Menarche Status Research Articles

Is the Story Over? Progression After Bracing in AIS

ABSTRACT Introduction Despite successful bracing for adolescent idiopathic scoliosis (AIS), some curves progress after brace cessation. The purpose of this study was to identify the incidence, rate, and risk factors for progression after successful brace management of AIS. Materials and Methods Patients treated with orthoses for AIS were prospectively enrolled at brace initiation, followed through successful brace completion and, on average, for 33 months (range 12–95) after brace cessation. Inclusion criteria were curves 25° to 45° and Risser 0 to II at brace initiation with cessation at Risser IV with curves measuring <50°. Exclusion criteria were cessation before Risser IV or curve progression >50° during bracing. Demographics and radiographic measures were collected. Brace compliance was measured using Thermachron temperature sensor. Postbrace progressors were compared with nonprogressors using Mann-Whitney U test, Fisher exact test, and two-sample t-test. Results Eighty-five patients who completed bracing with final curves <50° were followed after brace discontinuation >1 year. Twenty-seven/85 (31.8%) progressed postbracing to surgical curve magnitude >50° (n = 12) or progressed >5° after brace cessation without progression to surgical magnitude (n = 15). There was no difference between progressors and nonprogressors in age or menarchal status at brace initiation or completion, nor was there a difference in curve magnitude or morphology at initiation. There was no difference in duration of or compliance with bracing. Patients with postbrace surgical progression completed bracing at 46° on average compared with 33° for those who did not progress to surgical magnitude (P < 0.0001). Patients who completed bracing at >45° had an incidence of postbrace surgical progression of 67%. No patients who completed bracing with curves <40° showed progression after brace cessation. Conclusions A total of 14.1% of patients successfully treated for AIS with bracing later progressed to surgical magnitude, and an additional 17.6% progressed >5° after brace completion. Findings suggest that patients with curves measuring >40° at brace completion should be followed into young adulthood. Counseling regarding the potential future need for surgery is warranted once a curve exceeds 45° in braced patients. Level of Evidence Level 2 prospective cohort study

Influences of Differing Menarche Status on Motor Capabilities of Girls, 13 To 16 Years: A Two-Year Follow-Up Study.

Puberty and the onset of menarche influences the motor performance of girls. However, the magnitude of these influences during varying maturity status, is not clear. This longitudinal study over two years aimed to investigate differences in motor fitness between early and late developing girls based on pre- and post-menarche status. A convenience sample (n = 58) of girls aged 13.51 ± 3.51, divided by means of the Status Quo method into pre (n = 13) and post-menarche (n = 45) groups, was used. Motor fitness was tested once annually by standardized protocols. Basic statistics, independent t-testing and a repeated measures ANOVA with a post hoc Bonferonni correction were used (p < 0.05 = statistical significance). Effect sizes were determined by Cohen’s d-values. Only explosive upper body strength differed significantly between groups during baseline, favoring post-menarche girls. Initially, post-menarche girls showed advantages in hand-eye coordination and speed (p > 0.05) with pre-menarche girls performing better in agility and explosive leg strength (p > 0.05). At 15.51 years, no significant, between-group differences were found. Pre-menarche girls surpassed post-menarche girls in hand-eye coordination and 0–40 m speed and post-menarche girls displayed higher explosive leg and upper body strength scores (p > 0.05). Our data show that the potential to excel in sport based on motor capabilities can only be accurately estimated 1–2 years after reaching menarche.

Longitudinal Investigation of Pubertal Milestones and Hormones as a Function of Body Fat in Girls

