A description of 200 consecutive admissions to an adolescent male treatment unit

OBJECTIVES

The objective of this study is to characterize patients admitted to a mental health Adolescent Male Treatment Unit (AMTU) over an 18-month interval.

METHODS

The study is a cross-sectional retrospective chart review. Data concerning medication management was abstracted along with age, psychiatric diagnoses, degree of impairment, length-of-stay (LOS), and episodes of locked seclusion/restraint.

RESULTS

Two hundred consecutive admissions were analyzed. It was common for a patient to be receiving multiple psychiatric medications. Multiple psychiatric diagnoses were the rule, and externalizing disorders were very frequent. Based on LOS, 4 distinct categories emerged. Patients in Categories I and II accounted for two-thirds of admissions to AMTU and had an LOS of 2 weeks or less. Patients in Category III and IV were one-third of admissions, were more ill, needed locked seclusion/restraint, and required a longer LOS to stabilize and treat them. Treatment tended to include a reduction in the number of psychiatric medications previously prescribed.

CONCLUSIONS

The majority of patients could be stabilized and discharged in 2 weeks or less. A minority required more intensive intervention including a long LOS. Receiving multiple psychiatric medications may not be of benefit for some patients. Psychiatric medications may induce behavioral adverse effects in at least a subset of patients.

Adolescents as health agents and consumers: results of a pilot study of the health and health-related behaviors of adolescents living in a high-poverty urban neighborhood

Although there is a considerable literature on how adolescents make decisions which lead to risky behaviors (e.g., unprotected sex, drug use) and adversely affect the health and well-being of youth, little is known about the routine behaviors youth engage in which influence their health (e.g., having permanent teeth extracted, discontinuing antibiotics prematurely, delaying or going without treatment of subacute illnesses and minor injuries) and concomitantly the factors which influence these behaviors. In an effort to begin to fill this gap, we have undertaken a study of routine health behaviors and the factors which bear on them in adolescents from a high-poverty urban neighborhood. In this article, we present the results of the pilot phase of the study in which we documented the behavior of 10 adolescents from Camden, New Jersey, the fifth poorest city in the United States, and explored with them their perceptions of the decisions they made and the factors that gave rise to them. We found that participants had an insufficient understanding of their health problems and consequences of their health actions, problems in understanding and being understood by health care professionals, and reluctance to involve parents in routine health care decisions. The implications of these findings are discussed in relation to improving the health of vulnerable youth.

Primary care services provided to adolescents in detention: a cross-sectional study using ICPC-2

AIM

The aim of this study was to provide a detailed description of the health problems for which primary care services are provided to adolescents in a juvenile detention facility in Europe.

METHODS

We reviewed the medical files of all detainees in a juvenile detention centre in Switzerland in 2007. The health problems for which primary care services were provided were coded using the International Classification for Primary Care, version 2. Analysis was descriptive, stratified by gender.

RESULTS

A total of 314 adolescents (18% female) aged 11-19 years were included. Most (89%) had a health assessment and 195 (62%) had consultations with a primary care physician; 80% of the latter had a physical health problem, and 60% had a mental health problem. The most commonly managed problems were skin (49.7%), respiratory (23.6%), behavioural (22.6%) and gynaecological problems (females: 23.9%); 13% females (no males) had sexually transmitted infections (STI), and 8.7% were pregnant. Substance abuse was common (tobacco: 64.6%, alcohol: 26.2%, cannabis: 31.3%).

CONCLUSION

In addition to health problems known to be more prevalent among young offenders, such as mental health problems and STI, these adolescent detainees required care for a range of common primary care problems. These data should inform the development of comprehensive primary care services in all juvenile detention facilities in Europe.

[Inequalities in access to preventive health care for school children]

Access to health care, including preventive health care for pupils affects the health of society. Equal access to pupils'preventive health care means the same level of preventive services for all children and adolescents regardless of school type, place and region of domicile.

AIM

To analyse the quality of preventive health care for pupils in school year 2007/2008 in all school types in Poland, giving special attention to inequalities and access of this healthcare.

MATERIAL AND METHODS

Reports from national public statistics filled by school nurses regarding preventive healthcare for pupils were analysed. Special attention was given to inequalites in access to

RESULT

Disparities in access to preventive health care were observed. They affected more often pupils from rural schools, basic vocational schools and special schools. As a result, 60% rural elementary schools did not have a school health office. School nurses working in these schools were overburdened, each of them had to look after excessive number of pupils. Nearly one-quarter of basic vocational school pupils didn't have periodic check-up. Pupils from these schools less frequently participated in health education conducted by school nurses compared with pupils from other school types. In special schools school nurses were overburdened. One school nurse from these schools had to look after above limit of pupils' number (above 25% in urban and above 75% in rural schools).

