Showing papers in "Adolescent medicine (Philadelphia) in 1999"

Sexuality and sex education at home and school.

Abstract: This article reviews numerous studies of parent-adolescent communication about sexuality and 30 studies of sexuality and HIV education programs. Although parent-adolescent communication about sexuality has increased during the last few decades, both the occurrence and the quality of this communication could still be greatly improved. There does not exist a clear simple relationship between greater parent-adolescent communication and less adolescent risk-taking behavior, but both adults and youth believe it is important anyway. Sexuality and HIV education programs do not increase any measure of sexual activity, but some of them with ten common characteristics do reduce sexual risk-taking, either by delaying or reducing sexual behavior or increasing condom use. Thus, these programs can be an effective component in a larger initiative to reduce HIV, other STDs, and unplanned pregnancy in adolescence.

Sexually transmitted diseases, unintended pregnancy, and adolescent health promotion.

Abstract: Adolescence is a critical period in the development of sexual behaviors that may lead to acquiring sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and to unintended pregnancy. Understanding adolescent sexual behavior is essential for understanding adolescents' risk of pregnancy and STD/HIV infection and for planning and evaluating health promotion activities. This chapter reviews the sexual behaviors and psychosocial factors associated with STDs and unintended pregnancy among adolescents as well as school-, community-, and clinic-based interventions designed to reduce risk behaviors and promote adolescent sexual health.

The social environments of adolescents: associations between socioenvironmental factors and health behaviors during adolescence.

Abstract: The social worlds of the adolescent and their potential effect on health behavior are the focus of this chapter. Social cognitive theory, resiliency theories, and the theoretical implications of focusing on lifestyle patterns of adolescents are discussed in order to provide a theoretical frame of reference for viewing the complex interactions between individual factors, socioenvironmental factors, and health-related behaviors among adolescents. Factors within the different social environments (family, school, peers, and community) are discussed and some general recommendations based upon empirical research findings and theories about adolescent health behavior are made.

Promoting healthy eating and physical activity in adolescents.

Abstract: The purpose of this article is to provide an update on promoting healthy dietary and physical activity behaviors in adolescents. In the first part of the article the authors discuss the importance of healthy eating and physical activity during adolescence, present national recommendations and guidelines for diet and activity, and briefly review major nutrition and physical activity concerns of adolescents today. The second part presents a review of diet- and activity-related health promotion and risk reduction factors in a variety of settings and provides recommendations for practitioners. Future research needs are also addressed.

Polycystic ovary syndrome.

Abstract: Many adolescents present with hirsutism and irregular menses. The challenge for the clinician is to distinguish physiologic anovulatory cycles from true menstrual disorders such as PCOS, and to differentiate PCOS from other causes of hyperandrogenism in hirsute adolescents. Common clinical features seen in adolescents with PCOS include hirsutism, acne, menstrual irregularity, and obesity. Biochemical abnormalities include hyperandrogenism, acyclic estrogen production, LH hypersecretion, decreased levels of SHBG, and hyperinsulinemia. Management strategies for a patient with PCOS include treatment of features which may cause distress to the adolescent, such as hirsutism, acne, and irregular menses, and prevention of long-term sequelae. Oral contraceptive pills, antiandrogens, and cosmetic treatments are used to treat hirsutism, acne, and menstrual irregularity. Oral contraceptive pills or medroxyprogesterone acetate are given to prevent endometrial hyperplasia and carcinoma. Counseling about weight loss and nutrition are essential, as weight loss may improve signs of hyperandrogenism and menstrual irregularity and may prevent NIDDM and cardiovascular disease. Insulin-sensitizing agents show promise in terms of decreasing hyperandrogenism, restoring ovulatory cycles, treating infertility, and preventing long-term sequelae. Finally, it is important to recognize that adolescents with PCOS may experience psychological distress because of the clinical manifestations of hyperandrogenism or when confronted with the information that they have a chronic illness. Psychological support should be available for these young women. Future research is likely to further elucidate the pathophysiology of PCOS, identify candidate genes, and clarify which adolescents are at risk for long-term sequelae. Prospective studies are needed to identify which therapies could potentially reduce the risk of infertility, diabetes, cardiovascular disease, and endometrial carcinoma in young women with PCOS.

