Retrospective assessment of ICD-10/DSM-5 criteria of childhood ADHD from descriptions of academic and social behaviors in German primary school reports.

BACKGROUND: The diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adolescence and adulthood is particularly challenging because retrospective confirmation of previous childhood ADHD is mandatory. Therefore, collecting valid diagnostic information about behavior at school is important. Primary school reports often contain descriptions of academic performance and social behaviors associated with ADHD criteria. Yet, there is no systematic approach available how to assess such reports quantitatively, and therefore, there is also no study on how valid such an approach could predict an ADHD diagnosis. METHODS: We examined primary school reports from Germany (ADHD: n = 1197, typically developing controls: n = 656) for semantic references to ICD-10/DSM-5 main and sub-criteria of ADHD. Descriptions were assessed on a quantitative scale (blinded clinical expert rating) for disorder-associated behaviors (symptoms scale) as well as for desired, adaptive behaviors (competencies scale) according to these criteria. The scores of these developed scales have been summarized to summary scores. Scores were analyzed using linear mixed models, and sensitivity and specificity were estimated using receiver operating characteristics (ROC). RESULTS: Ratings showed highly significant differences between school reports of children with and without ADHD. For the summary scores, both symptoms and competencies scales showed high diagnostic accuracy (ROC area under the curve at least 0.96) with best discrimination when combining both into an integrated index (sensitivity and specificity > 0.97). CONCLUSIONS: Our findings suggest that systematic quantitative analysis of primary school reports should be further explored to construct a valid instrument for retrospective assessment of childhood ADHD criteria to aid the diagnostic process in adolescents and adults.

Evaluation of palate-related factors of the effectiveness of microimplant-assisted rapid palatal expansion in late adolescents and adults.

INTRODUCTION: This study investigated the factors of the effectiveness of microimplant-assisted rapid palatal expansion (MARPE) in late adolescents and adults, such as age, midpalatal suture maturation (MPSM) stage, palate length (PL), palatal index (PI), and midpalatal bone thickness (MBT), and at each microimplant position, the palate bone thickness (PBT), the nasal cortical bone thickness (CoTN), the cancellous bone thickness (CaT), and the palate cortical bone thickness (CoTP) were evaluated. METHODS: Cone-beam computed tomography (CBCT) images of 50 patients (mean, 23.30 ± 7.03 years; range, 16-51 years) treated with MARPE were evaluated. Maxillary expansion ratio (MER) was used to assess the MARPE effectiveness and grouped patients into low and high MER groups according to the mean of MER. MER was the ratio of maxillary expansion width to MARPE screw expansion measured in CBCT images. The t-test was used to analyze the differences between the low and high MER groups. The Pearson correlation test was performed to investigate the correlation between MER and age, MPSM stage, PL, PI, MBT, PBT, CoTN, CaT, and CoTP. RESULTS: Age, MPSM stage, and MBT in regions 18 mm and 21 mm behind the incisor foramen correlated negatively with MER ([Formula: see text], - 0.390, - 0.386, and - 0.335, respectively, all [Formula: see text]), whereas PBT and CoTN of anterior microimplant positions correlated positively with MER ([Formula: see text] and 0.418, respectively, all [Formula: see text]). No correlation was observed between other variables and MER. CONCLUSIONS: MARPE effectiveness decreased as age and midpalatal suture maturation stage increased, respectively. Thinner midpalatal suture bone in regions 18 mm and 21 mm behind the incisor foramen, thicker palate bone, and nasal cortical bone of anterior microimplant positions were related to more effective MARPE. CLINICAL RELEVANCE: In patients with older chronological age and later MPSM stages, MARPE effectiveness might be unsatisfactory. Clinicians should carefully evaluate the palate bone thickness before MARPE treatment.

Intelligence trajectories in adolescents and adults with down syndrome: Cognitively stimulating leisure activities mitigate health and ADL problems.

