Tag: Adolescent Health

Children with multiple sclerosis have better outcomes if treated early and with high-efficacy therapies

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A ground-breaking study – the largest of its kind globally – has found children with multiple sclerosis (MS) have better outcomes if treated early and with the same high-efficacy therapies as adults.

There are a limited number of therapies approved for children with MS, with only one considered to be of high-efficacy – meaning highly effective.

However, a Royal Melbourne Hospital (RMH) observational study has determined that pediatric patients should be treated with the same high-efficacy treatments offered to adults as early in their diagnosis as possible to avoid the onset of significant disability.

We found that patients who were treated with high-efficacy disease-modifying therapies during the initial phases of their disease benefitted the most compared to patients who were not treated.

Based on our findings we recommend that patients with pediatric-onset multiple sclerosis should be treated early in the disease course, when the disability is still minimal, to preserve neurological capacity before it’s damaged.”

Dr. Sifat Sharmin, Research Fellow at the Royal Melbourne Hospital’s Neuroimmunology Centre, and the University of Melbourne’s Department of Medicine

The observational study analyzed global data of more than 5000 people diagnosed with MS during childhood over the last 30 years – including from MSBase, a large international registry encompassing 41 countries, and a national registry in Italy, where the disease is highly prevalent.

It compared the strength of treatment with the severity of the disease later in life, and concluded patients treated with the most effective treatments early on in their diagnosis were less likely to experience disability worsening. These disease-modifying therapies include highly effective antibodies that change the way in which an individual’s immune system behaves.

The findings were published in the prestigious journal the Lancet Child and Adolescent Health this week.

The research also confirmed that any treatment – including low-efficacy treatments – was better than no treatment

Dr Sharmin, who led the study, said because paediatric-onset MS was a rare disease – about four to eight per cent of MS patients are diagnosed before age 18 – it wasn’t as well investigated.

“This is the largest study of its kind for pediatric MS,” she said.

“We hope this may have some policy implications so children with MS can access the most effective therapies as early as possible.”

MS is a chronic condition that occurs when the immune system attacks the brain and spinal cord. There is currently no cure for the condition.

Source:

Journal reference:

Sharmin, S., et al. (2024) Disease-modifying therapies in managing disability worsening in paediatric-onset multiple sclerosis: a longitudinal analysis of global and national registries. The Lancet Child & Adolescent Health. doi.org/10.1016/S2352-4642(24)00047-6.

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March 26, 2024
Radiology study uncovers patterns of intimate partner violence across age groups

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Intimate partner violence (IPV) disproportionately impacts women and younger populations, with incidences peaking between adolescence and young adulthood. Alarmingly, a strong correlation exists between IPV experienced in adolescence and its persistence into adulthood.

Radiologists can play a key role in identifying physical signs of IPV, since specific fracture patterns detected in imaging have been shown to be predictive of abuse in children and adults. However, limited information is available about injury patterns in IPV-exposed adolescents and emerging adults despite their vulnerability. In a recent study, researchers from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, offer insights that will help healthcare providers detect IPV in these previously overlooked age groups.

The researchers conducted a retrospective data review of IPV patients in US Emergency Departments from 2005 to 2020, aiming to identify patterns related to IPV across three age groups: adolescents (<18 years), emerging adults (18-25 years), and adults (>25 years). Their findings revealed that, while overall IPV severity increased with age, adolescents exhibited a significantly higher incidence of sexual assault than emerging adults and adults. The proportion of female patients was highest among adolescents and decreased with age. Additionally, adolescent patients showed higher rates of lower trunk injuries, facial fractures, and fractures in the hands, fingers, and toes. Notably, they had a fourfold increased likelihood of cervical fractures compared to older age groups.

While IPV is a critical issue across all age groups, the developmental stage, social dynamics, and systemic structures surrounding adolescents provide unique opportunities for effective intervention. Efforts to address teen IPV can leverage these factors to promote lasting changes in behavior and relationships, potentially preventing the cycle of violence from continuing into adulthood.”

Bharti Khurana, MD, radiologist and founder and director of the Trauma Imaging Research and Innovation Center at the Brigham and Women’s Hospital

Source:

Brigham and Women’s Hospital

Journal reference:

Khurana, B., et al. (2024) Age-specific Patterns of Intimate Partner Violence Related Injuries in US Emergency Departments. Journal of Adolescent Health. doi.org/10.1016/j.jadohealth.2024.01.034.

