Adolescent male soccer players have higher growth rates and risk of injury is associated with biological maturity.

BACKGROUND: The objective of this study was to ascertain disparities in growth and maturation between male adolescents engaged in soccer and their non-athletic counterparts, as well as to examine the injury features specific to young soccer players. METHODS: A total of 206 soccer players between the ages of 11-16 years, and 208 non-athletic peers were enrolled. Height, weight, body mass index (BMI), annual growth rate, and skeletal age evaluated using a left handwrist x-ray were determined. Biological and sexual maturation were evaluated using skinfold thickness, body composition, and Tanner stages. The game positions, initial age for playing soccer, the number of games per/ week, the number of sports injuries, date of injury, duration for return to activity, the site, nature, mechanism, and rate of injury were recorded for soccer players. Using an injury card, the characteristics of soccer player injuries were recorded. RESULTS: The mean age of the participants was 13.6 ± 1.5 years. There was no difference in the growth rates between the groups at the ages of 11.0, 12.0, and 15.0 but at the ages of 13.0 and 14.0 years growth rates were higher in the soccer group. The soccer players were taller than the controls. For all Tanner stages, soccer players had a lower BMI and total body fat percentage, as well as a faster growth rate. Injuries occurred at a rate of 39.3% per year among soccer players. The most common being toe injuries, and playing soccer increased the risk of multiple injuries. Additionally, injuries occurred more frequently in soccer players who were taller, heavier, with higher total body fat and/or higher growth rate, and most commonly occurred during Tanner stage 4. Futhermore, Tanner stage 4 had a higher incidence of two or more injuries than the other stages. CONCLUSIONS: Adolescent male soccer players have higher growth rates than their non-athletic peers, and their biological maturity status is associated with an increased risk of injury.

Relationship of Temperament Differences with Diagnosis, Severity and Accompanying Psychiatric Symptoms in Autism Spectrum Disorder.

Introduction: Temperament differences were shown in children with autism spectrum disorder (ASD); however, associations of temperament with ASD severity and accompanying psychiatric symptoms have yet to be studied. Methods: We evaluated 58 ASD-diagnosed children's temperaments through disorder severity and psychiatric symptoms and compared them with 58 typically developed children. We utilized the Children's Behavior Questionnaire-Short Form, The Strengths and Difficulties Questionnaire (SDQ). The Childhood Autism Rating Scale (CARS) was used to evaluate psychiatric symptoms and ASD severity levels of children. Results: Negative affect, effortful control, and perceptual sensitivity were found lower in ASD-diagnosed children and decreased with ASD severity. Effortful control was also found negatively correlated with scores of behavioral problems, hyperactivity, and total difficulties. Besides, anger/frustration was found predictive for conduct and peer problems, and total difficulty scores. Conclusion: Further studies are needed to verify and expand these pioneer findings.

Psychological burden of asthma in adolescents and their parents.

INTRODUCTION: Asthma, a common chronic disease in adolescents is impacted by factors affecting quality of life. This study aimed to determine the psychosocial factors of adolescents with asthma and their parents. METHODS: The study included 122 adolescents with asthma, 82 healthy controls, and their parents who completed the Asthma Control Test (ACT), Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Brief Symptom Inventory (BSI). RESULTS: The mean age was 14.2 ± 1.9 years. ACT score was high and depression was low in patients with good treatment compliance. As the age of the first asthma symptoms/diagnosis increased, somatization, anxiety, hostility and general psychopathology scores increased, as did the somatization score of parents. Parental anxiety score was not related with adolescent BSI scores in the controls but in the study group when it was higher, the anxiety, depression, somatization, and general psychopathology scores were higher. PAQLQ showed that anxiety, negative self-esteem, somatization, depression, and general psychopathology were higher in patients concerned about asthma. Depression and somatization scores were higher in the parents of patients who perceived that "Treatment does not contribute to asthma control." Somatization scores were higher among parents of patients who noted: "Asthma will not pass in the long-term" and "I cannot control asthma." CONCLUSION: Higher scores of asthma patients who were anxious about the disease and families who were despondent about treatment demonstrate that health care providers should spend more time informing patients and caregivers. Increasing patient treatment compliance during early adolescence will lessen the psychological burden of the disease.

Characteristics of femoroacetabular impingement morphology and relation with skeletal maturity among asymptomatic adolescents.

