Status Quo Method Research Articles

Variation in the Age at Menarche of the Assamese and Bengali Girls of Guwahati, Assam

Data on age at menarche have been collected using status quo method among 230 Assamese girls and 223 Bengali girls of Guwahati (Assam) attending School. The median age, estimated by probits, is 12....

Onset of Breast and Pubic Hair Development and Menses in Urban Chinese Girls

To determine the current prevalence and mean ages of onset of pubertal characteristics in healthy urban Chinese girls. A cross-sectional study of sexual maturation of healthy Chinese girls was conducted in 9 representative cities of the eastern, western, southern, and northern parts and central region of China between 2003 and 2005. At examination, stages of breast and pubic hair development were rated on girls 3 through 19.83 years of age, and height and weight were also recorded. Data on menses were collected by the status quo method. Probit analysis was used to calculate the median age and 95% confidence interval (CI) for onset of breast and pubic hair development and menarche. Data were analyzed for 20654 apparently healthy girls. At age 8 years, 19.57% of these girls had evidence of breast development. The median ages of onset of Tanner stages 2 and 3 for breast development were 9.20 (95% CI: 9.06-9.32) years and 10.37 (95% CI: 10.28-10.45) years, respectively. The median ages of onset of Tanner stages 2 and 3 for pubic hair development were 11.16 (95% CI: 11.03-11.29) years and 12.40 (95% CI: 12.25-12.55) years, respectively. Menses occurred at 12.27 years (95% CI: 12.16-12.39). These data suggest that urban Chinese girls are actually experiencing earlier breast development than currently used norms. The up-to-date reference for normal pubertal development in urban Chinese girls needs to be established for the purpose of determining precocious puberty or pubertal delay.

Age of puberty in a representative sample of Iranian girls

To obtain normal references for growth and pubertal development in a given population, assessment of pubertal stages is of great importance. This study aimed to determine the age of appearance of secondary sexual characteristics in a representative sample of Iranian girls. This cross-sectional study was conducted during 2005-2006 in 3192 girl students, aged 6-17 years, in Isfahan, Iran. Participants were selected by multistage random cluster sampling from school students. Secondary sexual characteristics were evaluated by inspection and palpation, and were recorded according to Tanner staging. The self-reported date of menarche (if any) was recorded as well. Data were analyzed with Probit analysis based on the status quo method. The median ages (10th-90th percentile) of Tanner stage 2 breast development (B2) and Tanner stage 2 pubic hair growth (PH2) were 10.14 years (8.33-11.95 years) and 10.78 years (9.09-12.48 years), respectively. The ages of the 3rd percentile for B2 and PH2 were 7.48 and 8.29 years, respectively. The median age of menarche among the 3192 girls who had experienced menarche was 12.65 years (11.18-14.11 years). The median age of puberty onset is 10.14 years, and the onset of puberty before 7.5 years is considered as precocious puberty in a representative sample of Iranian girls. The values obtained from the present study can provide baseline data for analysis of time trends, as well as for international comparisons.

Nurses Roll Up Their Sleeves at the Bedside to Improve Patient Care

Technology can be a powerful enabler, but it is insufficient on its own to create a broad cultural shift. At Solaris Health System we decided to ensure that clinical transformation is more than just a buzzword in the central New Jersey facilities. We shed the status quo method of implementing piecemeal procedural changes to find truly effective, comprehensive solutions that give nurses more time for direct patient care. To reach this point, the leadership had to recognize the hard truth that every system is perfectly designed to achieve exactly the results it gets. 1 Miller D, Rutherford P, Taylor J, Gaido L, Nelson B. Transforming care at the bedside. Paper presented at: 18th National Forum on Healthcare Improvement; December 11, 2006; Orlando, FL. Google Scholar Accepting this reality meant improving performance by dramatically redesigning entire systems of care. To that end, we engaged our frontline nurses as the primary drivers for bedside care improvements. Technology can be a powerful enabler, but it is insufficient on its own to create a broad cultural shift. At Solaris Health System we decided to ensure that clinical transformation is more than just a buzzword in the central New Jersey facilities. We shed the status quo method of implementing piecemeal procedural changes to find truly effective, comprehensive solutions that give nurses more time for direct patient care. To reach this point, the leadership had to recognize the hard truth that every system is perfectly designed to achieve exactly the results it gets. 1 Miller D, Rutherford P, Taylor J, Gaido L, Nelson B. Transforming care at the bedside. Paper presented at: 18th National Forum on Healthcare Improvement; December 11, 2006; Orlando, FL. Google Scholar Accepting this reality meant improving performance by dramatically redesigning entire systems of care. To that end, we engaged our frontline nurses as the primary drivers for bedside care improvements.

