Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review.

Strong associations between early antibiotic exposure and increased risk of childhood allergies have been established. Antibiotics have the potential to induce microbial dysbiosis that may be linked to allergic conditions. This review examines the limited available evidence on the associations between adult antibiotic use, microbial dysbiosis and atopic conditions. A systematic literature search was conducted using PubMed and Embase for relevant studies, published between 01-01-2000 and 08-17-2022. We searched for associations between antibiotic use, microbial dysbiosis, and allergic conditions in adults, defined as over 13 years of age for the purposes of this review. Twenty-one studies were analyzed, with the inclusion of four narrative reviews as scarce relevant literature was found when stricter selection criteria were employed. Relevant studies predominantly focused on asthma. Significant microbial differences were observed in most measures between healthy subjects and subjects with allergic conditions. However, no system-wise and strain-wise associations were evident. Notably, at the phyla level, the Bacillota and Pseudomonadota phyla were associated with asthmatics, while the Actinobacteria phylum was linked to healthy controls. Asthmatics tends to reflect upregulation in the Bacillota and Pseudomonadota phyla in both airway and gut microbiomes. No compelling evidence could be found between adult antibiotic exposure, consequent microbial dysbiosis, and allergic conditions in adults. Our review is limited by scarce literature and therefore remains inconclusive. However, potential implications of antibiotic use impacting on allergic conditions justify additional research and heightened pharmacovigilance in this area.

The tough thing about adulthood is it starts before you even know it starts (Robert Redford) It is estimated that up to a quarter of children and young people live with a long-term health condition (defined as lasting 12 months or more) in resource-rich countries such as the UK. They experience higher morbidity, admission rates and psychosocial consequences.1 Allergy and asthma in particular are on the rise in 11- to 25-year-olds, and this age group has a high risk of fatal anaphylaxis.2 Allergic multi-morbidity, although not new, is being increasingly studied in terms of prevalence and underlying pathophysiology. A recent study showed multi-morbidity in 43% of children and adolescents with eczema, including psychosocial disorders, with increasing risk of multi-morbidity as children approached the age of 17 years.3 An increasing number of allergic conditions have been shown to be associated with higher healthcare usage in the UK.4 It is therefore clear that we need to consider the healthcare needs of young people with allergy as they move from paediatric to adult services. In this editorial, we consider the challenges faced by adolescents and young adults (AYA) as they move from paediatric to adult allergy care and what information and support are available to help UK allergy services provide health care as AYA make this transition. Transition has been defined as an “active and evolving process that addresses the medical, psychosocial and educational needs of young people as they prepare to move from child- to adult-centred health care”.5 However, there is a notable lack of discussion and published work around transition for AYA with allergy, who are largely faced with changing from a fairly holistic paediatric setting to organ-based adult care (eg allergy, dermatology, respiratory). In UK practice, the majority of paediatric care providers will, at the age of 16 years, either discharge patients or transfer care to adult services. This occurs at a time of significant change and pressure related to education and examinations and/or leaving school for the workplace or higher education. The move from paediatric to adult services and the developmental move from being a child to being an adult involves an increase in independence, a reduction in parental support and involves the young person being more in control of their own actions and therefore their own health. To do this, they need advice, guidance and training relevant to them and their developmental stage. Knowledge, skills and confidence (self-efficacy) are all needed to become independent, competent and eventually an expert in their own condition management. Not all young people will need to go to adult services, so transition can also be about helping them transition to “being an adult” rather than transitioning to adult services. To assess the challenges faced by AYA with asthma and allergies and how we can help them manage their allergies when transitioning from paediatric to adult services, a European Asthma Allergy and Clinical Immunology (EAACI) Taskforce was set up. The Allergic Diseases in Adolescents and Young People Taskforce are multi-disciplinary with members from primary, secondary and tertiary care, including nurses, clinicians and psychologists. The Taskforce has conducted two systematic reviews to assess current knowledge regarding the challenges faced by AYA with asthma and allergies6 and interventions that have been undertaken to help improve psychosocial outcomes for AYA with asthma and allergy.7 The work shows that key challenges for AYA with asthma and allergy includes maintaining good health-related quality of life and psychological health, adhering to medication, the self-management of their condition and having supportive relationships.6 Interventions (randomized controlled trials or case-control studies) to help AYA with these conditions have only been published for those with asthma.7 Furthermore, these tend to be pilot or feasibility studies with small sample sizes, although peer-supported interventions do look promising for improving QoL for AYA.7 The Taskforce has also conducted a Europe-wide survey with healthcare professionals to assess challenges of working with AYA and their current transition practices. With over 1000 responses from 41 countries, the survey revealed that awareness and in particular resources for transition processes for AYA were badly lacking.8 On the basis of this work, the Taskforce has published EAACI guidelines for the effective transition of AYA with asthma and allergic conditions,9 which add some condition-specific elements to already published generic transition documents such as the NICE guidelines (https://www.nice.org.uk/guidance/ng43, last accessed 7 September 2020). The EAACI guideline recommendations were reviewed and seconded by over 1000 AYA and parents in Europe (paper in preparation) and include general and allergy-specific guidance. General healthcare transition guidance outlined by the Taskforce includes taking a multi-disciplinary approach, starting transition early (around age 11-13 years depending on when the young person is developmentally ready), ensuring the AYA has a full understanding of their condition, ensuring the AYA has access to resources and understand how to adhere to their management plan. More specific asthma and allergy guidance focuses on what we know about the challenges AYA with asthma and allergies face and what type of interventions have proved successful. The EAACI guideline discusses the importance of identifying and managing psychological and socio-economic issues to help AYA transition to taking control of their own condition management. Enrolling the family and encouraging AYA to tell their friends about their allergies can also be crucial in helping them successfully manage while maintaining a good quality of life.9 It is clear from the work conducted thus far that effective transition is extremely important in ensuring continuation of health care for our young people with asthma and allergies. However, there are many challenges faced by allergy clinics and healthcare professionals in providing a transition service, particularly a lack of funding, resources and training and a lack of psychological support. A recent paper has highlighted the unmet need for psychological services in the UK for food allergy.10 There are also practicalities and challenges around information access and integrating transition across primary, secondary and tertiary care within the NHS. To help healthcare providers, the EAACI Taskforce is currently developing a toolkit that will be accessible online and will provide materials to assist in the development of transition services for AYA. It is hoped that the new guidelines and toolkit will help the development of effective transition services in allergy services across the UK. Both RCK and CG are members of the Allergic Diseases in Adolescents and Young People EAACI Taskforce.

