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Objectives: To determine the proportion of Australian adolescent girls who experience menstrual pain (dysmenorrhea); to assess associations of dysmenorrhea and period pain severity with adolescents missing regular activities because of their periods. Study design: Prospective, population‐based cohort study; analysis of Longitudinal Study of Australian Children (LSAC) survey data. Setting, participants: Female adolescents in the nationally representative cross‐sequential sample of Australian children recruited in 2004 for the Kinder cohort (aged 4–5 years at enrolment). Survey data from waves 6 (mean age 14 years), wave 7 (16 years) and wave 8 (18 years) were analysed. Main outcome measures: Severity of period pain during the preceding three months (very, quite, a little, or not at all painful); number of activity types missed because of periods; relationship between missing activities and period pain severity. Results: Of the 1835 participating female members of the LSAC Kinder cohort at waves 6 to 8, 1600 (87%) responded to questions about menstruation during at least one of waves 6 to 8 of data collection. At wave 6 (14 years), 227 of 644 respondents (35%) reported dysmenorrhea, 675 of 1341 (50%) at wave 6 (16 years), and 518 of 1115 (46%) at wave 8 (18 years). Of the 366 participants who reported period pain severity at all three waves, 137 reported no dysmenorrhea at all three waves (37%), 66 reported dysmenorrhea at all three waves (18%), 89 reported increasing period pain over time (24%), and 38 reported declining pain (10%). At wave 6, 223 of 647 participants reported missing at least one activity because of their periods (34%), 454 of 1341 at wave 7 (34%), and 344 of 1111 at wave 8 (31%). Of the participants who experienced very painful periods, 72% (wave 6), 63% (wave 7), and 65% (wave 8) missed at least one activity type because of their periods, as did 45% (wave 6), 36% (wave 7), and 40% (wave 8) of those who experienced quite painful periods. Conclusions: A large proportion of adolescent girls in Australia experience period pain that affects their engagement in regular activities, including school attendance. Recognising adolescent period pain is important not only for enhancing their immediate quality of life with appropriate support and interventions, but also as part of early screening for chronic health conditions such as endometriosis. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Care must be taken to mitigate the effect of cognitive bias in times of frequent common presentations. The etiology of bicytopenias and pancytopenias must always be carefully investigated. Blast cells in low count B ALL may not be seen on a peripheral smear and diagnosis often requires confirmational bone marrow aspirate with flow cytometry and molecular typing. [ABSTRACT FROM AUTHOR]

Background/Purpose: Exposure to sunlight has been shown to cause pigmentary alterations, photoaging and photocarcinogenesis. Understanding photoprotective patterns in adolescent populations is beneficial to public health initiatives. We utilized data provided by the American College Health Association's National College Health Assessment to evaluate photoprotective behaviors among adolescent populations. Methods: Behavioral questions related to photoprotection were analyzed from the American College Health Association (ACHA) National College Health Assessment (NCHA) (Version III). Results: When comparing races, Black/African American respondents had the lowest association of practicing photoprotective behaviors in comparison to white respondents (p <.05). When comparing US geographic regions, the south had the lowest association of photoprotective measures (p <.05). Limitations: The response rate of each institution varied, although there was still a large quantity of respondents. Finally, we cannot discern the specific reasoning for adolescent populations not using sunscreen. Conclusion: These data identify demographics where efforts to enhance education on photoprotective behaviors, specifically among skin of color and southern population, to support public health initiatives. [ABSTRACT FROM AUTHOR]

This document explores the significance of culture and identity in promoting positive health outcomes and wellbeing for Australian children and adolescents, with a particular focus on Indigenous peoples and marginalized groups. It emphasizes the importance of policies that respect and support cultural practices and identities. The document also highlights the lack of national indicators for measuring cultural wellbeing and suggests including measures such as cultural pride, language proficiency, experiences of racism, and the impact of cultural wellbeing on health outcomes. It further discusses the concepts of resilience, social determinants of health, and cultural determinants of health and wellbeing, emphasizing the role of cultural practices and connections in building resilience and improving outcomes in various aspects of life. The document stresses the need for a collaborative, inter-sectoral approach to address the complex drivers of wellbeing and ill health, and recognizes the potential benefits of Indigenous perspectives and practices for mainstream systems and social determinants. It also emphasizes the principles of self-determination, freedom from discrimination and assimilation, and collective rights, and suggests the need for alternative measures of wellbeing that capture people's feelings about their lives and cultural identity. The document was funded by the Victorian Health Promotion Foundation (VicHealth). [Extracted from the article]

This article discusses the importance of monitoring the physical and mental health of Australian children and young people. It emphasizes the need for accurate data on indicators such as overweight and obesity, mental health problems, and risk factors for these conditions. The article suggests integrating existing survey systems to provide a comprehensive and sustainable way of tracking the health of young populations. It also highlights the importance of addressing health inequities and prioritizing the needs of vulnerable groups. The article recommends connecting existing survey systems to create a national data system that provides continuous developmental data up to age 24, as well as more frequent surveys and the inclusion of measures for positive development indicators. It also emphasizes the need for a centralized data visualization platform to improve data utilization. These improvements aim to enhance the physical and mental health of young Australians. [Extracted from the article]

