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BACKGROUND: Alcohol use disorder (AUD) most often onsets in young adulthood (YAO), but prospective studies are needed to determine whether an onset in adolescence (AO) confers a more severe trajectory of psychiatric problems (e.g., depression, antisocial behavior, and other substance use) alongside AUD in men and women.METHODS: Using a prospective approach, we compared the trajectories of psychiatric problems for men and women with an AO, a YAO, and no history of AUD from ages 17 to 29 years old. RESULTS: Both gender and AUD onset moderated linear and non-linear changes in problems from adolescence to adulthood. AO conferred the poorest adolescent and young adult adjustment relative to the same-gender control and YAO groups. Critically, onset groups were more distinct among men (i.e., AO > YAO > no AUD) than women (i.e., AO = YAO > no AUD).CONCLUSIONS: Adolescent onset of alcohol problems portends severe, broad spread problems for both men and women into adulthood. Critically, adolescent onset yields the worst psychiatric problems among men (vs. YAO) while women experience severe, persistent problems across domains irrespective of onset timing. For both genders, mitigating the long-term, cascade of problems that accompany AUD will require special attention to heterogeneity in the timing of its onset and acceleration of psychiatric problems thereafter.

Sjögren’s syndrome (SS) is very rare in teenagers and there are only anecdotal reports world-wide of its occurrence in prepubertal children. Paediatric cohort studies have demonstrated that approximately half of patients with Sjögren’s syndrome (SS) have primary disease. As with adults, secondary SS is most commonly associated with systemic lupus erythematosus, although cases have also been reported in patients with juvenile idiopathic arthritis, mixed connective tissue disease, and other autoimmune conditions. The condition is almost certainly underdiagnosed. Children and young adults rarely complain of dryness and usually present with parotid gland swelling and systemic disease. Clinical manifestations, diagnosis, and management are all discussed in this chapter.

Purpose This study aimed to evaluate the current status of reproductive disorders as long‐term complications in adolescent and young adult (AYA) cancer patients by comparing survivors of childhood‐onset with those of AYA‐onset cancer in Japan. Methods We conducted a national survey of AYA cancer survivors and healthy AYAs and analyzed the results from survivors who underwent chemotherapy and reported fertility problems as their current concern. Results Among all of the childhood‐onset survivors, 27 (35.5%; nine males [28.1%] and 18 females [40.9%]) listed reproduction fertility problems as their current concern. Among all AYA‐onset survivors, 25 (69.5%; 1/4 males [25.0%] and 24/32 females [75.0%]) listed these problems as a current concern. In contrast, 96.3% (26/27) of all childhood‐onset cancer survivors and 68.0% (17/25) of all AYA‐onset cancer survivors who received chemotherapy listed these problems as a current concern. Conclusions A considerable number of both childhood‐onset and AYA‐onset cancer survivors, and especially those who had undergone chemotherapy, reported reproductive dysfunction as a delayed complication. It is vitally important to establish a supportive care system both for the patients whose fertility was abolished after the completion of cancer treatment and prophylactically for patients before they begin treatment.

Purpose: Colorectal cancer (CRC) incidence is increasing in adults younger than 50 years. This study evaluated clinicopathological characteristics and outcome of adolescent and young adult (AYA)-on...

Alzheimer's and Parkinson's diseases (AD, PD) have a pediatric and young adult onset in Metropolitan Mexico City (MMC). The SARS-CoV-2 neurotropic RNA virus is triggering neurological complications and deep concern regarding acceleration of neuroinflammatory and neurodegenerative processes already in progress. This review, based on our MMC experience, will discuss two major issues: 1) why residents chronically exposed to air pollution are likely to be more susceptible to SARS-CoV-2 systemic and brain effects and 2) why young people with AD and PD already in progress will accelerate neurodegenerative processes. Secondary mental consequences of social distancing and isolation, fear, financial insecurity, violence, poor health support, and lack of understanding of the complex crisis are expected in MMC residents infected or free of SARS-CoV-2. MMC residents with pre-SARS-CoV-2 accumulation of misfolded proteins diagnostic of AD and PD and metal-rich, magnetic nanoparticles damaging key neural organelles are an ideal host for neurotropic SARS-CoV-2 RNA virus invading the body through the same portals damaged by nanoparticles: nasal olfactory epithelium, the gastrointestinal tract, and the alveolar-capillary portal. We urgently need MMC multicenter retrospective-prospective neurological and psychiatric population follow-up and intervention strategies in place in case of acceleration of neurodegenerative processes, increased risk of suicide, and mental disease worsening. Identification of vulnerable populations and continuous effort to lower air pollution ought to be critical steps. © 2021 The authors and IOS Press. All rights reserved.

