Journal of pediatric and adolescent gynecology最新文献_第7页

Use of Vaginoscopy after Vaginoplasty in Individuals with Congenital Adrenal Hyperplasia 对先天性肾上腺皮质增生症患者进行阴道成形术后使用阴道镜检查。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2024-08-24 DOI: 10.1016/j.jpag.2024.08.008

Marija Kamceva MD , Julie Strickland MD , John Gatti MD , Frances W. Grimstad

Study Objective

To explore the use of exam under anesthesia with vaginoscopy (EUA-V) after vaginoplasty in patients with congenital adrenal hyperplasia (CAH)

Design

Retrospective cohort

Methods

An institutional review board-approved retrospective chart review was performed of the postsurgical follow-up care of all patients diagnosed with classic CAH who sought care at a tertiary children's hospital from 2000 to 2017 and had undergone vaginoplasty at that institution.

Results

Twenty-six patients met the inclusion criteria. The median age at vaginoplasty was 1.25 years (IQR 0.67-9). The median postsurgical follow-up was 5.5 years (IQR 1.5-9). Twenty-six EUA-Vs were performed, on 22 patients. Four were for complication assessment (rectovaginal fistula¹ and urethrovaginal fistula³—on the same patient). The remaining 22 EUA-Vs, performed on 20 patients with 2 each undergoing 2 EUA-Vs, were planned for routine evaluation of vaginal patency. They were done a median of 0.67 years (IQR 0.25-2) after surgery and at a median of 6.67 years of age (IQR 1.75-12). Of these, 5 EUA-Vs identified stenosis in 5 patients (25%), a median of 0.91 years (IQR 0.5-7) after surgery, at a median age of 8.42 years (IQR 2-10.92). Of the 4 who did not undergo EUA-V, 1 had stenosis on clinical exam with ultrasound-verified hematocolpos. The remaining 3 were all prepubertal at last follow-up.

Conclusion

Most CAH patients after vaginoplasty underwent routine EUA-V, roughly a quarter of which detected stenosis. EUA-Vs may play a beneficial role in routine postoperative care after vaginoplasty in patients with CAH.

研究目的探讨先天性肾上腺皮质增生症（CAH）患者阴道成形术后麻醉下阴道镜检查（EUA-V）的应用：回顾性队列方法：对 2000-2017 年期间在一家三级儿童医院就诊并接受阴道成形术的所有确诊为典型 CAH 患者的术后随访情况进行了一项经 IRB 批准的回顾性病历审查：26名患者符合纳入标准。阴道成形术时的中位年龄为1.25岁（IQR：0.67，9）。手术后随访的中位数为 5.5 年（IQR：1.5，9）。共对 22 名患者进行了 26 次欧盟腹腔镜检查。其中四例用于并发症评估（直肠阴道瘘（1例）；尿道阴道瘘（3例）--同一患者）。其余22例EUA-V手术是为常规评估阴道通畅性而计划进行的，共为20名患者进行了EUA-V手术，每名患者接受了两次EUA-V手术。这些手术是在术后中位 0.67 年（IQR：0.25，2）、中位 6.67 岁（IQR：1.75，12）时进行的。其中，5 名患者（25%）在术后 0.91 年（IQR：0.5-7）、中位年龄 8.42 岁（IQR：2-10.92）时接受了 5 次 EUA-V 检查，发现了血管狭窄。在没有接受 EUA-V 的四名患者中，有一人在临床检查中发现血管狭窄，并经超声波证实为血栓。其余三人在最后一次随访时均为青春期前：结论：阴道成形术后的大多数 CAH 患者都接受了常规的阴道超声检查，其中约四分之一的患者发现了阴道狭窄。EUA-V在CAH患者阴道成形术后的常规术后护理中可能发挥有益的作用。

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引用次数: 0

The Impact of Menstrual Disorders on Sleep Quality in Adolescents: An Observational Study 月经紊乱对青少年睡眠质量的影响：观察研究

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2024-08-21 DOI: 10.1016/j.jpag.2024.08.005

Hüseyin A. Kocabey MD , Alkim Oden Akman MD , İsmail Kasim MD

Study Objective

Premenstrual syndrome (PMS), dysmenorrhea, and abnormal uterine bleeding are frequent gynecological problems in adolescent girls. Studies show that sleep disorders and menstrual cycle irregularities are common conditions and indicate that they may occur together. Studies on the relationship between sleep quality and menstruation are mostly available for late adolescents (17 years and older) and young adult age groups. Our study aims to evaluate this relationship in adolescents aged 12-18.