Introduction: Diagnosing von Willebrand Disease (VWD) in adolescent females is challenging as menstruation and physiologic stress elevate von Willebrand factor (VWF) laboratory values. Aim: To develop a VWF prediction model for adolescent females based on initial VWF results. Methods: We identified female patients aged 9 to 21 years with any VWF laboratory test over a 5‐year period (2017–2021) at any Texas Children's Hospital facility. Patient demographics, VWF testing, haemoglobin concentration, serum ferritin and site of clinical testing were collected (initial and subsequent laboratory evaluations). A Bayesian linear regression model was developed. Prediction intervals were analysed to identify thresholds for patients in whom repeat testing was unlikely to identify low VWF levels (< 50%), consistent with VWD. Results: A total of 6125 adolescent females underwent VWF testing; 1204 (19.7%) had repeat testing. Based on the prediction model, initial VWF antigen values of 80%, 90% and ≥100% carried a 92.6%, 96.6% and ≥98.0% probability of having repeat normal repeat VWF values, respectively. Subjects assessed in outpatient adolescent medicine or gynaecology clinics were more likely to have low VWF values compared to those assessed in the acute care setting (p <.001). Median presenting haemoglobin and serum ferritin were 12.4 g/dL and 13 ng/mL, respectively and were similar in those with normal versus low VWF antigen values. Conclusion: Repeat testing in adolescent females whose initial VWF antigen values are ≥90% is unlikely to identify additional patients with VWD. Iron deficiency screening should be performed in all adolescent females. [ABSTRACT FROM AUTHOR]

Purpose: Teenagers experience high rates of rejection and organ failure after heart transplantation due to non‐adherence to medications, poor transition into adult care, and difficulties communicating with adults including healthcare providers. This project aimed to creatively bridge this gap—including teenage patients, their parents, and healthcare providers in the development of a new resource meant to motivate teenage heart‐transplant‐patients to take interest and ownership of their long‐term health. Methods: Four teenage heart‐transplanted patients, four parents, and three healthcare providers provided insight into relevant content for an educational resource through semi‐standardized questionnaires and interviews. Their input guided the style and substance of the resource developed under the supervision of Fine Arts professors and the pediatric heart transplant team. Results: Parents and healthcare providers were concerned about teenagers' health choices and lack of perspective while patients were more bothered by parental nagging and being careful about infections than worrying about post‐transplant risks. The resource that was developed therefore used subtlety within a narrative medium: a graphic novel that involved mutant worms, secret plots, and daring escapes, to address identified medical concerns and encouragements without triggering teenage resistance to instruction. Conclusion: The discrepancies between the priorities of healthcare providers, parents, and teenage heart‐transplant‐patients illustrate the significance of basing resource‐development on input from the target population. We developed the first graphic novel written for teenage heart‐transplant‐patients with patient input and interdisciplinary cooperation, using the subtlety of a narrative medium as a model for integrating medical content within an appealing, motivational, patient‐centered, and age‐appropriate resource. [ABSTRACT FROM AUTHOR]

The article discusses the neglect of menstrual pain in adolescents and its impact on individuals with persistent pelvic pain. The authors highlight the frequency and severity of dysmenorrhea (period pain) in Australian adolescents and emphasize the importance of early identification and treatment to improve quality of life and minimize school and work absences. The article also addresses the complex factors contributing to persistent pelvic pain and the need for evidence-based interventions. The authors suggest that the continuous use of oral contraceptives can be a simple method for managing dysmenorrhea but note that it is underused. They argue that menstrual and pelvic pain should be recognized and addressed to improve the long-term outcomes for individuals. [Extracted from the article]

Keywords: Informed consent; Legislation, medical; Medicolegal; Gender identity; Hormone replacement therapy; Community care; Physician-patient relations; Adolescent medicine EN Informed consent Legislation, medical Medicolegal Gender identity Hormone replacement therapy Community care Physician-patient relations Adolescent medicine 230 233 4 03/22/22 20220315 NES 220315 It is essential that clinicians know the law to shape its evolution In Australia, and across the world, an estimated 2-3% of young people identify as transgender and/or gender diverse (trans),1 with a gender identity that is not congruent with their sex assigned at birth. If there is a dispute about consent or treatment, a doctor should not administer stage 1, 2 or 3 treatment without court authorisation [63].". [Extracted from the article]

Objective: To assess knowledge, attitudes, and perceived barriers (KAP) regarding e‐cigarette use counselling among adolescent healthcare clinical staff in an urban system, and to compare results between providers and rooming staff. Methods: Primary care clinical staff (n = 169) completed an anonymous survey. Descriptive statistics and Chi‐square tests were used to summarize data and compare KAP between medical providers and rooming staff. Results: Staff wanted to learn more about e‐cigarettes (87.6%). The most common knowledge deficits were how to use the 5As + 5Rs model for tobacco cessation counselling (66.7%) and the chemical content of e‐liquids (55.4%), with no differences across groups. Overall, 58% of providers expressed confidence in their ability to talk with adolescent patients about e‐cigarette use. The most common barriers to counselling were low knowledge about e‐cigarettes (74.0%) and how to refer adolescent patients for cessation support (43.8%). Conclusions: Provider and rooming staff expressed similar educational needs surrounding e‐cigarettes, counselling, and treatment for adolescent patients. Clinical staff expressed confidence in their ability to affect change. There were no differences in the identified knowledge gaps or barriers to care between rooming staff and providers, suggesting that the same educational format can be used to target both groups. [ABSTRACT FROM AUTHOR]

Aim: The right of underaged patients to confidential health care should be considered an inalienable human right. Access to such care is also advisable according to contemporary medical knowledge. The aim of this study was to verify the extent this right is exercised in Poland and to examine social attitudes towards this issue. Methods: A sample of Polish school‐age pupils and parents (n = 800) was surveyed using an online questionnaire. Results: Only 4.2% of the surveyed adolescents were offered private time with a doctor during their last preventive visit (well‐child visit), and this was more frequent for girls. At the same time, a very high level of acceptance for private time with a doctor was observed among Polish adolescents (90.8%) and their parents (84.3%). Conclusion: Our findings suggest serious deficiencies in the protection of adolescent patients confidentiality. It is necessary to change medical practice and adapt legal regulations to the provisions of the Convention on the Rights of the Child. [ABSTRACT FROM AUTHOR]

