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PubMed2005

The Health of the Nation Outcome Scales for Children and Adolescents in an adolescent in-patient sample.

OBJECTIVE: The primary aims of the study were to examine the reliability and validity of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) in a sample of adolescents requiring medium to long-term in-patient psychiatric treatment and to examine the association between HoNOSCA scores and age, gender and length of treatment. METHODS: A multidisciplinary team completed the HoNOSCA for 51 adolescent patients at intake and at 3- and 6-months following admission to the unit. RESULTS: The study provided support for the test-retest reliability, concurrent and convergent validity, but not the internal reliability, of the HoNOSCA. Total HoNOSCA scores at intake were similar to those found in adolescent outpatient samples, although there were some differences at the level of individual items. Similarly, while the total HoNOSCA score showed some sensitivity to change, using the total HoNOSCA score obscured important changes in specific domains of functioning over the course of admission. CONCLUSION: The HoNOSCA was found to be a valid measure of global functioning at intake, thereby supporting its use in an adolescent psychiatric unit. However, focusing on individual items, rather than total score, appears more useful in evaluating the impact of inpatient psychiatric treatment on adolescents.

Adolescent↗
PubMed2006

Serum homocysteine is related to food intake in adolescents: the Child and Adolescent Trial for Cardiovascular Health.

BACKGROUND: An understanding of the relation in adolescents between serum homocysteine and foods rich in vitamin B-6, vitamin B-12, and folate is important because high homocysteine concentrations in childhood and adolescence may be a risk factor for later cardiovascular disease. However, little is known about the relation between food intake and homocysteine in adolescents. OBJECTIVE: Five years after national folic acid fortification of enriched grain products, cross-sectional relations between food intake and serum homocysteine concentrations were examined in 2695 adolescents [x age: 18.3 (range: 15-20) y] enrolled in the Child and Adolescent Trial for Cardiovascular Health. DESIGN: A nonfasting blood specimen was analyzed for serum homocysteine, folate, and vitamins B-6 and B-12. Dietary intake was assessed by using a food-frequency questionnaire. Multiple regression analyses were used to evaluate the relation of intakes of whole grains, refined grains, fruit, vegetables, dairy products, red and processed meats, and poultry with serum homocysteine concentrations after adjustment for demographic characteristics, lifestyle factors, and food intake. RESULTS: Serum homocysteine concentrations were lower with greater intakes of whole grains (P for trend = 0.002), refined grains (P for trend = 0.02), and dairy foods (P for trend <0.001); were higher with greater intake of poultry (P for trend = 0.004); and were not related to intakes of fruit, vegetables, or red or processed meat. After additional adjustment for serum B vitamins, the relations of serum homocysteine with most food groups were attenuated. CONCLUSION: These observational findings suggest a beneficial effect of whole-grain, refined-grain, and dairy products on serum homocysteine concentrations in an adolescent population.

Adolescent↗
PubMed2005

Parent and adolescent versions of the diabetes-specific parental support for adolescents' autonomy scale: development and initial testing.

OBJECTIVE: To develop and initially test the psychometric properties of parent and adolescent versions of the Diabetes-Specific Parental Support for Adolescents' Autonomy Scale. METHODS: Data-based scale items were developed, analyzed for content validity, and then piloted with 43 adolescents with type 1 diabetes and their parents. Psychometric properties of the scales were then determined with 100 adolescents with type 1 diabetes and their parents. RESULTS: Content validity indices of .80 or greater were obtained for 26 items. Item analysis in the pilot and large-sample groups resulted in 22 items being deleted. Principal Components Analysis of the remaining four items indicated one factor in both parent and adolescent versions, accounting for 50-62% of variance and with Cronbach alpha coefficients of .67-.80. CONCLUSIONS: This newly developed parsimonious scale, initially tested to be reliable, and valid, will facilitate research on parental support for adolescents' development of diabetes management autonomy.

Adolescent↗
PubMed2003

Bilateral reduction mammoplasty in an adolescent population: adolescent bilateral reduction mammoplasty.

