Prevalence of obesity, acanthosis nigricans and hyperinsulinemia in an adolescent clinic

A descriptive chart analyses was conducted of 100 consecutive patients at an adolescent medicine clinic at West Virginia University School of Medicine between April and May 2002 to determine the prevalence of overweight and obesity, acanthosis nigricans and hyperinsulinemia. Height, weight, body mass index (BMI), blood pressure, and screening for acanthosis nigricans (AN) were recorded. For patients with AN, fasting lipid, glucose, and insulin levels were also recorded. A total of 37% (37/100) of adolescents were found to be significantly overweight or obese, with BMIs greater than the 85th percentile for gender and age, 28% (28/100) had a BMI greater than the 95th percentile for gender and age, and 17% (17/100) were observed to have AN. In this cohort, 94% (16/17) had a BMI greater than the 95th percentile. Patients with AN were found to have higher mean BMI (39.7 vs. 29.7), systolic (132 vs. 122), and diastolic (73 vs. 65) blood pressures that the patients who were obese and did not have AN. In addition, 16 of the 17 adolescents with AN were found to have elevated fasting insulin levels (mean 33.6). A fasting insulin level was not obtained on a 12-year-old girl with AN already receiving treatment with rosiglitazone (Avandia) for type 2 diabetes mellitus. The prevalence of overweight and obesity in patients at the adolescent clinic is over twice the national average. The prevalence of acanthosis nigricans in this mostly non-minority population is over three times the highest previously reported rate for Caucasians.

Young people's health: the need for action

Engaging adolescents with their health can prevent a lifetime of bad habits and should be a priority for an efficient future health service

Impact of rapid socio-economic changes on teenage pregnancies in Estonia during 1992-2001

BACKGROUND

Major socio-economic changes, including health care reforms and changes in the school curriculum, took place in Estonia after the country regained its independence in 1991. These changes affected people's reproductive behavior in many ways. In this article, the impact of the changes on the reproductive behavior of teenage girls, measured by adolescent fertility and abortion rates between 1992 and 2001, is analyzed.

METHODS

National data on abortions and births were obtained from official medical statistics, particularly from the Estonian Abortion Registry and the Estonian Medical Birth Registry. Female population denominators for the age group 15-19 were obtained from the Statistical Office of Estonia.

RESULTS

In teenagers, the birth rate decreased more than two times, from 49.7 per 1000 in 1992 to 23.8 per 1000 in 2001. The abortion rate per 1000 decreased from 55.5 in 1992 to 30.4 in 2001. Compared with all women of fertile age (15-49 years), at the beginning of the decade, teenagers decided more often to have a baby, and, at the end of the decade, they decided more often to terminate the pregnancy. Two-thirds of all pregnancies in teenagers end in abortion--either legally induced abortion (legal abortion and therapeutic abortion) or spontaneous abortion. In 2001, the abortion ratio was 116.4 among ethnic Estonians and 147.9 among non-Estonians.

CONCLUSIONS

The case in Estonia again proves that the availability of information, contraceptives, services and education, and the existence of other goals in life besides childbearing, have an impact on teenage birth and abortion rates. Successful health promotion activities should take into consideration the differences in the reproductive behavior of different ethnic groups.

A community-based intervention designed to increase preventive health care seeking among adolescents: the Gonorrhea Community Action Project

OBJECTIVES

We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents.

METHODS

Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression.

RESULTS

Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes.

CONCLUSIONS

This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents.

Atypical Squamous Cells of Undetermined Significance: Human Papillomavirus Testing in Adolescents

OBJECTIVE

To estimate the age-stratified prevalence of oncogenic human papillomavirus (HPV) infection and to evaluate risk factors for HPV acquisition among women with atypical squamous cells of undetermined significance (ASC-US).

METHODS

This was a chart review of all women with ASC-US smears who underwent oncogenic HPV testing between July 2002 and February 2004. To be eligible, HPV DNA results had to be available. Data extracted from charts included demographic information as well as certain patient characteristics historically associated with HPV acquisition or carriage.

