Introduction : L’anorexie prépubère survient généralement chez les enfants de 9 à 12 ans. Elle demeure relativement rare puisqu’elle ne concerne que 5 % de tous les cas d’anorexie. Cette forme d’anorexie semble se distinguer de l’anorexie pubère sur certaines caractéristiques, ce qui pose la question du degré de parenté entre ces troubles. Plusieurs spécialistes se demandent même s’il ne faudrait pas considérer l’anorexie prépubère comme un nouveau sous-type d’anorexie. Objectifs : L’objectif général de la présente étude est de déterminer si les anorexiques prépubères se distinguent des anorexiques pubères. De façon plus spécifique, elle vise à : 1. décrire un groupe d’enfants présentant une anorexie prépubère sur la base de caractéristiques psychologiques, familiales et sociales généralement associées à l’anorexie; 2. identifier, parmi un ensemble de caractéristiques psychologiques, familiales et sociales, celles qui permettent de distinguer un groupe d’anorexiques prépubères d’un groupe d’anorexiques pubères. Méthode : L’échantillon de cette étude transversale est composé de 21 patients anorexiques prépubères âgés en moyenne de 12,1 ans (écart-type = 0,8) et de 126 patients anorexiques pubères âgés de 15,4 ans (écart-type = 1,4). Ces patients ont été recrutés dans le cadre d’une étude longitudinale qui se déroule dans trois Centres hospitaliers universitaires du Québec. Les instruments de mesure utilisés sont ceux auxquels ont généralement recours les chercheurs dans ce domaine. Les répondants aux questionnaires sont les patients ainsi que leurs parents. Des analyses descriptives (moyenne et écart-type ou équivalent non-paramétrique) et comparatives (test t ou équivalent non-paramétrique) sont présentées. Résultats : Au niveau psychologique, les patients anorexiques prépubères apparaissent significativement plus en difficulté que la population générale pour la plupart des variables mesurées. Au plan familial et social, les résultats rapportés par les patients et leurs parents indiquent l’absence de distinction avec la population générale. En regard du second objectif de recherche, les patients anorexiques prépubères présentent un profil psychologique généralement moins sévère que celui des anorexiques pubères. Les scores obtenus par les patients anorexiques prépubères et pubères ou par leurs parents ne diffèrent pas pour les variables familiales et sociales. Conclusion : Les résultats ne supportent pas l’hypothèse de spécificité de l’anorexie prépubère. Les principales différences observées semblent attribuables à l’effet de l’âge, notamment au manque de maturité des enfants comparativement aux adolescents sur le plan des fonctions exécutives. En somme, la puberté n’apparaît pas le meilleur moyen pour catégoriser les différents profils des patients anorexiques. Des méthodes alternatives de catégorisation, notamment celles basées sur le profil de personnalité, semblent davantage prometteuses.

In this qualitative, phenomenological study I employed oral history methodology, grounded in a life-span developmental and feminist approach, to explore the developmental importance of menarche in twenty older women's "bodily histories." Menarche is an important developmental event in the female life course because it represents a major point of confluence where the various streams of what it means to be female coalesce. Menarche is not only a biophysical phenomenon originating from inside a girl's body, but is a psychosocial transition as well. Further, menarche is a biopsycho-social event which is shaped by sociocultural and historical discourses and may have life-span developmental implications. Qualitative analyses of the bodily histories revealed that the older women remembered their first menstrual periods very clearly. The women spoke of menarche as an abrupt and disruptive event symbolic of adult fertility and sexuality and surrounded by silence. They associated menarche with the imposition of menstrual taboos and rules of adult femininity which restricted their behaviors. Many of the themes that emerged from the women's memories of menarche were also present in their narratives about subsequent menstrual and menopausal experiences. There was a continuation throughout their menstrual careers of the restrictions on their behaviors as a result of menstrual bleeding; the silence and confusion associated with processes of the female body; and the sexualization of their fertile bodies. Further, there was evidence of a continuity well into later-life of the medicalization of their bodies, as well as their use of language suggestive of a separation between their bodies and their selves. The generalizability of these findings is limited; the study sample was small, homogenous, and self-selected, and the bodily histories were collected retrospectively. Implications of these findings and directions for research, theorizing, and action are discussed. / Graduation date: 1996