Bilateral reduction mammoplasty in adolescent patients can be a controversial procedure because of the significance of possible long-term complications and the permanence of the results. There are no current criteria specifically for adolescent candidates for reduction surgery, although many of these young women may have severe physical symptoms. Therefore, the demographics and outcomes of these patients are of particular interest in determining the risks and benefits particular to this surgery for younger patients. Seventy-three patients who had undergone bilateral reduction mammoplasty between 1981 and 2000 were identified in the hospital and office records of four midwestern plastic surgeons. Patient ages ranged between 12.5 and 18.9 years, with a mean age of 16.1 years. A two-pronged investigation involved examination of demographics of the adolescent population and short- and long-term outcomes and satisfaction. Demographic survey included age, weight, height, BMI, breast size, and amount of tissue removed. Indications for surgery and postoperative complications were surveyed in office records and via questionnaire. Seventeen patients (23%) were successfully contacted and returned a detailed questionnaire evaluating indications for surgery, preoperative and postoperative complications, and overall satisfaction. Eighty-two percent of patients reported resolution of their physical symptoms, including back, shoulder, and neck pain. Self-esteem, however, was cited most commonly as a reason to recommend this procedure to other adolescent women. Nearly 65% of respondents would repeat their adolescent surgical experience, and 82.4% would recommend this procedure to a teenaged friend in a similar situation. The authors' data suggest that adolescent patients benefit significantly from reduction mammoplasty and that long-term satisfaction remains high, despite the age of the patients at surgery.

Adolescent↗
PubMed1993

Mother-adolescent agreement on the symptoms and diagnoses of adolescent depression and conduct disorders.

OBJECTIVE: To determine rates and correlates of mother-adolescent agreement on the symptoms and diagnoses of depression and conduct disorders. METHOD: The Schedule for Affective Disorders and Schizophrenia in School Age Children was administered to a community sample of 460 adolescents and their mothers. Race, gender, family adaptability and cohesion, and living arrangement were evaluated as predictors of agreement. RESULTS: Mother-adolescent agreement was low (kappa < 0.40) for all diagnoses and symptoms with these exceptions: feeling tired (kappa = 0.40), inattention (kappa = 0.50), vandalism (kappa = 0.50), and chronic violation of rules (kappa = 0.72). Cohesion and adaptability were associated with mother-adolescent agreement on the symptoms and diagnosis of depression. This association was not demonstrated as consistently for agreement on the symptoms and diagnosis of conduct disorders. CONCLUSION: Study findings underscore the necessity of collecting data from both a parent and the adolescent when assessing an adolescent's psychological status.

Adolescent↗
PubMed2000

Seroprevalence and risk factors of hepatitis B, hepatitis C, and human cytomegalovirus among HIV-infected and high-risk uninfected adolescents: findings of the REACH Study. Adolescent Medicine HIV/AIDS Research Network.

BACKGROUND AND OBJECTIVES: In adolescents and young adults, multiple studies have identified sexual activity and behaviors as significant risk factors for acquiring both human cytomegalovirus (HCMV) and hepatitis B virus (HBV). However, there are no reports on the prevalence or risk factors for infection of these viruses and hepatitis C virus (HCV) in an adolescent population with sexually acquired HIV. GOALS: To examine the seroprevalence and risk factors of HBV, HCV, and HCMV infection in a population of HIV-infected male and female adolescents and in an age- and risk behavior-matched HIV-uninfected cohort. STUDY DESIGN: A cross-sectional analysis of HBV, HCV, and HCMV infections in a cohort of HIV-infected and HIV-uninfected adolescents. RESULTS: Adolescent males infected with HIV were more likely to have evidence of HBV and HCMV infection than HIV-uninfected males (23.7% versus 0%, respectively, for HBV, P = 0.008; 79.7% versus 50%, respectively, for HCMV, P = 0.004). HIV-infected females were more likely to have evidence of HCMV infection (78.5% versus 61.4%, P = 0.003) than HIV-uninfected females. No significant difference was found for HBV infection in the two groups of females. The rate of HCV infection (1.6%) was too small to make comparisons between the groups. To determine whether the differences in infection rates for HBV and HCMV could be explained by factors other than HIV status, a variety of possible risk factors were examined using univariate and multivariate analyses. A significant risk factor for HBV and HCMV infections for males was a homosexual or bisexual orientation. For females, a risk factor for HBV infection was having more than 10 lifetime sexual partners; for HCMV infection, HIV infection was the only risk factor. In addition, in the HIV-infected cohort, 15% of females and 36% of males who were seropositive for HBV had evidence of active HBV infection. CONCLUSIONS: These results emphasize the need for continued development of primary and secondary prevention programs and clinical screening and treatment for HBV and HCMV in adolescents.

