118,007 research outputs found
La disforia di genere in età pediatrica e adolescenziale: nozioni per il pediatra
No full textThe number of children and adolescents referred to the gender identity clinics is significantly increasing. The pediatrician often represents the first healthcare professional to be consulted
by families or who suspects a gender identity disorder. Consequently, the knowledge of some notions related to this condition are essential to provide the basic care to the child/adolescent and
address the topic in the most appropriate manner. Thereafter, the care will require
a multidisciplinary team composed of professionals who received a specific education
How do Italian pediatric endocrinologists approach gender incongruence?
No full textBackground: Gender incongruence (GI) is a term used to describe a marked and persistent incompatibility between the sex assigned at birth (SAAB) and the experienced gender. Some persons presenting with GI experience a severe psychological distress defined as gender dysphoria (GD). Although the prevalence of GI is probably underestimated, recently a great increase in numbers of transgender and gender diverse (TGD) youths presenting at the gender clinics has been registered. After a careful multidisciplinary evaluation and upon acquisition of informed consent from the youth and the legal guardian(s), puberty suppression can be started in TGD youths, followed by the addition of gender affirming hormones (GAH) by the age of 16 years. Although Italian specific guidelines are available, their application is often complex because of (among other reasons) lack of specialized centers and healthcare professional with experience in the field and the regional differences within the Italian healthcare system. Main body: To investigate the care offered to TGD youths across Italy, we proposed a survey of 20 questions to the directors of the 32 Italian Centers of pediatric endocrinology participating to the Study Group on Growth and Puberty of the Italian Society of Pediatric Endocrinology (ISPED). Eighteen pediatric endocrinologists representative of 16 different centers belonging to 11 different regions responded to the survey. In the large majority of centers TGD youths are taken in charge between the age of 12 and 18 years and at least three healthcare professional are involved. Most of Italian pediatric endocrinologists follow only a very limited number of TGD youths and reference centers for TGD youths are lacking. Conclusion: There is an urgent need for gender clinics (homogeneously distributed on the national territory) where TGD youths can access high standard care
Difficulty in visual motor coordination as a possible cause of sedentary behaviour in obese children.
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La disforia di genere in età pediatrica e adolescenziale
No full textWhile the sex of an individual refers to his/her genetic and anatomical characteristics, gender concerns the perception of oneself, personal and private, as belonging to the male
or female gender, to both or neither. Generally gender perception between 3 and 7 years
of age. Gender incongruence is defined by the absence of concordance between these
two aspects, while gender dysphoria refers to the psychological distress that can follow.
The number of children and adolescents showing gender incongruence is increasing and
poses problems of diagnosis and treatment. Providing care requires the presence of a
multidisciplinary team made up of expert professionals trained in this field, which should
include neurospichiatrists, psychologists and pediatric endocrinologists. Pharmacological
therapy, that follows a phase of psychotherapy, should be started in puberty and is preliminary to subsequent therapeutic interventions; the latter ones are prerogative of adulthood. A
careful multidisciplinary follow-up is needed for these patients until adulthood
Drugs for children with hypercholesterolemia: be cautious.
No full textWhile the efficacy in childhood of other antilipidic drugs (Bile acid-binding resins, Statins) are proved with long-term studies, the long-term efficacy of Ezetimibe in pediatric age remains to be ascertained, also using surrogate markers for atherosclerosis, as intimal-media thickness and endothelial function. More important, the recent concern about the augmented cancer risk related to the use of Ezetimibe in adults strongly raises the question about the ethics of the use of this drug in children. In any way, to avoid a misuse of Ezetimibe and to confirm the findings of the anecdotic studies published until now, it’s time to perform a randomized, multicentre. double-blinded, placebo-controlled study. Meanwhile. despite the recent liberalization by AAP, we maintain a cautious approach in the use of any antilipidic drugs in children, tailoring the treatment on the basis of individual risk
Medicina dell’adolescenza
No full textL’Organizzazione Mondiale della Sanità definisce come “adolescenti” le persone di età compresa tra 10 e 19 anni. Questi minori rappresentano circa il 10-25% della popolazione a seconda dei vari paesi europei (www.euro.who.int) e poco più del 9,0% in Italia al 1° gennaio 2023 (www.istat.it). Nel nostro Paese si osserva inoltre una rapida contrazione dei soggetti in età adolescenziale in conseguenza del progressivo calo delle nascite; ad esempio, si ha una riduzione di oltre l’8% (-47.165 unità) dei bambini di 10 anni rispetto ai ragazzi di 18 anni. Una prima ovvia considerazione a questo dato di fatto è la necessità di assicurare il migliore stato possibile a questa fascia di età anche in prospettiva futura. In effetti, la maggior parte degli adolescenti in Europa è sana, ma ogni giorno oltre 3.000 di loro muoiono per cause prevenibili o curabili. Inoltre, gli adolescenti presentano cause specifiche di morbilità [lesioni non intenzionali o intenzionali, disturbi della salute mentale (depressione, abuso di sostanze, disturbi alimentari), malattie infettive, comportamenti sessuali a rischio, gravidanza e parto precoci] con conseguenze sia a breve che a lungo termine (Slobođanac M., et al. www.eapaediatrics.eu/young-eap-eap-july-2019-blog-adolescent-medicine-and-health-a-training-challenge-for-europe/).
Ne deriva la necessità di percorsi formativi dedicati pre-laurea e post-laurea, compresi quelli di educazione medica continua, in Medicina dell’adolescenza. Alcuni paesi (USA, Canada, Australia) hanno riconosciuto le esigenze specifiche di salute degli adolescenti, creando percorsi formativi anche specialistici in questo nuovo settore medico
Changes in Dopaminergic control of circulating melanocyte- stimulating hormone-related peptides at puberty.
No full textDesacetyl alpha-melanocyte-stimulating hormone (MSH) (ACTH 1-13) is the main form of immunoreactive alpha-MSH circulating in human plasma. This study evaluates the possibility that a dopaminergic inhibitory mechanism could be operative during human development. Thus, alpha-MSH and ACTH 1-13 plasma levels were measured after dopaminergic blockade (domperidone (0.3 mg/kg body weight, maximum 10 mg, p.o.) in 13 prepubertal (aged 4.5-12.3 y) and 12 pubertal (aged 10.2-16.9 y) children. Both peptides were measured by RIA after plasma extraction on Sep-pak C-18 cartridges and reverse phase HPLC. The chromatographic profile of alpha-MSH immunoreactivity falls into two main peaks, corresponding to the retention time of alpha-MSH and ACTH 1-13. Moreover, in prepubertal children domperidone induced a significant increase of alpha-MSH from 1.7 (median) to 5.0 pmol/L, whereas no changes in alpha-MSH plasma levels were found in pubertal subjects (from 5.0 to 4.1 pmol/L). Similarly, ACTH 1-13 plasma levels significantly increased from 3.0 to 19.8 pmol/L in prepubertal children remaining stable in pubertal ones (from 7.8 to 4.6 pmol/L). Moreover, a significant negative correlation was found between basal DHEA-S levels and the plasma alpha-MSH increase after domperidone. These data demonstrate that: 1) ACTH 1-13 is the main form of immunoreactive alpha-MSH in prepubertal life and 2) the dopaminergic inhibition of both ACTH 1-13 and alpha-MSH plasma levels is apparent only in prepubertal subjects
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