Pubertal assessment: targeted educational intervention for pediatric trainees

2017 ◽  
Vol 31 (6) ◽  
Author(s):  
Aditi Khokhar ◽  
Sairaman Nagarajan ◽  
Yagnaram Ravichandran ◽  
Sheila Perez-Colon
Keyword(s):  
Educational Intervention ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Clinical Practices ◽  
Post Intervention ◽  
Tanner Staging ◽  
Confidence Levels ◽  
Comfort Levels ◽  
Pediatric Residency ◽  
Baseline Knowledge

Abstract Background Timely and periodic pubertal assessment in children is vital to identify puberty related disorders. Pediatricians need to have working knowledge of puberty time and tempo. Pediatric residency is an important platform to acquire physical examination skills including pubertal assessment. Objective An educational intervention for teaching pubertal assessment was piloted on pediatric residents at our institution. Methods The intervention comprised of interactive lecture series, ID badge size Tanner stage cards and Tanner posters placed in residents’ continuity clinics. Pre-intervention, post-intervention and 3 months post-intervention surveys for participating trainees were administered to determine the effectiveness of the intervention. Attitudes, practices, knowledge scores, and barriers to Tanner staging conduct were analyzed. Results Forty-three residents participated in the intervention. Knowledge scores of PGY1 (5.95 ± 1.6 vs. 7.47 ± 1.4, p < 0.01) improved right after the intervention, as did self-reported clinical practices of all trainees 3 months post- intervention with regards to conducting external genital examination and performing pubertal assessment. Confidence levels of pediatric trainees in conducting pubertal assessment and comfort levels in assessing the need for endocrine referral based on abnormal Tanner staging improved after the intervention, although the effect was not statistically significant. Conclusion Our intervention is a worthwhile technique for teaching pubertal assessment to residents as it is simple to conduct, easily reproducible, provides baseline knowledge needed for recognition of normal pubertal development and puberty related conditions, and instills confidence in residents.

scholarly journals Urinary and salivary endocrine measurements to complement Tanner staging in studies of pubertal development

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251598
Author(s):  
Mandy Goldberg ◽  
Anna J. Ciesielski Jones ◽  
John A. McGrath ◽  
Christie Barker-Cummings ◽  
Deborah S. Cousins ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Pubic Hair ◽  
Health Study ◽  
Final Visit ◽  
Tanner Staging ◽  
Non Invasive ◽  
Stage 1

Background Many studies investigating pubertal development use Tanner staging to assess maturation. Endocrine markers in urine and saliva may provide an objective, sensitive, and non-invasive method for assessing development. Objective Our objective was to examine whether changes in endocrine levels can indicate the onset of pubertal development prior to changes in self-rated Tanner stage. Methods Thirty-five girls and 42 boys aged 7 to 15 years were enrolled in the Growth and Puberty (GAP) study, a longitudinal pilot study conducted from 2007–2009 involving children of women enrolled in the Agricultural Health Study (AHS) in Iowa. We collected saliva and urine samples and assessed pubertal development by self-rated Tanner staging (pubic hair, breast development (girls), genital development (boys)) at three visits over six months. We measured dehydroepiandrosterone (DHEA) in saliva and creatinine-adjusted luteinizing hormone (LH), testosterone, follicle stimulating hormone (FSH), estrone 3-glucuronide (E13G) and pregnanediol 3-glucuronide (Pd3G) concentrations in first morning urine. We evaluated the relationships over time between Tanner stage and each biomarker using repeated measures analysis. Results Among girls still reporting Tanner breast stage 1 at the final visit, FSH levels increased over the 6-month follow-up period and were no longer lower than higher stage girls at the end of follow-up. We observed a similar pattern for testosterone in boys. By visit 3, boys still reporting Tanner genital stage 1 or pubic hair stage 1 had attained DHEA levels that were comparable to those among boys reporting Tanner stages 2 or 3. Conclusions Increasing concentrations of FSH in girls and DHEA and testosterone in boys over a 6-month period revealed the start of the pubertal process prior to changes in self-rated Tanner stage. Repeated, non-invasive endocrine measures may complement the more subjective assessment of physical markers in studies determining pubertal onset.