GOALS: This study examined: (a) crystallized/fluid intelligence trajectories of adolescents and adults with Down syndrome; and (b) the contribution of endogenous (health, activities of daily living-ADL) and exogenous (cognitively stimulating leisure activities) factors on adults' intelligence with age. METHOD: Four cohorts (N = 80) with Down syndrome participated: adolescents (ages 16-21) and adults (ages 30-45, 46-60 and 61+). All completed Vocabulary and Similarities (crystallized) and Block Design and Raven (fluid) intelligence tests (WAIS-IIIHEB , Wechsler, 2001). RESULTS: The 30-45 cohort significantly outperformed the 16-21 cohort. Except for Vocabulary, which remained stable, onset of decline was at 40-50. Age-related declining health and ADL correlated with participants' lower fluid intelligence, but cognitive leisure activities mitigated this influence. CONCLUSIONS: Intelligence development into adulthood supported the continuous trajectory and compensation age theory, rather than accelerated or stable trajectories. Not only endogenous factors but also exogenous factors determined intelligence levels in adults with Down syndrome, supporting cognitive activity theory.

Psychological and nutritional correlates of objectively assessed physical activity in patients with anorexia nervosa.

BACKGROUND: Physical activity (PA) plays a role in the course of anorexia nervosa (AN). OBJECTIVE: To assess the association between PA, nutritional status and psychological parameters in patients with AN. METHOD: Using a wearable activity monitor, PA was assessed in 60 female AN inpatients, by step count and time spent in 4 metabolic equivalent (MET)-intensity levels: sedentary behaviour, light, moderate and vigorous PA. In addition, BMI, psychological (patient-reported outcome questionnaires) and nutritional parameters (body fat, energy and macronutrient intake) were assessed. RESULTS: The study population spent little time in vigorous PA. BMI on admission and discharge was higher when more time was spent in sedentary behaviour, and lower with more time spent in light PA. Relationships between PA and patient-reported outcomes were weak and limited to an association between vigorous PA and compulsiveness. Low fat mass was associated with more time spent in light PA, while subjects with higher step counts showed less intake of energy, carbohydrates and fat. CONCLUSION: The relationship between inadequate food intake and increased PA in patients with AN requires further investigation.

Pica behaviors in a German community-based online adolescent and adult sample: an examination of substances, triggers, and associated pathology.

PURPOSE: To examine self-reported pica substances, situational triggers for, and associated psychosocial burden of pica eating in adolescents and adults in a Western European population. METHODS: A total of 78 individuals aged 16 years and over, who indicated consuming a substance that in their opinion is not considered as food, participated in an online survey. Two questionnaires assessed eating disorder and general psychopathology, and a third asked about the substances consumed, duration and frequency of consumption, triggers for consumption, emotions thereafter, and interest in treatment. RESULTS: The most frequently reported substances included foods in an uncooked or non-edible form, body parts/fluids, grass, leaves, paper, and earth-like substances, with 54 (69.23%) participants reporting a substance that would qualify as pica substance according to DSM-5. The main triggers for consumption were taste of the substance/indulgence, boredom, curiosity, and release of internal tension. The most common emotion after consumption was relief. Pica eating frequency was not significantly related to eating disorder and general psychopathology (both p > 0.05). A total of 24 individuals considered their pica eating as disruptive, of whom only eight declared an interest in treatment. CONCLUSIONS: The kind of substances consumed is in line with the previous reports in other populations. Pica eating does not seem to be associated with significant psychosocial burden; only a subgroup indicated that they experience it as disruptive and expressed interest in treatment. Nevertheless, for these individuals, triggers for pica eating and emotions thereafter might provide first hints for the development of interventions. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Dravet syndrome: Early electroclinical findings and long-term outcome in adolescents and adults.