Human papillomavirus oral papilloma is often sexually transmitted, but non-sexual modes of transmission should be considered, including autoinoculation from skin lesions. A patient-centered multimodality approach should be utilized in the pediatric population. [ABSTRACT FROM AUTHOR]

Neurocutaneous melanosis (NCM) is a rare phakomatosis that may be associated with intracerebral masses. The differential diagnosis of intracerebral masses in NCM is often challenging and should include pigmented and nonpigmented lesions. [ABSTRACT FROM AUTHOR]

Hypothyroidism and diabetes insipidus present in children with Aicardi Goutières Syndrome (AGS) often years after disease onset and frequently resolve spontaneously. Screening and regular reassessment for both conditions are recommended in all children with AGS. [ABSTRACT FROM AUTHOR]

Background: Domestic minor sex‐trafficked (DMST) youth experience profound medical and mental health consequences. This retrospective study reviewed healthcare utilization patterns and documented individualized risk factors of sex‐trafficked youth in the 5 years prior to presenting to a healthcare setting. The primary aim of this study was to examine healthcare utilization patterns among DMST youth with the goal of determining opportunities for earlier identification within the healthcare system. Methods: A chart review was conducted of all patients <18 years old referred for suspected or confirmed sex trafficking to a child and adolescent protection centre (CAPC) in an urban, academic children's hospital in Washington, DC from January 1, 2006 to March 1, 2017. Patients were seen by a child abuse pediatrician or a trauma‐informed social worker in an inpatient, outpatient, or emergency department setting. Demographics and medical, psychiatric, and social history were abstracted from encounters within the hospital's healthcare system along with provider concern for DMST up to 5 years prior to their initial CAPC visit. Descriptive statistics were performed. Results: Thirty‐nine patients were identified with a mean age of 14.6 years (SD = 1.7). Ninety percent (n = 35/39) of patients were seen in the healthcare system within the 5 years prior to their initial CAPC visit, totaling 191 encounters. Of the visits, 57% (n = 108/191) occurred in the emergency department. The most common chief complaints for encounters were psychiatric (21%, n = 41/191). Less than half of the youth, 43%, had any documented provider concern for sex trafficking in their medical record prior to identification as DMST. Conclusion: Most of this cohort was previously evaluated within the healthcare system. However, there was limited provider documentation of concern for DMST despite the presence of risk factors. Provider recognition of youth at risk for DMST is crucial for providing care for youth. [ABSTRACT FROM AUTHOR]

Keywords: General practice; Mental health policy; Prescribing; COVID-19; Primary health care; Psychotropic drugs; Adolescent medicine EN General practice Mental health policy Prescribing COVID-19 Primary health care Psychotropic drugs Adolescent medicine 26 27 2 06/30/23 20230701 NES 230701 The mental health of children and adolescents was harmed by the coronavirus disease 2019 (COVID-19) pandemic, partly because of reduced access to social and wider family support networks and disruptions to school-based services.[1] The prescribing of psychotropic medications by general practitioners, 84.7% of mental health-related prescribing in Australia,[2] is a key indicator of mental health care activity. General practice, Mental health policy, Prescribing, COVID-19, Primary health care, Psychotropic drugs, Adolescent medicine Psychotropic medication prescribing for children and adolescents by general practitioners during the COVID-19 pandemic. [Extracted from the article]

This study aims to understand the role that optimism could play in the context of a health asset approach to promote adolescent health-related quality of life (HRQOL). Adolescents (n = 948), between 11 and 16 years old from a medium-sized rural town in Sweden, answered questionnaires measuring optimism, pessimism, and HRQOL. The findings indicate a significant decrease in optimism and a significant increase in pessimism between early and midadolescence. The study has allowed us to present associational evidence of the links between optimism and HRQOL. This infers the potential of an optimistic orientation about the future to function as a health asset during adolescence and by implication may provide additional intervention tool in the planning of health promotion strategies. [ABSTRACT FROM AUTHOR]

Abstract: Obesity is an ongoing global health concern and has only recently been recognized as a chronic disease of energy homeostasis and fuel partitioning. Obesity afflicts 17% of U.S. children and adolescents. Severe obesity (≥120% of the 95th percentile of body mass index (BMI) for age, or a BMI ≥ 35 kg/m2) is the fastest‐growing subgroup and now approaches 6% of all U.S. youth. Health consequences (eg, type 2 diabetes, coronary heart disease) are related in a dose‐dependent manner to severity of obesity. Because therapeutic interventions are less effective in severe obesity, prevention is a high priority. Treatment plans involving combinations of behavioral therapy, nutrition, and exercise achieve limited success. Only one drug, orlistat, is U.S. Food and Drug Administration approved for long‐term obesity management in adolescents 12 years and older. As part of comprehensive medication management, clinicians should consider the propensity for a given drug to aggravate weight gain and to consider alternatives that minimize weight impact. Medication management must take into account developmental changes as well as the pathophysiology of obesity and comorbidities. Despite expanding insight into obesity pathophysiology, there are gaps in its translation to therapeutic application. The historical construct of obesity as simply a fat‐storage disorder is fundamentally inaccurate. The approach to adjusting doses based solely on body size and extrapolating from therapeutic knowledge of adult obesity may be based on assumptions that are not fully substantiated. Classes of drugs commonly prescribed for comorbidities associated with obesity should be prioritized for clinical research evaluations aimed at optimizing dosing regimens in pediatric obesity. [ABSTRACT FROM AUTHOR]