Self-assessment of pubertal development in a puberty cohort

2018 ◽  
Vol 31 (7) ◽  
pp. 763-772 ◽  
Author(s):  
Andreas Ernst ◽  
Lea Lykke B. Lauridsen ◽  
Nis Brix ◽  
Camilla Kjersgaard ◽  
Jørn Olsen ◽  
...  
Keyword(s):  
Clinical Examination ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Weighted Kappa ◽  
Pubic Hair ◽  
Kappa Statistics ◽  
Random Errors ◽  
Rater Agreement ◽  
Self Assessment ◽  
Tanner Staging

Abstract Background We evaluated the inter-rater agreement between self-assessed Tanner staging and clinical examination and the intra-individual agreement of self-assessed information on various puberty markers in late adolescents from the longitudinal nationwide Puberty Cohort, a sub-cohort of the Danish National Birth Cohort (DNBC). Methods We invited 715 children from the ongoing Puberty Cohort between June 2016 and January 2017. In total, 366 children (51%) returned an add-on questionnaire identical to the questionnaire used to collect information on puberty markers, including Tanner staging, in the Puberty Cohort. Of these, 197 (54%) also participated in a clinical examination with Tanner staging. We used percentage agreement and weighted kappa statistics to evaluate the inter-rater and intra-individual agreement. Results Due to late entry, more than 75% of children were Tanner stage 4 or above at clinical examination. In girls, the inter-rater agreement for pubic hair and breast staging was 54% and 52%, respectively, yielding weighted kappas of fair strength. In boys, pubic hair and genital staging agreed in 55% and 33%, respectively, corresponding to weighted kappas of fair to moderate strength. Boys tended to underestimate genitalia staging consistently. The intra-individual agreement on Tanner staging was 75–77% in girls and 69% in boys, whereas the intra-individual agreement on axillary hair and acne was above 92%. Conclusions Self-assessment of late stages of pubertal development may be misclassified, leading to random errors in studies of puberty timing. However, self-assessment continues to serve as an important time- and cost-saving tool in large prospective puberty cohorts.

An Educational Measure to Significantly Increase Critical Knowledge Regarding Interfacility Patient Transfers

2015 ◽  
Vol 30 (3) ◽  
pp. 244-248 ◽  
Author(s):  
Torben K. Becker ◽  
James F. Skiba ◽  
Cemal B. Sozener
Keyword(s):  
Educational Intervention ◽  
Daily Practice ◽  
Legal Aspects ◽  
Daily Basis ◽  
Publication Type ◽  
Post Intervention ◽  
Patient Transfers ◽  
Medicolegal Aspects ◽  
Critical Knowledge ◽  
Comfort Levels

AbstractBackgroundPatient transfers among medical facilities are high-risk situations. Despite this, there is very little training of physicians regarding the medical and legal aspects of transport medicine.ObjectivesTo examine the effects of a one hour, educational intervention on Emergency Medicine (EM) residents’ and Critical Care (CC) fellows’ knowledge regarding the medical and legal aspects of interfacility patient transfers.MethodsPrior to the intervention, physician knowledge regarding 12 key concepts in patient transfer was assessed using a pre-test instrument. A one hour, interactive, educational session followed immediately thereafter. Following the intervention, a post-intervention test was given between two and four weeks after delivery. Participants were also asked to describe any prior transportation-medicine-related education, their opinions as they relate to the relevance of the topic, and their comfort levels with patient transfers before and after the intervention.ResultsOnly a minority of participants had received any formal training in patient transfers prior to the intervention, despite dealing with patient transfers on a frequent, often daily, basis. Both groups improved in several categories on the post-intervention test. They reported improved comfort levels with the medicolegal aspects of interfacility patient transfers after the intervention and felt well-prepared to manage transfers in their daily practice.ConclusionA one hour, educational intervention objectively increased EM and CC physician trainees’ understanding of some of the medicolegal aspects of interfacility patient transfers. The study demonstrated a lack of previous training on this important topic and improved levels of comfort with transfers after study participation.BeckerTK, SkibaJF, SozenerCB. An educational measure to significantly increase critical knowledge regarding interfacility patient transfers. Prehosp Disaster Med. 2015;30(3):1-5

Can we rely on adolescents to self-assess puberty stage? A systematic review and meta-analysis

2020 ◽  
Vol 105 (8) ◽  
pp. 2846-2856 ◽  
Author(s):  
Susan C Campisi ◽  
Josée D Marchand ◽  
Fahad Javaid Siddiqui ◽  
Muhammad Islam ◽  
Zulfiqar A Bhutta ◽  
...  
Keyword(s):  
Data Extraction ◽  
Meta Analysis ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Pubic Hair ◽  
Cochrane Library ◽  
Self Assessment ◽  
Pubertal Stage ◽  
Tanner Staging ◽  
Stage 1

