Mobile Application Measurement of Menstrual Cycle Characteristics and Their Association with Dysmenorrhea and Activity Limitation in Early Adolescents

OBJECTIVE

Real-time tracking of menstrual bleeding is a barrier to research due to limitations with traditional data collection tools. This prospective cohort study utilized a mobile application (TDot app) in young adolescents aged 10-14 years to assess the relationship between heavy menstrual bleeding (HMB), dysmenorrhea, and activity limitation.

METHODS

Menstrual cycles were captured over six months in real-time using the Pictorial Blood loss Assessment Chart (PBAC). A median PBAC score of >100 was used to identify participants with HMB. Participants also completed a modified WaLIDD (Working ability, Location, Intensity, Days of pain, Dysmenorrhea) scale. Impact of menses on daily activities was collected for each cycle.

RESULTS

A total of 160 participants enrolled and 100 (63%) participants with ≥3 cycles recorded in the mobile app were analyzed. HMB was noted in 41% of participants. Median modified WaLIDD score was significantly higher in participants with HMB than those without HMB (p=0.01). No significant differences were found in activity limitations between participants with and without HMB (p=0.34). Median modified WaLIDD score for participants with activity limitation was significantly higher than those without activity limitation (p=0.01).

CONCLUSION

Utilizing mobile app technology, we were able to gather real-time menstrual outcome data from young adolescents on heaviness of flow, dysmenorrhea and activity limitations. While we did not find that patients with HMB were more likely to have activity limitations, we did find that those with limitations had modestly higher dysmenorrhea scores. Future studies should focus on identifying additional variables that impact activity limitation during menstruation.

The Shared Ovary: A Multidisciplinary Discussion With Pediatric and Adolescent Gynecology

Pediatric and adolescent ovarian lesions are common and are frequently managed by both pediatric surgeons and pediatric and adolescent gynecologists. During the 2023 American Academy of Pediatric Section on Surgery meeting, an educational symposium was delivered focusing on various aspects of management of pediatric and adolescent benign and malignant masses, borderline lesions, and fertility options for children and adolescents undergoing cancer therapies. This article highlights the discussion during this symposium.

Model-based geostatistical design and analysis of prevalence for soil-transmitted helminths in Kenya: Results from ten-years of the Kenya national school-based deworming programme

Background

Kenya is endemic for soil-transmitted helminths (STH) with over 6 million children in 27 counties currently at-risk. A national school-based deworming programme (NSBDP) was launched in 2012 with a goal to eliminate parasitic worms as a public health problem. This study used model-based geostatistical (MBG) approach to design and analyse the impact of the NSBDP and inform treatment strategy changes.

Methods

A cross-sectional study was used to survey 200 schools across 27 counties in Kenya. The study design, school selection and analysis followed the MBG approach which incorporated historical data on treatment, morbidity and environmental covariates to efficiently predict the helminths prevalence in Kenya.

Results

Overall, the NSBDP geographic area prevalence for any STH was estimated to sit between 2 % and <10 % with a high predictive probability of >0.999. Species-specific thresholds were between 2 % and <10 % for Ascaris lumbricoides, 0 % to <2 % for hookworm, and 0 % to <2 % for Trichuris trichiura, all with high predictive probability of >0.999.

Conclusions

Based on the World Health Organization guidelines, STH treatment requirements can now be confidently refined. Ten counties may consider suspending treatment and implement appropriate surveillance system, while another 10 will require treatment once every two years, and the remaining seven will require treatment once every year.

Sexual and reproductive health education for patients with myelomeningocele

AIM

To evaluate the sexual and reproductive health education received by patients with myelomeningocele, the most severe form of spina bifida.

METHOD

A survey designed to assess the sexual and reproductive health education given by a healthcare provider to patients with myelomeningocele was offered to all English-speaking patients aged 12 years or older with a myelomeningocele clinic visit.

RESULTS

In total, 67 surveys were completed. Menstruation and menstrual management were discussed at a rate of 85% in females. Few patients had discussions with a provider about fertility (42%), sexuality (37%), risk of sexually transmitted infections (45%), or had a relationship with a reproductive healthcare provider (54%). Differences by sex were observed for contraceptive education. The rate of discussions increased with age. A total of 67% of female patients and 33% of male patients requested a referral to a reproductive healthcare provider.

INTERPRETATION

Sexual and reproductive health education is part of comprehensive care for all patients and those with disabilities should not be excluded. The lack of consistent education received by patients supports the need for increased attention to this topic. We encourage multidisciplinary myelomeningocele clinics to establish a process for delivering complete and patient-specific sexual and reproductive health education.