Antropometria, maturação sexual e idade da menarca de acordo com o nível socioeconômico de meninas escolares de Cascavel (PR)

To evaluate age of menarche and anthropometric data of schoolgirls of different socioeconomic levels in Cascavel, state of Parana, in Southern Brazil. A cross-sectional study was carried out in 2006 with 2,761 girls evaluated in 27 private and public schools. Age at menarche was obtained by the status quo method. Sexual maturity was assessed by self evaluation, according to Tanner's criteria. Socioeconomic level was obtained through the ABEP (2003) questionnaire. Data of weight, stature and Body Mass Index (BMI) were obtained. Data were analyzed by descriptive statistics and Mann-Whitney test at 5% significance. Age at menarche was 12.2+/-1.2 years in the whole sample, and was 12.1+/-1.1; 12.3+/-1.2 and 12.4+/-1.2 in girls from high, medium and low socioeconomic levels, respectively. Post-menarche girls aged 10-17 years had higher values of stature and weight and girls aged 11-14 years had higher BMI. Age at menarche was lesser in girls from a higher socioeconomic level. Although these differences had been found in distinct socioeconomic levels, they were considered biologically small.

Sexuelle Reifung von Kindern und Jugendlichen in Deutschland

Following the standstill in maturity acceleration in the eighties of the twentieth century, now a further shift in maturity development towards younger ages is the issue of an international and also German discussion. The collection of sexual maturity data in boys and girls as part of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) is intended to pro vide population-representative information on sexual maturation and to evaluate associations between maturity status and selected health and social data. Girls were interviewed regarding their first menstrual period (menarche) and boys regarding voice change (status-quo method). Pubic hair was self-assessed by children and adolescents from 10 to 17 years of age, based on drawings of Tanner's defined developmental stages. The median age for menarche, for voice change and pubic hair stages were calculated using a logit model. At an age of 10 years, 42.4 % of girls and 35.7 % of boys report the development of pubic hair. At 17 years of age, the majority of girls and boys have reached the stages PH5 (girls 57.5 %, boys 47.8 %) and PH6 (girls 23.6 %, boys 46.5 %) according to Tanner. The average age for each pubic hair stage is lower in girls (PH2 10.8; PH3 11.7; PH4 12.3; PH5 13.4 years) than in boys (PH2 10.9; PH3 12.6; PH4 13.4; PH5 14.1). The median age at menarche is 12.8 years, the median for voice change (voice low) 15.1 years. Significant differences in age at menarche are found in girls depending on socioeconomic status (12.7/12.9/13.0 years for low/middle/high status) and between girls with and without migration background (12.5/12.9 years). No differences in age at menarche can be seen between East and West Germany or cities and rural areas. The association between maturity status and BMI is more pronounced in girls than in boys. Overall, the onset of maturity development in German children and adolescents is not significantly earlier than in other European studies.

Some Trends in the Somatic Development of Children and Adolescents under Iodine-deficiency: Materials from the Saratov Region

2,106 girls and 2,169 boys from 7 to 17 were investigated in 2002-2004 in three urban settlements of the Saratov region (Povolzhje area): the town of Khvalynsk, population 15,000, with a low level of industrialization; the city of Balakovo, population 220,000, highly industrialized and with a nuclear power station; and the city of Saratov, population around 1,000,000 a regional capital, and also highly industrialized. The whole area, particularly the location of Khvalynsk, is also characterized by iodine deficiency (iodine concentration is 0.78 mkg/kg v. normal values of 5-7 mkg/kg). The program included about 30 anthropometric measurements, evaluation of developmental stages of secondary sexual characteristics, and information on menarcheal age by the status quo method. Information on parental occupation and education, as well as number of children per family was collected by questionnaire. For the analysis all the data were standardized, and further comparisons were made irrespective of age groups. The significance of differences was assessed by one-way ANOVA. For height, weight and chest circumference there are significant differences among the three populations (p < 0.001), with Khvalynsk children being the smallest in body height and weight. However, in chest circumference they are close to or even bigger (girls) than Balakovo children. The children from Khvalynsk are characterized by the lowest values for subcutaneous fat layer, both on the trunk and extremities. For the age of menarche, Khvalynsk girls have the highest values: 13 years 5 months (13.42). In Balakovo and Saratov, the corresponding figures are identical: 13 years 2 months (13.17). Secular changes in Khvalynsk and Saratov children are discussed as compared to the literature.