Adolescent↗
PubMed2004

Support network of adolescents with chronic disease: adolescents' perspective.

The purpose of this study was to describe the support network of adolescents with a chronic disease from their own perspective. Data were collected by interviewing adolescents with asthma, epilepsy, juvenile rheumatoid arthritis (JRA) and insulin-dependent diabetes mellitus (IDDM). The sample consisted of 40 adolescents aged between 13 and 17 years. Interview data were examined using content analysis. Six main categories were established to describe the support network of adolescents with a chronic disease: parents, peers, school, health care providers, technology and pets. Peers were divided into two groups: fellow sufferers and peers without a chronic disease. At school, teachers, school nurses and classmates were part of the support network. Health care providers included nurses, physicians and physiotherapists. Technology was also part of the support network and included four techniques that may be used to communicate: computers, mobile telephones, television and videos. The results provided a useful insight into the social network of adolescents with chronic disease and serve to raise awareness of the problems and opinions experienced by adolescents with this condition.

Adolescent↗
PubMedDate not supplied

[Cross-cultural adaptation to Spanish of the Vécu et Santé Perçue de l'Adolescent (VSP-A):: a generic measure of the quality of life of adolescents].

BACKGROUND: Different measures of health related quality of life for use exclusively in children and adolescents have been developed over the last ten years. However, few instruments of this type have been adapted in Spain. The VSP-A is a generic health related quality of life measure for adolescents aged 11-17 developed in France. The objective of this study was to adapt the VSP-A into Spanish as a first step towards obtaining this questionnaire. METHODS: The version of the VSP-A including 39 questions was adapted following the forward-backward translation methodology, including two translations into Spanish, scoring of difficulty (0 min-10 max.) and classification of semantic and conceptual equivalence, two panel discussions with adolescents, as well as meetings of consensus with the original authors. Finally, a backward translation (translation back into the original language) was carried out into French, and the final pre-test version was administered in a pilot test. RESULTS: Most of the questions were classified as equivalent (24/39). Following the meetings with adolescents, changes were made in some questions. After the back-translation into French, three questions required some minor changes. CONCLUSIONS: The Spanish version of the VSP-A seems to be semantically and culturally equivalent to the original version and suitable for adolescents in Spain. The inclusion of easy statements in the original version, the comments of the adolescents and the involvement in the adaptation process of the original authors has offered the possibility of achieving a suitable pre-test version. The next phase of the study will involve the questionnaire's reliability and validity testing. The VSP-A is expected to be useful for measuring the health-related quality of life in health surveys or as a screening tool in schools and primary care centers in Spain.

Adolescent↗
PubMed1991

Parent-adolescent conflict and adolescent injuries.

Several studies have linked cumulative measures of stress to injuries, however none have examined the relationship between a prevalent stressor in adolescence, conflict between the parent and adolescent, and injuries. Data for this study came from 8231 British adolescents born one week in 1958 who had information on injuries between ages 15 and 17 available. A conflict scale was devised by summing mothers' assessments of the frequency of arguments with their 16-year-old offspring about eight problem areas. This scale had a linear association with injury rates for both boys and girls. Adolescent boys with high levels of conflict (greater than 90th percentile on conflict scale) had 2.9 times the rate of injuries resulting in hospitalization compared with boys from low conflict families (less than 25th percentile), and 1.6 times the number of injuries resulting in outpatient care. Girls with high levels of conflict had 2.9 times the hospitalized injuries and 1.8 times the rate of less severe injuries compared with girls with low conflict. These findings suggest that conflictual parent-adolescent relationships may be an indicator of increased injuries in adolescents.

