The Association Between Patterns of Trauma Exposure, Family Dysfunction, and Psychopathology Among Adolescent Females With Depressive Symptoms From Low-Income Contexts

Distinguishing profiles of trauma exposure among low-income adolescent females with depressive symptoms is important for understanding comorbidity, family relationships, and treatment. Specifically, child maltreatment is essential to examine in comparison to other traumas. Participants included 170 adolescent females (65.3% Black; 21.2% White; 13.5% other race; 14.1% Latina/x) with depressive symptoms and their primary caregiver from low-income families. Latent class analysis (LCA) identified three trauma classes. Probabilities of endorsing different subtypes of maltreatment (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse), number of subtypes of maltreatment, and non-maltreatment traumas (accident, experiencing or witnessing physical assault, death or injury of loved one, medical trauma) varied among groups. Higher levels of family dysfunction and traumatic stress symptoms were reported in both classes with maltreatment exposure as compared to the class with only non-maltreatment trauma exposure. Findings have implications for family-focused interventions for maltreated adolescent females with depressive symptoms from low-income contexts.

Does substance use play a role in gender differences in residential independence and returns to the parental home?

Young adults are co-residing with their parents at higher rates now than in the past, and recent research has explored the correlates of both leaving and subsequently returning to the parental home. Of relevance here, females tend to leave home earlier than their male counterparts, and research finds that drinking and drug use are also linked to residential transitions. This research note explores if substance use during adolescence and young adulthood plays a role in gender differences in home-leaving and home-returning. We find that marijuana use plays a role in both home-leaving and home-returning, with adolescent females who use marijuana the most at risk for early exits from home, and marijuana using males the most at risk for home-returning.

Rapunzel Syndrome – A Case Report: Trichobezoar as a Cause of Gastric Outlet Obstruction and Intestinal Perforation

Rapunzel syndrome is described as a rare manifestation of gastric trichobezoar extending throughout the bowel and is associated with psychiatric disorders. Its incidence in Pakistan is very rare and is found characteristically in adolescent females. Large or complicated trichobezoars are best managed by surgery. Psychiatric follow-up is essential to diminish the frequency of recurrence. We report an unusual case of Rapunzel syndrome causing gastric outlet obstruction and intestinal perforation.

Age and Sex-Specific Joint Biomechanics in Response to Partial and Complete ACL Injury in the Porcine Model

Context: Pediatric anterior cruciate ligament (ACL) injury rates are increasing and are highest in adolescent females. Complete ACL tears are typically surgically reconstructed, but there are few guidelines and very limited data regarding the need for surgical reconstruction or rehabilitation for partial ACL tears in skeletally immature patients. Objective: To evaluate the impact of partial (anteromedial bundle) and complete ACL transection on joint laxity and tissue forces under anterior and rotational loads in male and female stifle joints throughout skeletal growth in the porcine model. Design: Descriptive Laboratory Study. Setting: Laboratory. Patients or Other Participants: Sixty male and female Yorkshire cross-breed pigs aged 1.5, 3, 4.5, 6, and 18 months (n=6/age/sex). Main Outcome Measure(s): Joint laxity was measured in intact, anteromedial bundle-transected, and ACL-transected joints under applied anterior-posterior drawer and varus-valgus torque using a robotic testing system. The loading of the soft tissues in the stifle joint was measured under each condition. Results: Anterior-posterior joint laxity increased by 13–50% (p<0.05) after anteromedial bundle transection and 75–178% (p<0.05) after ACL transection. Destabilizations after anteromedial bundle transection increased with age (p<0.05) and were greater in late adolescent females than late adolescent males (p<0.05). In anteromedial bundle-transected joints, the posterolateral bundle resisted the anterior load. In ACL-transected joints, the medial collateral ligament (MCL) contribution was largest, followed by the medial meniscus. MCL contribution was larger while medial meniscus contribution was smaller in males versus females. Conclusions: Partial ACL transection resulted in moderate increases in joint laxity, while the remaining bundle performed the primary ACL function. Destabilizations due to partial ACL transection were largest in late adolescent joints, indicating that operative treatment should be considered in active, late adolescent patients. Increased forces in the MCL and medial meniscus after ACL transection suggest that rehabilitation protocols may need to focus on protecting these tissues.