To describe the outcome of Dravet syndrome (DS) in adolescents and adults we conducted a longitudinal retrospective study of two independent cohorts of 34 adolescents (group 1) and 50 adults (group 2). In both cohorts, we collected information about genetic mutation, and semiology of seizures at onset and during disease course. At the last evaluation, we considered the following features: epilepsy (distinguishing myoclonic/complete and nonmyoclonic/incomplete phenotype), neurologic signs, intellectual disability (ID), and behavioral disorders. Moreover, in both cohorts, we performed a correlation analysis between early characteristics of the disease and the outcome of DS with regard to seizure persistence, ID, behavioral disorder, and neurologic impairment at last evaluation. Group 1 includes 22 adolescents with complete form of DS and 12 with incomplete form; group 2 includes 35 adults with complete form and 15 with incomplete form. The seizures persisted in 73.6% of adolescents and in 80% of adults, but epilepsy severity progressively decreased through age. Seizure persistence correlated with the complete phenotype and with the occurrence of reflex seizures. At last evaluation, ID was moderate or severe in 70.5% of adolescents and in 80% of adults. The most severe cognitive and motor impairment was observed in patients with persisting seizures. The severity of cognition, language, and neurologic impairment at last evaluation correlated statistically with the complete phenotype. The study confirms that the global outcome of DS is poor in most cases, albeit epilepsy severity decreases throughout adulthood. The improvement of epilepsy throughout ages is not associated with improvement in intellectual abilities and motor skills; this confirms that the unfavorable outcome is not a pure consequence of epilepsy.

Medication use by adolescents and adults with fragile X syndrome.

BACKGROUND: The behavioural challenges and medical conditions associated with fragile X syndrome (FXS) can lead to increased need for medications. METHOD: This longitudinal study examined the use of prescription medications for psychotropic and non-psychotropic purposes by adolescents and adults with FXS drawn from a North American community sample (N = 105). Odds and probabilities of continuing or discontinuing medication were calculated. Predictors of medication use were calculated. RESULTS: More than two-thirds took psychotropic medication, and about one-quarter took non-psychotropic medication. Over a 3-year period, those who initially took prescription medications were considerably more likely to remain on medications than to stop. Individuals with more autism symptoms, more behavioural problems, a mental health diagnosis, and greater family income were significantly more likely to use psychotropic medication 3 years later. Individuals who had more health problems, a mental health diagnosis, and were female were more likely to use non-psychotropic medication over this time period. CONCLUSIONS: Findings highlight the elevated and ongoing use of medication by individuals with FXS. Implications for social and behavioural research on FXS are discussed.

Measuring Gender Dysphoria: A Multicenter Examination and Comparison of the Utrecht Gender Dysphoria Scale and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults.

This study examined two instruments measuring gender dysphoria within the multicenter study of the European Network for the Investigation of Gender Incongruence (ENIGI). The Utrecht Gender Dysphoria Scale (UGDS) and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) were examined for their definitions of gender dysphoria and their psychometric properties, and evaluated for their congruence in assessing the construct. The sample of 318 participants consisted of 178 male-to-females (MtF) and 140 female-to-males (FtM) who were recruited from the four ENIGI gender clinics. Both instruments were significantly correlated in the group of MtFs. For the FtM group, there was a trend in the same direction but smaller. Gender dysphoria was found to be defined differently in the two instruments, which led to slightly different findings regarding the subgroups. The UGDS detected a difference between the subgroups of early and late onset of gender identity disorder in the group of MtFs, whereas the GIDYQ-AA did not. For the FtM group, no significant effect of age of onset was found. Therefore, both instruments seem to capture not only similar but also different aspects of gender dysphoria. The UGDS focusses on bodily aspects, gender identity, and gender role, while the GIDYQ-AA addresses subjective, somatic, social, and sociolegal aspects. For future research, consistency in theory and definition of gender dysphoria is needed and should be in line with the DSM-5 diagnosis of gender dysphoria in adolescents and adults.

Burden of diabetes attributable to dietary cadmium exposure in adolescents and adults in China.

