Paracetamol use,availability, and knowledge of toxicity among British and American adolescents.

Paracetamol is the commonest agent employed in self poisoning, however it is not clear whether adolescents possess insight into the serious complications associated with its misuse. Using a one page questionnaire, the availability, usage, and knowledge of toxicity of paracetamol among 1147 American and British adolescents was assessed. Although 90% of all students recognised that paracetamol could kill, the great majority of students overestimated the lethal dose. In addition, while knowledge regarding side effects of paracetamol was poor the drug was widely available to, and used by, the study population. It is proposed that gross overestimation of the number of tablets required to kill, poor understanding of paracetamol side effects, and wide availability of the drug contribute to its frequent use in adolescent suicidal behaviour. The inclusion of some over-the-counter medications in school drug education programs in addition to tighter control of the availability of paracetamol may help reduce the problem of adolescent self poisoning.     

Knowledge amongst adolescent girls about nutritive value of foods and diet during diseases, pregnancy and lactation.

Knowledge about nutritive value of food, diet during diseases and antenatal and postnatal period was assessed amongst 152 adolescent school girls. A total of 23.69 and 55.93% students had incorrect knowledge that pulses and non-vegetarian foods should be avoided during later half of the pregnancy. A total of 63.82, 66.45 and 71.72% of subjects had incorrect knowledge that almonds have more nutritive value than groundnuts, fruits are rich sources of calories and desi ghee has more nutritive value than vanaspathi, respectively. Majority (90.78%) had correct knowledge that obesity is caused due to excess intake of calories than required by an individual and low iron content and poor availability of iron from food is a major cause of anemia in mothers and children.     

Effects of Objective and Subjective Socioeconomic Status on Self-Rated Health, Depressive Symptoms, and Suicidal Ideation in Adolescents

The purpose of this study was to identify relationships between three indicators of socioeconomic status (SES)—parental education, Family Affluence Scale (FAS), and subjective household economic status—and adolescent health (self-rated health, depressive symptoms, and suicidal ideation). Data from 69,196 students from 800 middle and high schools were analyzed. Relationships between the three SES indicators and adolescent health were examined using the chi-square test, and logistic regression analysis was then performed after adjusting for covariates. Female students whose parents had less education were more likely to report poor health than were those whose parents had a higher education. Low FAS scores were associated with higher odds ratios for poor self-rated health but not for depressive symptoms or suicidal ideation. In the logistic regression analysis, lower subjective household economic status significantly predicted poor self-rated health, higher levels of depressive symptoms, and more suicidal ideation. The findings suggest that subjective household economic status, rather than objective SES measures, is associated with adolescent health. Thus, future research about adolescent health should consider multiple dimensions of subjective social status of adolescents.     

Adolescent body image and attitudes to anabolic steroid use.

Eleventh-grade students at seven high schools in central Arkansas were surveyed regarding anabolic steroid use, risk-taking behavior, satisfaction with body image, and attitudes and beliefs regarding anabolic steroids. A total of 1492 adolescents were surveyed. Fifty-one (7.6%) of 672 males and 12 (1.5%) of 806 females admitted anabolic steroid use. Fourteen students did not specify gender. Bivariate comparisons showed significant differences between users and nonusers in risk-taking behaviors and degree of satisfaction with body image and muscles. Users were more likely than nonusers to approve of anabolic steroid use in sports and to believe that anabolic steroid use could improve one's health. Multivariate analyses found gender, knowledge of beneficial side effects, knowing other anabolic steroid users, age, and race to be significantly related to anabolic steroid use. Information about steroids' effects seldom came from physicians, but often came from peers. Anabolic steroid use was strongly motivated by social influences, some knowledge of beneficial effects, and denial of adverse effects in white adolescent males in our study population.     

