Implicating factors in the increase in cases of central precocious puberty (CPP) during the COVID-19 pandemic: Experience of a tertiary centre of pediatric endocrinology and review of the literature.

Sexual development is a complex mechanism activated by the hypothalamic-pituitary-gonadal axis. Over the last one hundred years there has been a decline in the age at puberty onset in industrialised countries. Some Italian studies showed an increase in diagnoses of Central Precocious Puberty (CPP) during the COVID-19 pandemic. It is thus supposed that in this period there was an increased impact of factors that can influence pubertal development. Our retrospective monocentric study aimed to confirm the existence of this phenomenon and analysed possible related factors. We retrospectively evaluated clinical, laboratory, radiological and ultrasound (US) data of 154 girls referred to our Tertiary Centre of Paediatric Endocrinology from January 2019 to April 2021 for different forms of Precocious Puberty. We subdivided the cases into subgroups according to the final diagnosis: CPP, Early Puberty (EP), isolated thelarche and isolated pubarche. The observation period was subdivided into: Period 1, before lockdown (1 January 2019 - 8 March 2020) and Period 2, lockdown and the following months (9 March 2020 - 30 April 2021). Period 2 was further divided into "restrictive lockdown period" (Period 2.1) (March 2020 - 14 June 2020, in which the schools were closed) and "less restrictive lockdown period" (Period 2.2) (15 June 2020 - 30 April 2021). We analysed data regarding the use of electronic devices before and during lockdown in a group of girls with CPP diagnosed in Period 2 and we compared the data with that of a control group. Our data show an increase in the number of new diagnoses of CPP during lockdown and in the following months, compared with the previous period. We also detected a higher use of PCs and smartphones in girls with CPP diagnosed in Period 2, compared with the control group. The percentage of the presence of endometrial rhyme detected during the pelvic ultrasound was higher in girls with CPP in Period 2, compared with the previous period. Based on our data we assume there was an environmental effect on pubertal timing that calls our attention to factors such as food, use of electronic devices and stress. We will need further studies to better understand this data.

The interplay between sleep quality and adolescents’ psychosocial development: a systematic review and meta-analysis of longitudinal studies

Introduction: Adolescence is defined as the period of a gradual transition between childhood and adulthood, with conceptually distinct physical changes marking puberty and maturation. Sleep is a critical aspect for overall well-being and healthy development across physical, behavioral, cognitive, academic, and psychosocial domains. This can pave the way to a new frontier for adolescent research, in which the dynamic interplay between sleep and multiple psychosocial aspects of adolescents’ life can explain long-term developmental outcomes. Thus, systematizing and assessing longitudinal research on this topic is required to understand both changes of sleep during adolescence and its complex over time relationship with psychosocial development. Material and methods: The first aim of this systematic review and meta-analysis is to identify all studies that evaluated longitudinally sleep quality, with standardized objective and/or subjective measures, in adolescence. The second aim is to evaluate the longitudinal interplay between sleep quality and psychosocial development in adolescents (particularly considering the domains of social experiences in multiple ecological contexts;identity processes and well-being outcomes). This work could lead to a better understanding of both changes in sleep quality during adolescence and its bidirectional link to psychosocial development. Pubmed;Psychinfo, PsycArticles, Medline, Web of Science, Scopus;ProQuest Dissertations and Theses;ERIC;GreyNet databases were systematically searched without publication period restriction until 23th of September 2021. Eligible studies had to: include adolescents from the general population aged between 10/11 to 18/19 years old;use a longitudinal design;report sleep quality-related outcomes as measured by objective and/or subjective standardized measures for at least two time-points. The corresponding author worked in pairs with another team member and independently screened at first the titles and s and then the full text against the eligibility criteria. Results: A total of 362 full-texts were screened and a final number of 250 studies were included. The inter-rater agreement between the first and other authors of the team that worked in pairs for the selection process was substantial. Of these studies, 163 evaluated the longitudinally sleep quality of adolescents over time and its connection to physical health;psychological and social wellbeing. 81 studies evaluated longitudinally the interplay between sleep quality and different ecological contexts and identity development of adolescents. Finally, 6 studies evaluated the change over time of sleep quality outcomes and its relationship with wellbeing, context and identity in adolescents before and after the pandemic due to the Covid-19 outbreak. Conclusion: Because of the broad scope of this project, the data can be used to examine a large variety of research questions. From this large selection of literature, different systematic reviews on different specific topics will be obtained. Particularly, our work will focus at first on systematically assessing the development and change over time of the sleep quality during the adolescence period. Furthermore, different works on the longitudinal interplay between sleep quality and physical health, different contexts and identity development will be systematically evaluated and presented. Acknowledgements: This work was conducted within the ERC-Consolidator project IDENTITIES (Grant Agreement n. 101002163).

Time in range and glucose variability were not similar between children, adolescents and adults with type 1 diabetes during lockdown due to CoVid-19 pandemic

Objectives: Lockdown period may have influenced the metabolic control of patients with type 1 diabetes mellitus (T1D) of any age group. The aims of our study were (I) to compare continuous glucose monitoring (CGM)-derived parameters in children, adolescents and adults with T1D before and during lockdown period in Italy and (II) to identify factors potentially contributing to glucose control. Methods: We enrolled 130 consecutive patients with T1D (30 children [1-12 years], 24 adolescents [13-17 years], and 76 adults [>18 years]), using either Dexcom® or FreeStyle Libre® monitoring systems >70% during study period, not wearing hybrid closed loop insulin pump. We calculated several CGM-derived metrics during the 20 days before and the 20 days after lockdown. By phone interview, we retrieved data on adult working activity and performed validated physical activity and perceived stress questionnaires. Results: In children, significantly lower standard deviation of glucose (SDglu) (P = 0.029) and time below range < 54 mg/dL (TBR2) (P = 0.029) were detected after lockdown, when compared to prelockdown. In adolescents, all CGM-derived metrics were comparable between pre- and post-lockdown. In adults, significant improvement of time in range 70-180 mg/dL (TIR) (P < 0.001) and all remaining metrics, apart from % coefficient of variation and TBR2, was detected after lockdown. In adults, considering pre- and post-lockdown changes in SDglu and TIR, we identified a group of patients with improved TIR and SDglu, who has performed more physical activity, a group with improved glucose variability, younger than other patients, and a group with worsened glucose variability, who had higher perceived stress than others. Conclusions: CGM glucose-metrics mostly improved in children and adults with T1D after lockdown, whereas it remained unchanged in adolescents. Age, physical activity, and perceived stress may be relevant factors contributing to metabolic control of T1D in adults.