Showing papers in "Adolescent medicine (Philadelphia) in 1997"

"Sex, Drugs, Rock 'n' Roll," and the Media-Are the Media Responsible for Adolescent Behavior?

Abstract: The old controversy about the role of the media in violent behaviors of adolescents can be combined with another unsettled question-Does the media simply reflect the violent, aggressive, and sexually oriented society, or does it actually cause some of the behaviors it depicts? This chapter reviews existing studies on the exposure of adolescents to media-derived violence, sexual behaviors, and use of tobacco, alcohol, and drugs, and the influences that such images have on this population.

School-based Health Centers.

Abstract: Over the past decade there has been a rapid increase in the number of school-based health centers (SBHCs). This chapter discusses the expanding role of SBHCs in adolescent health care, the controversies that surround the provision and utilization of such services, and different relationships between SBHCs and managed care organizations.

Acculturation Issues in Adolescent Immigrants: How Are They Related to Health?

Abstract: Following immigration to a new country, adolescents must deal with many challenges in addition to the normal intergenerational conflicts that characterize this age The need to learn a new language and adapt to a different educational system combined with the struggle to make new friends can have visible consequences on the health status of immigrant youth, many of whom suffered severe deprivations prior to immigration This chapter reviews physical and mental health-related problems, such as posttraumatic stress disorder, depression, anxiety, and psychosomatic problems, that concern adolescent immigrants and their families

Office-based Adolescent Health Care: Issues and Solutions.

Abstract: Because the field of adolescent medicine is relatively young, guidelines for care are still in need of definition. This chapter provides an overview of the issues related to the provision of health care to adolescents, including training of physicians, considerations in establishing an office-based practice, consent and confidentiality, and health care reimbursement.

Confidentiality in an Age of Managed Care: Can It Exist?

Abstract: Adolescents in need of medical care can be greatly influenced by concerns about privacy; therefore confidentiality remains one of the foundations of adolescent health care. This article discusses confidentiality and quality adolescent care in different settings of managed care. With consent laws that vary from state to state and different administrative restrictions of managed care, confidentiality of adolescent health care often may be compromised, causing adolescents to look outside the health care insurer for the medical help they need. The author discusses the benefits of HMO models able to provide easily accessible, quality confidential care to adolescents, including preventive adolescent medicine.

The Medical Clinician's Roles in Preventing Adolescent Involvement in Violence.

Abstract: This chapter discusses the role of health care providers in preventing adolescent exposure to violence and involvement in violent and criminal behaviors. The author reviews the existing primary, secondary, and tertiary violence prevention programs. The chapter also offers practical suggestions for clinicians to identify adolescents exposed to and involved in violence and provide clinical interventions to help youth suffering from substance abuse, AD/HD, anxiety, depression, and other mental health problems associated with exposure to violence.

Controversies in the Diagnosis and Treatment of Attention Deficit/Hyperactivity Disorder in Adolescents.

Abstract: Attention deficit/hyperactivity disorder (AD/HD) is one of the most common behavioral problems in childhood, and for about 80% of diagnosed cases remains a problem through adolescence. This article discusses general controversies that surround recognition, correct diagnosis, and treatment of AD/HD in children, and its relationship to conduct disorder in adolescents and adults.

One Test Too Many: Toward an Integrated Approach to Psychosomatic Disorders.

Abstract: Conditions such as chronic fatigue syndrome (CFS), fibromyalgia, and several others belong to the group of disorders in which both physiologic and psychologic factors are substantially involved, and in some cases there may be no real distinction between the two. However, primary patient assessment usually employs an array of clinical tools, and only after known physiologic factors are excluded is the patient referred for psychologic or psychiatric evaluation. This chapter suggests that clinical evaluation should initially include both physiologic and psychosocial assessment, which would minimize the division and greatly improve the efficacy of the treatment.

Treating Adolescent Obesity.

Abstract: Obesity's genetic, metabolic, behavioral, and environmental influences make the disorder difficult, but not impossible, to manage. Treatment at an early age is crucial, as 80% of obese adolescents will become obese adults, and are unlikely to "outgrow" obesity on their own. The author describes some of the current notions about the etiology of obesity, associated medical risks, and behavioral and medical treatments available for obese adolescents.

Assessing and Managing Adolescents with School Problems.

Abstract: Although school performance is highly influenced by socioeconomic and cultural forces, neurodevelopmental and psychological factors are major determinants of educational success. Clinicians should approach school problems as a health issue, with the specific objectives of determining whether a primary disease process or neurodevelopmental disorder is interfering with learning; providing medical evidence to support further evaluation of the patient; and offering medical treatment for conditions responsive to medication. The author also recognizes the value of effective collaboration with school staff and mental health professionals and primary care clinicians in assisting the adolescent patient to address his or her school difficulties.

A Primer on Adolescent Psychopharmacology.