10604 Background: Adolescent and young adult (AYA) cancer survivors are at increased risk of subsequent primary cancer (SPC); however, a comprehensive examination of risk patterns across cancer types is lacking in the U.S. Methods: SPC incidence and mortality was calculated among >1-year cancer survivors aged 15 to 39 years at first primary cancer (FPC) diagnosis during 1992-2016 in 12 Surveillance, Epidemiology, and End Results registries. Rates were expressed as number of cases/deaths per 10,000 person-years and compared with those expected in the general population using standardized incidence (SIR) and standardized mortality ratios (SMR). Results: Among 202,440 survivors of AYA-onset cancers (mean age at FPC diagnosis, 31.8 years; 60.7% women), 6,675 SPC cases (34.3 per 10,000) and 3,786 SPC deaths (19.4 per 10,000) occurred during 1,955,119 person-years of follow-up (mean, 9.7 years), corresponding to an SIR of 1.58 (95%CI = 1.54-1.62) and SMR of 4.19 (95%CI = 4.06-4.33. In men, overall incidence and mortality SPC rates were statistically significantly higher for each of 21 FPC types compared with risks in the general population, except for thyroid cancer mortality. In women, risk was statistically significantly higher for 14/23 FPC types for incidence and 19/23 FPC types for mortality. SIRs were highest in survivors of pancreatic cancer (SIR = 5.68, 95% CI = 2.94-9.93; 84 per 10,000), Kaposi sarcoma (SIR = 5.15, 95%CI = 4.62-5.73; 116 per 10,000) and liver cancer (SIR = 4.97, 95%CI = 2.57-8.68; 68.4 per 10,000) in men, and acute lymphoid leukemia (SIR, 3.27, 95% CI = 2.22-4.64; 49.5 per 10,000), Hodgkin lymphoma (SIR = 2.47, 95% CI = 2.22-2.73; 51.6 per 10,000), and bone sarcoma (SIR = 2.41, 95%CI = 1.80-3.16; 47.6 per 10,000) in women. SMRs were highest in survivors of pancreatic cancer, acute lymphoid leukemia, and stomach cancer in men, and liver cancer, acute lymphoid leukemia, and soft tissue sarcoma in women. Conclusions: Overall and type-specific risk patterns of SPCs among AYA cancer survivors differ considerably across FPC type, highlighting the need for targeted approaches for cancer prevention and surveillance in survivorship care planning.

Objective Hypopituitarism diagnosed in childhood, adolescence and young adulthood has the potential to affect growth and somatic development. Less is known about the impact of such a diagnosis on other aspects of development. Design An analysis of the KIMS Database (Pfizer International Metabolic Database) was performed to explore social, educational and vocational outcomes of adult patients diagnosed in childhood, adolescence and young adulthood compared with adult-onset controls. Patients 2952 adult patients diagnosed with hypothalamic pituitary conditions before the age of 25 were divided into 2 group: childhood-onset [

The paucity of studies that examine women’s criminal careers, particularly beyond the period of young adulthood, has made it difficult for scholars to determine whether developmental pathways—especially precursors of adult-onset offending—vary. This paper examines the onset of offending among women, from childhood to adulthood. We draw from a retrospective life event calendar administered to women prisoners across three data collection sites. Sorting the women into different onset groups based on self-reports of first time offending, we ask whether there are unique predictors of early, adolescent, and adult-onset status and whether our results are sensitive to the age at which adulthood is measured (18–20 versus 21 and older). In contrast with some criminal career research, this study reveals a sizeable percentage of female offenders who initiate offending in adulthood (43 %). Compared with adult onset, early initiation is associated with childhood sexual abuse, sexual precocity, and low supervision and lack of childhood bonds. Adolescent onset is also associated with some of these same characteristics (compared to adult initiation), but a lack of childhood bonds is unassociated with young adult onset compared to adult initiation. Adult offenders are differentiated by the absence of these risks. Post-offending, young adult starters tend to have, on average, a more extensive criminal history and association with criminal friends, somewhat higher drug involvement (use and drug dealing), and more offense variety than do offenders who initiate after age 21. Early initiation, and to some extent adolescent onset, tends to reveal more post-offending disadvantages especially when compared with adults. Our findings suggest distinct groups among the adult offenders—one consistent with Thornberry and Krohn’s idea of “late bloomers” and another older initiator group for whom the mechanisms of onset remain unidentified.

In the UK, through the use of a forced economic model, endocrinologists are in the curious position of offering GH replacement to some patients with severe GH deficiency (GHD) but withholding it from other patients with even more severe GHD. This approach is counter-intuitive to endocrine practice in treating endocrine deficiency states. For all other endocrine deficiencies, one would opt for treating those with the most severe biochemical evidence of deficiency first. If this endocrine approach was applied to adult GH replacement in an era of rationing, one would start with the GHD patients with a pathologically low IGF1 level. Given that the prevalence of subnormal IGF1 levels in a GHD population is age-dependent, this would result in GH replacement being offered to more young adult onset (AO) GHD and childhood onset GHD adults, and less often to middle-aged and elderly AO GHD adults. This in itself has the added advantage that the skeletal benefits appear more real in the former cohort of patients.