Abstract Context Clinicians, researchers, and global health advocates often include pubertal development in outcomes. However, assessments of pubertal stage can be challenging because of the sensitive nature and feasibility of clinical examinations, especially in larger settings. Objective To determine the accuracy of self-assessed Tanner staging when compared with physically assessed Tanner stages by a clinician. Data Sources MEDLINE, PubMed, Embase, Web of Science, Scopus, the Cochrane Library, CINAHL. Study Selection Studies were included if they reported 5 × 5 tables of self-assessment compared to clinician–assessment for the 5-stage Tanner scale. Data Extraction We extracted data to generate complete 5 × 5 tables for each study, including any subgroup eligible for the analysis, such as overweight/obese youth. Data Synthesis After screening, 22 studies representing 21,801 participants met our inclusion criteria for the meta-analysis. Overall agreement was moderate or substantial between the 2 assessments, with breast stage 1, female pubic hair 1, male pubic hair 1, and male pubic hair 5 having the highest agreement. When stages were collapsed into pre- (Tanner stage 1), in (stages 2,3), and completing (stages 4,5) puberty, levels of agreement improved, especially for pre- and completing pubertal development. Most included studies comprised Caucasian youth. More studies are needed which include a broader range of geographic and socioeconomic settings, as well as a greater diversity of racial/ethnic groups. Conclusions Self-assessment of puberty is most accurate when identifying Tanner stage 1, Tanner stage 5 and when development is categorized into prepuberty, in, and completing puberty phases. Use of self-assessment data should be structured accordingly. Protocol Registration PROSPERO # CRD42018100205

Self-rated Tanner stage and subjective measures of puberty are associated with longitudinal gonadal hormone changes

2019 ◽  
Vol 32 (6) ◽  
pp. 569-576 ◽  
Author(s):  
Ben W.R. Balzer ◽  
Frances L. Garden ◽  
Mazen Amatoury ◽  
Georgina M. Luscombe ◽  
Karen Paxton ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Pubertal Development ◽  
Serum Testosterone ◽  
Tanner Stage ◽  
Self Report ◽  
Gonadal Hormone ◽  
Community Based ◽  
Hormone Levels ◽  
Tanner Staging ◽  
Large Community

Abstract Introduction In large community-based studies of puberty, Tanner staging by a clinician is often not possible. We compared self-rated Tanner staging and other subjective ratings of pubertal development with serum hormone levels measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to reassess the utility of self-rated pubertal stage using highly sensitive and specific hormone analysis. Methods Adolescents and their parents enrolled in the Adolescent Rural Cohort study of Hormones and health, Education, environments and Relationships (ARCHER) answered annual survey questions on pubertal development. Annually, adolescents provided blood samples for serum testosterone and estradiol measured by LC-MS/MS. Results Longitudinally, self-rated Tanner stage was positively associated with serum testosterone and estradiol levels in both sexes. Confirmation by adolescent and parent that puberty had commenced was associated with higher gonadal hormone levels in both sexes. Parent and adolescent responses demonstrated ‘fair’ to ‘moderate’ agreement. Conclusions Over a 3-year follow-up, self-rated Tanner staging and simple questions regarding pubertal onset and development are positively associated with adolescent gonadal hormone concentrations in serum measured by mass spectrometry. Thus, self-report of puberty stage still has a role in large community-based studies where physical examination is not feasible.

scholarly journals Health education through mass media announcements by loudspeakers about malaria care: prevention and practice among people living in a malaria endemic area of northern Myanmar

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Pyae Linn Aung ◽  
Tepanata Pumpaibool ◽  
Than Naing Soe ◽  
Jessica Burgess ◽  
Lynette J. Menezes ◽  
...  
Keyword(s):  
Intervention Group ◽  
Malaria Prevention ◽  
Care Seeking ◽  
Endemic Region ◽  
Post Intervention ◽  
Chi Square ◽  
Transmission Season ◽  
Baseline Knowledge ◽  
Peak Transmission

Abstract Background Interventions to raise community awareness about malaria prevention and treatment have used various approaches with little evidence on their efficacy. This study aimed to determine the effectiveness of loudspeaker announcements regarding malaria care and prevention practices among people living in the malaria endemic villages of Banmauk Township, Sagaing Region, Myanmar. Methods Four villages among the most malaria-burdened areas were randomly selected: two villages were assigned as the intervention group, and two as the control. Prior to the peak transmission season of malaria in June 2018, a baseline questionnaire was administered to 270 participants from randomly selected households in the control and intervention villages. The loudspeaker announcements broadcasted health messages on malaria care and prevention practices regularly at 7:00 pm every other day. The same questionnaire was administered at 6-month post intervention to both groups. Descriptive statistics, Chi-square, and the t-test were utilized to assess differences between and within groups. Results Participants across the control and intervention groups showed similar socio-economic characteristics; the baseline knowledge, attitude and practice mean scores were not significantly different between the groups. Six months after the intervention, improvements in scores were observed at p-value < 0.001 in both groups, however; the increase was greater among the intervention group. The declining trend of malaria was also noticed during the study period. In addition, more than 75% of people expressed positive opinions of the intervention. Conclusions The loudspeaker intervention was found to be feasible and effective, as shown by the significant improvement in scores related to prevention and care-seeking practices for malaria as well as reduced malaria morbidity. Expanding the intervention to a larger population in this endemic region and evaluating its long-term effectiveness are essential in addition to replicating this in other low-resource malaria endemic regions.