The aim of this study was to analyze presence of the morphological characteristics and prevalence of FAI in asymptomatic adolescents and assess the relation of skeletal maturation with development of FAI morphology. Abdominopelvic computed tomography (CT) of 265 adolescents (9-19 years old) who were admitted to the emergency department between 2011 and 2016 were evaluated retrospectively. Radial reformatted CT images from the femoral neck were created using the multiplanar reconstruction (MPR) method. The femoral neck was divided into 12 segments and alpha angle (AA), femoral head-neck ratio (FHNR) and center-edge angle (CEA) were measured from each segment. Additionally, images were evaluated for the physiological status (open or closed) of the triradiate- cartilage and proximal femoral epiphyses. 204 hips from 102 patients (32 females, 70 males) were retrospectively reviewed. There were 27 (26.5%) patients with cam-type morphology and 18 (17.6%) patients with pincer-type morphologies. No statistically significant difference was detected between the prevalences of cam and pincer morphologies between the two genders. Cam deformity was most frequently seen in anterosuperior segment. All of the patients (100%) with pincer-type morphology and 88% of the patients with cam-type morphology had closed triradiate cartilage, 89% of the patients with cam morphology and 83% with pincer morphology had open proximal femoral physis. Our results showed that prevalence of cam and pincer-type morphology in asymptomatic adolescents is similar to asymptomatic adults. Our findings also indicate that cam- and pincer-type FAI morphologies likely develop during late adolescence after closure of triradiate cartilage and before closure of proximal femoral physis. Level of Evidence - 3.

Over restrictive elimination of foods in children with food allergy.

BACKGROUND: Previous studies demonstrated critical deficits in diagnosis and management of childhood food allergy (FA), and recent developments in FA research support adopting a proactive approach in FA management. Our objective was to describe FA knowledge and management patterns of pediatricians. METHOD: We applied a 24-item survey to 170 general pediatricians, pediatric allergists and pediatric gastroenterologists practicing in Turkey. RESULTS: Some IgE-mediated symptoms of FA such as cough, urticaria, wheezing and anaphylaxis were falsely recognized as symptoms of non-IgE-mediated FA by 30%, 29%, 25% and 19% of the participants, respectively. By contrast, 50% of the participants falsely recognized bloody stool, a finding of IgE-mediated FA. Most frequently and least frequently used diagnostic tools were specific IgE (30.5%) and oral food challenge test (1.7%), respectively. Maternal diet restrictions and infant diet restrictions were advised by 82% and 82%, respectively. Percentages of physicians eliminating only 1 food were 21%, 19%; 2 foods were 15%, 11%; 3 foods were 7%, 8%; 4-5 foods were 8%, 11%; 5 to 10 foods were 21%, 26%; and > 10 foods were 28%, 25% from the maternal and infant diet, respectively. Cow`s milk, cheese, butter, yoghurt, baked milk products and hen`s egg were the most commonly restricted items. CONCLUSION: Overall, FA knowledge of pediatricians was fair. Pediatricians utilize an overly restrictive approach when advising diet eliminations in FA. Recent developments favor a more proactive approach to induce immune tolerance and need to be encouraged in pediatric clinical practice. Future educational efforts should focus on emphasizing the deleterious effects of injudicious and extensive eliminations.

Life-stage factors associated with overweight severity in adolescents.

BACKGROUND: Investigating life-stage factors associated with overweight may be useful in the prevention of excessive BMI increase. The main aim of this study was to investigate the influence of the route of delivery, birth weight and overweight onset on overweight severity in a sample of overweight adolescents followed at a Pediatric Obesity Clinic. METHODS: Clinical data from 412 adolescents with overweight (BMI ≥ p85), aged 10-18 were retrospectively collected and analyzed. RESULTS: Adolescents born by cesarean section (CS) showed a lower age of overweight onset, compared to other methods of delivery (d= 0.33, p= .009). Birth weight was positively associated with BMI z-score (r=.164, p= 002) and waist circumference (WC) (r=.191, p=.001). The overweight onset was negatively associated with BMI z-score (r= -.277, p < .001), WC (r= -.270, p < .001) and body fat mass (r= -.199, p=.001). Overweight duration was the best predictor of BMI z-score, explaining in 75% its variation (F=1,317)=26.94, p < .001), which increased to 99% when birth weight was included in the model (F(2,316)=18.47, p < .001). CONCLUSIONS: This study suggests that lifestyle may interrupt the burden of CS on BMI z-score throughout growth. Moreover, increased birth weight may anticipate overweight onset, and consequently overweight duration in the presence of inadequate lifestyle behaviors.

A brief study on the knowledge and choice of contraception methods in married adolescent girls.

INTRODUCTION: The fertility rate is 0.25% for 15-19-year-old girls and 16% for 19-year-old girls who are mothers or pregnant with their first child. Fifty-two percent of married adolescents did not have affective contraception. To encourage using the right contraceptive methods in married adolescents, it is essential to examine the behaviors of this group, the level of contraceptive knowledge and the choices they make regarding contraceptive use. MATERIALS AND METHODS: One hundred and ten married adolescent females, less than 20 years of age, who visited a gynecology and obstetrics clinic between January 2015 and October 2016 were enrolled in this prospective study. RESULTS: Of them 96.4% were unemployed. At the time of the study, 70% of them were pregnant. Of these pregnancies, 46.4% was a first, 19.1% a second and 8.2% a third pregnancy. The abortion rate in this study was 18.3%, and stillbirth was 2.8%. The interval between pregnancies was 20.9 months. The unplanned pregnancy rate was 45.5% and 37.3% of these unplanned pregnancies resulted in at least one healthy child. The most common contraceptive method was the use of condoms (10.9%). Changes in contraceptive methods resulted in pregnancy in 66.7% of the cases. Although 20.9% of the husbands in the study used contraceptive methods, 40.9% of them felt that their husbands should be using contraception. Of the participants 43.5% received their knowledge regarding family planning and contraceptive methods from local health clinics. DISCUSSION: Teen marriage, pregnancy and teen parents result in socio-economic and educational difficulties. It is essential to support the adolescent parents using affective contraceptive methods and adolescent-friendly health clinics.

