RESUMO
OBJECTIVE: To examine how height and youth as well as parenting characteristics associate with quality of life (QoL) and self-esteem among healthy youth undergoing growth evaluation with growth hormone (GH) testing. STUDY DESIGN: Healthy youth, aged 8-14 years, undergoing provocative GH testing, and a parent completed surveys at or around the time of testing. Surveys collected demographic data; youth and parent reports of youth health-related QoL; youth reports of self-esteem, coping skills, social support, and parental autonomy support; and parent reports of perceived environmental threats and achievement goals for their child. Clinical data were extracted from electronic health records. Univariate models and multivariable linear regressions were used to identify factors associated with QoL and self-esteem. RESULTS: Sixty youth (mean height z score -2.18 ± 0.61) and their parents participated. On multivariable modeling, youth perceptions of their physical QoL associated with higher grade in school, greater friend and classmate support, and older parent age; youth psychosocial QoL with greater friend and classmate support, and with less disengaged coping; and youth height-related QoL and parental perceptions of youth psychosocial QoL with greater classmate support. Youth self-esteem associated with greater classmate support and taller mid-parental height. Youth height was not associated with QoL or self-esteem outcomes in multivariable regression. CONCLUSIONS: Perceived social support and coping skills, rather than height, were related to QoL and self-esteem in healthy short youth and may serve as an important potential area for clinical intervention.
Assuntos
Hormônio do Crescimento Humano , Qualidade de Vida , Adolescente , Criança , Humanos , Adaptação Psicológica , Qualidade de Vida/psicologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To describe menstrual cycle patterns in adolescents with concussion and investigate whether menstrual cycle phase at injury influenced postconcussion cycle pattern changes or concussion symptoms. STUDY DESIGN: Data were collected prospectively from patients aged 13-18 years presenting to a specialty care concussion clinic for an initial visit (≤28 days postconcussion) and, if clinically indicated, at a follow-up visit 3-4 months postinjury. Primary outcomes included menstrual cycle pattern change since injury (change/no change), menstrual cycle phase at time of injury (calculated using date of last period before injury), and symptom endorsement and severity, measured by Post-Concussion Symptom Inventory (PCSI). Fisher exact tests were used to determine the association between menstrual phase at injury and change in cycle pattern. Multiple linear regression was used to determine whether menstrual phase at injury was associated with PCSI endorsement and symptom severity, adjusting for age. RESULTS: Five hundred twelve postmenarchal adolescents were enrolled (age 15.2 ± 1.4 years), with 111 (21.7%) returning for follow-up at 3-4 months. Menstrual pattern change was reported by 4% of patients at initial visit and 10.8% of patients at follow-up. At 3-4 months, menstrual phase at injury was not associated with menstrual cycle changes (P = .40) but was associated with endorsement of concussion symptoms on the PCSI (P = .01). CONCLUSIONS: At 3-4 months' postconcussion, 1 in 10 adolescents experienced a change in menses. Menstrual cycle phase at injury was associated with postconcussion symptom endorsement. Leveraging a large sample of postconcussion menstrual patterns, this study represents foundational data regarding potential menstrual cycle effects of concussion in female adolescents.