At present, the health risk assessment of cadmium exposure has become a major focus of environmental health research. However, there is still a lack of systematic research on the burden of diabetes (DM) attributable to dietary cadmium exposure in adolescents and adults in China. Using the top-down method, the blood cadmium level (B-Cd) of Chinese adolescents and adults from 2001 to 2023 was combined with the relative risk (RR) of cadmium-induced diabetes to calculate the population attribution score (PAF). Subsequently, PAF was used to assess the disease burden (DB) of diabetes caused by cadmium exposure, expressed in disability adjusted life years (DALYs), and attribution analysis was carried out for cadmium exposure from different sources. The average blood cadmium concentration in Chinese adolescents and adults was 1.54 ± 1.13 µg/L, and the burden of DM attributable to cadmium exposure was 56.52 (44.81, 70.33) × 105 DALYs. The contribution rate of dietary cadmium exposure was 59.78%, and the burden of DM attributable to dietary cadmium exposure was 337.86 (267.85, 420.42) × 108 DALYs. In addition, the highest blood cadmium concentrations were found in Henan, Shanxi, and Jiangxi provinces, while the highest burden of DM attributable to cadmium exposure was found in Jiangsu, Henan, and Guangdong provinces. Cadmium exposure is a risk factor for DM, and we need to take comprehensive action to reduce the burden of DM attributable to dietary cadmium from health, economic, and social perspectives.

Seroepidemiology of pertussis in the east of China: Estimates of incidence of infection in adolescents and adults pre- and post-COVID-19.

Introduction: The dramatic decrease in the number of reported cases of pertussis during COVID-19 pandemic has been underestimated. The objective was to compare the estimated incidence rate of pertussis in populations pre- and post-COVID-19 pandemic by analyzing the anti-pertussis toxin (anti-PT) IgG and anti-filamentous hemagglutininant (anti-FHA) IgG antibodies in healthy Chinese population from 2018 to 2021. Methods: All serum samples (N = 1,000) were collected from healthy population (aged ≥ 15 years) who attended an annual monitoring project of antibody levels in Jiangsu province in 2018-2021 were measured by ELISA. Results: The positive rates of anti-PT IgG and anti-FHA IgG antibodies were 11.4% (114/1,000) and 20.2% (202/1,000) (≥40 IU/ml), the GMC were 17.25 (95% CI: 15.49-19.03) IU/mL and 24.94 (95% CI: 22.73-27.16) IU/mL in the study population, respectively. The percentage of participants with anti-PT IgG antibodies higher than 40 IU/mL was 5.20% (11/212) in 2018, 5.5% (19/348) in 2019, 21.2% (46/217) in 2020 and 17.0% (38/223) in 2021, respectively. The non-detectable rate (<5 IU/mL) of anti-PT IgG antibodies was 16.9, 17.7, 28.1, and 37.3% in 2018, 2019, 2020, and 2021, respectively. We assumed that the infection occurred within 58.6 days, and based on the overall proportion (2.9%) of individuals with anti-PT IgG antibody ≥100 IU/ml, the incidence rate (/100) was estimated by the formula to be 18.08 (95% CI: 12.40-26.11). In addition, the estimated incidence of Post-COVID-19 was higher than that of Pre-COVID-19 (36.33/100 vs. 12.84/100), and the difference was statistically significant (p < 0.05). Conclusions: Our results suggest a high rate of under-reporting of pertussis in Jiangsu Province both pre- and post-COVID-19 pandemic, and there are a large number of adults of childbearing age who are susceptible to pertussis. It seems imperative that vaccination of adolescents and adults should be considered for inclusion in vaccination programs.

The use of the MUSS and the SIR scale in late-implanted prelingually deafened adolescents and adults as a subjective evaluation.

