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Early adolescent pregnancy: a comparative study of pregnancy outcome in young adolescents and mature women.

Thirty-two adolescents were matched to mature controls for a study of variables known to influence the course and outcome of pregnancy. These included: ethnicity; clinic payment status; year of delivery; parity; and presence or absence of alcohol and tobacco use. The comparative factors examined included: age of menarche; gynecologic age; admission hemoglobin; prepregnant weight and height; weight gain during pregnancy; complications of pregnancy; length of gestation; birth weight; 1- and 5-minute apgar scores; and the presence or absence of congenital defects. There was no significant difference between young adolescents and matched controls in infant birth weight or apgar scores when the above confounding factors were controlled. Young gravidae, however, had significantly shorter gestations, earlier menarche, lower hemoglobin levels, and poorer weight gain during pregnancy than mature women. Multiple-regression analysis suggests that 1) pregnancy weight gain was associated with the trimester the gravida enrolled in the Supplemental Food Program for Women, Infants, and Children (WIC) (p = 0.008) and maternal stature (p = 0.012); 2) length of gestation was associated with maternal stature (p = 0.022) and prepregnant weight (p = 0.011); and 3) maternal hemoglobin was associated with birth weight (p = 0.087). Alternative interpretations are discussed.

Adolescent↗

What sexually transmitted disease screening method does the adolescent prefer? Adolescents' attitudes toward first-void urine, self-collected vaginal swab, and pelvic examination.

OBJECTIVE: To assess sexually active adolescents' attitudes toward 3 screening collection techniques for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis using first-void urine (FVU), self-collected vaginal swab specimens, and pelvic examination with clinician-collected endocervical swab specimens. DESIGN: Participants completed a preexamination health survey, provided FVU and self-collected vaginal swab samples, and had a pelvic examination with endocervical swab specimen collection. In a confidential postexamination interview, patients ranked the 3 screening techniques according to preference and responded to qualitative positive and negative descriptors to evaluate each technique. SETTING: San Francisco area health maintenance organization and university clinics. PARTICIPANTS: A convenience sample of 155 ethnically diverse females aged 12 to 21 years, who were sexually active and were to have a pelvic examination. MAIN OUTCOME MEASURES: Adolescents' preferences for and evaluations of 3 sexually transmitted disease screening techniques. RESULTS: Participants preferred the FVU test for sexually transmitted disease screening over the pelvic examination and the self-administered vaginal swab test (P<.001). These results were consistent when controlling for potentially mitigating experiences, including previous pelvic examination, tampon or condom use, and prior pregnancy. In evaluating what they liked and disliked about each of the 3 screening methods, participants described the FVU most positively, the pelvic examination most negatively, and the vaginal swab technique slightly less positively than the FVU. CONCLUSION: Most sexually active adolescents attending clinics for pelvic examination prefer to be screened for sexually transmitted diseases first by the FVU, second by the self-collected vaginal swab test, and last by the pelvic examination.

Adolescent↗

Pre-adolescent chumship as a buffer against psychopathology in adolescents with weak family support and weak parental bonding.

This study examines the degree to which the existence of a pre-adolescent "chum" interacts with family and social environments to buffer mental distress in adolescents. 831 high school students participated in this study, (male: 355; female: 476; mean age 16.7 +/- 1.0). Subjects were administered questionnaires assessing psychopathology and support systems. A pathway analyses model was used to investigate pathways and their interrelationships from chum to psychopathology and from social and family support to psychopathology. Only when adolescents experience weak parental bonding does chumship have a role in buffering distress.

Adolescent↗

Bone mineral density differences between adolescent dancers and non-exercising adolescent females.