Psychological subtyping finds pathological, impulsive, and 'normal' groups among adolescents who self-harm

Background: Research to date suggests that as many as 12–15% of young people engage in self‐harm behaviour; however, the current understanding of the psychological basis of adolescent self‐harm is limited. The objective was to determine whether adolescents who self‐harm are a psychologically homogenous group. It was hypothesised that psychological subtypes would exist and these groups would report different rates of self‐harm. Method: Nine hundred and forty‐four school students aged 11 to 19 and 166 first‐year psychology students aged 21 or younger completed a self‐report questionnaire. Participants were aged 11 to 21 (mean = 15.4, SD = 2.1). Sixty‐two percent of the sample were female (n = 692). Students were allocated to psychologically distinct groups. Rates of self‐harm were compared for the psychological subtypes of self‐harmers. Results: Two hundred and thirty‐four participants reported lifetime self‐harm (21.1%; 95% CI 19–23%) and 78 reported recent self‐harm (7.0%; 95% CI 6.7–7.3%). The present study identified three psychologically quite distinct groups of adolescents within those who reported self‐harm – a psychologically pathological group, a psychologically ‘normal’ group, and an impulsive group. The pathological group reported the highest rate of recent self‐harm (50.9%); the psychologically ‘normal’ and impulsive groups reported similar rates of self‐harm (28.7% and 24.6%, respectively). Conclusions: Adolescents who self‐harm are not a psychologically homogenous group. One pathological subtype of self‐harmers appears to most closely reflect a number of the psychological and social factors previously associated with self‐harm. However, a large proportion of the sample was allocated the psychologically ‘normal’ subtype. This finding highlights the importance of psychological screening of adolescents presenting for treatment for self‐harm as subtypes of self‐harmers may require disparate strategies for intervention. Further research is required in order to identify appropriate treatment strategies for each subtype.     

Acquired immunodeficiency syndrome and adolescents: knowledge, beliefs, attitudes, and behaviors

Adolescents are a group at high risk for exposure to acquired immunodeficiency syndrome (AIDS). Results of a random-sample survey of 860 adolescents 16 to 19 years of age, in Massachusetts indicate that many adolescents are still misinformed or confused about AIDS and AIDS transmission. Of the adolescent respondents, 70% said they were sexually active (having sexual intercourse or other sexual contact) but only 15% of them reported changing their sexual behavior because of concern about contracting AIDS, and only 20% of those who changed their behavior used effective methods. Of both sexually active and nonactive adolescents, 8% did not know that AIDS is transmitted by heterosexual sexual intercourse. Psychoactive drugs other than alcohol and marijuana had been used by 13% of those responding, and 1% reported injecting drugs. Of those psychoactive drug users, 8% did not know that AIDS can be transmitted by injecting drugs. There was no significant difference in knowledge between the sexually active and nonactive adolescents concerning sexual behavior and AIDS transmission or between the drug users and nonusers concerning drug use and AIDS transmission. The majority of respondents knew a relationship exists between AIDS and blood, and other body fluids, but knowledge of the mode of transmission was limited. Hence, many adolescents, including those in the highest risk subgroups of sexually active or psychoactive drug users, did not know what sexual and drug precautions are needed to prevent transmission of the virus. School systems and health care providers should systematically educate this population about AIDS to counter the current misinformation and confusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Paracetamol poisoning in children

Paracetamol (acetaminophen) has become an antipyretic drug of choice. Due to its widespread use, toxicity secondary to overdose has increased in recent years. Children are especially vulnerable to accidental exposure due to non availability of child proof containers in India. The main clinical features of acute toxicity include anorexia, vomiting, abdominal pain, jaundice, hematuria and metabolic acidoses. Diagnosis is based on history and laboratory findings of acidosis and abnormal liver function tests. N-acetylcysteine is the specific antidote. This article reviews in detail the toxicokinetics, pathophysiology, clinical features and management of paracetamol poisoning in children.     

