Adolescer Saudável: screening and follow-up of risk at school.

OBJECTIVE: To characterize adolescents referred to medical consultation based on the screening tool "Perfil de Saúde do Utente Adolescente", and to compare to information gathered from a questionnaire and data assessed during the visit. METHODS: A retrospective and descriptive study, with analysis of the questionnaires filled out by adolescents and their respective medical records, in the period from January 2013 to June 2016. RESULTS: A total of 54 adolescents were seen, 57% male and mean age of 12±1.7 years. In the questionnaire, 37% stated that they had some kind of health problem; 35% would like to change the relationship with their parents; 18% had some concern about safety at school; and 39% made dietary mistakes. Approximately 31% had consumed alcohol, 13% had tried smoking, and 4% had used other drugs. At the first medical appointment, 38% stated they had chronic disease, 11% reported poor family environment, 39% had school problems and 39% made dietary mistakes. About 13% had tried smoking, 24% had tried to consume alcohol, and 2% had tried other drugs. Thirty seven percent of adolescents were referred to adolescent medicine consultation, and 39% to another hospital consultation. CONCLUSION: Many of the biopsychosocial risk items identified through the questionnaire were confirmed during consultation, indicating that it could be a useful screening method for problems linked to the adolescence period.

Adolescent students attitudes towards sexuality: the construction and validation of a scale / Atitudes dos alunos adolescentes sobre a sexualidade: construção e validação de uma escala

ABSTRACT Objective: To construct a scale of adolescents' attitudes towards sexuality and to determine their psychometric characteristics. Methods: Methodological study conducted with 394 students from the 8th to 12th grades of a school in central Portugal. They answered a questionnaire consisting of the Adolescent Students' Attitude Scale for Sexuality (E3AS) and socio-demographic and academic data. The project received a favorable opinion from the National Data Protection Commission (authorization No. 10421/2017). Construct validity analysis was performed through exploratory factor analysis and internal consistency was performed through Cronbach's alpha. A maximum error probability of 5% was considered. Results: The mean age of the sample was 14.9±1.4 years, with 53.3% being female. The instrument consisted of 34 items distributed into five factors: F1. Family planning and sex education (α=0.826); F2. First sexual relationship (α=0.819); F3. Violation of sexual rights and who to turn to in the event of unplanned pregnancies (α=0.695); F4. Gender expression and identity (α=0.542), and F5. Unplanned pregnancy and parenting (α= 0.761), with a total alpha value of 0.766, accounting for 45.3% of total variance. Conclusions: The psychometric adequacy of the E3AS for the Portuguese population allows us to affirm that it is a valid and reliable instrument that can be used in future studies to assess the attitudes of adolescent students towards sexuality.

RESUMO Objetivo: Construir uma escala de atitudes dos adolescentes em face da sexualidade e determinar as suas caraterísticas psicométricas. Métodos: Estudo metodológico realizado com 394 alunos do 8º ao 12º ano de escolaridade de uma escola da região Centro de Portugal que responderam a um questionário constituído da Escala de Atitudes dos Alunos Adolescentes em face da Sexualidade e de dados sociodemográficos e acadêmicos. O projeto recebeu parecer favorável da Comissão Nacional de Proteção de Dados (autorização nº 10421/2017). Realizou-se a análise de validade do constructo, por análise fatorial exploratória, e de consistência interna, por alfa de Cronbach. Foi considerada probabilidade de erro máximo de 5%. Resultados: A média de idades da amostra foi de 14,9±1,4 anos, e 53,3% dos participantes eram do sexo feminino. O instrumento foi constituído de 34 itens distribuídos por cinco fatores: Fator 1. Planejamento familiar e educação sexual (α=0,826); Fator 2. Primeira relação sexual (α=0,819); Fator 3. Violação dos direitos sexuais e a quem recorrer na gravidez não planejada (α=0,695); Fator 4. Expressão e identidade de gênero (α=0,542); Fator 5. Gravidez não planejada e parentalidade (α=0,761). O valor do alfa total da escala foi 0,766, o que explica 45,3% da variância total. Conclusões: A adequação psicométrica da escala para a população portuguesa permite afirmar que se trata de um instrumento válido e confiável, que poderá ser utilizado em estudos futuros com o intuito de avaliar as atitudes dos alunos adolescentes em face da sexualidade.