STUDY OBJECTIVE: To compare the bone mineral density (BMD) of the axial and appendicular skeleton between regularly exercising collegiate dancers and age matched non-exercising young females between the age of 17 and 19 to assess the impact of weight-bearing exercises and menstrual status on BMD. DESIGN: Prospective observational cohort. SETTING: Sports clinic in a collegiate school of dance and a hospital-based adolescent clinic. PARTICIPANTS: The adolescent dancers consisted of full-time collegiate dance students from a tertiary Performing Arts Institute (n = 35). The non-exercising controls consisted of eumenorrhoeic patients of the same age presenting to the Adolescent Clinic (n = 35). INTERVENTIONS: All subjects had a full hormonal profile, bio-impedance estimation of body fat, and dual energy X-ray absorptiometry and quantitative peripheral CT scans (pQCT) to determine bone density. MAIN OUTCOME MEASURES: Comparison of the mean bone mineral density in the axial and appendicular skeleton between the two groups. RESULTS: The incidence of oligo/amenorrhoea in the dancers was 20%. The lumbar spine BMD (1.006 g/cm(2) vs. 0.938, P = 0.048) and hip BMD (neck of femur 0.978 g/cm(2) vs. 0.838, P < 0.001; Ward's triangle 0.816 g/cm(2) vs. 0.720, P = 0.003; trochanter 0.777 g/cm(2) vs. 0.682; P < 0.001) were significantly higher in the eumenorrhoeic dancers as compared to controls. The radial BMD as measured by pQCT did not differ between the two groups, but the core trabecular tibial BMD was also higher in the dancers (321 mg/cm(3) vs. 286, P = 0.006). When only oligo/amenorrhoeic dancers (n = 7) were compared with the controls, the same differences in BMD values were no longer observed. CONCLUSION: Young women undergoing regular intensive weight-bearing exercises as in the collegiate dancers here studied have higher BMD in the axial and appendicular skeleton as compared to non-exercising females of the same age if they remain eumenorrhoeic during their training. This advantage was apparently lost when they developed oligo/amenorrhoea.

Absorptiometry, Photon↗

Financial compensation to adolescents for participation in biomedical research: adolescent and parent perspectives in seven studies.

OBJECTIVE: To examine the impact of financial compensation on pediatric asthma research participation decision-making and determine whether perceptions of fair compensation differed for parents and adolescents, lower and higher income participants, and compensation-informed and uninformed participants in minimal and above minimal risk research. STUDY DESIGN: Adolescents (n = 36) with asthma and their parents reviewed 7 pediatric asthma research protocols, decided whether they would choose to participate, and provided estimates of "fair" compensation for their participation. Chi-square, analysis of variance, and analysis of covariance were used to determine the affects of compensation on participation and whether various respondents differed in the perceptions of fair compensation. RESULTS: Financial compensation did not affect participation decisions. Estimates of fair compensation were lower for adolescents, lower income respondents, and participants who were naive about potential compensation. Fair compensation estimates were higher than actual compensation for minimal risk studies and lower for above minimal risk studies. CONCLUSIONS: Financial compensation may be a minor consideration in pediatric research participation decision-making. Still, differences in how pediatric researchers and their prospective participants judge fair compensation create the potential for undue influence. Pediatric researchers should use caution when determining a reasonable financial compensation for research participation.

Adolescent↗

Dramatic decline in acute hepatitis B infection and disease incidence rates among adolescents and young people after 12 years of a mass hepatitis B vaccination programme of pre-adolescents in the schools of Catalonia (Spain).

The aim of the study was to describe the impact of hepatitis B vaccination and disease incidence in adolescents and young people 12 years after the launching of a mass hepatitis B vaccination of pre-adolescents in schools. Vaccination coverage was assessed using administrative and serological data. Infection trends were evaluated by means of seroepidemiological surveys. High levels of vaccination coverage and vaccine-induced immunity were achieved. The resulting low proportions of susceptible adolescents and young people have undoubtedly contributed to the substantial reduction in the prevalence of hepatitis B infection in the 15-24 years age group (0.9 per 100 in 2001 versus 9.3 per 100 in 1986) and in the reported incidence of hepatitis B cases (80% reduction). Over the last 3 years, the declining trend seems to have been halted, although 35% of cases reported during this period corresponded to immigrants.

Adolescent↗

Blood pressure during adolescence: a study among Belgian adolescents selected from a high cardiovascular risk population.

