Promoting adolescent health

The aim is to discuss why paediatricians should be involved in adolescent health care and provide youth-friendly-health-services. Global epidemiological data on morbidity and mortality demonstrate that much of ill health in the short and long run are connected to adolescent behaviour and in theory available for prevention. Young people seemingly lose their heads and do not consider dangers. Recent research on brain development provides us with an understanding how this may have a biological base. Also psychology has long taught us how adolescents use experimental behaviours as means to satisfy developmental needs and explore identity. Prevention and health promotion are areas of research where much more needs to be done. There is also a lack of venues for publishing even excellent studies in this field.     

The obese adolescent

Childhood obesity is one of the formidable challenges that healthcare providers face. Early recognition and implementation of preventive strategies is crucial in combating this problem. Inculcation of a healthy lifestyle in our youth by encouraging physical activity, decreasing sedentary pastimes, and making healthy food choices is critical right from the start, before poor habits become ingrained. More research is needed to find more effective ways to treat obesity in childhood and adolescence.     

The hypertensive adolescent

The hypertensive adolescent requires a careful blood pressure evaluation. In most cases, extensive diagnostic studies will not be necessary, particularly if the patient exhibits characteristics of early essential hypertension. On the other hand, further evaluation should not be withheld in the absence of risk factors or the presence of significant hypertension. A management plan that includes patient education is appropriate for all adolescents with hypertension. In some, but not all, hypertensive adolescents, a limited course of medication may be beneficial.     

Management of the suicidal adolescent on a nonpsychiatric adolescent unit.

Suicide attempts by adolescents far outnumber suicide fatalities, yet there is lack of agreement regarding the optimal approach to their immediate care. Since 1968, we have admitted all such patients to a general adolescent in-patient unit. A review of the first 100 admissions of adolescents who had attempted suicide was undertaken to determine the safety, economy, and efficacy of this practice. During an average six-day hospitalization, 12 patients required constant nursing observation for more than one day, and six received tranquilizers. No major disruption on the unit, suicide attempts, or self-abusive acts occurred. Twelve patients required subsequent transfer to in-patient psychiatric facilities because of on-going suicidal ideation or psychosis or both. Hospitalization on a general unit for adolescent survivors of suicide attempts is safe, usually adds minimal cost to ordinary hospital care, permits meticulous medical attention for poisoning, and provides a stabilizing influence following a major life crisis.     

Assessment of adolescent varicocele

Varicocele is the most important male factor responsible for decreased fertility potential in married couples. From March through June 1994, 2,470 school boys aged 10–20 years were examined to establish the incidence of consecutive grades of varicocele and to develop a protocol for diagnosis and treatment of adolescents with varicocele. Grade 1 varicocele was found in 18%, grade 2 in 12%, and grade 3 in 5% of the population examined. An original protocol of ultrasonographic (US) examination (previously verified by angioscintigraphy) was introduced to assess boys with clinically diagnosed varicocele. The volume of each testis, testicular volume decrease (TVD), pampiniform vein diameter (PVD), and basal (BBF) and maximum blood flow (MBF) velocities were measured in 625 boys. In 74 cases a semen analysis was performed. The statistical analysis revealed that the presence of venous reflux and PVD correlated with the grade of varicocele. Decreases in testicular volume were highly dependent on the grade of varicocele, PVD, and BBF and MBF velocities. Analysis of the relationship between spermatic (boys over 17 years) and US findings revealed that the quality of spermatogenesis can be predicted by US examination in adolescents with varicocele. The authors recommend multiparametric US examination as a reliable, objective, and repeatable technique for establishing criteria for operative treatment in boys under 18 years of age with varicocele as well as for postoperative evaluation.     

Child and adolescent obesity

Obesity and overweight are a pandemic that has been building since the 1980s. The causes are multi-factorial, and the solutions are ultimately political. The consequences, however, are medical. Admissions to hospital with obesity-related illness increased 4-fold between 2000 and 2009, and paediatricians regularly see comorbidities in their clinics and on their wards. Broaching the subject of obesity and overweight when we are talking to young people and their families is difficult. Detailed history and examination, in a systemic and non-judgemental way can identify these comorbidities so that they may be treated. Not to do so is a missed opportunity. Interdisciplinary working can support the child and their family to manage their weight. This article offers some personal experience and practical advice for health care professionals who want to make a real difference to the children in their care.     

The adolescent trauma patient

Trauma poses the greatest medical problem for the adolescent in terms of morbidity, mortality, and years of productive life lost. The emergency physician caring for the adolescent trauma patient must consider physical and intellectual changes that occur during this period of life. Clinicians must be familiar with both the approach to the traumatized child as well as the adult, and decide on the apropriate approach to the individual adolescent. The emergency physician is also in a position to support greater preventive measures by continued contributions to trauma surveillance, and by serving as a spokesperson and educator about adolescent injuries.     

Child and adolescent obesity

Childhood obesity has reached epidemic proportions worldwide. With adult obesity-related co-morbidities now appearing in obese children, there has been a big push to educate the population and establish effective weight-losing initiatives. However, the limited success of non-operative methods has led to the introduction of bariatric surgery in the under 18-year olds. Laparoscopic Roux-en-Y gastric bypass is the most commonly performed operation, followed by the adjustable gastric band and sleeve gastrectomy. This review seeks to present the current position of bariatric surgery in the treatment of obese adolescents, and reviews the available evidence on selection and outcome, as well as the inherent uncertainties, particularly within the UK.