Graves disease (GD) is the primary cause of hyperthyroidism in children. The standard management options—namely, antithyroid drugs (ATD), radioactive iodine, and surgery—have not changed for many years. Although ATD therapy is often the first-line treatment for pediatric patients, the low likelihood of spontaneous remission means that most children will require a more permanent solution. Recent clinical trials and systematic reviews have shed light on the long-term outcomes of ATD therapy, radioactive iodine, and surgical interventions in managing pediatric GD. Additionally, novel therapies aimed at B-cells or the thyroid-stimulating hormone receptor, both implicated in the pathogenesis of GD, are under investigation. However, their definitive role in treating childhood GD has yet to be established. This review will cover the latest developments in the treatment of childhood GD, including information on emerging targeted therapies.
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, Eu Seon Noh, Il Tae Hwang Recent advances in medicine have led to an increase in the number of children and adolescents treated for various chronic diseases and cancer. Increasingly sophisticated genetic analysis techniques have also clarified some genetic factors that contribute to bone fragility. Osteoporosis, characterized by reduced bone mass and skeletal fragility, can result from primary or secondary causes that originate in childhood and adolescence, which are critical periods for bone mineral acquisition. It is essential to identify children and adolescents at risk of fractures due to osteoporosis, and early intervention is crucial. Conservative management strategies, such as treating underlying diseases, replacing deficient hormones, providing nutritional support to meet calcium and vitamin D requirements, and encouraging regular physical activity, should be prioritized. Pharmacological treatment should be initiated in a timely manner following a comprehensive bone health examination. Intravenous pamidronate therapy has been safely and effectively administered to children and adolescents, although long-term follow-up is necessary. Further investigation is needed regarding bone fragility fractures of unknown etiology and the application of new medications for pediatric use.
, Il Tae Hwang Cardiovascular disease (CVD) is the most common cause of death worldwide, and dyslipidemia is a major risk factor. Atherosclerosis can begin in childhood and continue into adulthood, thereby contributing to CVD development. Obesity is the most common cause of dyslipidemia, and the prevalence of childhood obesity and dyslipidemia is increasing worldwide, making it a public health concern. As clinical evidence has accumulated, guidelines for dyslipidemia in children have been continuously revised since 1992. The limitations of screening tests for individuals with a family history of dyslipidemia emphasize the necessity of universal screening, and non-HDL cholesterol assessment is recommended as a screening test for dyslipidemia in children. The guidelines for dyslipidemia in Korean children and adolescents published in 2017 recommend that non-HDL cholesterol screening tests be performed in non-fasting conditions at 9–11 years and 17–21 years of age. The main purpose of this article is to describe the history and rationale of lipid screening recommendations in children and adolescents and to review the currently recommended screening methods and treatments for dyslipidemia. (Ewha Med J 2022;45(3):e4)
, Jae Hyun Kim The incidence of type 2 diabetes mellitus (T2DM) is increasing in youth, largely in correlation with an increase in childhood overweight and obesity. Youth-onset T2DM is a major public health concern worldwide, and tends to show more aggressive features than adult-onset T2DM. Early diagnosis and treatment are important to prevent the occurrence of complications and comorbidities. However, current treatment options are limited and only modestly successful in youth-onset T2DM. Over the last few decades, significant progress has been made in the understanding of youth-onset T2DM. This review summarizes the current understanding of the pathogenesis, diagnosis, and treatment of T2DM in youth. (Ewha Med J 2022;45(3):e3)
, Kyunghee Jung-Choi, Bo Young Kim, Kyoung Ae Kong This study aimed to investigate the prevalence of unhealthy dietary habits by maternal educational level and how the effect of maternal education changed between 2009 and 2019.
Using data from the Korea Youth Risk Behavior Survey conducted between 2009 and 2019, we assessed the prevalence of each unhealthy dietary habit (insufficient consumption of milk and fruit/vegetable, breakfast-skipping, and frequent consumption of fast food, soft drinks, and instant noodles) and the prevalence difference between maternal middle/high school and college graduate groups in four periods. The models included maternal educational level, four periods and the interaction between them, sex, and grade. In addition, we estimated the ORs of unhealthy dietary habits between the two maternal educational groups at each period.
Throughout the study period, unhealthy dietary habits were consistently more prevalent among mothers with lower education levels. Between 2009–2010 and 2017–2019, the prevalence of unhealthy dietary habits increased, with a particular increase in that of frequent consumption of fast food and soft drink. The prevalence differentials between the middle school and college graduate group decreased or did not differ, while those between the high school and college graduate groups increased over time. A similar trend was observed in the relative scale.
Considering the increase in the prevalence of unhealthy dietary habits and the prevalence differentials by maternal educational level, targeted efforts are needed not only for all adolescents and their parents but also for those with low socioeconomic status to improve the dietary habits of adolescents.
This study aims to investigate the domographic characteristics, main clinical problems, diagnoses and treatments of child and adolescent psychiatric outpatients.
The statistical analyses were based on the clinical reports and medical records of 111 child and adolescent psychiatric patients who wisited to the outpatient clinic during current 6 months.
1)The sex ratio(male : female) of these 111 patients was 1.1:1 and the most frequent age group was adolescent period(13-18 years of age). In sibling order, the first born child was more prevalent. Almost all the patients had both parents and was accompanied by a mother on the first visit. The most living place of the patients was in Seoul. 2) The main problems visiting our coinic were in following order : somatic symptoms, learning problems, anxiety, fear & restlessness, attention deficits, conduct problems and substance abuse etc. 3) Diagnostic distribution of the patients was in following order : conduct disorder, mood disorder, organic mental disorder, attention deficit hyperactivity disorder, anxiety disorder etc. 4) The patients who visited to the outpatient coinic above 5 times were more frequent. The more frequently used method for treatments was in the sequence of pharmacotherapy combined with psychotherapy and behavior therapy.
These results suggest that the necessity of the space of special therapy(such as play and behavior therapy) for the children and division of child and adolescent psychiatry is very important in current situation.
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, Gyoung Hee Kim This study was performed to investigate the prevalence of abnormal behavior, ada-ptability and intelligence of child and adolescents and the usefulness of KAS(Korean Attitude System) as a screening method to detect the psychopathology of child and adolescents.
478 child and adolescents were completed the instruments of KAS that focused on development of behavior, adaptability and intelligence at the children's medical examination center.
The most influenced subcategories to the disturbance of behavior of the subjects were leadership, cooperation, and emotion (in order). The preference of adaptability was high in the fields of literature, law, technology, medicine and sociology. The mean I.Q. of the subjects was high average and not different in both sex. The subjects with below average of I.Q. were three cases(0.6%) and the two of them were boderline and only one case was mild mental retardation. The total number of patients referred to the department of psychiatry was eight cases(1.7%) and revealed the disturbance of behavior, affect, and thought.
Finally the authors concluded that KAS test performed at the children's medical examination center was useful primary screening method to detect the psychopathology of child and adolescents.
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