Resolução de conflitos familiares por adolescentes e defesa do domínio pessoal / Adolescents' family conflict resolution and defense of personal domain / Resolución de conflictos familiares por adolescentes y defensa del dominio personal

Compreender as estratégias de resolução de conflitos utilizadas por adolescentes na relação com seus pais é fundamental para entender como ocorre seu desenvolvimento saudável. Este artigo investigou a resolução de conflitos de adolescentes em situações de confronto entre o seu domínio pessoal e o controle parental. 36 adolescentes com idades entre 15 e 17 anos, divididos igualmente conforme o sexo, responderam a uma entrevista semiestruturada, que continha quatro situações de conflito hipotéticas. Os dados foram submetidos à análise de conteúdo semântica e a testes não paramétricos. Os resultados foram categorizados em sete estratégias: Assunção de culpa, Submissão, Mentira, Hostilidade, Diálogo/Explicação, Negociação e Outra. A forma predominante de resolução utilizada foi o Diálogo/Explicação, considerada como uma forma recorrente de defender o domínio pessoal. Foram encontradas diferenças em relação ao sexo dos participantes e à situação hipotética. Por fim, os resultados são discutidos em termos de grau de autonomia e tipo de defesa do domínio pessoal.(AU)

Understanding the conflict resolution strategies used by adolescents in their relationship with their parents is fundamental to understanding how their healthy development occurs. This article investigated the resolution of conflicts by adolescents in confrontation situations between their personal domain and parental control. A total of 36 adolescents, aged 15 to 17 years, divided equally according to sex, answered a semi-structured interview that contained four hypothetical conflict situations. Data were subjected to semantic content analysis and non-parametric tests. The results were categorized into seven strategies: Assumption of Guilt, Submission, Lie, Hostility, Dialogue/Explanation, Negotiation, and Other. The predominant form of resolution used was Dialogue/Explanation, considered a recurrent form of defense of the personal domain. Differences were found depending on the participants' gender and the hypothetical situation. Finally, the results are discussed regarding the degree of autonomy and type of defense of the personal domain.(AU)

Enterarse de las estrategias de resolución de conflictos que los adolescentes utilizan en la relación con sus padres es fundamental para comprender cómo ocurre el desarrollo saludable de los adolescentes. A partir de una entrevista semiestructurada, presentamos cuatro situaciones hipotéticas de conflicto que fueron analizadas y respondidas por 36 adolescentes de entre 15 y 17 años, divididos según el género. Los datos se sometieron a un análisis de contenido semántico y a pruebas no paramétricas. Los resultados se categorizaron en siete estrategias de resolución de conflictos: Asunción de culpa, Sumisión, Mentira, Hostilidad, Diálogo/Explicación, Negociación y Otros. La forma de resolución más utilizada fue Diálogo/Explicación, y esta categoría fue una forma de defensa del dominio personal. Asimismo, se encontraron diferencias en función del género de los participantes y conforme la situación hipotética. Los resultados se discuten en términos de grado de autonomía y tipo de defensa del dominio personal.(AU)

Uma teoria psicológica transfeminista: sobrevivendo aos escombros da saúde mental brasileira / A transfeminist psychological theory: surviving the debris of brazilian mental health / Una teoría psicológica transfeminista: sobrevivir a los escombros de la salud mental brasileña

Este artigo reflete sobre os modos como a cisnormatividade, conceito impulsionado pelos transfeminismos, tem auxiliado na composição da psicologia de maneira histórica. Ao elaborar uma crítica sobre como a violência de gênero está expressivamente presente no território brasileiro, discute-se como tem sido pensada a saúde mental, esfera que, uma vez inserida nesse contexto mais amplo, está sendo convocada a produzir saídas criativas em relação aos sujeitos que são alvo de discriminações transfóbicas. Na busca de deslocar o olhar do indivíduo para o social, foi realizado um estudo bibliográfico para investigar os diferentes impactos que a cisnormatividade opera em nossos currículos psicológicos, gerando efeitos na prática e na própria profissão. A aposta está em reconhecer outras epistemologias como projetos éticos e políticos a uma psicologia contemporânea, e a contribuição transfeminista a "outra" clínica. É nesse sentido que este trabalho se destina a pensar um modo de cuidado que esteja baseado na singularidade, mas que, ao mesmo tempo, seja capaz de dedicar alguma atenção ao paradigma normativo que nos guia como terapeutas.(AU)

This article reflects on the ways that cisnormativity, a concept boosted by transfeminisms, has played a historical role in the composition of psychology. Elaborating a criticism on how gender violence is expressively present in the Brazilian territory, we discuss how mental health is conceived, a sphere that, inserted in this wider context, is invited to create creative solutions related to the subjects who are the target of transphobic discrimination. Trying to shift the focus from the individual to the collective, a bibliographical study was conducted to recognize the different impacts that cisnormativity has in our psychological curriculums, having effects on the practice and on the profession itself. The goal is to recognize other epistemologies as ethical and political projects for contemporary psychology and the transfeminist contribution to "another" clinic. It is in this sense that this work aims to think about a form of care that is based on singularity, but that can also pay attention to the normative paradigm that guides us as therapists.(AU)