Age at menarche and age of onset of pubertal characteristics in 6-14-year-old girls from the Province of L'Aquila (Abruzzo, Italy).

The present study is part of a research project on growth models of children in an area of central-southern Italy. It analyzes the phases of pubertal breast development (BD) in 397 girls, pubic hair development (PHD) in 399 girls, and menarche in 583 girls from 6-14 years old. The status quo method was used to evaluate the age at menarche. Probit analysis was used to analyze the data for all three variables. The onset of BD and PHD (Tanner stage 2) occurs at age 7 in 6.1% of girls. Passage to stage 3 of one or both secondary sexual characteristics occurs at age 10 in 8.5% of girls. Comparison with data from the United States shows higher percentages of American white girls in stage 2 (or greater) of both characteristics at any age. The mean (median) age of onset (Tanner stage 2) of BD or PHD or both of them is 9.96 years. The passage to stage 3 occurs at age 12.36 for BD (95% confidence interval: 1.36 years) and at age 12.10 for PHD (95% confidence interval: 0.51 years). The mean age at menarche is 12.55 years, in general agreement with other values found in Italy. Sexual maturation at any considered stage for both pubertal characteristics is generally in line with literature data concerning other Mediterranean and industrialized countries or countries in which the demographic transition is in an advanced phase. It does not show a significant earlier onset. The evidence emerging from the general project suggests that the secular trend is still in progress in this region of Italy.

Body composition characteristics and fat distribution patterns in young infertile women

Objective To document body composition and fat patterning characteristics in normal and underweight infertile women. Design Status quo method. Setting University clinics. Patient(s) Fifteen amenorrheic women with anorexia nervosa, 16 women with polycystic ovary syndrome (PCO2), 10 women with primary amenorrhea and 19 healthy controls. Intervention(s) None. Main outcome measure(s) Determination of body mass index, body composition parameters such as fat mass, lean body mass, bone mass using dual-energy x-ray absorptiometry (DEXA), fat distribution patterns, 17β-estradiol, FSH, LH, prolactin, progesterone, testosterone, DHEA-S, and androstenedione levels. Result(s) A statistically significant difference was found comparing all proband groups with healthy controls for the majority of body fat and bone mineral content parameters but not for lean body mass. Infertile women of normal weight, with PCOS, and with primary amenorrhea exhibited an extraordinarily high amount of fat tissue and a tendency toward android fat patterning. In contrast, patients with anorexia nervosa and the healthy controls showed predominantly gynoid fat patterning. According to logistic regression analyses, anorexia nervosa was characterized by reduced fat tissue and PCOS was characterized by android fat patterning and an increased fat percentage. Patients with primary amenorrhea were characterized by reduced bone mass. Conclusion(s) Infertile young women showed characteristic differences in body composition and fat distribution patterns when compared with healthy, fertile, age-matched counterparts.

