The Duration of the correction loss after removing cheneau brace in patients with adolescent idiopathic scoliosis

Objective

The aim of the study was to evaluate the loss of truncal rotation over 54 hours after removing Chêneau brace.

Life-threatening cardiac arrhythmia and sudden death during electronic gaming: An international case series and systematic review

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The dental health of Indo-Chinese and Australian-born adolescents

Since 1975, more than 100,000 Indo-Chinese refugees from Vietnam, Kampuchea, and Laos have been resettled in Australia. This dental survey was undertaken to compare the dental health of 104 Australian-born and 126 Indo-Chinese adolescents from a State high school within a high migrant area of Melbourne. The mean DMFT score for the Australian-born group was 3.37 teeth, compared with 6.05 for the Vietnamese group, and 3.10 for the Kampuchean-Laotian group. More restorations and extractions were required by the Vietnamese subjects compared with the Australian-born and Kampuchean-Laotian subjects. Almost all subjects had gingivitis, however the proportion of Indo-Chinese subjects with shallow and deep pockets was greater than that of the Australian-born subjects. The periodontal health of the Kampucheans and Laotians was the most severe of the Indo-Chinese groups. These findings indicate that the Indo-Chinese adolescent refugees represent a high risk group for dental problems within the Australian population.     

POLARIZATION OF DENTAL CARIES AMONG INDIVIDUALS AGED 15 TO 18 YEARS

Objective:

To evaluate the role of socioeconomic variables and self-perceived oral health in the polarization of caries among adolescents in Santa Bárbara D''Oeste, Brazil.

Material and Methods:

Cross-sectional study. Sampling was randomized and sample size was defined according to WHO criteria. Two hundred and seventy seven adolescents (15 to 18 year-old) were examined by five trained examiners that assessed DMFT index according to WHO criteria. Self-perceived oral health, access to dental services and socio-demographic variables were self-reported. Student''s t tests, chi-square tests, and multivariate logistic regression (with significant caries index (SiC) as the outcome), were performed.

Results:

Mean DMFT was 5.48 (±4.22) and the proportion of "caries free" subjects was 15.5%. Mean DMFT (9.71±2.85) and mean D (1.67±2.18) of SiC positive subjects were significantly higher than mean DMFT (2.88±2.17) and mean D (0.45±0.87) of SiC negative subjects (p<0.0001). Mean D of white (0.76±1.51) was significantly smaller than mean D of non-white subjects (1.32±2.01). The only variable independently associated with the "SiC positive" outcome was "report of toothache within six months prior to the study" [OR=1.83 (95%CI 1.08 to 3.12)], p<0.001.

Conclusion:

SiC was associated with "report of toothache" but not with sociodemographic variables in the studied population.     

An inactive lifestyle and low physical fitness are associated with functional somatic symptoms in adolescents. The TRAILS study

Objective

An inactive lifestyle has been associated with functional somatic symptoms (FSS), but findings are contradictory. Moreover, mediating factors in this relationship are unclear. We examined whether low physical activity was related to FSS in adolescents, and whether this association was mediated by low physical fitness.

Methods

This study was part of the Dutch longitudinal cohort study TRAILS, in which 1816 adolescents (mean age 16.3 years, SD 0.7) participated during the third (T3) and 1881 (mean age 19.1 years, SD 0.6) during the fourth (T4) assessment waves. Adolescents' exercise and sedentary behavior levels and the number of FSS were assessed by questionnaires at T3 and T4. Physical fitness (VO₂Max) was determined for 687 adolescents by a shuttle run test at T3. The association between physical activity and FSS was examined with bootstrapped linear regression analyses, adjusted for smoking and gender. In addition, bootstrapped mediation analyses were performed.

Results

A lack of exercise (b = 0.05, bootstrap 95%-CI: 0.01 to 0.09) and high sedentary behavior (b = 0.10, bootstrap 95%-CI: 0.06 to 0.14) at T3 were positively associated with FSS at T3. Since no longitudinal effects were found, shared associations were tested instead of mediation. The associations between a lack of exercise and FSS, and sedentary behavior and FSS were shared with physical fitness (b = 0.01, bootstrap 95%-CI: 0.010.02. and b = 0.03, bootstrap 95%-CI: 0.010.05).

Conclusion

An inactive lifestyle is associated with increased FSS in adolescents. Only part of this association is shared with low physical fitness.     

Emotional variability during mother–adolescent conflict interactions: Longitudinal links to adolescent disclosure and maternal control

The aim of this study was to examine relations of emotional variability during mother–adolescent conflict interactions in early adolescence with adolescent disclosure and maternal control in early and late adolescence. Data were used from 92 mother–adolescent dyads (M age T1 = 13.05; 65.20% boys) that were videotaped at T1 while discussing a conflict. Emotional variability was derived from these conflict interactions. Mothers also completed questionnaires at the start of the study (T1) and five years later (T6) on adolescent disclosure and maternal control. Path analysis showed that more emotional variability during conflict interactions in early adolescence was associated with higher levels of adolescent disclosure in early adolescence and with relative decreases in maternal control from early to late adolescence. More emotional variability of mother–adolescent dyads serves an important function in adaptively dealing with relational challenges that arise during adolescence.     

Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure

Background contextAdolescent idiopathic scoliosis (AIS) patients treated before the 1990s have a 1% to 2% increased lifetime risk of developing breast and thyroid cancer as a result of ionizing radiation from plain radiographs. Although present plain radiographic techniques have been able to reduce some of the radiation exposure, modern treatment algorithms for scoliosis often include computed tomography (CT) and intraoperative fluoroscopy. The exact magnitude of exposure to ionizing radiation in adolescents during modern scoliosis treatment is therefore unclear.PurposeTo determine the difference in radiation exposures in patients undergoing various forms of treatment for AIS.Study designRetrospective cohort.Patient samplePatients aged 9 to 18 years with a diagnosis of AIS, followed and/or treated with nonoperative or operative management for a minimum of 2 years.Outcome measuresNumber of radiographs and total radiation exposure calculated.MethodsThe charts and radiographs of patients managed for AIS at a single institution between September 2007 and January 2012 were reviewed. Patients were divided into three groups: operative group, braced group, and observation group. Patient demographics, Cobb angles, and curve types were recorded. The number of radiographs per year that each patient received and the total radiation dose were recorded. The plain radiographic radiation exposure was then combined with the direct exposure recording from ancillary tests, such as fluoroscopy and CT, and a radiation exposure rate was calculated (mrad/y). A single-factor analysis of variance (α=0.01) with a Tukey honest significant difference post hoc analysis was used to test significance between groups.ResultsTwo hundred sixty-seven patients were evaluated: 86 operative, 80 brace, and 101 observation. All groups had similar demographics and curve type distribution. The mean initial Cobb angle at presentation was significantly different between the groups: operative (57°±11°), brace (24°±7.9°), and observation (18°±9.4°) (p<.01). There was a significant difference among the groups in terms of the mean number of radiographs received per year; operative group, 12.2 (95% confidence interval [CI]: 10.8–13.5; p<.001); braced group, 5.7 (95% CI: 5.2–6.2; p<.001), and observed group, 3.5 (95% CI: 3.160–3.864; p<.001). The operative group received 1,400 mrad per year (95% CI: 1,350–1,844; p<.001), braced group received 700 mrad per year (95% CI: 598–716; p<.001), and observed group received 400 mrad per year (95% CI: 363–444; p<.001). Importantly, 78% of radiation in the operative group was attributable to the operative fluoroscopy exposure.ConclusionsSignificant differences exist in the total radiation exposure in scoliosis patients with different treatment regimens, with operative patients receiving approximately 8 to 14 times more radiation than braced patients or those undergoing observation alone, respectively. Operative patients also receive more than twice the radiation per year than braced or observed patients. Almost 78% of the annual radiation exposure for operative patients occurs intraoperatively. Because children are notably more sensitive to the carcinogenic effects of ionizing radiation, judicious use of present imaging methods and a search for newer imaging methods with limited ionizing radiation should be undertaken.     

Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire

Temporomandibular disorders (TMD) screeners assume significant item overlap with the screening questionnaire proposed by the American Academy of Orofacial Pain (AAOP).

Objective

To test the reliability and validity of the Portuguese version of AAOP questions for TMD screening among adolescents.

Material and Methods

Diagnoses from Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I were used as reference standard. Reliability was evaluated by internal consistency (KR-20) and inter-item correlation. Validity was tested by sensitivity, specificity, predictive values, accuracy and receiver operating characteristic (ROC) curves, the relationship between the true-positive rate (sensitivity) and the false-positive rate (specificity). Test-retest reliability of AAOP questions and intra-examiner reproducibility of RDC/TMD Axis I were tested with kappa statistics.

Results

The sample consisted of 1307 Brazilian adolescents (56.8% girls; n=742), with mean age of 12.72 years (12.69 F/12.75 M). According to RDC/TMD, 397 [30.4% (32.7% F/27.3% M)] of adolescents presented TMD, of which 330 [25.2% (27.6% F/22.2% M)] were painful TMD. Because of low consistency, items #8 and #10 of the AAOP questionnaire were excluded. Remaining items (of the long questionnaire version) showed good consistency and validity for three positive responses or more. After logistic regression, items #4, #6, #7 and #9 also showed satisfactory consistency and validity for two or more positive responses (short questionnaire version). Both versions demonstrated excellent specificity (about 90%), but higher sensitivity for detecting painful TMD (78.2%). Better reproducibility was obtained for the short version (k=0.840).

Conclusions

The Portuguese version of AAOP questions showed both good reliability and validity for the screening of TMD among adolescents, especially painful TMD, according to RDC/TMD.     

ASMBS pediatric metabolic and bariatric surgery guidelines, 2018

The American Society for Metabolic and Bariatric Surgery Pediatric Committee updated their evidence-based guidelines published in 2012, performing a comprehensive literature search (2009–2017) with 1387 articles and other supporting evidence through February 2018. The significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents since 2012 strengthens these guidelines from prior reports. Obesity is recognized as a disease; treatment of severe obesity requires a life-long multidisciplinary approach with combinations of lifestyle changes, nutrition, medications, and MBS. We recommend using modern definitions of severe obesity in children with the Centers for Disease Control and Prevention age- and sex-matched growth charts defining class II obesity as 120% of the 95th percentile and class III obesity as 140% of the 95th percentile. Adolescents with class II obesity and a co-morbidity (listed in the guidelines), or with class III obesity should be considered for MBS. Adolescents with cognitive disabilities, a history of mental illness or eating disorders that are treated, immature bone growth, or low Tanner stage should not be denied treatment. MBS is safe and effective in adolescents; given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities, such as depressed health-related quality of life score, type 2 diabetes, obstructive sleep apnea, and nonalcoholic steatohepatitis exist. Early intervention can reduce the risk of persistent obesity as well as end organ damage from long standing co-morbidities.