Menstrual bleeding patterns in adolescents using etonogestrel (ENG) implant.

BACKGROUND: Etonogestrel (ENG) implant is an effective method of contraception. The implant is designed to provide contraceptive efficacy for 3 years with a relatively quick return of fertility upon its removal. Menstrual irregularities are not uncommon on long-acting progestins and can often be the factor for discontinuation or removal. A retrospective chart analysis was done on 58 patients who chose to be on the ENG implant. Age ranged from 12 to 24 years. The cycle ranged from 1 to 17 months. The mean length of use of the implant was 10.9 months. Over the 20-month period, 13 ENG implants were removed because of menstrual bleeding problems. METHOD: We conducted a chart review of the adolescent patients who received the ENG implant in our adolescent clinic. An analysis was done based on symptoms experienced by patients who were on the ENG implant and their management, which in some cases resulted in its removal. SETTING: The data is presented on adolescent and young adult patients who receive their reproductive care in the Adolescent Medicine Clinic at the University of Kentucky, Lexington, KY, USA. CONCLUSIONS: ENG implant when used correctly and as indicated is extremely effective in providing contraception for up to 3 years. However, menstrual irregularities can be very troublesome and often a reason for its removal. In our experience, 22.4% (13 out of the 58 subjects) had menstrual problems post-insertion that led to its removal. It is crucial for a clinician to inform and be informed about such side effects.

Brazilian adolescents infected by HIV: epidemiologic characteristics and adherence to treatment.

Over the last 3 decades since the first AIDS cases appeared, we have witnessed great progress in therapeutic methodologies that have transformed the evolution of the disease from debilitating and fatal, into chronic and controllable. HIV-infected children are arriving at adolescence and bringing specific challenges, not only to themselves, but also to their families and caregivers. This retrospective study sets forth epidemiological and treatment characteristics of 46 HIV-infected adolescents followed in a specialized university service relating said characteristics to therapy adherence assessed through a combination of three indirect methods. Therapy adherence did not reveal any association with either epidemiologic characteristics regarding age, sex, school level, household composition, age at diagnosis, mode of infection, knowledge of diagnosis, treatment time, or initial antiretroviral scheme. Patients with good therapy adherence presented lower viral load and used a smaller number of antiretroviral schemes.

Discovering the complexities of adolescent compliance to treatment.

To explore the challenges faced in enhancing adolescent treatment compliance and to understand the roles of key players in this endeavor: the adolescent, parent and healthcare provider. Obtaining compliance from adolescents requires collaboration from the adolescent, caregiver and provider and depends on well-established relationships between each person in the triad: adolescent-provider, adolescent-caregiver, and caregiver-provider. Ensuring and improving adherence to treatment by adolescents is a challenging task but crucial to overall health outcomes. It requires the collaboration of the adolescent, parent and physician to create the optimal treatment plan, specifically tailored to the adolescent. For the clinician, maintaining good communication and relationships, active listening, as well as partnering with the adolescent and parent are keys to positive outcomes.

Trends in mental health of an adolescent medicine clinic patient population.

The correlation between exposure to forms of violence and development of mental disorders in victims is well established. The purpose of this paper was to identify mental health problems in an adolescent medicine clinic population in Lexington, KY and to investigate potential correlation of mental disorders with psychosocial factors. Data were gathered from the charts of 169 adolescent clinic patients (age 10-22) seen in the clinic for mental health care and analyzed using Excel. Of the patient population, 68% were urban, whereas 32% were rural. In terms of gender, 40% of the patients were male and 60% were female, 80% were white, 13% black, and 7% had other racial background(s). The most prevalent mental disorders in this group were depression 32.12%, 13% with generalized anxiety disorder, 8.2% with an attention deficit disorder (including ADHD), and 5.76% with an adjustment disorder. The abovementioned demographic trends showed that depression continues to be the most common mental health problem in this population regardless of gender, ethnic origin, or economic status. This finding highlights the need for availability of mental health support to this patient population. Further work is needed to spotlight the most significant psychosocial factors and root causes of mental health conditions in this age group.

It is more than just a reproductive healthcare visit: experiences from an adolescent medicine clinic.