Long-term consequences of adolescent health behaviors: implications for adolescent health services.

Abstract: The authors discuss the evidence supporting the effectiveness of adolescent preventive services to influence health outcomes, the magnitude of the long-term consequences of adolescent health-compromising behaviors, and their implications for health policies. Particular attention is given to the contribution that behaviors participated in or begun during adolescence have on long-term health, including cancer and heart disease. They postulate the health benefits that might accrue from the widespread implementation of comprehensive adolescent preventive services, assuming a conservative estimate of effectiveness, could be significant.

The psychological basis of health promotion for adolescents.

Abstract: Temporal trends in adolescent morbidity and mortality and the psychological factors that underlie adolescents' risk-taking behavior are reviewed in this chapter Theoretical models useful for understanding risk-taking behavior and developing effective preventive interventions are described Finally, intervention strategies, both on individual and community level, are identified that may enhance adolescent health promotion efforts Language: en

Adolescent tobacco, alcohol, and drug use: current findings.

Abstract: The authors provide assessment of prevalence of adolescent substance use, along with a description of risk and protective factors and process-oriented conceptual approach to prevention of substance use among teens. They present selected adolescent substance use prevention programs and results from evaluation studies. Limitations of existing prevention programs and suggestions for future prevention efforts are also discussed.

Injuries and violence: risk factors and opportunities for prevention during adolescence.

Abstract: More adolescent in the United States die from injuries than from any other cause. This chapter describes the three leading causes of death among adolescents-interpersonal violence, suicide, and motor vehicle-related injuries. The authors examine risks associated with alcohol use and access to firearms as well as injuries that occur at work and while playing sports, and end with recommendations for preventing adolescent injuries for health care providers, schools and communities.

Adolescent development: setting the stage for influencing health behaviors.

Abstract: Adolescent development is viewed as the overarching framework for approaching disease prevention and health promotion. This chapter is a review of salient developmental issues in adolescence, identification of the potential effects of adolescent development on health behaviors, identification of conceptual and theoretical frameworks to address the behaviors, and suggestions for the timing and tailoring of interventions to prevent health risk behaviors and promote health.

The success of limb-salvage surgery in the adolescent patient with osteogenic sarcoma.

Abstract: Malignant bone tumors in the adolescent population are rare but serious problems that are both life- and limb-threatening. Most of these tumors originate in the extremities, hip girdle, or pelvic girdle and require complete surgical resection for adequate therapy. The greatest majority of these tumors are diagnosed as osteogenic sarcomas. In the past, limb ablation was the only effective therapeutic option available to surgical oncologists in adolescent osteosarcoma patients. However, today, after two decades of advances in chemotherapy protocols and reconstructive surgical techniques, limb-salvage surgery has become an accepted treatment standard. Because skeletal immaturity and future bone growth is generally not a major reconstructive consideration in adolescents, 90% of the patients in this age group are today treated with limb-sparing surgery. The most significant question regarding the successful use of limb-salvage surgery is whether it adversely affects long-term outcome compared with standard amputations. The principal studies, both single- and multi-institutional, that compared the risk of local tumor recurrence and overall disease-free survival rate of the two types of procedures, demonstrated no significant difference in disease-free survival rates between the two groups. Similarly, multivariant analyses have shown no survival benefit for choice of surgical procedure in osteosarcoma patients. As a result, limb-sparing surgery for osteosarcoma patients has now been firmly established as a safe, effective, and successful oncology procedure compared with limb ablation.

Gynecological health care for adolescents with developmental disabilities.

Abstract: The gynecological health care of adolescents with developmental disabilities presents a unique challenge to care providers. Adolescence is a time of turmoil for many girls and for adolescents with special needs it may seem overwhelming. Patients, their parents and their caregivers need special attention during these changes in their lives. This chapter focuses on how to perform a reproductive health evaluation focusing on the history and physical exam, especially the pelvic exam. Menstrual hygiene and menstrual abnormalities are discussed in detail. Other topics include abuse and abuse prevention, contraception, and cyclical behavior changes. Patience, persistence, and adaptation of the usual examination techniques can lead to a thorough and balanced assessment of the patient and help her, her parents, and her caregivers with the challenges of adolescence.