Background: Studies comparing the timing and pace of puberty in overweight/obese girls (OW/OB) vs normal weight girls (NW) have produced conflicting results; some suggest earlier activation of the central components of the reproductive axis in OB while others are more consistent with a peripheral source of estrogen (e.g. adipose tissue) driving puberty in OB. Importantly, there have been no longitudinal assessments of both clinical and biochemical pubertal markers in OB vs. NW. Methods: 90 healthy pre-menarchal girls (26 OW/OB, 54 NW) from the community, aged 8.2-14.7 years, completed 2.8 ± 1.7 (mean, SD) study visits over the course of 4 years. Visits included dual-energy x-ray absorptiometry to calculate percent total body fat (TBF), Tanner staging, breast ultrasound for morphological staging (BMORPH; stages A-E), pelvic ultrasound, hand x-ray (bone age, BA), blood tests for reproductive hormones, and urine collection to determine a vaginal maturation index (VMI), an index of estrogen exposure in urogenital epithelial cells. Menarchal status was determined at each visit and via follow-up questionnaires. The effect of TBF on hormones and markers of estrogen action, the pace of breast maturation, and age at menarche were determined using a mixed, multi-state, or Cox proportional hazards model, respectively. Mixed and Cox models controlled for BMORPH at visit 1 (V1) and race. Results: NW girls were older than OW/OB (11.3 vs. 10.2 yrs, p<0.01) at V1, more likely to be non-Hispanic White (66 vs. 40%, p=0.03), and had more advanced breast morphology BMORPH (p<0.01). LH, E2, VMI, BA, and ovarian and uterine volume increased with time with no effect of TBF. There was an interaction between time and TBF for FSH, INHB, E1, Total T, Free T, and A’dione (p<0.05): levels were initially similar in all TBF groups, but after 1 yr, levels increased in girls with higher TBF, plateaued in girls with mid-range TBF, and decreased in girls with lower TBF. Girls with higher TBF progressed through BMORPH stage D (corresponding to growth/arborization of the breast ductal system), more slowly than girls with lower TBF but achieved menarche at a younger age (risk 1.04x higher per 1 unit increase in TBF). Conclusions: Intensive reproductive phenotyping of girls during the pubertal transition reveals that both the neuroendocrine and ovarian components of the axis are generally preserved in girls with higher TBF but that the axis appears to be activated earlier than in girls with lower TBF. In late puberty, however, girls with higher TBF demonstrate subtle differences in standard hormonal (e.g. serum FSH, INHB, and androgen) and clinical (e.g. delayed growth of breast bud) markers of puberty. Investigation of the mechanistic basis for these differences and their potential clinical consequences for girls with higher TBF deserves further study.

79. Predicting Adnexal Torsion in Pediatric and Adolescent Patients

<h3>Background</h3> Diagnosis of adnexal torsion is complicated by symptom overlap with other diagnoses. Failing to accurately diagnose adnexal torsion can lead to devastating reproductive consequences. Previous small research studies on pediatric and adolescent gynecology patients have developed diagnostic algorithms and composite scores using clinical and radiologic findings to help predict adnexal torsion and streamline which patients require surgical intervention. In our study, we evaluate the validity of a previously developed algorithm in a retrospective cohort of girls undergoing diagnostic laparoscopy for concern for adnexal torsion. <h3>Methods</h3> After IRB approval, a retrospective review of patients < 21 years of age who underwent diagnostic laparoscopy for possible torsion between January 2016 and April 2020 was performed. Patients were included if they had a CPT code diagnosis of torsion or operative notes suggesting torsion or concern for torsion, and if they had a pelvic ultrasound done prior to surgery. Each case was assigned a score based on an algorithm including presence of vomiting, ovarian volume, adnexal ratio, and menarchal status (Table 1). A composite score of 0-6 was calculated for each patient and compared to surgical findings. Based on a prior study, a score of 0-1 conferred a 3% risk of torsion, a score of 2-3 had a 3-10% risk of torsion, and a score greater than 4 had a > 25% risk of torsion. <h3>Results</h3> Among the charts reviewed, 103 met inclusion criteria. 92.2% had adnexal torsion, while 7.8% had no torsion. Of those with a composite score of ≥4, 96.7% were found to have torsion, compared to 92.9% with scores of 2-3 and 73.3% with scores of 0-1. A higher composite score was significantly associated with surgically-identified adnexal torsion by chi-squared analysis, X2 (2, N = 103) = 9.14, p = 0.010. Further analysis of each component score showed a significant relationship between vomiting (p=0.0015) and adnexal torsion. Adnexal volume and ratio scores were not independent predictors of torsion (p=0.121 and 0.726, respectively). <h3>Conclusions</h3> This data suggests higher composite scores and associated vomiting indicate a greater likelihood of torsion. However, clinical significance of these results is limited by the fact that low scores are not sufficient to exclude torsion. Further prospective research evaluating the validity of this algorithm is needed, and currently underway, in order to better elucidate the composite score's utility in clinical practice.