Background: The SIR scale has been widely used to measure speech improvement in late-implanted prelingually deafened adolescents and adults. However the ceiling effect of the SIR scale may lead to the loss of some information.Aim/objectives: To evaluate the oral ability of late-implanted prelingually deafened adolescents and adults using the MUSS and SIR scale and to analyse the relationship between the SIR score and the MUSS score.Material and methods: Ninety-four prelingually deafened adolescents and adults who had received cochlear implants were investigated. The MUSS and SIR scale were used to evaluate oral ability.Results: The relationship between the duration of implant use and the MUSS score was significantly different. No significant differences were found among the groups for age at implantation, gender and side of cochlear implantation. The total score on the MUSS was positively correlated with the SIR score.Conclusions and significance: The MUSS and the SIR scale could be used to evaluate the oral ability of late implanted patients. The SIR scale could be used to perform a rapid assessment and the MUSS could help provide more information. The combination of the two scales could be used to evaluate vocal ability more accurately and effectively.

Adolescent Awkwardness: Alterations in Temporal Control Characteristics of Posture with Maturation and the Relation to Movement Exploration.

A phenomenon called adolescent awkwardness is believed to alter motor control, but underlying mechanisms remain largely unclear. Since adolescents undergo neurological and anthropometrical changes during this developmental phase, we hypothesized that adolescents control their movements less tightly and use a different coordinative structure compared to adults. Moreover, we tested if emerging differences were driven by body height alterations between age groups. Using 39 reflective markers, postural movements during tandem stance with eyes open and eyes closed of 12 adolescents (height 168.1 ± 8.8 cm) and 14 adults were measured, in which 9 adults were smaller or equal than 180 cm (177.9 ± 3.0 cm) and 5 taller or equal than 190 cm (192.0 ± 2.5 cm). A principal component analysis (PCA) was used to extract the first nine principal movement components (PMk). The contribution of each PMk to the overall balancing movement was determined according to their relative variance share (rVARk) and tightness of motor control was examined using the number of times that the acceleration of each PMk changed direction (Nk). Results in rVARk did not show significant differences in coordinative structure between adolescents and adults, but Nk revealed that adolescents seem to control their movements less tightly in higher-order PMk, arguably due to slower processing times and missing automatization of postural control or potential increases in exploration. Body height was found to not cause motor control differences between age groups.

Economic evaluations and cost analyses in posttraumatic stress disorder: a systematic review.

BACKGROUND: Posttraumatic stress disorder is associated with a high economic burden. Costs of treatment are known to be high, and cost-effectiveness has been analysed for several treatment options. OBJECTIVE: As no review on economic aspects of posttraumatic stress disorder exists, the aim of this study was to systematically review costs-of-illness studies and economic evaluations of therapeutic treatment for posttraumatic stress disorder, and to assess their quality. METHOD: A systematic literature search was performed in March 2017 and was last updated in February 2020 in the databases PubMed, PsychInfo and NHS Economic Evaluation Database. Cost-of-illness studies and economic evaluations of treatment for posttraumatic stress disorder were selected. Extracted cost data were categorized as direct costs and indirect costs and inflated to 2015 US-$ purchasing power parities (PPP). Quality was assessed using an adapted cost-of-illness studies quality checklist, the Consensus on Health Economic Criteria list, and the questionnaire to assess relevance and credibility of modelling studies by the International Society for Pharmacoeconomics and Outcome Research. RESULTS: In total, 13 cost-of-illness studies and 18 economic evaluations were included in the review. Annual direct excess costs ranged from 512 US-$ PPP to 19,435 US-$ PPP and annual indirect excess costs were 5,021 US-$ PPP per person. Trauma-focused cognitive-behavioural therapy (+selective serotonin re-uptake inhibitor) was found to be cost-effective compared with treatment as usual and no treatment. Overall, included studies were of low and moderate quality. Studies used inappropriate economic study designs and lacked information on the economic perspective used. CONCLUSIONS: Posttraumatic stress disorder is a major public health problem that causes high healthcare costs. While trauma-focused cognitive-behavioural therapy was found to be cost-effective, further investigations regarding pharmacotherapy and other treatments are necessary.