Methods

A survey study was structured and consisted of 4 sections. The first section includes anthropometric measurements and medical history of the participants; the second section includes “menstruation and menstruation symptoms history”; the third section includes “The Sleep Quality Scale and Sleep Variable Questionnaire”; and the fourth section includes the “Premenstrual Syndrome Assessment Scale” (PMSAS). Our survey was applied to those who visited the adolescent medicine outpatient clinic.

Results

The Sleep Quality Scale score was significantly lower in those with high PMSAS scores (P < .001). The participants who had dysmenorrhea and experienced other symptoms during menstruation had significantly lower SQS scores and sleep efficiency (SE) (P < .001). There was no significant difference between heavy menstrual bleeding, defined as lasting more than 7 days, requiring more than 5-6 pads/tampons per day, and SE/quality (P > .05).

Conclusion

According to our study, dysmenorrhea and the presence of PMS may negatively affect the sleep quality of adolescents. Health professionals dealing with young people should take into account the effects of menstrual problems on sleep quality and offer appropriate support/treatment options.

研究目的经前期综合征（PMS）、痛经和异常子宫出血是青春期少女经常遇到的妇科问题。研究表明，睡眠障碍和月经周期不规律是常见的情况，并表明它们可能同时发生。有关睡眠质量与月经之间关系的研究大多针对晚期青少年（17 岁及以上）和青年年龄组。我们的研究旨在评估 12-18 岁青少年的睡眠质量与月经之间的关系：调查研究分为四个部分。第一部分包括人体测量和参与者的病史；第二部分包括 "月经和月经症状史"；第三部分包括 "睡眠质量量表和睡眠变量问卷"（SQS-SVQ）；第四部分包括 "经前综合征评估量表"（PMSAS）。我们的调查对象是到青春期医学门诊就诊的患者：结果：睡眠质量量表（SQS）得分在 PMSAS 得分高的人群中明显较低（P0.05）：根据我们的研究，痛经和经前期综合征可能会对青少年的睡眠质量产生负面影响。与青少年打交道的医务人员应考虑到月经问题对睡眠质量的影响，并提供适当的支持/治疗方案。

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引用次数: 0

Communication and Counseling Preferences of Women Who Chose Abortion During Adolescence: A Qualitative Study 青春期选择流产的女性的沟通和咨询偏好：一项定性研究。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2024-08-21 DOI: 10.1016/j.jpag.2024.08.007

Laura A. Kirkpatrick MD , Lauren A. Bell MD, MPH , Elizabeth I. Harrison MD, MS , Traci M. Kazmerski MD, MS , Margaret R. Russell MD , Tahniat S. Syed MD, MPH , Nicholas A. Szoko MD, MS , Crystal P. Tyler PhD, MPH

Study Objective

As part of a larger study about pregnancy options counseling with adolescents, we interviewed women in the United States who chose abortion during adolescence about preferences and experiences regarding communication from healthcare professionals during abortion care.

Design, Setting, and Participants

We conducted individual semi-structured interviews with women ages 18-35 years old who were pregnant before age 20 years old and chose abortion. We recruited participants through social media, a research registry, and flyers in healthcare facilities. We recorded and transcribed interviews. Two investigators coded interview transcripts using thematic analysis.

Results

We conducted interviews with 17 US women (median age 32 years old, range 20-35 years old) from 11/2020-4/2021. The median age at time of abortion was 18 years old (range 14-19 years). The sample was 58% (n = 10) Caucasian and 65% (n = 11) heterosexual. Themes included: 1) Participants perceived options counseling before abortion as important and necessary but did not always feel they personally needed it. 2) Participants reported that clinicians including nurses, physicians, and other staff sometimes had poor bedside manner, which was not aligned with their perceived need for gentleness due to their adolescence. 3) Participants valued nonjudgmental communication including normalization of abortion care. 4) Participants desired privacy and confidentiality throughout their clinic appointment, but clinic logistics led to concerns about limited privacy. 5) Participants appreciated medically accurate information about abortion in plain language balancing safety and risk information for reducing fear before the procedure.

Conclusion

Responses suggested specific best practices that healthcare providers can adopt to improve care for youth considering abortion.