PREVALENCE OF IRON DEFICIENCY ANEMIA IN ADOLESCENT GIRLS IN JAIPUR DISTRICT: A CROSS SECTIONAL STUDY

Globally anemia accounts for a majority of the nutritional problem and it is principally engendered by deficiency of iron. Its prevalence is inordinately higher among developing nations, because of low socioeconomic status and poor access to healthcare services. In developing countries, the adolescent group is more exposed to nutritional challenges and adolescent girls are more vulnerable to the disease. This survey is intended to evaluate the prevalence of anemia and its associated factors among adolescent girls in age group of 12-15 year in Jaipur district, this survey also generated the anemic cases in the adolescent girls of age 12-15 year. A cross sectional study was conducted from August 2019 to January 2020 by attending health check-up camps at various areas situated within 20 kilometers in Jaipur district. Hemoglobin estimation was done by using three-part auto analyzer method. Statistical analysis was done using Percentages and Chi-square Test. 75.39% girls were found anemic. Statistically significant association (p &lt; 0.05) was found in anemia in adolescent girls with the history of receiving iron folic acid (IFA) supplementation, deworming, age, habitat, family type and status of menarche. Present study reveals that 75.39% girls were found anemic and the problem is significantly associated with status of IFA supplementation, deworming and family type.

Age at menarche among rural school youth in west-central Poland: variation with weight status and population growth

Studies of age at menarche in Poland have a long history and consistently show an urban-rural gradient. The objectives of the study were to to estimate the age at menarche among school girls resident in ten rural communities of the Greater Poland province in 2016 and to compare ages at menarche by weight status and by population growth. The sample included 1146 girls, 7–16 years of age, resident in ten rural communities. Menarcheal status was obtained via interview. Heights and weights were measured; the BMI was calculated. Based on the latter, the girls were classified as thin, normal weight and overweight (including the obese) relative to IOTF criteria. Population growth between 1986 and 2016 in each community was estimated from local records. Ages at menarche were estimated with the probit regression protocol (SPSS) using the logistic model with log 10 transformation for the total sample and for the subsamples by weight status and population growth. The median age at menarche for the total sample of rural girls was 13.25±0.20 years. Menarche was earlier among Overweight (13.06±0.32 years) compared to Normal Weight (13.25±0.37 years) and Thin (13.81±0.41 years), and among girls resident in communities with Major population growth (12.58±0.44 years) compared to Little/No growth (13.65±0.14 years). Results of the present survey were generally consistent with recent surveys of age at menarche among rural girls in Poland and among girls classified by weight status. Corresponding comparative data relating menarche to population growth are lacking.

Hubungan Asupan Makan, Status Gizi, Dan Usia Menarche Ibu Dengan Menarche Dini Pada Remaja Putri Di Wilayah Perumahan Bumi Pertiwi 2, Kabupaten Bogor

There has been a decrease in the age of menarche in the last few years. Various degenerative diseases can appear due to early menarche, women with early menarche have a relatively higher risk of heart disease, breast cancer, and increase 2.3 times the risk of metabolic syndrome regardless of ethnicity and race. Early menarche can be caused by genetic factors or changes in environmental factors, maternal age of menarche (genetic), nutritional status,and lifestyle. The purpose of this research is to find out the relationship of dietary intake, nutritional status, and maternal age of menarche with early menarche in adolescents in the Perumahan Bumi Pertiwi 2, Bogor. This study uses a cross sectional design with research subjects is adolescents with aged 10-14 years and life in the Perumahan Bumi Pertiwi 2 as many as 40 people. The variables studied in this study were food intake, nutritional status, and age of maternal menarche. The results of this study are there is a relationship between protein intake and nutritional status with the age of menarche, while the energy intake, fat, carbohydrates, calcium, and the age of maternal menarche have no relationship with the age of menarche in adolescents in the Bumi Pertiwi 2

Longitudinal Investigation of Pubertal Milestones and Hormones as a Function of Body Fat in Girls