Age at Menarche Among Scheduled Caste Girls of Punjab

The purpose of the present investigation is to report median age at menarche among the Scheduled Caste population of Punjab. Cross-sectional data on 500 Sikh and 500 Hindu Harijan girls of Amritsar district of Punjab were collected during the year 1996-97. The information on age at menarche was obtained using status quo method. The probit analysis of the status quo data Table 1: Total number and percentage of Sikh and Hindu Harijan girls who attained menarche and median age at menarche Age Frequency Cumulative Sikh Harijans Probit Frequency Cumulative Hindu Harijans Probit frequency percentage analysis frequency Percentage analysis 8 1 1 0.20 2.12 – – – – 9 10 11 2.20 2.99 5 5 1.00 2.67 10 34 45 9.00 3.66 25 30 6.00 3.45 11 113 158 31.60 4.52 75 105 21.00 4.19 12 104 262 52.40 5.06 120 225 45.00 4.87 13 94 356 71.20 5.56 110 335 67.00 5.44 14 71 427 85.40 6.01 80 415 83.00 5.95 15 53 480 96.00 6.75 60 475 95.00 6.65 16 12 492 98.40 7.15 15 490 98.00 7.05 17 8 500 100.00 – 10 500 100.00 – Median age at menarche 11.88±1.16 12.23±1.43 yielded median age at menarche as 11.88 and 12.23 years among Sikh and Hindu Harijan girls, respectively.

Breastfeeding, Wage Labor, and insufficient milk in peri-urban Kathmandu, Nepal

This article presents a case study of breastfeeding mothers who are working as carpet-makers in peri-urban Kathmandu, Nepal. A sample of women surveyed about their current infant feeding practices revealed that half of the infants aged three to four months had been introduced to non-breast milk foods and liquids. During in-depth interviews some mothers explained that they supplemented breastfeeding with either milk or solids if they felt that they did not have enough breast milk for their infants. Reports of insufficient milk (IM) among these Nepali women is discussed within the larger context of IM as a worldwide phenomenon that is often associated with the cessation of breastfeeding and the switch to bottle-feeding based on commercial milk products. On average, the women in this study breastfed their infants until the latter were approximately three years of age. A status quo method for determining median duration of breastfeeding indicates that there is no significant difference in the duration of breastfeeding between mothers who work in carpet-making factories and those who spin wool at home. It is argued that reports of IM in this setting are not associated with the abandonment of breastfeeding, for a number of reasons including: the cultural approbation of breastfeeding; the low usage of baby bottles among peri-urban mothers, and the flexible labor practices of the carpet-making industry.

Associations with age at natural menopause in Blackfeet women.

This study seeks to determine the age at natural menopause and factors that may predict that age for Blackfeet women living on the reservation in Montana. Data were obtained from a probability sample of 150 women. Rates of surgical menopause among women who had experienced menopause were similar to those found in NHANES I for U.S. women. Median age at natural menopause by the status quo method (51.2 years) was comparable to that determined for other populations. Within the group of women who already had experienced natural menopause, age at menopause was associated in bivariate models with age at menarche (b = -0.83 +/- 0.44 years, P = 0.07), household income (b = 1.85 +/- 0.71 years, P = 0.01), "ever use" of birth control (b = 4.52 +/- 1.58 years, P = 0.008), "ever use" of oral contraceptives (b = 5.48 +/- 1.91 years, P = 0.007), current or recent unemployment (b = 4.75 +/- 1.97 years, P = 0.02), having been breastfed (b = -6.93 +/- 2.67 years), and educational attainment (ANOVA by tertiles of menopause age, mean 10.0 +/- 3.6 years of education for earliest, 13.0 +/- 2.2 years for latest, P = 0.04). In multivariate models, "ever use" of oral contraceptives, household income, and age at menarche remained significant predictors of age at menopause (R2 = 0.33-0.35, P = 0.002-0.004), with household income modifying the effect of age at menarche (analysis ofjoint effects). The findings are discussed in the context of cohort experiences, examining implications for both early and later-life influences on menopause age.

Short Report: Trend in menarcheal age in Spain: rural and urban comparison during a recent period

Menarcheal age of a sample of rural (n = 342) and urban (n = 469) girls with ages ranging from 9 to 16 years from Madrid province was analysed. Results, obtained through the status quo method and probit analysis (age 12.79 SD 1.04 in Madrid city and 12.90 SD 1.03 in rural sample), were compared with data from previous studies carried out in the same area, as well as those from other regions of the Iberian Peninsula. The aim of these comparisons was to establish the variability of menarche in the recent past, considering physical environment, degree of urbanization and socio-economic development. Decline in menarcheal age was detected and, in general, a tendency towards similar means among Spanish populations in the period studied.