The growth of height and weight of 275 Japanese girls was followed longitudinally over a period of three years, which included the time of menarche. The association between height and weight at menarche was examined, using path analysis to describe the relationship. Two hypotheses (I and II) were evaluated: Hypothesis I. Menarche in an individual girl is triggered by attainment of a particular weight. Hypothesis II. Menarche in an individual girl is triggered after attainment of a particular threshold body size or weight. As the result of this analysis, no particular weight and/or height was observed which discriminates between girls who have attained menarche and those who have not attained menarche. Although the results did not disprove the importance of weight as a factor which influences the onset of menarche, it did not support the existence of a particular critical weight or threshold body size or weight. Instead, a more random pattern of growth before menarche was evident, i.e. there was no correlation between weight at one year before menarche and increment in weight during the year before menarche. To describe the observed relationship, an alternative hypothesis (hypothesis III) concerning the existence of a threshold phase between two years and one year before menarche is suggested. According to this hypothesis, menarche in an individual girl is triggered by attainment of a threshold phase of growth between two years and one year before menarche, although this phase is not defined by a particular invariant weight for each girl in a given population. There is a central tendency of weight in this sample of Japanese girls which lies between 31 and 36 kg of weight. After completing this phase, further weight increment before menarche in each girl occurs independent of the weight already attained during the threshold phase. At present, the biological meaning of the suggested threshold phase is not clear. In further studies, the growth curve of each girl between two years and one year before menarche must be followed carefully. / text

Using data from the Third National Health and Nutrition Examination Survey, we assessed measures of puberty in U.S. girls in relation to blood lead levels to determine whether sexual maturation may be affected by current environmental lead exposure. The study sample included 1,706 girls 8-16 years old with pubic hair and breast development information; 1,235 girls 10-16 years old supplied information on menarche. Blood lead concentrations (range = 0.7-21.7 pg/dL) were categorized into three levels: 0.7-2.0, 2.1-4.9, and 5.0-21.7 μg/dL. Sexual maturation markers included self-reported attainment of menarche and physician determined Tanner stage 2 pubic hair and breast development. Girls who had not reached menarche or stage 2 pubic hair had higher blood lead levels than did girls who had. For example, among girls in the three levels of blood lead described above, the unweighted percentages of 10-year-olds who had attained Tanner stage 2 pubic hair were 60.0, 51.2, and 44.4%, respectively, and for girls 12 years old who reported reaching menarche, the values were 68.0, 44.3, and 38.5%, respectively. The negative relation of blood lead levels with attainment of menarche or stage 2 pubic hair remained significant in logistic regression even after adjustment for race/ethnicity, age, family size, residence in metropolitan area, poverty income ratio, and body mass index. In conclusion, higher blood lead levels were significantly associated with delayed attainment of menarche and pubic hair among U.S. girls, but not with breast development.

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Typescript (photocopy). / Digitized by Kansas Correctional Industries

published_or_final_version / Community Medicine / Master / Master of Public Health

Previous research has demonstrated that exposure to family disruption/father absence (due to parental relationship dissolution) is a significant risk factor for early pubertal development in daughters. Moreover, the earlier in life that this exposure occurs, the greater the risk of these outcomes for girls. Two opposing classes of explanation have been proposed for this reliable finding. First, evolutionary-based developmental experience models have proposed that father absence may actually cause early pubertal development in daughters through mechanisms that remain to be elucidated. Second, this association may arise from either a genetic or a family-wide environmental confound. To discriminate between these two competing classes of explanation (i.e., causal vs. noncausal), a retrospective study employing a community sample of full biological sister pairs was conducted in New Zealand. This study examined menarchael age in (a) a primary group comprising age-discrepant biologically disrupted/father absent sister pairs (n = 68), and (b) a matched control group comprising age-discrepant biologically intact/father present sister pairs (n = 93). According to the causation model, if greater exposure to family disruption/father absence causes earlier pubertal development in girls, then in families in which (a) full biological sisters are discrepant in age, and (b) the younger sister has experienced more prolonged father absence than has her older sister, younger sisters should be at greater risk for earlier pubertal development. By contrast, if a genetic or family-wide environmental confound explains this association, full biological sisters should not systematically differ in pubertal timing as a function of birth order, even if they have experienced different amounts of father absence. The unique contribution of the current study to this area of inquiry is its employment of a differential sibling exposure design to test the explanatory value of the two opposing classes of explanation (i.e., causal versus noncausal). This genetically and environmentally controlled sibling design was utilised (a) to test the central hypothesis that the birth order/age discrepancy (older versus younger) between sisters would interact with family type (biologically disrupted vs. biologically intact) to predict the size of sibling differences in menarcheal age, and (b) to test for potential moderating effects of paternal dysfunction. Consistent with evolutionary causal models, the current sibling comparison study revealed that within biologically disrupted/father-absent families, younger sisters (who had more prolonged exposure to father absence) had earlier menarcheal ages than did their older sisters. The current study was therefore not only able to distinguish between the two competing classes of explanations, but its findings plausibly supported a causal rather than a noncausal explanation for the association between father absence and earlier pubertal timing in girls. Moreover, it revealed that this association is more nuanced than previously thought, because the accelerating effect of family disruption/father absence on daughters’ menarcheal timing was moderated by fathers’ functioning in the family. The current study has eight important limitations that can be used to direct future research. These limitations are detailed along with proffered suggestions (where applicable) for addressing them in future studies. Possible mediating mechanisms for the earlier menarcheal timing found in daughters from biologically disrupted/father absent families are also proposed. Finally, the implications of the current study’s findings for both parents and daughters in biologically disrupted/father absent families are discussed.