Epidemiologic studies demonstrated that overweight/obese girls (OW/OB) undergo thelarche and menarche earlier than normal weight girls (NW). There have been no longitudinal studies to specifically investigate how body weight/fat affects both clinical and biochemical pubertal markers in girls. 90 girls (36 OW/OB, 54 NW), aged 8.2-14.7 years, completed 2.8 ± 1.7 study visits over the course of four years. Visits included dual-energy x-ray absorptiometry to calculate total body fat (TBF), Tanner staging, breast ultrasound for morphological staging (BMORPH; A-E), pelvic ultrasound, hormone tests, and assessment of menarchal status. The effect of TBF on pubertal markers was determined using a mixed, multi-state, or Cox proportional hazards model, controlling for baseline BMORPH. NW were older than OW/OB (11.3 vs. 10.2 yrs, p<0.01) at baseline and had more advanced BMORPH (p<0.01). LH, estradiol, and ovarian and uterine volumes increased with time with no effect of TBF. There was a time x TBF interaction for FSH, inhibin B, estrone, total and free testosterone, and androstenedione: levels were initially similar, but after 1 yr, levels increased in girls with higher TBF, plateaued in girls with mid-range TBF, and decreased in girls with lower TBF. Girls with higher TBF progressed through BMORPH stage D more slowly but achieved menarche earlier than girls with lower TBF. In late puberty, girls with higher TBF demonstrate differences in standard hormonal and clinical markers of puberty. Investigation of the underlying causes and clinical consequences of these differences in girls with higher TBF deserves further study.

The Prevalence of Müllerian Anomalies in Women with a Diagnosed Renal Anomaly.

To characterize the prevalence of Müllerian anomalies (MAs) among patients with renal anomalies (RAs). DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A retrospective chart review of female patients with RAs who presented to an academic pediatric hospital between 2007 and 2019 was performed. Patients were identified using International Classification of Diseases 9th and 10th revision codes. Data collected included the type of RA, presence and type of MA, method of diagnosis, and associated anomalies. RA subtype analysis was performed. We identified 5590 cases of RA for the years 2007 through 2019. A random, retrospective chart review was performed resulting in a study population of 363 RA patients. The prevalence of any MA in the overall RA population was 104/363 (29%) (95% confidence interval, 24% - 33%). The prevalence of MA for patients with renal agenesis was 59/182 (32%) compared with 45/181 (25%) for patients with renal dysgenesis. The most common MA were failures of Müllerian duct fusion. Only 73/352 (21%) of patients received screening for a MA at the time of RA diagnosis. Of patients without a diagnosed MA 187/259 (72%) were unscreened and either not yet menarchal or had unknown menarchal status. Of all RA patients, 29% (n = 104/363) had an underlying MA. No difference was found in the prevalence of MA in patients with renal agenesis vs dysgenesis. Limitations noted are that some patients might be of an age at which assessment of the Müllerian structures is suboptimal or who might not have been screened. These results suggest the need for a prospective study to determine evidence-based guidelines for screening for MA among patients diagnosed with any RA to avoid complications from an unrecognized MA.

FACTORS AFFECTING THE RECEDING AGE OF ONSET OF MENARCHE IN YOUNG GIRLS – AN OBSERVATIONAL STUDY

Background: The time of first menarche is an important milestone in female sexual maturation. Studies have shown trends of decreasing age of menarche in most Indian states. Objective: To trace the factors associated with receding age at menarche and to evaluate the strength of association between those factors with receding age at menarche. Materials and methods: An observational study was done in the schools in Davangere from July 2018 to June 2019. 372 menstruating girls between the age of 9–15 years were included in the study. The participants data regarding chronological age, age of menarche, socioeconomic status, physical activity and diet were collected using a questionnaire. The anthropometric measurements were taken using standard techniques and general physical examination was done for all the participants. Results: The mean age of attainment of menarche was 11.94 ± 1.02 years. The study had a strong association between age at menarche and socioeconomic status (p&lt;0.001). Body mass index (BMI) and waist circumference (WC) was inversely and significantly associated with age of menarche (p&lt;0.01). Conclusion: The world wide trends of declining age of menarche were seen in our study too. The factors affecting being mother’s age of menarche, BMI, Waist circumference and higher socioeconomic status. This underline that further evaluation of factors associated with it and studying future implications of lower age at menarche is important.