目的：作为一项有关青少年妊娠选择咨询的大型研究的一部分，我们对美国在青春期选择堕胎的女性进行了访谈，了解她们在堕胎护理期间与医护人员沟通的偏好和经历：我们对年龄在 18-35 岁之间、在 20 岁之前怀孕并选择堕胎的女性进行了半结构化访谈。我们通过社交媒体、研究登记处和医疗机构的传单招募参与者。我们记录并转录了访谈内容。两名研究人员采用主题分析法对访谈记录进行了编码：我们在 2020 年 11 月至 2021 年 4 月期间对 17 名美国女性（中位年龄为 32 岁，年龄范围为 20-35 岁）进行了访谈。堕胎时的中位年龄为 18 岁（14-19 岁不等）。样本中有 58%（10 人）为白种人，65%（11 人）为异性恋者。主题包括1) 参与者认为人工流产前的选择咨询是重要和必要的，但并不总是觉得他们本人需要这种咨询。2) 参与者报告说，临床医生（包括护士、医生和其他工作人员）有时在床边的态度很差，这与她们认为的青春期对温柔的需求不符。3) 参与者重视非评判性的沟通，包括堕胎护理的正常化。4) 参与者希望在预约门诊的整个过程中都能得到隐私和保密，但门诊的后勤工作导致她们担心隐私受到限制。5) 参与者赞赏以通俗易懂的语言提供准确的人工流产医学信息，同时平衡安全和风险信息，以减少手术前的恐惧：答复提出了医疗服务提供者可采用的具体最佳实践，以改善对考虑堕胎的青少年的护理。

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引用次数: 0

Cyberchondria Levels in Adolescent Patients With Polycystic Ovary Syndrome in the Digital Age 数字时代多囊卵巢综合征青少年患者的网络芳香族水平。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2024-08-19 DOI: 10.1016/j.jpag.2024.08.006

Serap Topkara Sucu MD , Tuğba Kolomuç Gayretli MD , Ayşe Sena Küçükkayıkçı MD , Dilara Kurt MD , Samet Kutluay Ergörün MD , Tahir Eryılmaz MD , Sadun Sucu MD , Çağanay Soysal Assoc. Prof. Dr.

Study Objective

Cyberchondria is defined as a form of anxiety characterized by excessive health searches on the Internet. Our aim in this study is to investigate the extent of cyberchondria in adolescents with polycystic ovary syndrome (PCOS) and to compare them with adolescents of the same age.

Methods

A total of 426 adolescents who presented to clinic between April 2023 and September 2023 and agreed to participate in the study were included in the study. Patients were divided into two groups: PCOS group (135 patients) and control group (291 patients). The Cyberchondria Severity Scale (CSS) was administered to participants face-to-face. The CSS and subscale scores of both patient groups were analyzed and compared.

Results

Total CSS scores were significantly different between groups (P = .007) with a mean value of 72 (59-83) in the control group and 77 (63-91) in the PCOS group. When cyberchondria subscales were analyzed, statistical difference was found between the groups in the subcategories of compulsion (P: .015), distress (P: .039), excessiveness (P: .028), and mistrust of medical professional (P: .005).

Conclusion

Adolescents with PCOS demonstrated higher levels of cyberchondria which could aggravate associated symptoms of anxiety and depression. Health providers should be mindful to evaluate internet use in this patient population and provide anticipatory guidance.

研究目的网络焦虑症被定义为一种以在互联网上过度搜索健康信息为特征的焦虑症。本研究的目的是调查多囊卵巢综合征青少年网络成瘾的程度，并将其与同龄青少年进行比较。方法：本研究纳入了在 2023 年 4 月至 2023 年 9 月期间就诊并同意参与研究的 426 名青少年。患者分为两组：多囊卵巢综合征组（135 名）和对照组（291 名）。研究人员面对面地对患者进行了网络成瘾严重程度量表（CSS）测试。对两组患者的 CSS 和分量表得分进行了分析和比较：结果：两组患者的 CSS 总分有明显差异（p=.007），对照组的平均值为 72（59-83）分，多囊卵巢综合征组的平均值为 77（63-91）分。在分析网络成瘾子量表时，发现各组之间在强迫（p:0.015）、苦恼（p:0.039）、过度（p:0.028）和对医疗专业人员的不信任（p:0.005）等子类别上存在统计学差异：结论：患有多囊卵巢综合症的青少年显示出较高的网络成瘾水平，这可能会加重相关的焦虑和抑郁症状。医疗服务提供者应注意评估该患者群体的互联网使用情况，并提供预期指导。

