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PubMed2006

The risks and benefits of being a young female adolescent standardised patient.

OBJECTIVE: To follow the progress of young female adolescents, as risk-taking standardised patients (SPs), and to monitor for adverse affects that role-playing may have on the adolescents. METHODS: A prospective design was used in which 11 female adolescents, aged 13-15 years, were recruited from 2 schools. The adolescents were trained to portray risk-taking individuals with a medical condition and were interviewed with their SP mother by final-year medical students 1-3 times a month over 6-14 months. A control group was selected from both schools (n = 6). Main outcome measures were pre- and post-interviews using standardised questionnaires [Achenbach's Youth Self-Report (YSR) and Piers Harris Children's Self Concept Scale (SCS),] and focus groups. RESULTS: The adolescent group simulated 111 interviews (mean per adolescent 10.1, SD = 6.2) each lasting 60-70 minutes. QUANTITATIVE DATA: The pre- and post-scores from the YSR and SCS demonstrated no significant differences within the SP study participants or between the control group vs. the study group. FOCUS GROUP FINDINGS: The initial focus group acted as a debriefing exercise and prompted the adolescents to request that they come out of their role when giving feedback. Subsequent focus group discussion was around the medical student performance and their family doctors. CONCLUSION: Adolescent females showed no adverse effects when used extensively to portray risk-taking SPs. The focus groups provided the adolescents with an opportunity to debrief together. The adolescent SPs reported benefiting from this study but requested unanimously that they come "out of character" when giving feedback to the medical students.

Adolescent↗
PubMed2002

A comparison of self-reported and measured height, weight and BMI in Australian adolescents.

OBJECTIVE: To explore the relationship between self-reported weight and height to actual weight and height in older Australian adolescents. METHOD: Weights and heights of 572 adolescents aged 15-19 years who participated in the 1995 Australian National Health Survey (NHS) and National Nutrition Survey (NNS) were examined. RESULTS: Self-reported heights were significantly higher than measured heights in participants. There were no differences in the accuracy of self-reported heights among the adolescents by gender. Self-reported weights were significantly lower than measured weights among both boys and girls (p < 0.01). There were no differences in the accuracy of self-reported weights among the boys and girls. Differences between actual weight and self-reported weight were significantly greater for overweight or obese adolescents compared with normal/underweight adolescents (p < 0.01). The use of self-reported weight and height resulted in the correct classification of overweight or obesity in 69% boys and 70% of girls. CONCLUSIONS: There was no significant gender difference in reporting weight and height in older adolescents. Bias in reporting weight and height was much higher in overweight or obese adolescents than normal/underweight adolescents. IMPLICATIONS: The percentage of misclassification of overweight or obesity from self-reported data in this study was 31% for boys and 30% for girls, respectively. Therefore, the self-reported weight and height of older adolescents needs to be more cautiously utilised. Efforts to improve the accuracy of self-reporting in older adolescents are needed if this measure is to be reliable.

Adolescent↗
PubMed2005

The borderline personality diagnosis in adolescents: gender differences and subtypes.

BACKGROUND: This study aimed to identify personality features characterizing adolescent girls and boys with borderline personality disorder (BPD) and to see whether meaningful patterns of heterogeneity exist among adolescents diagnosed with the disorder. METHODS: Two hundred and ninety-four randomly selected doctoral-level clinicians described adolescent patients using Axis II rating scales and the Shedler-Westen Assessment Procedure-200 for Adolescents (SWAP-200-A). We used the SWAP-200-A to provide empirically derived descriptions of female and male adolescents meeting DSM-IV criteria for BPD (who differed substantially in their profiles), and used Q-factor analysis to identify naturally occurring groupings of female patients based on shared personality features. RESULTS: The symptoms and phenomenology of adolescent girls with BPD are similar to those of adults. Adolescent boys meeting BPD criteria have a more aggressive, disruptive, antisocial presentation. Although Ns did not permit further analysis of the data on adolescent boys, Q-analysis isolated four clinically coherent subgroups of girls with BPD: high-functioning internalizing, histrionic, depressive internalizing, and angry externalizing. CONCLUSIONS: BPD in female adolescents resembles DSM-IV BPD as defined for adults. The operating characteristics of the DSM-IV criteria for adolescent boys require further investigation. Empirically derived subgroups are similar to those identified in recent research with adult females. Differences across subgroups on internalizing and externalizing Child Behavior Checklist (CBCL) scales provide preliminary data on the validity of subgroups and raise questions about the place of BPD among internalizing and externalizing spectrum disorders.

