BACKGROUND & AIMS: OBJECTIVE:Inadequate sunlight exposure and calcium intake during rapid growth at puberty lead to hypocalcemia, hypovitaminosis D and eventually to overt rickets. To determine serum biochemical findings of rickets in healthy 11-15 yr old girls, the effect of sunlight exposure and oral vitamin D supplementation on serum 25- hydroxy vitamin D and calcium administration in girls with abnormal findings during December 2002 through March 2003 in Tehran, Iran. METHODS:Healthy middle school girls were selected for estimation of vitamin D, calcium and phosphorus intake by a three-day food recall. And measurement of serum calcium, phosphorus, parathyroid hormone, alkaline-phosphatase and 25- hydroxyvitamin D concentration. The girls with abnormal findings divided in two groups. Hypovitaminosis D girls subdivided into two groups, supplementary sunlight exposure and vitamin- D administrated for them and calcium administration for the second group for 20 days. RESULTS:Of 414 girls, the mean daily vitamin D acquirement and calcium intake were 119 +/- 52 IU and 360 +/- 350 mg among all girls respectively. Mean serum 25-hydroxyvitamin D with two or more abnormal biochemical findings in 15 (3.6%) girls (group I) were 7.8 ng/ml and alkaline phosphatse with normal or low calcium in 29 (7%) girls (group II) was 1187 IU/L. Mean serum calcium was 8.2 mg % in 8 of 29 girls. Serum 25- hydroxyvitamin D before and after sunlight exposure was 7.1 +/- 1.9 ng/ml and 13.9 +/- 2.4 ng/ml and vitamin D administration was 7.4 +/- 1.8 ng/ml (group Ia) and 27.9 +/- 4.2 ng/ml (group Ib) respectively. Serum alkaline phosphatase before and after calcium administration were 1187 IU/L and 666 IU/L respectively. CONCLUSION:We conclude that low daily calcium intake and vitamin D acquirement are two important problems in Iranian girls during rapid growth at puberty; therefore, for prevention of overt rickets calcium and vitamin D Supplementation appear to be necessary.

背景与目标：

BACKGROUND & AIMS: :Use of electroconvulsive therapy (ECT) has been infrequently described in patients with systemic lupus erythematosus and is most commonly used in patients with catatonia. In this report, we describe the use of ECT in a young adolescent girl who had bipolar affective disorder associated with systemic lupus erythematosus and was treated with ECT for the depressive episode. The patient achieved remission with a course of 6 ECT treatments.

背景与目标： : 在系统性红斑狼疮患者中很少使用电惊厥疗法 (ECT)，最常用于卡托尼亚患者。在本报告中，我们描述了在患有与系统性红斑狼疮相关的双相情感障碍并接受ECT治疗的年轻少女中使用ECT的情况。患者通过6个疗程的ECT治疗获得缓解。

BACKGROUND & AIMS: :While adolescents have received increasing attention in the global HIV response and international strategies and commitments, adolescent mothers and their children remain largely overlooked in research, funding and, programming for health-related outcomes. We conducted an extensive scoping review of current evidence on the experiences of adolescent mothers affected by HIV and their children in this region. We included published literature and conference abstracts, complemented by consultations with key stakeholders, and a review of documents through grey literature searching. First, we summarise the experiences of adolescent mothers and their children related to HIV and key health and development indicators. The syndemic of early motherhood and HIV in sub-Saharan Africa increases the vulnerability of adolescent mothers and their children. We then highlight lessons from a series of promising programmes focused on supporting adolescent mothers through novel approaches. In sub-Saharan Africa, supporting adolescent mothers living in high HIV-risk communities is critical not only to eliminate HIV/AIDS, but also to attain the Sustainable Development Goals. While research on and programming for adolescent mothers and their children is growing, the complex needs for this vulnerable group remain unmet. We conclude with evidence gaps and programming priorities for adolescent mothers affected by HIV and their children.