Development of a multimedia intervention to improve pneumoconiosis prevention in construction workers using RE-AIM framework

2021 ◽  
Author(s):  
Jieling Chen ◽  
Cho Lee Wong ◽  
Bernard Man Hin Law ◽  
Winnie Kwok Wei So ◽  
Doris Yin Ping Leung ◽  
...  
Keyword(s):  
South Asian ◽  
Educational Intervention ◽  
Self Efficacy ◽  
Intervention Mapping ◽  
Intervention Development ◽  
Educational Interventions ◽  
Construction Workers ◽  
Post Intervention ◽  
Cohen’S D ◽  
Cohen's D

Summary Pneumoconiosis is a common occupational lung disease among construction workers. Educational interventions targeting specific ethnic groups of construction workers are of benefit for pneumoconiosis prevention. The aim of this study was to develop a multimedia educational intervention for pneumoconiosis prevention for South Asian construction workers, and to evaluate its feasibility, acceptability and effectiveness in increasing knowledge of pneumoconiosis, modifying beliefs about pneumoconiosis, and enhancing intention to implement measures for its prevention among the workers. This evaluation was performed using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. A one-group design was adopted and intervention mapping was used to guide the process of intervention development, while the Health Belief Model guided the development of intervention content. The intervention was delivered at construction sites, ethnic minority associations and South Asian community centres. Data were collected via surveys completed at pre-intervention, post-intervention and 3 months after the intervention. A total of 1002 South Asian construction workers participated in the intervention. The participants reported a moderate-to-large increase in knowledge, perceived susceptibility, perceived severity, perceived benefits, cues to action and self-efficacy (Cohen’s d: 0.37–0.89), a small reduction in perceived barriers (Cohen’s d = 0.12) and a moderate improvement in attitudes and intention to practice (Cohen’s d: 0.45, 0.51) at post-intervention. A follow-up survey of 121 participants found that the implementation of preventive measures appeared to increase. Overall, the findings demonstrate that the implementation of a culturally adapted multimedia educational intervention could be an effective approach to improving knowledge, self-efficacy and intention regarding pneumoconiosis prevention among South Asian construction workers.

Urinary gonadotropin measurements by enhanced luminometric assays (LIA) for the evaluation of pubertal development

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
And Demir ◽  
Adem Aydın ◽  
Atilla Büyükgebiz ◽  
Ulf-Håkan Stenman ◽  
Matti Hero
Keyword(s):  
Healthy Subjects ◽  
Reliable Method ◽  
Pubertal Development ◽  
High Sensitivity ◽  
Tanner Stage ◽  
Time Resolved ◽  
Stage 1 ◽  
Sensitive Detection Technique ◽  
Serum And Urine

Abstract Objectives Determination of LH in urine has proved to be a reliable method for evaluation of pubertal development. The human LH assay based on time-resolved immunofluorometric (IFMA) technology (AutoDELFIA, PerkinElmer, Wallac) has been found to be suitable for this purpose thanks to its high sensitivity but other assays have not been evaluated. We have analyzed our data obtained by another potentially sensitive detection technique, enhanced luminometric assay (LIA) with the objective of finding a viable alternative to IFMA since these may not be available in the future. Methods LIA was used to measure LH and FSH in serum and urine samples from 100 healthy subjects of each Tanner stage and both genders, whose pubertal development has been determined. Results Urinary gonodotropin concentrations measured by LIA correlated well with Tanner stage [(r=0.93 for girls, r=0.81 for boys; p<0.01 for LH) and (r=0.81 for girls, r=0.73 for boys; p<0.01 for FSH)]. LIA determinations revealed the increase in U-LH concentrations during the transition from Tanner stage 1–2 in both girls and boys (p<0.001), whereas U-FSH and S-LH were able to detect the increase from Tanner stage 1–2 only in boys or girls, respectively (both p<0.001). Conclusions Measurement of urinary gonadotropin concentrations by LIA may be useful for the evaluation of overall pubertal development and also in the detection of transition from prepuberty to puberty.