CONCLUSIONS

1. Inequalities in access to preventive health care affected pupils from rural, basic vocational schools and special schools. They reflected existing social disparities in Poland. 2. Inequalities exist mainly in the social groups, who are at risk of social exclusion. 3. Equal opportunity for pupils'preventive health care requires systemic solutions in health and educational cooperation at government level.

Assertive outreach strategies for narrowing the adolescent substance abuse treatment gap: implications for research, practice, and policy

In any given year, only about 10% of the nearly two million adolescents exhibiting substance abuse or dependence in the United States receive substance abuse treatment. Given this state of affairs, it is unlikely that the massive effort and expenditure of resources over the past decade on developing, testing, and disseminating effective treatments for adolescent substance abuse will have an appreciable impact on the prevalence of substance use disorders among the adolescent population. In order to substantially diminish the pervasive gap between levels of need for and utilization of adolescent substance abuse treatment, specialized assertive outreach strategies may be needed. This paper outlines a framework for assertive outreach for adolescents with substance use disorders and proposes specific types of strategies for identifying and enrolling such adolescents into treatment. Implications for practice and policy pertaining to adolescent substance abuse treatment service delivery are considered.

The Israel Survey of Mental Health Among Adolescents: aims and methods?

OBJECTIVE

The Israel Survey of Mental Health among Adolescents (ISMEHA) aimed to ascertain the prevalence of selected mental disorders and patterns of comorbidity, service utilization and unmet needs, health and sociodemographic covariates, and risk and protective factors. This paper reviews the methods used and discusses the strengths and limitations of the survey.

METHOD

The ISMEHA was a cross-sectional survey that included 957 Israeli adolescents, representative of the adolescent population aged 14-17 years. The Strengths and Difficulties Questionnaire, Hebrew version (SDQ-H), the Development and Well-Being Assessment (DAWBA) inventory, services utilization, health status and sociodemographic questions were administered to adolescents and their mothers at the respondents homes between January 2004 and March 2005.

RESULTS

The overall response rate was 68.2%, and it varied by gender and type of locality. Among boys, 71.3% responded, as compared to 65.2% among girls. The response rate among adolescents living in a Jewish or mixed city was 62.5% as compared to 89.6% among adolescents living in an exclusively Arab-populated city.

CONCLUSIONS

The ISMEHA allows the creation of a unique and comprehensive database informing on the prevalence, burden, services utilization and unmet needs of adolescents with psychiatric disorders. These data will enable policymakers to more rationally plan services and prevention programs for the target population.

Service use patterns for adolescents with ADHD and comorbid conduct disorder

Service use patterns and costs of youth diagnosed with attention-deficit/hyperactivity disorder (ADHD) and comorbid conduct disorder (CD) were assessed across adolescence (ages 12 through 17). Featured service sectors include mental health, school services, and the juvenile justice system. Data are provided by three cohorts from the Fast Track evaluation and are based on parent report. Diagnostic groups are identified through a structured assessment. Results show that public costs for youth with ADHD exceed $40,000 per child on average over a 6-year period, more than doubling service expenditures for a non-ADHD group. Public costs for children with comorbid ADHD and CD double the costs of those with ADHD alone. Varying patterns by service sector, diagnosis, and across time indicate different needs for youth with different conditions and at different ages and can provide important information for prevention and treatment researchers.

The impact of obesity on health service utilization and costs in childhood

Most studies of the economic costs of childhood obesity have focused upon hospitalization for comorbidities of obesity, whereas increased expenditures may also be the result of additional outpatient/emergency room visits or prescription drug expenditures. To quantify the magnitude of increased health-care utilization and expenditures among overweight and obese children, we performed descriptive, bivariate, and multivariable analyses on data from 6- to 19-year olds in the 2002-2005 Medical Expenditure Panel Survey (MEPS), a national probability survey of the noninstitutionalized civilian population in the United States. Compared with normal/underweight children, we found that children who were obese during both years of the MEPS had USD194 higher outpatient visit expenditures, USD114 higher prescription drug expenditures, and USD12 higher emergency room expenditures. Children who were overweight during both years, or overweight in one year and obese in the other had USD79 higher outpatient visit expenditures, USD64 higher prescription drug expenditures, and USD25 higher emergency room expenditures than normal/underweight children. Significantly, increased utilization was noted for outpatient visits, prescription drug use, and emergency room visits. Increased costs and utilization were concentrated among adolescents, though 6-11-year-old children who were obese in both years did have more outpatient visits and expenditures than other children. Extrapolated to the nation, elevated BMI in childhood was associated with USD14.1 billion in additional prescription drug, emergency room, and outpatient visit costs annually. Although further research is needed to identify effective interventions, the immediate economic consequences of childhood obesity are much greater than previously realized, and further reinforce efforts to prevent this major comorbidity are needed.

