{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T04:51:29Z","timestamp":1764305489537,"version":"3.46.0"},"reference-count":34,"publisher":"Walter de Gruyter GmbH","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_ijamh-2016-0122_s_999_w2aab3b7b9b1b6b1aab1c16b1Aa\">\n                    <jats:title id=\"d60720e38226_w2aab3b7b9b1b6b1aab1c16b1aAa\">Background and objective<\/jats:title>\n                    <jats:p>Sex maturity rating (SMR), defines different levels of sexual maturity, based on the development of secondary sexual characteristics. Periodic assessment of pubertal maturation by physicians is crucial for timely identification of puberty-related disorders. With this pilot study, we aimed to assess the attitudes, knowledge and practices of pubertal assessment by current US pediatric trainees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_ijamh-2016-0122_s_998_w2aab3b7b9b1b6b1aab1c16b2Aa\">\n                    <jats:title id=\"d60720e38235_w2aab3b7b9b1b6b1aab1c16b2aAa\">Methods<\/jats:title>\n                    <jats:p>An anonymous online survey questionnaire was sent to categorical pediatric residents at different levels of training and pediatric chief residents across the US.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_ijamh-2016-0122_s_997_w2aab3b7b9b1b6b1aab1c16b3Aa\">\n                    <jats:title id=\"d60720e38244_w2aab3b7b9b1b6b1aab1c16b3aAa\">Results<\/jats:title>\n                    <jats:p>We received responses from 2496 pediatric residents from all over the US. We found that 96% of trainees understand the importance of assessing SMR, 62% feel confident in assessing it and 55% feel comfortable assessing the need for an endocrinology referral. Only 33% of trainees performed external genital exams during all regular clinic visits while 26.9% never performed them during sick visits and 6% never assessed SMR during any of the patient visits. Higher levels of training and having completed an endocrinology rotation were associated with improvement in comfort level, practice and knowledge of trainees regarding pubertal assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_ijamh-2016-0122_s_996_w2aab3b7b9b1b6b1aab1c16b4Aa\">\n                    <jats:title id=\"d60720e38253_w2aab3b7b9b1b6b1aab1c16b4aAa\">Conclusion<\/jats:title>\n                    <jats:p>This study revealed that the current clinical practices of performing external genital exams and SMR among pediatric residents need improvement. Stronger reinforcement from continuity clinic preceptors and\/or online and clinic based resources for SMR assessment for trainees may improve adherence to the recommended guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/ijamh-2016-0122","type":"journal-article","created":{"date-parts":[[2017,7,6]],"date-time":"2017-07-06T06:01:41Z","timestamp":1499320901000},"source":"Crossref","is-referenced-by-count":2,"title":["Pubertal assessment: a national survey of attitudes, knowledge and practices of the US pediatric trainees"],"prefix":"10.1515","volume":"30","author":[{"given":"Aditi","family":"Khokhar","sequence":"first","affiliation":[{"name":"Department of Pediatrics , Division of Pediatric Endocrinology, SUNY Downstate Medical Center and Kings County Hospital , 445 Lenox Road, Box 49 , Brooklyn , NY-11203, USA , Phone: +718-613-8605, Fax: +718-270-1985"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yagnaram","family":"Ravichandran","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , SUNY Downstate Medical Center and Kings County Hospital Center , Brooklyn , NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitre G.","family":"Stefanov","sequence":"additional","affiliation":[{"name":"Statistical Design and Analysis, Research Division, SUNY Downstate Medical Center , Brooklyn , NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheila","family":"Perez-Colon","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Division of Pediatric Endocrinology, SUNY Downstate Medical Center and Kings County Hospital , 445 Lenox Road, Box 49 , Brooklyn , NY-11203, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2017,7,6]]},"reference":[{"key":"2025112800393601527_j_ijamh-2016-0122_ref_001_w2aab3b7b9b1b6b1ab1b7aAa","doi-asserted-by":"crossref","unstructured":"Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970;45(239):13\u201323.10.1136\/adc.45.239.135440182","DOI":"10.1136\/adc.45.239.13"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_002_w2aab3b7b9b1b6b1ab1b7b1Aa","doi-asserted-by":"crossref","unstructured":"Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291\u2013303.578517910.1136\/adc.44.235.291","DOI":"10.1136\/adc.44.235.291"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_003_w2aab3b7b9b1b6b1ab1b7b2Aa","unstructured":"Tanner JM. Growth at adolescence, 2nd ed UK: Oxford: Blackwell Scientific Publications; 1962."},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_004_w2aab3b7b9b1b6b1ab1b7b3Aa","unstructured":"Kaprio J, Rimpela A, Winter T, Viken RJ, Rimpela M, Rose RJ. Common genetic influences on BMI and age at menarche. Hum Biol. 1995;67(5):739\u201353.8543288"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_005_w2aab3b7b9b1b6b1ab1b7b4Aa","doi-asserted-by":"crossref","unstructured":"van Wieringen JC. Secular growth changes. US: Springer; 1978. p. 445\u201373.","DOI":"10.1007\/978-1-4684-2622-9_16"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_006_w2aab3b7b9b1b6b1ab1b7b5Aa","doi-asserted-by":"crossref","unstructured":"Bridges NA, Christopher JA, Hindmarsh PC, Brook CG. Sexual precocity: sex incidence and aetiology. Arch Dis Child. 1994;70(2):116\u20138.10.1136\/adc.70.2.1168129431","DOI":"10.1136\/adc.70.2.116"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_007_w2aab3b7b9b1b6b1ab1b7b6Aa","doi-asserted-by":"crossref","unstructured":"Klein KO. Precocious puberty: who has it? Who should be treated?. J Clin Endocrinol Metab. 1999;84(2):411\u20134.1002239310.1210\/jcem.84.2.5533","DOI":"10.1210\/jcem.84.2.5533"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_008_w2aab3b7b9b1b6b1ab1b7b7Aa","doi-asserted-by":"crossref","unstructured":"Lebrethon MC, Bourguignon JP. Management of central isosexual precocity: diagnosis, treatment, outcome. Curr Opin Pediatr. 2000;12(4):394\u20139.1094382310.1097\/00008480-200008000-00020","DOI":"10.1097\/00008480-200008000-00020"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_009_w2aab3b7b9b1b6b1ab1b7b8Aa","doi-asserted-by":"crossref","unstructured":"Fuqua JS. Treatment and outcomes of precocious puberty: an update. J Clin Endocrinol Metab. 2013;98(6):2198\u2013207.2351545010.1210\/jc.2013-1024","DOI":"10.1210\/jc.2013-1024"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_010_w2aab3b7b9b1b6b1ab1b7b9Aa","doi-asserted-by":"crossref","unstructured":"Kaplowitz P, Bloch C. Section on endocrinology AAoP. Evaluation and referral of children with signs of early puberty. Pediatrics. 2016;137(1):e20153732.10.1542\/peds.2015-3732","DOI":"10.1542\/peds.2015-3732"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_011_w2aab3b7b9b1b6b1ab1b7c10Aa","doi-asserted-by":"crossref","unstructured":"Mogensen SS, Aksglaede L, Mouritsen A, Sorensen K, Main KM, Gideon P, et al. Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty. J Clin Endocrinol Metab. 2011;96(5):1393\u2013401.10.1210\/jc.2010-274521346077","DOI":"10.1210\/jc.2010-2745"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_012_w2aab3b7b9b1b6b1ab1b7c11Aa","doi-asserted-by":"crossref","unstructured":"Cesario SK, Hughes LA. Precocious puberty: a comprehensive review of literature. J Obstet Gynecol Neonatal Nurs. 2007;36(3):263\u201374.10.1111\/j.1552-6909.2007.00145.x17489932","DOI":"10.1111\/j.1552-6909.2007.00145.x"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_013_w2aab3b7b9b1b6b1ab1b7c12Aa","doi-asserted-by":"crossref","unstructured":"Kaplowitz PB, Oberfield SE. Reexamination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society. Pediatrics. 1999;104(4 Pt 1):936\u201341.1050623810.1542\/peds.104.4.936","DOI":"10.1542\/peds.104.4.936"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_014_w2aab3b7b9b1b6b1ab1b7c13Aa","doi-asserted-by":"crossref","unstructured":"Ehrhardt AA, Meyer-Bahlburg HF. Psychosocial aspects of precocious puberty. Horm Res. 1994;41(Suppl 2):30\u20135.10.1159\/0001839568088701","DOI":"10.1159\/000183956"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_015_w2aab3b7b9b1b6b1ab1b7c14Aa","doi-asserted-by":"crossref","unstructured":"Herman-Giddens ME, Sandler AD, Friedman NE. Sexual precocity in girls. An association with sexual abuse?. Am J Dis Child. 