Adolescent↗
PubMed1989

Mental health in Dutch adolescents: self-reported competencies and problems for ages 11-18.

Beside parents and teachers, adolescents themselvess may be valuable informants about their own psychological functioning. The present study, which provides prevalence data on behavioral/emotional problems and competencies reported by adolescents aged 11-18 from the general population, was preceded by two studies providing such data for parent and teacher reported problems. The instrument used in the present study is the Youth Self Report (YSR) developed by Achenbach and Edelbrock to obtain adolescents' self-reports on their problems and competencies in a standardized way. YSRs completed by 52 adolescents on two occasions with a time-interval of 3-4 weeks revealed test-retest reliability expressed as intraclass correlation coefficients of 0.87 for total problem scores and 0.69 for total competence scores. The YSR was completed by 941 adolescents aged 11-18 from the general population. For each of the 103 problem items and 17 competence items, the prevalence rates were presented graphically for both genders in two-year age-groups. To identify differences related to sex, age and socio-economic status (SES), ANCOVAs were performed on the scores for each problem and competence item as well as on total problem and total competence scores. Whereas the level of problem scores was the same across the 11-18 years age-span, girls obtained higher total problem scores with increasing age. Younger girls scored lower and older girls scored somewhat higher than boys. Implications of these findings with respect to sex differences in referral rates for children and adults are discussed. The increase with increasing age in self-reports of problems concerning inner feelings and thoughts may reflect the adolescent's change in cognitive, socio-emotional and physical functioning. We could not demonstrate significant SES differences in problem scores. Comparisons of problem scores obtained for referred and nonreferred adolescents revealed a correct classification rate of 73.6%, which seems satisfactory given the fact that parents rather than the adolescent usually initiate referrals. Comparisons of problem item scores in ANCOVAs of referred and nonreferred samples revealed significant referral status effects for 68 of the 103 problem items, with referred adolescents scoring higher than nonreferred adolescents. The largest effect of referral status was found for the item "Nervous". The third largest effect was obtained for the item "Unhappy, sad, depressed", which also showed strong discrimination between parent scores for referred and nonreferred samples. Competence scores showed much weaker discrimination between referred and nonreferred groups.

Adolescent↗
PubMed1998

Body image and psychopathology in adolescence: a controlled clinical study.

The aim of this study was to investigate mentally disturbed adolescents' problems of acknowledging and accepting the physical changes and sexual maturation of their bodies, in comparison with healthy adolescents. The study sample consisted of 60 adolescents (30 boys and 30 girls), 15-18 years of age, who had been referred for psychiatric examination, and 60 healthy controls, matched on the basis of age, sex, place of residence and level of education. The study methods were the self-rated questionnaire and psychiatric in-depth interview modified on the basis of the diagnostic profile of adolescents. Mentally disturbed adolescents had more negative attitudes towards developmental body changes than healthy adolescents. They were unable to describe the physical changes they had undergone. Healthy adolescents were more aware of developing sexual characteristics. On discriminant analysis, independent background variables explaining problems relating to sexual maturation in mentally disturbed adolescents were found to be a lack of or low number of peer relationships, and long-term stress. In the healthy adolescents, independent variables associated with problems in sexual maturation were found to be a lack of or low number of peer relationships and a single-parent home. We conclude that adolescents with psychiatric problems seem to have a poorer capacity to process mentally the ongoing bodily and sexual maturation of their bodies than matched healthy controls.

