Selecting optimal progestational agents either alone or in combination in common pediatric endocrine settings: challenges of unmet needs.

Progesterone is a natural hormone, mainly produced by the corpus luteum, with the foremost endocrine function on the secretory glands of the endometrium. Since being isolated, both natural and synthetic forms have been produced and are utilized for several purposes, including regulating the menstrual cycle and preventing endometrial hyperplasia. Specifically, the use of progestational agents is essential in the treatment of many common endocrine conditions, including Polycystic Ovary Syndrome, Congenital Adrenal Hyperplasia, Turner Syndrome, and Functional Hypothalamic Amenorrhea. Although these agents are essential for disease management, literature that focuses on the benefits of specific progestins as well as the effects on glucocorticoid receptors (GR), mineralocorticoid receptors (MR), and androgenic receptors (AR) is limited. In this review, we provide a disease specific summary of the available literature and highlight where more information is needed.

Parent Education and Adolescent Health Outcomes: The Potential Role of Adolescent Academic Intention.

Parental educational attainment significantly shapes child socioeconomic status, potentially influencing various aspects of adolescent health. This study aimed to uncover the relationships between parental education and self-reported adolescent health outcomes, including overall health, mental well-being, and body mass index (BMI). Analyzing data from 1,448 participants in the Future of Families and Child Wellbeing Study, we identified notable associations. Our findings revealed that higher maternal and paternal education correlated with reduced odds of adolescent obesity. Furthermore, increased adolescent academic intention was associated with better overall and mental health in adolescents. Notably, it also played a mediating role in lowering adolescent BMI, thereby potentially explaining the association between parent education and adolescent BMI category (overweight vs. obese). These findings emphasize the significant impact of both parent education and adolescent academic intention on adolescent health. Future research should explore interventions leveraging academic intention to positively influence the health trajectory of adolescents.

Teaching SSHADESS Versus HEADSS to Medical Students: An Association With Improved Communication Skills and Increased Psychosocial Factor Assessments.

OBJECTIVE: The most recent Bright Futures edition describes both the HEADSS (Home, Education, Drugs, Sexuality, Safety) and the strength-based SSHADESS (Strengths, School, Home, Activities, Drugs, Emotions, Sexuality, Safety) frameworks for conducting an adolescent psychosocial history. We found limited research comparing the effectiveness of these 2 frameworks. Our study objective was to examine whether teaching medical students SSHADESS versus HEADSS is associated with increased communication skills and/or completion of the psychosocial assessment. METHODS: In this retrospective cohort study of pediatric clerkship students at New York University Grossman School of Medicine, we collected data from observer (faculty, fellow, and resident) and standardized patient (SP) assessments during Objective Structured Clinical Examinations. Primary outcomes were observer and SP-rated usage of communication skills. Secondary outcomes were observer-rated assessment of 6 psychosocial factors. Our predictor variable was whether students were taught HEADSS (11/2015-10/2016) or SSHADESS (11/2016-10/2017). We used Fisher's exact tests and then logistic regressions to adjust for pediatrics clerkship timing and baseline communication skills. RESULTS: About 200 students were assessed (n = 97 HEADSS cohort, n = 103 SSHADESS cohort). In adjusted analyses of observer scores, the SSHADESS cohort was more likely to use all communication skills (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI] 1.7-6.3]) and assess all psychosocial factors (aOR 1.9, 95% CI 1.01-3.4). There was no significant difference in SP communication scores. DISCUSSION: Teaching SSHADESS was associated with higher observer-rated communication skills scores and improved completeness in assessment of psychosocial factors. Future work should examine the efficacy of SSHADESS through workplace-based assessments and 360 degree assessments from adolescent patients.

Social Capital and Sleep Outcomes Across Childhood in United States Families.