背景与目标： : 尽管青少年在全球艾滋病毒应对措施以及国际战略和承诺中受到越来越多的关注，但青少年母亲及其子女在与健康有关的成果的研究，资金和方案编制方面仍然被忽视。我们对该地区受艾滋病毒影响的青春期母亲及其子女的经历的当前证据进行了广泛的范围界定审查。我们包括了已发表的文献和会议摘要，并与主要利益相关者进行了磋商，并通过灰色文献搜索对文件进行了审查。首先，我们总结了青春期母亲及其子女与艾滋病毒有关的经验以及关键的健康与发展指标。撒哈拉以南非洲地区早期孕产和艾滋病毒的共同感染增加了青春期母亲及其子女的脆弱性。然后，我们重点介绍了一系列有前途的计划的教训，这些计划侧重于通过新颖的方法支持青春期母亲。在撒哈拉以南非洲，支持生活在艾滋病毒高风险社区的青春期母亲不仅对消除艾滋病毒/艾滋病至关重要，而且对实现可持续发展目标也至关重要。尽管对青少年母亲及其子女的研究和规划正在增长，但对这一弱势群体的复杂需求仍未得到满足。最后，我们为受艾滋病毒影响的青春期母亲及其子女提供了证据空白和计划优先事项。

BACKGROUND & AIMS: :This case series from a hospital-based academic in vitro fertilization clinic outlines the feasibility of oocyte cryopreservation for transgender male adolescents after varying degrees of exposure to pubertal blockers and/or testosterone. A description of each patient's oocyte cryopreservation cycle is reviewed, including prior exposure to pubertal blockers and/or testosterone, anti-Mullerian hormone level, stimulation medications, trigger injections, number of oocytes retrieved and cryopreserved, and complications. All patients tolerated stimulation and retrieval well and had mature oocytes cryopreserved in each cycle. There were no complications. Adolescent transgender males who choose to undergo oocyte cryopreservation tolerate the process well, reinforcing the importance of fertility preservation in providing comprehensive care for transgender patients.

背景与目标： : 该病例系列来自一家医院的学术体外受精诊所，概述了变性男性青少年在不同程度暴露于青春期阻滞剂和/或睾丸激素后进行卵母细胞冷冻保存的可行性。回顾了每个患者的卵母细胞冷冻保存周期的描述，包括先前暴露于青春期阻滞剂和/或睾丸激素，抗苗勒氏激素水平，刺激药物，触发注射，回收和冷冻保存的卵母细胞数量以及并发症。所有患者对刺激和恢复的耐受性良好，并且在每个周期中都冷冻保存了成熟的卵母细胞。没有并发症。选择进行卵母细胞冷冻保存的青春期跨性别男性可以很好地耐受该过程，从而增强了保留生育能力在为跨性别患者提供全面护理中的重要性。

BACKGROUND & AIMS: :We examined the influence of two measures of maternal nutritional status: prepregnant body mass (kilograms/meter2 ) and Weight gain during pregnancy (adjusted for duration of gestation) on spontaneous preterm delivery (<37 completed Weeks' gestation) and duration of gestation, as well as on low birthweight (<2,500 grams) and small-for-gestational-age (SGA) in pregnant adolescents. Inadequate Weight gain for gestation increased the risk of spontaneous preterm delivery when prematurity was reckoned by the obstetric estimate (Adjusted Odds Ratio, AOR = 1.75 95% CI 1.22-2.50) or from the mother's LMP (AOR = 1.49 95% CI 1.10-2.02). In linear models, gestation duration was significantly reduced, by more than half a week, when reckoned from eiter estimate of gestation. However, the association between preterm birth or gestation duration and prepregnancy body mass was not consistent and depended on the method of estimating gestation. Low birthweight and SGA were each significantly associated with inadequate weight gain during pregnancy as well as with prepregnant body mass. These results suggest that current maternal nutritional status, as measured by weight gain during pregnancy, may influence preterm delivery and gestation duration. The inconsistent results obtained with prepregnancy body mass may reflect a size bias inherent in the obstetric estimate of gestation, rather than effects of prepregnant maternal nutritional status on gestation.

