Postpubertal Adolescents Research Articles

Laparoscopic varicocele ligation: Are there advantages compared with the microscopic subinguinal approach?

Objectives To compare the operative time, outcome, complications, and patient costs between laparoscopic varicocele ligation (LVL) and subinguinal microscopic varicocelectomy (SMV) in two patient cohorts. Varicocele therapy is a controversial issue, with no single approach adopted as the best therapeutic option. LVL has been considered more expensive and of no proven benefit compared with SMV. Methods We compared two groups of patients who underwent surgical correction of varicocele at our institutions during a 6-year period. Group 1 included postpubertal adolescents who underwent LVL and group 2 included adults seen at an infertility practice who underwent SMV. The outcome measures selected included operative time, direct hospital costs to the patient, and negative outcomes. Results We identified a total of 72 patients, 36 (mean age 13.8 years) in group 1 and 36 (mean age 34.1 years) in group 2. Group 1 had no persistent or recurrent varicoceles compared with 4 patients in group 2. Three men in group 2 required emergency room evaluation and no patient did so in group 1. No hydroceles developed in group 2, but three developed in group 1. Conclusions LVL resulted in shorter operative times and fewer negative outcomes compared with SMV. This translated into lower direct patient costs for LVL. For those who have mastered laparoscopic techniques, LVL should be considered a safe, cost-effective option in the correction of varicoceles.

Effects of sex on sleep-disordered breathing in adolescents.

This study was conducted to determine the influence of puberty on features of sleep-disordered breathing (SDB) in adolescents. The study was performed in a general population sample of 226 adolescents of both sexes (aged 11-19 yrs) recruited from the secondary school population of the city of Seville, Spain. Subjects were divided into two groups: 1) postpubertal, i.e. females who had undergone menarche and males in whom axillary hair development or peak height velocity had occurred > 1 yr before the study; and 2) peripubertal, i.e. females who had not undergone menarche and males who had not developed axillary hair nor reached peak height velocity, or subjects in whom these pubertal changes had appeared < 1 yr before the study. All subjects answered a questionnaire on SDB and underwent overnight cardiorespiratory polygraphy. There were 50 males and 40 females (mean +/- SD age 13.5 +/- 1.2 yrs) in the peripubertal group, and 54 males and 82 females (age 16.3 +/- 1.7 yrs) in the postpubertal group. Males exhibited significantly higher neck circumference/height index and waist/hip index than females in both the peripubertal and postpubertal groups. In the postpubertal group, snoring and polygraphic alterations (respiratory events and oximetric parameters) were significantly more frequent in males than in females. Postpubertal adolescents showed sex differences in clinical and polygraphic parameters that were not observed at earlier pubertal stages. These findings support the influence of sex hormones on sex differences in sleep-disordered breathing.

Clinical Presentation and Course of Depression in Youth: Does Onset in Childhood Differ From Onset in Adolescence?

To simultaneously and prospectively compare the clinical presentation, course, and parental psychiatric history between children and adolescents with major depressive disorder. A group of prepubertal children (n = 46) and postpubertal adolescents (n = 22) were assessed with structured interviews for psychopathology and parental psychiatric history and followed once every 2 years for approximately 5 years. With the exception of more depressive melancholic symptoms in the adolescents, both groups had similar depressive symptomatology, duration (average 17 months), severity of the index episode, rates of recovery (85%) and recurrence (40%), comorbid disorders, and parental psychiatric history. Female sex, increased guilt, prior episodes of depression, and parental psychopathology were associated with worse longitudinal course. In general, major depressive disorder is manifested similarly in children and adolescents, and both groups have a protracted clinical course and high family loading for psychiatric disorders.

Ultrasound bone measurement in children and adolescents: Correlation with nutrition, puberty, anthropometry, and physical activity

Ultrasound bone measurement in healthy Croatian children and adolescents has been evaluated. Relationships between pubertal status, anthropometry, nutrition, and physical activity with ultrasound bone parameter were analyzed. A total number of 501 children and adolescents of both sexes participated in the study. There were 244 prepubertal children (120 boys and 122 girls) and 259 postpubertal adolescents (112 boys and 147 girls). Anthropometric measurements included height, weight, percent of fat tissue, and body mass index. Quantitative ultrasound measurements of the heel (nondominant side) were performed using “Sahara” sonometer and included speed of sound (SOS), broad-band ultrasound attenuation (BUA), and calculated bone stiffness (QUI). Dietary data were assessed using specially designed semiquantitative food frequency questionnaire calculations based on the daily intakes of calcium, carbohydrates, fats, and proteins. Quantitative ultrasound bone measurements (BUA, SOS, and QUI) were similar in prepubertal boys and girls. Adolescent boys had significantly higher BUA ( P<.01) than girls. The percentage of children and adolescents who consumed more than 1,000 mg of calcium per day were 54.8% and 48.7%, respectively. Body weight and pubertal status and activity were significantly correlated with bone stiffness but not the calcium intake. In this study, bone stiffness in children and adolescents is determined by pubertal status and body weight, rather than by calcium intake.