RESULTS

Of 527 eligible women with ASC-US, 357 (68%, 95% confidence interval [CI] 64-72%) tested positive for oncogenic HPV. As compared with women who tested negative, this population was significantly younger and less likely to be married. When stratified by age, 77% of the women aged younger than 20 years were positive for high-risk subtypes, compared with 58% of women aged older than 25 years (P < .01). In the multivariate analysis, young age (relative risk [RR] 1.30, 95% CI 1.14.-1.49), current smoking (RR 1.14, 95% CI 1.03-1.25) and a history of chlamydial infection (RR 1.20, 95% CI 1.09-1.32) were associated with an increased likelihood of HPV infection, while oral contraceptive use (RR 0.86, 95% CI 0.72-1.03) had a marginal protective effect. The protective effect of oral contraceptives was most pronounced among adolescent women (RR 0.57, 95% CI 0.31-1.03).

CONCLUSION

Given that the rate of oncogenic HPV infection approached 80% in our population of adolescent women with ASC-US, the usefulness of HPV testing in this age group requires further investigation.

LEVEL OF EVIDENCE

II-3.

[Adolescent reproductive health in Senegal: situation and care strategies]

INTRODUCTION

Adolescent reproductive health is a public health concern in Senegal because of early sexuality and fecondity and its consequences. The objectives of this study is to address key issues of adolescent reproductive health and interventions in order to give recommendations.

MATERIAL AND METHODS

For this review article, data collection was performed from work carried out in Sénégal and related to adolescent reproductive health. Thus, aspects related to sexuality and its consequences in adolescent health have been studied. Also, interventions which address adolescent reproductive health have been highlighted.

RESULTS

Adolescents represent the quater of the population in Senegal. They are faced with h ealth issues related to early pregnancies, unsafe abortion, sexually transmitted diseases and HIV infection. Despite these remarks, adolescents hardly use health services because of stigmatisation, shame, fear or because of health providers attitudes. Several interventions have been launched and implemented. They have included sensibilisation, information, education and services provision in structures specially reserved for adolescents and youth.

CONCLUSION

Several research studies and interventions have been done in adolescent reproductive health. However, few of them have been published in peer review journals. During adolescence, continuous actions with an holistic approach should be taken to address adolescent health issues and development.

Sexually transmitted infections, blood-borne viruses and risk behaviour in an Australian senior high school population—the SHLiRP study

Objectives: To determine the feasibility and acceptability of screening for sexually transmitted infections and blood-borne viruses and to study the profile of sexual activity and other risk behaviours in a senior high school population. Methods: In this descriptive study we provided sexual health education and screening to students from two senior high schools in the Australian Capital Territory. We collected behavioural data using a self-administered questionnaire. Urines and swabs were tested for Chlamydia trachomatis (Ct), Neisseria gonorrhoea (Ng), Trichomonas vaginalis (Tv) and human papilloma virus (HPV). Blood specimens were tested for hepatitis B and C, HIV, herpes simplex viruses (HSV-1 and HSV-2) and syphilis. Results: A total of 795 students participated (31% of the enrolled population; female to male ratio 60 : 40) and 67.0% were sexually active. Of 795 students, 644 (81.0%) were screened. Rates of infection were Ct 1.1% (95% CI: 0.4–2.6), HPV 11.7% (95% CI: 7.4–17.3), HSV-1 32.5% (95% CI: 28.9–36.3), HSV-2 2.4% (95% CI: 1.3–3.9), hepatitis B surface antigen 0.3% (95% CI: 0.04–1.1) and hepatitis C antibodies 0.7% (95% CI: 0.07–1.6). Only 22.3% (95% CI: 19.3–25.7) of students had immunity to hepatitis B. There were no cases of HIV, gonorrhoea, trichomoniasis or syphilis. Of the sexually active students, 49.2% (95% CI: 38.9–59.2%) reported never or only sometimes using condoms, 41.5% (95% CI: 32.2–52.3%) reported unsafe drinking, 33.3% (95% CI: 23.9–43.1%) were smokers and 1.9% (95% CI: 0.2–7.0%) reported injecting drug use. Conclusions: Rates of STI and blood-borne viruses and immunity to hepatitis B were low in this population, but unsafe sex and other risk behaviours were common. We have demonstrated that STI screening, including serological testing, was well accepted in a senior high school population.