背景与目标： : 我们研究了两种母亲营养状况指标的影响: 怀孕前体重 (千克/米2) 和怀孕期间体重增加 (根据妊娠持续时间进行调整) 对自发早产 (<37个完整妊娠周) 和妊娠持续时间的影响，以及怀孕青少年的低出生体重 (<2,500克) 和小于胎龄儿 (SGA)。当产科估计值 (调整后的比值比，AOR = 1.75 95% CI 1.22-2.50) 或母亲的LMP (AOR = 1.49 95% CI 1.10-2.02) 估计早产时，妊娠体重增加不足会增加自发早产的风险。在线性模型中，根据eiter对妊娠的估计，妊娠持续时间显着减少了半周以上。然而，早产或妊娠持续时间与孕前体重之间的关联并不一致，并且取决于估计妊娠的方法。低出生体重和SGA均与怀孕期间体重增加不足以及怀孕前的体重显着相关。这些结果表明，以怀孕期间体重增加衡量的当前孕产妇营养状况可能会影响早产和妊娠持续时间。与孕前体重获得的不一致结果可能反映了产科妊娠估计中固有的大小偏差，而不是孕前孕妇营养状况对妊娠的影响。

BACKGROUND & AIMS: PURPOSE:Pregnancy rates among adolescents have declined in the U.S. and Britain but remain high compared with other high-income countries. This comparison describes trends in pregnancy rates, recent sexual activity, and contraceptive use among women aged 16-19 years in the U.S. and Britain to consider the contribution of these two behavioral factors to the decline in pregnancy rates in the two countries and the differences between them. METHODS:We use data from two rounds of the U.S. National Survey of Family Growth, conducted 2002-2003 and 2011-2015, and the British National Survey of Sexual Attitudes and Lifestyles, conducted 2000-2001 and 2010-2012, to describe population-level differences between countries and over time in sexual activity and contraceptive use. We calculate pregnancy rates using national births and abortions data. RESULTS:Pregnancy rates declined in both countries; this began earlier in the U.S. and was steeper. There was no change in sexual activity in Britain, but in the U.S., the proportion reporting recent sex declined. In both countries, there was a shift toward more effective contraception. A higher proportion in Britain than the U.S. reported ever having had sex (65% vs. 49%) and sex in the last year (64% vs. 45%), 6 months (59% vs. 39%), and 4 weeks (48% vs. 29%). A higher proportion in Britain reported using more effective contraception (68% vs. 52%). CONCLUSIONS:In both countries, improvements in contraceptive use have contributed substantially to declines in pregnancy rates; however, the steeper decline in the U.S. likely also reflects declines in recent sex occurring only in that country.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Cancer-related cognitive impairment (CRCI) among adolescent and young adult (AYA) cancer patients with noncentral nervous system (CNS) cancers has not been well studied. In this study, we aimed to describe CRCI-associated trends and characteristics among AYA cancer patients. METHODS:In a longitudinal cohort of AYA cancer patients without CNS disease, CRCI was evaluated over 1 year using the Functional Assessment of Cancer Therapy-Cognitive Function Instrument, a self-reported cognitive outcome measure. CRCI prevalence was quantified using the previously established minimal clinically important difference. CRCI-associated longitudinal trends and factors were evaluated with mixed-effects model analysis. RESULTS:Ninety-one patients (mean age = 28.4 ± 6.7 years) were included. Approximately one-third (34.1%) experienced CRCI at least once during the study follow-up. Female gender (P = .02), Indian ethnicity (P < .01), current smokers (P < .01), anxiety/depressive symptoms (P < .01) and fatigue (P < .01) were found to be associated with poorer cognitive function among AYAs. CONCLUSIONS:Although AYA cancer patients were relatively young and without CNS disease involvement, a significant proportion of them experienced clinically important decline in cognitive function. With improved understanding of this subject, effective strategies can be formulated to promote awareness of CRCI and mitigate its negative effects among AYA cancer patients.