Adaptation, Psychological↗
PubMed2004

Bone mineral density in adolescent women using depot medroxyprogesterone acetate.

PURPOSE: To present current data on bone mineral density (BMD) in adolescent women using the long-acting contraceptive depot medroxyprogesterone acetate (DMPA) and also to discuss the importance of developing maximal bone mass during adolescence to offset bone demineralization later in life. DATA SOURCES: Research-based articles in the medical literature, review articles, and recommendations from the American Academy of Pediatrics and the National Osteoporosis Foundation. CONCLUSIONS: Osteoporosis is a preventable disease that affects millions of Americans, particularly older women. Factors influencing the attainment and maintenance of peak bone mass during childhood and adolescence affect the future risk of fractures. Although longitudinal studies conducted on adolescent women using DMPA are very limited, findings suggest that adolescents are losing bone density during a time of expected bone accretion. IMPLICATIONS FOR PRACTICE: Clinicians must consider all the risks and benefits when prescribing contraceptives to adolescents. By themselves, the findings related to BMD and DMPA use by adolescents are not sufficient to limit the use of DMPA as a contraceptive method. However, clinicians must take into account the addition of other modifying factors associated with BMD that may contribute to overall bone loss in adolescent females. More prospective data on the long-term use of DMPA by adolescents are needed to determine DMPA's effect on bone loss and to determine if bone loss is transient in adolescents.

Adolescent↗
PubMed2005

Sex and informant effects on diagnostic comorbidity in an adolescent community sample.

OBJECTIVE: To investigate sex and informant effects on comorbidity rates for anxiety disorders, depressive disorders, attention-deficit hyperactivity disorder (ADHD), and conduct-oppositional disorder (CD-ODD) in an adolescent community sample. METHOD: The Diagnostic Interview Schedule for Children-2.25 (DISC-2.25) was administered to 1201 adolescents and their mothers. RESULTS: The highest comorbidity risk found was between ADHD and CD-ODD, with odds ratios (ORs) of 17.6 for adolescent reports and 12.0 for mother reports. The second-highest comorbidity risk, with ORs of 13.2 for adolescent reports and 11.0 for mother reports, was between anxiety and depressive disorders. There was not much overlap between internalizing and externalizing disorders. Adolescent girls had higher rates of coexisting anxiety and depressive disorders, whereas adolescent boys had higher rates of coexisting ADHD and CD-ODD. There was partial support for the hypothesis that adolescent-reported comorbidity rates would exceed mother-reported rates. CONCLUSIONS: There is a greater cooccurrence of within-category, compared with between-category, disorders. Adolescent girls are more likely to have coexisting internalizing disorders, while adolescent boys are more likely to have coexisting externalizing disorders. Mothers tend to report more externalizing disorders (that is, ADHD), while adolescents generally report more internalizing disorders.

Adolescent↗
PubMed1988

Acute lymphoid leukemia in adolescents: clinical and biologic features predict a poor prognosis--a Pediatric Oncology Group Study.

Analysis of remission induction rates for 1,768 children (1.5 to 11 years) and 425 adolescents (greater than or equal to 11 years) with acute lymphoid leukemia (ALL), and of event-free survival times for 570 children and 147 adolescents, disclosed that adolescents fared significantly worse by both measures of treatment outcome (P = .0001). Adolescents with either T cell or non-T cell ALL entered remission significantly less often than did children (P = less than .02 and P = less than .001, respectively). Within each of the major immunophenotypes of ALL, adolescents had shorter duration of continuous complete remission: early pre-B (non-B, non pre-B, non-T) (P = .001), pre-B (P = .05), and T (P = .027). We compared the clinical characteristics of adolescents and children, and lymphoblast characteristics present at diagnosis to account for the inferior prognosis of adolescent patients. Adolescents had a higher incidence of T cell ALL (P = .0001) and thus a higher incidence of all T cell-associated characteristics. Adolescents with non-T, non-B ALL were more likely to be male (P = .044), and to have higher leukocyte counts (P = .002) and lower levels of IgG (P = .0003), IgA (P = .0001), and IgM (P = .002). Their leukemic cells had lower PAS scores (P = .0001), a higher incidence rate of L2 morphology by French-American-British (FAB) criteria (P = .001), common ALL antigen negativity (P = .0001), and hypodiploid or pseudodiploid karyotypes (P = .004). These findings clearly indicate an increased incidence of prognostically unfavorable clinical and biologic features in adolescents with ALL, providing a biologic explanation for their poor prognosis.