Adolescent decision-making is highly sensitive to input from the social environment. In particular, adult and maternal presence influence adolescents to make safer decisions when encountered with risky scenarios. However, it is currently unknown whether maternal presence confers a greater advantage than mere adult presence in buffering adolescent risk taking. In the current study, 23 adolescents completed a risk-taking task during an fMRI scan in the presence of their mother and an unknown adult. Results reveal that maternal presence elicits greater activation in reward-related neural circuits when making safe decisions but decreased activation following risky choices. Moreover, adolescents evidenced a more immature neural phenotype when making risky choices in the presence of an adult compared to mother, as evidenced by positive functional coupling between the ventral striatum and medial prefrontal cortex. Our results underscore the importance of maternal stimuli in bolstering adolescent decision-making in risky scenarios. [ABSTRACT FROM AUTHOR]

Inhibitory control (i.e., the ability to resist automatisms, temptations, distractions, or interference and to adapt to conflicting situations) is a determinant of cognitive and socio-emotional development. In light of the discrepancies of previous findings on the development of inhibitory control in affectively charged contexts, two important issues need to be addressed. We need to determine (a) whether cool inhibitory control (in affectively neutral contexts) and hot inhibitory control (in affectively charged contexts) follow the same developmental pattern and (b) the degree of specificity of these two types of inhibitory control at different ages. Thus, in the present study, we investigated the developmental patterns of cool and hot inhibitory control and the degree of specificity of these abilities in children, adolescents and adults. Typically developing children, adolescents, and adults performed two Stroop-like tasks: an affectively neutral one ( Cool Stroop task) and an affectively charged one ( Hot Stroop task). In the Cool Stroop task, the participants were asked to identify the ink color of the words independent of color that the words named; in the Hot Stroop task, the participants were asked to identify the emotional expression of a face independent of the emotion named by a simultaneously displayed written word. We found that cool inhibitory control abilities develop linearly with age, whereas hot inhibitory control abilities follow a quadratic developmental pattern, with adolescents displaying worse hot inhibitory control abilities than children and adults. In addition, cool and hot inhibitory control abilities were correlated in children but not in adolescents and adults. The present study suggests (a) that cool and hot inhibitory control abilities develop differently from childhood to adulthood - i.e., that cool inhibition follows a linear developmental pattern and hot inhibition follows an adolescent-specific pattern - and (b) that they become progressively more domain-specific with age. [ABSTRACT FROM AUTHOR]

Background Impairments in macrovascular, microvascular and autonomic function are present in asymptomatic youths with clustered cardiovascular disease risk factors. This study determines the within-day reliability and between-day reliability of a single protocol to non-invasively assess these outcomes in adolescents. Methods Forty 12- to 15-year-old adolescents (20 boys) visited the laboratory in a fasted state on two occasions, approximately 1 week apart. One hour after a standardized cereal breakfast, macrovascular function was determined via flow-mediated dilation ( FMD). Heart rate variability (root mean square of successive R-R intervals; RMSSD) was determined from the ECG-gated ultrasound images acquired during the FMD protocol prior to cuff occlusion. Microvascular function was simultaneously quantified as the peak ( PRH) and total ( TRH) hyperaemic response to occlusion in the cutaneous circulation of the forearm via laser Doppler imaging. To address within-day reliability, a subset of twenty adolescents (10 boys) repeated these measures 90 min afterwards on one occasion. Results The within-day typical error and between-day typical error expressed as a coefficient of variation of these outcomes are as follows: ratio-scaled FMD, 5·1% and 10·6%; allometrically scaled FMD, 4·4% and 9·4%; PRH, 11% and 13·3%; TRH, 29·9% and 23·1%; and RMSSD, 17·6% and 17·6%. The within- and between-day test-retest correlation coefficients for these outcomes were all significant ( r > 0·54 for all). Conclusion Macrovascular, microvascular and autonomic functions can be simultaneously and non-invasively determined in adolescents using a single protocol with an appropriate degree of reproducibility. Determining these outcomes may provide greater understanding of the progression of cardiovascular disease and aid early intervention. [ABSTRACT FROM AUTHOR]

SOFT and BAR scores utilize recipient, donor, and graft factors to predict the 3-month survival after LT in adults (≥18 years). Recently, Pedi- SOFT score was developed to predict 3-month survival after LT in young children (≤12 years). These scoring systems have not been studied in adolescent patients (13-17 years). We evaluated the accuracy of these scoring systems in predicting the 3-month post- LT survival in adolescents through a retrospective analysis of data from UNOS of patients aged 13-17 years who received LT between 03/01/2002 and 12/31/2012. Recipients of combined organ transplants, donation after cardiac death, or living donor graft were excluded. A total of 711 adolescent LT recipients were included with a mean age of 15.2±1.4 years. A total of 100 patients died post- LT including 33 within 3 months. SOFT, BAR, and Pedi- SOFT scores were all found to be good predictors of 3-month post-transplant survival outcome with areas under the ROC curve of 0.81, 0.80, and 0.81, respectively. All three scores provided good accuracy for predicting 3-month survival post- LT in adolescents and may help clinical decision making to optimize survival rate and organ utilization. [ABSTRACT FROM AUTHOR]

Solid organ transplantation requires ongoing adherence to immunosuppressants and other medications. Although adolescence is a risk factor for poor medication-taking, little is known about the patterns of adherence within individuals over time. This study aimed to examine the stability of adherence over time using three different assessment techniques. Sixty-six AYA transplant recipients and/or their caregiver completed interviews of adherence at baseline and at least one yr later. Serum immunosuppressant assay levels were collected via medical chart review. Non-adherence percentages based on AYA report, caregiver report, and bioassay did not differ from Time 1 to Time 2. However, correlations for these measures across time were non-significant. Further, the majority of AYAs shifted to a different adherence category from Time 1 to Time 2. Overall, these results demonstrate individual variability in non-adherence over the course of adolescence and young adulthood and highlight the importance of frequent assessment across time for solid organ transplant recipients. [ABSTRACT FROM AUTHOR]