scholarly journals Nutrition Standards For Infants and Young Children can be Implemented by Family Child Care Home Providers

2021 ◽  
Vol 8 ◽  
pp. 2333794X2198955
Author(s):  
Lorrene D. Ritchie ◽  
Victoria Keeton ◽  
Danielle L. Lee ◽  
Klara Gurzo ◽  
Elyse Homel Vitale ◽  
...  
Keyword(s):  
Child Care ◽  
Educational Intervention ◽  
Care Home ◽  
Family Child Care ◽  
Average Score ◽  
Post Intervention ◽  
Convenience Sample ◽  
Nutrition Standards ◽  
Infants And Young Children ◽  
Provider Surveys

The study evaluated an educational intervention with family child care home (FCCH) providers to implement nutrition standards. A convenience sample of licensed California FCCH providers (n = 30) attended a 2-hour, in-person group training in English or Spanish on nutrition standards for infants and children aged 1 to 5 years. Provider surveys and researcher observations during meals/snacks were conducted pre- and 3 months post-intervention. Providers rated the training as excellent (average score of 4.9 on a scale of 1-5). Adherence, assessed by survey and observation and compared over time using paired t-tests, increased from an average of 36% pre-intervention to 44% post-intervention ( P = .06) of providers (n = 12) for infant standards and from 59% to 68% ( P < .001) of providers (n = 30) for child standards. One-third (39%) of providers rated infant standards and 19% of providers rated child standards as difficult to implement. Nutrition standards can be implemented by FCCH providers after an educational intervention; a larger study is warranted with a representative group of providers.

scholarly journals 1120. Impact of Training Residents to Improve HIV Screening in a Teaching Hospital in Mexico City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S590-S590
Author(s):  
Lorena Guerrero-Torres ◽  
Isaac Núñez-Saavedra ◽  
Yanink Caro-Vega ◽  
Brenda Crabtree-Ramírez
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Hiv Testing ◽  
Teaching Hospital ◽  
Educational Intervention ◽  
Temporal Trends ◽  
Hiv Screening ◽  
Hiv Diagnosis ◽  
Post Intervention ◽  
Hiv Test

Abstract Background Among 230,000 people living with HIV in Mexico, 24% are unaware of their diagnosis, and half of newly diagnosed individuals are diagnosed with advanced disease. Early diagnosis is the goal to mitigate HIV epidemic. Missed opportunities may reflect a lack of clinicians’ consideration of HIV screening as part of routine medical care. We assessed whether an educational intervention on residents was effective to 1) improve the knowledge on HIV screening; 2) increase the rate of HIV tests requested in the hospitalization floor (HF) and the emergency department (ED); and 3) increase HIV diagnosis in HF and ED. Methods Internal Medicine and Surgery residents at a teaching hospital were invited to participate. The intervention occurred in August 2018 and consisted in 2 sessions on HIV screening with an expert. A questionnaire was applied before (BQ) and after (AQ) the intervention, which included HIV screening indications and clinical cases. The Institutional Review Board approved this study. Written informed consent was obtained from all participants. BQ and AQ scores were compared with a paired t-test. To evaluate the effect on HIV test rate in the HF and ED, an interrupted time series analysis was performed. Daily rates of tests were obtained from September 2016 to August 2019 and plotted along time. Restricted cubic splines (RCS) were used to model temporal trends. HIV diagnosis in HF and ED pre- and post-intervention were compared with a Fisher’s exact test. A p&lt; 0.05 was considered significant. Results Among 104 residents, 57 participated and completed both questionnaires. BQ score was 79/100 (SD±12) and AQ was 85/100 (SD±8), p&lt; .004. Time series of HIV testing had apparent temporal trends (Fig 1). HIV test rate in the HF increased (7.3 vs 11.1 per 100 episodes) and decreased in the ED (2.6 vs 2.3 per 100 episodes). HIV diagnosis increased in the HF, from 0/1079 (0%) pre-intervention to 5/894 (0.6%) post-intervention (p&lt; .018) (Table 1). Fig 1. HIV test rates. Gray area represents post-intervention period. Table 1. Description of episodes, HIV tests and rates pre- and post-intervention in the Emergency Department and Hospitalization Floor. Conclusion A feasible educational intervention improved residents’ knowledge on HIV screening, achieved maintenance of a constant rate of HIV testing in the HF and increased the number of HIV diagnosis in the HF. However, these results were not observed in the ED, where administrative barriers and work overload could hinder HIV screening. Disclosures All Authors: No reported disclosures

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