Levonorgestrel-Releasing Intrauterine System Utilization in Patients with Developmental Delays

INTRODUCTION

Adolescent females with developmental delays (DDs) experience unique physical and emotional challenges related to menstruation. Providers often recommend hormonal medication for menstrual management. The objective of our study was to describe the utilization and safety of the levonorgestrel-releasing intrauterine system (LNG-IUS) in adolescents with DDs.

METHODS

We utilized the Pediatric Health Information System to identify females aged 10-25 with DDs who underwent an LNG-IUS insertion between 2011 and 2020. Using a gynecologic procedure and diagnosis codes, we assessed indications for and complications of LNG-IUS use. We also evaluated early LNG-IUS removal.

RESULTS

One thousand five hundred and sixty female patients with DDs underwent LNG-IUS insertion. LNG-IUS insertion under anesthesia was most commonly performed in patients with autism and Down syndrome, and unspecified menstrual issues were documented for 40% of the cohort. Perforation was observed in 11 patients (1%), and mechanical complications (malpositioned IUS or lost threads) were observed in 23 patients (1%).

DISCUSSION

This is the largest analysis of LNG-IUS use in patients with DDs to our knowledge and shows the utilization of LNG-IUS in patients with DDs. We provide descriptive information that providers can use to accurately advise their patients with DDs on the risks and benefits of LNG-IUS use for menstrual management.

Impact of Pelvic Floor Physical Therapy on Function in Adolescents and Young Adults with Biopsy-Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series

STUDY OBJECTIVE

The purpose of this case series is to describe the change in capability to perform self-selected activities in adolescent and young adult patients with chronic pelvic pain and surgically proven endometriosis following pelvic floor physical therapy as part of multidisciplinary treatment.

DESIGN

Retrospective case series SETTING: Tertiary care pediatric hospital PARTICIPANTS: Twenty patients with ages ranging from 14 to 22 years and a median age of 16.5 years with biopsy-confirmed endometriosis INTERVENTION: Pelvic floor physical therapy MAIN OUTCOME MEASURE(S): Patient-Specific Functional Scale (PSFS) outcome measure RESULTS: Patients had a clinically significant functional improvement (median score of 6.0 points on the PSFS outcome measure; interquartile range, 3.8-13.5) over the course of care (median number of 12 visits; range 4-48 visits) (P < .001).

CONCLUSIONS

Patients with chronic pelvic pain and surgically proven endometriosis experienced significant functional improvement after physical therapy treatment. The results of this case series suggest that physical therapy is a viable additional intervention for adolescents and young adults with chronic pelvic pain and endometriosis and warrants further research.

Examining predictors and outcomes of fertility consults among children, adolescents, and young adults with cancer

Infertility has a negative impact on quality of life among cancer survivors. Studies show establishing a fertility team results in improved patient satisfaction. A review of electronic medical records was performed to examine predictors of fertility referrals, interventions, and the impact of an opt-out consult mechanism. Findings show many patients, particularly those that are younger, are still not receiving fertility counseling despite the presence of a fertility team. Notably, patients were 3.6 times more likely to receive a consult after the opt-out. Strategies are needed to improve access to fertility related care, particularly in groups where consults are underutilized.

Fertility preservation in children and adolescents: current options and considerations

PURPOSE OF REVIEW

The purpose of this review is to outline current pediatric fertility preservation options, and discuss ethical and financial considerations impacting this rapidly expanding field.

RECENT FINDINGS

With the improvement in treatment of pediatric malignancies and medical conditions that threaten fertility, survival rates are increasing. Therefore, minimizing long-term morbidities such as gonadal damage and infertility is of utmost importance. Impaired fertility not only has a significant negative impact on patient's quality of life; in women, gonadal damage puts patients at risk for premature menopause, and increased risk of cardiac, skeletal, and cognitive issues. Fortunately, fertility preservation options exist for both female and male prepubertal and pubertal patients, and discussion of such options with patients and their families prior to the initiation of therapy and/or before further deterioration of gonadal function is crucial. A multidisciplinary approach to fertility counseling, with attention to the patient's goals and cultural beliefs, is ideal.

SUMMARY

Although several national organizations support integrating a fertility consultation into routine care, fertility preservation is still underutilized. Continued research is needed to understand barriers for patients/families and reduce the number of missed opportunities for fertility preservation.

Into a SEIFA SES cul-de-sac?

Use of the Australian Bureau of Statistics' SEIFA scores has almost become an automatic practice in area-based research on socio-economic status (SES) correlates of health inequalities in Australia in recent years. This article questions the wisdom of this emerging heavy, often singular, reliance on the SEIFA indexes for representing a real socio-economic condition. It is argued that improvements in our understanding of the social and economic processes that produce health inequalities will not occur unless we move beyond SEIFA's broad brush. Data for New England Area Health local government areas are used to support the argument.