[The evolution of strategic plan for measles elimination in Malopolskie voivodeship]

The Regional Committee for the European Region of the World Health Organization made a commitment to interrupt indigenous measles transmission by 2007 year. This report presents data on measles control in Malopolskie voivodeship during 1999-2004 and summarizes progress of programme implementation at the regional level. The immunization coverage and measles surveillance have improved in this region, making realistic the achievement of measles elimination on time.

Telemedicine in a child and adolescent mental health service: participants' acceptance and utilization

Video-conferencing equipment was set up in Scotland in response to the increased pressure faced by the child and adolescent mental health services (CAMHS), and the need for specialist services to be accessible to, and harmonize with, 'mainstream' health services. Three sites were linked to the inpatient service in Edinburgh. Data were collected via questionnaires and diary logs. During a 24-month study, a total of 65 adolescents were admitted for inpatient care, of whom only five had their cases reviewed and monitored in a total of 20 teleconsultations. Adolescents and their carers involved in the study expressed great satisfaction with telemedicine and were keen to use it. Clinicians were resistant to telemedicine, with consequently low levels of utilization. Our results suggest that managers may be unwilling to re-allocate funding away from staffing, even where these costs are small and represent considerable improvements in the process of care for patients. Widespread integration of telemedicine to CAMHS is likely to be hard to achieve.

[Vaccination coverage among children and adolescents in Malopolskie voivodeship in period 1999-2004]

Malopolskie voivodeship was established in 1999 from regions where alarming low vaccination coverage had place. It was necessary to introduce an improvement program of vaccination performance in this area. The vaccination coverage in Malopolska voivodeship in period 1999-2004 has been analyzed. The immunization coverage has improved during this time, but is very sensitive on any problems in organization of vaccination performance.

The status of health services research on adjudicated drug-abusing juveniles: selected findings and remaining questions

This article focuses on the factors that affect the availability, accessibility, and opportunity of effective treatment for the adjudicated adolescent drug user The social and developmental context of "drug abuse" and its treatment in adolescents, and particularly in adjudicated adolescents, is reviewed and compared with that in adults. Selected health services research findings on this population are discussed in terms of the effectiveness of delivering treatment services; the organization, management, and financing of services; and adoption of best practices (technology transfer).

Are we getting the message across? Trends among young men attending an inner city young people's clinic

BACKGROUND

A young people's clinic has been running at the Archway Sexual Health Clinic since 1997. This offers a weekly walk-in service to both young men and women under 20 years old.

OBJECTIVES

To review the audit data of over 7 years' experience from the dedicated young people's clinic at the Archway Sexual Health Clinic, the "Arch."

METHODS

These data were collected by retrospective notes review of a consecutive series of all male attendees over a 7 year period from 1997 to the end of 2003 with collection of data in Microsoft Excel database.

RESULTS

These figures show an overall increase in attendee numbers, but also a relative rise in the numbers of young men using the service. A high number of bacterial sexually transmitted infections were detected. In 2001 and 2003 respectively, 14.5% and 17.8% of the young men using the service were diagnosed with Chlamydia trachomatis. A user survey aimed to identify factors that may be encouraging the young men to access the service.

CONCLUSIONS

Responding to the views of young men using the service has played a part in service development. Initiatives at the "Arch" such as the condom policy and choice of gender of staff may be factors encouraging increasing attendances. Continuing to work with other agencies to develop ways to engage young men are recommended. Word of mouth recommendation cannot be underestimated in publicising the service.

Who sees the young women? A resource-sharing model for providing comprehensive adolescent women's health care

Female adolescents are underserved in military medicine. This article describes an innovation in preventive care created to address the unmet health needs of female adolescents at a large military community hospital. A "Teen Women's Health Clinic" was created through shared resources between the Departments of Pediatrics and Gynecology. Female teenagers visited the clinic for routine gynecologic care, preventive health maintenance, acute care treatment for gynecologic and general complaints, and subspecialty referral consultation for adolescent medicine. The mean appointment fill rate from May 2001 through April 2002 was 93.8% (range, 63-127%). The mean no-show rate was 16% (range, 0-27%). There was minimal cost to the program. Comprehensive teen women's health with acute and preventive adolescent health care is achievable at the community hospital level at little expense through cooperation between departments. The clinic was well attended, on average working near full capacity, with a low no-show rate for teenagers. Reproduction of this model may be achieved throughout the Department of Defense at minimal cost.