Antecedentes: El trastorno por estrés postraumático está asociado con una alta carga económica. Se sabe que los costos de tratamiento son elevados, y su costo-efectividad ha sido analizado para varias opciones de tratamiento.Objetivo: Debido a que no existe ninguna revisión sobre los aspectos económicos del trastorno de estrés postraumático, el objetivo de este estudio fue hacer una revisión sistemática de estudios de costo de enfermedad y evaluaciones económicas del tratamiento terapéutico para trastorno por estrés postraumático, y evaluar su calidad.Métodos: Se realizó una revisión sistemática de la literatura en Marzo de 2017 y fue actualizada por última vez en Febrero 2020 en las bases de datos PubMed, PsychInfo y la Base de datos de Evaluación Económica de NHS. Se seleccionaron estudios de costo de enfermedad y evaluaciones económicas de tratamiento para trastorno por estrés postraumático. Los datos extraídos sobre los costos fueron categorizados como costos directos e indirectos y elevados al dolar estadounidense del 2015 y su Paridad de Poder Adquisitivo (PPP por sus siglas en inglés). La calidad fue evaluada usando una lista de chequeo adaptada sobre la calidad de estudios de costo de enfermedad, la lista del Consenso en Criterios de Economía de Salud, y el cuestionario para evaluar relevancia y credibilidad de estudios de modelado de la Sociedad Internacional de Farmacoeconomía e investigación de Resultados.Resultados: En total, 13 estudios de costo de enfermedad y 18 evaluaciones económicas fueron incluidas en la revisión. Los costos anuales directos en exceso oscilaron entre 512 US-$ PPP a 19,435 US-$ PPP y los costos anuales indirectos en exceso fueron de 5,021 US-$ PPP por persona. La terapia cognitivo-conductual focalizada en el trauma (+ un inhibidor selectivo de la recaptura de la serotonina) fue costo-efectiva en comparación con el tratamiento usual y con no tratar. Los estudios usaron diseños inapropiados para un estudio económico y carecían de información sobre la perspectiva económica usada.Conclusiones: el trastorno por estrés postraumático es un problema de salud pública importante que causa grandes costos en atención de salud. Si bien se encontró que la terapia cognitivo-conductual focalizada en el trauma fue costo-efectiva,se requieren investigaciones futuras en relación a la farmacoterapia y otros tratamientos.

Should the Minimal Intervention Principle Be Considered When Investigating Dual-Tasking Effects on Postural Control?

Dual-tasking charges the sensorimotor system with performing two tasks simultaneously. Center of pressure (COP) analysis reveals the postural control that is altered during dual-tasking, but may not reveal the underlying neural mechanisms. In the current study, we hypothesized that the minimal intervention principle (MIP) provides a concept by which dual-tasking effects on the organization and prioritization of postural control can be predicted. Postural movements of 23 adolescents (age 12.7 ± 1.3; 8 females) and 15 adults (26.9 ± 2.3) were measured in a bipedal stance with eyes open, eyes closed and eyes open while performing a dual-task using a force plate and 39 reflective markers. COP data was analyzed by calculating the mean velocity, standard deviation and amplitude of displacement. Kinematic data was examined by performing a principal component analysis (PCA) and extracting postural movement components. Two variables were determined to investigate changes in amplitude (aVark) and in control (Nk) of the principal movement components. Results in aVark and in Nk agreed well with the predicted dual-tasking effects. Thus, the current study corroborates the notion that the MIP should be considered when investigating postural control under dual-tasking conditions.

Selection of a Surgical Treatment Approach for Aortic Coarctation in Adolescents and Adults.

