Health, growth and sexual development of teenagers exposed in utero to medroxyprogesterone acetate.

General health, growth and sexual development were evaluated in 74 teenage boys and 98 girls who had been exposed to medroxyprogesterone acetate (MPA) in utero, and 385 boys and 448 girls not exposed. In this 17-year prospective study, the ascertainment of the end points was 'double blind' in that neither the interviewer nor the subject was aware of our interest in MPA. On average, girls exposed to MPA reported reaching the menarche 4 months earlier than the comparison group. This difference disappeared, however, in a multiple regression analysis taking into account social class, the mother's age at menarche and height of the girl's mother and father. Boys exposed to MPA reported their growth spurt to have occurred an average of 6 months earlier and voices to have broken 5 months earlier than unexposed boys. Again, the differences between them and the comparison group disappeared after controlling for confounding variables. There were no significant differences between the MPA-exposed and comparison groups in a wide variety of indices of health reported by the teenagers' mothers. These findings are consistent with the hypothesis that intrauterine exposure to MPA, in the doses used for pregnancy maintenance or for contraception, poses no threat to the long-term health and development of the progeny.

Tracking of blood pressure over an eight year period in Jerusalem school children.

Tracking of blood pressure (BP) over an 8-year period between the age of 6 and 14 years and the effect of weight, height, BMI and weight gain has been studied in a population of school children in Jerusalem (n = 533). Pearson's correlation coefficients were 0.65 for weight, 0.61 for height, 0.32 for systolic BP and 0.29 for diastolic BP over an 8-year period. Children maintaining their percentile rank for weight or BMI showed higher correlations than those increasing or decreasing their percentile rank. Girls' menarcheal status did not have a significant effect on the level of BP at 14 years of age. The prevalence of significant and severe BP as defined by the NHLBI Task Force was 1% at 6 years and 0.4% at 14 years. The predictive value of the BP at 6 years for 14 years of age was low even for those with hypertension levels: for SBP 16-33% and for DBP 0-37%. Based on the present study and others, large scale screening of BP is not recommended, rather community based programs aimed at modifying health behaviour in order to prevent development of cardiovascular risk factors and associated morbidity and mortality should be introduced.

Risk factors for coronary artery disease in 124 Jerusalem medical students.

As part of an epidemiologic teaching exercise, we studied coronary risk factors in two consecutive classes of Jerusalem medical students (n = 124) and calculated a summary coronary risk score for each student. Men were at higher risk than women because of greater body mass, higher blood pressure and more cigarette smoking. Married males were at lower risk than single males because they had lower cholesterol levels and smoked less. Married and single females were at equal risk. Jerusalem students smoked more than most groups of American medical students and less than their European counterparts. There is reason to believe that an exercise of this kind may result in risk-reducing behavior on the part of high-risk students.

The advisability of the prudent diet in adolescence.

Risk factor status for cardiovascular disease is affected by life style. Adolescence is a time during which long term life-style habits, including dietary habits, are established. Physicians who treat adolescent patients have a responsibility to be aware of the scientific evidence on the diet-heart question so that they can provide their patients with sound dietary advice. The American Heart Association has recommended that Americans consume a "prudent diet" in which daily consumption of cholesterol is no more than 300 mg with up to 30-35% of calories derived from fat, and less than 10% of calories derived from saturated fat and less than 10% from polyunsaturated fat. This paper reviews this recommendation with particular reference to studies of adolescents. This review centers around four main issues: 1) the estimated effect on serum cholesterol levels of a switch from the usual American diet to the prudent diet; 2) the effect of a predicted decrease in serum cholesterol on the risk of developing cardiovascular disease; 3) evaluation of the evidence of possible adverse effects of the prudent diet; 4) feasibility of the prudent diet. Based on a review of these four issues, the authors feel that the American Heart Association's prudent diet should be strongly recommended for all healthy adolescents.

Familial aggregation of blood pressure, weight and height among sibling pairs at school entry.