Este artículo reflexiona sobre las formas en que la cisnormatividad, un concepto impulsado por los transfeminismos, ha tenido un papel en la composición de la psicología de manera histórica. Al elaborar una crítica sobre como la violencia de género está expresamente presente en el territorio brasileño, se discute cómo se ha pensado la salud mental, dominio que, una vez insertado en este contexto más amplio, es convocado a producir soluciones creativas con relación a los sujetos que son objeto de discriminación transfóbica. Al desviar el enfoque del individuo hacia lo social, se realizó un estudio bibliográfico para investigar los diferentes impactos que tiene la cisnormatividad en nuestros planes de estudios psicológicos, generando efectos en la práctica y en la propia profesión. El foco está en reconocer otras epistemologías como proyectos éticos y políticos para la psicología contemporánea y la contribución transfeminista a una "otra" clínica. En este sentido, este trabajo pretende pensar en una forma de cuidado que se basa en la singularidad, al mismo tiempo que sea capaz de dedicar cierta atención al paradigma normativo que a nosotras nos guía como terapeutas.(AU)

Familia y Escuela. Perspectivas transformacionales en el acompañamiento afectivo y sexual / Family and School. Transformational perspectives in emotional and sexual accompaniment

Familia y escuela son instituciones primarias de la sociedad que convergen en la construcción de las bases del carácter y las pautas de comportamiento; por ello, se espera que en estas inicien los acompañamientos al desarrollo afectivo-sexual, mediante el reconocimiento del derecho a la libertad y la autonomía de los niños, niñas y adolescentes. Este artículo tuvo como objetivo analizar la transformación de las perspectivas sobre el acompañamiento afectivo-sexual de la familia y la escuela. Se llevó a cabo una revisión documental de textos académicos que tratan a la familia y la escuela como escenarios de formación afectivo-sexual. Se encontró que las perspectivas del acompañamiento afectivo-sexual son muy diversas, en ocasiones se abordan con fines informativos y, otras, como un elemento importante para la formación de seres sociales. Se concluyó que familia y escuela son aptas para ofrecer acompañamiento afectivo-sexual, por lo cual es importante que su labor sea colaborativa y en pro de la libertad y autonomía de los niños, niñas y adolescentes.

Family and school are the primary institutions of society, which converge in the construction of the foundations of character and behavior patterns; For this reason, it is there that support for affective-sexual development is expected to begin, by recognizing the right to freedom and autonomy of children and adolescents. This article aimed to analyze how the perspectives on the affective-sexual accompaniment of the family and the school have been transformed. A documentary review of academic texts that treat the family and the school as scenarios of affective-sexual formation was carried out. It was found that the perspectives of affective-sexual accompaniment are very diverse, sometimes it is addressed for informational purposes and, others, as an important element for the formation of social beings. It was concluded that family and school are suitable to offer affective-sexual accompaniment, for which it is important that their work is collaborative and in favor of the freedom and autonomy of children and adolescents.

Relationship between body mass index and sexual development in Chinese children / 中华儿科杂志

Objective: To investigate the relationship between body mass index (BMI) and sexual development in Chinese children. Methods: A nationwide multicenter and population-based large cross-sectional study was conducted in 13 provinces, autonomous regions and municipalities of China from January 2017 to December 2018. Data on sex, age, height, weight were collected, BMI was calculated and sexual characteristics were analyzed. The subjects were divided into four groups based on age, including ages 3-<6 years, 6-<10 years, 10-<15 years and 15-<18 years. Multiple Logistic regression models were used for evaluating the associations of BMI with sexual development in children. Dichotomous Logistic regression was used to compare the differences in the distribution of early and non-early puberty among normal weight, overweight and obese groups. Curves were drawn to analyze the relationship between the percentage of early puberty and BMI distribution in girls and boys at different Tanner stages. Results: A total of 208 179 healthy children (96 471 girls and 111 708 boys) were enrolled in this study. The OR values of B2, B3 and B4+ in overweight girls were 1.72 (95%CI: 1.56-1.89), 3.19 (95%CI: 2.86-3.57), 7.14 (95%CI: 6.33-8.05) and in obese girls were 2.05 (95%CI: 1.88-2.24), 4.98 (95%CI: 4.49-5.53), 11.21 (95%CI: 9.98-12.59), respectively; while the OR values of G2, G3, G4+ in overweight boys were 1.27 (95%CI: 1.17-1.38), 1.52 (95%CI: 1.36-1.70), 1.88 (95%CI: 1.66-2.14) and in obese boys were 1.27 (95%CI: 1.17-1.37), 1.59 (95%CI: 1.43-1.78), and 1.93 (95%CI: 1.70-2.18) (compared with normal weight Tanner 1 group,all P<0.01). Analysis in different age groups found that OR values of obese girls at B2 stage and boys at G2 stage were 2.02 (95%CI: 1.06-3.86) and 2.32 (95%CI:1.05-5.12) in preschool children aged 3-<6 years, respectively (both P<0.05). And in the age group of 6-10 years, overweight girls had a 5.45-fold risk and obese girls had a 12.54-fold risk of B3 stage compared to girls with normal BMI. Compared with normal weight children, the risk of early puberty was 2.67 times higher in overweight girls, 3.63 times higher in obese girls, and 1.22 times higher in overweight boys, 1.35 times higher in obese boys (all P<0.01). Among the children at each Tanner stages, the percentage of early puberty increased with the increase of BMI, from 5.7% (80/1 397), 16.1% (48/299), 13.8% (27/195) to 25.7% (198/769), 65.1% (209/321), 65.4% (157/240) in girls aged 8-<9, 10-<11 and 11-<12 years, and 6.6% (34/513), 18.7% (51/273), 21.6% (57/264) to 13.3% (96/722), 46.4% (140/302), 47.5% (105/221) in boys aged 9-<10, 12-<13 and 13-<14 years, respectively. Conclusions: BMI is positively correlated with sexual development in both Chinese boys and girls, and the correlation is stronger in girls. Obesity is a risk factor for precocious puberty in preschool children aged 3-<6 years, and 6-<10 years of age is a high risk period for early development in obese girls.