INTRODUCTION: The Belgian province of Luxembourg has a high incidence of cardiovascular (CV) disease according to the MONICA register. Surveys conducted in adults and children have also found high CV risk factor levels in this province. DESIGN: cross-sectional study. OBJECTIVE OF THE PRESENT STUDY: To collect data about blood pressure (BP) and its determinants in adolescents from this high CV risk population and to analyse their relationship. PARTICIPANTS: 1526 adolescents (12-17 years) in 24 secondary schools of the province. RESULTS: Mean systolic BP levels were 125 mm Hg (sd = 12 mm Hg) and 122 mm Hg (sd = 11 mm Hg) for boys and girls, respectively. Mean diastolic BP was equal to 74 mm Hg (sd = 10 mm Hg) in both genders. Systolic BP increased with age and differed significantly between genders from 15 years onwards. Body fatness indices increased with age except waist-to-hip ratio in girls and triceps skinfold in boys. Regression models including age, anthropometric indices and physical activity explained a small percentage of BP variance (for systolic BP, r2 = 0.21 and 0.12 for boys and girls, respectively). Weight was the first parameter related to BP in correlation and regression analyses. CONCLUSIONS: This study showed high BP and body fatness indices in adolescents from a high CV risk population. The model under study showed a moderate relationship between body fatness and BP. This finding suggests other influences as a genetic component to account for the high levels observed.

Adolescent↗

[Quality of life of children and adolescents with psychiatric disorders. Results of the 1st multicenter study with an inventory to assess the quality of life in children and adolescents].

OBJECTIVE: A newly developed, disorder-nonspecific instrument to measure the quality of life in children and adolescents (ILK, Mattejat et al., 1998) was tested with regard to its ability to differentiate between psychiatric in- and outpatient samples. METHODS: 626 children and adolescents from regionally different in- and outpatient clinics completed the ILK questionnaire. The data obtained were first described and then analyzed by means of logistic regression analysis. RESULTS: Whereas the descriptive analysis revealed that inpatients evaluated all areas of life more unfavorably than outpatients did, the logistic regression analysis modified these results. It became evident that some of the findings obtained were due to the effects of age and/or gender. However, given age and gender as covariates, there still remained some important life domains in which inpatients were more impaired than outpatients. CONCLUSIONS: The ILK turned out to be an efficient and economic instrument to measure the quality of life in children and adolescents depending on the severity of their disorder. Moreover, it is sensitive to effects of age and gender. As the ILK is able to reliably identify areas with a reduced quality of life, it offers valuable starting points for indications, therapy planning and initial therapeutic interventions.

Activities of Daily Living↗

[Aggressive behaviour and substance abuse among schizophrenic adolescents compared to antisocial adolescents--a follow-up study].

OBJECTIVES: The objective of this study was to analyze aggressive behaviour towards others by schizophrenic as opposed to antisocial adolescents, and the influence of substance abuse before, during and after their hospitalization. METHODS: We analyzed 21 schizophrenic adolescents and compared their aggressive behaviour and their substance abuse to that of 21 antisocial juveniles before and during their hospitalization and again at the time of a follow-up interview. The two samples were matched for age, sex and intelligence. In a first step, data were gathered from the hospital records, in a second step, for follow-up data we conducted standardized telephone interview with the patient and his or her parent or caregiver. Within the analysis we focused on aggressive behaviour towards other people and objects, as well as on criminal acts and regular substance abuse. RESULTS: We found less aggressive behaviour among psychotic patients during and post-hospitalization than among their antisocial counterparts. As inpatients, the acutely psychotic juveniles were at higher risk for aggressive acts, but adequate treatment subdued their offensive behaviour. In the long term, there were fewer criminal arrests among psychotic patients. Only in connection with their substance abuse, their aggressive misconduct towards others increased. CONCLUSIONS: Our results suggest that drug treatment during adolescence might help to lessen the risk of aggressive behaviour towards others.

Adolescent↗

[Evaluation with the "Psychotherapie Basisdokumentation" for Children and Adolescents: Psy-BaDo-KJ--a questionnaire for quality assurance and evaluation of psychotherapy for children and adolescents].

