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关于性早熟

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现在的孩子青春期真的提前了吗?
Are children today really going through puberty earlier?
1977年, 在意大利米兰附近一所学校,许多幼小的男女学生突然出现了胸部发育的症状。据后来发表在LANCET 上的调查报告称,受污染的牛肉及家禽可能是这次事件的元凶。10年前,在加利弗里亚也发生了一宗类似事件,有7个孩子表现出了青春期的症状,而起因源于一种用于治疗结核病的药不小心掺入了一些类似于雌激素的混合物。笔者曾经在2006年的NEW YORK TIMES 上发表的一篇报道中进述过这样一件事情:一家两兄妹在未达到上幼儿园的年龄之前就出开始长出阴毛。究其原因,原来是孩子的父亲为了美容和提高性生活质量,偷偷使用了一种从网上药店买来的强效的睾丸激素霜; 小孩在与大人的日常接触中,也受到了影响。
In 1977, hundreds of young Italian boys and girls attending a school near Milan suddenly began growing breasts. A subsequent investigation published in the Lancet suggested that contaminated beef and poultry were the likely cause. A decade earlier, another outbreak of early puberty in seven young kids in California had been traced to a tuberculosis drug that was accidently laced with estrogen-like compounds. In a 2006 piece for the New York Times—which, incidentally, was embellished for an episode of House—I described the case of a brother and sister who began growing pubic hair before reaching kindergarten. It turned out their father was secretly applying a high-potency testosterone cream purchased from an Internet pharmacy, for supposed cosmetic and sexual performance benefits, and the cream was rubbing off onto his kids from normal daily contact.
由于一些感染及化学品的泄漏,会出现小范围内的早熟现象。但更大规模更大范围的类似事件会不会发生呢?最近,许多的科学出版物都推测说,现在的孩子比几十年前的孩子会更早的进入青春期。这也引起了人们对普遍存在的环境诱因的担忧,像双酚-A,邻苯二甲酸盐及肥胖症等。
As with infections or chemical spills, early puberty can occur in small outbreaks. But can it also happen on a larger, population-wide scale? Recently, a drumbeat of scientific publications have speculated that children today undergo puberty earlier than in decades past, spurring worry about pervasive environmental triggers like bisphenol-A (BPA), phthalates, and obesity.
但如果对以往的数据仔细分析,会发现其实没有必要的对早熟现象过分忧虑。
But a closer look at the data suggests that fears about early puberty may be misplaced.
人们对普遍早熟现象的担忧始于上世纪90年代,当时一名叫Marcia Herman-Giddens的医师助理发现许多年龄在7到8岁之间的女孩都表现出了乳房发育的症状。她感到很不解,为此组织了一场研究活动,共有225名小儿科医生参与其中,他们把有早熟症状的小女孩的乳房及阴毛发育情况进行了归纳分析,最后得出结论:目前青春期的开始时间要早于60年代的一份联合健康研究报告中所说的时间。
The concerns about widespread early puberty began in the 1990s, when a North Carolina physician's assistant named Marcia Herman-Giddens wondered why many 7- and 8-year old girls appeared to be developing breasts. She organized a study in which 225 pediatricians graded the maturity of young girls' breasts and pubic areas. In a controversial 1997 Pediatrics paper, she concluded that puberty occurred earlier than in previously reported federal health studies from the 1960s.
去年,丹麦的研究者对比了两组有关性早熟特征的数据(一组收集于2006至2008年间,另一组从1991到1993年)后,也发现女孩子青春期的出现比以前早了一年。本月早些时候,一只由 Frank Biro 带领的辛辛那提市儿童医院的研究团队在一篇报告中说,从2004到2006年,被查检出有性早熟特征的美国女孩的青春期甚至比 Herman-Giddens 所报告的时间更早出现。从而也加剧了人们对早熟趋势的担忧。
Last year, Danish researchers compared data taken from girls from 2006 to 2008 to another cohort from 1991 to 1993 and also found the breast and pubic hair development was now occurring earlier by about one year. And in a well-publicized study released earlier this month, a team led by Frank Biro of Cincinnati Children's Hospital reported that American girls examined between 2004 and 2006 appeared to undergo puberty even earlier than reported by Herman-Giddens, prompting fears that the trend was accelerating.
人类通往成熟的进程可以改变的很快,这可能吗?其实,对青春期的定义具有很强的主观性,许多对早熟尤其是针对胸部过早发育的研究也是不全面的,容易引起误导。关键是能不能找到青春期开始的标志,让人真正信服。
Is it really possible that the process of human maturation could be changing rapidly? Identifying the start of puberty is very subjective and many studies showing earlier puberty, particularly those that focus on breast development, can be flawed and misleading. The key is to find a more reliable marker of puberty.
幸运的是,还真有:
Thankfully, there is one.
触发性成熟的真正诱因,我们并不知道。可是就在小时候的某天夜里,大脑里有一颗葡萄大小的下丘脑决定该是发育的时候了。于是从那天晚上开始,下丘脑会定期的滴一些被称为“GnRH”的荷尔蒙激素到豌豆大小的脑垂体腺上,把它从休眠状态中唤醒。
The precise trigger for sexual maturation is unknown, but sometime during childhood, a grape-sized area of the brain called the hypothalamus decides one night that it's time to grow up. Beginning that night, the hypothalamus periodically drops a bit of a hormone called GnRH just onto the pea-sized pituitary gland, rousing it from its lifelong slumber.