Airway goblet cell mucin: its structure and regulation of secretion

Mucociliary clearance is a major function of the airway epithelium. This important function depends both on the physicochemical properties of the airway mucus and on the activity of the cilia. The former, in turn, is dependent mainly on the quality and quantity of mucous glycoproteins or mucins, which are produced by two different cell types, namely, goblet cells of the epithelium and mucous cells of the submucosal gland. Neither the structural nor the functional differences of mucins produced by these two cell types are yet known. The availability of primary airway epithelial cell culture systems, however, has made it possible to study the structure and regulation of airway goblet cells to some extent. The epithelial mucins are extremely hydrophobic and are associated with various macromolecules, the quality and quantity of which may also affect the physicochemical properties of the mucus. Secretion of epithelial mucins is stimulated by various factors, including a number of inflammatory agents. The recent progress in mucin molecular biological research will allow us to identify different mucin core proteins produced by those different cell types, and, hopefully, the differential functions of these mucins in health and disease.

ATP-induced mucin release from cultured airway goblet cells involves, in part, activation of protein kinase C

Extracellular nucleotides stimulate mucin release by binding to the P2u receptor coupled to phospholipase C via G proteins (Br. J. Pharmacol. 103:1053-1056, 1991; Am. J. Respir. Cell Mol. Biol. 8:121-125, 1993). In the present study, we intended to investigate pathways downstream to the phospholipase C activation which is responsible for adenosine triphosphate (ATP)-induced mucin release in hamster tracheal epithelial cells in primary culture. We have found that: (1) Ca2+ ionophores (A23187 and ionomycin) did not affect mucin release even at 1 microM; (2) thapsigargin (10 microM), either alone or in combination with ATP (20 microM), did not enhance mucin release over its respective control group; (3) pretreatment of hamster tracheal surface epithelial (HTSE) cells with 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid-acetoxymethyl ester (BAPTA-AM) (50 microM) did not inhibit ATP-induced mucin release; (4) 4beta-phorbol 12alpha-myristate 13-acetate (PMA, 1 microM) stimulated mucin release and its effect was completely blocked by protein kinase C inhibitors such as sphingosine (10 microM) and calphostin C (0.1 microM), whereas ATP-induced mucin release was blocked, only in part, by these inhibitors; (5) desensitization of protein kinase C by pretreatment with PMA inhibited the PMA-induced mucin release completely, however, ATP-induced mucin release was inhibited only partially. We conclude that mucin release by ATP does not require an increase in the intracellular Ca2+ level but involves the activation of protein kinase C. The results also suggest the presence of another mechanism separate from the phospholipase C-protein kinase C pathway for the ATP-induced mucin release.

Femoral nailing without a fracture table

This retrospective trail was designed to evaluate the effectiveness and safety of femoral nailing on a radiolucent table with manual traction only. Eighty-three femoral shaft fractures treated by antegrade nailing were included in this study. Group 1 consisted of 24 femur fractures that were reduced and nailed with manual traction. Group 2 consisted of 59 femur fractures treated with the aid of a fracture table. There were 10 patients in Group 1 and 19 patients in Group 2 needing multiple procedures. In Group 1, significantly fewer redrapings and table transfers were necessary. There was no increase in operative time. There were no operative complications in Group 1 and there was 1 operative complication in Group 2--a radial nerve palsy. Postoperative malalignment was minimal in both groups. Intramedullary nailing of femoral shaft fractures on a radiolucent table using manual traction is associated with no increase in morbidity. It also facilitated quicker and more effective treatment of the patient with polytrauma. No undue risks or contraindications were identified; however, the help of an assistant was invaluable.

(Na+-K+)-ATPase activity and ouabain-binding sites in the cerebral cortex of young and aged Fischer-344 rats

(Na+-K+)-ATPase is an enzyme responsible for ionic homeostasis in excitable tissues. Thus, the activity of this enzyme is essential for the maintenance of optimal function of the cerebral cortex. Although abnormalities of cerebral oxidative metabolism have been described in aging, these abnormalities do not appear to be associated with changes in the in vitro enzyme characteristics of (Na+-K+)-ATPase. Specifically, there were no significant differences between preparations from the cerebral cortex of 3- and 28-month-old Fischer-344 rats in their: (i) high-affinity binding to [3H]-ouabain, (ii) number of ouabain-binding sites, or (iii) K+-p-nitrophenylphosphatase activity.