Legal issues in reproductive health care for adolescents.

Abstract: Adolescents need reproductive and sexuality-related health care. State and federal laws affect consent, confidentiality, and payment for services. State minor consent laws allow minors to consent based on the minor's status or the services sought. State and federal laws affect confidentiality of health information generally as well as programs for specific services, such as family planning or drug and alcohol abuse treatment. Medicaid, the new State Children's Health Insurance Program, and categorical funding programs are important funding sources. Adolescents' ability to use these sources for confidential reproductive and sexuality-related services is evolving. However, possible changes in federal law and the transition to managed care in both public and private insurance present significant challenges they may face in the future.

Progress in adolescent mental health.

Abstract: This chapter reviews the status of emotional and behavioral problems in adolescents and current issues in their assessment and treatment. The authors emphasize the need for the development of mental health programs for adolescents in natural settings such as schools, and present a conceptual framework for intervention based on provider knowledge of risk and protective factors.

Menstrual cycle abnormalities: diagnosis and management.

Abstract: In summary, the diagnosis and management of menstrual disorders in adolescent girls is a particular challenge. The clinician must keep an open mind and consider physical conditions as well as psychosocial factors that may play a role in the menstrual dysfunction. Knowledge of congenital and genetic conditions, chronic biomedical as well as psychosomatic disorders, lifestyle choices, and complications of sexual behavior are essential to properly diagnose and treat menstrual disorders in young women. A detailed and confidential medical and psychosocial history and a thorough physical examination, including external genital examination, rectoabdominal or vaginal bimanual examination, and speculum examination (if indicated) are necessary.

An update on contraception for adolescents.

Abstract: Almost one million American adolescents become pregnant each year. Awareness of up-to-date contraceptive methods allows clinicians to appropriately counsel male and female adolescents, preferably prior to the onset of sexual activity. Abstinence, barrier methods, including the female condom and non-latex male condom, and hormonal methods, including oral contraceptive pills, injectables, and subdermal implants, are all suitable for adolescent use. New oral contraceptive pills with lower estrogen content or multiphasic hormone levels may ameliorate side effects, such as headache or breakthrough bleeding. Frank discussion of confidentiality and of the various contraceptive methods and their side effects allows adolescents to choose the best method for them, thus improving the likelihood of adherence.

Adolescents, cancer, and hospice.

Abstract: The transition from childhood to adulthood represents a time of great physiologic and psychologic change. The adolescence period can be divided into early, middle, and late adolescence. The diagnosis of cancer and impending death during adolescence can add more stress and demands during this difficult period. The normal tasks of adolescence include separation from parents, development of abstract thinking, sexual awareness, and future orientation with goals for career and marriage. These tasks must be accomplished even in the face of severe illness. The physical changes brought about by cancer and its treatment may be the major concern for the adolescent patient. The prospect of death is met with denial and anger. Independence and therefore refusal of help is maintained until the younger adolescent can no longer care for himself. The older adolescent is more confident and may allow family closeness as death approaches. The uniqueness of the adolescent requires the knowledge and patience of health care providers. Hospice professionals who are trained to understand adolescents may be able to allow them to die with independence and dignity.

Adolescent health assessment and promotion in office and school settings.

Abstract: Issues of health assessment and health promotion for adolescents have received increased attention during the past decade with the publication of several national and international guidelines for health assessment and a more intense examination of "what works and what doesn't work" in the area of health promotion In this chapter, history and definitions of adolescent health assessment are reviewed, a synopsis of currently available office guidelines is provided, data regarding health screening and promotion in clinical practice are presented, and issues of health screening and education in school settings are discussed

Sexually transmitted diseases: testing and treating.

Abstract: Adolescents remain a group at particular risk for STD acquisition due to a combination of biological and psychosocial factors. Access to care can be an obstacle to seeking appropriate screening and treatment for many adolescents; undetected infection may lead to unwanted sequelae, including pelvic inflammatory disease, chronic abdominal pain, tubal scarring, and increased risk of ectopic pregnancy. With respect to gonorrhea, chlamydia, syphilis, and chancroid, the hope is that improved detection will decrease sequelae by prompting earlier recognition and treatment. In all cases of suspected sexual abuse cultures remain of utmost importance because of the negative consequences associated with a possible false-positive test result. Urine screening in certain settings, such as school-based health centers and juvenile detention centers, remains positive; however, adolescents with a positive test may still require further evaluation to identify HPV and abnormal Pap smear findings, syphilis, and other STDs currently not recognizable with a simple urine screen.