Prevalence of anemia and its correlates among adolescent girls in rural area of Dakshina Kannada District, Karnataka

Background: In India, the population in the age of 10-19 years is currently estimated at 253.2 million, the largest ever cohort of young people to make a transition to adulthood. Nutritional anemia is one of most common micronutrient deficiencies in the world. It is most common in pregnant and lactating women, infants, preschool children and adolescent females. Iron deficiency anemia is a problem of serious public health significance. Present study was undertaken to assess the baseline data of prevalence of anemia and its associated factors among adolescent females belonging to rural community in Dakshina Kannada.Methods: A cross sectional study was done among the adolescent female population in rural field practice area of Dakshina Kannada district from July 2012 to June 2013. A pretested semi-structured questionnaire was used to collect data regarding socio demographic profile, health status and nutrition. Haemoglobin estimation was done by Sahli’s method. Statistical analysis was performed using SPSS software trial version 16.Results: The study comprised of 436 study participants, out of which majority (25.5%) were aged 14 years. The mean age was 14.02±2.57 years. The prevalence of anemia among adolescent girls was 72%. Moderate anemia, mild anemia and severe anemia was 68.5%, 28.3% and 3.2% respectively. Pallor was present among 69.72% of adolescent girls.Conclusions: This study showed high prevalence of anemia among adolescent girls and the major associated factors age, diet, menarche attained and presence of pallor. Hence, there is a need to address the anemia problem of the adolescent population.

Export-Driven, Extensive Coastal Aquaculture Can Benefit Nutritionally Vulnerable People

Export-orientated shrimp and prawn farming in coastal ghers has been associated with negative environmental, social, and nutritional impacts. This study challenges these perceptions based on field observations from four communities in South West Bangladesh. Most households observed (>60%) were either directly involved in seafood farming or engaged elsewhere in the seafood value chain. Our study set out to establish how the type and location of aquaculture impacted on access to and consumption of aquatic animals. Additionally, we assessed the effects of both household socioeconomic status and intra-household food allocation on individual diet and nutritional outcomes. We used a blended approach, including a 24-h consumption recall on two occasions, analysis of the proximate composition of aquatic animals and biomarkers from whole blood from a sample of the target population. The diverse polyculture systems generated broad social benefits, where “export-oriented” production actually supplied more food locally than to global markets. Key findings: (1) worse-off households achieved higher productivity of farmed aquatic animals on smaller landholding than better-off households with larger landholdings; (2) vegetable production on gher dikes was a significant source of nutrition and income in lower saline gradients; (3) more fish was eaten in lower saline gradients although fish consumption was highly variable within and between households; (4) intra-household allocation of specific foods within diets were similar across communities; (5) recommended nutrient intakes of protein and zinc exceeded daily requirements for adolescent females, but energy, calcium, and iron were below recommended intake levels; (6) n-3 LC-PUFA, expressed as percentage of total fatty acids, in whole blood samples of adolescent females declined with ambient salinity level regardless of household socioeconomic status; (7) analysis of aquatic animals consumed found that mangrove species and tilapia harvested from higher saline ghers contained high levels of desirable PUFAs. These findings suggest that export-driven, extensive coastal aquaculture can be nutrition sensitive when co-products are retained for local consumption.

Case series: Psychosocial challenges of female youth within the Irish Travelling community

Background: The Irish Travelling community are an ethnic minority group known for their distinct identity, traditions and language. Although this group has its roots in Ireland, they are marginalised and discriminated against by every part of Irish society. Irish Travellers are a group who are vulnerable to exclusion and experience health, economic and educational inequalities. Young female Irish Travellers in Ireland are highly susceptible to mental illnesses which makes the engagement of this ethnic group by healthcare services important. Aims: To review the cases of three female adolescents from the Irish Travelling community living in Ireland with a focus on their psycho-social difficulties. Complete a literature review, to complement and inform the three cases reviewed, on the socio-cultural and mental health challenges which effect adolescent females in the Irish Travelling community. Methods: Case series with literature search and review of relevant published articles using a keyword search of databases PubMed, PsycINFO and HSE protocols and reports. Hand searching of relevant references utilised. Informed signed consent obtained from each patient attending child and adolescent services in Ireland. Signed parental consent also obtained. Written consent obtained due to the use of patient history and assessments in the case series. Results: Adolescent females within the Irish Travelling community encounter particular difficulties within the moral constraints and expectations of this community. They encounter specific issues including mental illness, sexual stigma, domestic violence and limitations to the role of women. The three cases outlined give representative examples of the challenges faced by adolescent females within the Travelling community. Conclusions: Psychiatric services need to be aware of this vulnerable group and focus on the recognition of their needs within the context of their community.