Adolescent↗
PubMed1999

Health concerns and risk behaviors of rural adolescents.

Although much has been written about the health status of adolescents, little is known about adolescents' perception of their own health. The purpose of this article is to describe the health concerns of rural adolescents. Two national studies, the Youth Risk Behavior Survey and the National Longitudinal Study of Adolescent Health (Add Health Project), are used as comparisons. Data from the rural survey represent 624 community adolescents attending 4 rural Pennsylvania schools. The students were in the 9th, 10th, and 11th grades. The Adolescent Health Inventory was used to report concerns related to general health, psychosocial issues, and risk behaviors. Overall, rural adolescents in the study reported an average of 6.5 (SD = 3.2) health concerns with frequencies of occurrence being always or often and reported an average involvement in 1 (SD = 1.3) risk behavior. Psychosocial issues were reported by 28%, and 23% worried about their general health. Frequently reported risk behaviors included alcohol use, drug use, and a lack of exercise. There was minimal concern expressed regarding venereal disease or AIDS, whereas 12% expressed concern about the possibility of pregnancy. These results suggest the likelihood that adolescents perceive health from a holistic perspective and that health promotion programs should consider involving adolescents in planning, both (a) to ensure congruence of the plan of care with adolescents' concerns and (b) to clarify the interpretation and meaning of their concerns. We present implications for the community health nurse.

Adolescent↗
PubMed2000

Gender and sexual maturation-dependent contrasts in the neuroregulation of growth hormone secretion in prepubertal and late adolescent males and females--a general clinical research center-based study.

Although numerous studies have delineated an impact of gender on the neuroendocrine control of GH secretion in the adult, few investigations have defined the nature and extent of sex differences before puberty. This deficit reflects jointly the sensitivity limitations of earlier GH assays and the paucity of intensive sampling protocols in healthy children. Here we have applied a chemiluminescence-based GH assay (sensitivity, 0.005 microg/L) to study GH release in blood sampled every 10 min for 12 h from 1800-0600 h in 58 healthy children. Males and females were evaluated in prepuberty (n = 17 boys; n = 11 girls) and late adolescence (n = 13 males; n = 17 females). We quantitated the principal regulated facets of GH release by 1) deconvolution analysis to assess basal vs. pulsatile GH secretion, 2) approximate entropy to compute the regularity of GH release patterns, and 3) cosine regression analysis to evaluate the overnight rhythmic release of GH. Gender by maturation analysis of variance revealed a mean 2.3-fold increase in the integrated serum GH concentration between prepuberty and late adolescence (P < 10(-6)). Deconvolution analysis disclosed that 91-97% of total GH secretion was pulsatile. Pulsatile, but not basal, GH release showed marked sexual maturation dependence (P < 10(-5)). Pulsatile GH release rose in adolescents due to a 2.25-fold greater GH secretory burst mass (P = 0.00011), which reflected joint 1.5-fold increases in GH secretory pulse amplitude and duration (P < 0.01). Pulse-mass enhancement across puberty was gender independent, but mechanistically specific, as GH pulse frequency, intersecretory burst interval, and half-life were invariant of pubertal status. The approximate entropy statistic identified more disorderly GH secretion patterns in adolescent females compared with prepubertal children and adolescent males (P = 0.00074). Cosinor analysis unmasked elevated overnight rhythms in GH secretory burst mass and interburst intervals in late adolescents of both genders compared with prepubertal boys (for burst mass) or girls (for interburst intervals). Linear regression analysis disclosed strong correlations among 1) the plasma insulin-like growth factor I concentration and GH secretory burst mass (P < 10(-3)), 2) the GH pulse mass and the serum testosterone concentration (P = 10(-3)), 3) the irregularity (entropy) of GH secretory patterns and the serum estradiol concentration (P < 10(-4)), and 4) the basal GH secretion rate and the serum estradiol concentration (P = 10(-2)). In summary, healthy prepubertal children and late adolescent boys and girls manifest distinctive mechanisms controlling GH release, as appraised for all three of the pulsatile, entropic, and 12-h rhythmic modes of GH neuroregulation. The major maturational contrast in the pulsatile mode of GH secretion is amplified secretory burst mass in adolescents due to jointly heightened GH pulse amplitude and duration. The dominant gender distinction lies in the reduced orderliness of GH release patterns in late adolescent girls. Overnight rhythms in GH secretory burst mass and interburst intervals enlarge in both sexes at adolescence, thus signaling enhanced coupling between the rhythmic and pulsatile control of GH release at this time. At the extrema of pubertal development, sex steroid hormones are associated differentially with specific facets of GH release, e.g. an elevated basal GH secretion rate (estrogen), greater irregularity of GH release patterns (estrogen), and amplified GH secretory burst mass and higher plasma insulin-like growth factor I concentrations (testosterone). Accordingly, we postulate that sex steroids supervise selectively each of the dominant facets of GH neurosecretory control across human puberty.