Orientador: Antonio de Azevedo Barros Filho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T00:05:07Z (GMT). No. of bitstreams: 1 Roman_EvertonPaulo_D.pdf: 3049280 bytes, checksum: 5a2a84847aa54e85486b0ce1ff343f44 (MD5) Previous issue date: 2008 / Resumo: Objetivo: Avaliar a antropometria, o estado nutricional e a maturação sexual de meninas de nove a 17 anos de idade em diferentes níveis socioeconômicos na cidade de Cascavel, oeste do estado do Paraná - Brasil. Métodos: Estudo transversal realizado no ano de 2006 com 2.761 meninas em 27 escolas (14 particulares e 13 públicas).Foram avaliados o peso e estatura para o cálculo do Índice de Massa Corporal (IMC). A idade da menarca foi obtida pelo método status quo. Para a avaliação da maturação sexual foi realizada a auto-avaliação de acordo com os critérios descritos por Tanner.O nível socioeconômico foi obtido por meio do questionário da ABEP (2003) sendo dividido nos tercis alto, médio e baixo. Todas as avaliações foram realizadas de acordo com os procedimentos internacionalmente aceitos. O estado nutricional foi definido como baixo peso IMC< percentil 5; eutrofia IMC = percentil 5 e < percentil 85, sobrepeso IMC = percentil 85 e obesidade = percentil 95 e comparados com os padrões propostos pelo CDC (2000) e Conde e Monteiro (2006). Para análise dos dados foi realizada estatística descritiva, com valores de média e desvio padrão.Utilizou-se o teste qui-quadrado ), análise de variância seguida do teste de Tukey, teste t Student, teste de Kappa para as devidas comparações. O nível de significância foi de p< 0,05. Resultados: A idade da menarca das meninas foi de 12,1±1,1; 12,3±1,2 e 12,4±1,2 anos para os tercis alto, médio e baixo, respectivamente. A idade da menarca geral sem a distinção do nível socioeconômico foi de 12,2±1,2 anos. Foram constatados valores superiores e estatisticamente significativos para as meninas pós-menarca no peso e na estatura dos 10 aos 17 anos de idade e no IMC dos 11 aos 14 anos de idade. Em relação ao estado nutricional, os resultados demonstraram que aos 09 anos de idade 29,7% das meninas estão com sobrepeso ou obesidade pelos critérios estabelecidos por Conde e Monteiro. Na avaliação do estado nutricional em relação aos estadios maturacionais 27,7% das meninas que estão no estadio M5 apresentam sobrepeso ou obesidade (Conde e Monteiro) enquanto que 9,8% das meninas que estão no estadio M2 pelos critérios do CDC são desnutridas. Observou-se também que meninas de melhor nível socioeconômico e que estudam em escolas particulares tendem a apresentar maiores percentuais de desnutrição, sobrepeso e obesidade. Conclusão: As meninas pertencentes ao nível socioeconômico alto apresentaram idade da menarca de maneira antecipada e também maior estatura. Embora estas diferenças ocorram em níveis socioeconômicos distintos, biologicamente estas diferenças são pequenas. Quanto ao estado nutricional, os valores estão dentro do esperado. Os referenciais estabelecidos por Conde e Monteiro identificaram mais escolares com sobrepeso e obesidade e menos desnutridas que o CDC, contudo, os dois referenciais detectaram resultados muito próximos / Abstract: Objective: To evaluate the anthropometry, the nutritional status and the sexual maturation of girls from nine to 17 years old in different social economic levels in the city of Cascavel, west of the state of Paraná ¿ Brazil. Methods: Cross sectional study was carried in 2006 with 2,761 girls in 27 schools (14 private and 13 public). Were evaluated the weight and the stature to the Body Mass Index (BMI) calculus. The age at menarche was obtained by the status quo method. To the evaluation of the sexual maturation was accomplished a self-evaluation according to the criterion described by Tanner. The social economic level was obtained by the ABEP (2003) questionnaire being divided as High, Average and Low. All the evaluations were accomplished according to the internationally accepted procedures. The nourishment state was defined