Respiratory, Hepatic, Renal and Hematological Disorders Among Adolescent Females Environmentally Exposed To Pesticides, Menoufia Governorate, Egypt

Adolescent females are often environmentally exposed to pesticides by living near agricultural fields, by using pesticides at home, or by having contact with contaminated clothes and pesticide application work tools. This study assessed respiratory, hepatic, renal and hematological health disorders that might arise due to environmental exposure to pesticides among adolescent females. A cross-sectional study was conducted with 100 adolescent females environmentally exposed to pesticides who had one or more of their family members working as seasonal pesticides' applicators and 50 non- exposed (control) adolescent females from Menoufia governorate, Egypt. The studied period of pesticide application season of cotton crop was from May 1st to the end of September 2017. Participants completed a self-administered questionnaire about pesticide exposure and respiratory, hepatic, renal and hematological disorders. In addition, serum acetyl cholinesterase (AChE), spirometry, complete blood count, liver and kidney functions' tests were measured pre and post pesticide application season. The control adolescent females had a higher AChE activity, a lower prevalence of respiratory symptoms and higher means of spirometric measurements than the exposed group. During the pre and postseason, the exposed group presented a prevalence of (6%, 24%) for cough, (4%, 11%) for rhinitis, and (6%, 26%) for dyspnea during the pre and postseason; respectively. In addition, there was a decrease in means of spirometric measurements (FEV1%, FEV1/FVC%, FEF 25-75% and PEF%) in post season compared to preseason among the exposed group. Also, there were significant associations between (AChE) activity and both the prevalence of respiratory manifestations and spirometric measurements among the exposed females. On the other hand, there were significantly increased red blood corpuscles (RBCs) and lymphocytes counts, and a significantly lower mean hemoglobin level among the exposed group (post season) than each of their pre-season values and the control group (P<0.05). AChE level, total protein, albumin and albumin/globulin (A/G) ratio levels were significantly lower, while SGPT, SGOT, and globulin, blood urea and serum creatinine mean levels were significantly higher among the exposed group (post season) than either of their pre-season or the control group (P<0.05). There was a positive correlation between AChE level and all studied CBC parameters for the exposed group reaching a significant level with basophils (P<0.05). Also, there was a negative correlation between AChE level and each of SGPT, SGOT, ALP, globulin, blood urea and serum creatinine for the exposed group reaching a significant level with each of SGPT and SGOT (P<0.05). At the same time, a non-significant positive correlation was found between AChE level and each of total protein, albumin and A/G ratio (P>0.05). So, environmental exposure to organophosphorus pesticides has a detrimental impact on respiratory, hepatic, renal and hematological systems of adolescent females living in rural districts at Menoufia governorate. Educational and training intervention programs on pesticide handling and safety precautions are recommended for protecting both pesticides' workers and their family members who might be exposed.

The Association between Heavy Menstrual Bleeding and Depressive Symptoms in Adolescents