Adolescent↗
PubMedDate not supplied

Alcohol and adolescent suicide.

Adolescent suicide is a major public health problem. In this review, the authors discuss different aspects of the relation between alcohol abuse and suicidal behavior in adolescents, including epidemiology, role of family history, comorbidity, gender differences, neurobiology, treatment, and prevention. In the general population, about 2,000 adolescents in the United States die by suicide each year. Suicide continually ranks as the second or third leading cause of death of persons between the ages of 15 and 34 years old. The suicide rate in young people has more than doubled during the period from 1956 to 1993. This increasing suicide rate has been blamed on the increase of adolescent alcohol abuse. Availability of alcohol and guns at home may contribute to suicide risk in adolescents. Comorbid psychopathology, which is common among adolescent alcohol abusers, substantially increases risk for suicide completions and attempts. Depressed adolescents may use alcohol to self-medicate depressive symptoms. Alcohol abuse and suicidal behavior in adolescents and in adults has been found to have biochemical, genetic, and psychological correlates. Ideally, treatment of adolescents who receive a diagnosis of an alcohol use disorder and co-occurring suicidality should follow an integrated protocol that addresses both conditions. Future studies of psychological and neurobiological mechanisms of suicidality in adolescents with alcohol and/or substance abuse are merited.

Adolescent↗
PubMedDate not supplied

Family-based treatment development for adolescent alcohol abuse.

A range of family-related risk factors have been linked to adolescent alcohol problems and predict escalation of use and alcohol dependence into adulthood. Family-based interventions have strong research and clinical traditions in the treatment of adult alcoholism and adolescent drug abuse, but have been infrequently applied to the unique problems of adolescent alcohol abuse and dependence. Researchers in the adolescent alcohol abuse specialty area have developed a robust developmentally oriented knowledge base about alcohol-specific risk and protective factors. Adolescent alcohol treatment researchers have made significant advances in recent years, including a deeper understanding of outcome trajectories. However youth relapse to alcohol use at high rates following standard community-based treatment, and few empirically supported treatments exist for adolescent alcohol abusers. Employing selected contemporary research findings, this article outlines specific areas of focus for a family-based intervention for alcohol abusing teens. We first review intervention-relevant research on the development of alcohol problems among adolescents with a focus on family risk and protective factors. Second, clinical research findings are presented supporting the use of family-based interventions with alcohol abusing youth. Finally, areas of intended focus in an empirically supported family-based intervention for adolescent alcohol problems are outlined. By addressing these gaps, empirically supported family-based interventions for adolescent alcohol abuse have significant potential to advance the field of adolescent alcohol treatment.