Rates and risk factors for sexual violence among an ethnically diverse sample of adolescents

OBJECTIVES

To investigate the occurrence of rape/attempted rape and verbal sexual coercion among an ethnically diverse adolescent population and to evaluate whether unique risk factors existed for victims of either type of forced sexual experience.

DESIGN

Cross-sectional survey assessing sexual violence within the past 12 months, behaviors that occurred on each subject's most recent date, and the occurrence of unwanted sexual experiences on any dates in the past year and details about that date. Subjects identified as experiencing either rape/attempted rape or verbal sexual coercion were compared with nonvictims using bivariate and multivariate analyses.

SETTING

Urban adolescent health care facility.

PARTICIPANTS

Female adolescents and young adults (n = 689) between the ages of 14 and 23 years who presented for care and met the eligibility criteria.

RESULTS

Approximately 30% of young women reported having an unwanted sexual experience in the past year. The risk of rape/attempted rape was increased by past mild to moderate (adjusted odds ratio [AOR] = 4.27) or severe (AOR = 15.24) physical aggression by the dating partner; date-specific behaviors, including decreased level of romantic involvement (AOR = 0.63 per point decline) and going to the perpetrator's house to be alone (AOR = 3.01); past sexual victimization as an adolescent (AOR = 4.70); and lower levels of self-reported ethnic identity (AOR = 1.07 per point decline). More important, alcohol use by the victim or perpetrator was unrelated to an increased risk of rape/attempted rape. The risk of verbal sexual coercion was increased by past mild to moderate (AOR = 4.38) or severe (AOR = 13.79) verbal aggression from the dating partner; date-specific behaviors, including decreased level of romantic involvement (AOR = 0.70 per point decline) and greater number of past dates (AOR = 7.53); going to the perpetrator's house to be alone (AOR = 3.52); past sexual victimization as an adolescent (AOR = 9.83); pressures to use alcohol (AOR = 9.49); the victim not drinking alcohol during the date (AOR = 14.38); and increasing age discrepancy between victim and perpetrator (AOR = 1.23 per year increase).

CONCLUSIONS

Approximately 1 in 4 urban young women reported having experienced verbal sexual coercion or rape/attempted rape by a date or acquaintance in the past year. Distinct risk profiles for rape/attempted rape and verbal sexual coercion were identified when compared with those who did not report any victimization.

Teenagers' use of sexual health services: perceived need, knowledge and ability to access

INTRODUCTION

An individual teenager's use of services may depend on perceived need, on knowledge of sexual health and local services, and on ability to access. This paper presents the first UK large-scale quantitative analysis of these factors, comparing those who use services with those who do not.

METHODS

15/16-year-olds (n = 5747) were questioned about their use of sexual health services in the SHARE trial of a school sex education programme in 25 schools in Lothian and Tayside, Scotland, UK. Multilevel statistical models examined the role of different factors on service use.

RESULTS

One-third of teenagers had used a service, and use was strongly related to sexual experience. In addition, some family influences and being a school leaver were associated with service use, although we found no evidence for class, ethnic or religious barriers to use. Proximity to specialist clinics was linked with greater use, while low spending money and high parental monitoring were associated with less use. Teenagers with better knowledge, who rated their school sex education as effective, who were comfortable talking about sex and who had discussed contraception with peers were more likely to have used services. Differences in use relating to sexual experience, knowledge, feeling comfortable talking about sex and talking with peers helped to explain gender differences in service uptake.

CONCLUSION

There is potential to influence service use through better knowledge and confidence imparted through school sex education, and by improving the links between services and schools.