Clinical Signs and Diagnostic Tests in Acute Respiratory Infections.

OBJECTIVES: To evaluate clinical manifestations of acute respiratory system infectious diseases and specific tests for causative agents in pediatric patients. METHODS: The authors evaluated children aged 0-16 y with clinical symptoms of acute respiratory tract infections who were administered rapid strep A test and/or throat culture test and/or respiratory viral panel test, from February 2012 through January 2013 at pediatric department of Acibadem Maslak Hospital, Turkey. RESULTS: A total of 1654 patients were evaluated; 45.9 % were girls, 54.1 % were boys. Absence of cough and presence of headache were higher in the patients >6 y of age (p 0.0001, p 0.002 respectively). Positive respiratory viral panel test was higher in the patients <2 y of age (p 0.002). Both positive rapid strep A test and positive throat culture test were higher in the patients >6 y of age (p 0.0001). Positivity of rapid strep A or throat culture test were not observed in children <2 y of age. CONCLUSIONS: A clinician should mostly consider viral infections in the etiology of acute respiratory infections in children under 2 y of age and there is no need to rush for the use antibiotherapy. Bacterial etiology should be frequently considered after 6 y of age and rapid use of antibiotherapy is essential to avoid the complications.

Seasonal and gender differences in hemoglobin value in infants at 5-7 months of age.

Our aims were to analyze the changes in hemoglobin (Hb) value according to gestational age, birth weight, sex, birth season, and weight gain and to detect distribution of Hb values among healthy infants, breastfed for at least four months and receiving routine health care. We conducted a descriptive study using the data of 469 healthy infants at 5-7 months of age in Hacettepe University Ihsan Dogramaci Children's Hospital Well-Baby Clinic between 2001-2004. Infants with acute or chronic illness, exchange transfusion and those who had taken or were currently taking iron supplementation were not included into the study. Information regarding the child was obtained from hospital files. Infants with Hb value <10.5 g/dl and <9.5 g/dl were considered to have mild and moderate anemia, respectively. The mean Hb value was 10.7 g/dl (SD = 0.90). The prevalence of anemia was 41.4%. Boys had significantly lower Hb, hematocrit and mean corpuscular volume values and higher red cell distribution width values than girls. Infants born before 37 weeks of gestational age had moderate anemia more frequently. Anemia at 5-7 months of age was more frequent in infants born in spring and summer than in those born in fall and winter (49.2%, 26.8%, p<0.001). Birth weight was positively correlated with Hb value at 5-7 months of age (r=0.14, p=0.003). In the present study, female gender, at-term birth, birth in winter and fall, weight appropriate for gestational age, and regular weight gain showed the lowest risk for anemia development in infants aged 5-7 months with a breast-feeding period of more than four months.

Oxidative stress and genetic and epidemiologic determinants of oxidant injury in childhood asthma.

BACKGROUND: The factors contributing to the oxidant/antioxidant imbalance in asthma are incompletely understood. OBJECTIVE: To determine the factors associated with oxidative stress including asthma severity and the genotype of the antioxidant enzymes. METHODS: A total of 196 children with mild asthma, 116 children with moderate-severe asthma, and 2 healthy control groups (187 and 68 children) were included in the study. Plasma levels of malondialdehyde were measured as the indicator of oxidative stress, and reduced glutathione levels as the indicator of antioxidant defense. Children were genotyped for null variants of glutathione S transferase (GST) T1 and GSTM1, and ile105val variant of GSTP1. Risk factors were analyzed with multivariate logistic regression. RESULTS: Systemic levels of malondialdehyde increased and reduced glutathione levels decreased significantly from healthy controls to patients with mild asthma and then to patients with moderate-severe asthma (P < .001 for each). Multivariate logistic regression identified asthma and asthma severity as independent factors associated with oxidative stress (odds ratio between 17 and 56; P < .001). Children with asthma with GSTP1 val/val genotype had higher malondialdehyde and lower glutathione levels compared with other genotypes (P = .023 and P = .014, respectively). GSTP1 val/val genotype was independently associated with asthma severity (odds ratio, 4.210; 95% CI, 1.581-11.214; P = .004). CONCLUSION: Our study indicates the presence of a strong oxidative stress in children with asthma that increases with the severity of the disease. In this population, val/val genotype at GSTP1 ile105val locus may be an important factor in determining the degree of oxidant injury. CLINICAL IMPLICATIONS: Children with asthma with val/val genotype at GSTP1 ile105val locus may be good candidates for supplemental antioxidant therapy.