Abstract: Because new applications for known medications are emerging, focusing on medications rather than syndromes enables the primary care physician to apply known medications to new indications. The article is accordingly organized around classes of medications rather than diagnostic entities. To be truly effective, adolescent psychopharmacology must be practiced in the context of a broader knowledge of adolescent development and psychodynamics.

Condom Availability in High Schools.

Abstract: Increased incidence of sexually transmitted diseases, especially HIV/AIDS, and unintended pregnancies among adolescents call for immediate measures that should educate adolescents and reduce risk from such outcomes. This article discusses school-based condom availability programs as one means to facilitate access to condoms and provide additional counseling for prevention of undesired consequences of adolescent sexual behaviors.

Cosmetic Plastic Surgery in Adolescents.

Abstract: Perceived or real physical defects may be important for an adolescent trying to establish self-image and adjust socially. Port-wine stains, breasts too small or too large, ethnic nose, prominent ears or chin, excess of adipose tissue-all these "defects" can lead to loss of self-esteem and have severe consequences with regard to an adolescent's development. This chapter discusses surgical procedures that can help adolescents change their physical appearance and consequently improve their self-confidence and social integration.

Chronic Complaints in Adolescence: Chest Pain, Chronic Fatigue, Headaches, Abdominal Pain.

Abstract: Most patients and their parents tend to favor a physical explanation of symptoms; to counter this trend, the author emphasizes the need for health care providers to maintain a more psychosocial approach in treating adolescents. The necessity and wisdom of extensive lab testing in the absence of definitive symptoms are questioned. Physical and psychological etiologies for the most common complaints are detailed.

Discrimination in Minority Health Care.

Abstract: Racial/ethnic minority adolescents are reported to have lower general health status, including higher prevalence of many infectious diseases, than white, non-Hispanic youth. Factors such as lower socioeconomic position, neighborhoods they live in, different cultural views on health, and different role of the family in health care providing are all thought to contribute to this situation. This chapter comprehensively reviews the existing data on the health status of minority adolescents, social, demographic, educational and cultural determinants of racial/ethnic minority populations and how they might interfere with health care delivery to the adolescents, and discusses the need for initiatives to improve the existing conditions.

Rebellious Adolescents: Is Toughlove the Answer?

Abstract: Grassroots, mutual-help groups exist as an alternative or an addition to professional help for families who are experiencing aggressive and antisocial behaviors by their rebellious adolescents. The Toughlove approach is one example of a mutual-help program created to help parents deal with serious behavioral problems of their children. This chapter discusses the concepts, limitations, and benefits of such a family-based program and its effectiveness in children vs. adolescents.

The Health Care Provider's Role in Adolescent Medical Decision-Making.

Abstract: In caring for adolescent patients, health care providers often face problems other than their medical conditions. This chapter presents three case studies that illustrate a diversity of ethical questions that arise in the context of adolescent health care. The investigators present and define the basic ethical principles that should govern a health care provider's approach to treating an adolescent. Even though this study was primarily directed toward adolescents who live without proper adult supervision, the principles and guidelines derived from this study can apply to the health care of all adolescents.

Growth Hormone Treatment for Children without Growth Hormone Deficiency: Does It Work and Will It Produce Adolescents Who Are Better Adjusted?

Abstract: The development of recombinant DNA technology offered a breakthrough for treatment of children with growth hormone (GH) deficiency However, children who are not GH-deficient but have idiopathic short stature (ISS) represent another group of frequent candidates for GH treatment This chapter reviews the results of existing studies of GH treatment of such children and discusses the necessities, benefits, and limitations of this approach

How Should Pediatricians Approach the Depressed Adolescent

Abstract: Mood disorders, such as depression, dysthymia, and bipolar disorder, affect a large number of adolescents and impair their normal development. This chapter discusses the pediatrician's approaches to treatment of such disorders in adolescents and specifically addresses the role of pharmacotherapy in achieving the best therapeutic results.

Common Menstrual Problems of Adolescence.

Abstract: Menstrual symptoms and patterns of menstrual bleeding are common complaints of adolescent patients. All presenting menstrual concerns must be clearly defined and should not be minimized, including both the patient's and parent's or guardian's perceptions of the problem and possible consequences to health. The author outlines the initiation and control of menstrual cycles and the spectrum of menstrual problems, including evaluation and treatment strategies. Symptoms associated with dysmenorrhea and premenstrual strategies are reviewed, along with other diagnoses that should be considered.

Should Adolescents Have Over-the-Counter Access to Oral Contraceptive Pills and Antibiotics?

Abstract: The rate of teenage pregnancy and abortion in the U.S. is the highest in the developed world. Oral contraceptive pills (OCPs) are an effective method of contraception that has very few contraindications in healthy adolescents. This article discusses the issue of whether adolescents should be allowed access to OCPs and antibiotics for treatment of sexually transmitted diseases without prior consultation with a health care provider. The author argues that patient education and counseling that result from an interaction with a clinician are necessary for sexually active adolescents and could be greatly diminished if OCPs become available over-the-counter.