Nutritional status and age at menarche in a rural area of Bangladesh

The age at menarche and its association with nutritional status in a rural area of Bangladesh was determined. A cross-sectional study was conducted in four villages of Rupganj Thana of Narayanganj district. Data was collected through October to December 1996 using a pre-tested structured questionnaire interview schedule, and nutritional status was measured by weight, height, body mass index (BMI) and physical examination. Data were obtained on 436 adolescent girls aged 10-17 years. Among them, 165 (37.8%) girls had commenced menarche. The mean age at menarche as determined by retrospective recall was 13 years SD 0.89 (n=165). The median age at menarche determined by the status quo method was 13.0. Among the adolescents 60.1% were thin (BMI< 5th centile WHO recommended reference) and 48.2% were stunted (< 3rd centile NCHS/WHO). The mean weight and BMI were significantly higher among the menstruating girls of 13, 14 and 15 years (p < 0.01) than non-menstruating girls. The mean height was found to be significantly higher at 11-14 years among the menstruating girls (p < 0.05). A lower prevalence of angular stomatitis was found among the menstruating adolescent girls compared with the non-menstruating girls, 36.4% versus 46.5%, although this was statistically non-significant (odds ratio=0.66, 95% CI 0.43-1.00). For glossitis, no significant difference was found. Among the menstruating girls 12.1% were suffering from menorrhagia and 31.5% from dysmenorrhoea. We conclude that the age of menarche among this rural Bangladeshi community is not as delayed as expected. Not surprisingly, menarche is associated with better nutritional status. The surveyed population had extremely high rates of undernutrition which suggests that adolescents in this and similar situations require specific intervention programmes to improve their nutritional status.

Changes in menarcheal age in girls exposed to war conditions.

The purpose of this study was to assess changes in mean menarcheal age of girls in the city of Sibenik in the period from mid-1980s to the mid-1990s. Sibenik is a Dalmatian town which was exposed to hard war conditions in 1991-1995. Menarcheal status of Sibenik girls was surveyed three times, in 1981, 1985, and 1996, and included 720, 1,207, and 1,680 girls, respectively, ages 9.5-16.5 years. Mean menarcheal age was estimated by the status quo method and application of probit analysis. Results show a slight decrease in menarcheal age from 1981 to 1985 (from 12.97 +/- 0.06 years to 12.87 +/- 0.05), and then a significant increase from 12.87 +/- 0.05 years in 1985 to 13.13 +/- 0.10 years in 1996. The increase in mean menarcheal age occurred in all socioeconomic groups based on parental occupation and number of siblings. In the group of girls whose homes were damaged during war, menarche occurred at an average of 13.53 +/- 0.14 years, while those who lost a family member experienced menarche at an older mean age, 13.76 +/- 0.27 years. However, when the girls who experienced personal tragedies were excluded the onset of menarche was still later than in girls surveyed in the earlier periods. The results suggest that the general reversal in the secular trend of menarcheal age in Sibenik girls can be attributed to persistent psychological pressures and uncertainties associated with conditions of war. Am. J. Hum. Biol. 12:503-508, 2000. Copyright 2000 Wiley-Liss, Inc.

Why did they lie? Socio-economic bias in reporting menarcheal age

To show that socio-economically dependent cultural bias distorts results of the status quo method of estimating age at first menstruation. Questionnaires asking for menstrual status and the recalled age at menarche were distributed to approximately 1000 Javanese girls who attended junior and senior high schools in Malang. Age of participants ranged from 11.98 to 18.89 years. Probit analysis was applied to the status quo data while average menarcheal age recalled by girls > or =16 year old was also calculated. t-test, F-test, ANOVA and chi2 tests were applied to test significance of differences between groups. Girls of low occupational status fathers (Group 1) had a probit average menarcheal age of 13.99 years (SD = 1.33, n = 524). Girls of medium occupational status fathers (Group 2), had a lower probit average menarcheal age (13.06 SD = 1.38, n = 315). Girls of fathers with the highest occupational score (Group 3) rarely reported premenarcheal status (less than 10% in all age groups studied) and the probit analysis of their reports yielded an unbelievable average of 9.61 (SD = 3.41, n = 157) years. Group 3 girls tend to report their menarcheal status incorrectly, probably due to a 'fashion' of appearing mature or to 'contagion' during filling out of a questionnaire. The recalled average menarcheal age of Group 3 females questioned when they were aged 16 years and above, yields an average that seems to be more reliable (12.74 years, SD = 1.41, n = 7), because at a fully postmenarcheal age there is no need to enhance one's status by falsely claiming maturity.