Interpretación medicolegal para el abordaje de individuos con desórdenes del desarrollo sexual en Colombia / Interpretation of medical-legal Colombian legislation to treat individuals with disorders of sexual development

Objetivo Los desórdenes del desarrollo sexual (DDSs) son un grupo de condiciones médicas cuyo manejo implica un enfoque transdisciplinario. En la legislación colombiana, no existe una regulación específica en materia de intervenciones médicas en individuos con DDSs. La Corte Constitucional Colombiana se ha encargado de proferir sentencias, en las cuales se han establecido unos lineamientos y parámetros para el manejo jurídico de los casos de ambigüedad genital. Teniendo en cuenta lo anterior, nos proponemos en este artículo exponer y analizar, desde la visión de un grupo transdisciplinario, las sentencias más relevantes que han sido proferidas por la Corte Constitucional Colombiana. Métodos Se realizó una revisión narrativa en las bases de datos de la Corte Constitucional y de la literatura legal. Se recopilaron todas las sentencias disponibles, y se evaluaron lo casos clínicos identificados por el grupo transdisciplinario de DDSs del Hospital Universitario San Ignacio. Finalmente, los autores generaron por consenso un texto de discusión, como guía para los lectores, luego de analizar cada una de las sentencias y los casos presentados. Resultados Se identificaron 9 sentencias y los antecedentes que llevaron a la elaboración de cada una de ellas. Los nueve casos presentados contienen conceptos importantes para la articulación por parte del grupo transdisciplinario, tales como, autonomía, consentimiento sustituto y asistido, e indicación médica del tratamiento. Se excluyeron las sentencias T-692/99 y la T-918/2012, dado que daban información duplicada con referencia a sentencias incluidas en este documento. Conclusión La Corte Constitucional Colombiana ha proferido sentencias en las cuales no se ha contado con la participación de grupos de expertos. La terminología usada no describe apropiadamente el lenguaje técnico que se aplica al manejo de nuestros pacientes. Para el abordaje de individuos con DDSs, resulta muy importante conocer la relevancia de las sentencias basadas en un análisis individual de cada caso.

Objective Disorders of sexual development (DSDs) are a group of conditions that require a transdisciplinary approach. In the Colombian legislation, there are no specific regulations regarding medical interventions in individuals with DSDs. The Colombian Constitutional Court has issued sentences establishing some guidelines and parameters for the legal management of cases of genital ambiguity. Considering the aforementioned information, the present manuscript aims to describe and analyze, from the perspective of a transdisciplinary team, the most relevant sentences issued by the Colombian Constitutional Court. Methods We performed a narrative review of the database of the Colombian Constitutional Court and of the legal literature. We compiled all available court sentences and evaluated the clinical cases identified by the transdisciplinary team at Hospital Universitario San Ignacio. Lastly, the authors composed, through consensus, a text for discussion, as a guide to the readers, after the analysis of each of the sentences and cases presented. Results We identified nine sentences and the precedents that led to their development. The nine cases presented contain important concepts for the work of the transdisciplinary team, such as autonomy, substitute and assisted consent, and the medical indication of treatment. Sentences T-692/99 and T-918/2012 were excluded, as they provided duplicate information concerning sentences included in this document. Conclusion The Colombian Constitutional Court has issued sentences without the participation of a team of experts in DSDs. The terminology used does not properly describe the jargon that is applied in the management of our patients. In order to approach individuals with DSDs, awareness regarding the relevance of the sentences based on an individual analysis of each case is of great importance.

Concordancia en la medición testicular de varones adolescentes con 3 métodos de orquidometría / Concordance of testicular measurement in male adolescents with three methods of orchidometry

Introducción. El orquidómetro de Prader es el método estándar para medir el volumen testicular (VT) en niños y adolescentes. Objetivo. Evaluar la concordancia en la estimación del VT y del inicio puberal con las técnicas de orquidometría de Prader, Chipkevitch y Sotos. Métodos. Diseño descriptivo transversal realizado en varones de entre 9 y 20 años. Se midió el VT (ml) en cada adolescente con las técnicas de Prader (método de referencia), Chipkevitch (modelo gráfico) y Sotos (medición de ancho testicular con regla plástica y fórmula equivalente a ecuación elipsoide). Se excluyeron varones con patología urogenital y enfermedades que afectan el crecimiento testicular. Para la concordancia entre métodos, se utilizó kappa para el inicio puberal, y coeficiente de correlación intraclase (CCI) y gráficos de Bland-Altman (GBA) para el VT. Resultados. Se incluyeron 377 varones sanos. Para la concordancia en VT (ml), la comparación Prader-Chipkevitch obtuvo CCI: 0,994 y p < 0,001; y de CCI; 0,312 y p < 0,001 para la de Prader-Sotos. En los GBA se halló una media de las diferencias cercana a 0 ml en la comparación Prader-Chipkevitch y cercana a 8 ml en la de Prader-Sotos. El acuerdo en el inicio puberal obtuvo un valor de kappa 0,93 en la comparación Prader-Chipkevitch y de 0,75 en la de Prader-Sotos. Conclusión. Los orquidómetros de Prader y Chipkevitch tienen una excelente concordancia en la estimación del VT y el inicio puberal; por lo tanto, podrían intercambiarse en la atención diaria de varones adolescentes. El método de Sotos mostró una concordancia buena en la estimación del inicio puberal, pero baja en la medición del VT