Breast cancer knowledge and perception among health care professionals and senior medical students at Bolan Medical Complex Hospital Quetta, Pakistan

Abstract&#x0D; Objective: To assess knowledge and perception about different aspects of Breast Cancer among health care professionals at Bolan Medical Complex Hospital Quetta, Pakistan.&#x0D; Methods: This cross-sectional study was carried out at Bolan Medical Complex Hospital Quetta from October to December 2017. A total of 312 health care workers including consultants (42), residents (85), medical officers (52), interns (45), nurses (48) and final year medical students (40) took part in the study. The study tool was a self-designed questionnaire with separate sections to assess the knowledge about risk factors, signs and symptoms, screening tools, breast self-examination (BSE), treatment and barriers in seeking medical advice.&#x0D; Results: Participants had satisfactory knowledge about risk factors and signs of breast cancer but poor knowledge about association of breast cancer with menarche status, oral contraceptive pills and smoking. Majority was aware of mammography benefits and believed that breast cancer is curable with therapy. All perceived that cultural and socioeconomic barriers are the cause of late stage presentation. The nurses particularly were having misconceptions in knowledge about breast cancer risk factors and screening tools.&#x0D; Conclusion: The current study demonstrated that knowledge related to breast cancer was average and highlighted the need for provision of continuing medical education programs to improve health practitioners' practice on cancer screening tools. Knowledge was particularly deficient regarding screening modalities and BSE method and timing. Special emphasis is needed to train nurses, so they could play an expanded role in breast cancer care.&#x0D; Keywords: Breast Cancer, Pakistan, Risk Factors, Awareness, Continuous...

Abortion is associated with knee osteoarthritis among older women in China: A STROBE-compliant article.

The current studies revealed inconsistent relationship between reproductive factors and osteoarthritis. Community-based research has not been conducted in China. The study was to examine the association of reproductive factors with the prevalence of knee osteoarthritis (OA).Through a multistage stratified random sampling method, 10 streets or villages from 5 cities in Hunan province were randomly selected, a total 2746 eligible women aged 50 to 83 were recruited in this cross-sectional study. A structured questionnaire including demographic factors, socio-economic status, reproductive factors, and knee OA was used. According to the criteria of American College of Rheumatology, clinical knee OA was assessed by doctors in community or village health clinics for knee pain, age, morning stiffness, crepitus on active motion or for knee pain, morning stiffness, crepitus on active motion, and tenderness of the bony navigation of the joint. Self-reported age of menarche, parity, abortion history, and menopausal status were collected.The prevalence of knee OA was 13.44%. Abortion is associated with knee OA (odds ratio [OR] = 1.271, 95% confidence interval [CI] = 1.007, 1.606), but age at menarche, parity, and menopausal status were not the factors. Furthermore, age (OR = 1.040, 95% CI = 1.020, 1.060), weight (OR = 1.019, 95% CI = 1.004, 1.035), higher education level (OR = 1.530, 95% CI = 1.121, 2.088), higher monthly household income (OR = .583, 95% CI = 0.441, 0.770 for 3000–4999 ¥ and OR = 0.599, 95% CI = 0.431, 0.833 for 5000 ¥ or more), and chronic gastritis (OR = 3.364, 95% CI = 2.548, 4.442) were associated with knee OA.Abortion may increase the risk of knee OA. Special attention should be paid to women with a history of abortion, and women who are planning to abort should be informed of the risk of knee OA later in life. The relationship between abortion and knee OA should be interpreted with caution and further confirmed.

Age at menarche in Seveso daughters exposed in utero to 2,3,7,8-tetrachlorodibenzo-p-dioxin.

