IntroduÃÃo: A Puberdade Precoce (PP) à problema cada vez mais freqÃente em todo o mundo. CrianÃas em PP estÃo em risco de iniciaÃÃo sexual mais cedo, abuso sexual, baixa estatura na vida adulta, risco aumentado de obesidade, hiperinsulinemia e hipertensÃo arterial. O estudo trata da freqÃÃncia e condiÃÃes associadas à PP, visando propor medidas de SaÃde PÃblica para reduÃÃo deste problema e de suas possÃveis seqÃelas. MÃtodos: O estudo transversal, desenvolve abordagem analÃtica das crianÃas acometidas de PP, atendidas no ambulatÃrio de endocrinologia do Hospital UniversitÃrio Walter CantÃdio (HUWC) no perÃodo 1994 a 2010, contando com uma amostra de 342 crianÃas de 1 a 11 anos. As variÃveis analisadas incluÃram as caracterÃsticas biolÃgicas, sÃcioeconÃmicas, familiares e nutricionais. A anÃlise dos dados foi realizada atravÃs do programa SPSS,utilizando-se o teste do qui-quadrado para medir associaÃÃes, com o valor alfa de 5%. Resultados: Encontrou-se uma razÃo feminino: masculino de 37:1. As caracterÃsticas mais freqÃentes das crianÃas com PP foram: cor da pele parda, 64,1%; adotadas, 7,3%; sobrepeso e obesidade, 27,1 e 25,1%, respectivamente; inÃcio da puberdade abaixo dos 5 anos, 27,1%; altura dos pais abaixo da mÃdia populacional, 80%. CrianÃas com PP atendidas tardiamente pelo serviÃo especializado tenderam a apresentar mais cedo sinais da puberdade (p<0,001) e a pertencerem a famÃlias de menor renda (p<0,002). ConclusÃes: Encontraram-se elevadas proporÃÃes de crianÃas com PP que haviam sido adotadas e que apresentavam sobrepeso/obesidade, dois fatores de risco importantes na gÃnese do problema. O retardo na atenÃÃo especializada esteve associado ao aparecimento muito precoce dos sinais da puberdade e à baixa renda familiar, sugerindo a necessidade de aÃÃes de saÃde pÃblica que promovam a detecÃÃo e a atenÃÃo ao problema nas camadas mais pobres da populaÃÃo / Introduction: Precocious puberty (PP) is an increasingly common problem worldwide. PP children are at risk of early sexual initiation, sexual abuse, short stature in adult life, increased risk of obesity, hyperinsulinemia and hypertension. The study addresses the frequency and conditions associated with PP in order to propose measures to reduce this public health problem and its possible sequels. Methods: A cross-sectional study develops analytical approach to children affected by PP, who were given assistance at the clinic of Endocrinology, in the University Hospital Walter CantÃdio (HUWC) in the period from 1994 to 2010, with a sample of 342 children aged 1 to 11 years. The variables looked over included the biological, socio-economic, family and nutrition features. Data analysis was performed by using the SPSS program by means of the chi-square test to evaluate any association with the alpha value of 5%. Results: A ratio female-male of 37:1 was found. The most frequent features of children with PP were: dark skin, 64.1%; adopted, 7.3%; overweight and obesity, 27.1 and 25.1%, respectively; onset of puberty under 5 years, 27.1%; parental height below the average population, 80%. Children with late PP assistance by specialized service tended to show early signs of puberty (p <0.001) and belong to households with lower income (p <0.002). Conclusions: It was found a high proportion of children with PP which had been adopted and that had overweight/obesity, two important risk factors in the genesis of the problem. The delay in specialized care was associated with signs of very early onset of puberty and low household income, which suggests that public health actions are required to encourage detection and attention to the problem among the poorest strata of the population.

