Outcomes For Boys Research Articles

Impact of fetal versus perinatal hypoxia on sex differences in childhood outcomes: developmental timing matters

To examine how the timing of hypoxic exposure results in specific childhood outcomes and whether there is a differential effect by sex. A sample of 10,879 prospectively followed pregnancies was drawn from the Boston and Providence sites (New England, NE) of the National Collaborative Perinatal Project. Based on placental pathology, we developed and validated a measure of probable chronic placental hypoxia (CHP) and contrasted the effects of acute perinatal hypoxia on age 7 emotional, behavioral, and cognitive outcomes. Perinatal hypoxia had a significant impact on multiple behavioral and cognitive outcomes in boys and girls by age 7, in contrast to probable CHP which had a differential effect on girls and boys such that there was decreased verbal IQ and increased inhibition in females alone. Findings underscore the importance of considering the timing of obstetric complications and offspring sex in investigations of the impact of fetal and perinatal hypoxia on offspring's outcomes throughout the life course.

A Conservative Approach to Testicular Rupture in Adolescent Boys

Management for blunt trauma with breach of the renal capsule or bladder (extraperitoneal) has largely become nonsurgical since a conservative approach proved to be effective and safe. Currently the recommendation for managing testicular rupture is surgical exploration and débridement or orchiectomy. We report outcomes in boys diagnosed with testicular rupture and treated without surgical intervention. In the last year we conservatively treated 7 consecutive boys with delayed presentation of testicular rupture after blunt scrotal trauma. Patients were treated with scrotal support, antibiotics to prevent abscess, rest, analgesics and serial ultrasound. We report clinical information and outcomes. The 7 boys were 11 to 14 years old and presented 1 to 5 days after injury. Trauma was to the left testis in 3 cases and to the right testis in 4. Patients presented with mild to moderate pain and similar scrotal swelling. Ultrasound findings consistently revealed hematocele and increased echogenicity. Blood flow was present in the injured portion of the testes in 3 cases and to the remainder of the affected testicle in 6 of the 7 boys. In the remaining boy an adequate waveform was not seen in either testicle, which the radiologist thought was secondary to prepubertal status. Other findings included scrotal edema, irregular contour and seminiferous tubule extrusion. Followup was greater than 6 months in all cases. Five boys were seen at the office and the 2 remaining had telephone followup. In all cases hematocele resolved, testicular size stabilized without atrophy and echogenicity normalized in the 5 patients with followup ultrasound. One patient required surgical repair of hydrocele 4 months after trauma but no other patient needed surgical exploration. No abscess or infection developed. A conservative approach in a select group of adolescent boys with testicular rupture can result in resolution of the fracture and maintenance of testicular architectural integrity.

Resources in vocational education and post‐schooling outcomes

PurposeThe purpose of this paper is to examine the determinants of labour market outcomes after the initial vocational basic education (ISCED 3).Design/methodology/approachA multinomial logit model is used for examining the effect of school resources and other factors on students' post‐schooling outcomes defined as employment, further studies, non‐employment and dropping out. Analysis has been done by using unique linked register data on students, their parents, teachers, educational organisations and business companies in Finland.FindingsThe results indicate that teaching expenditures do not matter but teachers' characteristics have a role to play. Teachers with a university degree increase the employment probability of the students, whereas the formal competence of the teachers does not have such positive effects. The students' characteristics and performance in comprehensive schools play an important role in determining the outcomes. Local business conditions affect the outcomes of boys but less those of girls. The official quality evaluations adopted in recent years seem to pay attention especially to such aspects of education production that are important for providing capabilities for further studies but less so for employability.Originality/valueEmployability seems to be a great challenge to the initial vocational basic education. The findings for local business conditions give support to the view that measures of education policy do not suffice but need to be complemented with those of regional or employment policy, for example, policies aiming to increase regional mobility of the labour force. Such complementary tools are particularly important for boys.