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引用次数: 0

Is Polycystic Ovary Syndrome Associated With Night Eating Syndrome and Sleep Complaints in Adolescence? 多囊卵巢综合征与青春期夜食综合征和睡眠不适有关吗？

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2024-08-13 DOI: 10.1016/j.jpag.2024.08.004

Ayşe Gül Güven , Mustafa Can Akdoğan , Demet Taş

Study Objective

To evaluate the relationship between polycystic ovary syndrome (PCOS), night eating syndrome (NES), and sleep problems in the adolescent population.

Methods

PCOS patients (n = 43) and healthy controls (n = 62) aged between 15 and 19 years were recruited from the clinics of Adolescent Medicine and Adolescent Gynecology. The Night Eating Questionnaire (NEQ), Pittsburg Sleep Quality Index (PSQI), and Pediatric Sleep Questionnaire-Short Form (PSQ-SF) were completed by the participants.

Results

The PSQI (P = .175), PSQ-SF (P = .320), and NEQ (P = .493) scores were not statistically different between the PCOS and control groups. The NEQ scores were positively correlated with illness duration (r = 0.348, P = .024) in the PCOS group. There was no significant correlation between the NEQ scores and body mass index Z-score, total testosterone and dehydroepiandrosterone sulfate levels, or modified Ferriman–Gallwey Score. The NEQ scores were positively correlated with both the PSQI (r = 0.532, P < .001) and PSQ-SF scores (r = 0.204, P = .037) in the PCOS group. The ratio of adolescents at risk for NES (having an NEQ score ≥25) did not differ significantly between the PCOS and control groups (P = .601).

Conclusion

Adolescents with PCOS have NES scores similar to those of healthy controls. This result may change as the duration of exposure to the disease increases. When screening adolescents with PCOS for eating, psychiatric, and sleep problems, they should also be screened for NES due to the high comorbidity rates and symptom overlap of these health conditions.

研究目的评估青少年多囊卵巢综合征（PCOS）、夜食综合征（NES）和睡眠问题之间的关系：方法：从青少年医学和青少年妇科诊所招募 15 至 19 岁的多囊卵巢综合征患者（43 人）和健康对照组（62 人）。参与者填写了夜食问卷（NEQ）、匹兹堡睡眠质量指数（PSQI）和儿科睡眠问卷-简表（PSQ-SF）：多囊卵巢综合征组和对照组的 PSQI（p = 0.175）、PSQ-SF（p = 0.320）和 NEQ（p = 0.493）得分在统计学上无差异。多囊卵巢综合征组的 NEQ 分数与病程呈正相关（r = 0.348，p = 0.024）。NEQ 评分与体重指数 Z 值、总睾酮和硫酸脱氢表雄酮（DHEAS）水平或改良费里曼-高维评分（mFGS）之间无明显相关性。在多囊卵巢综合征组中，NEQ 评分与 PSQI（r = 0.532，p < 0.001）和 PSQ-SF 评分（r = 0.204，p = 0.037）呈正相关。多囊卵巢综合征组和对照组的 NES 风险青少年比率（NEQ 分数≥25）没有显著差异（p = 0.601）：结论：患有多囊卵巢综合症的青少年的 NES 分数与健康对照组相似。结论：患有多囊卵巢综合症的青少年的 NES 分数与健康对照组相似，但随着患病时间的延长，这一结果可能会发生变化。在对患有多囊卵巢综合症的青少年进行饮食、精神和睡眠问题筛查时，也应对他们进行NES筛查，因为这些健康问题的合并率很高，而且症状重叠。

