Pubertal assessment: a national survey of attitudes, knowledge and practices of the US pediatric trainees

2017 ◽  
Vol 30 (6) ◽  
Author(s):  
Aditi Khokhar ◽  
Yagnaram Ravichandran ◽  
Dimitre G. Stefanov ◽  
Sheila Perez-Colon
Keyword(s):  
Online Survey ◽  
Comfort Level ◽  
Clinical Practices ◽  
Continuity Clinic ◽  
Pediatric Residents ◽  
Secondary Sexual Characteristics ◽  
The Us ◽  
Sexual Characteristics ◽  
Recommended Guidelines ◽  
Different Levels

AbstractBackground and objectiveSex maturity rating (SMR), defines different levels of sexual maturity, based on the development of secondary sexual characteristics. Periodic assessment of pubertal maturation by physicians is crucial for timely identification of puberty-related disorders. With this pilot study, we aimed to assess the attitudes, knowledge and practices of pubertal assessment by current US pediatric trainees.MethodsAn anonymous online survey questionnaire was sent to categorical pediatric residents at different levels of training and pediatric chief residents across the US.ResultsWe received responses from 2496 pediatric residents from all over the US. We found that 96% of trainees understand the importance of assessing SMR, 62% feel confident in assessing it and 55% feel comfortable assessing the need for an endocrinology referral. Only 33% of trainees performed external genital exams during all regular clinic visits while 26.9% never performed them during sick visits and 6% never assessed SMR during any of the patient visits. Higher levels of training and having completed an endocrinology rotation were associated with improvement in comfort level, practice and knowledge of trainees regarding pubertal assessment.ConclusionThis study revealed that the current clinical practices of performing external genital exams and SMR among pediatric residents need improvement. Stronger reinforcement from continuity clinic preceptors and/or online and clinic based resources for SMR assessment for trainees may improve adherence to the recommended guidelines.

Reproductive failure of the red shiner (Cyprinella lutrensis) after exposure to an exogenous estrogen

2010 ◽  
Vol 67 (11) ◽  
pp. 1730-1743 ◽  
Author(s):  
Michelle M. McGree ◽  
Dana L. Winkelman ◽  
Nicole  K.M.  Vieira ◽  
Alan  M.  Vajda
Keyword(s):  
Reproductive Success ◽  
Great Plains ◽  
Endocrine Disrupting Chemicals ◽  
Water Control ◽  
Secondary Sexual Characteristics ◽  
Cyprinella Lutrensis ◽  
The Us ◽  
Sexual Characteristics ◽  
Solvent Control ◽  
17Β Estradiol

Endocrine disrupting chemicals (EDCs) have been detected in surface waters worldwide and can lead to developmental and reproductive disruption in exposed fishes. In the US Great Plains, EDCs are impacting streams and rivers and may be causing adverse reproductive effects. To examine how estrogenic EDCs might affect reproductive success of plains fishes, we experimentally exposed male red shiners ( Cyprinella lutrensis ) to exogenous 17β-estradiol. We characterized the effects of estradiol on male gonadal histology and secondary sexual characteristics, determined whether exposure reduced reproductive success, and examined the effects of depuration. Adults were exposed to a mean concentration of 70 ng·L−1 estradiol, a solvent control, or a water control for at least 83 days. Male exposure to estradiol resulted in elevated plasma vitellogenin concentrations, changes in spermatogenesis, reduced mating coloration and tubercles, altered mating behaviors, and reduced reproductive success with no viable progeny produced. Reproductive endpoints improved upon depuration (28 days). Exposure to estradiol had significant adverse effects on red shiners, indicating that wild populations may face developmental and reproductive difficulties if they are chronically exposed to estradiol.