Introduction: Sporadic late-onset nemaline myopathy (SLONM) is a rare intractable acquired myopathy characterized by progressive muscle weakness and atrophy, usually with middle to late adult onset. Autologous peripheral blood stem cell transplantation (auto-PBSCT) has been reported to be a promising treatment for SLONM. Methods: In this study we performed clinical characterization, muscle histopathological analysis, and muscle power monitoring after auto-PBSCT in a 27-year-old HIV-negative man with monoclonal gammopathy. Results: He showed improved muscle strength after treatment with high-dose melphalan and auto-PBSCT. Conclusions: Considering the recent reports of successful treatment of SLONM, early and correct diagnosis of this condition in association with monoclonal gammopathy is important. SLONM should be added to the list of diseases to consider in the differential diagnosis of progressive muscle weakness with young adult onset. Muscle Nerve 51:772–774, 2015

BackgroundPrevious research reported that childhood adversity predicts juvenile- onset but not adult-onset depression, but studies confounded potentially genuine differences in adversity with differences in the recency with which adversity was experienced. The current study paper took into account the recency of risk when testing for differences among child-, adolescent- and young adult-onset depressions.MethodUp to nine waves of data were used per subject from two cohorts of the Great Smoky Mountains Study (GSMS; n=1004), covering children in the community aged 9–16, 19 and 21 years. Youth and one of their parents were interviewed using the Child and Adolescent Psychiatric Assessment (CAPA) between ages 9 and 16; these same youth were interviewed using the Young Adult Psychiatric Assessment (YAPA) at ages 19 and 21. The most common psychosocial risk factors for depression were assessed: poverty, life events, parental psychopathology, maltreatment, and family dysfunction.ResultsConsistent with previous research, most childhood psychosocial risk factors were more strongly associated with child-onset than with adolescent-/adult-onset depression. When potentially genuine risk differences among the depression-onset groups were disentangled from differences due to the recency of risk, child- and young adult-onset depression were no longer different from one another. Adolescent-onset depression was associated with few psychosocial risk factors.ConclusionsThere were no differences in putative risk factors between child- and young adult-onset depression when the recency of risk was taken into account. Adolescent-onset depression was associated with few psychosocial risk factors. It is possible that some adolescent-onset depression cases differ in terms of risk from child- and young adult-onset depression.

Background Childhood exposures in mothers, signaled by number of older and younger siblings, have lifelong consequences for aspects of immune function. We hypothesized that these may influence young adult-onset Hodgkin’s lymphoma (HL) risk in offspring. Materials and methods Swedish registers identified 2028 cases of young adult onset HL (diagnosed between ages 15–39 years) up to 2012 among those born since 1958; and 18,374 matched controls. Conditional logistic regression was used to assess HL risk associated with number of older and younger siblings of mothers. Results Having a mother with more than two older siblings is associated with lower HL risk, and the association is statistically significant for mothers with three or more siblings, compared with none. The adjusted odds ratios (and 95% confidence intervals) are 1.04 (0.93–1.16); 0.95 (0.81–1.10); and 0.81 (0.66–0.98) for one, two, and three or more older siblings, respectively. There is no association between number of mothers’ younger siblings and HL risk. Conclusions Exposures during the childhood of mothers may influence young onset adult HL risk in offspring, perhaps through vertical transmission of infectious agents, or through other long-term influences on maternal immune function.

Background Apolipoproteins B (apoB) and AI (apoAI) are strong predictors of cardiovascular disease (CVD). We describe apolipoprotein distributions and their associations with lipids and diabetes subtype in diabetic young adult South Asians. Methods In 995 subjects with diabetes, we measured fasting total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), triglycerides (TG), apoB and apoAI, glycosylated haemoglobin (HbA1c) and glutamic acid decarboxylase antibodies (GADA). Low-density lipoprotein cholesterol (LDLC) and non-HDLC (NHDLC) were calculated. We compared values in subjects aged 15–50 y from the United States National Health and Nutrition Examination Survey (NHANES). Results Median age and duration of diabetes were 38 (range 14–45) and 4 (0–24) y. Men had significantly higher TC, TG, NHDLC, TC/HDLC, apoB/AI and NHDLC/apoB, and lower apoAI than women. Compared with the reference group, patients with type 1 diabetes had lower TG, apoB:apoAI and HDLC:apoAI, and higher HDLC and apoAI. Patients with type 2 diabetes had higher TG, TC, LDLC, NHDLC, TC:HDL, apoB, apoAI and apoB:apoAI, and lower HDLC, LDLC:apoB and HDLC:apoAI. Among patients with type 2 diabetes, 54% had high apoB (>1.2 g/L) and 33% also had high TG (>1.5 mmol/L). Measures of obesity (body mass index and waist circumference) were weakly correlated with lipid and apoprotein parameters, suggesting a modest contribution to dyslipidaemia. Conclusions A large proportion of young adult Sri Lankan patients with type 2 diabetes has a low LDLC:apoB and high apoB and/or TG, suggesting that these patients are at increased risk of CVD.