Commentary: Self‐harm in adolescents: the best predictor of death by suicide? – reflections on Hawton et al. (2012)

The preceding article by Hawton and colleagues reporting on a prospective study of adolescents presenting with self‐harm to Accident and Emergency departments (A&E) is one of the largest epidemiological studies to examine the long‐term outcomes of selfharm in children and adolescents. After a median of 6 years nearly 30% re‐presented to A&E with self‐harm and 1% died, half of those due to likely suicide and the rest mainly due to accidents. It may be that many accidental deaths were also suicides judging from the method of death. In comparison to adults presenting with self‐harm, the absolute risk of suicide was lower despite a high self‐harm repetition rate. Self‐injury by cutting was a strong independent predictor of suicide as was previous psychiatric treatment and previous self‐harm. Finally the eventual method of suicide was different from that used at either the first or the last episode of selfharm. This is at odds with the data generated by adult literature which consistently shows that those with the most violent methods of selfharm, e.g. attempted hanging or shooting, tend to also die using these methods. In summary the field of adolescent self‐harm is of immense importance and requires urgent research to develop our ability to predict those likely to die of suicide, and to offer effective treatment to those at risk. The article by Hawton and colleagues is an important step in our understanding of the risk factors of suicide in those adolescents who present with self‐harm and in highlighting the overlapping nature of self‐injury and self‐poisoning in relation to suicide.     

Children, adolescents, and advertising

Advertising is a pervasive influence on children and adolescents. Young people view more than 40,000 ads per year on television alone and increasingly are being exposed to advertising on the Internet, in magazines, and in schools. This exposure may contribute significantly to childhood and adolescent obesity, poor nutrition, and cigarette and alcohol use. Media education has been shown to be effective in mitigating some of the negative effects of advertising on children and adolescents.     

Prevention and risk of adolescent substance abuse. The role of adolescents, families, and communities

Adolescents as young as 12 to 14 years of age are engaging in substance use [16]. Those who use substances are at risk for immediate and future consequences that affect morbidity and mortality. The theoretical models of substance use in adolescents provide a framework for understanding risk and protective factors. These risk and protective factors are pertinent to all contexts, including the individual traits, interpersonal relationships, and greater society. Knowledge of these factors should help the clinician in assessment of the individual adolescent. Knowledge of these factors also should help the clinician provide appropriate interventions. In the case of primary prevention, clinicians can advocate for families and communities to teach children how to be more goal-oriented, insightful, and in tune with their cultures and beliefs. Parents also can be encouraged to set clear limits, monitor their adolescents' behaviors, be good role models, and provide a loving and supportive environment. Advocacy to address some of the societal factors that are less easily changed also has its place. Addressing media portrayal of drug use, availability of substances, and poverty would have a broad impact on the problem of adolescent substance use and would help to improve the health status of many adolescents in the United States.     

Adolescents' drug use and drug knowledge

Self-medication is a common event. To use drugs correctly, a basic knowledge about drugs is required. Poor data are available about adults' drug knowledge. Furthermore, adolescents' basic drug knowledge has not been investigated. This study was designed in order to explore adolescents' drug use and knowledge and the factors that influence them. A total of 56 tenth grade students between 15–17 years of age at a secondary school in Dresden, Germany were enrolled in a pilot study by answering a self-completion questionnaire. Of adolescents, 57% took from one to six different drugs in the 2 weeks before questioning. In particular, a chronic consumption of non-opioid analgesics was found. Some 15% of adolescents took headache remedies at least several times per month. Self-acquisition occurred more often for these drugs than for any other drug group. The best score for drug knowledge was 10 out of 13 possible points and only 43% of students attained from 7 to 10 points. Astonishingly, more than two-thirds of adolescents could not describe in their own words how a medicinal agent is ingested. Female gender and a chronic drug consumption were detected as influencing factors of better drug knowledge. Conclusion The results indicate that adolescents gain drug knowledge through drug consumption and not before taking drugs. This leads to a potential risk particularly in the case of self-medication. Received: 30 October 1999 and in revised form: 2 February and 23 February 2000 Accepted: 25 February 2000     

Neonatal paracetamol poisoning: treatment by exchange transfusion.

The metabolism and excretion of paracetamol was studied in an infant of 29 weeks'' gestation who was exposed to the drug when his mother ingested 32.5 g 16 hours before delivery. We have confirmed that sulphation is the major pathway and that the mixed function oxidase system is sufficiently active at this gestational age to produce hepatotoxic metabolic products. As most of the recognised drug treatments for paracetamol poisoning seemed unsuitable in this case, the infant was treated with exchange transfusions.     