Hypogonadotropic Hypogonadism Associated With Obesity: A Case Report

2021 ◽  
Author(s):  
Niloufar Johari Varnoosfaderani ◽  
Sahar Karimpour Reyhan ◽  
Mahsa Abbaszadeh ◽  
Nasim Khajavirad
Keyword(s):  
Adipose Tissue ◽  
Risk Factor ◽  
Hypogonadotropic Hypogonadism ◽  
Reproductive Disorders ◽  
Secondary Sexual Characteristics ◽  
Cardiovascular Comorbidities ◽  
Preventable Risk Factor ◽  
Sexual Characteristics ◽  
Different Levels ◽  
Significant Factors

One of the most significant factors with a broad impact on health is obesity. Besides cardiovascular comorbidities caused by obesity, its probable association with hypogonadotropic hypogonadism in men was discussed in this article. We described a severe obese boy, presenting with no secondary sexual characteristics and hypertension. The hypothalamus-hypophyseal-gonadal axis can be influenced by multiple mechanisms at different levels of the axis. Some of these pathophysiological mechanisms, related to our case, were explained aiming at explaining the association between obesity and accompanied reproductive disorders. Adipose tissue, as an essential influencer, insignificantly affects the metabolism of hormones secreted by other glands. Obesity, as a preventable risk factor, is valuable to be researched to decrease the burden of its induced morbidity and mortality. Thus, further studies should be conducted to exactly determine the complex network of characteristics impacting hormonal imbalances in obese individuals.

Hypogonadism and Testosterone Replacement Therapy

2005 ◽  
Vol 00 (01) ◽  
pp. 75
Author(s):  
Adrian S Dobs
Keyword(s):  
Bone Mass ◽  
Sexual Function ◽  
Replacement Therapy ◽  
External Genitalia ◽  
Testosterone Replacement Therapy ◽  
Male Hypogonadism ◽  
Secondary Sexual Characteristics ◽  
The Us ◽  
Sexual Characteristics ◽  
Normal Spermatogenesis

Male hypogonadism affects an estimated four to five million men in the US. It is defined as failure of the testes to produce an adequate amount of testosterone and/or conduct normal spermatogenesis. The production of adequate amounts of testosterone is necessary for development of external genitalia and development of secondary sexual characteristics in children and adolescents. In adults, androgen production is necessary for maintenance of lean body mass (LBM), bone mass, libido, sexual function, and spermatogenesis.

Medicinal Cannabis

2016 ◽  
Vol 34 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Beatriz H. Carlini ◽  
Sharon B. Garrett ◽  
Gregory T. Carter
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Online Survey ◽  
Descriptive Analysis ◽  
Scientific Basis ◽  
Washington State ◽  
Comfort Level ◽  
Care Providers ◽  
Clinical Practices ◽  
Medicinal Cannabis

Introduction: Washington State allows marijuana use for medical (since 1998) and recreational (since 2012) purposes. The benefits of medicinal cannabis (MC) can be maximized if clinicians educate patients about dosing, routes of administration, side effects, and plant composition. However, little is known about clinicians’ knowledge and practices in Washington State. Methods: An anonymous online survey assessed providers’ MC knowledge, beliefs, clinical practices, and training needs. The survey was disseminated through health care providers’ professional organizations in Washington State. Descriptive analysis compared providers who had and had not authorized MC for patients. Survey results informed the approach and content of an online training on best clinical practices of MC. Results: Four hundred ninety-four health care providers responded to the survey. Approximately two-third were women, aged 30 to 60 years, and working in family or internal medicine. More than half of the respondents were legally allowed to write MC authorizations per Washington State law, and 27% of those had issued written MC authorizations. Overall, respondents reported low knowledge and comfort level related to recommending MC. Respondents rated MC knowledge as important and supported inclusion of MC training in medical/health provider curriculum. Most Washington State providers have not received education on scientific basis of MC or training on best clinical practices of MC. Clinicians who had issued MC authorizations were more likely to have received MC training than those who had not issued MC authorization. Discussion: The potential of MCs to benefit some patients is hindered by the lack of comfort of clinicians to recommend it. Training opportunities are badly needed to address these issues.

scholarly journals Hypogonadotropic Hypogonadism Associated With Obesity: A Case Report