Assuntos
Traumatismos em Atletas , Concussão Encefálica , Síndrome Pós-Concussão , Humanos , Adolescente , Feminino , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Síndrome Pós-Concussão/diagnóstico , Ciclo Menstrual , Fatores de RiscoRESUMO
Growth hormone (GH) has been used for over 35 years, and its safety and efficacy has been studied extensively. Experimental studies showing the permissive role of GH/insulin-like growth factor 1 (IGF-I) in carcinogenesis have raised concerns regarding the safety of GH replacement in children and adults who have received treatment for cancer and those with intracranial and pituitary tumours. A consensus statement was produced to guide decision-making on GH replacement in children and adult survivors of cancer, in those treated for intracranial and pituitary tumours and in patients with increased cancer risk. With the support of the European Society of Endocrinology, the Growth Hormone Research Society convened a Workshop, where 55 international key opinion leaders representing 10 professional societies were invited to participate. This consensus statement utilized: (1) a critical review paper produced before the Workshop, (2) five plenary talks, (3) evidence-based comments from four breakout groups, and (4) discussions during report-back sessions. Current evidence reviewed from the proceedings from the Workshop does not support an association between GH replacement and primary tumour or cancer recurrence. The effect of GH replacement on secondary neoplasia risk is minor compared to host- and tumour treatment-related factors. There is no evidence for an association between GH replacement and increased mortality from cancer amongst GH-deficient childhood cancer survivors. Patients with pituitary tumour or craniopharyngioma remnants receiving GH replacement do not need to be treated or monitored differently than those not receiving GH. GH replacement might be considered in GH-deficient adult cancer survivors in remission after careful individual risk/benefit analysis. In children with cancer predisposition syndromes, GH treatment is generally contraindicated but may be considered cautiously in select patients.
Assuntos
Hormônio do Crescimento Humano , Neoplasias Hipofisárias , Adulto , Criança , Hormônio do Crescimento , Hormônio do Crescimento Humano/efeitos adversos , Humanos , Fator de Crescimento Insulin-Like I , Recidiva Local de Neoplasia/induzido quimicamente , Neoplasias Hipofisárias/tratamento farmacológico , SobreviventesRESUMO
OBJECTIVE: To determine if the racial/ethnic inequity in growth hormone (GH) use is due to differences in GH stimulation testing and/or prescribing patterns in children referred for endocrine evaluation of short stature. STUDY DESIGN: Retrospective chart review was performed including children aged 2-16 years, height z-score of ≤-1.5, and of non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic race/ethnicity, referred for endocrine growth evaluation between January 2012 and December 2019. RESULTS: This study included 7425 children (5905 NHW, 800 NHB, and 720 Hispanic). GH stimulation testing was performed in 992, and 576 were prescribed GH. NHW children were 1.4 (95% CI, 1.04-1.8) times more likely than NHB children and 1.7 (95% CI, 1.2-2.2) times more likely than Hispanic children to undergo GH stimulation testing. GH-treated NHB children had (1) a lower median peak GH concentration when compared with NHW (P = .02) and Hispanic (P = .08) children (NHB 4.7 ng/mL [95% CI, 1.2-8.3 ng/mL] ng/mL, NHW 7.2 ng/mL [95% CI, 4.9-9.7 ng/mL], Hispanic 7.1 ng/mL [95% CI, 4.3-11.9 ng/mL]); (2) lower median height z-scores than NHW (P = .01) but not Hispanic children (P = .5); and (3) a greater height deficit from midparental height when compared with NHW (P = .01) and Hispanic (P = .002) children. CONCLUSIONS: Racial and ethnic disparities exist in the evaluation and treatment of children with disordered growth. This likely results from both overinvestigation of NHW children as well as underinvestigation and undertreatment of children from minority communities. The evaluation and treatment of children with short stature should be determined by clinical concern alone, but this is not current practice.