Adolescer Saudável: screening and follow-up of risk at school / Adolescer Saudável: rastreio e seguimento do risco na escola

ABSTRACT Objective To characterize adolescents referred to medical consultation based on the screening tool "Perfil de Saúde do Utente Adolescente", and to compare to information gathered from a questionnaire and data assessed during the visit. Methods A retrospective and descriptive study, with analysis of the questionnaires filled out by adolescents and their respective medical records, in the period from January 2013 to June 2016. Results A total of 54 adolescents were seen, 57% male and mean age of 12±1.7 years. In the questionnaire, 37% stated that they had some kind of health problem; 35% would like to change the relationship with their parents; 18% had some concern about safety at school; and 39% made dietary mistakes. Approximately 31% had consumed alcohol, 13% had tried smoking, and 4% had used other drugs. At the first medical appointment, 38% stated they had chronic disease, 11% reported poor family environment, 39% had school problems and 39% made dietary mistakes. About 13% had tried smoking, 24% had tried to consume alcohol, and 2% had tried other drugs. Thirty seven percent of adolescents were referred to adolescent medicine consultation, and 39% to another hospital consultation. Conclusion Many of the biopsychosocial risk items identified through the questionnaire were confirmed during consultation, indicating that it could be a useful screening method for problems linked to the adolescence period.

RESUMO Objetivo Caracterizar adolescentes referenciados à consulta médica a partir do instrumento de triagem Perfil de Saúde do Utente Adolescente e comparar as informações obtidas do questionário e os dados avaliados na consulta. Métodos Estudo retrospectivo e descritivo, com análise dos questionários preenchidos por adolescentes e respectivos processos clínicos da consulta realizada no período de janeiro de 2013 a junho de 2016. Resultados Foram consultados 54 adolescentes, 57% do sexo masculino, com média de idade 12±1,7 anos. No questionário, 37% responderam ter algum problema de saúde; 35% gostariam de mudar a relação com os pais; 18% tinham algum tipo de preocupação com a segurança na escola; e 39% cometiam erros alimentares. Aproximadamente 31% já tinham consumido álcool, 13% já tinham experimentado fumar, e 4% tinham experimentado outras drogas. Na primeira consulta, 38% dos respondentes responderam ter doença crônica, 11% referiram mau ambiente familiar, 39% apresentaram problemas escolares e 39% revelaram erros alimentares. Cerca de 13% experimentaram fumar, 24% consumiram álcool, e 2% experimentaram outras drogas. Foram referenciados à consulta de medicina do adolescente 37% dos adolescentes, e 39% foram direcionados a outra consulta hospitalar. Conclusão Em consulta, confirmaram-se muitos dos itens de risco biopsicossocial identificados por meio do questionário aplicado, o que pode indicar que este é um método útil no rastreio de problemática ligada à adolescência.

ADOLESCENT STUDENTS' ATTITUDES TOWARDS SEXUALITY: THE CONSTRUCTION AND VALIDATION OF A SCALE.

OBJECTIVE: To construct a scale of adolescents' attitudes towards sexuality and to determine their psychometric characteristics. METHODS: Methodological study conducted with 394 students from the 8th to 12th grades of a school in central Portugal. They answered a questionnaire consisting of the Adolescent Students' Attitude Scale for Sexuality (E3AS) and socio-demographic and academic data. The project received a favorable opinion from the National Data Protection Commission (authorization No. 10421/2017). Construct validity analysis was performed through exploratory factor analysis and internal consistency was performed through Cronbach's alpha. A maximum error probability of 5% was considered. RESULTS: The mean age of the sample was 14.9±1.4 years, with 53.3% being female. The instrument consisted of 34 items distributed into five factors: F1. Family planning and sex education (α=0.826); F2. First sexual relationship (α=0.819); F3. Violation of sexual rights and who to turn to in the event of unplanned pregnancies (α=0.695); F4. Gender expression and identity (α=0.542), and F5. Unplanned pregnancy and parenting (α= 0.761), with a total alpha value of 0.766, accounting for 45.3% of total variance. CONCLUSIONS: The psychometric adequacy of the E3AS for the Portuguese population allows us to affirm that it is a valid and reliable instrument that can be used in future studies to assess the attitudes of adolescent students towards sexuality.

OUTPATIENT ANALYTIC ASSESSMENT OF ANOREXIA NERVOSA - THE IMPORTANCE OF VENOUS BLOOD GASES.

OBJECTIVE: To evaluate serum biochemical parameters' evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. METHODS: Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. RESULTS: A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). CONCLUSIONS: Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.