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March 19, 2024
Parental touch can relieve acute procedural pain in neonates and parents’ anxiety

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The Neuroimaging Group, at the Department of Pediatrics, in collaboration with Bliss, the charity for babies born premature or sick, has launched a new suite of information resources for parents of neonates, designed to make them feel more confident about being involved in the care of their babies.

While evidence demonstrates that parents can play a positive role in comforting their baby during painful procedures, practice in the UK lags far behind. However new research by the Neuroimaging Group, published in the Lancet Child & Adolescent Health and Pain has brought further proof of the positive impact that being involved in their baby’s care has on parents.

The Parental touch trial (Petal) aimed to assess whether parental touch at a speed of approximately 3 cm/s to optimally activate C-tactile nerve fibres, provides effective pain relief during a heel-prick procedure. While there was no difference in the babies’ brain, behavioural or heart rate response to pain regardless of whether the parent touched their baby before or after the painful procedure, the findings did demonstrate that the majority of parents had positive emotions when involved in their child’s care – such as feeling useful and reassured – and an overall decrease in parental anxiety after their participation.

These new resources, a combination of beautifully curated and informative videos, FAQs and online information content, have been developed in light of the collaboration with parents and healthcare professionals. They are free to access online and set out in detail the many ways that parents can touch and comfort babies of all gestations during painful procedures on the neonatal unit, including skin-to-skin care.

Commenting on the research in an accompanying Lancet Child and Adolescent Health editorial, Ruth Guinsburg, said: “This study is an example of excellence in research. The trial was carefully designed with a clear question, strict inclusion and exclusion criteria, a well-designed and reproducible intervention based on biological plausibility, and defined outcomes, with the strength of using an objective rather than a subjective measure of pain. Only with trials like this might we transform faith in science and test the efficacy of traditional aspects of parental care in order to incorporate them, or not, in bundles to alleviate the pain in neonates.”

Dr. Rebeccah Slater, Professor of Pediatric Neuroscience and Senior Wellcome Fellow at the Neuroimaging Group, said: “Working with parents, babies and healthcare professionals to better understand how we can support premature and sick babies during painful procedures has been a highlight of my career.

“Developing these resources with Bliss has placed families at the heart of all the research we do, and has directly improved our engagement with families and the quality of our research. We will continue to find new ways to support parents and their babies when painful procedures form an essential component of neonatal care.”

The Petal trial has highlighted the importance of involving parents in the provision of care and comfort for relieving their child’s pain. Future studies can build upon the insights gained from this trial including the positive parental experiences observed in this study. Prospective research might, for example, exercise a more spontaneous approach to delivering the gentle touch, such as allowing parents to stroke their child at their own pace, for as long as they need to calm and comfort their child, rather than a more mechanical and precise application.”

Dr. Roshni Mansfield, a Pediatrics trainee and NIHR Academic Clinical Fellow in the Pediatric Neuroimaging Group

Dr. Maria Cobo, a postdoctoral researcher who managed the trial, added: “Another positive aspect of the study was the high degree of involvement by both fathers (35%) and mothers (65%) in delivering the parental touch to their babies. This contrasts with many studies, where only mothers’ opinions and involvement have been sought.”

Caroline Lee-Davey, Chief Executive of Bliss, said: “We are thrilled to have worked alongside the amazing team of researchers at the University of Oxford to further our understanding on the importance of parental involvement in their babies’ neonatal care. We know that babies have the best chance of survival and quality of life when their parents are empowered to be partners in their care but, sadly, we hear all too often that parents are not informed about their babies’ procedures or the role that they can have in comforting their baby. The outcomes of this research have directly shaped a new suite of Bliss information for parents and healthcare professionals which will help to validate what families often instinctively know to be true – that no matter how unexpected or strange the neonatal environment can feel, they are still their baby’s parent and they have a vital role to play in their comfort and care.”

Additional funding from the Wellcome Trust enabled Bliss to develop these valuable resources for families, including new information, video content filmed at John Radcliffe Hospital’s neonatal unit giving precious insight into neonatal care, as well as translated flyers for neonatal units and a webinar for healthcare professionals on how to support parents to be involved in their babies’ procedures. These resources were created in collaboration with parents and healthcare professionals, and included a listening event with the Raham Project, a CIC supporting ethnic minority families, where four mothers shared their neonatal stories.

Source:

Journal reference:

Hauck, A. G. V., et al. (2024). Effect of parental touch on relieving acute procedural pain in neonates and parental anxiety (Petal): a multicentre, randomised controlled trial in the UK. The Lancet Child & Adolescent Health. doi.org/10.1016/s2352-4642(23)00340-1.