Introdução - A puberdade precoce verdadeira ou dependente de GnRH apresenta importante morbidade: a baixa estatura, conseqüência da rápida progressão da idade óssea, além das seqüelas psico-emocionais do desenvolvimento sexual secundário precoce. Daí a importância da realização de um diagnóstico precoce e preciso, a fim de que a terapêutica adequada seja instituída o quanto antes. O uso do análogo do GnRH (aGnRH) em teste diagnóstico vem sendo utilizado com este objetivo. Neste estudo avaliou-se os valores de corte para o diagnóstico de puberdade precoce verdadeira, usando-se o teste do aGnRH. Material e métodos - Estudo prospectivo, com 44 meninas, com desenvolvimento dos caracteres sexuais secundários antes dos 8 anos de idade, atendidas no Ambulatório de Ginecologia Infanto-Puberal do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Realizou-se, em todos os casos, o teste do aGnRH, que consistiu na coleta de amostra sanguínea basal para dosagem de FSH e LH, seguida da aplicação subcutânea de 500µg de acetato de leuprolida (Lupron®). Novas amostras sanguíneas foram realizadas após 3 horas, para dosagem de FSH e LH, e após 24 horas da aplicação, para dosagem de estradiol Compararam-se os níveis de LH e FSH basais, de 3 horas e a relação LH/FSH obtida, além do estradiol de 24h, com a evolução clínica das pacientes. Este foi o padrão ouro utilizado para análise do teste, sendo que, após 6 meses, as pacientes foram divididas em 2 grupos: puberdade progressiva (puberdade precoce verdadeira) e não-progressiva. Para análise estatística, utilizou-se curvas ROC, estabelecendo-se sensibilidade, especificidade e melhor nível de corte para o diagnóstico de puberdade precoce verdadeira, para os diferentes critérios analisados. Além disso, avaliou-se a concordância entre os diversos tipos de análise do teste, através do coeficiente kappa. Resultados - O LH de 3 horas apresentou valor de corte > 4,5 mUI/mL, sensibilidade 59,1% e especificidade 86,4%, com área sobre a curva de 0,723. O valor de kappa foi de 0,45, com concordância de 0,73. O estradiol de 24 horas apresentou valor de corte > 40,6 pg/mL, sensibilidade 70% e especificidade 73,7%, com área sobre a curva de 0,703. O valor de kappa foi de 0,436, com concordância de 0,718. Dentre todos os critérios analisados, o melhor deles foi a relação LH/FSH de 3 horas, com valor de corte > 0,14, sensibilidade 72,7% e especificidade 77,3%, com área sobre a curva de 0,771. O valor de kappa foi de 0,5, com concordância de 0,75. Conclusões - Em nossa avaliação, a relação LH/FSH de 3 horas foi superior ao valor de LH de 3 horas ou estradiol de 24 horas, que haviam sidos os melhores critérios diagnósticos no trabalho pioneiro na utilização deste teste. / Introduction - True or GnRH-dependent precocious puberty involves important morbidity such as short stature due to the rapid progression of bone age, as well as psycho-emotional sequels of precocious secondary sexual development. Thus, it is important to make an early and precise diagnosis so that appropriate treatment can be instituted as early as possible. The GnRH analogue (aGnRH) in the diagnostic test has been used for this purpose. In the present study, the sensitivity and specificity of different laboratory criteria for the diagnosis of true precocious puberty were compared using the aGnRH test. Material and methods - This was a prospective study conducted on 44 girls with the development of secondary sexual traits before 8 years of age attended at the Childhood-Pubertal Gynecology Outpatient Clinic of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo. The aGnRH test was performed in all cases, consisting of collection of a basal blood sample for the determination of FSH and LH, followed by subcutaneous application of 500 µg leuprolide acetate (Lupron®). New blood samples were obtained after 3 hours, for the determination of FSH and LH, and after 24hours of application, for determination of estradiol. Basal LH and FSH levels and levels after 3 hours, the LH/FSH ratio obtained 3 hours after the administration of 500 µg Lupron®, and 24 hour estradiol levels were compared with the clinical course of the patients. This was the gold standard used for the analysis of the test and after 6 months the patients were divided into 2 groups: progressive puberty (true precocious puberty) and non-progressive puberty. ROC curves were used for statistical analysis, with the determination of the sensitivity, specificity and best cut-off value for the diagnosis of true precocious puberty of the different criteria analyzed. In addition, the agreement of the various types of test analysis was evaluated using the kappa coefficient. Results - Three hour LH presented a cut-off value of > 4.5 mIU/mL, 59.1% sensitivity and 86.4% specificity, with an area under the curve of 0.723. The kappa value was 0.45, with 0.73 agreement. Twenty-four hour estradiol presented a cut-off value of > 40.6 pg/mL, 70% sensitivity and 73.7% specificity, with an area under the curve of 0.703. The kappa value was 0.436, with 0.718 agreement. The best of all criteria used was the 3 hour LH/FSH ratio, with a cut-off value of > 0.14, 72.7% sensitivity and 77.3% specificity, with an area under the curve of 0.771. The kappa value was 0.5, with 0.75 agreement. Conclusions - In the present evaluation, the 3 hour LH/FSH ratio was superior to the 3 hour LH value and the 24 hour estradiol value, which had been the best diagnostic criteria in the pioneering study using this test.