Introduction. The Prader orchidometer is the standard method used to measure testicular volume (TV) in children and adolescents. Objective. To assess the concordance in the estimation of TV and puberty onset with the Prader, Chipkevitch, and Sotos orchidometric techniques. Methods. Cross-sectional descriptive study conducted among male children and adolescents aged 9-20 years. For each adolescent, TV was measured with the methods by Prader (gold standard), Chipkevitch (graphic model), and Sotos (measurement of testicular width with a plastic ruler and use of a formula equivalent to the ellipsoid equation). Male children and adolescents with urogenital conditions and disorders affecting testicular growth were excluded. Kappa statistics was used to determine concordance among methods for puberty onset, and intraclass correlation coefficient (ICC) and Bland-Altman (B&A) plots for TV. Results. In total, 377 healthy males were included. Regarding the concordance for TV (mL), the Prader-Chipkevitch comparison obtained an ICC of 0.994 and a p < 0.001; while the Prader-Soto comparison obtained an ICC of 0.312 and a p < 0.001. With the B&A plots, mean differences were close to 0 mL in the Prader-Chipkevitch comparison and close to 8 mL in the Prader-Sotos comparison. Concordance for puberty onset obtained a kappa value of 0.93 and 0.75 in the Prader-Chipkevitch and Prader-Sotos comparisons, respectively. Conclusion. The Prader and Chipkevitch orchidometers show an excellent concordance in estimating TV and puberty onset; therefore, both methods could be used interchangeably in the daily care of male adolescents. The Sotos method showed a high concordance in estimating pubertal onset, but low in measuring TV.

Performance of mutation pathogenicity prediction tools on missense variants associated with 46, XY differences of sex development

OBJECTIVES: Single nucleotide variants (SNVs) are the most common type of genetic variation among humans. High-throughput sequencing methods have recently characterized millions of SNVs in several thousand individuals from various populations, most of which are benign polymorphisms. Identifying rare disease-causing SNVs remains challenging, and often requires functional in vitro studies. Prioritizing the most likely pathogenic SNVs is of utmost importance, and several computational methods have been developed for this purpose. However, these methods are based on different assumptions, and often produce discordant results. The aim of the present study was to evaluate the performance of 11 widely used pathogenicity prediction tools, which are freely available for identifying known pathogenic SNVs: Fathmn, Mutation Assessor, Protein Analysis Through Evolutionary Relationships (Phanter), Sorting Intolerant From Tolerant (SIFT), Mutation Taster, Polymorphism Phenotyping v2 (Polyphen-2), Align Grantham Variation Grantham Deviation (Align-GVGD), CAAD, Provean, SNPs&GO, and MutPred. METHODS: We analyzed 40 functionally proven pathogenic SNVs in four different genes associated with differences in sex development (DSD): 17β-hydroxysteroid dehydrogenase 3 (HSD17B3), steroidogenic factor 1 (NR5A1), androgen receptor (AR), and luteinizing hormone/chorionic gonadotropin receptor (LHCGR). To evaluate the false discovery rate of each tool, we analyzed 36 frequent (MAF>0.01) benign SNVs found in the same four DSD genes. The quality of the predictions was analyzed using six parameters: accuracy, precision, negative predictive value (NPV), sensitivity, specificity, and Matthews correlation coefficient (MCC). Overall performance was assessed using a receiver operating characteristic (ROC) curve. RESULTS: Our study found that none of the tools were 100% precise in identifying pathogenic SNVs. The highest specificity, precision, and accuracy were observed for Mutation Assessor, MutPred, SNP, and GO. They also presented the best statistical results based on the ROC curve statistical analysis. Of the 11 tools evaluated, 6 (Mutation Assessor, Phanter, SIFT, Mutation Taster, Polyphen-2, and CAAD) exhibited sensitivity >0.90, but they exhibited lower specificity (0.42-0.67). Performance, based on MCC, ranged from poor (Fathmn=0.04) to reasonably good (MutPred=0.66). CONCLUSION: Computational algorithms are important tools for SNV analysis, but their correlation with functional studies not consistent. In the present analysis, the best performing tools (based on accuracy, precision, and specificity) were Mutation Assessor, MutPred, and SNPs&GO, which presented the best concordance with functional studies.

Advance in research on the role of MAMLD1 gene in disorders of sex development / 中华医学遗传学杂志

MAMLD1 gene has been implicated in 46,XY disorders of sex development (DSD) in recent years. Patients carrying MAMLD1 gene variants showed a "continuous spectrum" of simple micropenis, mild, moderate and severe hypospadias with micropenis, cryptorchidism, split scrotum and even complete gonadal dysplasia. The function of MAMLD1 gene in sexual development has not been fully elucidated, and its role in DSD has remained controversial. This article has reviewed recent findings on the role of the MAMLD1 gene in DSD, including the MAMLD1 gene, its encoded protein, genetic variants, clinical phenotype and possible pathogenic mechanism in DSD.