Recurrent Aphthous Stomatitis, also known as aphthous ulcers or simply aphthous, is considered the most common of oral mucosal lesions. To describe the prevalence of recurrent aphthous stomatitis. Descriptive, cross-sectional and prospective study. 847 patients who attended the Family Medical Office No. 28, San Francisco comunity, Manzanillo, from July 1, 2021 to June 30, 2022, Cuba, were evaluated. A calibrated and trained assistant investigator evaluated the following variables: Clinical classification of recurrent aphthous stomatitis (minor aphthosis, major aphthosis, or aphthosis herpetiformis), lesion pain intensity, lesion location, and risk factors (viral infection), bacterial infection, immunological alterations, psychosomatic alterations, oral trauma, gastrointestinal alterations, endocrine factors, allergic conditions, heredity, blood and nutritional deficiencies, smoking), age group, sex, race, and duration of the lesion. Aphthous stomatitis occurred in 30.46%, with greater frequency in the age group 30 - 39 years (24.42%). Minor aphthosis was the most frequent with 91.09%. The duration of the lesion of 10 to 12 days predominated with 37.60%, the most frequent location corresponded to the edge and tip of the tongue with 32.94% and the most representative pain intensity was mild with a total of 63.18%. The highest frequency among the risk factors corresponded to psychosomatic alterations with 100%. Recurrent Aphthous Stomatitis had a prevalence greater than 30% with a predominance of the female sex and young adults. Minor Aphtosis and a stay time of more than 10 days were the most frequent. The most common location is the tongue and bottom of the vestibular sulcus with the possible existence of a relationship between the mobile parts of the mouth. Stress, the main risk factor, exacerbated by Covid-19.