Accidents↗
PubMed1990

The Millon Adolescent Personality Inventory profiles of depressed adolescents.

The evidence indicates that adolescent depression may be more difficult to recognize than its adult counterpart, although the reasons for this difficulty remain unclear. The research in this area is in part impeded by the lack of adolescent-specific measures of personality functioning. In this study the personality styles, expressed concerns, and behavioral tendencies of depressed adolescents were investigated by means of the Millon Adolescent Personality Inventory (MAPI), a relatively new personality inventory designed specifically for this age group. Three hundred sixty-six high school students completed the Beck Depression Inventory (BDI) and the MAPI, resulting in 332 valid and reliable MAPI profiles. The data were reduced to two factors, accounting for 65.1% of the total variance, by means of a principal components analysis. The two factors were interpreted as two dimensions of personality functioning associated with depression in adolescents. The first dimension suggested a socially withdrawn, overtly recognizable depression, whereas the second presents acting-out tendencies that may overshadow depressive symptomatology. The findings are integrated with the theoretical positions represented in the literature. Theoretical and practical implications for the use of the MAPI with depressed adolescents are discussed.

Adolescent↗
PubMed1996

Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents.

BACKGROUND: The "Report of the Second Task Force on Blood Pressure Control in Children-1987" developed normative blood pressure (BP) data for children and adolescents. These normative data are used to classify BP levels. Since 1987, additional BP data in children and adolescents, the use of newer classes of drugs, and the role of primary prevention of hypertension have expanded the body of knowledge regarding the classification and treatment of hypertension in the young. OBJECTIVE: To report new normative BP data in children and adolescents and to provide additional information regarding the diagnosis, treatment, and prevention of hypertension in children. METHODS: A working group was appointed by the director of the National Heart, Lung, and Blood Institute as chair of the National High Blood Pressure Education Program (NHBPEP) Coordinating Committee. Data on children from the 1988 through 1991 National Health and Nutrition Examination Survey III and nine additional national data sets were combined to develop normative BP tables. The working group members produced initial draft documents that were reviewed by NHBPEP Coordinating Committee representatives as well as experts in pediatrics, cardiology, and hypertension. This reiterative process occurred for 12 draft documents. The NHBPEP Coordinating Committee discussed the report, and additional comments were received. Differences of opinion were adjudicated by the chair of the working group. The final report was sent to representatives of the 44 organizations on the NHBPEP Coordinating Committee for vote. It was approved unanimously by the NHBPEP Coordinating Committee on October 2, 1995. CONCLUSIONS: This report provides new normative BP tables for children and adolescents, which now include height percentiles, age, and gender. The fifth Korotkoff sound is now used to define diastolic BP in children and adolescents. New charts have been developed to guide practicing clinicians in antihypertensive drug therapy selection. The primary prevention of hypertension in these age groups is discussed. A statement on public health considerations in the treatment of children and adolescents is provided.

Adolescent↗
PubMed2003

Public and private domains of religiosity and adolescent health risk behaviors: evidence from the National Longitudinal Study of Adolescent Health.

The purpose of this study was to examine the association of public and private domains of religiosity and adolescent health-related outcomes using data from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of American adolescents in grades 7-12. The public religiosity variable combines two items measuring frequency of attendance at religious services and frequency of participation in religious youth group activities. The private religiosity variable combines two items measuring frequency of prayer and importance of religion. Our results support previous evidence that religiosity is protective for a number of adolescent health-related outcomes. In general, both public and private religiosity was protective against cigarettes, alcohol, and marijuana use. On closer examination it appeared that private religiosity was more protective against experimental substance use, while public religiosity had a larger association with regular use, and in particular with regular cigarette use. Both public and private religiosity was associated with a lower probability of having ever had sexual intercourse. Only public religiosity had a significant effect on effective birth control at first sexual intercourse and, for females, for having ever been pregnant. However, neither dimension of religiosity was associated with birth control use at first or most recent sex. Public religiosity was associated with lower emotional distress while private religiosity was not. Only private religiosity was significantly associated with a lower probability of having had suicidal thoughts or having attempted suicide. Both public and private religiosity was associated with a lower probability of having engaged in violence in the last year. Our results suggest that further work is warranted to explore the causal mechanisms by which religiosity is protective for adolescents. Needed is both theoretical work that identifies mechanisms that could explain the different patterns of empirical results and surveys that collect data specific to the hypothesized mechanisms.