Amenorrhea in the athlete.

Abstract: Amenorrhea in the athlete is commonly encountered in clinical practice. The work-up of an athlete with amenorrhea should include consideration of all the physiological and pathological conditions that give rise to amenorrhea in any adolescent. Delay or failure to recognize and manage these patients may result in the emergence of athletic triad with potential serious consequences of increased stress fractures, scoliosis, and thin body mass. This article reviews amenorrhea in the adolescent athlete with respect to body composition, disordered eating, osteoporosis, psychological factors, warning signs, treatment, and outcomes. Need for further strategies specific to prevention, surveillance, research, health consequences, medical care, and public and professional education is addressed.

Pap smears: screening, interpretation, treatment.

Abstract: Cervical cancer remains an important public health problem in the United States. Cervical dysplasia and rarely carcinoma in situ can occur during adolescence, especially in adolescents who become sexually active with multiple partners or who have been exposed to HPV, especially types 16 and 18. Papanicolaou smear is recommended for any adolescent who has ever been sexually active or exposed to human papillomavirus or is 18 years of age. This article discusses the new classification systems for cytological diagnoses, as well as some of the new types of Pap smear preparations, including the ThinPrep system and computer-assisted automated Pap test screening, which may increase the sensitivity of this screening test and reduce the false-negative rate of Pap smears.

Vulvar disorders in adolescents.

Abstract: Bacterial and fungal vulvitis, dermatitis, inflammatory dermatoses, secondary drug reactions, viral infections, and a variety of vulvar tumors can all present as primary vulvar problems in adolescents. In addition, systemic disease can present with vulvar involvement. These disorders can be extremely anxiety-provoking in adolescent females who are dealing with issues surrounding self-image, physical maturation, and sexuality. A detailed history and physical exam can provide many clues to the underlying problem, but sometimes a biopsy is necessary to establish a diagnosis. Consultations from other services, such as dermatology or infectious diseases, can be very helpful. The best approach involves a combination of empathetic reassurance, careful diagnosis, and successful treatment. In order to facilitate optimal care of adolescents with vulvar disorders, a comprehensive review of the literature is presented.

Cross-cultural issues in prevention, health promotion, and risk reduction in adolescence.

Abstract: The important roles that culture, race, and poverty play in contributing to health beliefs and health behaviors are reviewed in this chapter. It also outlines strategies for working with young people, their parents, and their communities in order to deliver "culturally effective" health care services, with an emphasis on prevention, health promotion, and risk reduction. Language: en

Anemia and coagulation disorders in adolescents.

Abstract: The transition of childhood to adulthood includes many changes to nearly all parts of the body and that is certainly true of blood and the coagulation system. Some disorders, like iron deficiency anemia, develop as the result of rapid growth. Approximately 10% of American adolescents are anemic and the prevalence is far greater in high-risk populations, such as urban, indigent African-American adolescents, in which 40-50% of young women are anemic. Adolescents at greater-than-average risk for developing iron deficiency anemia, such as athletes involved in lengthy, intense physical activities and pregnant adolescents, should be screened for anemia. Other blood problems are inherited but the first manifestations may not emerge until adolescence, as in the case of an adolescent girl discovered to have von Willebrand's disease during the evaluation of excessive menstrual bleeding. Besides iron deficiency anemia and von Willebrand's disease, this review focuses on management of other common hematologic disorders seen in adolescent patients, including immune thrombocytopenic purpura, hemophilia, thrombocytosis, and hypercoagulable disorders.

Lymphomas and bone tumors: clinical presentation, management, and potential late effects of current treatment strategies.