The incidence of major depressive disorder (MDD) in adults has been associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated secretion of cortisol. However, limited research has been done globally on how the dysregulated HPA axis and changed cortisol levels relate to depression in adolescents and young adults. The objective of this research was to conduct a systematic review and meta-analysis of the association between cortisol level, a marker of HPA axis activity, and depression in adolescents and young adults. A systematic search was conducted using four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals written in English. The odds ratio (OR) and standard mean difference (SMD) were calculated, along with their 95% confidence intervals. We assessed heterogeneity using Cochrane c2 and I2 statistics and the appropriate P-value. The analysis used RevMan 5.3. The current meta-analysis included 10 cross-sectional studies with a total of 1301 adolescents and young adults across various age cohorts, with 629 depressed and 672 non-depressed individuals. It was found that the likelihood of depression is higher among the included adolescents and young adults, with an OR of 1.62 (95% CI: 0.44-5.92), and depressed individuals have significantly higher cortisol levels (SMD of 0.87 (95% CI 0.43-1.31) and cortisol stress response SMD of 0.68 (95% CI 0.31-1.05)). Furthermore, there was a strong positive linear association ( r = 0.82) between morning and afternoon cortisol levels in adolescents and young adults and depression scores. The results of our study indicate that an increase in both morning and afternoon cortisol levels is associated with the development of depression in adolescence and young adults. Research has indicated that an increased level of cortisol is considered a risk factor for depression during adolescence and a linear correlation exists between cortisol levels and depression scores.

BackgroundSuicide is the second leading cause of death among young people worldwide and remains a major public health concern. Research indicates that negative social contexts involving familial and peer relationships, have far-reaching influences on levels of suicidal behaviours in later life. Previous systematic reviews have focused on evaluating associations between negative life events such as abuse and bullying in childhood and subsequent self-harm or suicidality. However, the association between adolescent experiences of humiliation and shame, and subsequent self-harm or suicidal behaviour among children and young adults has not been well examined. As such, this systematic review is conducted to examine the prevalence and association between humiliation and shame and self-harm, suicidal ideation, and death by suicide among adolescents and young adults.MethodsA systematic literature search in extant electronic databases including; MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, and Embase will be conducted to identify potential studies. Google Scholar, and the reference list of the retrieved articles and/or previous systematic reviews in this area, will also be scanned to identify further potential studies. ProQuest will be searched to identify relevant studies available within grey literature. There are no restrictions on the date of publications. Based on our initial review, the following terms were identified: Population: Adolescent (MESH), young adult (MESH), teen, teenage. Exposure: Humiliation, degradation, shame (MESH) or embarrassment (MESH), harassment victimisation, abasement. Outcome: Self-injurious behaviour (MESH), suicide (MESH), suicide attempted (MESH), suicide completed (MESH), self-harm, intentional self-injury, deliberate self-harm, overdose, deliberate self-poisoning, non-suicidal self-injury, self-mutilation, suicidal thought, suicidal ideation, suicidal intent, suicide. At least one term from each category will be used for conducting the literature search. All original quantitative studies published in the English language which examined the prevalence or association between humiliation or shame and self-harm and/or suicidal ideation and/or completed suicide will be included. The studies will be assessed for methodological quality using the Joanna Briggs Institute critical appraisal tools. Narrative synthesis will be performed for all of the studies. If the studies are sufficiently homogenous, the results will be pooled for a meta-analysis. This systematic review protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) guidelines. The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022289843].DiscussionThis is the first review to synthesise evidence on the prevalence of, and associations between the experiences of humiliation and shame and subsequent self-harm and/or suicidal behaviours among adolescents and young adults. As there is growing evidence on increased self-harm among this age group, it is important to identify population-specific risk factors for self-harm and suicidality which will have significance in formulating tailored and effective treatment and therapeutic services for adolescents and young adults.