The gynecologist may be the only physician that an adolescent depends on for primary and reproductive healthcare services. Because adolescent females often make personal healthcare decisions without the benefit of supportive parents/caregivers, it is imperative that the gynecologist understands the developmental issues encountered during this phase of life. The objective of this study is to identify cited complaints of adolescent females seeking reproductive care and, thus, provide gynecologists with needed information about the medical/mental health issues that may be encountered during routine reproductive care exams. The study group was adolescent females between the ages of 12 and 20 years old. The medical records of 479 adolescent females seeking reproductive care from an adolescent medicine clinic at a southeastern teaching medical center were reviewed to determine the most frequently cited medical/mental health complaints of adolescent females initiating a "routine" gynecological exam. Results indicated that adolescent females present for "routine" reproductive care exams with a myriad of concerns without formally requesting medical/mental health intervention upon initial presentation. The identified primary healthcare needs of adolescent females seeking reproductive healthcare include: 1) issues related to reproductive dysfunction (60%); 2) gastroenterological pain/issues (15%) 3) mental health issues (15%) and 4) general medical physical complaints (10%). Gynecologists are often asked to serve as a primary care provider as well as a reproductive healthcare specialist. Identification of the specific healthcare needs (reproductive and otherwise) of adolescent females will assist gynecologists in being uniquely prepared to practice in the setting of their choice.

Sexuality and persons with Down syndrome. A study from Brazil.

In recent years, important gains and changes have been observed in the life of teenagers with Down syndrome (DS) with increased inclusion into society. This review will discuss adolescence and sexuality in teenagers with DS from a descriptive study of 50 patients with DS between the ages of 10 and 20 years. The mean age was 13.5 years, 50% females; 86% went to school with 62.2% in school for over six years. Of the patients that attended school, 60% went to special education school and only 10% read and wrote correctly. In an evaluation of autonomy, 66% took showers, 78% performed their physiological needs, 77% intimate hygiene and 76% oral hygiene without help. 42% affirmed being able to do anything that is asked; 22% perform all tasks in the home; 10% felt they were incapable of doing anything and 4% used public transportation without help. 42% of the teenagers masturbated, 24% on a daily basis, 75% in private, and 25% in a public location. 42% had already kissed at a mean age of 12.9 years, mean age of the partner 16.1 years; 26.8% of these partners had DS. 82% found themselves attractive and 33% would not change anything in their appearance. We found that they presented normal development in the exercise of their sexuality, but with important difficulties in their autonomy and difficulties in school, needing careful interventions to make their social interaction the best possible. Their pubertal development was normal and they were satisfied with their body image with future perspectives of working, finding a partner, and living a normal life of getting married and having children.

Sexuality issues and gynecologic care of adolescents with developmental disabilities.

All human beings are sexual from birth to death and all children and adolescents with or without disability or chronic illness must incorporate appropriate sexuality concepts into their processes of development from childhood to adolescence. This article considers sexuality issues and reproductive care of adolescents with developmental disabilities. Potential consequences of disability on sexuality are reviewed, including sexual abuse and sexual dysfunction. Comprehensive sexuality education is vital for normal growth and development of all youth including those with developmental disabilities.

Clinical management of adolescents with autism.

Autism spectrum disorder is a spectrum of neurodevelopmental disorders that includes autistic disorder and pervasive developmental disorder-not otherwise specified. This article provides the reader with an overview of the major psychosocial issues related to adolescents with autism. This discussion is followed by an interjection of medications that may be useful in maximizing the functioning of adolescents with autism.

Caffeine use: association with nicotine use, aggression, and other psychopathology in psychiatric and pediatric outpatient adolescents.

The objective of this study was to evaluate the relationship between caffeine use, other drug use, and psychopathology in adolescents, using self-report measures. The study group consisted of 132 adolescents (average age 14.01 +/- 2.06 years, 52% female, 19% African American, 5% other categories, 76% Caucasian). Most (47%) were recruited from a child psychiatry clinic with emphasis on youth with disruptive disorders, with 35% from an adolescent pediatric clinic with emphasis on prevention of risk-taking behavior and 18% from a pediatric clinic for families with limited resources. Subjects were consecutively recruited before or after regular clinic visits. Consent was obtained from parents and assent from the youth. High caffeine consumption was associated with daily cigarette use; aggressive behavior; conduct, attention deficit/hyperactivity, and social problems; and increased somatic complaints in adolescents.