背景与目标：

BACKGROUND & AIMS: :Adolescent idiopathic scoliosis (AIS) is a pathological entity of unknown etiology. The causes of osteoporosis or osteopenia in AIS remain undetermined. Whether poor bone quality is an etiologic factor remains controversial. To determine the correlation between low bone mineral status and AIS, a review of literature was performed. After a literature search from 1966 to June 2007 (using Medline, EMBASE, Cochrane DSR, ACP Journal Club, DARE, CCTR, CINAHL and hand searches of references) for studies regarding low bone mineral status and AIS, 20 studies meeting the inclusion criteria were reviewed in terms of the appropriateness of valuation technique, the validity of descriptive system, the number and type of respondents, and overall quality of the studies. Nearly all investigations demonstrated that low bone mineral density (BMD) was a generalized phenomenon and a systematic disorder in AIS. The prevalence of AIS with osteoporosis is approximately 20-38%. The follow-up studies indicated that osteopenia in patients with AIS may be a persistent phenomenon. BMD could be affected by the mechanical loading and lower bone mineral mass is always associated with lower bone strength. The spinal architecture associated with the osteopenia may aggravate the spinal deformity. However, with regard to the concave and convex femoral neck BMD values, and the correlation of BMD to scoliosis parameters, the results remain inconsistent. Bracing may not result in permanent loss of bone mineral mass. The effect of the eccentric tension-compression environments on BMD, the correlation of BMD with scoliosis parameters and the effect of bracing on BMD should be investigated further in prospective, randomized and longitudinal follow-up studies.

背景与目标： : 青少年特发性脊柱侧凸 (AIS) 是病因不明的病理实体。AIS中骨质疏松症或骨量减少的原因尚未确定。骨质量差是否是病因仍存在争议。为了确定低骨矿物质状态与AIS之间的相关性，对文献进行了回顾。在1966年2007年6月 (使用Medline，EMBASE，Cochrane DSR，ACP Journal Club，DARE，CCTR，CINAHL和参考文献的手工搜索) 进行有关低骨矿物质状况和AIS的研究之后，对20项符合纳入标准的研究进行了审查。评估技术的适当性，描述系统的有效性，受访者的数量和类型以及研究的整体质量。几乎所有研究都表明，低骨矿物质密度 (BMD) 是AIS的普遍现象和系统疾病。患有骨质疏松症的AIS的患病率约为20-38%。随访研究表明，AIS患者的骨量减少可能是一种持续的现象。BMD可能会受到机械负荷的影响，而较低的骨矿物质质量始终与较低的骨强度有关。与骨质减少相关的脊柱结构可能会加剧脊柱畸形。但是，关于凹凸股骨颈BMD值以及BMD与脊柱侧弯参数的相关性，结果仍然不一致。支撑可能不会导致骨矿物质质量的永久性损失。在前瞻性，随机和纵向随访研究中，应进一步研究偏心拉伸压缩环境对BMD的影响，BMD与脊柱侧弯参数的相关性以及支撑对BMD的影响。

BACKGROUND & AIMS: BACKGROUND:Young women aged 15-24 years are disproportionately affected by the HIV epidemic. Two phase III trials of a vaginal ring containing 25-mg dapivirine demonstrated HIV-1 risk reduction in adult women older than 21 years but not in those aged 18-21 years. Lack of protection was correlated with low adherence. METHODS:In this phase-IIa, randomized, double-blind, placebo-controlled, US, multicenter trial of the dapivirine ring in sexually active females, aged 15-17 years, participants were randomized 3:1 to a dapivirine or placebo ring to be inserted monthly for 6 months (NCT02028338). Primary safety end points included grade 2 product related adverse events and any grade 3 and higher adverse events. Adherence to ring use was assessed by plasma dapivirine concentrations, residual levels in used rings, and self-report. A plasma dapivirine concentration of >95 pg/mL was used to define short-term adherence; a residual ring level of <23.5 mg was used to define long-term adherence. Acceptability was assessed through computer-assisted self-interviews. RESULTS:Ninety-six participants were enrolled across 6 US sites. The median age was 16.0 years. There were no differences in safety outcomes between treatment arms. Adherence to the dapivirine ring was demonstrated by both plasma measurements (87%) and residual drug levels in rings (95%). Forty-two percent (95% confidence interval: 32 to 52) of participants reported that they never removed the ring. Participants noted no discomfort due to the ring at 87% of visits and "liking" the ring at 93% of visits. CONCLUSION:The dapivirine vaginal ring, a promising topical microbicide, was well tolerated and acceptable in young US adolescents.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Regular physical activity (PA) has many benefits for children and adolescents, yet many do not meet PA recommendations. Social context is important for promoting or discouraging PA among children and adolescents. This review aimed to identify social network variables related to PA among children and adolescents. METHODS:A systematic review of the literature was conducted in September 2018 using PsycINFO, MEDLINE, PubMed, and Web of Science. Included articles needed to (1) be focused on children (aged 5-11 y) or adolescents (aged 12-17 y), (2) include a measure of PA, (3) include a measure of egocentric or sociocentric social connection in which alters were nominated, and (4) perform an analysis between network data and PA. RESULTS:A search of 11,824 articles was refined to a final sample of 29 articles. Social network themes and concepts such as homophily, centrality, and network composition were related to child and adolescent PA behavior across the literature. CONCLUSIONS:The impact of an individual's social network is evident on their PA behaviors. More research is needed to examine why these networks form in relation to PA and how interventions can utilize social network analysis to more effectively promote PA, especially in underserved and minority populations.