The following thesis addresses the theme of puberty through three Italian novels: Agostino by Alberto Moravia, Ernesto by Umberto Saba, and Dietro la porta by Giorgio Bassani. The introduction outlines the history of the children's and adolescents' protagonism in literature since the beginning. One chapter is dedicated to each author, his biographic data and generic work. The analyzed novels are then formally presented whose contents reveal a prevalence of the puberty theme. The authors' life journeys and unique youthful traumas are clearly projected in each novel. We can find the reflection of complicated family relationships, first sexual experiences, and initial problems of adult life in the stories of the young protagonists. Finally, the difference between the characters and their authors is shown with a brief comparison.

Abstract The markers of microvascular complications of type 1 diabetes were evaluated in adolescents in a cross sectional survey of 100 out of 138 eligible patients aged 9-19 years with a duration of diabetes over two years who visited the Paediatric Outpatient Clinic at Oulu University Hospital in 1997-1999, and one hundred healthy controls. Two patients in early or mid-puberty had non-proliferative diabetic retinopathy, but no other signs of microvascular complications. The five patients with persistent microalbuminuria were all girls; one prepubertal, one late pubertal and three postpubertal. Their mean glycated haemoglobin A1c (HbA1c) was higher, but they had a similar duration of diabetes and age distribution to those without microalbuminuria. The adolescent patients were predisposed to higher fasting serum total and low-density lipoprotein cholesterol and triglyceride levels and higher diastolic blood pressure than the control subjects. The proportional total body fat was highest in the girls with diabetes by the end of puberty, while serum leptin levels did not differ between the patients and healthy controls. The patients had low fasting serum insulin levels and high insulin-like growth factor-binding protein 1 levels, related to hypoinsulinaemia. Distal motor nerve function in the lower extremities were already affected before puberty, and distal and proximal nerve function deteriorated as puberty advanced. Ten patients had neurophysiologically confirmed distal diabetic polyneuropathy, and they were older and they had longer duration of diabetes and higher HbA1c than patients without polyneuropathy. Although cardiovascular function was in the main well preserved in the adolescents with type 1 diabetes, the power spectrum analysis of heart rate variability showed attenuated autonomic nervous system reactivity. Taken together these data show that a relatively small proportion of adolescents with type 1 diabetes have signs of microvascular complications. The prevalences of diabetic retinopathy, persistent microalbuminuria and distal diabetic polyneuropathy were 2%, 6% and 10%, respectively. Pubertal maturation seems to promote the progression of early signs of microvascular complications in patients affected by type 1 diabetes.

Exercise-induced anaphylaxis (EIA) is a rare severe disease in which patients express asthmatic and allergic symptoms. Little is known about EIA and its pathology. This manuscript presents an hypothesis that combined hormonal (estrogen and progesterone) contraceptive use and stress during puberty alter the immune system and predispose the adult female to EIA. Presented here is what is known about asthma, a much more common disease, and a pilot, experimental paradigm in which EIA is induced in Syrian hamsters. Asthmatic and allergic cases are much more prevalent in pubescent and adult females than in adult males. Women express higher levels of lung inflammation at stages of their lives when estrogen and progesterone levels are at their lowest (i.e., the follicular phase of the menstrual cycle and menopause). Combined birth control pills have been utilized by doctors to treat asthmatic women. Contraceptive treatments maintain steady levels of estrogen and progesterone throughout the menstrual cycle. It is hypothesized that if female hamsters are given constant levels of hormones as well as ovalbumin and exercise challenges during puberty and then have the hormones taken away during adulthood, they will produce abnormal lung sounds and corresponding pathological histology. To test this hypothesis, female Syrian hamsters were treated with ovalbumin, exercise challenge, both and none (the control). They were also treated to maintain constant levels of estrogen and progesterone during puberty. Although the results were inconclusive, the model may demonstrate that constant ovarian hormones, ovalbumin sensitization, and exercise challenges permanently strain the immune system of females in adulthood.