Outpatient analytic assessment of anorexia nervosa — the importance of venous blood gases / Avaliação laboratorial em ambulatório na anorexia nervosa: a importância da gasometria venosa

ABSTRACT Objective: To evaluate serum biochemical parameters' evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. Methods: Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. Results: A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). Conclusions: Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.

RESUMO Objetivo: Avaliar a evolução laboratorial, particularmente da gasometria venosa, na anorexia nervosa (AN), correlacionando os achados com parâmetros clínicos. Métodos: Estudo retrospetivo com adolescentes com AN seguidos em ambulatório, entre janeiro de 2014 e maio de 2017. Foram comparadas três avaliações: (t1) primeira consulta; (t2) consulta com escore Z de índice de massa corpórea (IMC) mais baixo; e (t3) consulta com escore Z de IMC mais elevado. Resultados: Incluídos 24 adolescentes, 87,5% do sexo feminino, idade média de apresentação de 14,9±1,7 anos, início dos sintomas 6,4±3,2 meses antes da primeira consulta. Em t1, escore Z de IMC de -1,91±1,11 kg/m2 e % de peso ideal de 84,3±9,2. Tinham amenorreia 88%. Em t2 as alterações laboratoriais encontradas foram: gasometria venosa alterada em 100%, ferritina alterada (72% elevada), função tiroideia alterada (53% com diminuição da tiroxina), dislipidemia (31% com elevação de lipoproteína de alta densidade, 25% com hipercolesterolemia), elevação da ureia (25%), elevação da alanina aminotransferase (14%), hipoglicemia (14%) e anemia (9%). A acidose respiratória esteve presente em 91% em t1, 100% em t2 e 94% em t3. Verificou-se diminuição significativa entre t2 e t3 da pressão parcial de CO2 (pCO2) média (57,2 versus 53,6 mmHg; p=0,009) e HCO3 médio (30,0 versus 28,8 mEq/L; p=0,023). Conclusões: A acidose respiratória e o aumento da ferritina foram comuns nesse grupo. Acidose respiratória foi a alteração mais frequente, com variação significativa de pCO2 e HCO3 na fase de recuperação. A gasometria venosa deve ser considerada na avaliação laboratorial na AN, pois parece ser importante na avaliação da gravidade e monitorização da doença.

[Contraception for Adolescents: Knowledge and Practices in Portugal]. / Contraceção em Adolescentes: Conhecimentos e Práticas em Portugal.

INTRODUCTION: Adolescents are a target group for reproductive health intervention. Family physicians, gynecologists and pediatricians are the main providers of contraceptive counseling. MATERIAL AND METHODS: Correlational, cross-sectional study, approved by the ethics committee of Leiria Hospital, Portugal. Data was collected through a validated online questionnaire (Cronbach's alpha and Exploratory Factorial Analysis) using a semantic differential scale (1 - Totally Agree; 5 - Totally Disagree). Higher scores were indicative of greater knowledge or suitability concerning the matter in question. Results were compared by gender, specialty, years of career and rank: consultant or resident. RESULTS: We received 338 responses (51% family physicians, 29% pediatricians, 20% gynecologists), 66% were specialists, 36% had been working for less than 5 years and 17% for more than 20 years. Awareness of national recommendations was higher in gynecologists [4.38 (1.09)] and in the female gender [3.65 (1.41)] with statistically significant differences. Gynecologists had more recent training [3.79 (1.42)] and considered themselves to be up-to-date [4.41 (0.70)], p < 0.001. DISCUSSION: The questionnaire showed reliability and validity. Gynecologists were more familiarized with adolescent contraception; pediatricians and young clinicians highlighted the need for an update on this matter. Gynecologists had more training and considered themselves up-to-date, so training in this area seems to have a positive impact. CONCLUSION: Knowledge about contraceptive counseling is not yet sufficient, so it is very important to invest in the continuous medical education of clinicians.