OBJECTIVES: Currently only few instruments exist to evaluate psychotherapy for children and adolescents (Mattejat & Remschmidt, 1993). This study presents the development of a new instrument: the "Psychotherapie Basisdokumentation für Kinder und Jugendliche: Psy-BaDo-KJ" (Winter, 2002). This instrument assesses individual therapy goals and the outcome of therapy on the basis of information from children and adolescents, parents and therapists. METHODS: We based our instrument on a questionnaire originally developed for adults: the "Psychotherapie Basisdokumentation" (Psy-BaDo, Heuft & Senf, 1998). To develop the new instrument, we conducted expert interviews that were then analysed qualitatively. Between January 2002 and June 2003 all inpatients (> or = 14 years) as well as their parents and therapists were given questionnaires. To date, data for 35 patients have been evaluated and included in the current study. The diagnoses were recorded according to ICD-10 (Remschmidt et al., 2002). RESULTS: The study shows that patients, parents and therapists usually formulate two or three individual therapy goals but with different content. While the patients mention primarily goals focussed on somatic health, the focus of parents and therapists is predominantly on psychological and mental health. According to the outcome of therapy, the level of agreement among patients, parents and therapists is high. Patients tend to be more optimistic than their parents and therapists. CONCLUSIONS: The "Psychotherapie Basisdokumentation für Kinder und Jugendliche" (Psy-BaDo-KJ) is a new instrument and can be used efficiently for quality assurance and evaluation of psychotherapy for children and adolescents.

Adolescent↗

Parent-adolescent disagreement regarding psychopathology in adolescents from the general population as a risk factor for adverse outcome.

This study investigated whether parent-adolescent disagreement regarding adolescents' behavioral and emotional problems predicted adverse outcome. A Dutch sample of 15- to 18-year-olds was prospectively followed across a 4-year interval. The Child Behavior Checklist (CBCL: T. M. Achenbach, 1997) and Youth Self-Report (YSR; T. M. Achenbach, 1991b) were administered at initial assessment, and the following signs of poor outcome were assessed 4 years later: police/judicial contacts, expulsion from school/job, suicidal ideation, unwanted pregnancy, suicide attempts, deliberate self-harm, referral to mental health services, report of having a behavioral or emotional problem, and feeling the need for professional help without actually receiving help. Twenty CBCL syndrome scores, 23 YSR syndrome scores, and 16 discrepancy scores were significant predictors of poor outcome. It was concluded that to determine the prognosis of psychopathology in adolescents, discrepancies between informants may be important.

Adolescent↗

Adolescent depression: effects of mutuality in the mother-adolescent dyad and locus of control.

A group of 213 adolescents and their mothers participated in a study of the combined relationship between gender, locus of control, and perceived mutuality in the mother/adolescent dyad and self-rated adolescent depression. High mutuality and internal locus of control were significantly related to low levels of depression for both female and male adolescents. The study findings are considered in the context of current theoretical work on female relational psychology.

Adolescent↗

Blood pressure response to physical exercise in healthy adolescents and adolescents with insulin-dependent diabetes mellitus.

1. Reference values for systolic blood pressure during exercise are provided for 88 healthy adolescents (12-22 years of age) of both sexes. Data were related to oxygen uptake, heart rate, blood lactate concentration, rate of perceived exertion, age, sex, body size and physical fitness. 2. The same variables were measured in 55 adolescents of both sexes with insulin-dependent diabetes mellitus of about 12 years duration and were analysed with respect to the healthy control group, to degree of metabolic control and to late diabetic complications. 3. In healthy adolescents the pressure response was not related to sex or age. When compared with control subjects diabetic patients had a higher diastolic blood pressure at rest and a more marked blood pressure increase, 23 versus 19 mmHg W-1 kg-1 body weight, during exercise with no sex difference. The blood pressure rise was not related to metabolic control, glomerular hyperfiltration or physical fitness. 4. Prolonged exercise tests were no more informative regarding the blood pressure response to exercise than the stepwise increased load test. Analysing the blood pressure increase versus relative work load (W/kg body weight) during exercise reveals blood pressure differences otherwise not noted. A diabetic patient with blood pressure above the 97.5% confidence limit during exercise seems to have a higher risk of developing incipient nephropathy 5 years later.

Adolescent↗

[Is periodic psychosis in adolescence a disease of its own? The differential diagnosis of psychomotor psychoses in childhood and adolescence].