Early Hypospadias Surgery May Lead to a Better Long-Term Psychosexual Outcome

We evaluated long-term outcomes in boys treated for hypospadias at Royal Children's Hospital, Melbourne. Boys who underwent hypospadias surgery were reviewed at ages 13 to 15 years. Surgical results were evaluated using the Hypospadias Objective Scoring Evaluation. Lower urinary tract function was assessed using uroflowmetry and symptom questionnaire. Self-report surveys measured quality of life, patient satisfaction, memory of surgery, psychosexual outcomes and parent satisfaction with care. By Hypospadias Objective Scoring Evaluation score 80% of patients had an excellent surgical outcome. Two independent reviewers assessed lower urinary tract function as normal in 82% and 86% of cases, respectively. Quality of life scores were comparable to published values in normal children. Parents rated the institution highly. Overall 90% and 81% of boys were satisfied with the body and genital appearance, respectively. Those dissatisfied with genital appearance had poorer psychosexual outcomes than satisfied patients. When surgery was completed before age 5 years, boys had no perioperative memories. An association was found between no recollection of surgery and satisfaction with body appearance. Objective surgical and functional outcomes are excellent after early surgery. Post-repair quality of life is comparable to published data on normal children. Parents are pleased with care. Most boys are satisfied with the body and genital appearance. However, those dissatisfied with genital appearance must be identified in the interest of psychosexual development. The association between no recollection of treatment and satisfaction with body appearance suggests that surgery should be completed before age 5 years when possible to allow the development of good body image in adolescence.

Robust hope, democracy and early childhood education

This paper discusses a recent Australian study of boys' education using case studies to determine successful practices. It focuses on an early childhood site where access to ‘discourses of power’ for students and parents and a valuing of students' ‘action knowledge’ created a particular democratic culture achieving improved outcomes for boys. The data are drawn from focus groups with families, interviews with educators, conversations with children and on‐site observations over two days. The findings are discussed in terms of those factors deriving from Henry Giroux's work on democracy and hope. In addition, we build on the work of Giroux by discussing the site as an exemplar of what we have come to call ‘robust hope’.

Emotion socialization, child emotion understanding and regulation, and adjustment in urban African American families: differential associations across child gender.

The prospective relation of maternal emotion philosophy to children's emotion understanding and regulation and positive and negative adjustment was investigated. Sixty-nine African American youth (50% male; M age = 11.29 years) and their maternal caregivers living in high violence areas of a midsized city participated in this interview study. Caregivers' meta-emotion philosophy predicted child emotion understanding and emotion regulation, which also were associated with Time 2 grades, internalizing behaviors, externalizing behaviors, and social skills after controlling for Time 1 adjustment. Emotional understanding mediated the relationship between caregivers' emotional socialization and boys' internalizing behaviors and between caregivers' emotional socialization and girls' social skills. In addition, emotion regulation mediated the relationships between emotional socialization and all four outcomes for boys. Implications for future work on emotion socialization and clinical intervention, particularly related to emotion regulation, are discussed.

The pattern of physical activity in relation to health outcomes in boys

The pattern of physical activity in relation to health outcomes in boys

The pattern of physical activity in relation to health outcomes in boys

Spontaneous and transitory movement patterns are characteristic of children. The aim of this study was to explore the relationship between short, frequent activity bouts and children's health. Physical activity was recorded every 2 s by accelerometry (ActiGraph GT1M) for seven days in 47 boys (age 8-10 years). Summary activity measures and activity pattern characteristics (frequency, intensity and duration of > or = 4 s [short] and > or = 5 min [long] bouts of > or= light [> or = LIGHT], > or = moderate [> or = MOD], > or = vigorous [> or = VIG], and > or = hard [> or = HARD] intensity activity) were recorded. Microvascular function was assessed using laser Doppler perfusion imaging as the forearm skin blood flow response to the iontophoretic application of acetylcholine (endothelial dependent vasodilator) and sodium nitroprusside (endothelial independent vasodilator) at rest and following maximal exercise. Waist circumference, resting blood pressure and aerobic fitness (VO(2peak)) were measured. The intensity of short and long > or = LIGHT bouts and the frequency of short and long > or =MOD bouts were correlated with waist circumference (r = - 0.42 to -0.52, p < 0.01) and VO(2peak) (r = 0.42 to 0.47, p < 0.01), but not when scaled for lean body mass. The frequency of short and long > or =LIGHT bouts were associated with change in endothelial function from rest to post-exercise (r = 0.34 to 0.55, p < 0.05). No relationships were evident between blood pressure and activity. The relationship between the frequency of short bouts (> or =4 s) of activity and health was as strong as relationships identified between longer bouts (> or =5 min) and health. This is encouraging as sporadic intermittent activity is characteristic of children's activity pattern.