Introdução: Os adolescentes são um grupo de intervenção prioritária em saúde reprodutiva. Os médicos de medicina geral e familiar, ginecologistas e pediatras são os principais responsáveis pelo aconselhamento contracetivo. Material e Métodos: Estudo transversal, correlacional, de natureza quantitativa, aprovado pela comissão de ética do Centro Hospitalar de Leiria. Dados colhidos em questionário online validado (alfa de Cronbach e Análise Fatorial Exploratória), constituído por itens de tipo diferencial semântico, com cinco pontos ("Discordo totalmente ­ 1" e "Concordo totalmente ­ 5"). Pontuações mais elevadas conotam-se com maior conhecimento ou adequabilidade na questão. Análise por género, especialidade, anos de carreira e grau de formação: especialista, interno de formação específica. Resultados: Obtiveram-se 338 respostas (51% médicos de medicina geral e familiar, 29% pediatras, 20% ginecologistas). Do total, 66% eram especialistas, 36% tinham menos de cinco anos de carreira e 17% tinham mais de 20 anos de carreira. O conhecimento das recomendações foi superior entre os ginecologistas [4,38 (1,09); p < 0,001] e no género feminino [3,65 (1,41); p = 0,039] com diferença estatisticamente significativa. Os ginecologistas receberam mais formação recentemente [3,79 (1,42)] e consideram estar atualizados [4,41 (0,70), p < 0,001]. Discussão: O questionário revelou validade e fiabilidade. Os ginecologistas estão mais familiarizados com a contraceção na adolescência, enquanto pediatras e clínicos mais novos referem maior necessidade de atualização. Os ginecologistas receberam formação recentemente e consideram estar atualizados, pelo que a formação na área parece ter impacto positivo. Conclusão: O conhecimento acerca do aconselhamento contracetivo ainda não é ótimo, pelo que é fundamental investir na formação dos profissionais de saúde.

Hyperglycemia in pediatric age: could it be maturity onset diabetes of the young? Case reports and review of the literature.

Maturity Onset Diabetes of the Young (MODY) includes a clinically and genetically heterogeneous group of diabetes subtypes with MODY-2 being the second most prevalent form. We report 2 cases of MODY-2 identified during the investigation of asymptomatic hyperglycemia. A 12-year-old girl with a familiar history of diabetes (mother, maternal aunt, and maternal grandfather) was referred due to hypercholesterolemia, abnormal fasting glucose (114 mg/dL), and increased levels of glycated haemoglobin (HbA1c) (6%) presenting with negative ß-cell antibodies. A glucokinase (GCK) heterozygous missense mutation c.364C>T (p.Leu122Phe) in exon 4 was identified in the index patient and in the 3 family members. An obese 9-year-old boy was investigated for elevated fasting glycemic levels (99-126 mg/dL), HbA1c rise (6.6%-7.6%), and negative ß-cell antibodies. The patient's father, paternal aunt, and paternal grandfather had a history of diabetes during their childhood. A GCK heterozygous missense mutation c.698G>A (p.Cys233Tyr) in exon 7 was identified in the index patient. This variant was only described in another family strongly affected by both MODY and classic autoimmune mediated diabetes, contrary to our case. MODY-2 should be suspected in the presence of early onset of persistent mild fasting hyperglycemia and negative ß-cell antibodies associated with a positive family history of diabetes. These cases illustrate the challenging aspects of MODY diagnosis due to possible phenotypic overlap with other types of diabetes. The diagnosis requires a high level of suspicion and GCK genetic screening should be performed in the presence of compatible features. An early diagnosis allows for appropriate management, genetic counselling, and the identification of affected family members.

Sexual behaviors: study in the youth.

OBJECTIVE: To characterize sexual behaviors in a sample of adolescents and youth. METHODS: An analytical descriptive study using a questionnaire about sexual behaviors, adapted from the World Health Organization. It was distributed to students from a Portuguese city aged 14-24 years, during two months. Two age groups were defined: G1 - students aged 14-19 years; G2 - aged 20-24 years. RESULTS: The sample included 2,369 students, 61% females and 70% in G1. The mean age of first sexual intercourse was 16.4±1.8 years; 93% used some contraceptive method in the first sexual intercourse. Out of those who did not use contraception in the first sexual intercourse, 83% were in G1 (p<0.001). Emergency contraception was used at least once by 54% (63% in G2, p<0.001). Among those who had unprotected sexual intercourses, 9% were under the influence of alcohol, 53.6% were female and 53.4% were in G2 (p<0.001). Homosexual contacts occurred in 21% of cases; in that, 62% in G1 and 84% among females (p<0.001). CONCLUSION: The use of contraceptionin the first sexual intercourse was common in our sample. However, the number of adolescents not using any contraceptive method in subsequent sexual intercourses, and the high percentage of them who consider it unnecessary, are a concern. Unprotected sexual intercourses, as well as unplanned intercourses and under influence of alcohol or drugs, especially in the youngest, urge the need for intervention regarding sexual education.