背景与目标：

BACKGROUND & AIMS: :Meningoencephalitis caused by Acanthamoeba spp . is a rare opportunistic infection, difficult to diagnose and difficult to treat, which causes death in almost all cases. We report the neuropathologic findings of a 16-year-old girl with systemic lupus erythematosus (SLE) treated with immunosuppression who died of fulminant Acanthamoeba meningoencephalitis. Neuropathologic examination revealed multiple supratentorial and infratentorial hemorrhagic necrotizing lesions with encephalitis and vasculitis with mixed inflammatory infiltrates, fibrinoid necrosis of vessel walls, and local leptomeningitis. Acanthamoeba in the lesions may be misinterpreted as macrophages. Taking them into differential diagnostic consideration, cytological differences should be detected, and relevant additional stains for reliable differentiation of these cells can be performed. To our knowledge, this is the first published case of Acanthamoeba meningoencephalitis in a patient with SLE in Germany.

背景与目标： : 棘阿米巴引起的脑膜脑炎。是一种罕见的机会性感染，诊断困难，治疗困难，几乎导致所有病例死亡。我们报告了一名接受免疫抑制治疗的16岁系统性红斑狼疮 (SLE) 女孩的神经病理学发现，该女孩死于暴发性棘阿米巴脑膜脑炎。神经病理学检查发现多发性幕上和幕下出血性坏死性病变伴脑炎和血管炎混合炎性浸润，血管壁纤维蛋白样坏死和局部软脑膜炎。病变中的棘阿米巴可能被误解为巨噬细胞。考虑到它们的鉴别诊断，应检测细胞学差异，并可以进行相关的附加染色以可靠地分化这些细胞。据我们所知，这是德国SLE患者中第一例发表的棘阿米巴脑膜脑炎病例。

BACKGROUND & AIMS: STUDY DESIGN:An analysis of differences among healthy elementary school children and those with adolescent idiopathic scoliosis (AIS), and between groups of individuals with AIS with different Cobb angles. OBJECTIVES:To research the differences in dynamic balance among adolescents with a variety of postural statuses and verify the sensitivity value of the Cobb angle. SUMMARY OF BACKGROUND DATA:Assuming the biomechanical and functional particularities of the children with AIS, there is a need for an earlier diagnosis. METHODS:The participants' balance (left and right step test) was estimated using electromyography and the reaction of base power on the platform. RESULTS:Discriminant analysis confirmed a significant difference between the participants with AIS and healthy persons on the left step test. The values of the lumbal erector muscles, right gluteus, and side-to-side reaction of the force platform are more pronounced than the other variables. There is no significant difference among the participants with various Cobb angles. CONCLUSIONS:The dynamic balance tests contribute to the AIS screening process. The pathologic form of AIS and lateralization highly affect dynamic balance. The study confirmed the neurophysicians' claims of the neuroplasticity of the central nervous system. In addition, the research illustrated the compensational functioning of mobility, especially when there is a lack of normal mobility forms, and there are weak postural control mechanisms and proprioception. There was no proof of the value of the Cobb angle as a clinical method and a measurement of the functional capabilities of the participants in the screening process.