Adolescent↗
PubMed2006

Type 2 diabetes mellitus in African-American adolescents: impaired beta-cell function in the face of severe insulin resistance.

We have previously demonstrated abnormalities in insulin secretion in adolescents with type 2 diabetes mellitus (DM2) in response to the mixed meal test and to glucagon. In order to further assess beta-cell function in DM2, we measured insulin and C-peptide responses to oral glucose in adolescents with DM2 in comparison to non-diabetic obese and lean adolescents. We studied 20 patients with DM2, 25 obese adolescents with matching body mass index (BMI) (33.8 +/- 1.4 vs 34.3 +/- 1.0 kg/m2), and 12 non-obese control adolescents (BMI 22.6 +/- 0.6 kg/m2). Mean age, sex and sexual maturation did not differ between the three groups. All adolescents with DM2 had negative islet cell antibodies (ICA); five patients were on diet and 15 on insulin treatment. Fasting lipid profiles were determined in all participants. Plasma glucose and serum C-peptide and insulin levels were measured at 0, 30, 60, 90, and 120 min after an oral glucose load. The C-peptide increment (deltaCP) was calculated as peak minus fasting C-peptide. Area under the curve (AUC) was estimated using the trapezoid method. Insulin resistance was estimated using the HOMA model (HOMA-IR). The first phase of insulin secretion (PH1) was computed using a previously published formula. Serum triglyceride levels were significantly higher in the patients with DM2 compared to the non-obese controls (1.4 +/- 0.1 vs 0.9 +/- 0.1 mmol/l; p = 0.02). Plasma glucose AUC was greater in the patients with DM2 compared to the obese and non-obese control groups (1,660 +/- 130 vs 717 +/- 17 vs 647 +/- 14 mmol/l x min; p < 0.0001). ACP was lower in adolescents with DM2 than in obese and non-obese adolescents (761 +/- 132 vs 1,721 +/- 165 vs 1,225 +/- 165 pmol/l; p < 0.001). Insulin AUC was lower in the patients with DM2 compared to obese controls (888 +/- 206 vs 1,606 +/- 166 pmol/l x h; p = 0.009), but comparable to that of the non-obese controls (888 +/- 206 vs 852 +/- 222 pmol/l x h; p = 0.9). Insulin AUC was also higher in the obese than in the non-obese group (p = 0.05). PH1 was significantly higher in the obese group compared to the patients with DM2 as well as to the non-obese controls (2,614 +/- 2,47.9 vs 929.6 +/- 403.5 vs 1,946 +/- 300.6 pmol/l, respectively; p = 0.001). PH1 was also higher in the non-obese controls than in the patients with DM2 (p = 0.05). HOMA-IR was three-fold higher in the patients with DM2 than in the BMI-matched obese group, and five-fold higher than in the lean controls (14.3 +/- 1.2 vs 5.4 +/- 0.8 vs 2.9 +/- 0.4; p = 0.0002). Adolescents with DM2 have dyslipidemia, a significant cardiovascular risk factor. Decreased beta-cell function is characteristic of adolescents with DM2 in the presence of severe insulin resistance.

Adolescent↗
PubMed2004

Adolescent heavy episodic drinking trajectories and health in young adulthood.