Aggregation of blood pressure among sibling pairs of the same age and sex was studied. The children were of a restricted age group, 6-7 year olds, who entered school between 1976 and 1980 in a Western Neighborhood of Jerusalem. The mean systolic blood pressure (SBP) was 98.8 mmHg (SD 10.2), for the first sib of the pair and 97.3 mmHg (SD 9.7), for the second sib of the pair and the mean diastolic blood pressure (DBP) was 63.0 mmHg (SD 9.6) and 60.1 mmHg (SD 9.2), respectively. The Pearson correlation coefficient for SBP was 0.18 (p less than 0.05) and for DBP 0.12 (p less than 0.05), for weight 0.46 (p = 0.001) and for height 0.46 (p = 0.001). Pearson's and intraclass correlations and regression coefficients were calculated. Comparison with other studies was made. The degree of the correlation was found to differ among the various studies. The lowest correlations were those of the present study. The factors affecting the strength of the correlations are discussed.

Determinants of blood pressure in Jerusalem schoolchildren.

In 1982, 113 first- and second-graders attending an elementary school in West Jerusalem had their blood pressure (BP), height, weight, and resting pulse measured. Three successive BP readings were taken. The mean of the second and third readings was used for data analysis. Mean systolic blood pressure (SBP) was 98.30 +/- 8.51 mm Hg and mean diastolic blood pressure (DBP) was 67.63 +/- 6.85 mm Hg. An analysis of covariance was performed in order to determine the contribution of each independent variable (height, weight-for-height, sex, age, and resting pulse) to the variance in BP, while adjusting for all other independent variables. Height, weight-for-height, and resting pulse were all found to be significantly associated with both SBP and DBP. Children in the upper quartile of weight-for-height had a mean adjusted SBP that was 10.2 mm Hg higher than those in the lower quartile and a mean adjusted DBP that was 7.9 mm Hg higher. Children in the upper quartile of height (for age) had mean adjusted SBP and DBP that were 6.1 and 4.7 mm Hg higher, respectively, than those of children in the lower quartile. Sex and age showed no significant association with SBP. The associations between DBP and both sex and age were not statistically significant (P less than 0.10), but there was a trend for girls and older children to have a slightly higher DBP. In a subsample of 93 children who had both resting pulse and recovery index measured (using the Modified Harvard Step Test for children).(ABSTRACT TRUNCATED AT 250 WORDS)

Nonspecific somatic symptoms in early adolescent girls.

Nonspecific somatic symptoms such as headaches, stomachache, and tiredness are common among adolescent females. The epidemiology of such symptoms is poorly defined. As part of a study on the age of onset of puberty, 239 Jewish schoolgirls living in Jerusalem, Israel, grades 4-8, were asked to rate their usual state of health. Thirteen girls (5.5%) reported poor health and cited nonspecific somatic symptoms as the reason. Nonspecific somatic symptoms were most prevalent (13.8%) among girls in early puberty (Tanner stage B2). Low maternal educational level and large family size were significantly associated with such symptoms. In a comparison with a matched control group, the girls with nonspecific somatic symptoms were significantly more likely to have mothers with a chronic illness. The potential implications of our findings are discussed.

Sexual maturation of Jerusalem schoolgirls and its association with socio-economic factors and ethnic group.

A status quo study was undertaken in Jerusalem, Israel in 1977 in order to determine the mean age of attainment of breast stages 2 and 3 (B2 and B3), pubic hair stages 2 and 3 (PH2 and PH3), and menarche. A sample of 285 Jewish girls in grades 3 through 8 were examined for signs of pubertal development and questioned about their menarcheal status. The data were analysed by probit analysis. The mean age found for B2 was 10.30 +/- 0.28 years; for B3 was 11.01 +/- 0.16 years; for PH2 was 10.58 +/- 0.22 years; for PH3 was 11.39 +/- 0.11 years; and for menarche was 13.29 +/- 0.45 years. These are the first data available on an Israeli population of mean age of breast and pubic hair development. A trend was found for later mean age of attainment of B2, B3, PH2 and PH3 among girls of the lowest social class (as measured by father's occupation), girls whose mothers were poorly educated, and girls from large families. A trend towards early mean age of attainment of B2 and B3 was found among girls of European-American-Israeli ethnic origin and towards early mean age of attainment of PH2 and PH3 among girls of Near Eastern origin.