as low BMI weight < percentile 5; BMI eutrophia = percentile 5; and < percentile 85, BMI overweight = percentile 85 and obesity = percentile 95 according to the patterns proposed by the World Health Organization and compared to the CDC (2000) data. The nourishment state was also compared with a national proposal developed by Conde e Monteiro (2006) to the values of BMI. The analysis of the data was accomplished with descriptive statistics, with values of average and standard deviation. It was used the chi-squared-test (?2) and the Tukey test to the multiple comparison between the averages and the t Student test to the comparison among the groups and averages. The level of significance was of p < 0.05. Results: The age at menarche of girls was 12.1±1.1; 12.3±1.2 e 12.4±1.2 years old for high, average and low, respectively. The general age at menarche of the girls without the distinction of social economic levels was 12.2 ± 1.2 years old. There were found superior and statistically significant values for the pos-menarche girls in the body weight and in the stature from 10 to 17 years old and in the BMI from 11 to 14 years old. In relation to the nourishment state, the results point that at 09 years old, 29.7% of the girls were overweight or obese by the criterion established by Conde e Monteiro. In the evaluation of the nourishment state related to the mature stage, 27.7% of the girls that are in the M5 stage presented overweight or obesity (Conde e Monteiro) while 9,8% of the girls that are in the M2 stage by the CDC are malnourished. It was also noticed that the girls with better social economic levels who study in private schools tend to present a higher percentile of malnourishment, overweight and obesity. Conclusion: The girls who belong to the high social economic level presented the age at menarche sooner and also the higher stature. Although these differences occur in distinct social economic levels, biologically these differences are small. The classification of the nutritional status, the levels are inside the expected. The references established by Conde e Monteiro identify more students with overweight and obesity and less malnourished than the CDC, however, both references detected very close results. Key-words: Growth, body composition, sexual maturation and adolescent / Doutorado / Saude da Criança e do Adolescente / Doutor em Saude da Criança e do Adolescente

It has been shown that post-menarcheal girls are more likely to have increased their body weight and body mass index (BMI) than pre-menarcheal girls of the same age. In addition to the metabolic changes which occur during this interval, behavioural risk factors synergize to promote weight gain, putting adolescents at a much higher risk for excess weight gain and its associated health complications. Moreover, obesity during adolescence increase the risk of becoming an obese adult. A systematic review of English and French articles using MEDLINE, EMBASE, Cochrane, and CINAHL was conducted. Studies underwent a three level screening assessment by two independent assessors. Only studies with post-menarcheal weight change information were selected for data extraction and quality assessment, which was conducted by two independent reviewers. A meta-analysis was conducted for weight change and included 389 girls. Five studies discussed the effects of menarche on body weight change. Pooled results for three studies indicated a 10.39 kg increase from pre to post-menarche (95% CI, 9.16-11.62). The other two studies showed significant increases in body fat mass (p<0.05) and higher skinfolds measurements for post-menarcheal girls compared to pre-menarcheal girls. It is important to further explore the bio-psychosocial and environmental factors influencing the weight, especially the total fat mass and body fat distributions in young adolescent girls during the menarche transition in order to develop and evaluate preventive intervention strategies to prevent adolescent and adult obesity.