What are the most frequent diagnoses in adolescence? The reality of an Adolescent Medicine Clinic.

OBJECTIVE: To characterize the care flow and the primary diagnoses of an Adolescent Medicine Clinic. METHODS: A retrospective descriptive study, with analysis of clinical processes of adolescents (10-18 years) seen at the Adolescent Medicine Clinic, from January 2006 to December 2013. The following variables were analyzed: sex, age, number of visits, referring service and primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. As to the variable age, the adolescents were divided into two groups: Group I comprised those aged 10-14 years, and Group II, 15-18 years. RESULTS: A total of 7,692 visits were carried out, in that, 1,659 first visits (22%), with an annual growth rate of 6%. The mean age was 14.2 years, and 55% of patients were female. The group of endocrine, nutritional and metabolic diseases was the most representative in our sample (34%), with obesity being the most frequent diagnosis in both sexes and age groups (23%), with a higher prevalence in males (13% male versus 10% female, p<0.001) and younger adolescents (18% in Group I versus 5% in Group II p<0.001). The group of mental and behavioral disorders was the second most prevalent (32%), affecting mainly females (39% female versus 22% male, p<0.001) and the older age group (39% Group II versus 27% Group I, p<0.001). Social problems were the primary diagnosis in 8% of visits. CONCLUSION: Most diseases diagnosed have a strong behavioral and social component, particularly mental disorders and obesity. This specific type of diagnoses reinforces the need for a global approach for adolescents and specialized adolescent medicine units/clinics.

Sexual behaviors: study in the youth / Comportamentos sexuais: estudo em jovens

ABSTRACT Objective: To characterize sexual behaviors in a sample of adolescents and youth. Methods: An analytical descriptive study using a questionnaire about sexual behaviors, adapted from the World Health Organization. It was distributed to students from a Portuguese city aged 14-24 years, during two months. Two age groups were defined: G1 - students aged 14-19 years; G2 - aged 20-24 years. Results: The sample included 2,369 students, 61% females and 70% in G1. The mean age of first sexual intercourse was 16.4±1.8 years; 93% used some contraceptive method in the first sexual intercourse. Out of those who did not use contraception in the first sexual intercourse, 83% were in G1 (p<0.001). Emergency contraception was used at least once by 54% (63% in G2, p<0.001). Among those who had unprotected sexual intercourses, 9% were under the influence of alcohol, 53.6% were female and 53.4% were in G2 (p<0.001). Homosexual contacts occurred in 21% of cases; in that, 62% in G1 and 84% among females (p<0.001). Conclusion: The use of contraceptionin the first sexual intercourse was common in our sample. However, the number of adolescents not using any contraceptive method in subsequent sexual intercourses, and the high percentage of them who consider it unnecessary, are a concern. Unprotected sexual intercourses, as well as unplanned intercourses and under influence of alcohol or drugs, especially in the youngest, urge the need for intervention regarding sexual education.

RESUMO Objetivo: Caracterizar os comportamentos sexuais em uma amostra de adolescentes e jovens. Métodos: Estudo descritivo analítico, utilizando um questionário sobre comportamentos sexuais adaptado da Organização Mundial da Saúde. O questionário foi distribuído a estudantes entre os 14 e os 24 anos de uma cidade portuguesa, em período de 2 meses. Definiram-se dois grupos etários: G1, para estudantes de 14 a 19 anos; e G2, de 20 a 24 anos. Resultados: Da amostra, constaram 2.369 estudantes, sendo 61% do sexo feminino e 70% do G1. A média de idade da primeira relação sexual foi de 16,4± 1,8 anos. Foi utilizado método contraceptivo na primeira relação sexual em 93%. Dos que não utilizaram, 83% pertenciam ao G1 (p<0,001). Entre os estudantes, 54% recorreram pelo menos uma vez à contracepção de emergência (63% do G2; p<0,001). Dos que tiveram relações sexuais desprotegidas, 9% estavam sob influência do álcool. Destes últimos, 53,6% eram do sexo feminino e 53,4% pertenciam ao G2 (p<0,001). Os contatos homossexuais ocorreram em 21% dos casos, dos quais 62% eram do G1 e 84% do sexo feminino (p<0,001). Conclusão: O recurso à contracepção na primeira relação sexual foi uma prática comum na nossa amostra. No entanto, o número de adolescentes que não utiliza método contraceptivo nas relações subsequentes e a elevada percentagem que o considera desnecessária são preocupantes. Para além das relações sexuais desprotegidas, as relações não planejadas e sob o efeito de álcool ou drogas, sobretudo entre os mais novos, reforçam a necessidade de intervenção no âmbito da educação sexual.