Determining accurate vaccination coverage rates for adolescents: the National Immunization Survey-Teen 2006

Since 1994, the Centers for Disease Control and Prevention has funded the National Immunization Survey (NIS), a large telephone survey used to estimate vaccination coverage of U.S. children aged 19-35 months. The NIS is a two-phase survey that obtains vaccination receipt information from a random-digit-dialed survey, designed to identify households with eligible children, followed by a provider record check, which obtains provider-reported vaccination histories for eligible children. In 2006, the survey was expanded for the first time to include a national sample of adolescents aged 13-17 years, called the NIS-Teen. This article summarizes the methodology used in the NIS-Teen. In 2008, the NIS-Teen was expanded to collect state-specific and national-level data to determine vaccination coverage estimates. This survey provides valuable information to guide immunization programs for adolescents.

Access to contraceptive services among unmarried young people in the north-east of China

OBJECTIVE

The concerns about the potential threats of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) have increased, since, in China, there is a lack of sexual education and condom use is rare. A community-based survey was conducted in September 2001 in Changchun city among 1227 unmarried young people aged 15-24 years (619 males and 608 females) to assess risky sexual practices and the obstacles to accessing appropriate contraceptive and other services.

METHOD

The study comprised a survey employing self-administered questionnaires, as well as key informant interviews, focus group discussions and in-depth interviews. This paper investigates the factors associated with young people's access to contraceptive services.

RESULTS

Results showed that 16% of young people had experienced premarital sexual intercourse and, among them, only 48.2% used contraceptive methods during the first sexual intercourse; 29.9% used a condom. Drug stores were the main source of contraceptives.

CONCLUSIONS

While data are sparse, findings suggest that the hostile and judgmental attitudes of providers, as well as the lack of counseling and privacy, were the key obstacles that unmarried youth encountered in their search for contraceptive services. Findings suggest the need for a reorientation of the contraceptive services to focus on unmarried youth, and generally to make contraceptive services more accessible to young people.

Demography of adolescent health care delivery and training in Europe

BACKGROUND

We aimed to determine the status of and factors associated with adolescent health care delivery and training in Europe on behalf of the European Paediatric Association-UNEPSA.

MATERIALS AND METHODS

A questionnaire was mailed to the presidents of 48 national paediatric societies in Europe. For statistical analyses, non-parametric tests were used as appropriate.

RESULTS

Six of the countries had a paediatric (PSPCA), 14 had a combined and nine had a general practitioner/family doctor system for the primary care of adolescents (GP/FDSA). Paediatricians served children 17 years of age or older in 15 and 17, up to 16 years of age in three and six, and up to 14 years of age in six and six countries in outpatient and inpatient settings, respectively. Fifteen and 18 of the countries had some kind of special inpatient wards and outpatient clinics for adolescents, respectively. Twenty-eight of the countries had some kind of national/governmental screening or/and preventive health programmes for adolescents. In countries with a PSPCA, the gross national income (GNI) per capita was significantly lower than in those with a GP/FDSA, and the mean upper age limit of adolescents was significantly higher than in those with the other systems. In the eastern part of Europe, the mortality rate of 10-14 year olds was significantly higher than that in the western part (p=0.008). Training in adolescent medicine was offered in pre-graduate education in 14 countries in the paediatric curriculum and in the context of paediatric residency and GP/family physician residency programmes in 18 and nine countries, respectively. Adolescent medicine was reported as a recognised subspecialty in 15 countries and as a certified subspecialty of paediatrics in one country. In countries with a PSPCA, paediatric residents were more likely to be educated in adolescent medicine than paediatric residents in countries with a GP/FDSA.

CONCLUSION

The results of the present study show that there is a need for the reconstruction and standardisation of adolescent health care delivery and training in European countries. The European Paediatric Association-UNEPSA could play a key role in the implementation of the proposals suggested in this paper.

Gender differences in sexuality and life quality among young people visiting a Swedish youth clinic

A survey was performed in the spring of 2004 to investigate aspects of life quality and sexuality in young girls and boys visiting a youth clinic in the centre of Stockholm, Sweden.