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March 13, 2024
Early childhood appetite traits linked to adolescent eating disorders, study finds

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In a recent study published in The Lancet Child & Adolescent Health, researchers investigated the longitudinal relationships between appetitive qualities in early childhood and eating problem symptoms in adolescence.

Study: Early childhood appetitive traits and eating disorder symptoms in adolescence: a 10-year longitudinal follow-up study in the Netherlands and the UK. Image Credit: Oksana Kuzmina/Shutterstock.com

Background

Eating disorders and obesity are common mental health diseases across the world, and hunger is a neurobehavioral risk factor. Eating disorders are frequently associated with other mental problems and have a high death rate.

The lack of efficient preventative strategies warrants epidemiological research to uncover innovative risk factors and treatment options.

Eating disorders and BMI have similarities, such as food intake control and genetic overlap. The behavioral susceptibility theory may apply to eating disorders.

About the study

The present study investigated the association between childhood appetitive qualities and adolescent eating disorders.

The team analyzed the Gemini (Wales and England) and Generation R (Rotterdam) cohort data to measure appetitive traits using the Child Eating Behaviour Questionnaire (CEBQ) based on parent-reported data for four-to-five-year-olds and self-reported data for 12–14-year-olds.

They documented symptoms of overeating eating disorders (binge eating, uncontrolled eating, and emotional eating) and restrained eating disorders (compensatory behaviors and restrained eating).

The Generation R study included pregnant women with an expected delivery date between April 2002 and January 2006, resulting in 9,745 live-born children. The Gemini study cohort comprised 4,804 children (2,402 twin pairs).

The self-reported outcome measures included behavioral eating disorders (compensatory behaviors and binge eating symptoms) and disordered eating behaviors (restrained eating, uncontrolled eating, and emotional eating).

The team assessed compensatory behaviors in the past three months using the Developmental and Well-Being Assessment (DAWBA) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

They assessed restricted eating using the Dutch Eating Behavior Questionnaire (DEBQ) and emotional and uncontrolled eating using the Three Factor Eating Questionnaire (TFEQ).

The researchers used logistic regressions to determine odds ratios (OR), adjusting for sociodemographic covariates (age at outcome assessment, biological sex, gestational age, ethnicity, household income, maternal education, and maternal BMI) and the child’s age- and sex-adjusted body mass index (BMI) scores at ages four to five years.

They examined interaction effects for appetite by biological sex and obtained pooled ORs by meta-analysis, with sensitivity analyses performed using the inverse probability-type weighting method.

Results

The study included 2,801 Generation R participants and 869 Gemini study participants. Emotional overeating during early childhood elevated adolescent compensatory behavior odds (OR, 1.2).

Contrastingly, higher satiety responsiveness decreased adolescent uncontrolled eating odds (OR, 0.9) and compensatory behavior (OR, 0.9) odds.

Slow eating during early childhood reduced the likelihood of restrained eating and compensatory behavior (OR, 0.9 for both) in adolescence.

The study hypothesis was that higher responsiveness to food during early childhood enhanced overeating disorder risk in adolescence, with the highest risk being binge eating (ORpooled, 1.5 for every unit enhancement in response to food).

Contrary to the hypothesis, higher food responsiveness increased restrictive eating risk; in particular, food responsiveness increased moderate to high restricted eating risk (OR 1.2 for every unit increase).

Response to food and emotion-related overeating among young children increased adolescent comprehensive behavior risk (ORpooled, 1.2 for every unit increase). The cohort-specific analysis indicated that higher food enjoyment increased binge eating odds among Gemini (OR Gemini 1.6) but not among Generation R participants.

Emotional overeating during childhood elevated uncontrolled eating odds in adolescents among Gemini participants (ORGemini 1.5).

Contrary to the hypothesis, childhood food aversion traits did not elevate adolescent-restricted eating odds. Instead, slow eating reduced the chances of moderate to highly restrained eating symptoms (ORpooled, 0.9 for every unit increase).

Slow eating and high satiety responsiveness significantly lowered adolescent compensatory behavior odds (ORpooled of 0.9 and 0.9, respectively).

Among Generation R participants, the relationship between slow eating during early childhood and adolescent restrained eating showed lower odds among females.

Only male Gemini participants showed positive associations between emotional overeating during early childhood and emotional and binge eating in adolescence.

Conclusion

The study findings showed that early childhood food responsiveness increases adolescent eating disorder risk.

In contrast, slow eating and high satiety decrease the probability of eating disorders. Appetitive characteristics in children may be early neurobehavioral factors increasing eating disorder risk.