Abstract: While many pediatric malignancies are seen predominantly in pre-school children, many cases of childhood non-Hodgkin's lymphoma and most cases of Hodgkin's disease and bone tumors are seen in the older child and adolescent. This review focuses on current knowledge concerning the epidemiology, histopathology, molecular biology, clinical presentation, diagnosis, staging, treatment, and prognosis for older children and adolescents diagnosed with lymphoma or either of the two commonly seen childhood bone tumors, namely osteosarcoma and Ewing's sarcoma. Survival figures for all of these childhood malignancies have increased markedly in the past two decades. We now have the relatively new experience of having an increasingly large population of childhood cancer survivors to study and, unfortunately, are beginning to see the long-term consequences of these more successful treatments. This review concludes with an overview of the potential late effects of cancer therapy, effects that may first be detected by the primary care physician caring for the adolescent who is a cancer survivor.

Treatment strategies for adolescents with hemophilia: opportunities to enhance development.

Abstract: For adolescents, negotiating developmental tasks while living with hemophilia can be difficult. Affected adolescents must somehow negotiate tasks inherent within normal adolescent development, along with the added complications of hemophilia. Complications may include changes in physical appearance due to a history of bleeding episodes and the need for adolescents to think about the consequences of neglected treatment before they are developmentally ready. However, current strategies employed in the treatment of hemophilia have provided adolescents, their families, and their caregivers with opportunities to minimize the impact of hemophilia on adolescent development. Self-infusion minimizes the social impact by allowing adolescents to quietly leave the classroom, treat themselves, and return to class without notice. Prophylactic care maintains a factor level that allows adolescents to participate in many more activities. A multidisciplinary treatment center model for care promotes focused care, education, and anticipatory guidance to minimize the impact and help families adjust to chronic illness. Strong state and national leadership provides research advocacy and funding support for adolescent programming.

How legislation and health systems can promote adolescent health.

Abstract: This chapter focuses on some of the laws and regulations that could make it easier for adolescents to adopt health-promoting and disease-preventing behaviors, or that have minimized the dangers that might be caused by their behaviors. It also reviews some of the aspects of health care systems that may present barriers to health-promoting behaviors and suggests how they might be changed.

Bone marrow transplantation in adolescents.

Abstract: This paper reviews bone marrow transplantation in adolescents. The primary indications for bone marrow transplantation are malignancies, usually relapsed lymphomas or acute/chronic leukemias. Autologous bone marrow transplantation is used as a high-dose consolidation therapy in some solid tumor patients with varied success. Peripheral blood stem cells are a feasible source of autologous stem cells in adolescents. The process of stem cell transplantation and the complications are the same in adolescents as in younger children and adults. Adolescents face the same biologic barriers to allogeneic transplant (minimal residual disease, availability of donor), but may also face more problems with their insurance status. The psychological and social aspects of bone marrow transplantation during adolescence are unique to their developmental stage. With appropriate medical, nursing, and psychosocial support, bone marrow transplantation offers cure for the adolescent with high-risk disease.

Myelodysplastic syndromes in the adolescent.

Abstract: Myelodysplastic syndromes (MDS) are a group of acquired blood diseases that are the result of abnormal bone marrow function. The ineffective production of red cells, platelets, and white blood cells can lead to symptomatic anemia, bruising, infections, and the likelihood of evolution into acute myelogenous leukemia. While MDS is uncommon in the adolescent patient, a surprising number of affected individuals are also affected with a predisposing constitutional syndrome. The treatment of MDS in the adolescent patient is in part determined by symptoms and also by the historical outcomes associated with each of five morphologic categories of presentation. Improved supportive care has allowed for increasingly more children with MDS to survive into the second decade of life. The management of MDS in affected adolescents presents a number of interesting and worthwhile challenges to health care professionals.

Too little, too late: primary vs. secondary interventions for adolescents with sickle cell disease.

Abstract: The cognitive, biological, and psychological characteristics of adolescents affect their adaptation to a chronic medical condition. This article reviews the literature on how sickle cell disease alters the normal developmental challenges facing adolescents. Examples of these challenges include delayed maturation, neurologic complications, sequelae of pain episodes, and prolonged financial and family dependence. These challenges are also discussed within the context of family and peer relationships, as well as cultural norms. Using the principles of anticipatory guidance, interventions into the psychological development may help to preserve normal functioning. These interventions need to be provided in a manner acceptable to the adolescent within the community context. The education, counseling, and medical services provided by the multidisciplinary team in the Comprehensive Sickle Cell Program at Children's Hospital in Columbus, Ohio are used to highlight these intervention strategies.