METHODS

Girls and boys coming for treatment, as well as accompanying persons, were over a period of three months asked to complete a questionnaire covering physical, mental, and social matters, including sexuality and lifestyle.

RESULTS

The questionnaire was answered by 480 girls and 108 boys. The response rate was 87%. The mean age of the girls was 18.7 +/- 2.1 years and of the boys 19.8 +/- 2.9 years. Significantly more girls than boys felt depressed, suffered stress, and had physical pain. More girls than boys were dissatisfied with their bodies and consciously tried to control their weight. Girls had been forced to have sex to a higher degree than boys. Boys, more than girls, appreciated casual sex, enjoyed masturbating and watching pornography and had an orgasm during intercourse.

CONCLUSION

We found that girls were less satisfied than boys with life, their bodies, and sexuality. Weight-control behavior was notably common among teenage girls and could indicate eating disorder problems. These gender differences should be taken into account for the adequate care and treatment of young people and important when designing youth-friendly clinics and the help they can provide.

Prevalence of mental health problems among children and adolescents in Germany: results of the BELLA study within the National Health Interview and Examination Survey

BACKGROUND

Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany.

OBJECTIVES

The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation.

METHODS

The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7-17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/hyperactivity disorder (FBB-HKS, Conners' Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined.

RESULTS

Overall, 14.5% of the children and adolescents aged 7-17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed.

CONCLUSIONS

The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.

[Adolescents in Santo André Hospital: health needs]

BACKGROUND

In the context of the National Health Youth Program, Department of Pediatrics of Santo André Hospital (SAH) has as one of its objectives to extend its age limit up to 18 years of age.

OBJECTIVE

To evaluate adolescents' health needs followed up at SAH and to determine the impact of the proposed new age limit policy.

METHODS

Retrospective descriptive study that included adolescents (10-18 years old) seen at the emergency department (ED), outpatients or admitted to the pediatric ward between 2000 and 2004.

RESULTS

Adolescents represented 7.3% (average) of all the patients seen at SAH during this period. Approximately 11130 adolescents were seen yearly in the ED, 57% of these in the pediatric ED, 39.5% in general ED, and 3.5% in obstetrics/gynecology ED (the majority of these patients were between the ages of 15 and 18). Medical causes represented 53% of the final diagnosis and 43% were surgical related. The average number of outpatients consultations was 7657 per year and of these, 25% were seen by pediatricians (87% were 10 to 14 years of age). The specialties with the greatest number of consultations were: dentistry (13.3%), orthopedics (13.1%), ear, and nose and throat specialist (8.3%), ophthalmology (7.7%), dermatology (7.2%), psychiatric (5.3%) and obstetrics (5.2%). General medicine and other medical specialties were responsible for 6.4% of the consultations. Yearly about 590 adolescents were admitted, 60.3% in the pediatric ward regardless of the underlying cause. The remaining were admitted to the surgical ward, orthopedics ward and obstetrics/gynecology ward.

CONCLUSION

With the proposed new age limit policy we expect a 10% overall increase in the numbers of patients in the pediatric ED, 6.4% in the pediatric outpatients and 15.5 as inpatients. Adolescents will represent 33.7 of the pediatrics total inpatients population. Management of the patients will require the development of new installations, the training of medical professionals, both pediatric and adult health careers, that will in the future deal with this patient group.

Need of expansion of special adolescent clinic

A cross sectional study has been done over a period of one year to find out the total number of young people, adolescents and youth attending at general gynaecological OPD and special adolescent clinic and to analyse them in terms of their sex, ethnicity, address, marital status, education, occupation and their health problems in a teaching hospital at Kathmandu. Of the total 2480 patients 31.29% were young people, 18.34% of them were adolescents and 30.52% of them were youth. Male attendance was insignificant. Majority (91%) of the young people were Brahmins, Newars and Chhetriyas. Most (91%) of them were from Kathmandu valley, 73% were already married and 60% had experienced pregnancy. Approximately 12% of these people were illiterate, 24.85% of them had not completed the primary level education. Only 19%of them had completed the SLC examination Lack of education, trend of early marriage has been reflected on to their occupation. 64% of them are engaged in routine household work as housewives. Few (4.3%) of these young people were not doing anything at all. Majority (59%) of them presented with pregnancy related problems and rest of them came for problems like Pelvic infection, urinary tract infection, sub fertility, breast problems and others. This study conclude that good number of young people from different parts of the country attend special adolescent clinic with different needs. Therefore adolescent friendly services in the hospital need to be strengthened to provide special care for them.