Importância do gênero em doenças alérgicas / Gender importance in allergic diseases

As diferenças entre o sexo biológico, identidade de gênero e seu impacto na saúde podem ter implicações significativas para a prevenção, rastreamento, diagnóstico e tratamento de diversas doenças, inclusive as alérgicas. A medicina de precisão pode levar a novas classificações para as doenças, baseadas nos mecanismos moleculares. Já a medicina personalizada tem um significado mais amplo, levando em consideração o indivíduo a ser tratado. Embora a alergia seja mais prevalente em meninos na infância, isto muda rapidamente durante o desenvolvimento sexual das meninas, levando à predominância feminina vitalícia nas doenças alérgicas. Isso pode ser explicado pela influência dos hormônios sexuais, diferentes estilos de vida adotados por homens e mulheres, diferenças imunológicas, variações na microbiota, qualidade da alimentação, tipo de profissão, adesão ao tratamento, entre outros. Aspectos relacionados ao gênero devem se tornar parâmetros essenciais em alergologia para a estratificação diagnóstica e terapêutica, associados aos aspectos moleculares, genéticos e epigenéticos. Para o sucesso do tratamento é importante conhecer o indivíduo a ser tratado, levando em consideração seus aspectos biológicos, psicológicos, socioeconômicos e práticos, realizando uma abordagem personalizada.

Differences between biological sex, gender identity, and their impact on health may have significant implications to screening, diagnosis, and treatment of several diseases, including allergies. Precision medicine may lead to new classifications of diseases based on molecular mechanisms. Personalized medicine, in turn, has a wider spectrum considering the individual patient to be treated. Although boys have allergies more often in childhood, this quickly changes during girls' sexual development, leading to a lifelong female predominance of allergic diseases. This can be explained by influence of sexual hormones, different lifestyles adopted by men and women, microbiota variations, diet quality, occupation, and adherence to treatment, among others. Genderrelated aspects should become essential parameters in allergology for diagnostic and therapeutic stratification, associated with molecular, genetic, and epigenetic aspects. To obtain a successful treatment, knowing the individual to be treated, considering biological, psychological, socioeconomic, and practical aspects, is important to perform a personalized approach.

Genital abnormalities: Contextualization of a neglected area in prenatal diagnosis / Anomalías genitales: contextualización de un campo olvidado en el diagnóstico prenatal

RESUMEN Objetivo: hacer una reflexión sobre el bajo desarrollo que hay actualmente en el campo del diagnóstico prenatal de las anomalías genitales. Materiales y métodos: a partir de la tesis de que el desarrollo del diagnóstico antenatal de las anomalías genitales es escaso, se presenta una comparación con el estado actual de otros campos del diagnóstico prenatal, así como con su contrapartida posnatal; se analizan las distintas causas que pueden haber llevado a esta situación, y se reflexiona sobre formas de mejora de la especialidad. Conclusión: en comparación con otras áreas del diagnóstico prenatal, la detección de anomalías genitales tiene un menor nivel de desarrollo en cuanto a la disponibilidad de herramientas diagnósticas, de protocolos de manejo o investigación clínica. Algunas causas probables son la percepción de baja prevalencia, una importancia limitada o las dificultades para su exploración. Una forma de reforzar este componente de la medicina fetal sería la integración del conocimiento actual, la adquisición de herramientas adecuadas, y una traslación a la medicina clínica.

ABSTRACT Objective: To reflect on how the area of genital abnormalities has fallen behind in prenatal diagnosis. Materials and methods: Based on the thesis that prenatal diagnosis of genital abnormalities has scarcely developed, a comparison with other areas of prenatal diagnosis and with its postnatal counterpart is presented; different explanations for this situation are examined; and a reflection is made on ways to improve the specialty. Conclusion: Compared to other disciplines, prenatal diagnosis of genital abnormalities finds itself lagging behind in terms of diagnostic tools, management protocols and scientific literature. Potential causes include a perception of low prevalence and limited importance, or exploration challenges. Integration of current knowledge, together with the acquisition of the appropriate tools and translation to clinical medicine, would be a way to make this discipline stronger.

Desarrollo afectivo-sexual en las personas con trastornos del espectro autista / Affective-sexual development in people with autistic spectrum disorders

Los trastornos del espectro autista (TEA) son trastornos del neurodesarrollo que afectan la comunicación social y que presentan patrones de conducta repetitiva, estereotipada o/y inflexible. Un tercio de los casos diagnosticados de TEA tienen discapacidad intelectual y 2/3 una capacidad intelectual dentro de la norma. Los síntomas nucleares de autismo y otros asociados pueden afectar el desarrollo afectivo-sexual. En este artículo se expone qué dificultades en el desarrollo afectivo-sexual pueden presentar las personas con TEA y cuáles son las más frecuentemente descritas. Se propone de una manera breve, guías dirigidas a la evaluación y a la ayuda para un desarrollo afectivo-sexual satisfactorio en las personas con autismo-TEA.

Autistic spectrum disorders (ASD) are neurodevelopmental disorders that affect social communication and present repetitive, stereotyped and inflexible behaviour. A third of the people with a diagnosis of ASD also have intellectual disability associated and two thirds present an intellectual capacity within the average range. The nuclear autistic and others associated symptoms can affect the affective and sexual development. This article exposes which are the problems people with ASD present in the affective and sexual development, the most frequently described and brief guides for evaluation and support for an adequate affective-sexual development in people with ASD.