Presence in Relationship: A New Construct for Understanding Adolescent Friendships and Psychological Health

This article introduces the construct of “presence in relationship” along with a 25-item measure for its quantitative assessment. This construct expands upon the construct of “voice” as an indication of one’s experiences of self in relationships. Whereas voice focuses on the act of speaking out (saying what one thinks and feels) in relationships, presence in relationship further reflects the extent to which an individual feels connected to his or her self (is self-aware), connected to others (truly known and understood by others), and confident (trusting that one will be accepted and valued by others) within the context of interpersonal relationships. Results from the study of two samples of ethnically diverse middle school (N = 113; 59 males, 54 females) and high school (N = 176; 86 males, 90 females) students in New York City indicate that the Presence in Relationship Scale (PIRS) demonstrates good reliability and provides insight into adolescents’ friendship processes and sense of well-being. Because it includes indicators of the experience of self in relationships, as well as behavioral indicators, presence in relationship may be especially useful for understanding relationships and associated mental health outcomes in boys (and girls) who tend to place less emphasis on voice as a primary way of determining of closeness in relationships.

Intermittent Torsion of the Spermatic Cord Portends an Increased Risk of Acute Testicular Infarction

Intermittent torsion of the spermatic cord is an episode of acute torsion of the spermatic cord that resolves spontaneously. We compared the outcomes in boys with intermittent spermatic cord torsion treated electively with testicular fixation with those in boys with a history of recurrent scrotal pain who required emergent operation for acute spermatic cord torsion without spontaneous resolution. A retrospective review revealed 17 boys who required emergency operation for acute spermatic cord torsion and 30 who underwent elective surgery for intermittent spermatic cord torsion. The clinical presentation, number of recurrent painful episodes, lead time to operation, prior alternate diagnoses, intraoperative findings and clinical outcomes were recorded. There was a mean of 2 recurrent painful episodes in the elective group and 3 in the emergency group (p <0.005). In the elective group all boys were cured of pain after bilateral testicular fixation with 100% testicular preservation at a mean of 4 months of followup. In the emergency group at a mean of 10 months of followup the testicular preservation rate was 47% (p <0.01). Intraoperatively an ipsilateral bell clapper malformation was found in 100% of boys in each group. A contralateral bell clapper malformation was noted in 90% and 88% of boys in the elective and emergency groups, respectively. When diagnosed accurately, intermittent spermatic cord torsion can be treated with elective testicular fixation with an excellent outcome. Misdiagnosis may create a cohort of boys with intermittent spermatic cord torsion who are at risk for acute unresolved torsion and potential testicular loss. Urologists should be proactive in recommending elective scrotal exploration when intermittent spermatic cord torsion is a likely diagnosis.

G.P.1.10 Profiles of weight gain and cardiopulmonary outcomes in boys with Duchenne muscular dystrophy

G.P.1.10 Profiles of weight gain and cardiopulmonary outcomes in boys with Duchenne muscular dystrophy

Orthopedic outcomes of long-term daily corticosteroid treatment in Duchenne muscular dystrophy

To document the effects of long-term daily corticosteroid treatment on a variety of orthopedic outcomes in boys with Duchenne muscular dystrophy. We reviewed the charts of 159 boys with genetically confirmed dystrophinopathies followed at the Ohio State University Muscular Dystrophy Clinic between 2000 and 2003. Charts were reviewed for ambulation status, type and duration of steroid treatment (if any), and orthopedic complications including presence and location of long bone fractures, vertebral compression fractures, and the presence and degree of scoliosis. The cohort consisted of 143 boys (16 boys with Becker dystrophy were excluded); 75 had been treated with steroids for at least 1 year, whereas 68 boys had never been treated or had received only a brief submaximal dose. The mean duration of daily steroid treatment was 8.04 years. Treated boys ambulated independently 3.3 years longer than the untreated group (p < 0.0001) and had a lower prevalence of scoliosis than the untreated group (31 vs 91%; p < 0.0001). The average scoliotic curve was also milder in the treated group (11.6 degrees) compared with the untreated group (33.2 degrees; p < 0.0001). Vertebral compression fractures occurred in 32% of the treated group, whereas no vertebral fractures were discovered in the steroid naive group (p = 0.0012). Long bone fractures were 2.6 times greater in steroid-treated patients. Although boys with Duchenne muscular dystrophy on long-term corticosteroid treatment have a significantly decreased risk of scoliosis and an extension of more than 3 years' independent ambulation, they are at increased risk of vertebral and lower limb fractures compared with untreated boys.