OBJECTIVE: To examine whether aspects of social capital, or benefits received from social relationships, are associated with regular bedtime and sleep duration across childhood in US families with lower income. METHODS: Cross-sectional study using the 2018-19 National Survey of Children's Health in participants with incomes <400% federal poverty level. Separately for early childhood (0-5 years), school-age (6-12 years), and adolescence (13-17 years), we used weighted logistic regression to examine associations between social capital (measured by family social cohesion, parent social support, child social support) and sleep (measured by regular bedtime, sleep duration, adequate sleep per American of Academy of Sleep guidelines). Path analysis tested whether regular bedtime mediated associations between social capital and sleep duration. RESULTS: In our sample (N = 35,438), 84.9% had a regular bedtime, 60.2% had adequate sleep. Family social cohesion was associated with sleep duration and adequate sleep (infancy: adjusted odds ratio [aOR] 2.18 [95% confidence interval [CI], 1.32, 3.60]; school age: aOR 2.03 [95% CI, 1.57, 2.63]; adolescence: aOR 2.44 [95% CI, 1.94, 3.09]). In toddlerhood, parent social support was associated with adequate sleep (aOR 1.44 [95% CI, 1.06, 1.96]). In adolescence, child social support was associated with regular bedtime (aOR 1.70 [95% CI, 1.25, 2.32]. Across childhood, associations between family social cohesion and sleep duration were partially mediated by regular bedtime. CONCLUSIONS: Family social cohesion was associated with adequate sleep across childhood, this was partially mediated by regular bedtime. Associations between social support and sleep outcomes varied by development stage. Future work should consider how supportive relationships may influence child sleep outcomes.

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 3.0.

Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as fellowship programs in adolescent medicine. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners' reference. This updated curriculum replaces the previous 2018 publication with added content, resources, and updated references.

Description of Sexual Orientation and Sexual Behaviors among High School Girls in New York City.

STUDY OBJECTIVE: Examination of the association of sexual orientation to the sexual practices and health behaviors of high school girls in New York City (NYC). DESIGN, SETTING, AND PARTICIPANTS: Data were drawn from the 2013 Youth Risk Behavior Surveillance System survey of public high school students in grades 9-12 in NYC. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Independent variables included sexual orientation and gender of sexual partners. Dependent variables include sexual/health risk behaviors. We used t tests to compare mean ages and χ2 tests to compare distributions according to sexual orientation, gender of sexual partners, and differences in risk behaviors. RESULTS: The survey was completed by 4643 girls; mean age, 15.5 years; (1103 + 1842)/4254 (69%) black or Latina; 1101/4000 (27.5%) sexually active; 3574/4412 (81%) heterosexual; and (92 + 526)/4412 (14%) sexual minorities; 24.1% were heterosexual, 52.1% lesbian, and 49.4% were bisexual girls and were sexually active; 247 were classified as women who have sex with women (WSW) or WSW and men (WSWM). Of the sexually active girls, (65 + 182)/1081 (23%) were WSW/WSWM. The WSW/WSWM reported earlier sexual debut, more sexual partners, higher pregnancy rate, use of alcohol at last sex, history of intimate partner violence, and less likelihood of having an HIV test. CONCLUSION: Almost one in four of sexually active high school girls in NYC can be classified as WSW, who are vulnerable to increased sexual and health risk-taking behaviors leading to adverse health outcomes. The discordance between sexual behavior and sexual orientation emphasizes the importance of the provider sharing protective strategies in the sexual health counseling session for their patients who engage in sex with female partners regardless of sexual orientation.

Polycystic Ovary Syndrome: An Under-recognized Cause of Abnormal Uterine Bleeding in Adolescents Admitted to a Children's Hospital.

STUDY OBJECTIVE: To evaluate whether ovulatory dysfunction due to polycystic ovary syndrome (PCOS) is a common underlying etiology of abnormal uterine bleeding (AUB) in adolescents who require hospitalization and to explore etiology, treatment, and complications of AUB with severe anemia in adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We identified female patients aged 8-20 years admitted to a children's hospital for treatment of AUB from January 2000 to December 2014. Our hospital protocol advises hormonal testing for PCOS and other disorders before treatment for AUB. We reviewed medical records and recorded laboratory evaluations, treatments, and final underlying diagnoses as well as recurrences of AUB and readmissions in the subsequent year. RESULTS: Of the 125 subjects, the mean age was 16.5 ± 2.9 years; mean hemoglobin level was 7.0 ± 1.8 g/dL; 54% were overweight/obese; and 41% sexually active. PCOS accounted for 33% of admissions; hypothalamic pituitary ovarian axis immaturity 31%; endometritis 13%; bleeding disorders 10%. Girls with PCOS were more likely to be overweight/obese (74% vs 46%; P < .01) and girls with hypothalamic pituitary ovarian axis immaturity had lower hemoglobin levels (6.4 g/dL vs 7.4 g/dL; P < .05), than girls with all other etiologies of AUB. Treating physicians failed to diagnose endometritis as the etiology for AUB in 4 of 8 girls with positive tests for sexually transmitted infection and no other etiology. CONCLUSION: PCOS was the most common underlying etiology in adolescents hospitalized with AUB. Screening for hyperandrogenemia is important for early diagnosis of PCOS to allow ongoing management and prevention of comorbidities. Endometritis was frequently underestimated as an etiology for AUB.