Correlates of physical activity in adolescents of public schools in curitiba, paraná, brazil / Correlatos da atividade física em adolescentes de escolas públicas de curitiba, paraná

ABSTRACT Objective: To verify the association of nutritional status, biological maturation, social support and self-efficacy with the physical activity level of 2,347 students of both sexes, aged between 11 and 15 years old, enrolled in state schools in the city of Curitiba, Paraná, Brazil. Methods: Anthropometric measurements of body mass, height and sitting height were collected. The assessment of biological maturation was based on the analysis of the age at peak height and sexual maturity. The physical activity level, social support from parents and friends and self-efficacy were evaluated by self-reported questionnaires. Sex/age-specific body mass index (BMI) cutoff points identified the nutritional status. Gross and adjusted binary logistic regression were used to obtain odds (OR) ratios with 95% confidence intervals (95%CI), adopting p≤0.05 as significant. Results: More than half (52.3%; n=1,227) of students were active, with boys in a higher proportion (64.1%; p≤0.01). The correlates of physical activity were: nutritional status (OR 1.25; 95%CI 1.01-1.56), early somatic maturation (OR 0.71; 95%CI 0.54-0.93), moderate (OR 1.85; 95%CI 1.50-2.30) and high social support from parents (OR 2.70; 95%CI 2.11-3.42) and high social support from friends (OR 1.78; 95%CI 1.42-2.24). Conclusions: Nutritional status, early somatic maturation, social support of parents and friends were correlates of physical activity. Overweight girls with moderate and high parental support and boys with greater social support from parents and friends were more active. Girls with early somatic maturation were less active.

RESUMO Objetivo: Verificar a associação do estado nutricional, da maturação biológica, do apoio social e da autoeficácia com o nível de atividade física de 2.347 escolares, de ambos os sexos, com idades entre 11 e 15 anos, de escolas estaduais da cidade de Curitiba, Paraná. Métodos: Foram coletadas as medidas antropométricas de massa corporal, estatura e altura sentada. A avaliação da maturação biológica foi realizada pelas análises da idade do pico de velocidade de altura e maturação sexual. O nível de atividade física, o apoio social dos pais e dos amigos e a autoeficácia foram analisados por questionários autorreportados. O estado nutricional foi obtido por meio de pontos de corte de índice de massa corpórea (IMC) específicos para idade e sexo. Razões de chances com intervalos de confiança de 95% (IC95%) foram obtidas por meio da regressão logística binária bruta e ajustada, adotando-se p<0,05. Resultados: Pouco mais da metade (52,3%; n=1.227) dos escolares é ativa, sendo os meninos em maior proporção (64,1%; p≤0,01). Foram associados com atividade física: estado nutricional (Odds Ratio [OR] 1,25; IC95% 1,01-1,56), maturação somática precoce (OR 0,71; IC95% 0,54-0,93), moderado e elevado apoio social dos pais (OR 1,85; IC95% 1,50-2,30 e OR 2,70; IC95% 2,11-3,42, respectivamente) e elevado apoio social dos amigos (OR 1,78; IC95% 1,42-2,24). Conclusões: O estado nutricional, a maturação somática precoce, o apoio social dos pais e dos amigos foram correlatos da atividade física. Meninas com excesso de peso e com moderado e elevado apoio social dos pais, e meninos com maior apoio social dos pais e dos amigos foram mais ativos, enquanto meninas maturadas precocemente, menos ativas.

Research on childhood sexuality: limitations and recommendations / La investigación sobre sexualidad infantil: limitaciones y recomendaciones

Children may display behaviours and have feelings of a sexual nature. However, due to the paucity of research, society often fails to acknowledge developmentally appropriate sexual experiences in childhood, and there is no consensus on which behaviours are normative. The purpose of this article is to review empirical evidence on the sexuality of children up to 12 years old. Specifically, the article aims to describe the main conclusions of studies, as well as to analyse the knowledge gaps, the methodological shortcomings, and the resulting recommendations for future research. According to the findings, studies should pay more attention to thoughts and feelings related to sexuality, the children's perspective; normative, healthy sexual expressions; and the relevant sexual socialization factors. Both direct and indirect methods, quantitative and qualitative techniques, should be combined to enhance the richness and validity of findings. The article also presents ethical tips. In conclusion, there is a need to further examine childhood sexuality from a comprehensive and ecological approach that provides an empirical basis for the development of interventions in children's sexual health

Los niños pueden tener comportamientos y sentimientos de naturaleza sexual. Sin embargo, dada la escasa investigación científica, la sociedad a menudo no reconoce las experiencias propias del desarrollo sexual infantil, y no hay consenso sobre qué conductas son normativas. Por ello, el objetivo de este artículo es aportar una revisión de las evidencias empíricas disponibles sobre la sexualidad de los niños de hasta 12 años. Concretamente, se pretende describir las principales conclusiones alcanzadas en este campo, y analizar las lagunas de conocimiento y limitaciones metodológicas existentes, con las consiguientes sugerencias para futuras investigaciones. Los resultados indican que debe prestarse más atención a las cogniciones y sentimientos relacionados con la sexualidad, la perspectiva de los niños, las manifestaciones sexuales saludables y normativas, y los factores de socialización sexual relevantes. Se aconseja combinar métodos directos e indirectos, así como técnicas cuantitativas y cualitativas para una mayor riqueza y validez de los hallazgos. También se aportan consideraciones éticas. En conclusión, es necesario profundizar en la investigación de la sexualidad infantil desde una perspectiva integradora y ecológica que aporte una base empírica para el desarrollo de intervenciones en salud sexual infantil

