Ann Bruner

Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls

BACKGROUND Up to 25% of adolescent girls in the USA are iron deficient. This double-blind, placebo-controlled clinical trial assessed the effects of iron supplementation on cognitive function in adolescent girls with non-anaemic iron deficiency. METHODS 716 girls who enrolled at four Baltimore high schools were screened for non-anaemic iron deficiency (serum ferritin < or = 12 micrograms/L with normal haemoglobin). 98 (13.7%) girls had non-anaemic iron deficiency of whom 81 were enrolled in the trial. Participants were randomly assigned oral ferrous sulphate (650 mg twice daily) or placebo for 8 weeks. The effect of iron treatment was assessed by questionnaires and haematological and cognitive tests, which were done before treatment started and repeated after the intervention. We used four tests of attention and memory to measure cognitive functioning. Intention-to-treat and per-protocol analyses were done. FINDINGS Of the 81 enrolled girls with non-anaemic iron deficiency, 78 (96%) completed the study (39 in each group). Five girls (three control, two treatment) developed anaemia during the intervention and were excluded from the analyses. Thus, 73 girls were included in the per-protocol analysis. Ethnic distribution, mean age, serum ferritin concentrations, haemoglobin concentrations, and cognitive test scores of the groups did not differ significantly at baseline. Postintervention haematological measures of iron status were significantly improved in the treatment group (serum ferritin 27.3 vs 12.1 micrograms/L, p < 0.001). Regression analysis showed that girls who received iron performed better on a test of verbal learning and memory than girls in the control group (p < 0.02). INTERPRETATION In this urban population of non-anaemic iron-deficient adolescent girls, iron supplementation improved verbal learning and memory.

Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections

BACKGROUND Depot medroxyprogesterone acetate (DMPA) is a highly effective progestin-only contraceptive that is widely used by adolescents. We investigated bone mineral density (BMD) changes in female adolescents during and following use of this method. STUDY DESIGN A multicenter, prospective, non-randomized observational study in 98 healthy female adolescents aged 12-18 years who initiated DMPA intramuscular injections for contraception and provided BMD data for up to 240 weeks while receiving DMPA and for up to 300 weeks after DMPA cessation. BMD at the lumbar spine (LS), total hip (TH) and femoral neck (FN) was assessed by dual-energy X-ray absorptiometry. A mixed model analysis of variance was used to examine BMD changes. RESULTS At the time of their final DMPA injection, participants had mean BMD declines from baseline of 2.7% (LS), 4.1% (TH) and 3.9% (FN) (p<.001 at all three sites). Within 60 weeks of discontinuation of DMPA, mean LS BMD had returned to baseline levels, and 240 weeks after DMPA discontinuation, the mean LS BMD was 4.7% above baseline. Mean TH and FN BMD values recovered to baseline values more slowly: 240 weeks and 180 weeks, respectively, after the last DMPA injection. CONCLUSIONS BMD loss in female adolescents receiving DMPA for contraception is substantially or fully reversible in most girls following discontinuation of DMPA, with faster recovery at the LS than at the hip.

Biopsychosocial variables associated with substantial bone mineral density loss during the use of depot medroxyprogesterone acetate in adolescents: adolescents who lost 5% or more from baseline vs. those who lost less than 5%

BACKGROUND It is unclear why some adolescents experience substantial bone mineral density (BMD) loss, while others experience a minimal decrease during depot medroxyprogesterone acetate (DMPA) use. We examined biopsychosocial factors in adolescents who experienced ≥5% BMD loss from baseline compared with adolescents who experienced <5% BMD loss during DMPA use. STUDY DESIGN A multicenter, prospective, nonrandomized study of 181 female adolescents who initiated DMPA for contraception was conducted. BMD (by dual-energy X-ray absorptiometry) and serum estradiol were measured at initiation and every 6 months for 240 weeks of DMPA use. RESULTS Half of participants experienced BMD loss of ≥5% from baseline at the hip, and a quarter experienced BMD loss of ≥5% at the lumbar spine (BMD substantial losers, SL). Hip and lumbar spine BMD-SL received a significantly greater number of DMPA injections than non-SL (p<.001). Decreased estradiol levels did not statistically differ between BMD loss subgroups. Hip BMD-SL had significantly lower baseline body mass index (BMI) than non-SL (p=.002), and there was an inverse relationship between weight gain and degree of BMD loss. Mean calcium intake was significantly lower (p<.05) in hip BMD-SL, and reported alcohol use was significantly higher (p<.05) in lumbar spine BMD-SL compared with non-SL. CONCLUSIONS BMD loss of ≥5% was more common at the hip than at the lumbar spine among adolescents using DMPA. Decreased serum estradiol levels did not correlate with magnitude of BMD loss. Lower BMI and calcium intake and greater alcohol use were associated with greater BMD loss in adolescents using DMPA.

Opioid Use Disorders

Opioid use and addiction in adolescents and young adults is a health problem of epidemic proportions, with devastating consequences for youth and their families. Opioid overdose is a life-threatening emergency that should be treated with naloxone, and respiratory support if necessary. Overdose should always be an opportunity to initiate addiction treatment. Detoxification is often a necessary, but never sufficient, component of treatment for OUDs. Treatment for OUDs is effective but treatment capacity is alarmingly limited and under-developed. Emerging consensus supports the incorporation of relapse prevention medications such as buprenorphine and extended release naltrexone into comprehensive psychosocial treatment including counseling and family involvement.

Tetanus, Diphtheria, and Acellular Pertussis Vaccine: A Position Statement of the Society for Adolescent Medicine

Pertussis rates in the United States have been rising slowly since a nadir in 1976, and case rates have increased sharply in recent years. Although the Centers for Disease Control and Prevention reported over 25,000 cases in 2005, experts estimate that because of missed diagnoses, the actual burden of pertussis may be as high as 1 to 3 million cases per year [1]. In 2004, 38% of reported cases were among the 10to-19year-old age group [2]. Pertussis is a respiratory infection caused by Bordetella pertussis. The illness has three stages: the catarrhal stage (w1 to 14 days), which often looks like a common cold; the paroxysmal stage (w1 to 6 weeks), which includes spasmodic cough, posttussive vomiting, and inspiratory whoop; and the convalescent stage, which can last months and includes waxing and waning cough. Pertussis is most contagious before most patients know they have the disease: during the late catarrhal or early paroxysmal stage. Severe complications are more common among infants younger than 12 months and can include pneumonia, broken ribs, hypoxemia, seizures, encephalopathy, and death. Adolescents are particularly vulnerable to pertussis because immunity from either vaccination or natural infection wanes after 5 to 7 years. Adolescents with pertussis not only suffer disruption and morbidity from the illness, they also often unknowingly transmit disease to others, including vulnerable infants. In 2006, the Advisory Committee on Immunization Practices recommended the routine use of the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) for all 11to-12-yearolds (replacing the tetanus–diphtheria, or Td, booster), and recommended Tdap for all 13to-18-year-olds who have not previously received it. For those adolescents who have previously received a Td booster, a 5-year interval is encouraged prior to receiving Tdap, although a shorter interval can be used, especially when the risk of disease outweighs the risk of local reactions after vaccination [3]. One-time use of Tdap is also recommended for those aged 19 to 64 years in place of a Td booster. Among 19to-64-year-olds, a 2-year interval between a prior Td and Tdap is encouraged, although a shorter interval may be used. Adolescents and adults who anticipate close contact with infants under the age of