiatric diagnoses remained suboptimal at the end of follow-up. Our results highlight the necessity of comprehensive care and support for transition-phase JIA patients.

Teens on Wheels and Consequences: A Six-Year Population-Based Study of Bicycle and Moped Injuries.

INTRODUCTION: Road traffic accidents are a major contributor to morbidity and mortality in the pediatric and adolescent population. Among adolescents, bicycles and light motorized two wheelers are popular means of transportation and increase adolescents' autonomy. Most previous studies on injury risk and incidence have pooled different vehicles and age groups together but more distinct data are required to guide policy. MATERIALS AND METHODS: We gathered data on all 1,432 children and adolescents (age 7-15) who had been treated for injuries from bicycle(n = 841) or moped/motorized scooter (n = 591) accidents at our study centers during a 6-year period (2008-2013). In addition to clinical data, we reviewed Injury Severity Scores (ISS) and calculated incidence estimates for the population of 15-year-olds in the study area. RESULTS: Most bicyclists were injured after a fall (72%), whereas most moped/scooter riders were injured in a collision (51%), most often with a heavier motorized vehicle. Internal injuries, multiple injuries, and severe injuries (ISS >15) were more common among moped/scooter riders than bicyclists (p < 0·001 for all). Moped/scooter riders were more often hospitalized and underwent more operations than bicyclists (p < 0·001 for both). The annual estimated incidence rates of injury were roughly eightfold for 15-year-old moped/scooter riders compared to bicyclists of the same age. CONCLUSION: Cycling is in general a safe mode of transportation and rider safety could be further increased with the proper use of helmets. Although no patient deaths occurred in this study population, mopeds and motorized scooters led to significant morbidity.