Adolescent↗
PubMed2004

Psychiatric treatment and research unit for adolescent intensive care: the first adolescent forensic psychiatric service in Finland.

Finland does not have a history of providing forensic adolescent psychiatric units although the need for this kind of service has been established. According to legislation patients who are minors have to be treated separately from adults, however, this has not been possible in practice. Also, adolescent psychiatric wards have not always been able to admit the most severely ill patients, those with impulsive and aggressive behaviours, because of lack of staff resources, problems associated with protecting other vulnerable patients and a shortage of secure environments. A previous report demonstrated the significant increase in adolescent's involuntary treatment within adult psychiatric wards. Data from this report were acknowledged as an important starting point in the planning process for the psychiatric treatment and research unit for adolescent intensive care. This paper describes the background, development process, plan of action, tailor-made education programme and supporting evidence for the first Finnish adolescent forensic service opened in April 2003 in the Department of Psychiatry, Tampere University Hospital. The tool used for planning the unit's activities and staff education programme was the Balanced Score Card approach, the structure and development of which is also outlined within the paper.

Adolescent↗
PubMed2005

HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial.

BACKGROUND: Adolescent girls in the United States and around the world are at a heightened risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). OBJECTIVE: To determine the efficacy of a skill-based HIV/STD risk-reduction intervention in reducing self-reported unprotected sexual intercourse among African American and Latino adolescent girls. DESIGN: Randomized controlled trial with 3-, 6-, and 12-month follow-ups. SETTING AND PARTICIPANTS: Sexually experienced African American and Latino adolescent girls recruited from the adolescent medicine clinic of a children's hospital serving a low-income inner-city community (N = 682, mean age, 15.5 years); 88.6% were retained at the 12-month follow-up. INTERVENTIONS: Three 250-minute interventions based on cognitive-behavioral theories and elicitation research: an information-based HIV/STD intervention provided information necessary to practice safer sex; a skill-based HIV/STD intervention provided information and taught skills necessary to practice safer sex; or a health-promotion control intervention concerned with health issues unrelated to sexual behavior. MAIN OUTCOME MEASURES: Primary outcome measure was self-reported frequency of unprotected sexual intercourse; secondary outcomes included the frequency of sexual intercourse while intoxicated, the number of sexual partners, biologically confirmed STDs, and theoretical mediator variables, including the intention to use condoms, beliefs about using condoms, and condom-use knowledge. RESULTS: No differences between the information intervention and the health control intervention were statistically significant. Skills-intervention participants (mean [SE], 2.27 [0.81]) reported less unprotected sexual intercourse at the 12-month follow-up than did information-intervention participants (mean [SE], 4.04 [0.80]; P = .03), or health control-intervention participants (mean [SE], 5.05 [0.81]; P = .002). At the 12-month follow-up, skills-intervention participants (mean [SE], 0.91 [0.05]) reported fewer sexual partners (P = .04) compared with health control-intervention participants (mean [SE], 1.04 [0.05]) and were less likely to test positive for STD (mean [SE], 10.5% [2.9%]) than were health control-intervention participants (mean [SE], 18.2% [2.8%]; P = .05). No differences in the frequency of unprotected sexual intercourse, the number of partners, or the rate of STD were observed at the 3- or 6-month follow-up between skill-intervention participants and information-intervention or health control-intervention participants. CONCLUSION: Skill-based HIV/STD interventions can reduce sexual risk behaviors and STD rate among African American and Latino adolescent girls in clinic settings.

Adolescent↗
PubMed2000

(Im)maturity of judgment in adolescence: why adolescents may be less culpable than adults.