What are the most frequent diagnoses in adolescence? The reality of an Adolescent Medicine Clinic / Quais os diagnósticos mais frequentes na adolescência? A realidade de uma consulta de Medicina do Adolescente

ABSTRACT Objective To characterize the care flow and the primary diagnoses of an Adolescent Medicine Clinic. Methods A retrospective descriptive study, with analysis of clinical processes of adolescents (10-18 years) seen at the Adolescent Medicine Clinic, from January 2006 to December 2013. The following variables were analyzed: sex, age, number of visits, referring service and primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. As to the variable age, the adolescents were divided into two groups: Group I comprised those aged 10-14 years, and Group II, 15-18 years. Results A total of 7,692 visits were carried out, in that, 1,659 first visits (22%), with an annual growth rate of 6%. The mean age was 14.2 years, and 55% of patients were female. The group of endocrine, nutritional and metabolic diseases was the most representative in our sample (34%), with obesity being the most frequent diagnosis in both sexes and age groups (23%), with a higher prevalence in males (13% male versus 10% female, p<0.001) and younger adolescents (18% in Group I versus 5% in Group II p<0.001). The group of mental and behavioral disorders was the second most prevalent (32%), affecting mainly females (39% female versus 22% male, p<0.001) and the older age group (39% Group II versus 27% Group I, p<0.001). Social problems were the primary diagnosis in 8% of visits. Conclusion Most diseases diagnosed have a strong behavioral and social component, particularly mental disorders and obesity. This specific type of diagnoses reinforces the need for a global approach for adolescents and specialized adolescent medicine units/clinics.

RESUMO Objetivo Caracterizar o movimento assistencial e conhecer os diagnósticos principais de uma consulta de Medicina do Adolescente. Métodos Estudo descritivo retrospectivo, com análise dos processos clínicos dos adolescentes (10 a 18 anos) seguidos na consulta de Medicina do Adolescente, de janeiro de 2006 a dezembro de 2013. Foram analisadas as variáveis: sexo, idade, número de consultas, entidade que referenciou e diagnósticos principais, de acordo com a Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde. Com relação à variável idade, os adolescentes foram divididos em dois grupos: Grupo I, que incluiu adolescentes de 10 a 14 anos, e Grupo II, que incluiu aqueles com 15 aos 18 anos. Resultados Realizaram-se 7.692 consultas, sendo 1.659 (22%) primeiras consultas, com taxa de crescimento anual de 6%. A média de idade foi de 14,2 anos, com 55% do sexo feminino. O grupo das doenças endócrinas, nutricionais e metabólicas foi o mais representativo da amostra (34%), sendo a obesidade o diagnóstico mais frequente em ambos os sexos e grupos etários (23%), com maior prevalência nos rapazes (13% homens versus 10% mulheres; p<0,001) e nos adolescentes mais jovens (18% do Grupo I versus 5% do Grupo II; p<0,001). O grupo dos transtornos mentais e do comportamento foi o segundo mais prevalente (32%), afetando principalmente as adolescentes (39% mulheres versus 22% homens; p<0,001) e o grupo etário mais velho (39% do Grupo II versus 27% do Grupo I; p<0,001). Problemas sociais constituíram o principal diagnóstico em 8% das consultas. Conclusão A maioria das patologias diagnosticadas tem forte componente comportamental e social, com destaque para as doenças mentais e a obesidade. Esta tipologia específica de diagnósticos evidencia a necessidade de uma abordagem global do adolescente e de unidades/consultas especializadas nesta faixa etária.

Menstruation disorders in adolescents with eating disorders-target body mass index percentiles for their resolution.