接下来脑垂体会产生自己的荷尔蒙注入循环系统,并最终激活肾上腺和卵巢(产生雌性激素)/睾丸(产生雄性激素)。对女孩子而言,青春期的最早表现就是胸部的轻微隆起;男孩子则表现在睾丸的稍稍增大。在以后的日子里,其它的变化也会随之而来:阴毛及腋毛的出现,声音变得深沉,身体迅速成长,长痘,来月经,产生精子等等。
The pituitary then secretes its own hormones into the circulation, ultimately activating the adrenal glands and ovaries (which make lots of estrogen) or testes (which make lots of testosterone). In girls, the first sign of puberty is typically a slight budding of the breast; in boys, it's a mild enlargement of the testicles. Over the next years, other changes arrive: pubic and underarm hair, voice deepening, the adolescent growth spurt, acne, menstruation or semen production, and so on.
大多数医学专家在不经过验血以及扫描检查的情况下,就把胸部的隆起及睾丸的增大诊断为青春期开始的标志。这些做法具有主观片面性,尤其是对男孩子而言。比如儿科医生通过用手感及运用睾丸测量器对比的方式来判断睾丸的大小,就很不准确。
With no objective blood test or scan, most experts consider breast budding and testicular growth the hallmarks of puberty's beginning. Unfortunately, those measures are very subjective—particularly for male children. Pediatricians guess the size of a boy's testicles by touch and comparison to a rosary-like string of balls called an orchidometer, which is not very accurate.
这就导致许多针对早熟的研究都集中在了女孩子身上——且所采用的诊断方式不也尽人意。Herman-Giddens 在1997年进行的研究中,也只是通过许多从事不同项目的儿科医生的目测, 而不是通过触摸方式来对那些具有乳房发育特征的小硬块进行系统的检查。这样就可能把胖的孩子也误诊为性早熟。
As a result, most studies of early puberty focus on girls—but those assessments aren't much better. Herman-Giddens' 1997 study relied only on visual inspection by hundreds of different pediatricians trained in different programs, and not on actually feeling systematically for the small, firm masses that typify breast buds. That might lead obese kids to be prematurely termed pubertal.
其实还有更明确的判断是否进入青春期的标志: 女孩子的第一次月经,或是初潮。如果是真的早熟,就会有初潮,这个过程是跟荷尔蒙的产生相对应的。但是在过去的40年间,初潮发生的年龄段并没有实质性的改变,还是在12岁左右。另外,也没有任何研究显示青春期的生长发育有什么时段上的变化。2008年,美国环境保护机构领导的一批国际内分泌学家及其它专家也认为青春期不可能会提前。
There is a much clearer and defined marker of puberty: the age of a girl's first period, or menarche. If puberty is occurring earlier, one would think menarche should also, since the process responds to the same cascade of hormones. But in the past 40 years, there hasn't been any real change in age of menarche, which remains at just over 12 years. Additionally, no researcher has shown any objective change in the timing of adolescent growth spurts. In 2008, an international group of endocrinologists and other experts led by the U.S. Environmental Protection Agency found little agreement that puberty was happening much earlier.
研究者所谓的大范围的早熟现象也许源于他们只留意到了胸部的早期发育——对比下正常发育的身体就会发现,现在的青春期似乎会比几十年前经历更长的时间。这是千真万确的。(流行病学家称之为“交货时间差”.)
Perhaps researchers seeing widespread precocious puberty are just noticing breast development earlier—looking harder at normal bodies. It would follow that today's puberty would seem to take longer than in previous decades. That's precisely the case. (Epidemiologists call this "lead-time bias.")
尽管到目前为止还没有实质性的方法去证实肥胖会影响早熟,有些女孩子的早熟可能确实跟肥胖有关(但令人费解的是,肥胖的男孩子却比正常的男孩较晚进入青春期)。当然还有不得不令人担忧的就是有些毒素(如 硼化本基丙氨酸 以及 邻苯二甲酸盐)所带来的影响。
It's possible that obesity might correlate with earlier puberty in some girls (oddly, fat boys appear to have later puberty than other boys), though the population-wide effect is still imperceptible by objective measures. And there are plenty of other reasons to worry about toxins like BPA or phthalates.
可是有关大范围早熟的话题却越传越玄,成为媒体追逐的对象,有些研究人员也乐此不疲。其实,这种鼓吹与渲染是没有多少事实依据的,反而会加深人们对女孩子身体早熟情况的担忧,同时也引发了有关年轻女孩子在社会性化方面(无论是通过挑衅性的舞姿还是暴露的着装) 的关注。当然,这些话题肯定会有人津津乐道。遗憾的是,所有的解决方案都不大可能会来自我们内分泌科专家们的实验室。
But in the end, the epidemic of earlier and earlier puberty is a myth that the media love and certain researchers continue to propagate. The tale's promotion doesn't always depend on data. Instead, worries about earlier physical maturation in girls sublimate and propel concerns about society's sexualization of young girls, whether by provocative dance routines or revealing clothing. Those topics certainly get people talking. Unfortunately, any solutions are unlikely to come from the labs of our nation's endocrinologists.
标签:性早熟
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2010-09-07 18:23 编辑:kuaileyingyu
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