Aims The aims of this study are to provide a profile of sexual health behaviours of Māori youth and to identify factors associated with consistent condom and contraception use. Methods Multivariable analyses were conducted to determine relationships between consistent contraception and condom use among all 2059 sexually active Māori participants in the 2007 New Zealand youth health and well-being survey of secondary school students. Results Forty per cent of Māori students were currently sexually active; of these, 55.3% always used contraception, and 41.1% always used condoms. Risk factors for not using contraception were less than or equal to three sexual partners (males odds ratio ( OR) 0.55, P = 0.04, females OR 0.35, P = 0.04) and regular cigarette use for females ( OR 0.52, P = 0.02). Risk factors for not using condoms were 13- to 15-year-old females ( OR 1.95, P < 0.01) and females who enjoyed sex ( OR 0.52, P = 0.02). Family connection was associated with increased use of condoms among males ( OR 1.07, P < 0.01). Conclusions Reducing sexual risks, increasing opportunities for healthy youth development and family connectedness, alongside access to appropriate services, are required to improve the sexual health of Māori youth. [ABSTRACT FROM AUTHOR]

Aim This study aimed to measure protective factors and risk behaviour among adolescents with chronic conditions ( CCs) and to evaluate the impact of protective factors on risk-taking. Methods A population-based study of 7262 students aged 15 and 17 years old was performed in Sörmland, Sweden 2008 (response rate 82%). The questionnaire explored background factors, CCs, risk behaviours and protective factors. CCs were reported by 8%, while 58% had no health problems. Results Girls with CCs encompassed less individual protective factors, while boys with CCs tended to over-report all individual risk behaviours compared with healthy peers. Both boys and girls with CCs were more likely to report few protective factors and co-occurrence of risk behaviours. The adj OR for clustered health risk behaviours was 1.6 (1.0-2.5) in youths with CCs and ≥4 protective factors and 6.3 (3.6-10.9) in youths with CCs and 0-3 protective factors, as compared to healthy peers with ≥4 protective factors. Conclusion Adolescents with CCs reported fewer protective factors and more risk behaviours than their healthy peers. The vulnerability of adolescents with CCs and few protective factors is important to acknowledge. Professionals should provide stronger protection for these adolescents, to prevent risky behaviour. [ABSTRACT FROM AUTHOR]

Aim Many health professionals report interest in consulting more effectively with young people but have unmet training needs. We set out to evaluate a teaching resource in adolescent health and medicine that was designed for Australian trainees in specialist medicine. Methods Thirty-two paediatric and adult trainees of the Royal Australasian College of Physicians completed a pre-evaluation questionnaire to assess attitudes and confidence in working with young people. They were then provided with a training resource and, 6 weeks later, completed a post-evaluation questionnaire. Repeated-measures anovas were used to assess changes in attitudes, self-reported knowledge and confidence by trainee type. χ2-tests were used to compare variation in the use of and opinions about the resource. Results Trainees' awareness of the health issues that affect young people, confidence in working with young people and confidence in their knowledge greatly improved after using the resource. Beforehand, adult medicine trainees scored lower than paediatric trainees. A relatively higher rate of improvement resulted in similar scores between trainee types after using the resource, which was rated equally highly by the different groups of trainees. Conclusions As a result of significant gains in the confidence of specialist medicine trainees after access to the resource, it will now be made available for Australian trainees in specialist medicine. [ABSTRACT FROM AUTHOR]

Adolescents aged 15-18 years with acute lymphoblastic leukaemia ( ALL) have been historically reported to have a poorer prognosis than younger children. We retrospectively analysed the characteristics and outcome of 67 adolescents included in a population-based series of 1125 non-infant cases that were enrolled into four Austrian ALL- BFM (Berlin-Frankfurt-Münster) multicentre trials at paediatric institutions within a 25-year period. Five-year event-free survival ( EFS) and overall survival ( OS) were 66 ± 6% and 76 ± 5% respectively, and thus lower than in younger children (83 ± 1%, 91 ± 1%; P < 0·001). This was not due to an increased cumulative incidence of relapse (CIR) (5-year CIR: 19 ± 5% vs. 13 ± 1%; P = 0·284), but due to an increased incidence of treatment-related death [5-year cumulative incidence of death ( CID): 15 ± 4% vs. 3 ± 0%; P < 0·001] as a first event. Furthermore, while 44/67 (66%) non-high-risk adolescents had favourable 5-year EFS and OS rates (76 ± 7%, 89 ± 5%), 18/67 (27%) high-risk adolescents had an inferior outcome (5-year EFS: 56 ± 12%, OS 61 ± 11%, P < 0·05). Among the latter patients the CID was significantly higher than in younger high-risk children (22 ± 10% vs. 6 ± 2%; P = 0·020). Given that adolescent age is an independent risk factor for death as a first event, this specific age group may need particular vigilance when receiving intense BFM-type chemotherapy, as relapse-free survival is similar to younger children. [ABSTRACT FROM AUTHOR]

The author describes the shocking rapidity of bodily change which overtakes the pubescent and adolescent body while the mind may be still that of a child. She describes the way that these changes can make the child feel trapped in a body so alarming that she is filled with claustrophobic fears and agoraphilic longings for freedom from it. These are translated into anorexic behaviours whose denial of her body with its feelings and desires result in a loss of contact with it. The results instead are agoraphobic terrors and claustrophilic longings which translate into bulimic behaviours. The author describes the way in which she uses Ferrari's conceptual framework in order to break this claustrophobic-agoraphobic see-saw and to gradually accustom her patients to their new corporeal environment together with its issues of gender identity and sexuality using several clinical examples. [ABSTRACT FROM AUTHOR]