Borderline personality disorder: an overview of history, diagnosis and treatment in adolescents.

Borderline personality disorder (BPD) is a cluster B personality disorder. It is characterized by erratic behaviors, emotional instability and one of its hallmarks is self injurious behavior, which starts in adolescence. Patients with BPD are difficult to treat, most have a history of child sexual abuse, about a quarter present with sexual abuse from a caretaker. Although personality disorders are diagnosed only in adults, BPD manifests itself in adolescence in the form of uncontrollable anger, self mutilations, dissociation and other such behaviors. Hence, there is a growing number of scientists discussing the possibility of diagnosing BPD in adolescents. Here, we give an overview of the history and development of BPD in general; and in the adolescent population in particular. We also touch upon pharmacological and clinical interventions available for patients being diagnosed and/or possessing traits of BPD.

Obesity, hypertension, and mental health evaluation in adolescents: a comprehensive approach.

The global epidemic of childhood and adolescent obesity in developing and developed countries has become a major public health concern. Given the relation between obesity and hypertension as documented in several landmark studies, it is no surprise that as the prevalence of obesity has increased in the pediatric population, the rates of hypertension have also increased substantially. Hypertension is one of the most important risk factors for cardiovascular diseases and stroke; therefore, evaluation and initiation of appropriate treatment are extremely important in the pediatric population. Evaluation for secondary causes of hypertension, including renovascular, renoparenchymal, and endocrine disease is the approach most commonly used in healthcare settings, with the goal to detect abnormalities that already have or might, if left unrecognized, affect the physical health of the child in the future. Children and adolescents are commonly evaluated for organic disease even in situations in which secondary hypertension is unlikely and overweight or obesity is most likely the primary factor contributing to hypertension. Psychological and psychosocial factors, which may play an important role in the etiology of obesity and related blood pressure elevation, are often addressed inadequately or completely ignored, potentially reducing long-term therapy success and increasing the incidence of avoidable complications. It is proposed that a comprehensive evaluation by a behavioral health provider will improve outcomes and potentially reduce long-term morbidity and hypertension-related end organ disease. A framework for mental health evaluation is provided.

Medical supervision of young female athletes training in complex coordinational sports.

UNLABELLED: This article proposes simple medical criteria that can be used by trainers and others for effective medical supervision of young female athletes. METHODS: The cross-sectional, age-stratified study compared girls 10-17 years of age involved in intensive training in gymnastic floor exercises, trampoline, or badminton. Each sport and/or control group was represented by 40-45 girls. Data included medical history, morphometric variables and observation of biological development. RESULTS: Gymnasts started training earliest (approximately 5-years-old) and trained most intensely (18-20 h/wk), followed by trampolinists and then badmintonists. Height, weight, body mass index, and % body fat were reduced in athletes, with gymnasts showing the greatest reduction. Athletes showed higher ratios of leg length to height and shoulder width/hip width, and smaller pelvic size compared to height. The average age of menarche of gymnasts was 13.8 (1.6 year later than controls). Delays of biological development of more than 2 years were common in athletes, and some gymnasts showed more than a 4-year delay. These delays were related to morphometric indicators of hormonal imbalance and to low body fat. Gymnasts had more childhood diseases, with an infection index of 2.8 compared to 1.1 for the control group, and had a higher level of chronic ENT problems. CONCLUSIONS: Trainers need to protect the health of athletes. During the course of training, anamneses, delayed menarche and other signs of delayed biological development must be monitored. Morphometric measures and indicators of biological development are proposed to provide simple criteria important in protecting the athletes' health.

Contraception, adolescence, and ethics in Brazil: are we prepared?

