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Concept: Young adult

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Adolescents and young adults (AYAs, 15-39 years) with acute lymphoblastic leukemia (ALL) represent a heterogeneous population who receive care in pediatric or adult cancer settings. Using the California Cancer Registry, we describe AYA ALL patterns of care and outcomes over the past decade. Sociodemographics, treatment location, and front-line therapies administered to AYAs diagnosed with ALL between 2004 and 2014 were obtained. Cox regression models evaluated associations between ALL setting and regimen and overall survival (OS) and leukemia-specific survival (LSS) for the entire cohort, younger AYA (<25 years), and AYAs treated in the adult cancer setting only. Of 1473 cases, 67.7% were treated in an adult setting; of these, 24.8% received a pediatric ALL regimen and 40.7% were treated at a National Cancer Institute (NCI)-designated center. In multivariable analyses, front-line treatment in a pediatric (vs adult) setting (OS HR = 0.53, 95% confidence interval [CI], 0.37-0.76; LSS HR = 0.51, 95% CI, 0.35-0.74) and at an NCI/Children's Oncology Group (COG) center (OS HR = 0.80, 95% CI, 0.66-0.96; LSS HR = 0.80, 95% CI, 0.65-0.97) were associated with significantly superior survival. Results were similar when analyses were limited to younger AYAs. Outcomes for AYAs treated in an adult setting did not differ following front-line pediatric or adult ALL regimens. Our population-level findings demonstrate that two-thirds of AYAs with newly diagnosed ALL are treated in an adult cancer setting, with the majority receiving care in community settings. Given the potential survival benefits, front-line treatment of AYA ALL at pediatric and/or NCI/COG-designated cancer centers should be considered.

Concepts: Regression analysis, Cancer, Chemotherapy, Leukemia, Adolescence, National Cancer Institute, Acute lymphoblastic leukemia, Young adult

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Objective To examine the relation between childhood adversity, the role of school performance, and childhood psychopathology and the risk of suicide.Design Cohort study of register based indicators of childhood adversity (at ages 0-14) including death in the family (suicide analysed separately), parental substance abuse, parental psychiatric disorder, substantial parental criminality, parental separation/single parent household, receipt of public assistance, and residential instability.Setting Swedish medical birth register and various Swedish population based registers.Participants 548 721 individuals born 1987-91.Main outcome measures Estimates of suicide risk at ages 15-24 calculated as incidence rate ratios adjusted for time at risk and confounders.Results Adjusted incidence rate ratios for the relation between childhood adversity and suicide during adolescence and young adulthood ranged from 1.6 (95% confidence interval 1.1 to 2.4) for residential instability to 2.9 (1.4 to 5.9) for suicide in the family. There was a dose-response relation between accumulating childhood adversity and risk: 1.1 (0.9 to 1.4) for those exposed to one adversity and 1.9 (1.4 to 2.5) and 2.6 (1.9 to 3.4) for those exposed to two and three or more adversities, respectively. The association with increased risk of suicide remained even after adjustment for school performance and childhood psychopathology.Conclusion Childhood adversity is a risk factor for suicide in adolescence and young adulthood, particularly accumulated adversity. These results emphasise the importance of understanding the social mechanisms of suicide and the need for effective interventions early in life, aiming to alleviate the risk in disadvantaged children.

Concepts: Family, Epidemiology, Medical statistics, Risk, Sociology, Adolescence, Psychiatry, Young adult

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Many states have recently made significant changes to their legislation making recreational and/or medical marijuana use by adults legal. Although these laws, for the most part, have not targeted the adolescent population, they have created an environment in which marijuana increasingly is seen as acceptable, safe, and therapeutic. This clinical report offers guidance to the practicing pediatrician based on existing evidence and expert opinion/consensus of the American Academy of Pediatrics regarding anticipatory guidance and counseling to teenagers and their parents about marijuana and its use. The recently published technical report provides the detailed evidence and references regarding the research on which the information in this clinical report is based.

Concepts: Medicine, Law, Adolescence, Medical school, Cannabis, Young adult

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Advancements in accelerometer analytic and visualization techniques allow researchers to more precisely identify and compare critical periods of physical activity (PA) decline by age across the lifespan, and describe how daily PA patterns may vary across age groups. We used accelerometer data from the 2003-2006 cohorts of the National Health and Nutrition Examination Survey (NHANES) (n=12,529) to quantify total PA as well as PA by intensity across the lifespan using sex-stratified, age specific percentile curves constructed using generalized additive models. We additionally estimated minute-to-minute diurnal PA using smoothed bivariate surfaces. We found that from childhood to adolescence (ages 6-19) across sex, PA is sharply lower by age partially due to a later initiation of morning PA. Total PA levels, at age 19 are comparable to levels at age 60. Contrary to prior evidence, during young adulthood (ages 20-30) total and light intensity PA increases by age and then stabilizes during midlife (ages 31-59) partially due to an earlier initiation of morning PA. We additionally found that males compared to females have an earlier lowering in PA by age at midlife and lower total PA, higher sedentary behavior, and lower light intensity PA in older adulthood; these trends seem to be driven by lower PA in the afternoon compared to females. Our results suggest a re-evaluation of how emerging adulthood may affect PA levels and the importance of considering time of day and sex differences when developing PA interventions.

