A primary care approach for adolescent care and counseling services.

OBJECTIVE: Adolescents can have mental, emotional, and behavior problems that are a source of stress for the child as well as the family, school and community. These may disrupt the adolescent's ability to function normally. Adolescents also have reproductive concerns especially at menarche. Considering the extent of problems of adolescents and the lack of adolescent care and counseling services, it was felt that community adolescent care counseling services should be made available. This article describes the steps involved in the setting up of Taluk model of adolescent care and counseling services. METHODS: Following steps were involved in setting up a Taluk model of adolescent care counseling service delivery system. Step I: Focus Group Discussions (FGDs) among Stakeholders. Step II: Conceptualization and Strategy planning for service delivery. III: Finalization of service delivery model Step IV: Workshops for finalization of TSQ-T 2008 version the tool to be used for assessing the adolescents in the ARSH clinics. Step V: Training Programme for Medical/Paramedical health staff. Step VI: Awareness programs for mothers of adolescents. Step VII: Setting up of ACS/ARSH clinics at Taluk hospitals. Step VIII: Evaluation of the utilization of services at Taluk hospitals. The clinic has been well utilized with 1,588 adolescents being seen in 2 years. RESULTS: Medical and Reproductive problems among adolescent girls were anemia, underweight, dysmenorrhoea, menstrual irregularities and symptoms of Polycystic Ovarian Syndrome, whereas among boys problems were mostly related to concerns about masturbation and its perceived ill effects. The psychosocial problems ranged from minor anxieties, sadness and adjustment problems to psychiatric disorders. Scholastic problems included poor concentration, poor study habits and low intelligence quotient. CONCLUSIONS: The success of the clinics in these five hospitals can be replicated in other parts of the state as well as the country. These will go a long way to ameliorate the morbidity of adolescents.

Menstrual disorders and menstrual hygiene practices in higher secondary school girls.

OBJECTIVE: To study the menstrual problems and menstrual hygiene practices of adolescent girls in Thiruvananthapuram City Corporation. METHODS: Students of class XI and XII in the age group 15-19 years, belonging to ten Higher Secondary Schools within the Thiruvananthapuram City Corporation area were selected for the study by multistage sampling procedure and screened using a pretested self evaluation questionnaire. RESULTS: Menstrual disorders were reported in 21.1%. The most frequently reported problem during menstruation was dysmenorrhoea (72.4%) followed by oligomenorrhoea (11.3%). Only 11.5% of the girls who had menstrual problems sought treatment and majority from a gynecologist. Out of 81.5% girls who reported vaginal discharge, only 5.7% had abnormal discharge. Menstrual hygiene was adequate in the majority of girls. CONCLUSIONS: Menstrual disorders are common in adolescence and can have significant consequences on future reproductive health.

Markers of fetal onset adult diseases: a comparison among low birthweight and normal birthweight adolescents.

OBJECTIVE: To observe and compare the markers of fetal onset adult diseases among low birthweight (<2500 grams, LBW) and normal birthweight (> or =2500 grams, NBW) babies at 16 years of age. METHODS: Comparative cross sectional analysis of two groups of cohorts followed-up at 1 year and 16 years of age at Child Development Centre (CDC), Medical College, Thiruvananthapuram. 189 LBW babies formed the study group and 213 NBW babies formed the comparison group. At 16 years, the parameters used for assessment of both the groups were, body mass index (BMI) and the markers of fetal onset adult diseases fasting blood glucose level, fasting plasma insulin level, total cholesterol, low density lipoprotein, high density lipoprotein and triglycerides. RESULTS: High triglyceride values and overweight/obesity were significantly more in LBW adolescents when compared to NBW adolescents. This has policy implications in planning adolescent nutrition and care programs in India.

Markers of fetal onset adult diseases.

The fetal origins hypothesis, proposes that non-communicable diseases including coronary heart disease, type 2 diabetes and hypertension originate through the responses of a fetus to undernutrition, that permanently change the structure and function of the body. Associations between low birthweight and disease in later life have been widely studied in Europe and the USA. Studies in southern India have shown that babies who are short and fat tend to become insulin deficient and have high rates of non-insulin dependent diabetes. These findings have important public health implications as it suggests that associations with body size at birth underestimate the contribution of intrauterine development to later disease, and also, that while the primary prevention of coronary heart disease and non-insulin dependent diabetes may ultimately depend on changing the body composition and diets of young women. Therefore, more immediate benefit may come from preventing imbalances between prenatal and postnatal growth among children. The basic premise of the thrifty gene hypothesis is that certain populations may have genes that determine increased fat storage, which in times of famine represent a survival advantage, but in a modern environment result in obesity and type 2 diabetes. The fetal origins theory is of greatest relevance to the developing world and the implications of this work for global health are enormous. To reduce chronic diseases, we need to understand how the human fetus is nourished and how malnutrition changes its physiology and metabolism, so that interventions be implemented to limit the damage. The challenge for the next decade must be to discover the cellular and molecular mechanisms giving rise to these associations. If this aim is accomplished, it might be possible to devise strategies to reduce the impact of these disabling chronic and expensive diseases.

Low birthweight babies--outcome at 13 years.

The study was conducted to compare growth status, blood pressure, self esteem and intelligence of 200 low birthweight (LBW) and 224 normal birthweight (NBW) adolescents at 13 years of age. Intelligence scores at or below the 25th percentile (low performance) were observed among 51.4% LBW and 41.7% NBW adolescents (<0.05). Statistically significant lower scores for self esteem (mean difference 4.31, 95% CI 1.91-6.71) were observed among LBW adolescents. Height, weight and body mass index (BMI) were lower among all LBW adolescents and the difference reached statistical significance for weight and BMI among LBW adolescent girls.

Disappearing CT lesions in focal seizures.

A case of focal seizures with right hemiparesis in a 6-year-old Indian girl is presented. CT scan showed four ring-enhancing lesions in the left cortex. She was treated with phenytoin and a course of praziquantel. The hemiparesis recovered in 3 weeks and a repeat CT scan after 2 months was normal. Arbitrary use of anti-tuberculous therapy in Indian children with focal lesions in the brain is not recommended as the lesions are often due to cysticercosis.