Introduction: Heavy menstrual bleeding (HMB) is a type of abnormal uterine bleeding (AUB) that affects 30% of women of reproductive age and up to 40% of adolescents. Furthermore, 10-40% of adolescents with HMB have an underlying inherited bleeding disorder like von Willebrand disease or platelet dysfunction, requiring management by pediatric hematologists. HMB has been described as more than 80 ml of blood loss during one cycle and clinically, it is defined by several parameters such as the length of each cycle, severity of soaking through pads or tampons, size of clots passed and pictorial blood loss assessment chart (PBAC) score. Studies in adult women show a significant impact of HMB on their psychosocial and financial health. However, little is known about the psychological effects of HMB in adolescent females. In the adolescent population, depression is twice as common in females as it is in males, likely due to a combination of biological and social differences. In this study, we examine the association between heavy menstrual bleeding and depressive symptoms in adolescent girls. Methods: We conducted a retrospective records review of adolescent females aged 10-21 years that were seen as new patients at the Adolescent Medicine and Young Women's Bleeding Disorders clinics at our institution between January 1, 2018 and March 31, 2020. Patients were included in the study if they had started menses, and had a doumented menstrual history as well as a completed Patient Health Questionnaire (PHQ-9), a validated screening tool for depression.Patients with a severe underlying chronic medical disorder (Including but not limited to end stage renal disease, Juvenile Rheumatoid Arthritis, Systemic Lupus Erythematosis, severe eating disorder, previously diagnosed bipolar disorder or psychotic disorders) were excluded. HMB was determined by either a PBAC score of &gt;100 or the presence of two or more of the following criteria: Menses lasting &gt;7days Soaking through pad or tampon &lt;1hr Soaking through bed clothes or changing pads at night Passing large clots Low ferritin &lt; 15ng/ml (indicative of low iron stores) Anemia with Hemoglobin &lt; 12g/dl not due to any other cause (e.g. dietary, immunosuppression, medication induced) Depression was determined by a PHQ-9 score of 9 or greater. The two variables were dichotomized, and a chi-square test of independence was performed to test the association with a significance level of p &lt; 0.05. Results: A total of 203 records were reviewed after meeting inclusion and exclusion criteria. The mean age was 15.94 years (median 16, mode 16) with a range of 12-20years. 42 girls (20.7%) had a PHQ-9 score of &gt;9 and 52 (25.6%) had HMB. Eighteen of the 42 patients (42.8%) with elevated PHQ-9 score had HMB and 34/52 patients (65.3%) with HMB had an elevated PHQ-9 score. Pearson's chi-square test of independence showed a significant relation between HMB and PHQ-9 score of 9 or more with χ 2 (1, n=203) = 8.2618, p = 0.004. After the application of Yates correction, the result was still significant with χ 2 = 7.1603 and p = 0.007. Discussion and Conclusions: This study shows a significant association in the adolescent population between heavy menstrual bleeding and moderate or severe depression as defined by the presence of a PHQ-9 score of 9 or more. This retrospective analysis does not establish causation, but demonstrates a clinically noteworthy finding that has not been described before. The PHQ-9 is used widely across this population to screen for depression, but it is also important to screen young women aged 10-21years for HMB as a contributing factor to depression followed by timely and appropriate management of both problems. Additionally, it may be worthwhile to evaluate all young women with HMB through additional methods to diagnose depression as this patient population appears to be at higher risk. Future prospective studies are needed to better characterize this association. Disclosures No relevant conflicts of interest to declare.

An Exploratory Cohort Study of the Association between the Level of Testosterone and Suicidal Ideation in Hospitalized Adolescent Females with Depression in China

Background. To date, around 4 per 100,000 adolescents committed suicide within the 29 OECD countries. The suicidal behavior is related to psychological factors, genetics, neurobiology, and other biomarkers. The aim of this study was to examine risk factors for the development of suicidal ideation in adolescent females with depression, focusing on the relationship between different testosterone levels and suicidal ideation, in order to help develop strategies to intervene in suicidal behavior in female adolescents with depression. Method. In this single-center prospective cohort study, we enrolled adolescent females with depression. We collected information on their baseline data, testosterone levels, symptom self-rating scale scores, suicidal ideation, non-suicidal self-injurious (NSSI) behaviours, and suicide attempts. We used multivariate logistic regression to identify risk factors for the development of suicidal ideation in adolescent females with depression. Results. A total of 113 hospitalized adolescent females were enrolled with a mean age of 13.5 (1.20). Among these patients, there were 86 (76.11%) subjects who suffered from suicidal ideation, 59 (52.21%) had NSSI and 23 (20.35%) had suicide attempt behavior. In the final model, higher level of testosterone ( p = 0.04 ) and higher age ( p = 0.02 ) were associated with the higher odds of having suicidal ideation. Conclusion. In this exploratory cohort study, the emergence of suicidal ideation was common among adolescent females with depression. This study is consistent with the other studies. It shows that the age is a potential predictor for suicidal ideation in hospitalized adolescent females with depression.