Concepts: Male, Female, Obesity, Gender, Sex, Developmental psychology, Human development, Young adult

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Early puberty in girls is linked to some adverse outcomes in adolescence and mid-life. We address two research questions: (1) Are socioeconomic circumstances and ethnicity associated with early onset puberty? (2) Are adiposity and/or psychosocial stress associated with observed associations?

Concepts: Cohort study, Cohort, Puberty, Young adult, Precocious puberty

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The prospective association between cardiorespiratory fitness (CRF) measured in young adulthood and middle age on development of prediabetes, defined as impaired fasting glucose and/or impaired glucose tolerance, or diabetes by middle age remains unknown. We hypothesised that higher fitness levels would be associated with reduced risk for developing incident prediabetes/diabetes by middle age.

Concepts: Nutrition, Insulin, Middle Ages, Endocrinology, Glucose tolerance test, Impaired fasting glycaemia, Impaired glucose tolerance, Young adult

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Although smoking prevalence and average cigarette consumption have declined, very light smoking (5 or fewer cigarettes per day) has increased. Very light smoking is common among young adult women. This study examines the differences between the sociodemographic and psychosocial factors associated with women in emerging adulthood who are very light smokers and similar women who are at other smoking levels.

Concepts: Smoking, Tobacco, Cigarette, Nicotine, Cigar, Electronic cigarette, Adult, Young adult

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The purpose of this study was to investigate the influence of exposure to others' drink driving during adolescence on self-reported driving under the influence (DUI) of alcohol in young adulthood. Data were drawn from 1956 participants with a driving license enrolled in the International Youth Development Study from Victoria, Australia. During 2003 and 2004, adolescents in Grades 7, 9 and 10 (aged 12-17) completed questionnaires examining whether they had ridden in a vehicle with a driver who had been drinking, as well as other demographic, individual, peer and family risk factors for DUI. In 2010, the same participants (aged 18-24) then reported on their own DUI behaviour. 18% of young adults with a driving license reported DUI in the past 12 months. Exposure to others' drink driving during adolescence was associated with an increased likelihood of DUI as a young adult (OR=2.13, 95% CI 1.68-2.69). This association remained after accounting for the effects of other potential confounding factors from the individual, peer and family domains (OR=1.62, 95% CI 1.23-2.13). Observing the drink driving behaviours of others during adolescence may increase the likelihood of DUI as a young adult. Strategies to reduce youth exposure to drink driving are warranted.

Concepts: Adolescence, Youth, Alcoholic beverage, Driving under the influence, Adult, Driver's license, Young adult

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The early repolarisation (ER) pattern is associated with arrhythmic death in middle-aged populations. The risk is increased with ER followed by a horizontal ST segment (horizontal-ST ER). ER associated with a rapidly ascending ST segment (ascending-ST ER) has been shown to be benign. The prevalence of ER has not been documented in young adults and its significance in this group is not known. Furthermore, ER is commonly seen in athletes but underlying mechanisms are unclear. We demonstrate the prevalence of ER in a large population of young healthy adults and explore the relationship with physical activity.

Concepts: Biology, Demography, Population, Young adult

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Background Post-stroke cognitive impairment is common and a decisive prognostic factor. However, few studies have reported on post-stroke cognition in young adults, especially long-term cognition. This study was designed to investigate the influence of baseline factors, treatments, and functional outcome on the long-term cognitive outcome in young adults with ischemic stroke. Material and Methods Consecutive patients aged 18-45 years between January 1, 2006 and December 31, 2010, with a first-ever ischemic stroke, were recruited for cognitive assessment by telephone from December 10 to December 31, 2013 using modified versions of “Telephone Instrument for Cognitive Status” (TICS-m) scale. The relationship of cognitive impairment with baseline factors, treatments, and functional outcome were evaluated. Results A total of 350 patients with an average age of 41.0±6.8 years (69.7% males and 30.3% females) were reviewed. The average follow-up period was 5.8±3.2 years, and cognitive impairment existed in 39.4% of patients at follow-up. Stroke severity on admission, functional outcome (modified Rankin Scale, mRS >2) at discharge, left anterior circulation syndrome, and stroke recurrence were markedly associated with post-stroke cognitive impairment (all P<0.01). Post-stroke cognition was also significantly related to mRS at follow-up (r=-0.563, P<0.001). Conclusions Post-stroke cognition was related to functional outcome: hence, treatment directed toward reducing functional disability might also reduce cognitive impairment.

Concepts: Stroke, Modified Rankin Scale, Educational psychology, Disability, Reasoning, Barthel scale, Rehabilitation medicine, Young adult