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Item Endocrine and Metabolic Disorders in Survivors of Childhood Cancers and Health-Related Quality of Life and Physical Activity(Oxford, 2019-11) Pradhan, Kamnesh R.; Chen, Yan; Moustoufi-Moab, Sogol; Krull, Kevin; Oeffinger, Kevin C.; Sklar, Charles; Armstrong, Gregory T.; Ness, Kirsten K.; Robison, Leslie; Yasui, Yutaka; Nathan, Paul C.; Pediatrics, School of MedicineContext Childhood cancer survivors experience chronic health conditions that impact health-related quality of life (HRQOL) and participation in optimal physical activity. Objective The study aimed to determine independent effects of endocrine and metabolic disorders on HRQOL and physical activity. Design, Setting, and Patients Retrospective cohort with longitudinal follow-up of survivors of childhood cancer enrolled in the North American Childhood Cancer Survivor Study. Main Outcome Measures Medical Outcomes Short Form-36 estimated HRQOL, and participation in physical activity was dichotomized as meeting or not meeting recommendations from the Centers for Disease Control and Prevention. Log binomial regression evaluated the association of each endocrine/metabolic disorder with HRQOL scales and physical activity. Results Of 7287 survivors, with a median age of 32 years (range, 18 to 54 years) at their last follow-up survey, 4884 (67%) reported one or more endocrine/metabolic disorders. Survivors with either disorder were significantly more likely to be male, older, have received radiation treatment, and have experienced other chronic health conditions. After controlling for covariates, survivors with any endocrine/metabolic disorder were more likely to report poor physical function risk ratio (RR, 1.25; 95% CI, 1.05 to 1.48), increased bodily pain (RR, 1.27; 95% CI, 1.12 to 1.44), poor general health (RR, 1.49; 95% CI, 1.32 to 1.68), and lower vitality (RR, 1.21; 95% CI, 1.09 to 1.34) compared with survivors without. The likelihood of meeting recommended physical activity was lower among survivors with growth disorders (RR, 0.90; 95% CI, 0.83 to 0.97), osteoporosis (RR, 0.87; 95% CI, 0.76 to 0.99), and overweight/obesity (RR, 0.92; 95% CI, 0.88 to 0.96). Conclusion Endocrine and metabolic disorders are independently associated with poor HRQOL and suboptimal physical activity among childhood cancer survivors.Item Movement Disorders and Neurometabolic Diseases(Elsevier, 2018) Christensen, Celanie K.; Walsh, Laurence; Neurology, School of MedicineMany inherited metabolic disorders cause movement disorders in children. This review focuses on chorea, dystonia, myoclonus, tremor, and parkinsonism. Broad categories commonly responsible for pediatric movement disorders include mitochondrial disorders, organic acidemias, mineral metabolism and transport disorders, neurotransmitter diseases, purine metabolism disorders, lipid storage disorders, and disorders of creatine metabolism. Each movement disorder can be caused by many different inherited metabolic disorders and several of the inherited metabolic disorders can cause multiple movement abnormalities. Dietary modifications, medications, and increasingly specific therapy can improve outcomes in children with movement disorders caused by metabolic disorders. Recognition and characterization of secondary movement disorders in children facilitate management of the abnormal movements and diagnosis, and possible treatment, of an underlying metabolic disorder.