PURPOSE: Coarctation of the aorta (CoA) in adolescents and adults is relatively rare. Several operative techniques for CoA in adolescents and adults have been reported, but there is still no consensus. This study aims to highlight the use of individual patient characteristics to select optimal treatment strategies for CoA in adolescents and adults. METHODS: Surgical repair of CoA was performed in five patients (mean age: 34 ± 14 years, range: 13-58 years). All patients had primary CoA, and one had aneurysm above the CoA. One patient had undergone previous aortic valve replacement (AVR) and graft replacement of the ascending aorta. One patient underwent resection of the coarctation without cardiopulmonary bypass (CPB) followed by direct end-to-end anastomosis. Three patients underwent CoA resection with an interposition graft through a lateral thoracotomy with partial CPB. One patient underwent AVR with extra-anatomical bypass (ascending-descending aorta). RESULTS: No in-hospital deaths occurred, and there were no complications. During the follow-up period, there has been no recurrence of CoA. CONCLUSION: CoA in adolescents and adults is associated with different issues from those encountered in infant patients, and comprehensive surgery should be performed in all cases.

Pertussis may be the cause of prolonged cough in adolescents and adults in the interepidemic period.

OBJECTIVE: This study was aimed to evaluate the prevalence of pertussis in adolescents and adults with cough lasting more than 14 days and less than 30 days. METHODS: This is a prospective observational study in interepidemic period of pertusis. Ten public health outpatient clinics in the city of Recife, Brazil, were randomly selected for the study. The study population consisted of individuals aged 10 years and over with cough that had lasted between 14 and 30 days. Nasopharyngeal swabs were collected for culture and PCR in order to identify Bordetella pertussis. We adopted the Centers for Disease Control and Prevention in the US (CDC) definition of cases of pertussis. RESULTS: A total of 192 individuals were identified as suspected cases. Their mean age was 40.7 years. Pertussis was confirmed in 10 of the 192 suspected cases, with an estimated prevalence of 5.21% (95% confidence interval 2.03-8.38). All cases met the clinical case definition for pertussis; one suspect had both culture and PCR positive. PCR confirmed 100% of the cases, 7/10 by PCR and 3/10 by epidemiological linkage with a case confirmed by PCR. CONCLUSION: During an interepidemic period, 1 in 20 cases of prolonged cough had pertussis, suggesting this is an important cause of prolonged cough in adolescents and adults.

Serum uric acid and insulin sensitivity in adolescents and adults with and without type 1 diabetes.

HYPOTHESIS: Decreased insulin sensitivity (IS) exists in type 1 diabetes. Serum uric acid (SUA), whose concentration is related to renal clearance, predicts vascular complications in type 1 diabetes. SUA is also inversely associated with IS in non-diabetics, but has not been examined in type 1 diabetes. We hypothesized SUA would be associated with reduced IS in adolescents and adults with type 1 diabetes. METHODS: The cross-sectional and longitudinal associations of SUA with IS were investigated in 254 adolescents with type 1 diabetes and 70 without in the Determinants of Macrovascular Disease in Adolescents with Type 1 Diabetes Study, and in 471 adults with type 1 diabetes and 571 without in the Coronary Artery Calcification in Type 1 diabetes (CACTI) study. RESULTS: SUA was lower in subjects with type 1 diabetes (p<0.0001), but still remained inversely associated with IS after multivariable adjustments in adolescents (ß±SE: -1.99±0.62, p=0.001, R2 =2%) and adults (ß±SE: -0.91±0.33, p=0.006, R2 = 6%) with type 1 diabetes, though less strongly than in non-diabetic controls (adolescents: ß±SE: -2.70±1.19, p=0.03, R2 = 15%, adults: ß±SE: -5.99±0.75, p<0.0001, R2 =39%). CONCLUSION: We demonstrated a significantly weaker relationship between SUA and reduced IS in subjects with type 1 diabetes than non-diabetic controls.

Structural relationships among attachment insecurity, alexithymia, and body esteem in women with eating disorders.