In 2014, nearly 40 years after the explosion, we enrolled postexplosion offspring, 2 to 39 years of age, in the Seveso Second Generation Study. Age at onset of menarche (years) was collected for 316 daughters by maternal report or self-report at interview. In utero TCDD exposure was defined by maternal TCDD serum concentrations extrapolated to the pregnancy. At interview, 287 daughters were postmenarche and reported age at menarche averaged 12.1 years (±1.3 years). Overall, we found no change in risk of menarche onset with a 10-fold increase in in utero TCDD exposure (hazard ratio [HR] = 0.86; 95% confidence interval [CI] = 0.71, 1.04). When we considered maternal menarche status in 1976 as a potentially sensitive developmental exposure window, in utero TCDD (log10) was associated with later age at menarche among daughters whose mothers were premenarche (HR = 0.71; 95% CI = 0.52, 0.97) but not postmenarche (HR = 0.89; 95% CI = 0.71, 1.12) at the time of the explosion (P int = 0.24). These results suggest that in utero TCDD exposure may alter pubertal timing among daughters of women who were prepubescent at the time of the Seveso accident.

The influence of socioeconomic status on menarcheal age among Chinese school-age girls in Tianjin, China.

The association between socioeconomic status and the onset age of menarche is still not conclusive. This cross-sectional study was conducted among primary and middle school girls aged 7 to 16years old in Tianjin, China, to explore the distribution of menarcheal age and its association with socioeconomic status. A self-designed structured questionnaire was completed by students and their parents to collect information on socioeconomic status (i.e., family income, parental education level, living residence), menarcheal status, and covariates (weight status of girls and their parents, sleeping hours per day, physical activity). Information on menarcheal status included whether or not menarche had occurred (Yes/No) and the exact age at menarche. Linear regression analysis was used to explore the association between socioeconomic status and menarcheal age before and after covariate adjustment. Among 1485 eligible girls with complete information, 445 had experienced menarche, with an overall menarche rate of 30%. The mean age at menarche was 12.9years (95% confidence interval 12.8-13.0). Urban girls experienced menarche earlier than rural girls did (12.1years vs. 13.5years). Univariate analysis showed that urban residence and higher parental education were associated with earlier onset of menarche. After covariate adjustment, the significance still existed. However, after adjusting further for residence, the significant association with the parental education disappeared. Only urban residence was still significantly associated, even after further adjustment for parental education and family income, with adjusted regression coefficients (95% confidence interval) of - 1.087 (- 1.340,-0.834), indicating that the onset age of menarche among urban girls was 1.087years (0.834, 1.340) younger than that among rural girls. Family income was not related to the onset age of menarche in any analyses.Conclusion: Urban-rural differences played a more important role in the early onset of menarche than socioeconomic differences between families. What is Known: • The age at menarche varies by race and country, but the global trend is towards earlier onset as a result of changes in nutrition, family structure, socioeconomic status, and physical condition. What is New: • Urban girls experienced menarche earlier than rural girls, but this urban-rural difference could not be explained by family income, parental education, weight status of the participants and their parents, participants' physical exercise and sleeping hours. • Higher parental education was associated with earlier onset of menarche, but this association disappeared after adjustment for living residence.

Factors Related to the Age at Menarche in Iran: A Systematic Review and Meta-Analysis

Background Reduced age at menarche is an important health indicator for women and may be associated with complications such as an increased risk of asthma, breast cancer, ovarian cancer, type 2 diabetes. We aimed to examine the factors related to the age at menarche in Iran. Materials and Methods: In this systematic review and meta-analysis, an advanced search with no time restriction was conducted in online databases such as the Web of Science, Embase, Medline, Scopus, and Persian databases of SID and Magiran, as well as the Google Scholar search engine, until the end of 2019. The publication heterogeneity and bias of the extracted studies were evaluated by the Q test and Begg’s test, respectively. Results: In this study, 12 articles with a total sample size of 17672 were included. Based on the findings of these studies, the body mass index (BMI), the mother’s age at menarche, physical activity, nutrition, and socioeconomic status were correlated with the age at menarche for Iranian girls. A negative correlation was found between BMI (r=-0.07), and socioeconomic status (r=-0.57) with the age at menarche (p <0.05). A positive correlation existed between the girl's age at menarche and that of the mother (r=0.42, p <0.05). Moreover, correlation was weak and positive between the age at menarche and physical activity (r=0.14, p <0.05). The quantitative results of the studies were incomplete to establish a relationship between nutrition and age at menarche. Conclusion Due to the effects of numerous factors on the age at menarche, it is suggested that longitudinal studies be conducted to investigate the role of all the known factors, especially environmental factors, on the age at menarche.