Growth Pattern and Age at Menarche in Bania Girls of Mandi Gobindgarh

The present study is an attempt to investigate the growth pattern and age at menarche of Bania girls from Mandi Gobindgarh (Punjab). Cross-sectional data based on ten anthropometric measurements and two indices were collected from 284 Bania girls aged 9 to 16 years attending secondary school and belonging to middle socio-economic status. Additional information on age at menarche was obtained using status quo method. Bania girls are found to be shorter and lighter at all ages than well to do Indian and Punjabi girls. When compared to ICMR sample and Indian children belonging to low socio-economic group, Bania girls stand latter and heavier at all age levels. The probit analysis of the status quo data yielded median age at menarche of 12.88 ± 0.72 years.

Age at Menopause in Women with Type 2 Diabetes Mellitus

Considering that chronic diseases such as diabetes mellitus (DM) may determine premature ovarian failure by various mechanisms, we studied the age at menopause in women without diabetes and in women with type 2 DM. We studied 409 women without diabetes and 404 patients with type 2 DM, selected from 45 to 55 years of age, for analysis with the status quo method. The age at menopause was calculated with a logistic regression on the proportions of menopausal women for each age group. In the groups, 172 women without diabetes and 207 women with diabetes had menopause. The regression procedure gave a median age of 49.7 +/- SD 1.7 years for the whole group, 49.6 +/- 1.6 years for the nondiabetic group, and 49.8 +/- 1.7 years for women with diabetes. Women without diabetes were 1.4 years younger, but this factor did not have an influence on the results. Smoking habits, vegetarianism, and somatometric variables were similar in both groups, except for waist/hip and abdomen/hip ratios, larger in the group of women with diabetes. The mean for years since diagnosis in patients < 45 years of age was 4.9 years. For older patients, the figure increased to 8.9 years. No difference for age at menopause was found between women without diabetes and women with type 2 diabetes who were 5 to 8 years since the diagnosis was made.

Preschool stunting, age at menarche and adolescent height: a longitudinal study in rural Senegal.

To study the impact of preschool stunting on adolescent height and age at menarche in rural West Africa. A longitudinal, population-based study. The Niakhar study area in Central Senegal. 1650 children aged 12-17 y with known height-for-age at the age of 2-5 y. Adolescent height; mean age at menarche of girls estimated by the status quo method. The subjects were divided into three groups of preschool height-for-age: < -2, -2 to -1 and > -1 z-score of the NCHS reference. The mean height during adolescence differed significantly according to preschool height-for-age for both boys and girls (P < 0.001). Relative risk of adolescent stunting according to preschool stunting varied from 2.0-4.0 depending on age and sex. Estimated mean age at menarche was 17.2 (95% fiducial confidence interval: 16.6-18.7), 16.5 (16.1-17.2) and 15.6 (15.2-16.0) y, respectively, for the three groups of preschool height-for-age (P < 0.001). Mean increment from age 5 y to adolescence did not differ significantly among the boys according to preschool stunting, but among the girls aged 16-17 y, the increment was higher for those who had been stunted during preschool life (P < 0.01). Some evidence of catch-up growth between the ages of 5 and 17 y was found for stunted girls. The significant delay in sexual maturation of the stunted girls suggests that stunted children of both sexes have a possibility of catch-up growth after the age of 17 y.

A halt in the secular trend towards earlier menarche in Denmark

A halt in the decrease of menarcheal age has been reported in some countries but has not been documented in Denmark. The entire population of schoolgirls, attending grades 5 through 10 (n=979), in a particular region of Denmark was investigated by the status quo method in 1996. Similar investigations had been made in the same region and by the same method in 1966 and 1983. Mean age and standard deviation were estimated by probit analysis. Mean age was 13.00 years (s.e.=0.080; s.d. = 1.15) and almost identical with the mean age in 1983 (13.03 years), but significantly different from the mean age in 1966 (13.40 years). The results indicate a halt in the secular trend towards earlier menarche in the region at some time between 1966 and 1983.