A historically orientated analysis of a disease that must be seen in connection with menstruation is made on the basis of literature on periodical psychoses in adolescence, which are described as nosologically separate disturbances. This relation turns out to be by no means obligatory, and this also applies to the homogeneity of the disease. Psychomotor disturbances of psychopathological importance are described by means of ideally typical cases of disease and presented with a differentiated diagnosis. Psychoses occurring during different periods in childhood and adolescence, do not show any sex-specific differences and no absolute dependence in accordance with the menstruation rhythm, but are mostly connected with a hereditary and also a perinatal strain in childhood. In their acute and long-term progress the psychomotoric disturbances allow a differentiated prognosis and therefore a therapeutic explanation. They can be classified in accordance with the Wernicke-Kleist-Leonhard classification schema as motility psychosis and periodic catatonia. With this in mind, the positive-negative dichotomy of schizophrenic disturbances in childhood and adolescence should be carefully reconsidered.

Adolescent↗

Validity of the body mass index as an indicator of the risk and presence of overweight in adolescents.

The validity of the body mass index (BMI) as an indicator of the risk of becoming overweight and of the presence of overweight was evaluated in 6 groups of adolescents comprising several ethnic groups (n = 1570, aged 9-19 y). With use of triceps skinfold thickness and estimated percentage body fat as the criteria for adiposity, BMI had high specificities (86.1-98.8% for risk of overweight and 96.3-100% for presence of overweight) and lower but variable sensitivities (4.3-75.0% for risk of overweight and 14.3-60% for presence of overweight). Thus, almost all adolescents who were not at risk for overweight or who were not overweight were classified correctly. In contrast, many adolescents who were at risk of overweight or who were overweight were not correctly identified as measured by BMI. Partial correlations, controlling for age, between BMI and the triceps skinfold thickness and estimated percentage body fat were generally moderate to moderately high, whereas BMI and triceps skinfold thickness appeared to be equally related to estimated total body fatness and percentage body fat in Mexican American and Austrian white males. BMI was better correlated with trunk skinfold thicknesses, but when relative subcutaneous fat distribu-tion was statistically controlled, the trunk-extremity contrast in the correlations was no longer apparent.

Journal Article↗

Longitudinally predicting late adolescent and young adult drug use: childhood and adolescent precursors.

OBJECTIVE: To examine the childhood and adolescent personality determinants of young adult drug use. METHOD: Data were obtained on children when they were approximately 5.5 (time 1; T1), 14 (T2), 16 (T3), and 22 (T4) years of age. T2-T4 interviews of subjects and their mothers assessed child personality and behavior. At T1, 976 mothers were interviewed. The analysis was based on 734 subjects. RESULTS: Specific childhood and adolescent personality traits are related to stage of drug use in young adulthood. Regressions showed that (1) traits at T2 and T3 mediated the effect of traits at earlier ages on T4 drug use and (2) stage of drug use was stable from T3 to T4 despite controlling for personality. Significant interaction revealed two buffers weakening the effect of T3 drug use on T4 drug use. Many more T1-T3 personality traits, particularly low aggression, enhanced the effect of low T3 use on T4 use. CONCLUSIONS: Earlier findings that childhood personality is related to adolescent personality and then to drug use were extended to young adulthood. This mediational model indicates the stability of personality across development. Despite this stability, other results suggest ways to modify drug use.

Adolescent↗

Practice parameters for the forensic evaluation of children and adolescents who may have been physically or sexually abused. American Academy of Child and Adolescent Psychiatry.

These practice parameters describe the forensic evaluation of children and adolescents who may have been physically or sexually abused. The recommendations are drawn from guidelines that have been published by various professional organizations and authors and are based on available scientific research and the current state of clinical practice. These parameters consider the clinical presentation of abused children, normative sexual behavior of children, interview techniques, the possibility of false statements, the assessment of credibility, and important forensic issues. These parameters were approved by Council of the American Academy of Child and Adolescent Psychiatry in September 1996 and were previously published in J. Am. Child Adolesc. Psychiatry, 1997, 36:423-442.

Adolescent↗

Practice parameters for the assessment and treatment of children and adolescents with substance use disorders. American Academy of Child and Adolescent Psychiatry.

These practice parameters describe the assessment and treatment of children and adolescents with substance use disorders and are based on scientific evidence regarding diagnosis and effective treatment as well as on the current state of clinical practice. Given the paucity of research on the treatment of substance use disorders in children and adolescents, many of the recommendations are drawn from the adult literature and current clinical practice. These parameters consider risk factors for substance use and related problems, normative use of substances by adolescents, the comorbidity of substance use disorders with other psychiatric disorders, and treatment settings and modalities.

Adolescent↗