OBJECTIVE: This study examined the association of trajectories of heavy episodic drinking (at least five alcoholic drinks on one occasion) during adolescence with health status and practices at age 24. METHOD: Semiparametric group-based modeling and logistic regressions were used to analyze data from a longitudinal panel of 808 youths interviewed between 10 and 24 years of age. RESULTS: Four distinct trajectories of adolescent heavy episodic drinking were identified: nonheavy drinkers, late onsetters, escalators and chronic heavy drinkers. Overall, young adults who did not engage in heavy episodic drinking during adolescence had the lowest occurrence of health problems and were most likely to engage in safe health behaviors at age 24. Chronic and late-onset heavy episodic drinking during adolescence had negative effects on health status and practices at age 24. Adolescent chronic heavy drinkers were more likely to be overweight or obese and to have high blood pressure at age 24 than those who did not drink heavily in adolescence. Late-onset heavy drinkers were less likely to engage in safe driving practices at age 24 and were more likely to have been ill in the past year than adolescents who did not drink heavily. These health disparities remained even after current frequency of heavy episodic drinking at age 24, other adolescent drug use, ethnicity, gender and family poverty were controlled. CONCLUSIONS: Heavy episodic alcohol use during adolescence has long-term, negative health consequences. Distinct patterns of adolescent heavy drinking affect health status and practices in young adulthood differently.

Adolescent↗
PubMed2006

[Prevalence of constipation in adolescents enrolled in São José dos Campos, SP, Brazil, school's and in their parents].

BACKGROUND: There is few information concerning constipation in adolescence. AIMS: To evaluate the prevalence of constipation in adolescents enrolled in schools settled down in the city of São José dos Campos, state of São Paulo, Brazil, and in their biological parents. PATIENTS AND METHODS: A transversal study was carried out by analyzing a convenience sample which included adolescents between 9 years and 9 months and 18 years and 7 months old and their parents in five schools situated in São José dos Campos, SP. Data was obtained from an individual and personal questionnaire filled by the father, the mother and the adolescent. Three hundred and seventy two adolescents were studied. Constipation was defined as the elimination of hard stools and the presence of at least one of the following: painful or difficult defecation, soiling or bloody stools. Scybalous feces or dry cracked stools or the defecation frequency equal or minor than two per week were considered criteria for characterization of constipation. Rome II criteria was used for evaluate the prevalence of constipation in the parents. RESULTS: The prevalence of constipation in adolescents was 22.3%, being it more frequent in female (27.4%) than in male (14.9%). Among the fathers, the prevalence of constipation (7.3%; 20/274) was lower than in the mothers. Kappa's coefficient showed a slight concordance in the concomitance of constipation in the adolescent and his/her mother (kappa = 0.12) and in the adolescent and his/her father (kappa = 0.05). CONCLUSIONS: Intestinal constipation is a prevalent disturbance in the studied group of adolescents. However, it was not found relevant concordance between constipation in the adolescents and their parents.

Adolescent↗
PubMed2006

Generic health-related quality-of-life assessment in children and adolescents: methodological considerations.

The health-related quality of life (HR-QOL) of children and adolescents is increasingly considered a relevant topic for research. Instruments to assess quality of life in children and adolescents of a generic as well as disease- or condition-specific nature are being developed and applied in epidemiological surveys, clinical studies, quality assurance and health economics. This paper attempts to give an overview on the state of the art of HR-QOL assessment in children as it relates to methodological and conceptual challenges. Instruments available in international or cross-cultural research to assess HR-QOL in generic terms were identified and described according to psychometric data provided and the width of application. In an initial literature search, several challenges in the assessment of child and adolescent HR-QOL were identified, ranging from conceptual and methodological to practical aspects. Seven specific major issues were considered: (i) What are the dimensions of HR-QOL relevant for children and adolescents, and do suitable instruments for their measurement exist? (ii) Can these dimensions be collected in a cross-culturally comparable way? (iii) What advantages and disadvantages do self-rated versus externally evaluated HR-QOL measurements of children and adolescents have? (iv) How can HR-QOL be assessed in an age-appropriate way? (v) What are the advantages and disadvantages of disease-specific and generic data collection? (vi) What advantages and disadvantages do profile and index instruments have? (vii) How can HR-QOL be connected with utility- preference values? In a second literature search we identified nine generic HR-QOL instruments and four utility health state classification systems that complied with the prespecified inclusion criteria. It was concluded that (i) HR-QOL instruments are available to assess the dimensions of the construct relevant to children and adolescents; (ii) provided that an instrument was constructed in an appropriate way, the dimensions of HR-QOL can be measured in an interculturally comparable manner; (iii) the HR-QOL of children and adolescents can and should be ascertained by self-rating; (iv) the measurement instruments used have to consider maturity and cognitive development; (v) only generic quality-of-life instruments allow for an assessment of HR-QOL in both healthy and chronically ill children and adolescents; (vi) the representation of HR-QOL achieved through a singular index value is connected to strict psychometric conditions: the index instrument has to be tailored to these psychometric conditions; (vii) how far utility measures are employable with children and adolescents has to be investigated in further studies. The problem aspects identified indicate the necessity for further research. Nevertheless, instruments for assessing the HR-QOL of children and adolescents can be identified that meet the requirements mentioned above.