PURPOSE: to assess knowledge of pediatric residents attending adolescents, including ethical issues on contraceptive advice. METHODS: A prospective study was conducted involving 75 residents in order to assess their knowledge, along with ethical issues involved, in clinical attendance of adolescents. The SPSS 13 software package was used for data analysis. RESULTS: 100% of interviewees stated that adolescents have the right to privacy during medical appointments. Yet, when asked from what age this privacy should be granted, 62% reported at any age. When questioned on whether an adolescent could be examined alone, without another person with them in the room, 50% of physicians answered yes and 50% no. 91.7% of interviewees felt that adolescents had the right to confidentiality and medical secrecy, but only 84.8% knew the contents of the Code of Medical Ethics regarding medical secrecy. A further 79.2% felt prepared to give advice on contraception to adolescents. CONCLUSIONS: The attitudes held by pediatric residents on privacy, confidentiality and medical secrecy are highly ambiguous. The doctors interviewed were ill-prepared to deal with the issues of contraception in adolescence on both practical and legal levels.

Medical students: abuse of psychoactive substances and sexuality aspects.

UNLABELLED: University students aged 17 to 24 years of age are prone to many risk factors. OBJECTIVES: Identify risk factors related to exploring sexuality and characteristics of consumption of psychoactive substances in students attending medical school. METHODS: 465 Medical students from Santa Casa of São Paulo Faculty of Medical Sciences (FCMSCSP) were prospectively and transversely evaluated during 2005. An anonymous, semi-structured, self-filling questionnaire was used. The average age of the students was 21.5 years, 43% females. 76.2% preferred alcohol, and 11.1% tobacco consumption; chloroethane (lança-perfume) consumption occurred in 22.6% and 15.3% consumption of other types of illicit drugs, with marijuana as the most used one (94%). 70.3%, of the parents drink alcohol and 30.5% smoke tobacco. As for the students' sexuality, 85.3% have already had sexual intercourses, starting at average age of 17. 88.8% used condom during the first sexual intercourse, however, 35.6% did not use it regularly; 5.4% had already had some type of DST. 79.8% of the females preferred having used contraceptive methods; however, 28.1% had a suspicion of pregnancy, which was confirmed in 7.9% of the cases. 9.9% of the students had ideas of abortion, 12.5% have effectively attempted it. 85% found medical school stressing and to relieve tension, 33.8% practiced sports; 6.9% preferred either licit or illicit drug consumption, and 5% used tranquilizers. The results showed risk behaviors: unsafe sex and the use of licit and illicit drugs indicated the need to establish guidance programs on reproductive health, improving self-esteem, and prevention during medical education.

Integral care for pregnant adolescents: impact on offspring.

PURPOSE: To assess the impact of integral support on the health of children of adolescent mothers and their children. METHODS: A prospective study involving 50 adolescent mothers, who had frequent meetings with a multi-professional group throughout pregnancy. After birth, medical followup was provided to mother and child. RESULTS: Mean schooling proved higher than the national average. After follow-up, the rate of return to education was 24%. These adolescents had good social network support from both family and father of the child. They considered themselves good mothers and felt happier after maternity experience. Adolescents demonstrated a responsible sex life involving family planning and correct use of contraception, yielding extremely low levels of repeat pregnancy. Of the mothers, 48% were employed, working, earning a mean monthly salary of 150% minimum wage. The children of mothers followed by were breastfed longer and had greater vaccination cover than the average for São Paulo State. CONCLUSIONS: The results suggest that our program promotes education of adolescents and their children; demonstrates the importance of a social support network through the family of the young mother and father of the child; fosters positive maternal social model addressing self-esteem and responsibility; informs mothers on contraception and encourages a responsible sex life, baby care, vaccination, and maternal breastfeeding.

Membranous dysmenorrhea: a case series.

UNLABELLED: The purpose was to illustrate the variability of hormonal contraception of patients that presented with membranous dysmenorrheal. A case analysis chart review was completed on six patients referred to a Pediatric Gynecologist in an academic setting. In each case the patient underwent a thorough pelvic and bimanual exam. Following the initial presentation, each patient continued to be followed on a regular visits. CASES: Two were using the transdermal contraceptive patch and oral contraceptive, but following the expulsion of decidual cast, they were both placed on depot medroxyprogesterone acetate (DMPA) without further complications. Three of the six cases were on DMPA prior to the similar occurrence of membranous dysmenorrheal and following this incident, continued on DMPA without further problems. The final case was on the transdermal patch prior to decidual cast expulsion and remained on this form of hormonal contraception without further complications. These cases indicate that membranous dysmenorrheal is not limited to the use of DMPA.

Nonsexual transmission of anogenital warts in children: a retrospective analysis.