Background: Depression is common and frequently undiagnosed among college students. Social networking sites are popular among college students and can include displayed depression references. The purpose of this study was to evaluate college students' Facebook disclosures that met DSM criteria for a depression symptom or a major depressive episode (MDE). Methods: We selected public Facebook profiles from sophomore and junior undergraduates and evaluated personally written text: 'status updates.' We applied DSM criteria to 1-year status updates from each profile to determine prevalence of displayed depression symptoms and MDE criteria. Negative binomial regression analysis was used to model the association between depression disclosures and demographics or Facebook use characteristics. Results: Two hundred profiles were evaluated, and profile owners were 43.5% female with a mean age of 20 years. Overall, 25% of profiles displayed depressive symptoms and 2.5% met criteria for MDE. Profile owners were more likely to reference depression, if they averaged at least one online response from their friends to a status update disclosing depressive symptoms (exp(B) = 2.1, P<.001), or if they used Facebook more frequently (P<.001). Conclusion: College students commonly display symptoms consistent with depression on Facebook. Our findings suggest that those who receive online reinforcement from their friends are more likely to discuss their depressive symptoms publicly on Facebook. Given the frequency of depression symptom displays on public profiles, social networking sites could be an innovative avenue for combating stigma surrounding mental health conditions or for identifying students at risk for depression. Depression and Anxiety, 2011. © 2011 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Aims To examine the longitudinal associations in both directions between mental health and substance use in adolescence. Design Three-year longitudinal cohort. Setting Britain (nationally representative sample). Participants 3607 youths aged 11–16 years at baseline. Measurements Externalizing and internalizing mental health problems were measured using brief questionnaires (parent-reported Strengths and Difficulties Questionnaire) and diagnostic interviews, including clinician-rated diagnoses of mental disorder. Substance use was measured by youth self-report, and included regular smoking, frequent alcohol consumption, regular cannabis use and ever taking other illicit drugs. Findings Externalizing (specifically behavioural) problems at baseline independently predicted all forms of substance use, with a particularly strong effect on smoking. In all cases this association showed a dose–response relationship. In contrast, although internalizing problems had a strong univariable association with smoking, this disappeared after adjusting for comorbid externalizing problems. There was little or no evidence that baseline substance use predicted mental health at follow-up. Conclusions Externalizing problems predict adolescent substance use, and adjusting for comorbid externalizing problems is vital when investigating the effects of internalizing problems. A dose–response effect of externalizing problems is seen across the full range. Programmes seeking to prevent adolescent substance use by reducing externalizing problems may therefore wish to consider population-wide interventions rather than targeting individuals only at the negative extreme. [ABSTRACT FROM AUTHOR]

The benefits of a minimally invasive approach are now well documented in adult women, and thus surgeons have embraced the notion of expanding such expertise in adolescence with measured enthusiasm and a great sense of responsibility. Faster recovery is likely to have a positive impact on schooling, while less adhesion formation may reduce future fertility issues. Gynaecologists performing minimally invasive procedures in adolescents ought to be aware of the steep learning curve required for achieving proficiency with complex laparoscopic surgery. In the group of rare congenital anomalies and advanced endometriosis, the best surgical results can only be achieved after careful preoperative planning by a multidisciplinary team [ABSTRACT FROM AUTHOR]

Objective Shared decision making may increase satisfaction with health care and improve outcomes, but little is known about adolescents’ decision-making preferences. The primary purpose of this study is to describe the decision-making preferences of adolescents with chronic illnesses and their parents, and the extent to which they agree. Design Survey. Setting and participants Participants were 82 adolescents seen at one of four paediatric chronic illness subspecialty clinics and 62 of their parents. Main variables Predictor variables include sociodemographics, health parameters, risk behaviour, and physical and cognitive development. The main outcome variable is preferences for decision-making style. Results and conclusions When collapsed into three response categories, nearly equal percentages of adolescents (37%) and parents (36%) preferred shared decision making. Overall, the largest proportion of adolescents (46%) and parents (53%) preferred passive decision making compared to active or shared decision making. Across five response choices, 33% of pairs agreed. Agreement was slight and not significant. Improved general health perceptions (OR = 0.76, 95% CI = 0.59–0.99) and improved behaviour (OR = 0.75, 95% CI = 0.56–0.99) were significantly associated with parents’ preferences for less active decision making. Older age was significantly associated with agreement (OR 1.58, 95% CI = 1.09–2.30) between parents and adolescents. The paucity of significant predictor variables may indicate physicians need to inquire directly about patient and parent preferences. [ABSTRACT FROM AUTHOR]

The article focuses on the therapeutic management of the adolescents with asthma. It discusses the complex transitional changes involved in adolescence which frequently contribute to poor adherence to therapeutic regimens. It explores the inherent risk presented among adolescents which further increases by poor adherence to therapeutic regimens. It highlights the unique aspects of adolescence that must be addressed for successful adherence on the therapeutic regimens.

Drug development is a lengthy, costly, and complex process, with clinical trials essential for characterizing dosing, safety, and efficacy in treated populations. After regulatory approval, aggressive marketing ensures that most drugs are used by a broad spectrum of ages, genders, races, and ethnic groups. Unfortunately, not all groups are adequately represented in clinical trials; adolescents are commonly overlooked. This commentary explores how adolescents are considered during drug development, with a special focus on the influence of inherent psychosocial, biological, ethical, and regulatory issues in their recruitment and participation in clinical studies leading to drug licensing.Clinical Pharmacology & Therapeutics (2008); 84, 6, 655–659 doi:10.1038/clpt.2008.191 [ABSTRACT FROM AUTHOR]

The article discusses the challenges of managing diabetes in adolescents. In the context of type 1 diabetes, many adolescents experience a deterioration in metabolic control. Recommendations for those providing care for adolescents are provided which includes understanding the psychosocial and physiological development of adolescence and identifying the components of care unique to adolescents.