Prospective Controlled Long‐term Follow‐up for Functional Outcome After Anoplasty in Boys With Perineal Fistula

Functional outcomes after treatment of low anorectal anomalies remain controversial. To address this, we conducted a controlled, prospective single-center long-term follow-up study of functional outcome in boys treated for perineal fistula with anoplasty. Twenty-four consecutive boys treated exclusively for perineal fistula from 1992 to 2001 underwent prospective follow-up after completion of toilet training. All of the patients had identical surgical treatment. Functional outcome was assessed according to a previously validated bowel function score (7 questions, maximum score of 20). Daytime and nighttime wetting, as well as the age at toilet training, were also recorded. Thirty-seven age-matched boys served as healthy controls. An independent nurse specialist interviewed caregivers. Age of the patients (9.1 +/- 2.6 years) and controls (9.0 +/- 2.9 years) were similar. Seven patients (32%) had bowel function scores below the 10th percentile (17.2) of the controls, which was chosen as a lower limit of normality. The overall mean bowel function score was significantly lower (P < 0.01) among the patients (17.9 +/- 1.9) compared with the controls (19.1 +/- 1.2). The difference was attributed mainly to significantly lower scores (0-3) among patients in questions assessing constipation (2.4 +/- 0.8 vs 2.9 +/- 0.3; P < 0.05) and soiling (2.5 +/- 0.5 vs 2.8 +/- 0.4; P = 0.05). Constipation and soiling were significantly more common (P < 0.05) among patients (41% and 55%, respectively) compared with controls (8% and 24%, respectively). Overall long-term bowel function is impaired in one third of boys with perineal fistula. The main reasons for impaired functional outcome are constipation and soiling, which affect as many as half the patients.

Outcome of Vesicostomy V/S Primary Ablation for Posterior Urethral Valves

Purpose A vesicostomy is believed to have a detrimental effect in boys with posterior urethral valves compared to primary valve ablation. We compared the outcomes of boys managed by initial vesicostomy with those undergoing primary fulguration over a 15 year period. Material and methods The outcomes of 54 boys (23 vesicostomy, 31 primary valve fulguration) over 1 year of age who had not undergone renal transplant were considered. Outcome parameters identified were ultrasound findings, continence status, GFR and 1 year creatinine. Dryness was defined as completely dry both day and night with no need to wear pads. Results are presented with 95% confidence intervals. Results Ultrasound examinations were normal in 9/19 (47.4%) of the vesicostomy group and 11/24 (45.8%) of the fulguration group. Graded ultrasound results were not significantly different (p = 0.24). The vesicostomy patients were more often dry (79% vs 64%, p = 0.43). The vesicostomy group had on average higher GFR (95.26 vs 85.79) and lower 1 year creatinine values (49.58 vs 52.46). After accounting for age differences between groups, there was no significant difference in the GFR and 1 year creatinine values (p = 0.16 and p = 0.87 respectively). Conclusions There were no significant differences in the major outcomes between those children who were treated by initial vesicostomy and those who underwent primary fulguration.Vesicostomy may therefore be considered in selected cases of posterior urethral valves as the primary treatment option.

Violence Exposure and Psychopathology in Urban Youth: The Mediating Role of Posttraumatic Stress

Understanding the mechanisms underlying the development of violence exposure sequelae is essential to providing effective treatments for traumatized youth. This longitudinal study examined the mediating role of posttraumatic stress in the relationship between violence exposure and psychopathology, and compared the mediated models by gender. Urban adolescents (n=1,358) were surveyed using the Social and Health Assessment. The proposed relationships were examined using Structural Equation Modeling. Posttraumatic stress fully mediated the relationships between victimization and depression and anxiety in girls, and partially so in boys. In addition, posttraumatic stress partially mediated the relationships between violence exposure and commission of violence in boys. Current findings support the longitudinal effects of violence exposure on adolescent mental health. Posttraumatic stress represents a unique mechanism for the development of psychopathology in girls and is also related to negative outcomes in boys. These findings have direct implications for prevention and rehabilitation efforts among violence exposed youth.

G.P.10 06 Does deflazacort treatment impact the surgical outcomes for boys with Duchenne muscular dystrophy?

G.P.10 06 Does deflazacort treatment impact the surgical outcomes for boys with Duchenne muscular dystrophy?

Pubertal timing and health-related behaviours in adolescence - socio- economic outcomes in a follow-up study from Finland

Background. Pubertal timing is connected with health-related lifestyle in adulthood. We studied whether early or late pubertal timing is predictive of socio-economic outcomes in early adulthood and whether the associations are mediated by health behaviours. Methods. Survey data (1981, 1983, 1985, 1987) from samples of 14-year-old Finns (N=4246, response rate 85%) were linked with respondents’ attained educational level, socio-economic and labour market position in 2001 (ages 28-34). Ages of menarche and first ejaculation indicated pubertal timing. Results. As compared to adolescents with average age pubertal timing, boys and girls maturing at an early age more often participated in health-compromising behaviours, while those maturing at a later age participated less frequently. Pubertal timing was not associated with attained educational level or socioeconomic position in girls and not with labour market position at the time of follow-up in either sex. In boys, independently of health behaviours, early or late onset of puberty predicted low educational level, while late onset predicted low socio-economic position. Conclusion. Timing of puberty has a stronger connection with socio-economic outcomes in boys than in girls. Deviance from the normative pace of physical development, especially late maturation, is among boys slightly depicted in the hierarchy of socio-economic positions of the society. As pubertal timing is connected with health-related behaviours – especially with smoking – the pacing of developmental transitions should be considered in planning programmes preventing unhealthy behavioural patterns often linked with negative attitudes towards schooling.