Parental feeding practices that help children establish proper eating habits include educating them to identify internal hunger and fullness, promoting slower eating, and avoiding food for reasons other than homoeostatic hunger.

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February 23, 2024
Nutrition labels lead to healthier eating in teens, study finds
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In a recent study published in Nutrients, researchers at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin explored how nutrition labels affect eating behaviors among middle-school and high-school students in Texas.

Study: Using the Nutrition Facts Label to Make Food Choices Is Associated with Healthier Eating among 8th and 11th-Grade Students: An Analysis of Statewide Representative Data from the 2019–2020 Texas School Physical Activity and Nutrition Survey. Image Credit. progressman/Shutterstock.com

Based on self-reported information, their results indicate that improving nutrition literacy and using food labels could significantly enhance the quality of diet for school-going adolescents.

Background

Nutrition labels can help people compare different food items and inform healthier decision-making. In recent years, the use of food labels has increased dramatically among American adults, with around 80% making purchase decisions based on label information. Using labels is related to better dietary quality and health outcomes.

Adolescent health is a policy priority since this period of life is critical for well-being in adulthood. Today, nearly one in four American adolescents are categorized as obese, but studies on nutrition label use among this group have shown contradictory results.

While one study found high levels of label use among adolescents, this did not translate to having a healthier diet. Another found far lower levels of label use. These conflicting results highlight a critical need for further research to understand how best to address and prevent adolescent obesity.

About the study

In this study, researchers used a cross-sectional design with data collected through the Survey of Physical Activity and Nutrition in Texas from 2019 to 2020. During the academic year, students in the eighth and eleventh grades filled out survey questionnaires and answered questions about demographic information, physical activity, nutrition, dental habits, and screen time.

Their weight and height were also assessed to calculate their body mass index (BMI). Students were also asked whether they used food labels to inform their food choices. They were asked to respond on a Likert scale with five points ranging from ‘Always’ to ‘Never.’ This was the primary predictor.

The students’ dietary behavior was assessed using questions on how frequently they reported consuming various food items the previous day. The list contained 13 healthy foods, such as brown rice, vegetables, whole fruit, and baked meat, and 13 unhealthy foods, such as flavored milk, fried meat, caffeinated beverages, and frozen desserts. To include weekday consumption, the food consumption surveys were administered from Tuesday to Friday.

This information informed the calculation of the healthy eating index (HEI) and the health foods index (HFI) from 0 to 100, where a higher score indicated a healthier diet. The study’s primary outcomes were the HEI, HFI, and unhealthy foods index (UFI). The data was analyzed using adjusted and weighted linear and logistic regression models.

Findings

The sample included 4,730 students, of whom 49% were female, more than half were Hispanic, and had an average age of 14.7 years old. Most students were not economically advantaged, and nearly 15% had limited English proficiency. About 60% reported that they never or rarely used food labels to make decisions about eating. Only 11% said they always relied on labels to make food choices.

The regression analyses showed that using food labels was significantly positively associated with HEI and HFI scores and negatively associated with UFI scores. The researchers observed a dose-response relationship where stronger associations were observed as the frequency of label use increased.

Individuals who consistently or almost always used the food labels were likelier to eat healthy foods such as nuts, brown bread, baked meat, fruit, and vegetables; they also reported consuming lower amounts of chips, soda, and candy.

Conclusions

The findings from this study clearly showed a dose-response relationship. The benefits of using food labels were greater for those who used them more frequently, and students who always used food labels had significantly healthier diets than other groups. However, only 11% of the students made use of food labels all the time, indicating that not many are utilizing this resource.

Despite these benefits, many adolescents may struggle to understand the complex nutritional information on the labels. Using this information to guide food-related decision-making requires comprehending and responding to information on which nutrients should be avoided or limited (sodium, added sugars, and saturated fats) and those that are healthy (e.g., minerals and dietary fibers).

The strengths of this study included its state-level representative design; however, the study was also observational, which did not allow for causal inference, and relied on self-reported data, which is subject to recall and social desirability biases.

Future studies can explore the mechanisms behind the associations observed, how to encourage food literacy and label use among the youth, and explore possible sex-based differences to address the specific needs of female and male students.
Journal reference:

Pfledderer C, Ranjit N, Perez A, et al. (2024). Using the nutrition facts label to make food choices is associated with healthier eating among 8^th and 11^th-grade students: an analysis of statewide representative data from the 2019-2020 Texas school physical activity and nutrition survey. Nutrients. doi: 10.3390/nu16020311. https://www.mdpi.com/2072-6643/16/2/311
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February 11, 2024