Anthropometric assessment of nutritional status in adolescent populations in humanitarian emergencies.

To outline the difficulties and suggest potential solutions in anthropometric assessment of adolescents during humanitarian emergencies. Literature review. Multiple settings in which the nutritional status of adolescents has been assessed using anthropometric measurements. Adolescents in multiple populations. None. The use of anthropometry may be more difficult in adolescents than in other age groups because anthropometric indices in normally nourished adolescents change with age and sexual development. Moreover, survey and reference populations may differ in the age at which certain pubertal landmarks are attained, requiring adjustment for differences between survey and reference populations. Adolescent populations may also differ by ethnicity in various body proportions that affect anthropometric indices. Adjustment may be required when the body proportions of adolescents in the reference population differ from those in the population assessed. Although no definitive recommendation can be made regarding which anthropometric indices are the most appropriate for adolescents, some revisions may improve current practices. Weight-for-height could be used for prepubertal adolescents and body mass index could be used for postpubertal adolescents. Because cut-off points are age-specific, age should be collected as accurately as possible for all adolescents measured during screening or survey activities. The WHO-recommended reference population of US adolescents is inappropriate in most populations of adolescents. Adolescents should never undergo nutritional assessment in isolation; other population subgroups should be included, and other health, nutrition and food data should be collected at the same time. The United Nations Administrative Committee on Coordination/Sub-Committee on Nutrition.

Variations and determinants of energy expenditure as measured by whole-body indirect calorimetry during puberty and adolescence

Adolescence is characterized by rapid anatomic, physiologic, and behavioral alterations expected to induce changes in metabolic rate. The aim of the present study was to investigate variations in daily energy expenditure (DEE) and its main components during adolescence and to quantify their significant determinants. Eighty-three children and adolescents (44 boys and 39 girls aged 10-16 y) participated in this cross-sectional study. Tanner stages ranged from 1 to 5. Body composition was assessed by both the skinfold-thickness method and bioimpedance analysis. Energy expenditure (EE) was determined continuously over 24 h by using 2 whole-body calorimeters. The subjects followed a standardized activity program that included four 15-min periods of exercise on a cycle ergometer. Body composition, DEE, sleeping EE (SEE), resting EE, and EE during meals, miscellaneous activities, and physical exercise varied significantly with sex and stage of puberty. The DEE of boys and girls averaged 8.22 and 7.60 MJ in prepubertal children, 11.35 and 9.10 MJ in pubertal children, and 11.73 and 9.68 MJ in postpubertal adolescents, respectively. The significant determinants of DEE and SEE, respectively, were fat-free mass (r2 = 0.842 and 0.826), sex (r2 = 0.017 and 0.022), and season (r2 = 0.021 and 0.011). Stage of puberty and fat mass were not significant factors. DEE and SEE adjusted for fat-free mass were on average 5% higher in boys than in girls and 6% higher in spring than in autumn. The DEE of adolescents measured under standardized conditions varied with sex, body composition, and season, but not with stage of puberty. These variables could be predicted accurately from fat-free mass, sex, and season.

Cardiovascular reactivity to stress and left ventricular mass in youth.

We studied the relationships of cardiovascular reactivity during mental stress with left ventricular mass index in a group of prepubertal children 8 to 10 years old and in a group of peripubertal or postpubertal adolescents 15 to 17 years old. One hundred fifteen participants, varying in age group, sex, and race (black and white), took part in a laboratory stress protocol consisting of a reaction-time task, a mirror tracing task, a cold forehead challenge, and a stress interview. Cardiovascular measures included blood pressure and heart rate, as well as cardiac output, stroke volume, total peripheral resistance, and preejection period obtained noninvasively with impedance cardiography. Measures of left ventricular mass were made by echocardiography. Results indicated that across all participants, left ventricular mass index was associated with cardiovascular responses during the mirror tracing and cold forehead tasks, especially with those responses reflecting increased vasoconstriction. Subgroup analyses showed that these associations were significant for males and sometimes adolescents but not for females and children. As mirror tracing and cold forehead tasks most consistently produce alpha-adrenergic activation, the results suggest a model in which vasoconstriction due to mental stress is related to increased left ventricular mass in susceptible individuals, even at a young age.