{"title":"Is Polycystic Ovary Syndrome Associated With Night Eating Syndrome and Sleep Complaints in Adolescence?","authors":"Ayşe Gül Güven , Mustafa Can Akdoğan , Demet Taş","doi":"10.1016/j.jpag.2024.08.004","DOIUrl":"10.1016/j.jpag.2024.08.004","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate the relationship between polycystic ovary syndrome (PCOS), night eating syndrome (NES), and sleep problems in the adolescent population.</div></div><div><h3>Methods</h3><div>PCOS patients (<em>n</em> = 43) and healthy controls (<em>n</em> = 62) aged between 15 and 19 years were recruited from the clinics of Adolescent Medicine and Adolescent Gynecology. The Night Eating Questionnaire (NEQ), Pittsburg Sleep Quality Index (PSQI), and Pediatric Sleep Questionnaire-Short Form (PSQ-SF) were completed by the participants.</div></div><div><h3>Results</h3><div>The PSQI (<em>P</em> = .175), PSQ-SF (<em>P</em> = .320), and NEQ (<em>P</em> = .493) scores were not statistically different between the PCOS and control groups. The NEQ scores were positively correlated with illness duration (<em>r</em> = 0.348, <em>P</em> = .024) in the PCOS group. There was no significant correlation between the NEQ scores and body mass index Z-score, total testosterone and dehydroepiandrosterone sulfate levels, or modified Ferriman–Gallwey Score. The NEQ scores were positively correlated with both the PSQI (<em>r</em> = 0.532, <em>P</em> < .001) and PSQ-SF scores (<em>r</em> = 0.204, <em>P</em> = .037) in the PCOS group. The ratio of adolescents at risk for NES (having an NEQ score ≥25) did not differ significantly between the PCOS and control groups (<em>P</em> = .601).</div></div><div><h3>Conclusion</h3><div>Adolescents with PCOS have NES scores similar to those of healthy controls. This result may change as the duration of exposure to the disease increases. When screening adolescents with PCOS for eating, psychiatric, and sleep problems, they should also be screened for NES due to the high comorbidity rates and symptom overlap of these health conditions.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 6","pages":"Pages 574-578"},"PeriodicalIF":1.7,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Addressing Teenage Pregnancy and Reproductive Health Among Latinx Adolescents and Young Adults 解决拉美裔青少年和年轻成年人中的少女怀孕和生殖健康问题。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2024-08-13 DOI: 10.1016/j.jpag.2024.08.003

Frank A. Crespo MD, FACOG, CHCQM, CPE, MS-SHCD , Camille A. Clare MD, MPH, CPE, FACOG , Usha Verma MD, FACOG

Despite a national decline in teenage pregnancy rates, Latinx and Black individuals continue to have higher teenage birth rates compared with White teens. In the United States, Latinx females (ages 15-19) are more than twice as likely to have a teenage birth compared with non-Latinx White teens. With an increasingly diverse nation, a shift toward culturally inclusive approaches to care is critical to achieving equitable patient outcomes. Improving access to preventive care, workforce diversity, and insurance coverage will lead to cost-savings and help restore trust in a system that has failed past generations. In this commentary, targeted recommendations tailored specifically toward Latinx women will be provided, including culturally competent birth control counseling and a focus on reproductive justice. Not speaking English, low socioeconomic status, acculturation, legal status, and being uninsured are all teenage pregnancy risk factors unique to Latinx women. Cultural preferences and attitudes toward contraception must also be considered. Further expansion of Medicaid insurance coverage is also necessary to increase reproductive access among vulnerable populations. A cultural humility framework to reproductive health counseling and services is recommended. Within this framework, family engagement is encouraged, and women are free from reproductive coercion; they have the freedom to access over-the-counter contraception and receive guidance and support from providers and community health workers who are cognizant of culture and heritage. An integrated community-based approach that is culturally sensitive and in tune with Latinx heterogenicity is necessary to lower teenage pregnancy rates and achieve reproductive justice.

尽管全国少女怀孕率有所下降，但与白人青少年相比，拉丁裔和黑人青少年的生育率仍然较高。在美国，拉美裔女性（15-19 岁）的少女生育率是非拉美裔白人青少年的两倍多。随着美国日益多元化，转向具有文化包容性的护理方法对于实现公平的患者治疗效果至关重要。改善预防性护理的可及性、劳动力的多样性和保险覆盖面将节约成本，并有助于恢复人们对这个辜负了上一代人的系统的信任。在这篇评论中，我们将专门针对拉美裔女性提出有针对性的建议，包括符合其文化背景的节育咨询，以及对生殖公正的关注。不会说英语、社会经济地位低下、文化差异、法律地位和无保险都是拉美裔女性特有的少女怀孕风险因素。此外，还必须考虑文化偏好和对避孕的态度。还必须进一步扩大医疗补助保险的覆盖范围，以增加弱势人群获得生殖服务的机会。建议在生殖健康咨询和服务中采用文化谦逊框架。在这一框架内，鼓励家庭参与，使妇女免受生殖胁迫；她们可以自由获得非处方避孕药具，并接受服务提供者和社区卫生工作者的指导和支持，他们对文化和传统有深刻的认识。要降低少女怀孕率并实现生殖公正，就必须采取一种对文化敏感并符合拉丁裔异质性的综合社区方法。