背景与目标：

BACKGROUND & AIMS: STUDY DESIGN:A prospective review of patients undergoing epidural catheter placement after anterior spinal fusion and instrumentation for adolescent scoliosis was performed. Data were collected using visual analog pain scores reflecting the patients' perception of their pain control. OBJECTIVES:To present the authors' technique for epidural catheter placement and dosing protocol, and to demonstrate the results from postoperative pain control after anterior spinal instrumented fusion for 10 consecutive patients. SUMMARY OF BACKGROUND DATA:The literature regarding the benefits of epidural catheters after spinal surgery is contradictory, even with controlled studies comparing epidural catheters with intravenous morphine patient-controlled anesthesia. The authors believe that this lack of consensus stems from varied epidural dosing protocols and techniques in catheter placement, which they have witnessed anecdotally at their own institution. This prompted the authors to develop and refine a standardized dosing and catheter placement protocol for pain control after spinal surgery. METHODS:Epidural catheters were placed intraoperatively before wound closure, then removed on postoperative Day 5. Dosing consisted of fentanyl (1 microg/kg) and hydromorphone (5 microg/kg) diluted in preservative-free saline (0.2 mL/kg). After surgery, dosing consisted of 0.1% ropivacaine and hydromorphone (10 microg/ml) continuously infused at 0.2 mL/kg/hour. Postoperative pain control was assessed on each postoperative day using a visual analog pain scale with choices ranging from 0 to 10. RESULTS:The arithmetic mean of the median pain scores after surgery was 2.1. The mean of the maximum pain scores for the 5 days was 4.1. Three patients required an epidural bolus and a 20% increase in the epidural infusion rate. One patient was judged to be excessively sleepy, so the epidural infusion rate was decreased by 20%. Pruritus requiring diphenhydramine developed in three patients. No other adverse effects related to epidural analgesia were noted. No catheters were accidentally pulled out or disconnected. CONCLUSION:By following the dosing protocol described, epidural catheters can be used safely and effectively to control postoperative pain after anterior instrumentation and spinal fusion for adolescent scoliosis.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:There is a dearth of research on the perspectives of adolescent siblings growing up with a brother or sister with an autism spectrum disorder (ASD). METHOD:Semistructured interviews were used to elicit the perceptions and experiences of 12 typically developing adolescents with a brother with an ASD. Interpretative phenomenological analysis was used. RESULTS:The data analysis of the siblings' perceptions yielded 6 themes: (a) difficulties and negative impact of their brother's condition on themselves and their family, (b) how others' reactions to their brother negatively affected them as siblings, (c) how their histories with their brothers contextualised their present circumstances, (d) the varying degrees of acceptance and tolerance towards their brothers, (e) positive perceptions and experiences with their brothers, and (f) their thoughts and worries about the future. CONCLUSIONS:The main implications are for supports to adolescent siblings by helping them to develop skills in managing others' reactions and openly discussing concerns about their brother's future.

背景与目标：

BACKGROUND & AIMS: :AM:STARs, the Adolescent Medicine State of the Art Reviews series published by the American Academy of Pediatrics, devoted its April 2012 issue to the topic of Adolescent Gynecology. Developed in conjunction with the North American Society for Pediatric and Adolescent Gynecology (NASPAG), the issue consists of twelve articles, written mostly by members of NASPAG. As editors of the issue, we present in this review for the Journal of Pediatric and Adolescent Gynecology (JPAG) a synopsis of the most salient concepts presented in those 12 articles. This review of reviews is intended to be an update on the "state of the art" in adolescent gynecology.

背景与目标： : AM:STARs，由美国儿科学会出版的《青少年医学最新评论》系列，其2012年4月期致力于青少年妇科。该问题与北美儿科和青少年妇科协会 (NASPAG) 共同开发，由十二篇文章组成，主要由NASPAG成员撰写。作为该问题的编辑，我们在《儿科和青少年妇科杂志》 (JPAG) 的这篇评论中介绍了这12篇文章中提出的最突出概念的摘要。这篇评论旨在更新青少年妇科的 “最新技术”。