Although numerous resilience interventions have been developed for adolescents (age 10–19) and young adults (age 20–25), their comparative effectiveness remains unclear. This systematic review and network meta-analysis aimed to compare the efficacy of different resilience interventions and further investigate whether the intervention effects differed based on participants’ condition (at-risk or non-at-risk) and age group (adolescents or young adults). A systematic search across PsycINFO, Embase, PubMed, and Web of Science was conducted from inception to October 31, 2024. A total of 46 randomized controlled trials involving 8729 participants were identified (mean age = 15.61 years; 54.18% female). The main results indicate that physical activity, psychotherapy, mindfulness, and skill training significantly enhanced resilience compared to treatment as usual. However, the effectiveness of mindfulness should be interpreted with caution, as its effect was not significant in the sensitivity analysis. Subgroup network meta-analyses suggest that physical activity, psychotherapy, and skill training were particularly effective for adolescents, while psychotherapy, psychoeducation, mindfulness, and skill training were effective for young adults. Additionally, physical activity and skill training were effective for non-at-risk populations, whereas psychotherapy, skill training, mindfulness, and psychological placebo were effective for at-risk populations. Psychotherapy was more effective than skill training for at-risk individuals. Notably, there were no studies on psychoeducation for at-risk populations and no studies on physical activity for at-risk populations and young adults. Meta-regression revealed that the level of individualism and duration per session can influence the effectiveness of these interventions. This study provides valuable insights for clinicians to tailor interventions to specific populations of adolescents and young adults and highlights the need to consider cultural factors when designing interventions.

BackgroundCorticosteroids (CSs) are widely used to treat autoimmune diseases, allergic conditions, and cancers, but they are often associated with psychiatric side effects, such as insomnia, anxiety, depression, mania, and psychosis. Comprehensive evaluations of psychiatric risks, including acute and long-term effects, as well as their associations with dose and cumulative exposure, remain limited. Understanding these relationships is crucial for optimizing therapeutic strategies and minimizing psychiatric risks.Aims & ObjectivesThis study aimed to systematically evaluate the psychiatric risks associated with corticosteroid use, focusing on both acute and long-term settings. The primary objectives included assessing the risks of depression, mania, and psychosis, and examining their associations with dose, and duration.MethodA systematic literature search was conducted in MEDLINE and Embase databases up to March 22, 2024, using keywords related to corticosteroids and psychiatric symptoms. Observational studies with clearly defined psychiatric outcomes and quantifiable data were included. Data were analyzed using a random-effects model, and heterogeneity was assessed with the I² statistic. For studies reporting multiple non-independent outcomes, we conducted a three-level meta-analysis to account for the dependency between effect sizes within studies. In addition, qualitative data were synthesized to explore patterns of symptom progression and their relationship with treatment characteristics. The risk of bias was evaluated using the Newcastle-Ottawa Scale.ResultsA total of 69 studies were included, comprising cross-sectional, cohort, pre-post, case-control, and other observational study designs. The three-level meta-analysis of depressive symptoms, based on six studies with seven groups and 10 effect sizes, revealed a pooled standardized mean difference (SMD) of 1.01 (95%Confidence Interval (CI)=0.40–1.61, p<0.01) with significant heterogeneity (I²=84%). Six acute-phase studies on mania and depressive symptoms demonstrated that mania was more frequently reported than depressive symptoms, with a pooled odds ratio (OR) of 2.37 (95%CI=1.52–3.69, p<0.01) and low heterogeneity (I²=0%). For psychosis, a meta-analysis of six studies reported a pooled proportion of 3.0% (95%CI=1.0%–8.6%), with high heterogeneity (I²=92%) indicating variability across studies. Qualitative assessments suggested that high doses and prolonged use of CSs were consistently associated with an increased risk of psychiatric symptoms. Acute symptoms, such as mania and psychosis, were often reported within 3–14 days of treatment initiation, whereas depressive symptoms were more frequently associated with long-term exposure.Discussion & ConclusionsThis meta-analysis highlighted the differential risks of psychiatric symptoms associated with CS use. Mania and psychosis were more frequent during acute treatment, particularly at high doses, while depression was predominantly observed in long-term use. These findings underscore the importance of early monitoring and individualized treatment strategies, especially for patients receiving high-dose or prolonged CS treatment. The high heterogeneity observed in studies on depression and psychosis reflects the complexity of these risks and the need for further research to explore contributing factors. This study provides new insights into the dose- and time-dependent effects of CS-induced psychiatric symptoms, offering effective risk management strategies.