Aim: To enhance our knowledge on why adolescents with a chronic condition (insulin-dependent diabetes mellitus, IDDM) choose to smoke despite possible awareness of health risks. Methods: Twelve patients aged 15–20 with IDDM who smoked cigarettes volunteered to participate in qualitative interviews. The results were analyzed with content analysis according to Miles and Huberman 1994. Results: One set confirmed what is earlier known on cigarette smoking among adolescents, such as plain exploring, needs to conform with group norms, identity needs and denial of risks. Other themes gave new insights. One was the emotional attitudes—or lack of emotions—expressed by important others, which exerted strong influences on the smoking trajectories. These emotions affected both initiation and motivation for quitting cigarette smoking and seemed crucial as means of meaningful communications concerning smoking. One theme was a flow path of cigarette smoking, which demonstrated opportunities for secondary prevention. Finally, developmental reasons for smoking and motivation for quitting could be described. Conclusions: There are several windows of opportunities to lower the risk of adolescents with IDDM and other chronic conditions from becoming and remaining smokers, as reported by young people themselves. [ABSTRACT FROM AUTHOR]

Background: Inpatient treatment is a complex intervention for the most serious mental health disorders in child and adolescent psychiatry. This is the first large-scale study into its effectiveness and costs. Previous studies have been criticised for methodological weaknesses. Methods: A prospective cohort study, including economic evaluation, conducted in 8 UK units (total n = 150) with one year follow-up after discharge. Patients acted as their own controls. Outcome measurement was the clinician-rated Childhood Global Assessment Scale (CGAS); researcher-rated health needs assessment; parent- and teacher-rated symptomatology. Results: We found a significant ( p < .001) and clinically meaningful 12-point improvement in CGAS following mean 16.6 week admission (effect size .92); this improvement was sustained at 1 year follow-up. Comparatively, during the mean 16.4 week pre-admission period there was a 3.7-point improvement (effect size .27). Health needs assessment showed similar gain ( p < .001, effect size 1.25), as did teacher- and parent-rated symptoms. Improvement was found across all diagnoses. Longer stays, positive therapeutic alliance and better premorbid family functioning independently predicted better outcome. Mean cost of admission was £24,100; pre-admission and post-discharge support costs were similar. Conclusions: Inpatient treatment is associated with substantive sustained health gain across a range of diagnoses. Lack of intensive outpatient-treatment alternatives limits any unqualified inference about causal effects, but the rigour of measurement here gives the strongest indication to date of the positive impact of admission for complex mental health problems in young people. [ABSTRACT FROM AUTHOR]

ISSUES AND PURPOSE. Although blunt trauma injury is a common cause for adolescent pain, little is known about the experience of pain as perceived by adolescents. DESIGN AND METHOD. Semistructured interviews were conducted with 13 adolescents following blunt trauma injury. Two age-appropriate valid measures (i.e., Adolescent Pediatric Pain Tool and Temporal Dot Matrix) were incorporated into the interviews to elaborate their pain experiences. Grounded theory method was used to analyze data and build substantive theory. RESULTS. Adolescents’ behavioral and cognitive actions (i.e., “internal control”) to manage and endure pain were influenced by their pain perceptions, physical losses, and clinicians’ actions. PRACTICE IMPLICATIONS. Nurses, family members, and peers have a crucial role in alleviating adolescents’ distress and pain. [ABSTRACT FROM AUTHOR]

Aim: To describe the use of media as a sleep aid in adolescents and relate this to their sleep routines and feelings of tiredness. Methods: A questionnaire about using media as a sleep aid, media presence in bedrooms, time to bed and time out of bed on average weekdays and average weekend days, and questions regarding level of tiredness in the morning, at school, after a day at school and after the weekend was completed by 2546 seventh and 10th grade children in a random sample of 15 schools. Results: Of the adolescents, 36.7% reported watching television to help them fall asleep. In total, 28.2% of the boys and 14.7% of the girls used computer games as a sleep aid. Music was used to fall asleep by 60.2% of the adolescents in this sample. About half of the adolescents read books to fall asleep. Except for reading books, using media as a sleep aid is negatively related to respondents’ time to bed on weekdays, their number of hours of sleep per week and their self-reported level of tiredness. Conclusion: Using media as a sleep aid appears to be common practice among adolescents. Those who reported using music, television, and computer games more often as a sleeping aid slept fewer hours and were significantly more tired. [ABSTRACT FROM AUTHOR]

Aim To examine the effects of group visits and computer-assisted consultations on quality of life and glycaemic control in adolescents with Type 1 diabetes. Methods A total of 116 adolescents, aged 11–17 years, and their parents were randomly assigned to an intervention ( n = 62) or a control group ( n = 54). The intervention group was invited to a 15-month programme comprising group visits and computer-assisted consultations. The control group was offered traditional out-patient consultations. Outcomes included changes in HbA1c and the adolescents’ assessment of generic and disease-specific health-related quality of life measured by the Child Health Questionnaire (CHQ-CF87) and the Diabetes Quality of Life Questionnaire (DQOL), respectively. Results One hundred and one adolescents (55/46) agreed to participate, mean age 14.2 years ( sd 1.5), mean diabetes duration 6.5 years ( sd 3.6, range 1–16 years), mean HbA1c 9.3% ( sd 1.4, range 6.1–12.8%). Eighty-three (72%) completed the questionnaires at follow-up (intervention/control 45/38). There were significant age by randomization group interactions for diabetes-related impact ( P = 0.018), diabetes-related worries ( P = 0.004), mental health ( P = 0.046) and general behaviour ( P = 0.029), implying that the intervention was effective in older adolescents (above 13–14 years). No significant effects on mean HbA1c were identified. Conclusions Group visits and computer-assisted consultations had beneficial effects on health-related quality of life in older adolescents, the role of this intervention being questionable in younger adolescents. [ABSTRACT FROM AUTHOR]