Achieving quality health services for adolescents

In recent years, there has been an increased national focus on assessing and improving the quality of health care. This statement provides recommendations and criteria for assessment of the quality of primary care delivered to adolescents in the United States. Consistent implementation of American Academy of Pediatrics recommendations (periodicity of visits and confidentiality issues), renewed attention to professional quality-improvement activities (access and immunizations) and public education, and modification of existing quality-measurement activities to ensure that quality is delivered are proposed as strategies that would lead to improved care for youth.

Adolescents perception of reproductive health care services in Sri Lanka

BACKGROUND

Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery.

METHODS

This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17-19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done.

RESULTS

Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners.

CONCLUSIONS AND RECOMMENDATIONS

Adolescent health services are inadequate and available services are not being delivered in an acceptable manner. Proper training of health care providers on youth friendly service provision is essential. A National level integrated health care program is needed for the adolescents.

Chlamydia trachomatis reinfection rates among female adolescents seeking rescreening in school-based health centers

BACKGROUND

Chlamydia trachomatis (CT) infections are common among adolescents attending high and middle schools. The study objective was to determine the reinfection rates of CT for females attending school-based health centers.

METHODS

Adolescents attending school-based health centers who reported they were sexually active were screened for CT using nucleic acid amplification tests on cervical or urine samples. Between 1996 and 2003, 10,609 female students were tested. The overall annual prevalence for unduplicated students in a calendar year ranged from 15.1% to 19.5%. Reinfection was defined as a positive test result occurring between 30 and 365 days after an initial positive result.

RESULTS

There were 897 female students who tested positive for CT and returned for at least 1 subsequent test between 30 and 365 days later. Of these, 236 had 1 or more subsequent positive tests for a cumulative incidence of reinfection in 1 year of 26.3% (95% confidence interval = 23.4-29.2%). Young age at first infection was significantly associated with increased risk of subsequent infection (P <0.01). Across sites, the cumulative incidence of reinfection in these female students ranged from 14.3% to 38.9%.

CONCLUSIONS

The chlamydia cumulative incidence of reinfection in these female adolescents attending high and middle schools was high and supports the Centers for Disease Control and Prevention recommendation to screen adolescents frequently, especially those with a history of a previous chlamydia infection.

Six- and twelve-month outcomes among homeless youth accessing therapy and case management services through an urban drop-in center

RESEARCH OBJECTIVE

To evaluate the impact of case management and individual therapy offered through a drop-in center for homeless youth on substance use, mental health, housing, education, employment, and medical care utilization.

STUDY POPULATION

All youth (n=172) between the ages of 14-24 who accessed treatment services through an urban, southwestern drop-in center were included.

DATA SOURCE

Semistructured and self-report questionnaires were administered to youth between October 2002 and April 2005.

STUDY DESIGN

A repeated measures design was utilized. Youth were assessed at baseline, 6 months, and 12 months postbaseline. Hierarchical linear modeling was used to test the hypotheses.

PRINCIPAL FINDINGS

Statistically significant improvements were found in substance abuse, mental health, and percent days housed up to 12 months postbaseline. Decreased alcohol and drug use was associated with an increase in housing. However, most youth did not acquire permanent housing, and education, employment, and medical service utilization did not significantly change over time.

CONCLUSIONS

While treatment offered through drop-in centers for homeless youth can positively impact homeless youth, policy, funding, and service provision need greater focus, collaboration, and support if youth homelessness is to be successfully addressed.

Labeling disorder--the relationship between conduct problems and drug use in adolescents

OBJECTIVE

To verify how conduct disorder and conduct problems are associated with gender, age at onset of drug use and categories of drugs used.

METHOD

A test of association was conducted between the presence of comorbidity and gender. Mean age of first use of each drug was compared to mean age of first arrest, of first robbery/theft, and of first drug dealing.

RESULTS

In this sample, approximately 59% of adolescents had already robbed and/or stolen, 38.6% had already been arrested, 32.3% had prior history of drug dealing, 24.1% had depression, and 9.6% had conduct disorder. Prevalence of conduct problems was 65.2%. Tobacco, alcohol, marijuana and cocaine were used before the first robbery and/or theft, first drug dealing, and first arrest.

DISCUSSION

The fact that drug use onset preceded illegal acts suggests that the latter are the consequence of the consumption of the former, or perhaps, the consequence of "social invisibility" (feeling of not belonging to anything or to anybody) by which these youths undergo.

CONCLUSIONS

Labeling these youths as conduct-disordered adolescents may cloud a rather different reality, and it may submit them to more social isolation and stigmatization as well.