OBJECTIVE: To analyse the progression of body mass index in eating disorders and to determine the percentile for establishment and resolution of the disease. METHODS: A retrospective descriptive cross-sectional study. Review of clinical files of adolescents with eating disorders. RESULTS: Of the 62 female adolescents studied with eating disorders, 51 presented with eating disorder not otherwise specified, 10 anorexia nervosa, and 1 bulimia nervosa. Twenty-one of these adolescents had menstrual disorders; in that, 14 secondary amenorrhea and 7 menstrual irregularities (6 eating disorder not otherwise specified, and 1 bulimia nervosa). In average, in anorectic adolescents, the initial body mass index was in 75th percentile; secondary amenorrhea was established 1 month after onset of the disease; minimum weight was 76.6% of ideal body mass index (at 4th percentile) at 10.2 months of disease; and resolution of amenorrhea occurred at 24 months, with average weight recovery of 93.4% of the ideal. In eating disorder not otherwise specified with menstrual disorder (n=10), the mean initial body mass index was at 85th percentile; minimal weight was in average 97.7% of the ideal value (minimum body mass index was in 52nd percentile) at 14.9 months of disease; body mass index stabilization occurred at 1.6 year of disease; and mean body mass index was in 73rd percentile. Considering eating disorder not otherwise specified with secondary amenorrhea (n=4); secondary amenorrhea occurred at 4 months, with resolution at 12 months of disease (mean 65th percentile body mass index). CONCLUSION: One-third of the eating disorder group had menstrual disorder - two-thirds presented with amenorrhea. This study indicated that for the resolution of their menstrual disturbance the body mass index percentiles to be achieved by female adolescents with eating disorders was 25-50 in anorexia nervosa, and 50-75, in eating disorder not otherwise specified.

Menstruation disorders in adolescents with eating disorders ? target body mass index percentiles for their resolution / Distúrbios menstruais em adolescentes com transtornos alimentares ? meta de percentil de índice de massa corporal para resolução dos distúrbios menstruais

Objective To analyse the progression of body mass index in eating disorders and to determine the percentile for establishment and resolution of the disease. Methods A retrospective descriptive cross-sectional study. Review of clinical files of adolescents with eating disorders. Results Of the 62 female adolescents studied with eating disorders, 51 presented with eating disorder not otherwise specified, 10 anorexia nervosa, and 1 bulimia nervosa. Twenty-one of these adolescents had menstrual disorders; in that, 14 secondary amenorrhea and 7 menstrual irregularities (6 eating disorder not otherwise specified, and 1 bulimia nervosa). In average, in anorectic adolescents, the initial body mass index was in 75th percentile; secondary amenorrhea was established 1 month after onset of the disease; minimum weight was 76.6% of ideal body mass index (at 4th percentile) at 10.2 months of disease; and resolution of amenorrhea occurred at 24 months, with average weight recovery of 93.4% of the ideal. In eating disorder not otherwise specified with menstrual disorder (n=10), the mean initial body mass index was at 85th percentile; minimal weight was in average 97.7% of the ideal value (minimum body mass index was in 52nd percentile) at 14.9 months of disease; body mass index stabilization occured at 1.6 year of disease; and mean body mass index was in 73rd percentile. Considering eating disorder not otherwise specified with secondary amenorrhea (n=4); secondary amenorrhea occurred at 4 months, with resolution at 12 months of disease (mean 65th percentile body mass index). Conclusion One-third of the eating disorder group had menstrual disorder − two-thirds presented with amenorrhea. This study indicated that for the resolution of their menstrual disturbance the body mass index percentiles to be achieved by female adolescents with eating disorders was 25-50 in anorexia nervosa, and 50-75, in eating disorder not otherwise specified. .

Objetivo Analisar a progressão do índice de massa corporal nos transtornos alimentares e determinar o percentil para estabelecimento e resolução da doença. Métodos Estudo retrospectivo descritivo, com análise dos processos de adolescentes com transtorno alimentar. Resultados Das 62 adolescentes com distúrbio alimentar, 51 apresentavam distúrbio sem outra especificação, 10 anorexia nervosa, e uma bulimia. Vinte e uma adolescentes apresentavam distúrbios menstruais, sendo 14 amenorreia secundária, 7 irregularidades menstruais (6 distúrbio alimentar sem outra especificação e 1 bulimia). Em média, nas anoréticas: índice de massa corporal inicial - percentil 75, instalação da amenorreia secundária com um mês de doença, peso mínimo 76,6% do índice de massa corporal ideal, no percentil 4), com 10,2 meses de doença, resolução da amenorreia aos 24 meses com recuperação ponderal média de 93,4% do peso ideal. No distúrbio alimentar sem outra especificação com distúrbio menstrual (n=10), o índice de massa corporal inicial médio no percentil 85, peso mínimo, em média, 97,7% do valor de peso ideal (média no percentil 52 de índice de massa corporal), aos 14,9 meses, estabilização ponderal aos 1,6 anos, percentil médio de índice de massa corporal de 73. Na perturbação do comportamento alimentar sem outra especificação com amenorreia secundária (n=4): amenorreia secundária aos 4 meses, resolução aos 12 meses (média no percentil 65 do índice de massa corporal). Conclusão Um terço do grupo com transtornos alimentares teve distúrbios menstruais − sendo dois terços com amenorreia secundária. Este estudo indicou que, para resolução ...