2020 ◽  
Author(s):  
Niloufar Varnoosfaderan ◽  
Sahar Karimpour Reyhan ◽  
Mahsa Abbaszadeh ◽  
Nasim Khajavirad
Keyword(s):  
Hypogonadotropic Hypogonadism ◽  
Critical Factors ◽  
Reproductive Disorders ◽  
Obese People ◽  
Secondary Sexual Characteristics ◽  
Cardiovascular Comorbidities ◽  
Preventable Risk Factor ◽  
Sexual Characteristics ◽  
Severely Obese ◽  
Different Levels

One of the critical factors with a broad impact on health is obesity. Besides its cardiovascular comorbidities, obesity’s probable association with hypogonadotropic hypogonadism inmen will be discussed in this article by reporting a severely obese boy, presenting with the absence of secondary sexual characteristics and hypertension. The hypothalamus-pituitary-gonadal axis can be influenced by several mechanisms at different levels of the axis. Some of these pathophysiological mechanisms, related to our case are explained to explore the association of obesity with reproductive disorders. Adipose tissue plays a prominent role in the metabolism of hormones that are secreted by other glands. Obesity as a preventable risk factor is valuable to be researched, to decrease the burden of its morbidity and mortality. Thus more studies should be done in the future to determine the complex network of factors contributing to hormonal imbalances seen in obese people.

Educating Pediatric Residents About Parenting: A Survey of Residency Program Leaders

2020 ◽  
Vol 59 (7) ◽  
pp. 699-705
Author(s):  
Anne Martin ◽  
Aliza Waksal ◽  
Lianna Lipton ◽  
Joel Forman ◽  
Carrie Quinn ◽  
...  
Keyword(s):  
Online Survey ◽  
Parenting Skills ◽  
Continuity Clinic ◽  
Pediatric Residents ◽  
Program Leaders ◽  
Positive Discipline ◽  
Regulatory Development ◽  
Self Learning ◽  
Do So ◽  
American Academic

The American Academic of Pediatrics guides pediatricians to counsel parents about how to promote their children’s cognitive, emotional, and self-regulatory development, but the extent to which pediatricians receive the training needed to do so is unknown. An online survey was distributed to members of the Association of Pediatric Program Directors. Although most respondents agreed that it was “very important” to educate residents about parenting skills, only 11% rated their program as doing so “very well.” The most frequently reported reason for not doing very well was lack of a curriculum. Residents currently learn about parenting most commonly in continuity clinic talks, are educated via lectures, and are taught most frequently by clinic preceptors. Nearly half of the respondents reported that their residents relied on self-learning about parenting behaviors. When asked which topics respondents would like covered by an evidence-based parenting curriculum, the most commonly endorsed topic was positive discipline.

School-Based Speech-Language Pathologists' Perceived Self-Efficacy in Conducting Multidimensional Treatment With Children Who Stutter

2020 ◽  
Vol 51 (4) ◽  
pp. 1172-1186
Author(s):  
Carolina Beita-Ell ◽  
Michael P. Boyle
Keyword(s):  
Self Efficacy ◽  
Clinical Training ◽  
Online Survey ◽  
The United States ◽  
Comfort Level ◽  
Social Emotional ◽  
Speech Language Pathologists ◽  
Fluency Disorders ◽  
Cognitive Components ◽  
School Based