Assuntos
Negro ou Afro-Americano , Transtornos do Crescimento/diagnóstico , Disparidades em Assistência à Saúde/etnologia , Hispânico ou Latino , Hormônio do Crescimento Humano/deficiência , População Branca , Adolescente , Estatura , Criança , Pré-Escolar , Técnicas de Diagnóstico Endócrino , Feminino , Transtornos do Crescimento/etnologia , Transtornos do Crescimento/terapia , Humanos , Masculino , Padrões de Prática Médica , Estudos RetrospectivosRESUMO
OBJECTIVE: To create reference charts for sitting height to standing height ratio (SitHt/Ht) for children in the US, and to describe the trajectory of SitHt/Ht during puberty. STUDY DESIGN: This was a cross-sectional study using data from the 1988-1994 National Health and Nutrition Examination Survey III, a strategic random sample of the US population. Comparison between non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican American groups was performed by ANOVA to determine if a single population reference chart could be used. ANOVA was used to compare SitHt/Ht in pre-, early, and late puberty. RESULTS: NHANES III recorded sitting height and standing height measurements in 9569 children aged 2-18 years of NHW (n = 2715), NHB (n = 3336), and Mexican American (n = 3518) ancestry. NHB children had lower SitHt/Ht than NHW and Mexican American children throughout childhood (P < .001). In both sexes, the SitHt/Ht decreased from prepuberty to early puberty and increased in late puberty. Sex-specific percentile charts of SitHt/Ht vs age were generated for NHB and for NHW and Mexican American youth combined. CONCLUSIONS: SitHt/Ht assessment can detect disproportionate short stature in children with skeletal dysplasia, but age-, sex-, and population-specific reference charts are required to interpret this measurement. NHB children in the US have significantly lower SitHt/Ht than other children, which adds complexity to interpretation. We recommend the use of standardized ancestry-specific reference charts in screening for skeletal dysplasias and have developed such charts in this study.
Assuntos
Estatura/etnologia , Gráficos de Crescimento , Valores de Referência , Postura Sentada , Adolescente , Negro ou Afro-Americano , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Americanos Mexicanos , Inquéritos Nutricionais , Estados Unidos , População BrancaRESUMO
Growth hormone (GH) treatment of idiopathic short stature (ISS), defined as height <-2.25 standard deviations (SD), is approved by U.S. FDA. This study determined the gender-specific prevalence of height <-2.25 SD in a pediatric primary care population, and compared it to demographics of U.S. pediatric GH recipients. Data were extracted from health records of all patients age 0.5-20 years with ≥ 1 recorded height measurement in 28 regional primary care practices and from the four U.S. GH registries. Height <-2.25 SD was modeled by multivariable logistic regression against gender and other characteristics. Of the 189,280 subjects, 2073 (1.1%) had height <-2.25 SD. No gender differences in prevalence of height <-2.25 SD or distribution of height Z-scores were found. In contrast, males comprised 74% of GH recipients for ISS and 66% for all indications. Short stature was associated (P < 0.0001) with history of prematurity, race/ethnicity, age and Medicaid insurance, and inversely related (P < 0.0001) with BMI Z-score. In conclusion, males outnumbered females almost 3:1 for ISS and 2:1 for all indications in U.S. pediatric GH registries despite no gender difference in height <-2.25 SD in a large primary care population. Treatment and/or referral bias was the likely cause of male predominance among GH recipients.
Assuntos
Hormônio do Crescimento/administração & dosagem , Sexismo , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estados UnidosRESUMO
OBJECTIVE: To explore linear growth, puberty, and predictors of linear growth impairment among pubertal liver transplant recipients. STUDY DESIGN: Review of data collected prospectively through the Studies of Pediatric Liver Transplantation registry. Thirty-one variables were tested as risk factors for linear growth impairment, and factors significant at P < .1 were included in a logistic regression model. Risk factor analysis was limited to 512 patients who had complete demographic and medical data. RESULTS: A total of 892 patients surviving their first liver transplant by >1 year, with ≥ 1 height recorded, who were between 8 and 18 years old between the years 2005 and 2009 were included. Median follow-up was 70.2 ± 38.6 months, mean age was 12.9 ± 3.3 years, and mean height z-score (zH) was -0.5 ± 1.4 SD. Twenty percent had linear growth impairment at last follow-up. Of 353 subjects with Tanner stage data, 39% of girls and 42% of boys ages 16-18 years were not yet Tanner 5. Growth impairment rates were higher among boys than girls (30% vs 7%, P < .05) at Tanner stage 4, and occurred in 8/72 (11%) of Tanner 5 subjects. Among patients with parental height data, zH were lower than calculated mid-parental zH (P < .005). Independent predictors of growth impairment included linear growth impairment at transplant (OR 11.53, P ≤ .0001), re-transplantation (OR 4.37, P = .001), non-white race (P = .0026), and primary diagnosis other than biliary atresia (P = .0105). CONCLUSIONS: Linear growth impairment and delayed puberty are common in pubertal liver transplant recipients, with pre-transplant growth impairment identified as a potentially modifiable risk factor. Catch-up growth by the end of puberty may be incomplete.