Progress on evaluation, diagnosis and management of disorders of sex development / 浙江大学学报·医学版

Disorders of sex development (DSD) refer to a group of diseases characterized by abnormal congenital development of chromosomes, gonad or genitals with different pathophysiological changes and clinical manifestations. DSD is more common in neonates and adolescents, and neonates often show genital abnormalities while adolescents show abnormal sexual development during puberty. It is the international consensus that the scope of DSD should include basic clinical evaluation (internal and external genitalia and endocrine hormones), diagnostic confirmation (chromosome, genetic diagnosis), psychological assessment for children and family, treatment (sex assignment, hormone replacement and surgical intervention), potential fertility protection and long-term follow-up, which require the expertise of pediatric endocrinology, pediatric urology, clinical psychology, genetic disciplines, medical images and other related disciplines; that is, individualized management of children with DSD requires an experienced multidisciplinary team (MDT). This article reviews the recent progress on the evaluation, diagnosis and management of disorders of sex development.

Commentary to: "Transdisciplinary Management of Patients with Disorders of Sex Development in Colombia. Limiting Factors for an Appropriate Management" / Comentario a: "Manejo transdisciplinario de pacientes con desórdenes del desarrollo sexual en Colombia. Limitantes para un manejo oportuno e integral

As the first author of the manuscript[1] commented here, it is my responsibility to open to discussion a critical topic that has gained more awareness and will continue to evolve over time, given the participation of patients in this debate. Since the Chicago Consensus in 2005, the terminology for "disorders of sex development" (DSDs) was established.[2] Ever since that moment, the academic interest was to universalize the terminology to reduce confusion and to improve the academic utilization of a unified language. It also looked to reduce the stigmatization suffered by individuals with the use of the previous terminology.

Clinicopathological features of premature ovarian insufficiency associated with chromosome abnormalities

PURPOSE: The aim of this study was to investigate the clinicopathological features of premature ovarian insufficiency (POI) associated with chromosomal abnormalities. MATERIALS AND METHODS: This was a retrospective study of POI patients with chromosomal abnormalities diagnosed between January 2009 and December 2017. The definition of POI is based on hypergonadotropinism of 40 or greater in follicle stimulating hormone (FSH) measurements at age 40 years or less. FSH was measured twice at least 4 weeks apart. Karyotyping using peripheral blood for chromosomal testing was conducted in all patients diagnosed with POI. We analyzed the clinical characteristics and genetic causes of patients who were diagnosed with POI. RESULTS: Forty patients were diagnosed with POI including 9 (22.5%) with identified chromosomal abnormalities. The mean age at diagnosis was 23.1±7.8 years (ranging between 14 and 39). Three patients did not experience menarche. The presenting complaints were short stature in one case, one case of amenorrhea with ambiguous external genitals, one case of infertility, and six related to menstruation such as oligomenorrhea or irregular rhythm. Turner syndrome was diagnosed in four cases, Xq deletion in one case, trisomy X in two cases, and 46,XY disorder of sexual development in two other patients. CONCLUSION: Patients diagnosed with POI carrying the same type of chromosomal abnormality manifest different phenotypes. The management protocol also needs to be changed depending on the diagnosis. A karyotype is indicated for accurate diagnosis and proper management of POI in patients, with or without stigmata of chromosomal abnormalities.

Constituição e sexuação: interrogações clínicas / Constitution et sexuation: questions cliniques / Constitution and sexuation: clinical issues

Neste trabalho partimos da premissa de que a constituição do sujeito como produto dos efeitos do significante é solidária à assunção de uma posição sexuada. Esta por sua vez, é efeito da subjetivação de tal incidência. Desse modo, temos o objetivo, neste momento, de percorrer algumas das teorizações que sustentam a tensão entre os termos constituição/sexuação, com ênfase nas contribuições de Freud a respeito do funcionamento mental e do complexo de Édipo e de Lacan, em especial suas contribuições a respeito do Édipo, função paterna e significação fálica. Acreditamos ser possível encontrar nos processos subjacentes à constituição do sujeito os elementos que demarcam ao longo desse percurso a dissimetria estrutural de homens e mulheres para circunscrever e subjetivar o gozo. Advertimos que o ser sexuado não é o mesmo que o sujeito do inconsciente. Porém, estamos certos de que há uma profunda solidariedade entre a constituição de um sujeito falante e as possibilidades da posição sexuada

Dans cet article, nous partons de la prémisse que la constitution du sujet en tant que produit des effets du signifiant est en solidarité avec l'hypothèse d'une position sexuelle, qui à son tour est l'effet de la subjectivation d'une telle incidence. Ainsi, nous avons en ce moment l'objectif de passer en revue certaines des théorisations qui soutiennent la tension entre les termes constitution / sexuation, en mettant l'accent sur les contributions de Freud sur le fonctionnement mental et le complexe d'Œdipeet de Lacan, en particulier ses contributions. sur Œdipe, la fonction paternelle et la signification phallique. Nous pensons qu'il est possible de retrouver dans les processus sousjacents à la constitution du sujet les éléments qui délimitent le long de cette voie la dissymétrie structurelle des hommes et des femmes pour circonscrire et subjectiver la jouissance. Nous vous avertissons que l'être sexuel n'est pas le même que le sujet de l'inconscient. Cependant, nous sommes sûrs qu'il existe une profonde solidarité entre la constitution d'un sujet parlant et les possibilités de la position sexuelle