Purpose The purposes of this study were to examine the self-efficacy of school-based speech-language pathologists (SLPs) in conducting multidimensional treatment with children who stutter (CWS) and to identify correlates of self-efficacy in treating speech-related, social, emotional, and cognitive domains of stuttering. Method Three hundred twenty randomly selected school-based SLPs across the United States responded to an online survey that contained self-efficacy scales related to speech, social, emotional, and cognitive components of stuttering. These ratings were analyzed in relation to participants' beliefs about stuttering treatment and their comfort level in treating CWS, perceived success in therapy, and empathy levels, in addition to their academic and clinical training in fluency disorders as well as demographic information. Results Overall, SLPs reported moderate levels of self-efficacy on each self-efficacy scale and on a measure of total self-efficacy. Significant positive associations were observed between SLPs' self-efficacy perceptions and their comfort level in treating CWS, self-reported success in treatment, beliefs about the importance of multidimensional treatment, and self-reported empathy. There were some discrepancies between what SLPs believed was important to address in stuttering therapy and how they measured success in therapy. Conclusions Among school-based SLPs, self-efficacy for treating school-age CWS with a multidimensional approach appears stronger than previously reported; however, more progress in training and experience is needed for SLPs to feel highly self-efficacious in these areas. Continuing to improve clinician self-efficacy for stuttering treatment through improved academic training and increased clinical experiences should remain a high priority in order to enhance outcomes for CWS. Supplemental Material https://doi.org/10.23641/asha.12978194

Sex determination and Y chromosome constitutive heterochromatin

2019 ◽  
Vol 1 (1) ◽  
pp. 1-5
Author(s):  
Abyt Ibraimov
Keyword(s):  
Sex Determination ◽  
Y Chromosome ◽  
Constitutive Heterochromatin ◽  
Sex Differentiation ◽  
Secondary Sexual Characteristics ◽  
Biological Meaning ◽  
Heterochromatin Block ◽  
Sexual Characteristics ◽  
Open Question ◽  
Efficient Elimination

In many animals, including us, the genetic sex is determined at fertilization by sex chromosomes. Seemingly, the sex determination (SD) in human and animals is determined by the amount of constitutive heterochromatin on Y chromosome via cell thermoregulation. It is assumed the medulla and cortex tissue cells in the undifferentiated embryonic gonads (UEG) differ in vulnerability to the increase of the intracellular temperature. If the amount of the Y chromosome constitutive heterochromatin is enough for efficient elimination of heat difference between the nucleus and cytoplasm in rapidly growing UEG cells the medulla tissue survives. Otherwise it doomed to degeneration and a cortex tissue will remain in the UEG. Regardless of whether our assumption is true or not, it remains an open question why on Y chromosome there is a large constitutive heterochromatin block? What is its biological meaning? Does it relate to sex determination, sex differentiation and development of secondary sexual characteristics? If so, what is its mechanism: chemical or physical? There is no scientifically sound answer to these questions.

scholarly journals Investigating Community Pharmacy Take Home Naloxone Dispensing during COVID-19: The Impact of One Public Health Crisis on Another

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 129
Author(s):  
George Daskalakis ◽  
Ashley Cid ◽  
Kelly Grindrod ◽  
Michael A. Beazely
Keyword(s):  
Public Health ◽  
Community Pharmacy ◽  
Online Survey ◽  
Comfort Level ◽  
Future Research ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Pharmacy Technicians ◽  
The Impact ◽  
Overdose Deaths

A recent report found that the number of opioid-related deaths in Ontario in the first 15 weeks of the COVID-19 pandemic was 38.2% higher than in the 15 weeks before the pandemic. Our study sought to determine if pharmacy professionals self-reported an increase or decrease in naloxone provision due to the pandemic and to identify adjustments made by pharmacy professionals to dispense naloxone during the pandemic. A total of 231 Ontario community pharmacy professionals completed an online survey. Pharmacy professionals’ barriers, facilitators, and comfort level with dispensing naloxone before and during the pandemic were identified. The sample consisted of mostly pharmacists (99.1%). Over half (51.1%) reported no change in naloxone dispensing, while 22.9% of respondents reported an increase and 24.7% a decrease. The most common adjustments made during the pandemic were training patients how to administer naloxone over video or phone, delivering naloxone kits, and pharmacy technicians offering naloxone at prescription intake. Over half (55%) of participants said the top barrier for dispensing was that patients did not request naloxone. Naloxone distribution through pharmacies could be further optimized to address the increased incidence of overdose deaths during the pandemic. Future research should investigate the reasons for changes in naloxone dispensing.

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