Showing papers in "Adolescent medicine (Philadelphia) in 1996"

School-Based Nutrition Education Programs and Services for Adolescents.

Abstract: School-based nutrition education programs and services can offer a systematic and efficient venue for promoting health-enhancing eating behaviors among youth. This article reviews priority nutrition concerns of adolescents; guidelines for healthful eating; and plans of action schools can take to improve nutritional health of students, including an integrated model for comprehensive school-based nutrition education consisting of eight interrelated components.

Mental Health in the Schools: Promising Directions for Practice.

Abstract: Discontent with the state-of-the-art of mental health services being provided in schools has led to fundamental shifts in thinking about these services. This article reviews existing programs and highlights emerging trends in school mental health services. The authors demonstrate how mental health programs are changing from narrowly focused to comprehensive, from fragmented to coordinated, from problem-specific to cross-disciplinary, and from being supplementary services in the school to essential components that enable learning.

Who Is the Customer

Abstract: A 14-year-old girl was diagnosed at age 6 with type 1 diabetes mellitus. Both of her parents have been actively involved in her diabetic management. She recently gained 5.8 kg. At the time of presentation she was 174.2 cm tall and weighed 73.9 kg. While she was only moderately concerned about her recent weight gain, both her parents showed much more concern about her weight than about her blood sugar and vehemently objected to their daughter being interviewed separately, so that it became important to establish who the primary requester of treatment was. A very careful and delicate approach was chosen in which the adolescent was recommended to develop a regular exercise and eating regimen with participation and support of her parents.

School-Based Services and Adolescent Health: Past, Present, and Future.

Abstract: Health programs were introduced into schools approximately 100 years ago. Since that time, changes in school health programs and philosophies have been influenced by trends in the fields of both education and health care. This article describes the beginnings of school health in the United States, suggests the varying roles health and education have played in the evolution of its character, outlines the philosophical and political underpinnings of the system, and identifies three perspectives on school health as it is conceptualized and practiced in the 1990s.

Research and Evaluation in School-Based Health Care.

Abstract: With the rapid growth of school-based health centers has come a challenge to produce evidence that they are having an effect on the health and lives of the students they serve. The authors discuss the sources of data that are currently in place to assess the effects of school-based programs, present findings from these sources, address the problems of conducting research and evaluation in school settings, and present ideas about future data collection and research studies.

Comprehensive School Health.

Abstract: The Division of Adolescent and School Health of the Centers for Disease Control and Prevention has developed a model for comprehensive school health programs which consists of eight components that allow for collaboration among health care providers, educators, community groups, and other professionals concerned about the well-being of adolescents. This article presents the overall comprehensive school health program and offers strategies for health care practitioners who are interested in collaborating with school personnel and community members responsible for the eight components of the program.

School-Based Primary Care in a Managed Care Environment: Options and Issues.

Abstract: As school-based health centers have established a track record in providing access to primary care services for underserved school-age populations, financial viability of these programs has become increasingly dependent upon revenues generated from Medicaid and other third-party payers. The introduction of managed care concepts into this situation has created great uncertainty for the future. The authors discuss the various types of managed care models that school-based health centers are being called upon to work with and summarize the key issues (communications, confidentiality, linkages, reimbursement, and quality improvement) around which those relationships are being developed.

Poorly Controlled Diabetes

Abstract: A 17-year-old male with insulin-dependent diabetes mellitus was referred because of difficulties with diabetic control. Since his diagnosis at age 10, he has been hospitalized more than 60 times for diabetes or its complications, mostly ketoacidosis. He also has short stature, pubertal delay, and hepatomegaly, and on exam was uncooperative and hostile. The long-standing practice of binging and purging followed by vomiting was revealed. His condition was consistent with Mauriac syndrome. Addressing an associated eating disorder may improve diabetes control, but this combination significantly increases the risk of diabetic complications.

Lower Abdominal Pain in a Perimenarchal Adolescent.

Abstract: A 13-year-old girl presented to the emergency department with a 5-day history of lower abdominal pain and dysuria that coincided with the onset of her last menstrual period. Menarche occurred 4 months previously and previous cycles were normal. The CAT scan of the abdomen and pelvis revealed a uterus didelphis with obstruction. Abdominal pain was due to hematocolpos and hematometra. The left hemivagina was distended with hematocolpos, and left renal agenesis was also noted. The vaginal septum was removed surgically without complications and she continued to be monitored closely.

Comprehensive School-Based Health Centers: Implementing the Model.

Abstract: Increasing numbers of school health centers are being established nationwide as a means of easing access to and increasing utilization of primary health care services for high-risk youth. The multiple issues involved in establishing and maintaining a school-based health center are presented. The authors discuss the steps necessary to assess student needs and build community support, develop the plan for delivery of school-based primary care, implement the school-based health center model, and evaluate the health center program.

Winging of the Scapula in a Young Athlete.

Abstract: A 15-year-old high school football player noticed asymmetry of his right shoulder and thought that he was losing muscle mass around his right shoulder over the previous 2-3 weeks. There was no history of pain, recent or past direct trauma or surgery of the neck or thorax. He was diagnosed with serologically confirmed infectious mononucleosis about 2 months earlier, and was recovering clinically. Physical examination was normal, except for significant asymmetry and winging of the right scapula, and electromyographic and nerve conduction studies revealed demyealination and axonal damage to the right long thoracic nerve and paralysis of serratus anterior, most likely caused by Epstein-Barr virus infection. Conservative treatment approach allowing continued activity and strengthening exercises resulted in full functional recovery over the next 6-8 months.

Sexual Dysfunction and the Primary Care Physician.