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引用次数: 0

Noninvasive Diagnosis of Endometriosis in Adolescents and Young Female Adults: A Systematic Review. 青少年和年轻女性子宫内膜异位症的非侵入性诊断：系统综述。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2024-08-07 DOI: 10.1016/j.jpag.2024.07.005

Inês Jerónimo Oliveira, Pedro Viana Pinto, João Bernardes

Study objectives: Our aim was to review the evidence concerning the noninvasive diagnosis of endometriosis in adolescents.

Methods: A systematic review was written following the SWiM reporting guidelines. The study research was made across three databases (MEDLINE/PubMed, Scopus, and Web of Science) to identify articles about the adolescent population and the diagnosis of endometriosis through noninvasive methods. The search included the keywords "endometriosis," "adolescents," "diagnosis," "ultrasound," and "MRI." Only English-language articles were considered, and those published prior to 2000 were excluded. The established outcomes focused on clinical symptoms, ultrasound (US), and magnetic resonance imaging (MRI) findings suggestive of endometriosis.

Results: We included 26 articles, mostly comprising case series and cross-sectional studies. The pooled analysis involved 2,299 female adolescents (age range 8-25 years old) with clinically suspected, imaged, and/or surgically confirmed endometriosis. The most frequently reported symptom was dysmenorrhea, followed by chronic pelvic pain. Among adolescents clinically suspected of endometriosis undergoing ultrasound (US), 32.8% exhibited at least one sign of endometriosis. Of the 167 patients with ultrasound-diagnosed endometriosis, 48.5% had deep infiltrating endometriosis (DIE), and 45.5% had an endometrioma detected. Three studies assessed MRI findings, revealing that 49.8% presented with signs of endometriosis.

Conclusions: Dysmenorrhea and chronic pelvic pain stand out as key symptoms of adolescent endometriosis. Although their diagnostic accuracy varies, US and MRI have emerged as valuable tools for diagnosing the disease. While the US may have limitations, especially in detecting subtle lesions, MRI shows promise, even in cases with normal previous ultrasounds. Early recognition and proactive diagnosis are crucial for improving the management of endometriosis in adolescents.

研究目的我们的目的是回顾有关青少年子宫内膜异位症非侵入性诊断的证据：方法：根据 SWiM 报告指南撰写了一篇系统性综述。该研究通过三个数据库（MEDLINE/PubMed、Scopus 和 Web of Science）进行研究，以确定有关青少年人群和通过非侵入性方法诊断子宫内膜异位症的文章。搜索关键词包括 "子宫内膜异位症"、"青少年"、"诊断"、"超声波 "和 "核磁共振成像"。仅考虑英语文章，并排除了 2000 年以前发表的文章。研究结果主要集中在提示子宫内膜异位症的临床症状、超声波（US）和磁共振成像（MRI）结果：我们共纳入了 26 篇文章，其中大部分是病例系列和横断面研究。汇总分析涉及 2299 名临床怀疑、影像检查和/或手术证实患有子宫内膜异位症的女性青少年（年龄范围为 8-25 岁）。最常见的症状是痛经，其次是慢性盆腔疼痛。在接受超声检查（US）的临床疑似子宫内膜异位症的青少年中，32.8%的人至少表现出一种子宫内膜异位症的症状。在 167 名超声诊断为子宫内膜异位症的患者中，48.5% 患有深部浸润性子宫内膜异位症（DIE），45.5% 患有子宫内膜瘤。三项研究对核磁共振成像结果进行了评估，结果显示49.8%的患者有子宫内膜异位症的迹象：结论：痛经和慢性盆腔疼痛是青少年子宫内膜异位症的主要症状。尽管诊断准确率不一，但 US 和 MRI 已成为诊断该疾病的重要工具。虽然 US 可能存在局限性，尤其是在检测微小病灶方面，但 MRI 却显示出良好的前景，即使是之前超声波检查正常的病例也不例外。早期识别和积极诊断对于改善青少年子宫内膜异位症的治疗至关重要。