Purpose of review Aim of the review is to summarize the current knowledge about clinical presentation and prognosis of patients with juvenile onset systemic sclerosis and compare it with that of those with adult onset systemic sclerosis. Recent findings Juvenile onset systemic sclerosis and adult onset systemic sclerosis have a different subtype and organ involvement pattern of the juvenile onset patients in the pediatric age is compared with that of adult patients. The juvenile onset patients have 90% diffuse subset, despite a 5-year survival of around 90%. The organ involvement pattern in both the groups becomes equal over the disease duration, but renal involvement is rare. The subset pattern equalizes over time too; the adult-aged juvenile onset patients have the same disease subset distribution, with around 40% diffuse subset patients, as the young adult onset patients, and this presents a survival bias presumably. The survival even after 20-year disease course seems more favourable for the juvenile onset patients. Summary Currently we are looking at two time windows: one at the first 5 years of the disease and the second at 20 years after the onset. We do not have the data on why and when the subset distribution changes occur.

Juvenile Systemic Sclerosis (jSSc) is an orphan diseases. The incidence is approximately 0.27 per million children. The paediatric rheumatologist pioneered in the establishment of new classification of juvenile scleroderma, which requires only one major criteria and two minor criteria. Regarding presentation of the disease in juvenile age range, they are two large cohorts published. The organ involvement pattern at the time of onset differs from the adults with Systemc Sclerosis (SSc). The mean age at onset is around 8 years. In jSSc patients at pediatric age the diffuse subset dominates and there is a very low occurrence of anticentromere antibodies. The currently running prospective juvenile scleroderma incpetion cohort project (www.juvenile-scleroderma.com), where patient data is collected with a standardized assessment protocoll prospectively, 74% of the patients have diffuse subtype too. Regarding the outcome of the juvenile patients into the adulthood, they are three publications, which show the change of pattern of the organ involvement, which could reflect a survival bias. At the adult age the subset distribution between juvenile onset or young adult onset patients does not differ anymore. The survival of the pediatric patients at 5 years is around 90 to 95%, which is significantly better than in adulthood for the same kind mostly diffuse patient population. Disclosure of Interest I. Foeldvari Consultant for: chugai, novartis, pfizer

There is a long-standing controversy between diabetologists as to whether the level of metabolic control of diabetes mellitus affects the long-term outcome. The traditional belief has been that the cardiovascular complications are a result of the metabolic derangements. Until recently, this position, however attractive, lacked substantial basic and/or clinical verification. 1.2 Within the past two years, 3 several studies have appeared that significantly increase the scientific basis for this position, while remaining inconclusive in a practical, therapeutic sense from the point of view of this author. The cardiovascular complications of diabetes mellitus are of two distinctly different types. The lesion most characteristic of diabetes is the microvascular lesion, resulting in blindness, progressive renal failure, and neuropathy. It is this process that is responsible for most of the morbidity and mortality in the insulin-deficient patient of childhood or young adult onset. Several investigators have proposed that chronic hyperglycemia or some related

A sample of child guidance clinic cases with a young adult onset of schizophrenia were followed into middle age. Outcome ratings and marital status were used as predictive criteria for childhood measures of IQ, aggressiveness, and severity of disturbance. The interaction of IQ and levels of aggressive symptomatology revealed a subgroup of preschizophrenics with low IQ and below average aggressiveness who had disproportionately unfavorable adult outcomes and never-married status. The results demonstrated the important moderating effects of a second variable on the predictive statements made about an initial predictor.

IT HAS been reported that 1-methyl-Δ 1 -androstenolone administered as the acetate per os or as the enanthate by injection together with digitoxin improves skeletal muscle performance or retards loss of muscle strength in muscular dystrophy and related myopathies in man and in dystrophic mice. 1,2 Our findings in 21 patients with muscular dystrophy treated with these agents are herein described. Materials and Methods The two steroids cited above were administered according to Dowben's program 2 for five to seven months or longer to a total of 21 patients with muscular dystrophy of childhood, teenage, or young adult onset. Ten of the patients received 20 mg of 1-methyl-Δ 1 -androstenolone acetate by mouth each day. In the other 11 patients 1-methyl-Δ 1 -androstenolone (2.0 mg per kilogram of body weight) was injected as the enanthate in sesame oil every two weeks.* Both groups received digitoxin, 0.2 to 0.7 mg per