Relationship between Early Maladaptive Schemas and Anxiety in Adolescence and Young Adulthood: A systematic review and meta-analysis

To determine the association between combined lifestyle factors, including healthy diet, moderate alcohol consumption, non-smoking, physical activity, and optimal weight, and cardiovascular disease (CVD) risk among younger and older adults. We conducted a literature search using PubMed, EMBASE, Cochrane Library, and EBSCO databases up to November 30, 2019 and performed dose–response analysis, subgroup analysis and meta-regression with odds ratios and 95% confidence intervals (CIs). Twenty cohort studies involving 1,090,261 participants with 46,288 cardiovascular events and mean follow-up duration of 12.33 years were included. Compared with the group with the lowest number of healthy lifestyle factors, the group with the highest number had lower CVD risk [pooled hazard ratio, 0.37 (95% CI 0.31–0.43)]. With age as an effect modifier, the lifetime risk of CVD was 0.31 (95% CI 0.24–0.41) at age 37.1–49.9 years, 0.36 (95% CI 0.30–0.45) at age 50.0–59.9 years and 0.49 (95% CI 0.38–0.63) at age 60.0–72.9 years. The hazard ratio of CVD significantly increased from 37.1 to 72.9 years of age [slope in multivariate meta-regression: 0.01 (95% CI < 0.001–0.03; p = 0.042)]. Younger adults have more cardiovascular benefits from combined healthy lifestyle factors.

A strong and healthy microbiome is responsible for homeostasis between the host and microbiota which is necessary to achieve the normal functioning of the body. Dysbiosis provokes prevalence of pathogenic microbes, leading to alterations in gene expression profiles and metabolic processes. This in turn results in anomalous immune responses of the host. Dysbiosis may be associated with a wide variety of diseases like irritable bowel syndrome, coeliac disease, allergic conditions, bronchitis, asthma, heart diseases and oncogenesis. Presently, the links between oral microbial consortia and their functions, not only in the preservation of homeostasis but also pathogenesis of several malignancies have gained much awareness from the scientific community. The primary intent of this review is to highlight the dynamic role of oral microbiome in oncogenesis and its progression through various mechanisms. A literature search was conducted using multiple databases comprising of PubMed, Scopus, Google Scholar, and Cochrane electronic databases with keywords including microbiome, microbiota, carcinogenesis, tumorigenesis, and immunosuppression. Current and the past literature has pointed out the role of microorganisms in oncogenesis. It may be put forth that both the commensal and pathogenic strains of oral microbiome play an undeniably conspicuous role in carcinogenesis at different body sites.

Obesity is a growing public health concern worldwide, especially among young adults. This scoping review aims to identify and summarize the current evidence on dietary and lifestyle risk factors associated with obesity among young adults. A scoping review was performed using the PRISMA-ScR guidelines. A systematic search of five electronic databases published from inception to October 2023 was conducted. A total of 46 observational studies met the inclusion criteria and were included in the review. The findings suggest that high intake of energy-dense foods, unhealthy eating habits, poor sleep quality, and increased screen time were significant risk factors for obesity among young adults. In contrast, the association between obesity and sedentary behavior, low physical activity levels, alcohol consumption, and smoking habits was inconclusive. The reviewed evidence suggests that unhealthy dietary habits and lifestyle behaviors are associated with an increased risk of obesity among young adults. The findings highlight the need for further research on these modifiable risk factors to prevent and manage obesity among young adults.