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引用次数: 0

Young People's Support for and Personal Interest in an Advance Provision Model for Medication Abortion 年轻人对提前提供药物流产模式的支持和个人兴趣。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2024-08-06 DOI: 10.1016/j.jpag.2024.07.012

M. Antonia Biggs , Katherine Ehrenreich , Natalie Morris , Lela Bachrach , Jesus Crespin , Daniel Grossman

Purpose

To assess young people's interest in advance provision (AP) of medication abortion—receiving mifepristone and misoprostol from a clinician in advance for their future use.

Methods

From November 2022-August 2023 we administered an electronic survey regarding advance provision to patients assigned female at birth at four Bay Area youth-serving clinics.

Results

Among 152 people ages 14-24 years (mean 17.9) surveyed, 73.7% (95% CI, 65.9%-80.5%) supported and 46.1% (95% CI, 37.9%-54.3%) were interested in the AP model. AP interest was higher among people who experienced three or more difficulties trying to access reproductive healthcare (70.6% [95% CI, 44.0%-89.7%]) and who experienced food or housing insecurity (60.3% [95% CI, 46.6%-73.0%]). Most youth (81.6%) had a safe place to store the pills for later use; this proportion was significantly higher among people ages 18-24 years (88.5%) than teens ages 14-17 years (74.3%, P = .025). The most common perceived advantages of AP included being able to have the abortion earlier in pregnancy (61.8%), privacy (57.9%) and convenience (50.7%). Common disadvantages noted included concern that people might take the pills incorrectly (50.0%) or lose the pills (40.1%).

Conclusions

Young people have considerable interest in AP of medication abortion. Further research is needed to document the AP model's feasibility, clinical outcomes, and effect on access for adolescents.

目的：评估年轻人对提前提供药物流产（AP）的兴趣--提前从临床医生处获得米非司酮和米索前列醇，以供将来使用：方法：2022 年 11 月至 2023 年 8 月，我们在湾区四家为青少年服务的诊所对出生时被分配为女性的患者进行了有关提前提供药物流产的电子调查：在 152 名 14-24 岁（平均 17.9 岁）的受访者中，73.7%（95% CI，65.9%-80.5%）的人支持预产期模式，46.1%（95% CI，65.9%-80.5%）的人对预产期模式感兴趣。在试图获得生殖保健服务时遇到三次或三次以上困难的人[70.6%（95% CI 44.0%，89.7%）]和经历过食物或住房不安全的人[60.3%（95% CI 46.6%，73.0%）]中，对 AP 感兴趣的比例较高。大多数青少年（81.6%）都有一个安全的地方存放药片以备日后使用；这一比例在 18-24 岁人群中（88.5%）明显高于 14-17 岁青少年（74.3%，P=.025）。人们认为堕胎药最常见的优点包括可以在怀孕早期进行堕胎（61.8%）、隐私（57.9%）和方便（50.7%）。常见的缺点包括担心服药不当（50.0%）或药片丢失（40.1%）：结论：年轻人对药物流产 AP 相当感兴趣。需要进一步开展研究，记录药物流产 AP 模式的可行性、临床结果以及对青少年获取药物流产的影响。

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引用次数: 0

NASPAG Clinical Opinion: The Care of Transgender and Gender Nonbinary Adolescents and Young Adults 变性和性别非二元青少年的护理。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2024-08-05 DOI: 10.1016/j.jpag.2024.07.007

Frances Grimstad MD, MS , Gylynthia Trotman MD, MPH , Chance Krempasky FNP-BC, WHNP-BC , Uri Belkind MD , Jason Jarin MD , Stephanie Cizek MD , NASPAG Education Committee

Transgender and gender nonbinary (TGNB) adolescents and young adults (AYA) may present to clinicians with reproductive health expertise for the spectrum of gynecologic, sexual, and reproductive care. As such, clinicians should be knowledgeable in the many facets of gender-affirming care. This clinical opinion reviews language associated with gender diversity and gender-affirming care; current clinical, social, and political barriers faced by TGNB AYA; and the creation of welcoming and inclusive clinical spaces for TGNB AYA. It discusses social, medical, and surgical affirmation processes, and focuses on gynecologic care topics which may arise in the care of TGNB AYA, including those who undergo medical or surgical therapies. This includes menstrual suppression, breakthrough bleeding on testosterone, sexual health, fertility, and the pelvic care of individuals following gender affirming vulvovaginoplasty.

