An epidemiological view of adolescent health in Latin America.

PIP: Only recently has attention been given to the condition and needs of adolescents in Latin America. Many assume that the low mortality rate among adolescents is an indication of their more than adequate health status. In reality, however, data on the health status of Latin American teens in lacking and those data which are available have been poorly synthesized and employed. In an effort to redress this oversight, the authors review and synthesize existing data on the subject from UNESCO, the World Bank, PAHO, the ILO, and other international organizations. From sections on the demography of adolescents, education, employment, economic and social conditions, mortality, morbidity, risk behaviors, and reproductive health, the authors find that adolescents in Latin America suffer traditional infectious illnesses and nutritional deficiencies; are increasingly exposed to alcohol, tobacco and drugs; and are experiencing new morbidities from violence, self-destructive behaviors, injuries, and addictions. While the level of educational attainment had increased for these youths and illiteracy has decreased across the board, poverty pervades much of the region and constrains the ability of adolescents to secure and maintain a decent quality of life. Health professionals and the general public need to dismiss the myth that adolescents in Latin America are overwhelmingly healthy and move proactively to provide them with the attention and services they so desperately need.^ieng

Mineral balance and bone turnover in adolescents with anorexia nervosa.

We evaluated seven female adolescents with anorexia nervosa to determine whether calcium metabolism was affected by their disorder. We measured calcium absorption, urinary calcium excretion, and calcium kinetics, using a dual-tracer, stable-isotope technique during the first weeks of an inpatient nutritional rehabilitation program. Results were compared with those from a control group of seven healthy adolescent girls of similar ages. The percentage of absorption of calcium was lower in subjects with anorexia nervosa than in control subjects (16.2% +/- 6.3% vs 24.6% +/- 7.2%; p < 0.05). Urinary calcium excretion was greater in subjects with anorexia nervosa than in control subjects (6.4 +/- 2.5 vs 1.6 +/- 0.7 mg.kg-1 x day-1; p < 0.01) and was associated with bone resorption rather than calcium hyper-absorption. Calcium kinetic studies demonstrated a decreased rate of bone formation and an increased rate of bone resorption. These results suggest marked abnormalities in mineral metabolism in patients with anorexia nervosa. From these results, we hypothesize that improvement in bone mineralization during recovery from anorexia nervosa will require resolution of hormonal abnormalities, including hypercortisolism, in addition to increased calcium intake.

Adolescent health care in Brazil.

The period of youth and adolescence has been shown to have continuous demographic growth in the developing world. Young nations thus have to contend with the specific health needs of teenagers and young adults. This is illustrated by an analysis of the health-care needs of Brazilian adolescents. The issues highlighted here are adolescent morbidity and mortality, current delivery of adolescent health care, and future directions of adolescent programs in Brazil.

PIP: The health problems of Brazilian adolescents are attributable to economic and cultural underdevelopment, accelerated population growth, and the resultant problems of providing adequate health and social services. In the last decade maternal infant-care improved resulting in lower infant mortality. Increasing urbanization has the effect of the nuclear family replacing the extended family. The majority of Brazilian women either marry or live together in consensual union before the age of 25. School dropouts are numerous with less than half of the population completing high school. Accidents cause most deaths in the 15-24 year old group of men in the United States, Canada, and Venezuela. They are also the leading cause of mortality in Brazil. Suicide is more frequent among male adolescents than among females. Homicide is highest among males in the 20-24 year age group. Pregnancy and abortion complications cause high mortality in Brazilian female adolescents aged 15 to 24. Traditional medical problems continue to cause a high number of adolescent fatalities including infections (pulmonary diseases and tuberculosis), heart disease (sequelae of congenital heart disease and rheumatic fever), and malignant tumors (leukemia and solid tumors). Morbidity resulting from accidents is high among young people: for every fatality of an accident, 10-13 are severely injured and 30-40 mildly injured. Venereal disease, particularly gonorrhea, had increased in the 1970's, and it is increasing among teenagers. In the 15-19 age group there is a similar distribution of sexually transmitted disease among both sexes. Excessive alcohol consumption and smoking habits can also be traced back to adolescence. Health services designed to serve adolescents is a recent development in Brazil. A number of excellent teams are working to improve the health of Brazilian adolescents. These Brazilian programs are at various stages of development. The large number of Brazilian youths at times discourages the implementation of adolescent health care projects, still the work continues aided by the support provided by international agencies.

Diagnostico diferencial de los sintomas funcionales del adolescente. / Differential diagnosis of the functional symptoms of the adolescent

Los sintomas funcionales constituyen la causa mas frecuente de consulta medica por parte del paciente adolescente. Las quejas pueden coexistir con enfermedades organicas de menor y mayor importancia. La primera tarea del medico es distinguir el componente organico del funcional. Pero, asi como toda condicion organica exige una evaluacion diagnostica y un plan de tratamiento, cada desorden funcional requiere a su vez una variada estrategia. El medico, debe, por lo tanto, mantenerse alerta a la necesidad de profundizar el diagnostico diferencial de los sintomas funcionales del adolescente. Este articulo propone una definicion de sintomas funcionales, los clasifica y sugiere tecnicas para su tratamiento

Diagnostico diferencial de los sintomas funcionales del adolescente. / Differential diagnosis of the functional symptoms of the adolescent

Los sintomas funcionales constituyen la causa mas frecuente de consulta medica por parte del paciente adolescente. Las quejas pueden coexistir con enfermedades organicas de menor y mayor importancia. La primera tarea del medico es distinguir el componente organico del funcional. Pero, asi como toda condicion organica exige una evaluacion diagnostica y un plan de tratamiento, cada desorden funcional requiere a su vez una variada estrategia. El medico, debe, por lo tanto, mantenerse alerta a la necesidad de profundizar el diagnostico diferencial de los sintomas funcionales del adolescente. Este articulo propone una definicion de sintomas funcionales, los clasifica y sugiere tecnicas para su tratamiento