Influence of Changes in Soft Tissue Composition on Changes in Bone Strength in Peripubertal Girls: The STAR Longitudinal Study.

Obesity and osteoporosis remain two major public health concerns. Soft tissue composition and bone are interrelated; however, it is still not well understood how changes in adiposity during adolescence affect bone development. The aim of this study was to assess how changes in DXA-derived total body lean mass (TBLM) and total body fat mass (TBFM) associate with 2-year changes in bone outcomes at the 20% femur, 66% tibia, 66% radius, and 4% tibia, as measured by pQCT, during the years surrounding the onset of menarche in a cohort of 9- to 12-year-old (baseline) adolescent girls (70% Hispanic). From baseline to 2-year follow-up, girls showed statistically significant increases in all bone outcomes, except radial endosteal circumference. In separate linear regression models, change in TBLM and change in TBFM were both positively associated with 2-year changes in bone outcomes at all measured bone sites, after controlling for relevant covariates. However, when change in TBLM and change in TBFM were included in the same model, change in TBLM was the predominant predictor of bone outcomes, explaining 4% to 14% of the variance in bone strength outcomes. Change in TBFM remained a positive predictor of tibia polar strength strain index (SSIp) (2% variance explained). A significant interaction between change in TBFM and menarcheal status was identified at the radius for SSIp and indicated that greater gains in TBFM were beneficial for SSIp in girls that were premenarcheal at baseline but detrimental for girls who were postmenarcheal at baseline. The overall findings suggest that changes in TBLM during the peripubertal years have a greater influence on bone outcomes than changes in TBFM. While gains in TBFM might benefit the weight bearing 66% tibia, greater gains in TBFM may be detrimental to bone development at the non-weight bearing 66% radius after the onset of menarche. © 2020 American Society for Bone and Mineral Research (ASBMR).

The association between menarche and myopia and its interaction with related risk behaviors among Chinese school-aged girls: a nationwide cross-sectional study.

Nearly 80% of new cases of myopia arise between 9 and 13 years old when puberty development also progresses rapidly. However, little is known about the association between myopia and puberty. We aim to evaluate the association between myopia and menarche, the most important puberty indicator for girls, and to test whether menarche could modify the effects of myopia-related behaviors. The participants came from two consecutive national surveys conducted in 30 provinces in mainland China in 2010 and 2014. We included 102,883 girls (61% had experienced menarche) aged 10-15 years. Risk behaviors for myopia which included sleep duration, homework time, and outdoor activity were measured by self-administrated questionnaire. Myopia was defined according to a validated method, and its relationships with menarche status and behaviors were evaluated by robust Poisson regression models based on generalized estimated equation adjusting for cluster effect of school. We found that postmenarche girls were at 13% (95% confidence interval: 11%-16%) higher risk of myopia than premenarche girls, after adjusting for exact age, urban-rural location, survey year, and four behavioral covariates. Short sleep duration (<7 h/d), long homework time (>1 h/d) and low frequency of weekend outdoor activity tended to be stronger (with higher prevalence ratios associated with myopia) risk factors for myopia in postmenarche girls than in premenarche girls, and their interaction with menarche status was all statistically significant (P < 0.05). Overall, our study suggests that menarche onset may be associated with increased risk of myopia among school-aged girls and could also enhance girls' sensitivity to myopia-related risk behaviors.

Adolescent idiopathic scoliosis detection and referral trends: impact treatment options

Study designRetrospective cross-sectional study.ObjectiveTo analyze the patient demographic referred for scoliosis to the Hospital for Sick Children to determine the proportion of patients suitable for brace treatment, as per the Scoliosis Research Society guidelines.Summary of background dataThere is level 1 evidence that bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection.MethodsWe performed a retrospective review of 618 consecutive patients who underwent initial assessment in our Spine Clinic between Jan. 1 and Dec. 31, 2014. We included children 10–18 years, with scoliosis greater than 10°, excluding those diagnosed with non-idiopathic curves. Primary outcomes were Cobb angle, menarchal status, and Risser score. We analyzed the effect of specific referral variables (family history, the person who first noticed the curve, and geographic location of residence) on presenting curve magnitude.ResultsDuring the study period, 335 children met the inclusion criteria, with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8 ± 14.5°. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (> 40°), and 55% were skeletally mature, therefore not brace candidates. The majority of curves (54%) were first detected by the patient or family member and averaged 7° more than curves first detected by a physician. A family history of scoliosis made no difference to curve magnitude, nor did geographic location of residence.ConclusionThe majority of AIS patients present too late for effective management with bracing.Level of evidenceIII.