变性和性别非二元性（TGNB）青少年和年轻成人（AYA）可能会向临床医生求助，他们需要生殖健康方面的专业知识，以获得妇科、性和生殖方面的护理。因此，临床医生应了解性别确认护理的方方面面。本临床意见回顾了与性别多样性和性别肯定护理相关的语言；TGNB AYA 目前所面临的临床、社会和政治障碍；以及为 TGNB AYA 创造欢迎和包容的临床空间。它讨论了社会、医疗和手术平权过程，并重点关注在护理 TGNB AYA（包括接受医疗或手术治疗的 TGNB AYA）过程中可能出现的妇科护理主题。这包括月经抑制、睾丸激素突破性出血、性健康、生育以及性别平权外阴阴道成形术后的盆腔护理。

引用次数: 0

Factors Affecting Willingness to Provide Medication Abortion Among North American Society for Pediatric and Adolescent Gynecology Members Caring for Adolescents and Young Adults Following the Dobbs Decision 多布斯决定后，影响北美儿童和青少年妇科协会会员为青少年提供药物流产意愿的因素。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2024-08-05 DOI: 10.1016/j.jpag.2024.07.013

Amanda E. Bryson MD, MPH , Elizabeth R. Boskey PhD, MPH, MSSW , Laura K. Grubb MD, MPH, FAAP , Jessica Y. Shim MD , Kathryn E. Fay MD, MSCI

Study Objective

To assess willingness to provide medication abortion among North American Society for Pediatric and Adolescent Gynecology (NASPAG) clinicians caring for adolescents and young adults (AYA) following Dobbs v. Jackson Women's Health Organization.

Design

Cross-sectional online survey.

Methods

Potential participants received an e-mail invitation via the NASPAG listserv. A 43-item questionnaire queried demographics, practice setting, abortion training and practice, willingness to provide medication abortion, potential or real barriers to providing medication abortion, and sentiments of abortion. Descriptive statistics, χ², and Fisher's exact tests were used.

Results

Of the 70 participants, 51% were willing to provide a medication abortion for an adolescent who requested it in their clinical practice. The most common barriers to providing medication abortion were legislative restrictions (47%) and dispensing pills from clinic (33%). Participants’ willingness to provide a medication abortion differed by type of practice (P = .001), availability of mifepristone (P = .006), perception of state's abortion policy (P = .001), concern about legislative restrictions (P = .008), experience providing abortion (P = .04), and receipt of medication abortion training (P = .02). Willingness to provide medication abortion also differed based on various sentiments of abortion measured but not on opinion regarding legality of abortion for adolescents (P = .49).

Conclusions

Perception of state's abortion rights and concern about legislative restrictions influenced NASPAG clinicians’ willingness to provide medication abortion for adolescents. Interventions to minimize legislative interference with medical care, increase abortion training, and implement medication abortion in pediatric settings may expand AYA medication abortion access.

研究目的：设计：横断面在线调查方法：潜在参与者通过 NASPAG 列表服务器收到电子邮件邀请。调查问卷共 43 个项目，调查内容包括人口统计学、执业环境、人工流产培训和实践、提供药物流产的意愿、提供药物流产的潜在或实际障碍以及对人工流产的看法。使用了描述性统计、χ2 和费雪精确检验：结果：在 70 名参与者中，51% 的人愿意在临床实践中为提出要求的青少年提供药物流产。提供药物流产最常见的障碍是立法限制（47%）和从诊所配药（33%）。参与者提供药物流产的意愿因执业类型（p = .001）、米非司酮的可用性（p = .006）、对州流产政策的看法（p = .001）、对立法限制的担忧（p = .008）、提供流产的经验（p = .04）和接受过药物流产培训（p = .02）而有所不同。提供药物流产的意愿也因各种流产情绪而异，但对青少年流产合法性的看法则不同（p = .49）：结论：对国家堕胎权利的看法以及对立法限制的担忧影响了美国国家堕胎协会临床医生为青少年提供药物流产的意愿。最大限度地减少立法对医疗护理的干扰、增加人工流产培训以及在儿科环境中实施药物流产等干预措施可扩大青少年药物流产的可及性。

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