Assuntos
Transtornos do Crescimento/etiologia , Transplante de Fígado/efeitos adversos , Puberdade , Adolescente , Canadá , Criança , Estudos de Coortes , Feminino , Seguimentos , Transtornos do Crescimento/diagnóstico , Humanos , Transplante de Fígado/métodos , Masculino , Sistema de Registros , Análise de Regressão , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados UnidosRESUMO
OBJECTIVE: To determine the sex-based prevalence of growth faltering in a pediatric primary care setting. STUDY DESIGN: A total of 33 476 children attending 4 urban pediatric primary care practices affiliated with a tertiary pediatric hospital between July 2002 and June 2005 were studied. Growth faltering was defined as height <5th percentile or a drop in height z-score by >or= 1.5 standard deviations (SD) before age 18 months or by >or= 1 SD thereafter. The growth-faltering and nonfaltering groups were compared in terms of sex, race, age, number of clinic visits, and insurance, and by US census tract, socioeconomic status and parental education. Similar comparisons were made for children with height z-scores below -2.25 SD. RESULTS: Growth faltering was present in 3007 of the children studied (9%). Univariate and multivariate logistic regression analyses identified significant associations between growth faltering and younger age (P< .0001), Caucasian race (P< .0001), fewer clinic visits (P< .0001), and Medicaid insurance (P< .005), but not with sex nor by residential census tract, median income or proportion with less than high school education. Height below -2.25 SD was associated with male sex (P< .01), Medicaid insurance (P< .01), and more primary care visits (P< .0005). CONCLUSIONS: The sex disparity in subspecialty growth center referrals (2:1 male:female) is not due to male predominance in growth faltering among children in the urban primary care setting.
Assuntos
Transtornos do Crescimento/epidemiologia , Disparidades nos Níveis de Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Erros de Diagnóstico/prevenção & controle , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/etnologia , Acessibilidade aos Serviços de Saúde , Humanos , Cobertura do Seguro , Modelos Logísticos , Masculino , Medicaid , Análise Multivariada , Philadelphia/epidemiologia , Pobreza , Prevalência , Atenção Primária à Saúde , Estudos Retrospectivos , Distribuição por Sexo , Estados Unidos , População UrbanaRESUMO
OBJECTIVES: The objective of this study was to compare sex differences among referrals for evaluation of poor growth. STUDY DESIGN: This study was based on chart reviews of all new-patient encounters at Children's Hospital of Philadelphia Diagnostic and Research Growth Center for short stature or poor growth evaluations during 2001. Outcome measures were patient growth characteristics, frequency of underlying pathology, and frequency of laboratory and radiologic investigations before referral. RESULTS: One hundred eighty-two boys and 96 girls were referred ( P < .0001). Girls were shorter, relative to the general population (median height z score, -2.4 vs -1.9 for boys, P = .02) and mid-parental target heights (median deficit, 1.9 vs 1.3 SD, P < .01). Differences were more pronounced starting at age 9 years. Median time to referral from initial fall-off on the growth curve was 35 months in girls and 24 months in boys (not significant). The percentage of girls (41%) with organic disease significantly exceeded that of boys (15%). Conversely, more boys (72%) than girls (48%) were of normal height or short but healthy ( P < .0001). Sex was not associated with frequency of tests before referral; neither was severity of short stature. CONCLUSIONS: Sex differences in short stature referrals may delay diagnosis of diseases in girls while promoting overzealous evaluations of healthy boys who do not appear to be tall enough.