SPLIT ONLAY SKIN FLAP FOR THE SALVAGE HYPOSPADIAS REPAIR

Following failed hypospadias repair absence of the penile foreskin, a shortage of ventral skin and residual chordee may all contribute to poor long-term results. We describe a technique called the split onlay skin (SOS) flap that has improved our surgical outcomes in boys requiring salvage hypospadias repair. The SOS flap uses a transverse island of penile shaft skin that is mobilized on its vascular pedicle and rotated into position to the ventrum of the penis at the site of the urethral defect. The flap is transected transversely, and half of the flap is used as an onlay to repair the urethra and the other half is used for additional skin coverage where needed on the penile shaft. We treated 11 boys 30 to 124 months old (mean age 60.3 months) who had a mean of 2 previous failed hypospadias repairs. All 11 boys presented with complex combinations of urethrocutaneous fistulas, stricture or urethral diverticula. Of the 11 patients 6 (54.5%) had development of postoperative fistulas. Five of these fistulas were surgically closed with no further complications. One penoscrotal fistula closed spontaneously after 7 months. Mild chordee from contraction of the flap and a urethral diverticulum developed in 1 boy. At a mean followup of 24.5 months all patients, including those who underwent closure of the secondary fistula, were voiding well with excellent appearance. In cases where little local tissue is present the SOS flap procedure is an excellent way to transfer healthy dorsal tissue to the ventrum for an onlay salvage urethroplasty while providing additional coverage of the urethral defect and a tension-free skin closure. Despite the high fistula rate we encountered following the initial SOS procedure, we endorse this technique because the transferred dartos provides additional tissue, which facilitates subsequent fistula repair. These boys can achieve a successful cosmetic result without incorporation of scrotal tissue or a free graft, which we believe leads to more predictable results.

S.25.04 Long term outcome of boys and girls with attention deficit hyperactivity disorder: results of two controlled follow up studies

S.25.04 Long term outcome of boys and girls with attention deficit hyperactivity disorder: results of two controlled follow up studies

The Impact of Different Family Configurations on Delinquency

How do outcomes of boys who had experienced family disruption before age 12 years compare with those from intact families? This paper is based on a sample of 21,314 Swiss male recruits who completed a cross-sectional survey at age 20 years. As in the Cambridge Study, disrupted families predicted offending. However, intact high-conflict families predicted the same prevalence of offending as disrupted families. Boys not living with their mother, especially when they had lived in institutions before age 12 years, were most likely to become persistent offenders. Therefore, the dichotomy of disrupted versus intact family hides many important sub-groups, including those living with their mother (low-risk) and those who had experienced institutional rearing (high-risk). Background Many family factors have been shown to predict offending, including factors relating to child-rearing practices (e.g. harsh discipline, poor supervision and low parental involvement with the child) and factors relating to family characteristics (e.g. broken homes, parental conflict and family criminality) (see Farrington 2002). This paper focuses on family disruption which ‘seems to be as strong a predictor of self-reported and official delinquency as other major risk factors such as low family income, large family size, poor child-rearing, poor parental supervision, low IQ, low attainment and hyperactivity’ (Juby and Farrington 2001: 23). Interest in researching the link between disrupted families and delinquency has grown since the 1960s, largely because of the rise in both disrupted families and delinquency rates in Western industrialized countries. Rodgers and Pryor (1998) renewed research on disrupted families and estimated that the risk of delinquency for children from broken homes was double that for children from intact homes. In the Newcastle Thousand Family Study (UK), Kolvin, Miller, Fleeting and Kolvin (1988) found that 53 per cent of the boys from families where the parents had separated or divorced before age five years were convicted up to age 32 years, compared with 28 per cent of the other boys. However, research shows that the relationship between family disruption and delinquency is a complex one. In the CambridgeSomerville Youth Study in Boston (US), McCord (1982) examined serious offending among 232 adolescents from broken homes due to loss of the natural father, taking into account the level of parental conflict and whether or not the mother was loving.