Adolescent↗
PubMed2001

Good metabolic control is associated with better quality of life in 2,101 adolescents with type 1 diabetes.

OBJECTIVE: It is unclear whether the demands of good metabolic control or the consequences of poor control have a greater influence on quality of life (QOL) for adolescents with diabetes. This study aimed to assess these relations in a large international cohort of adolescents with diabetes and their families. RESEARCH DESIGN AND METHODS: The study involved 2,101 adolescents, aged 10-18 years, from 21 centers in 17 countries in Europe, Japan, and North America. Clinical and demographic data were collected from March through August 1998. HbA(1c) was analyzed centrally (normal range 4.4-6.3%; mean 5.4%). Adolescent QOL was assessed by a previously developed Diabetes Quality of Life (DQOL) questionnaire for adolescents, measuring the impact of diabetes, worries about diabetes, satisfaction with life, and health perception. Parents and health professionals assessed family burden using newly constructed questionnaires. RESULTS: Mean HbA(1c) was 8.7% (range 4.8-17.4). Lower HbA(1c) was associated with lower impact (P < 0.0001), fewer worries (P < 0.05), greater satisfaction (P < 0.0001), and better health perception (P < 0.0001) for adolescents. Girls showed increased worries (P < 0.01), less satisfaction, and poorer health perception (P < 0.01) earlier than boys. Parent and health professional perceptions of burden decreased with age of adolescent (P < 0.0001). Patients from ethnic minorities had poorer scores for impact (P < 0.0001), worries (P < 0.05), and health perception (P < 0.01). There was no correlation between adolescent and parent or between adolescent and professional scores. CONCLUSIONS: In a multiple regression model, lower HbA(1c) was significantly associated with better adolescent-rated QOL on all four subscales and with lower perceived family burden as assessed by parents and health professionals.

Adolescent↗
PubMed2004

Prevalence of underweight, overweight and obesity in Turkish adolescents.

BACKGROUND: The aim of this study was to determine underweight, overweight and obesity prevalence in a representative sample of adolescents living in urban and rural area of central Edirne, Turkey, and to compare the 95th percentile BMI curve to the curves of other countries. MATERIAL AND METHODS: Data concerning the height and weight of 989 adolescents, aged between 12 and 17 years were collected. The prevalence of underweight was defined as the percentage of adolescents below the 5th percentiles of the American adolescents' age and gender specific BMI; prevalence of overweight and obesity were based on the cut off points of the International Obesity Task Force values (excess of the 85th and 95th percentiles), respectively. RESULTS: This study demonstrated that the prevalence of underweight, overweight and obesity among adolescent girls was 11.1%, 10.6% and 2.1%, respectively, while it was 14.4%, 11.3% and 1.6% for adolescent boys. In the urban area the prevalence of underweight, overweight and obesity among adolescent girls was 10.0%, 10.3% and 2.1%, while it was 14.4%, 11.6% and 1.6% for boys, respectively. In the rural area; the prevalence of underweight, overweight and obesity among adolescent girls was 15.7%, 12.4% and 2.2%, while it was 14.5%, 9.6% and 1.2% for boys, respectively. DISCUSSION: Analyses of data collected during these studies support that adolescents living in the city of Edirne carry relatively lower further risk of overweight and obesity than adolescents in other countries do.

Adolescent↗