Background In adolescents with severe and persistent gender dysphoria (GD), gonadotropin releasing hormone analogues (GnRHa) are used from early/middle puberty with the aim of delaying irreversible and unwanted pubertal body changes. Evidence of outcomes of pubertal suppression in GD is limited. Methods We undertook an uncontrolled prospective observational study of GnRHa as monotherapy in 44 12–15 year olds with persistent and severe GD. Prespecified analyses were limited to key outcomes: bone mineral content (BMC) and bone mineral density (BMD); Child Behaviour CheckList (CBCL) total t-score; Youth Self-Report (YSR) total t-score; CBCL and YSR self-harm indices; at 12, 24 and 36 months. Semistructured interviews were conducted on GnRHa. Results 44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months. All had normal karyotype and endocrinology consistent with birth-registered sex. All achieved suppression of gonadotropins by 6 months. At the end of the study one ceased GnRHa and 43 (98%) elected to start cross-sex hormones. There was no change from baseline in spine BMD at 12 months nor in hip BMD at 24 and 36 months, but at 24 months lumbar spine BMC and BMD were higher than at baseline (BMC +6.0 (95% CI: 4.0, 7.9); BMD +0.05 (0.03, 0.07)). There were no changes from baseline to 12 or 24 months in CBCL or YSR total t-scores or for CBCL or YSR self-harm indices, nor for CBCL total t-score or self-harm index at 36 months. Most participants reported positive or a mixture of positive and negative life changes on GnRHa. Anticipated adverse events were common. Conclusions Overall patient experience of changes on GnRHa treatment was positive. We identified no changes in psychological function. Changes in BMD were consistent with suppression of growth. Larger and longer-term prospective studies using a range of designs are needed to more fully quantify the benefits and harms of pubertal suppression in GD.

National Institute for Health Research Policy Research Programme grant (115/0001).

BackgroundHealth risk behaviours are prominent in late adolescence and young adulthood, yet UK population-level research examining the relationship between drug or alcohol use and sexual health and behaviour among young people is scarce, despite public health calls for an integrated approach to health improvement. Our objective was to further our understanding of the scale of and nature of any such relationship, using contemporary data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).MethodsAnalyses of data from Natsal-3, a stratified probability survey of 15 162 men and women (3869 aged 16–24 years), undertaken in 2010–2012, using computer-assisted personal interviewing, were carried out. Logistic regression was used to explore associations between reporting (1) frequent binge drinking (≥weekly), (2) recent drug use (within past 4 weeks) or (3) multiple (both types of) substance use, and key sexual risk behaviours and adverse sexual health outcomes. We then examined the sociodemographic profile, health behaviours and attitudes reported by ‘risky’ young people, defined as those reporting ≥1 type of substance use plus non-condom use at first sex with ≥1 new partner(s), last year.ResultsMen and women reporting frequent binge drinking or recent drug use were more likely to report: unprotected first sex with ≥1 new partner(s), last year; first sex with their last partner after only recently meeting; emergency contraception use (last year) and sexually transmitted infection diagnosis/es (past 5 years). Associations with sexual risk were frequently stronger for those reporting multiple substance use, particularly among men. The profile of ‘risky’ young people differed from that of other 16–24 years old.ConclusionsIn this nationally representative study, substance use was strongly associated with sexual risk and adverse sexual health outcomes among young people. Qualitative or event-level research is needed to examine the context and motivations behind these associations to inform joined-up interventions to address these inter-related behaviours.

Background: Feed intolerance delays achievement of enteral feeding in preterm infants. Parenteral nutrition is associated with cholestasis and increased risk of sepsis. Glycerin suppositories have been used to promote gastrointestinal motility and feed tolerance. Objectives: To investigate whether daily glycerin suppositories (a) reduce the time to full enteral feeding in infants born at <32 weeks’ gestation, and (b) influence feed tolerance, incidence of sepsis or necrotizing enterocolitis, duration of oxygen requirement, growth or age at discharge. Methods: Design – prospective open randomized controlled trial; study population – preterm infants stratified into 2 subgroups, 24–27⁺⁶ weeks (24–27 weeks + 6 days) and 28–31⁺⁶ weeks; intervention – daily glycerin suppository for 10 days from 24 h of age, 250 mg (24–27⁺⁶ weeks subgroup) or 500 mg (two 250-mg suppositories; 28–31⁺⁶ weeks subgroup); controls – no intervention. The same feeding protocol and departmental guidelines for other aspects of neonatal intensive care were used in all subjects. Analysis was by intention to treat. Results: 54 babies were recruited (31 males), 29 randomized to receive suppositories; 48 achieved full enteral feeds. The median (range) time to full feeds was 1.6 days shorter in intervention group babies than controls, but not statistically significant: 7.4 (4.6–30.9) days versus 9.0 (4.4–13.3) days (p = 0.780; 95% confidence interval: –1.917, 2.166). No significant differences were observed in secondary outcomes. Intervention group babies passed their first stool earlier than controls (median: day 2 vs. day 4; p = 0.016). Conclusion: Regular glycerin suppositories did not reduce the time to full enteral feeds in infants born at <32 weeks’ gestation in our setting.

No clinically significant endocrinopathy was identified amongst survivors of accidental childhood TBI, although minor pituitary hormone abnormalities were observed.

No abstract

Smith (2020) Complex post-traumatic stress symptoms in female adolescents: the role of emotion dysregulation in impairment and trauma exposure after an acute sexual assault,

A systematic review of short and medium-term mental health outcomes in young people following sexual assault Introduction Sexual assault is common worldwide, peaking in mid-to-late adolescence. Global estimates for women having ever experienced non-partner sexual violence were 7.2% in 2010, with the highest rates of up to 21% of women in areas of Sub-Saharan Africa [1]. Intimate partner sexual violence against women is also common worldwide, with prevalence varying by countryfrom 5%, to up to 69% of women having ever experienced this form of sexual violence [2]. Adolescents are the group at the highest risk of sexual assault in the UK [3] with 17.8% of females aged 18-24 disclosing previous sexual abuse [4]. Figures globally appear similar, with 17.4% of females and 4.2% of males from age 1 month to 17 years experiencing sexual assault at some time in the USA [5], and 14.61% of females and 9.99% of males aged 15-17 reporting lifetime sexual victimization in South Africa [6]. Associations between sexual abuse and adverse psychiatric outcomes have long been reported in the literature, with the strongest evidence for links with depression, post-traumatic stress disorder (PTSD), eating disorders, and suicide attempts [7-11]. However, the cross-sectional design of most studies limits the inferences that can be drawn from the results. This also makes it difficult to distinguish between the acute consequences of an index assault, lifetime psychiatric outcomes, and the progress of symptoms over time. We conducted a comprehensive systematic review to evaluate the evidence around short and medium-term (i.e. within three years of assault) mental health outcomes in young people sexually assaulted between the ages of 10 and 24 years. Methods The protocol for this review was developed by clinicians and academics working in the fields of child and adolescent psychiatry, adolescent medicine, and sexual assault. The reporting of results was based on the guidelines provided by the Meta-analyses and Systematic Reviews of Observational Studies group (MOOSE guidelines) [12]. Study question What are the short and medium-term effects on mental health of sexual assault between the ages of 10 and 24 years? Databases and search strategies Five databases (Medline (Ovid), Embase (Ovid), CINAHL (Ebscohost), OpenGrey, and PsycINFO were searched on the 30 th of October 2013 by two reviewers. This search was updated in 2016 and again in November 2018, using Medline and Embase databases only.