1988;142(4):431\u20133.334818610.1001\/archpedi.1988.02150040085025","DOI":"10.1001\/archpedi.1988.02150040085025"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_016_w2aab3b7b9b1b6b1ab1b7c15Aa","doi-asserted-by":"crossref","unstructured":"Traggiai C, Stanhope R. Delayed puberty. Best Pract Res Clin Endocrinol Metab. 2002;16(1):139\u201351.1198790410.1053\/beem.2001.0186","DOI":"10.1053\/beem.2001.0186"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_017_w2aab3b7b9b1b6b1ab1b7c16Aa","doi-asserted-by":"crossref","unstructured":"Lee PA. Normal ages of pubertal events among American males and females. J Adolesc Health Care. 1980;1(1):26\u20139.10.1016\/S0197-0070(80)80005-26458588","DOI":"10.1016\/S0197-0070(80)80005-2"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_018_w2aab3b7b9b1b6b1ab1b7c17Aa","doi-asserted-by":"crossref","unstructured":"Roche AF, Wellens R, Attie KM, Siervogel RM. The timing of sexual maturation in a group of US white youths. J Pediatr Endocrinol Metab. 1995;8(1):11\u20138.","DOI":"10.1515\/JPEM.1995.8.1.11"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_019_w2aab3b7b9b1b6b1ab1b7c18Aa","doi-asserted-by":"crossref","unstructured":"Herman-Giddens ME, Slora EJ, Wasserman RC, Bourdony CJ, Bhapkar MV, Koch GG, et al. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network. Pediatrics. 1997;99(4):505\u201312.10.1542\/peds.99.4.505","DOI":"10.1542\/peds.99.4.505"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_020_w2aab3b7b9b1b6b1ab1b7c19Aa","doi-asserted-by":"crossref","unstructured":"Biro FM. Normal growth and development. In: Gail B, Slap FM, editors. Adolescent medicine: the requisites in pediatrics. Philadelphia, PA: Elsevier Health Sciences; 2008. p. 3\u20138.","DOI":"10.1016\/B978-032304073-0.10001-9"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_021_w2aab3b7b9b1b6b1ab1b7c20Aa","doi-asserted-by":"crossref","unstructured":"Sorensen K, Mouritsen A, Aksglaede L, Hagen CP, Mogensen SS, Juul A. Recent secular trends in pubertal timing: implications for evaluation and diagnosis of precocious puberty. Horm Res Paediatr. 2012;77(3):137\u201345.2250803610.1159\/000336325","DOI":"10.1159\/000336325"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_022_w2aab3b7b9b1b6b1ab1b7c21Aa","doi-asserted-by":"crossref","unstructured":"Afsari A, Mirghafourvand M, Valizadeh S, Abbasnezhadeh M, Galshi M, Fatahi S. The effects of educating mothers and girls on the girls\u2019 attitudes toward puberty health: a randomized controlled trial. Int J Adolesc Med Health. 2017;29(2):151\u2013156.","DOI":"10.1515\/ijamh-2015-0043"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_023_w2aab3b7b9b1b6b1ab1b7c22Aa","doi-asserted-by":"crossref","unstructured":"Saghi S, Mirghafourvand M, Alizadeh Charandabi SM, Nabighadim A, Seidi S, Rahmani A. Knowledge and attitude about pubertal health and their socio-demographic predictors in Iranian adolescents. Int J Adolesc Med Health. 2016;28(4):397\u2013405.26368043","DOI":"10.1515\/ijamh-2015-0016"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_024_w2aab3b7b9b1b6b1ab1b7c23Aa","unstructured":"FREIDA Online specialty training search\/Pediatrics: FREIDA Online. [Available from: https:\/\/freida.ama-assn.org\/Freida\/user\/specStatisticsSearch.do?method = viewDetail&pageNumber = 2&spcCd = 320, 2014."},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_025_w2aab3b7b9b1b6b1ab1b7c24Aa","doi-asserted-by":"crossref","unstructured":"Braverman PK, Breech L. Committee on A. American Academy of Pediatrics. Clinical report \u2013 gynecologic examination for adolescents in the pediatric office setting. Pediatrics. 2010;126:583\u201390.10.1542\/peds.2010-1564","DOI":"10.1542\/peds.2010-1564"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_026_w2aab3b7b9b1b6b1ab1b7c25Aa","doi-asserted-by":"crossref","unstructured":"Hagan JF, Shaw JS, Duncan PM. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed Elk Grove Village, IL: The American Academy of Pediatrics; 2008.","DOI":"10.1542\/9781581102239"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_027_w2aab3b7b9b1b6b1ab1b7c26Aa","doi-asserted-by":"crossref","unstructured":"Balk SJ, Dreyfus NG, Harris P. Examination of genitalia in children: \u2018the remaining taboo\u2019. Pediatrics. 1982;70(5):751\u20133.7133825","DOI":"10.1542\/peds.70.5.751"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_028_w2aab3b7b9b1b6b1ab1b7c27Aa","doi-asserted-by":"crossref","unstructured":"Donaruma-Kwoh MM, Tran XG, Giardino AP. Do pediatric chief residents recognize details of prepubertal male genital anatomy. Clin Pediatr (Philadelphia). 2010;49(8):756\u20139.10.1177\/0009922810365726","DOI":"10.1177\/0009922810365726"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_029_w2aab3b7b9b1b6b1ab1b7c28Aa","doi-asserted-by":"crossref","unstructured":"Powell HS, Bridge J, Eskesen S, Estrada F, Laya M. Medical students\u2019 self-reported experiences performing pelvic, breast, and male genital examinations and the influence of student gender and physician supervision. Acad Med. 2006;81(3):286\u20139.1650127810.1097\/00001888-200603000-00022","DOI":"10.1097\/00001888-200603000-00022"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_030_w2aab3b7b9b1b6b1ab1b7c29Aa","doi-asserted-by":"crossref","unstructured":"Leder MR, French GM. Precepting genital exams: challenges in implementing a complex educational intervention in the continuity clinic. Ambul Pediatr. 2005;5(2):112\u20136.10.1367\/A04-045R1.115780013","DOI":"10.1367\/A04-045R1.1"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_031_w2aab3b7b9b1b6b1ab1b7c30Aa","doi-asserted-by":"crossref","unstructured":"Drolet BC, Christopher DA, Fischer SA. Residents response to duty-hour regulations-a follow-up national survey. N Engl J Med. 2012;366(24):e35.10.1056\/NEJMp120284822646511","DOI":"10.1056\/NEJMp1202848"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_032_w2aab3b7b9b1b6b1ab1b7c31Aa","doi-asserted-by":"crossref","unstructured":"Drolet BC, Schwede M, Bishop KD, Fischer SA. Compliance and falsification of duty hours: reports from residents and program directors. J Grad Med Educ. 2013;5(3):368\u201373.2440429810.4300\/JGME-D-12-00375.1","DOI":"10.4300\/JGME-D-12-00375.1"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_033_w2aab3b7b9b1b6b1ab1b7c32Aa","doi-asserted-by":"crossref","unstructured":"Jhaveri KD, Sparks MA, Shah HH, Khan S, Chawla A, Desai T, et al. Why not nephrology? A survey of US internal medicine subspecialty fellows. Am J Kidney Dis. 2013;61(4):540\u20136.2333260310.1053\/j.ajkd.2012.10.025","DOI":"10.1053\/j.ajkd.2012.10.025"},{"key":"2025112800393601527_j_ijamh-2016-0122_ref_034_w2aab3b7b9b1b6b1ab1b7c33Aa","doi-asserted-by":"crossref","unstructured":"Minkovitz CS, Chandra A, Solomon BS, McDonnell KA, Silver GB, Tonniges TF, et al. Community pediatrics: gender differences in perspectives of residents. Ambul Pediatr. 2006;6(6):326\u201331.10.1016\/j.ambp.2006.07.00517116605","DOI":"10.1016\/j.ambp.2006.07.005"}],"container-title":["International Journal of Adolescent Medicine and Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.degruyter.com\/view\/j\/ijamh.2018.30.issue-6\/ijamh-2016-0122\/ijamh-2016-0122.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/ijamh-2016-0122\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/ijamh-2016-0122\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:40:19Z","timestamp":1764290419000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/ijamh-2016-0122\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7,6]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2017,5,17]]},"published-print":{"date-parts":[[2018,12,19]]}},"alternative-id":["10.1515\/ijamh-2016-0122"],"URL":"https:\/\/doi.org\/10.1515\/ijamh-2016-0122","relation":{},"ISSN":["2191-0278","0334-0139"],"issn-type":[{"type":"electronic","value":"2191-0278"},{"type":"print","value":"0334-0139"}],"subject":[],"published":{"date-parts":[[2017,7,6]]},"article-number":"20160122"}}