Patients with eating disorders tend to experience low levels of body esteem. To assess the psychosocial processes that may predict low body esteem in these individuals, we assessed the structural interrelations among attachment anxiety, attachment avoidance, alexithymia, and body esteem in a cross-sectional sample of patients with eating disorders. We tested a model in which alexithymia mediates the relationship between attachment insecurity and body esteem. Participants were 300 women with anorexia nervosa (n = 109), bulimia nervosa (n = 130), and eating disorders not otherwise specified (n = 61) who completed pretreatment self-report questionnaires at intake for a day hospital treatment program. We found a direct and negative relationship between attachment anxiety and body esteem. Additionally, attachment avoidance had an indirect negative relationship to body esteem through alexithymia. These results indicate that therapists may attend to attachment insecurity and affective regulation strategies when addressing body image issues in patients with eating disorders.

Pertussis may be the cause of prolonged cough in adolescents and adults in the interepidemic period

Objective: This study was aimed to evaluate the prevalence of pertussis in adolescents and adults with cough lasting more than 14 days and less than 30 days. Methods: This is a prospective observational study in interepidemic period of pertusis. Ten public health outpatient clinics in the city of Recife, Brazil, were randomly selected for the study. The study population consisted of individuals aged 10 years and over with cough that had lasted between 14 and 30 days. Nasopharyngeal swabs were collected for culture and PCR in order to identify Bordetella pertussis. We adopted the Centers for Disease Control and Prevention in the US (CDC) definition of cases of pertussis. Results: A total of 192 individuals were identified as suspected cases. Their mean age was 40.7 years. Pertussis was confirmed in 10 of the 192 suspected cases, with an estimated prevalence of 5.21% (95% confidence interval 2.03-8.38). All cases met the clinical case definition for pertussis; one suspect had both culture and PCR positive. PCR confirmed 100% of the cases, 7/10 by PCR and 3/10 by epidemiological linkage with a case confirmed by PCR. Conclusion: During an interepidemic period, 1 in 20 cases of prolonged cough had pertussis, suggesting this is an important cause of prolonged cough in adolescents and adults. .

Consciência morfossintática e ortografia em adolescentes e adultos escolarizados / Morphosyntactic awareness and spelling in schooled adolescents and adults

O objetivo do estudo foi avaliar o desempenho ortográfico e a consciência morfossintática em uma amostra composta por 224 adolescentes e adultos escolarizados. Foram aplicadas tarefas de ditado de palavras e pseudopalavras, julgamento e analogia de palavras, com justificativas, elaboradas com morfemas gramaticais e lexicais que apresentavam concorrência na representação gráfica dos fonemas /s/ e /z/. Os resultados mostraram diferenças importantes entre os morfemas gramaticais e lexicais, sugerindo que tais princípios ortográficos não são apreendidos do mesmo modo. Também não se observou a utilização gerativa desses princípios, apesar de haver evolução na conduta ortográfica e nas explicitações entre o final do ensino fundamental e médio. Foi encontrado um efeito preditor do conhecimento explícito sobre o desempenho ortográfico na escrita de palavras e pseudopalavras. Conclui-se que mesmo nos níveis mais avançados de escolarização ainda há dificuldade na explicitação consciente desses princípios ortográficos.

The aim of this study was to evaluate the spelling and morphosyntactic awareness in a sample of 224 schooled adolescents and adults. Participants were tested in a task of dictations of words and pseudowords, judgment of written words and analogy of words (both with justification) elaborated with grammatical and lexical morphemes that presents competition in the graphical representation of the fonemes / s / and / z /. The results showed significant differences between the morphemes grammatical and lexical, suggesting that these orthographic principles are not attained likewise. It was not also observed the use of generative principles, though it is possible to observe an evolution in the orthographic performance and in the type of justifications used at the end of primary and secondary education. A predictive effect of explicit knowledge about the orthographic performance in spelling words and pseudowords was also observed. It is concluded that even in the most advanced levels of schooling there is still difficulty in explicit aware of the orthographic principles.