In this work we start from the premise that the constitution of the subject as a product of the effects of the signifier is solidary to the assumption of a sexual position, this in turn, effect of the subjectivation of such incidence. In this way, we have the objective, at this moment, to explore some of the theories that support the tension between the terms constitution / sexuation, with emphasis on Freud's contributions to the mental and complex functioning of Oedipus and Lacan, especially their contributions about Oedipus, paternal function, and phallic signification. We believe that it is possible to find in the processes underlying the constitution of the subject the elements that demarcate along this path the structural asymmetry of men and women to circumscribe and subjectivate enjoyment. We are warned that being sexed is not the same as the subject of the unconscious. However, we are certain that there is a deep solidarity between the constitution of a speaking subject and the possibilities of the sexual position

Intervención de enfermería sobre educación sexual en adolescentes / Nursing intervention on knowledge of sexuality in adolescents

Introducción: La adolescencia con todas sus características y pautas constituye un problema asociado al mundo actual.Objetivo:Implementar una propuesta de intervención para la educación sexual de los adolescentes. Métodos:Se realizó un estudio observacional descriptivo, transversal de intervención educativa. Se seleccionó una muestra de 378 estudiantes pertenecientes a la ESBU "Eduardo Panizo Busto", del municipio Bahía Honda en Artemisa durante el año 2016, con el fin de modificar el nivel de conocimientos y comportamiento sexual de los mismos. Se desarrolló una intervención educativa sobre sexualidad con material específico, encaminada a resolver las principales deficiencias encontradas, después del análisis de una primera encuesta aplicada. Seis meses después se aplicó una segunda encuesta midiendo las mismas variables, los datos fueron procesados mediante estadística descriptiva e inferencial.Resultados:La gran mayoría de los estudiantes encuestados refieren haber iniciado las relaciones sexuales en edades tempranas como 14 y 15 años, el sexo masculino es de mayor incidencia con respecto al femenino. 278 encuestados (73.5%) rechazan el preservativo y le es incómodo, 124 (32.8%) no confían en él. Antes de la intervención educativa 180 (47.6%) de los adolescentes tenían deficientes conocimientossobre el tema, lográndose una mejoría después de la intervención educativa donde296 adolescentes (78.3%) obtuvieron resultados favorables.Conclusiones:La mayoría de los adolescentes inician a temprana edad sus relaciones sexuales con un nivel de conocimientos y actitudes deficientes en cuanto a la sexualidad que deviene en un comportamiento riesgoso, lográndose mejoría después de la intervención educativa aplicada por el personal de enfermería

Introduction: Adolescence with all its characteristics and patterns constitutes a problem associated with the current world.Objective:To implement an intervention proposal for the sexual education of adolescents.Methods:A descriptive, cross-sectional, educational intervention study was conducted. A sample of 378 students belonging to the ESBU "Eduardo Panizo Busto",from the Bahía Honda municipality in Artemisa during the year 2016, was selected in order to modify the level of knowledge and sexual behavior of the same. An educational intervention on sexuality was developed with specific material, aimed at solving the main deficiencies found, after the analysis of a first applied survey. Six months later a second survey was applied measuring the same variables, the data were processed by descriptive and inferential statistics.Results:The vast majority of the students surveyed reported having started sexual relations at an early age, such as 14 and 15 years old, the male sex being higher than the female sex. 278 respondents (73.5%) reject the condom and it is uncomfortable, 124 (32.8%) do not trust him. Before the educational intervention 180 (47.6%) of the adolescents had deficient knowledge on the subject, achieving an improvement after the educational intervention where 296 adolescents (78.3%) obtained favorable results.Conclusions:Most adolescents initiate their sexual relations at a young age with a level of knowledge and attitudes deficient in sexuality that becomes a risky behavior, achieving improvement after the educational intervention applied by the nursing staff.

Sexual Maturation, Attitudes towards Sexual Maturity, and Body Esteem in Elementary-School Children

PURPOSE: The purpose of this study is to evaluate sexual maturation, attitudes toward sexual maturity, and body esteem in the sexual development of Korean elementary-school boys and girls. METHODS: A descriptive cross-sectional study was conducted with 399 fifth and sixth graders (192 boys and 207 girls). The data were analysed with a χ2 test, t-test, and Pearson correlation coefficients. RESULTS: Among the 207 girls, 70.5% had pubic hair growth, 68.1% had breast development, and 56.0% had a menstrual period. In boys, 59.4% of the 192 subjects experienced the development of external genitalia and 52.6% had pubic hair growth. Sexual maturation was related to grade (boys, t=7.07, p=.008; girls, t=12.76, p < .001), age (t=−2.20, p=.030; t=−4.11, p < .001), height (t=−5.16, p < .001; t=−7.52, p < .001), and weight (t=−2.89, p=.004; t=−5.19, p < .001) in both boys and girls. Girls were more likely to have sexual maturity than boys (χ2=22.29, p < .001). Boys showed more positive attitudes toward sexual maturity (t=2.10, p=.036) and higher body esteem (t=2.12, p=.035) than girls. CONCLUSION: This study shows that sexual maturation, attitude toward sexual maturity, and body esteem in sexual development differ between boys and girls. The findings indicate that it is necessary to develop a tailored sex-education program according to the sex of elementary-school children.