A crucial step in the establishment of effective policies and regulations concerning legal decisions involving juveniles is the development of a complete understanding of the many factors-psychosocial as well as cognitive-that affect the evolution of judgment over the course of adolescence and into adulthood. This study examines the influence of three psychosocial factors (responsibility, perspective, and temperance) on maturity of judgment in a sample of over 1,000 participants ranging in age from 12 to 48 years. Participants completed assessments of their psychosocial maturity in the aforementioned domains and responded to a series of hypothetical decision-making dilemmas about potentially antisocial or risky behavior. Socially responsible decision making is significantly more common among young adults than among adolescents, but does not increase appreciably after age 19. Individuals exhibiting higher levels of responsibility, perspective, and temperance displayed more mature decision-making than those with lower scores on these psychosocial factors, regardless of age. Adolescents, on average, scored significantly worse than adults, but individual differences in judgment within each adolescent age group were considerable. These findings call into question recent arguments, derived from studies of logical reasoning, that adolescents and adults are equally competent and that laws and social policies should treat them as such.

Adolescent↗
PubMed1993

Adolescent stress and coping: implications for psychopathology during adolescence.

Stressful experiences and efforts to cope with stress are central to understanding psychological distress and psychopathology during adolescence. Depressive phenomena during adolescence offer a particularly interesting opportunity for understanding the role of stress and coping processes in adolescent psychopathology. Research concerned with stress and coping during adolescence is reviewed, using depression as a key example of a consequence of stress and coping processes. Based on this research, it is hypothesized that exposure to and appraisals of interpersonal stress combine with aspects of biological development and the use of maladaptive coping strategies to account for the emergence of significant gender differences in depression and other forms of psychopathology during adolescence. Directions for future research in this area are highlighted.

Adaptation, Psychological↗
PubMed2005

Comparative efficacy of cognitive behavioral therapy, fluoxetine, and their combination in depressed adolescents: initial lessons from the treatment for adolescents with depression study.

Adolescents with major depressive disorder (MDD), their families and clinicians experience significant challenges when weighing the potential risks versus benefits of available choices in the treatment of MDD. Although MDD is highly prevalent in adolescents and is associated with marked suffering, impairment and risk of suicide, the scientific data regarding the safety and efficacy of treatments for pediatric depression are limited. Controlled clinical trials have provided support for the use of psychotherapy and fluoxetine for the treatment of pediatric depression, but until recently no information on the comparative efficacy of these recommended interventions alone or in combination was available. The Treatment for Adolescents with Depression Study provides a very important therapeutic advance in the field by convincingly showing that combination treatment with cognitive behavioral therapy and fluoxetine has the best benefit to risk ratio for adolescents with moderate to severe depression, and is superior to monotherapy. Moreover, the study results confirm that fluoxetine alone is effective in the treatment of depressed adolescents.

Adolescent↗
PubMed1987

A review of Society for Adolescent Medicine abstracts and Journal of Adolescent Health Care articles.

Adolescent medicine research has dramatically increased over the past 20 years. The object of this study was to assess the status of design in adolescent health care research. All abstracts of presentations at the 1978-1985 Society for Adolescent Medicine (SAM) Meetings are included as well as all articles from the Journal of Adolescent Health Care (JAHC) from 1980 through September of 1985. The abstracts were analyzed for basic design, subject, sample size, study site, number of authors, and type of statistical analysis. A descriptive design comprised 32.8% of the SAM abstracts and 62.9% of the JAHC articles. An observational design comprised 57.8% of the SAM abstracts and 35.5% of the JAHC articles. An experimental design comprised 9.3% of the SAM abstracts and 1.6% of the JAHC articles. Of the 203 abstracts, 46% involved medical and 45.6% psychosocial topics. The JAHC articles were also fairly equally divided. Descriptive studies have decreased from 1978 to 1985 whereas observational studies have increased. The medium sample size of SAM abstracts increased from 1978 (83) to 1985 (100). Statistical methods were only analyzed for JAHC articles. Sixty-one percent used either no methods or used descriptive statistics only. The major statistical tests used were contingency tables, t-tests, analyses of variance, and Pearson correlations. Adolescent medicine research from these two sources usually involves descriptive and observational designs. The few clinical trials conducted involved small sample sizes. An increase in experimental and collaborative projects is needed.

Adolescent↗