Abstract: In addition to discussing the epidemiology and pathophysiology of sexual dysfunction, this comprehensive review addresses a host of chronic illnesses, including spinal cord injuries and endocrine, cardiopulmonary, hemato-oncologic, neurologic, nephrologic, rheumatologic, and orthopedic disorders. Subjects the physician should cover when taking the medical history and physical examination are detailed.

Human Papillomavirus Infection.

Abstract: Condyloma acuminata, or genital warts, is the anogenital expression of human papillomavirus infection (HPV), and is the most common viral sexually transmitted disease (STD) in the United States. If subclinical infection is considered, it is many times more frequent than any other STD. Its rapidly increasing frequency, with an estimated increase in incidence of 459% from 1966 to 1981, 5 has engaged the interest of epidemiologists; its role in the pathogenesis of cancer of the cervix has unleashed a great deal of research by basic scientists studying the mechanisms of this relationship. Primary care physicians are seeing more of these patients and are being encouraged to identify and treat HPV-infected males vigorously to reduce the rapidly rising rate of cervical cancer. 10 HPV infection in the male produces common and plantar warts. condyloma acuminata, and subclinical condyloma (also called flat condyloma) and is strongly associated with penile and anal carcinoma. It produces in women the same kinds of warts and condylomata, but also a cervical condition called squamous intraepithelial lesion (previously called cervical intraepithelial neoplasia), believed to be a precursor of carcinoma of the cervix. HISTORY

Bladder Dysfunction Syndromes.

Abstract: A discussion of normal voiding and urodynamic testing for bladder dysfunction is followed by a description of the causes, clinical features, and treatment of voiding disorders including unstable bladder, enuresis, Hinman's syndrome, bladder neck dysfunction, low pressure and low flow, and prostatodynia.

Benign Scrotal Masses in the Adolescent Male: Varicoceles, Spermatoceles, and Hydroceles.

Abstract: Because scrotal masses may be a source of embarrassment for adolescents concerned about fertility and sexual prowess, supportive counseling should be included in treatment. The authors summarize the history, pathophysiology, epidemiology, natural history, signs and symptoms, laboratory tests, diagnostic problems, treatment, and prognosis of these masses.

Can School-Based Health Services Reduce Absenteeism and Dropping Out of School?

Abstract: Studies have shown that a high school diploma, and preferably some post-high school education, is essential to economic success for most individuals in American society today. With large numbers of adolescents having excessive absenteeism or dropping out of school, programs are being developed to address these issues. The author examines what is known about the impact of health on absenteeism and dropping out, and the effects of programs that have tried to address these problems.

Nongonococcal Urethritis: Diagnosis, Management, and Complications.

Abstract: Topics covered here include the role of noninfectious and common and uncommon infectious agents in the development of nongonococcal urethritis; the relative usefulness of a variety of laboratory tests for organisms such as Chlamydia trachomatis and Neisseria gonorrhoeae; and complications including acute epididymitis, prostatitis, and Reiter's syndrome.

A Routine CBC Leads to a Nonroutine Diagnosis.

Abstract: A 20-year-old Hispanic female had 3 episodes of blood in her bowel movements, anal itching, burning, and constipation, and a history of hemorrhoids, hypothyroidism secondary to thyroiditis, depression, and an attempted suicide 3 months earlier. Family history was remarkable for iron deficiency anemia and hypothyroidism. Complete blood chemistry results indicated that she had vitamin B12 deficiency, but, except depression, did not exhibit other neuropsychiatric symptoms of cobalamin deficiency. A two-part Schiling test indicated that she was not producing adequate or active intrinsic factor, thus she was diagnosed with pernicious anemia and requires 1 mg of vitamin B12 intramuscularly for the rest of her life.

Roles and Responsibilities of School Nurses and Physicians in Adolescent School Health Programs.

Abstract: Studies indicate that more than 60% of all junior and senior high schools have at least one nurse providing school health services, whereas more than 30% include physicians in their health care programs. The diverse roles played by nurses and physicians in school health care are reviewed, with an emphasis on guidelines developed by the National Association of School Nurses and positions promulgated by the American Academy of Pediatrics.

Multiple Health Issues in a Homeless Adolescent.

Abstract: A 19-year-old homeless youth presented to the emergency department with right arm pain at the site of previous intravenous line and abdominal pain following a fight. Several days previously he had been treated for an unwitnessed grand mal seizure. The patient stated his history of seizure disorder, cardiac arrhythmia, reactive airway disease, and HIV infection (he reported CD4 count of 350 cells/mm(3)), and physical and sexual abuse. Upon admission, his CD4 count and percent were normal and HIV antibody test was negative. He refused to accept those results and kept none of his follow-up appointments. The case was consistent with factitious HIV disorder in adolescents.

Another Positive Pregnancy Test.

Abstract: A 16-year-old female presented to an emergency department with complaints of nausea and vomiting, dehydration, increasing weakness, and resting tremor. The past history included mild exercise-induced asthma. She denied sexual activity, but a urine test for beta-human chorionic gonadotropin was positive and she was transferred to a gynecology service for management of pregnancy. She also had primary amenorrhea and delayed growth for age. Further complaints included headaches accompanied with worsening of visual activity. Pelvic ultrasound revealed no intrauterine or ectopic pregnancy. Head CT scan showed a suprasellar tumor, better defined on an MRI as a hypothalamic tumor. Pathology following partial tumor resection revealed a mixed germ cell tumor with negative metastatic work-up.

Experiences with a Clinic for Young Men.

Abstract: The authors argue the case for every college campus having a men's clinic that can address concerns of the late adolescent and function as more than "a sexually transmitted disease clinic by some other name." Case examples describe situations that physicians in such clinics can expect to encounter.