[School performance: a question that divides. Analysis of learning difficulty]. / Il rendimento scolastico: una questione che divide. Analisi delle difficoltà di apprendimento.

The difficulty of learning is getting always more important, also in relation of a better knowledge of these problems. One factor which has to be taken in consideration as the behaviour of the school.

[They way adolescents live at home]. / Come l'adolescente vive la casa.

The kids, observing the relationship of their parents, are learning from them. Today the home is less home for everyone. At home you are eating, you are learning, especially you are watching a lot of TV. Often there is non a lot of trust between each other. Because of this the conversation is necessary and not the control of the adolescent secretly.

[Adolescence and family life cycle. Role of the pediatrician]. / L'adolescenza e il ciclo di vita della famiglia. Il ruolo del pediatra.

Adolescence observed as one of the step of the life cycle from the point of view of changes in the family. The role of paediatricians in the conversation with the adolescent and his parents is to pay attention to the influence that the whole family system could have on producing symptoms.

[Eating disorders in adolescence: anorexia in children]. / I disturbi alimentari in adolescenza: l'anoressia nel bambino.

When doctor visits adolescents have to pay attention to the massage of body like a mirror of difficulty about growth. Adolescents change their eating habits because they need to distinguish to the family. The doctor have to see first signals of more serious behaviour join to eating: anorexia nervosa.

[Advanced adolescence]. / L'adolescenza avanzata.

The advanced adolescence is the one after the eighteenth birthday. The adolescent tries to accomplish 3 engagements: 1. social and economic stability, 2. the research of a system of values, 3. record of concepts.

[Adolescence and alcohol abuse. Relevance of information given by the pediatrician]. / Gli adolescenti e l'abuso di alcol. L'importanza dell'informazione per il pediatra.

Often we don't see alcohol abuse among adolescents, but this kind of drug, easy to find, could be used to trying their limits. Contemporary group has an important role in the habit of drinking. Often family don't think that it's real problem and it's important that paediatrician grasp this dangerous signals.

[Children are born twice: at birth and in adolescence. The adolescent, his/her parents, and the pediatrician]. / Il bambino nasce due volte: quando viene alla luce e all'adolescenza. L'adolescente, i suoi genitori ed il pediatra.

We know the young's problem often depended to family and to society. In these years we have seen important changes of the family, that is no more a "patriarchal family" but is a "nuclear family". In general we can say that there is a change of the social levels of the family; in particular the Mass-media (especially television-set) are the most important factors responsible of these changes in fact they block the dialogue between family's members. In Italy we can found about 4.500.000 of adolescents (with age between 14 and 20 years). If we observe recent epidemiological data, we can suppose that: about 500.000 of young men have or will have problems that block them to live serenely their adolescence about 70.000 of young men have had a so important problem than they have a psychiatric personality in the future about 4.000 of young men will die for suicide, drugs or for road's incidences. For adolescents is necessary a doctor with multiple competence. We think that this doctor can be pediatrician because he is the doctor that visit children from neonatal age and, for this reason, ha can identify the "family with problems". In conclusion we can say that the pediatrician could say to adolescent's patents that "it is born a new child" with personal idea and with different attitudes, for these reason they must change the rules that they used before puberty because now the same rules are no more valid!

Precocious puberty and body composition: effects of GnRH analog treatment.

INTRODUCTION: Body composition changes with age and sex differences become significant only after puberty. Boys and girls before the age of 8 yr do not differ in fat, lean or bone mineral mass. Hormonal influences during pubertal development determine the physiological adult male and female body composition phenotype. AIM: The aim of our study was to evaluate body composition changes due to central precocious puberty (PP) and the specific effects of therapy on these modifications. SUBJECTS AND METHODS: Sixteen patients (14 girls, 2 boys) were included in the study. They were diagnosed as affected by idiopathic PP according to standard hormonal and clinical criteria; anatomic alterations of hypothalamus-hypophysis region were excluded by MRI. Mean age at diagnosis was 5.9 +/- 1.9 yr. All patients received GnRH analog (Leuprolide or Triptorelin) treatment subcutaneously every 4 weeks for at least 1 yr. Mean period of treatment was 3.4 +/- 1.9 yr. Standard anthropometry and body composition analysis were performed at baseline and every 6-12 months. A group of healthy subjects with normal timing of puberty was matched (for age or for pubertal stage) served as the control group (CA or CP, respectively). RESULTS: Patients with PP showed at baseline a significant increase of BMI and relative body weight; lean and fat compartments were also increased but not significantly. During treatment, the PP group showed increased fat mass compared to CA (p<0.05), while no difference was found between PP and CP. Lean mass was similar to CA but lower than in CP (p<0.05). During treatment a significant increase in lean mass (both as total as well as limb mass) was observed. After stopping treatment there was no difference between PP and CP, except for lower lean mass (p<0.04). CONCLUSION: When puberty occurs precociously, lean and fat mass are not significantly different from age-matched control subjects. Data collected during treatment confirm a shortening of prepubertal lean mass development and the block of further lean mass development due to puberty itself, while fat mass accumulation continues. The net result of these modifications determines a typical body composition pattern in PP patients, after the end of therapy: lean mass is reduced by a shortening of the prepubertal growing period and by the "menopausal effect" of treatment itself. Fat mass is increased as a consequence of therapy and could lead to future obesity.