Prediction of Final Body Height for Female Patients With Adolescent Idiopathic Scoliosis.

Study Design:Retrospective cohort study.Objectives:To explore the possibility of predicting final body height at maturity based on associating parameters at the time of diagnosing adolescent idiopathic scoliosis (AIS), while examining the effect of curve magnitude and deterioration.Methods:A total of 284 female patients with AIS (mean age 12.2 ± 1.1 years, 52.5% premenarchal) were followed till skeletal maturity, indicated by ≥Risser stage 4, static body height and arm span over the past 6 months, and postmenarche 2 years. Standing body height, arm span, menarchal status, Risser staging, distal radius and ulna (DRU) classification, Sanders staging (SS), Cobb angles (major and minor curves), and Lenke curve types at initial presentation were examined. Patients with/without curve deterioration were compared. Multiple linear regression was used for predicting final body height (cm), and remaining height increase (%).Results:Baseline body height was 152.1 ± 7.1 cm and major curve Cobb angle was 27.1° ± 7.4°, whereas at maturity they were 159.5 ± 5.4 cm and 32.5° ± 9.3°, respectively. For patients presented at Risser stage 0 or 1, radius grade (R) 6, ulnar grade (U) 5, or SS3, those with curve deterioration exhibited greater height increase potential at initial presentation (P < .05) than those without deterioration. No intergroup difference was found for patients presented at ≥Risser 2, R7, U6, SS4. Predictive baseline parameters were age, body height, Cobb angle (major curve), curve type, and DRU grades. Prediction models of final body height (R 2 = 0.735, P < .001) and remaining height increase (R 2 = 0.742, P < .001) were established.Conclusions:Final body height prediction model was derived for female patients with AIS, with baseline body height and ulnar grading having larger impacts than other parameters.

Impact of Puberty in Girls on Prevalence of Primary Headache Disorder Among Female Schoolchildren in Kuwait.

Background: The prevalence of primary headaches in the pediatric population is shaped by many factors, of which pubertal status may possibly play a substantial role. Epidemiological studies in the pediatric population in the gulf region remain scarce.Aims and objectives: To examine the impact of puberty on the prevalence of primary headache disorders among female schoolchildren in Kuwait.Methods: We conducted a cross-sectional study that included Kuwaiti primary and middle schoolgirls in randomly selected schools located in two governorates in Kuwait during the academic year 2018/2019. Prevalence of headache was assessed using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents. Female students were asked about their menarchal status and whether they attained menarche before or after experiencing headaches.Results: The questionnaire was completed by 669 girls with a mean age of 11.44 ± 2.14 years. The 1-year prevalence of migraine headache disorder among girls was 23.62%, and the lifetime prevalence of any headache was 84.9%, whereas the 1-year prevalence of primary headache disorders was 47.98%. The mean age of girls with headaches was 11.44 ± 2.14 years. With respect to diagnostic criteria, migraine headache was the most frequently reported (23.62%), followed by tension-type headaches (20.93%), chronic headaches (2.99%), and probable medication-overuse headaches (0.45%). Postpubertal females were at significantly higher risk of having primary headaches compared to their prepubertal counterparts (64.26 vs. 34%; p < 0.0001). All types of primary headaches were more significantly prevalent among postpubertal girls compared to those who are prepubertal.Conclusion: Migraine headache is commonly reported among Kuwaiti schoolgirls. Postpubertal females are at higher risk of developing primary headaches compared to prepubertal females. Pubertal transition and female sex hormones may play a significant role in the pathophysiology of headaches, migraines in particular, and further research is therefore needed to investigate the underlying mechanisms.