Unlabelled: Adolescent health surveys, like those for other segments of the population, tend to remain in the hands of researchers, where they can have no real impact on the way critical health issues are dealt with by policy makers or other professionals directly connected to young people in their everyday work. This paper reviews important issues concerning the dissemination of survey results among professionals from various fields. The content, length and wording of the messages should be tailored to the audience one wants to reach as well as the type of channels used for their diffusion. Survey data sets can be used to select priorities for interventions: ad hoc presentations, attractive summaries and brochures, or even films expressing young peoples' opinions have been used by European public health professionals to make data sets usable in various local, regional and national contexts.Conclusion: The impact of these diffusion strategies is, however, difficult to assess and needs to be refined. The adequate delivery of survey findings as well as advocacy and lobbying activities require specific skills which can be endorsed by specialized professionals. Ultimately, it is the researchers' responsibility to ensure that such tasks are effectively performed. [ABSTRACT FROM AUTHOR]

Background: Pubertal delay is thought to contribute to suboptimal peak bone mass acquisition in young people with cystic fibrosis (CF), leading to an increased fracture incidence. This study aims to compare pubertal development in young people with CF with that of a local healthy population and assess the influence it has on areal bone mineral density (aBMD). Methods: Tanner stage, age of menarche, bone age (BA), sex hormone levels and aBMD were examined in 85 individuals with CF (aged 5.3–18.1 years, 39 females) and 100 local controls (5.6–17.9 years, 54 females). Results: Tanner stage and age of menarche were not significantly different between controls and CF. Tanner stage-adjusted mean values for follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) were lower in males with CF (FSH: P = 0.004, LH: P = 0.01 and T: P = 0.002). Bone age was delayed in adolescents with CF compared to controls (chronological age–BA: controls = 0.13 years (SE = 0.16), CF = 0.95 years (SE = 0.22), P = 0.003). Areal bone mineral density (adjusted for age, sex, height and lean tissue mass) was not significantly different between CF and controls. Moderate negative correlations were found between delayed BA and weight ( r = −0.41, P < 0.001) and height ( r = −0.41, P < 0.001). Conclusions: There was no evidence of clinical pubertal delay or low aBMD (adjusted for short stature and lean tissue mass) in young people with CF when compared with a local population, despite lower nutritional markers, height and weight and delayed skeletal maturation. [ABSTRACT FROM AUTHOR]

The aim of this article is to consider the current and likely future status of cognitive behaviour therapy (CBT) for disturbed children and adolescents. Two definitions of CBT, narrow and broad, are provided and their core components described. Subsequently the historical development of these therapies and their reception by psychotherapists with different orientations is discussed. Assessment and therapeutic CBT approaches are described and the strength of the evidence for their use is briefly reviewed. Finally the challenges these therapies are currently meeting that might enhance or diminish their value are outlined. It is concluded that CBTs offer a most promising approach in the child and adolescent field and are likely to establish and maintain an important place in the therapeutic armoury of the next generation of professionals concerned to help children and young people with psychiatric disorders. [ABSTRACT FROM AUTHOR]

This paper presents a rationale for the education of CAMHS staff and service development as a partnership between the UK and developing countries. The local context and background of child and adolescent mental health services in India are described, and the rationale for the teaching principles is outlined. The planning and delivery of the teaching, following these principles, is illustrated through a case study of work in India. The discussion focuses on what worked well, problems and difficulties faced, how these were managed, and how visitors can influence change whilst respecting the local perspective. Suggestions are made for improving future programmes so as to maximise the outcomes of such links. [ABSTRACT FROM AUTHOR]

Objective: Sexually transmitted infections (STI) among adolescents continue to be an important public health problem for many industrialized and developing countries. This study evaluated knowledge and behaviour in adolescents regarding prevention of STI.Methods: Information was obtained by using self-reported questionnaire from a random sample of 644 undergraduate students at university and at public high schools aged 14–20 years in Catanzaro (Italy).Results: Only 14.2% of respondents knew about the main STI and that they can be transmitted through sexual intercourse with HIV seropositive partners; this knowledge was significantly higher among adolescents who had had a higher number of sexual partners in their lifetime and who had received information from physicians about STI. A total of 33.8% reported having had sexual intercourse at least once and the mean age at first intercourse was 16 years. Older males and adolescents with employed mothers were more likely to have reported having had a sexual experience. The prevalence of using condoms every time during sexual intercourse was 51.8% and such behaviour was more likely in younger adolescents and males. The prevalence of condom use on the last occasion of sex was 71.9%. Younger adolescents, those with a higher perception of the risk of contracting STI and those with lesser knowledge about STI were independent predictors for using condoms. The mean total score of the respondents' perception of a risk of contracting STI was 5.8.Conclusions: Evidence to develop and implement strategies with the hope of improving adolescents' level of knowledge and reducing unsafe sexual practices. [ABSTRACT FROM AUTHOR]

Comments on the federal rule governing the privacy of health information and medical records under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in the U.S. Issue of confidentiality in adolescent medical care; Provisions of HIPAA; Legal aspects of health information and medical records accessibility.

The Adolescent Health Project (AHP) was a rural pilot project aimed at strengthening the relationship between general practitioners (GPs) and adolescents within three Divisions of general practice. The evaluation assessed the implementation of the AHP model and strategies and their impact. The AHP used a centralised management/support and local delivery model. The AHP improved GP relationships and comfort with dealing with young people, and improved GP relationships with school counsellors. Divisional relationships with local schools improved. Students reported increased knowledge about GPs, increased confidence and comfort with accessing GPs. The AHP delivered a popular project to GPs, GP clinics, schools, school counsellors and students, which built the capacity of divisions, GPs, and schools to improve adolescent health care provision. Further research questions have emerged: What are the patterns of relationships between GPs and adolescents, and between GPs and school counsellors, and what strategies work best to sustain such relationships? [ABSTRACT FROM AUTHOR]