The role of cognition in balance control suggests that mental fatigue may negatively affect balance. However, cognitive involvement in balance control varies with the type or difficulty of the balance task and age. Steady-state balance tasks, such as quiet standing, are well-learned tasks executed automatically through reflex activities controlled by the brainstem and spinal cord. In contrast, novel, and challenging balance tasks, such as proactively controlling balance while walking over rugged terrain or reacting to unexpected external perturbations, may require cognitive processing. Furthermore, individuals with preexisting balance impairments due to aging or pathology may rely on cognitive processes to control balance in most circumstances. This systematic review and meta-analysis investigated the effect of mental fatigue on different types of balance control tasks in young and older adults. A literature search was conducted in seven electronic databases and 12 studies met eligibility criteria. The results indicated that mental fatigue had a negative impact on both proactive (under increased cognitive load) and reactive balance in young adults. In older adults, mental fatigue affected steady-state and proactive balance. Therefore, mentally fatigued older individuals may be at increased risk of a loss of balance during steady-state balance task compared to their younger counterparts.

Objective: This systematic review aimed to explore the evidence on whether the preferred listening levels (PLLs) and durations of music listening through personal listening devices (PLDs) in adolescents and young adults exceed the current recommended 100% daily noise dose; together with the impact on hearing and possible influential factors of such listening behaviours. Design: A systematic search was conducted using multiple online bibliographic databases. Study sample: The 26 studies were included on the basis of the inclusion and exclusion criteria. Results: The results showed that up to 58.2% of participants exceeded the 100% daily noise dose, particularly in the presence of background noise. Significantly positive correlations were found among background noise levels and mean PLLs, as well as the proportion of participants exceeding the 100% daily noise dose. Moreover, significantly worse hearing thresholds were found in PLD users using audiometry, and significantly poor results in otoacoustic emission (OAE), even in the participants with self-reported ‘normal hearing’. Conclusion: It is crucial to develop appropriate standards and safe recommendations for daily music exposure dose in future studies. Providing an essential guide and effective education to adolescents and young adults will help raise awareness, increase knowledge, and consequently change attitudes and listening habits.

This study explores intergenerational co-residence, explicitly focusing on the decision-making factors of older adults and their adult children. While previous research has touched on this topic, only a few studies have truly evaluated the factors driving both generations’ willingness to embrace this living arrangement. This study systematically reviews the factors influencing older and younger adults’ willingness to live in intergenerational households. Systematic searches were conducted through five databases: CINAHL, Embase, PsycINFO, PubMed, and Scopus; all studies until September 2022. Of the 467 articles initially identified, 17 articles were retained for data extraction. Extracted data were divided into two groups: older people’s and adult children's perspectives. Data extraction revealed six factors influencing older adults’ decision to live with their children, encompassing financial circumstances, health conditions, kinship systems, marital status, level of education, and number of family members. Similarly, these factors are relevant for adult children, except for health conditions. The interconnection between these factors and their dynamics is contingent upon the specific context of each region’s population.

Artificial light at night (ALAN) exposure is associated with the disruption of human circadian processes. Through numerous pathophysiological mechanisms such as melatonin dysregulation, it is hypothesised that ALAN exposure is involved in asthma and allergy, mental illness, and cancer outcomes. There are numerous existing studies considering these relationships; however, a critical appraisal of available evidence on health outcomes has not been completed. Due to the prevalence of ALAN exposure and these outcomes in society, it is critical that current evidence of their association is understood. Therefore, this systematic scoping review will aim to assess the association between ALAN exposure and asthma and allergy, mental health, and cancer outcomes. This systematic scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. We will search bibliographic databases, registries, and references. We will include studies that have described potential sources of ALAN exposure (such as shift work or indoor and outdoor exposure to artificial light); have demonstrated associations with either allergic conditions (including asthma), mental health, or cancer-related outcomes; and are published in English in peer-reviewed journals. We will conduct a comprehensive literature search, title and abstract screening, full-text review, and data collection and analysis for each outcome separately.