The purpose was to evaluate the prevalence of sexual abuse in patients who were referred to a pediatric gynecologist for evaluation based on the clinical findings of anogenital warts. A retrospective analysis was performed on 131 patients between the ages 6 month and 9 years referred to a pediatric gynecologist after the finding of anogenital warts by a clinical provider, parent or caregiver. A complete physical examination under colposcopy by a the same, trained pediatric gynecologist was completed, and a complete medical and family history including maternal and sibling history for evidence of Human Papillomavirus (HPV) and anogenital warts. The legal system completed a full investigation to examine the sexual abuse allegations. In 131 patients with anogenital warts, a maternal history of warts, cervical dysplasia or both was present in 66 (50%). The remaining patients had either a negative maternal history for HPV clinical findings (54 patients or 41.2%), or maternal history was unknown (11 patients, or 8.3%). Of 131 patients, 81 (61%) patients had a sibling. Of those with siblings 40 (49.4%) had warts and 41 (50.6%) did not. Forty-five (34%) of the cases had a positive maternal history for warts, dysplasia or both but also had a sibling. In that cohort, 32 (71%) of the siblings also had anogenital warts. Three of 131 patients were ruled suspicious for sexual abuse by the legal authorities but not confirmed. Of those three patients two were female and one was male. Two had no maternal history for HPV and both of these patients had a sibling without anogenital warts. Most cases of anogenital warts in children are likely to be the result of non-sexual transmission, namely prenatal mode. Thus, these patients should be handled differently by the legal system unless other reasons for suspicion exist. This study also showed the importance of maternal gynecologic history.

Teenage pregnancy: impact of the integral attention given to the pregnant teenager and adolescent mother as a protective factor for repeat pregnancy.

The purpose of this study was to evaluate the impact of the integral attention to the health of pregnant adolescents and adolescent mothers, having follow-up from the Integral Support Program for the Pregnant Teen (ISPPT), with the intention to determine quality of life and prevent repeat pregnancy. A prospective study comprised 85 adolescents attended by the ISPPT between January 2002 and June 2006 who participated in meetings during pregnancy with a multidisciplinary team that provided orientation concerning family planning, self-esteem, pregnancy prevention, motivation to continue education and/or work, and evaluate the postpartum mother-child relationship. The following were analyzed: education level, marital status, contraceptive use, thoughts and attempts at abortion, repeat pregnancy. This study was approved by the Human Research Ethics Committee. The Epi-Info v6.0b software was used for data and result evaluation using the means and the chi-squared test. The mean age of the adolescents was 15.7 years, 3.52% had repeat pregnancy within a mean follow-up of 23 months after childbirth, the mean education level was 8.1 years, 30.5% dropped out of school, with 79.4% occurring before pregnancy, 64.6% used no contraceptives, 68.3% were single, and 81.3% had a positive role model. One year after birth, 67.5% studied, 50% worked, 55.1% lived with the partner, 77% correctly used contraceptives, every child lived with their mothers and their vaccinations were up to date. The results demonstrate that the global attention given to the health of adolescent mothers and pregnant adolescents is a protective factor for pregnancy relapse and quality of life.

Navigating adolescence with a chronic health condition: a perspective on the psychological effects of HAIR-AN syndrome on adolescent girls.

HAIR-AN syndrome is a subphenotype of polycystic ovary syndrome and is characterized by acne, obesity, hirsutism, and acanthosis nigricans. It usually manifests in early adolescence, a time of significant developmental change in females across physical, cognitive, social, and emotional domains. We contend that adolescent development for females is difficult, even in the best of circumstances, and having a chronic health condition, like HAIR-AN syndrome, will likely impact the afflicted individual's development and psychological well-being. While many researchers have discussed the long-term health effects of HAIR-AN and similar disorders, little has been written about the potential psychological sequelae of HAIR-AN on the adolescent girl. We discuss the normal developmental sequence for adolescent girls across early, middle, and late adolescence; discuss common mental health problems that adolescents experience; define HAIR-AN syndrome and its clinical manifestations; and discuss its likely psychological impact on adolescent girls. We also make suggestions for future clinical interventions and research in the area of HAIR-AN syndrome and its psychological sequelae.