[Eating disorders in adolescents - what to look for?]. / Perturbações do comportamento alimentar em adolescentes - o que procurar?

BACKGROUND: Increase in the incidence and prevalence of Eating Disorders have made it increasingly important that Health Care Professionals be familiar with the early detection and appropriate management of this group of disorders. OBJECTIVES: To characterize an adolescent population followed in Adolescent Medicine office visit of Pediatric Department in Leiria's Hospital with Eating Disorders for type of disorder, presence of alert signs and symptoms and risk factors for an early detection of disease. METHODS: Retrospective analytic study conducted by consulting clinical processes and first office visit questionnaires of adolescent population followed for Eating Disorders, between August 2005 and April 2008. Criteria of Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition were considered to define Eating Disorder type. RESULTS: Twenty two adolescents were included, with 20 girls. Five adolescents met all Anorexia Nervosa criteria and two met all Bulimia Nervosa criteria. The other 15 were included in Eating Disorder Not Otherwise Specified. All samples showed intense fear of gaining weight and 20 adolescents a disturbed body image. All adolescents confessed having restrictive eating attitudes, half had compensatory behaviors and four assume having recurrent episodes of binge eating. Almost all revealed some type of somatic complaint and 19 showed psychological symptoms. One third of this population had personal history of obesity/overweight. Most adolescents presented weight lost when observed in the first office visit. Six adolescents showed body weight under 85% of that expected. One third of postmenarche adolescents suffered from secondary amenorrhea. Half of adolescents reported dysfunctional family and one quarter had separate parents; eight adolescents had family history of mental illness. CONCLUSION: Most adolescents were included in the diagnosis of Eating Disorder Not Otherwise Specified, according with other studies in this age. This fact implies that in practice the suspicion of an Eating Disorder in an adolescent should not be restricted to the meeting of other categories criteria. For an early detection, relevance should be given to aspects like a weight loss even without an abnormal body mass index, an inappropriate eating attitude, a dissatisfaction with body image, associated with a multiplicity of psychosomatic complaints, in a dysfunctional family environment.

[Adolescents in Santo André Hospital: health needs]. / Os adolescentes no Hospital Santo André: que necessidades de saúde?

BACKGROUND: In the context of the National Health Youth Program, Department of Pediatrics of Santo André Hospital (SAH) has as one of its objectives to extend its age limit up to 18 years of age. OBJECTIVE: To evaluate adolescents' health needs followed up at SAH and to determine the impact of the proposed new age limit policy. METHODS: Retrospective descriptive study that included adolescents (10-18 years old) seen at the emergency department (ED), outpatients or admitted to the pediatric ward between 2000 and 2004. RESULTS: Adolescents represented 7.3% (average) of all the patients seen at SAH during this period. Approximately 11130 adolescents were seen yearly in the ED, 57% of these in the pediatric ED, 39.5% in general ED, and 3.5% in obstetrics/gynecology ED (the majority of these patients were between the ages of 15 and 18). Medical causes represented 53% of the final diagnosis and 43% were surgical related. The average number of outpatients consultations was 7657 per year and of these, 25% were seen by pediatricians (87% were 10 to 14 years of age). The specialties with the greatest number of consultations were: dentistry (13.3%), orthopedics (13.1%), ear, and nose and throat specialist (8.3%), ophthalmology (7.7%), dermatology (7.2%), psychiatric (5.3%) and obstetrics (5.2%). General medicine and other medical specialties were responsible for 6.4% of the consultations. Yearly about 590 adolescents were admitted, 60.3% in the pediatric ward regardless of the underlying cause. The remaining were admitted to the surgical ward, orthopedics ward and obstetrics/gynecology ward. CONCLUSION: With the proposed new age limit policy we expect a 10% overall increase in the numbers of patients in the pediatric ED, 6.4% in the pediatric outpatients and 15.5 as inpatients. Adolescents will represent 33.7 of the pediatrics total inpatients population. Management of the patients will require the development of new installations, the training of medical professionals, both pediatric and adult health careers, that will in the future deal with this patient group.