The problem of this study is to determine the relationship that may exist among the variables of racial status, puberty status, anthropometric measurements, and physical fitness. Particularly of interest are the anthropometric differences that may exist among Negroes and Caucasians and the effect that these differences may have upon physical fitness as measured by the AAHPER Physical Fitness Battery. Differences among racial groups and puberty groups will be determined by analysis of variance technique and relations among anthropometric measures and physical fitness components will be compared and determined by correlational techniques.

Magister Chirurgiae Dentium (MChD) / Diabetes Mellitus (DM) is a well-known risk factor for Periodontal disease. Research has established that the prevalence of Periodontal disease is directly related to the glycaemic control of DM in adults and only a few research studies explore this prevalence in diabetic children and adolescents in South Africa. The aim of this study is to determine the periodontal health status of diabetic patients which include children and adolescents attending the Paediatric Diabetic Clinic at Tygerberg Hospital and compare periodontal status with diabetic control. cross-sectional study was employed to determine periodontal status and data relating to the HbA1c% level, the type and duration of DM, the body mass index (BMI) percentile, age, sex, and puberty and treatment regimens were collected from patient records and entered into data collection sheets.

The aim of this study was to compare pubertal development between the two main ethnic groups in the Cape, controlling for social class. This study aimed to investigate: 1. The age of menarche and other stages of pubertal development of white and coloured school girls living in greater Cape Town. 2. The relationship between the age of menarche and the other stages of pubertal development, social class and race. 3. The influence of home environment (childminder, sibling number, maternal education) on onset of menarche and breast development. This data further contributes to a larger study on pubertal development of all representative ethnic groups and social classes in the Cape. Our hypothesis is that social class, and not race, is a major determinant of pubertal development.

Submitted in partial fulfilment of the requirements for The Degree of Doctor of Philosophy (Community Psychology) Faculty of Arts University of Zululand, 2010. / The lives of individuals in all societies are a series of passages from one age to another and from one occupation to the other. Among the Vhavenda, there are fine distinctions among age or occupational groups and progression from one group to the next is accompanied by special rituals enveloped in ceremonies which involve actions that are clearly regulated and guarded so that the entire society suffer no discomfort or injury. The research explores and describes the lived experiences of Vha-Venda initiated women in the rural areas of Mashau, Mashawana and Shayandima village in Limpopo Province, South Africa. The perception that transition practices, otherwise known as initiation rituals or rites of passage, are only practiced in the ‘traditional’ societies because it is believed to be where the culture is embedded. This study draws on qualitative research principles based on the ethnographic approach. This research explores and describes the lived experiences of initiation of Venda women that is practiced and currently being implemented in the three villages that is, Mashau, Mashawana and Shayandima village in Limpopo Province, South Africa. As a result, this study is informed by the qualitative data gathered during the initial stages of the research with the assistance of research guides. The core material in this study emerges from in depth, semi-structured interviews conducted during individual interviews and focus group interviews with fifteen initiated women and two research guides between the age of thirty and sixty. The research guides, with special knowledge of the culture assisted the researcher on the process and activities of the initiation and also informed the researcher about the venues where certain rituals take place and also assisted in translation of certain phrases for clarification. In compliance with research ethics, the identities of the respondents remain confidential through the use of pseudonyms. The research concludes that the lived experiences of women initiation are private and one is strictly prohibited to talk about them, especially with uninitiated women. The aim is to portray the traditional social and cultural ritual proposed to be learnt and preserved. In this study, the researcher’s findings are that: Conformity, compliance and obedience with the initiation rituals can save a person from embarrassment in Limpopo Province where initiation is practiced. Participants reported that women are silenced and forbidden to talk about initiation outside ‘dombani’ with the uninitiated women. They reported that the initiation ritual is secret and thus a taboo to talk about it. Initiates are prohibited to disclose what happens during the initiation process. In contrast, uninitiated women viewed the ritual as barbaric and promiscuous. The initiated indicated that they were forced to attend because of fear of rejection, discrimination and isolation by the community. Other participants agreed to have attended for the sake of acceptance, though they believed to have gained knowledge about understanding womanhood. Most of the women mentioned that although it was some years that they had attended the initiation school, they still carried the burden of anger, shame, humiliation, frustration, low-self esteem, sense of helplessness and lack confidence and still find it hard to share their experiences or talk about them. The researcher concurs with the participants and Stayt (1968) that initiated women are denied freedom of expression. It is sticky prohibited to talk or share the initiation experiences with the non- initiated let alone discuss it outside dombani. Thereby, the aim, and its concomitant 4 objectives, have been thoroughly explored and achieved.

No description available.