Sociodemographic and symptom correlates of fatigue in an adolescent primary care sample

PURPOSE

To describe the prevalence of prolonged fatigue, chronic fatigue syndrome (CFS)-like illness, and associated symptom patterns in adolescents attending primary care.

METHODS

The design was cross-sectional. A questionnaire designed by the authors assessing fatigue and associated symptoms was administered to 901 adolescents (aged 11-18 years) attending 12 primary care clinics in the Chicago area. Prevalence rates for prolonged fatigue and CFS-like illness were calculated. Univariate comparisons involving sociodemographic data and fatigue severity were made between adolescents with and without prolonged fatigue, and sociodemographic and symptom predictors of prolonged fatigue were identified using logistic regression analysis.

RESULTS

Prolonged fatigue (> or = 1 month) occurred at a rate of 8.0% and CFS-like illness occurred at a rate of 4.4%. Adolescents with prolonged fatigue were significantly older and also reported greater fatigue severity than those without fatigue. Findings from logistic regression indicated that, in addition to increasing age, headaches, muscle pains, fever, and fatigue made worse by exercise were significantly associated with prolonged fatigue.

CONCLUSIONS

Abnormal fatigue is a disabling and prevalent condition in adolescents in primary care. It is associated with a number of additional symptoms, many of which may have viral origins.

Use of Mental Health Services by Youths in Public Sectors of Care

The present paper examined the lifetime rates of mental health service use in a representative sample of youths identified as receiving services in at least one sector of care in a publicly funded service system of a large, metropolitan area. Service use was examined in relation to age, gender, mental health diagnostic status, and service sector involvement. Participants were 1706 youths ages 6-17 years who were active in at least one of the following service sectors: alcohol and drug services, child welfare, juvenile justice, mental health, and special education services for serious emotional disturbance. Structured service use and diagnostic interviews were administered to youths and their caregivers. High lifetime rates of mental health service use were found. Eighty-seven percent of the sample used at least one outpatient service, 45% used at least one inpatient service, and 71% reported use of a school-based service. Youths involved with the mental health and special education sectors had the highest rates of service use. In contrast, youths enumerated from the juvenile justice system tended to have the lowest rates of use. Additional research is needed to refine our understanding of the factors associated with the observed patterns of service use.

Building a Model to Understand Youth Service Access: The Gateway Provider Model

Enhancing the functioning of parents, teachers, juvenile justice authorities, and other health and mental heal professionals who direct children and adolescents to services is a major mental health services concern. The Gateway Provider Model is an elaborated testable subset of the Network-Episode Model (NEM; B. A. Pescosolido & C. A. Boyer, 1999) that synthesizes it with Decision (D. H. Gustafson, et al., 1999) and organizational theory (C. Glisson, 2002; C. Glisson & L. James, 1992, 2002). The Gateway Provider Model focuses on central influences that affect youth's access to treatment, i.e., the individual who first identifies a problem and sends a youth to treatment (the "gateway provider"); and the need those individuals have for information on youth problems and relevant potential resources. Preliminary studies by the authors and other applicable studies (D. Carise & O. Gurel, 2003) show that providers' perception of need, and their knowledge of resources, and their environment are related to the decision to offer or refer to services, supporting key aspects of the Model.

Community Variation in Risk and Protective Factors and Substance Use Outcomes

Communities are the context in which many prevention activities take place. One approach to community prevention is to identify the most elevated risk factors and most depressed protective factors for substance use in a community and then to select and implement preventive interventions to address the most elevated risk factors and most depressed protective factors in the community. This approach presumes that there are reliable differences between communities in risk and protection and that these differences relate to differences in substance use across communities. This paper addresses these issues using data from 28,091 students in 41 communities across the U.S. Intraclass correlation coefficients are used to assess the degree to which there are reliable and meaningful differences between communities in levels of risk and protective factors. The community means of the risk and protective factors are then correlated with levels of substance use. Findings indicate that there are meaningful differences between communities in levels of specific risk and protective factors, and that those differences are related to different levels of substance use in these communities. These results provide an empirical foundation for tailoring community-wide efforts to prevent substance abuse to the specific profiles of risk and protective factors experienced by youths in different communities.