Nutrition in adolescent pregnancy

Prevention of unintended adolescent pregnancy is a primary goal of the American Academy of Pediatrics and of many health providers. Nevertheless, many adolescents become pregnant every year in America. Pediatricians therefore should be aware of nutritional recommendations for pregnant adolescents to provide optimal care. The importance of nutrition during pregnancy is here reviewed from a pediatric perspective. Pregnancy, particularly during adolescence, is a time of extreme nutritional risk. The adolescents most likely to become pregnant are often those with inadequate nutritional status and unfavorable socio-economic background. There is increasing evidence of competition for nutrients between the growing pregnant adolescent and her fetus. Also, the prenatal environment has been implicated in the development of obesity, cardiovascular disease, and diabetes in both the mother and her offspring. Many adolescents have poor diet quality and poor knowledge of appropriate nutrition; these habits may not change during pregnancy. Current knowledge and recommendations regarding the intake of energy, calcium, and folate are discussed in detail.     

R1 version,self‐concept in Taiwanese adolescents with congenital heart disease

Background: The objectives of this study were to evaluate and compare differences in self‐concept between male and female adolescents with congenital heart disease, and to compare the self‐concepts of these adolescents to that of the general adolescent population using normative data. Methods: A total of 300 adolescents, 143 male and 157 female, from two medical centers in Taiwan completed the Tennessee Self‐Concept Scales and the scores of male and female subjects were compared. The scores of adolescents with congenital heart disease were also compared with normative data of healthy Taiwanese adolescents. Results: Girls with congenital heart disease showed significantly lower mean scores in Physical Self, Social Self, Personal Self, Academic Self and Overall Self domains on the Tennessee Self‐Concept Scales when compared to boys with congenital heart disease. When compared to the average value of normative data, adolescent boys with congenital heart disease had significantly higher mean T‐scores on Physical Self, Family Self, Social Self, Personal Self, Academic Self and Overall Self, and adolescent girls had significantly higher mean T‐scores in Moral‐ethical Self, Social Self, Personal Self, Academic Self and Overall Self domains. There were weak negative correlations between severity of congenital heart disease and Physical Self T‐scores, and between the number of heart operations and Academic T‐scores. Conclusions: Self‐concept in adolescents with congenital heart disease is similar to or even higher than that of their normal counterparts. More holistic views of adolescents with congenital heart disease, including their self‐concept, appear warranted, especially for adolescent girls with congenital heart disease.     

Adolescent contraception: review and guidance for pediatric clinicians

The objectives of this article are to review current contraceptive methods available to adolescents and to provide information, guidance, and encouragement to pediatric clinicians to enable them to engage in informed up-to-date interactions with their sexually active adolescent patients. Pregnancy prevention is a complex and dynamic process, and young people benefit from having a reliable authoritative source for information, counseling, and support. Clinicians who provide services for adolescents have a responsibility to develop their skills and knowledge base so that they can serve as that source. This review begins with a discussion about adolescent sexuality and pregnancy in the context of the adolescent developmental stages. We discuss approaches to introduce the topic of contraception during the clinic visit and contraceptive counseling techniques to assist with the discussion around this topic. In addition, information is included regarding confidential services, support of parental involvement, and the importance of male involvement in contraception. The specific contraceptive methods are reviewed in detail with the adolescent patient in mind. For each method, we discuss the mechanism of action, efficacy, contraindications, benefits and risks from the medical perspective, advantages and disadvantages from the patient's perspective, side effects, patient adherence, patient counseling, and any medication interactions. Furthermore, we have included a section that focuses on the contraceptive management for the adolescent patient with a disability and/or chronic illness. The article concludes with an approach to frequently asked or difficult questions. This section largely summarizes subsections on specific contraceptive methods and can be used as a quick reference on particularly challenging topics. Finally, a list of useful contraceptive management resources is provided for both clinicians and patients.     

Perinatal and neonatal use of paracetamol for pain relief

Paracetamol (acetaminophen) is the most widely used drug to treat pain or fever in pregnant women or neonates, but its pharmacokinetics (PK) and pharmacodynamics (PD) warrant a focused analysis. During pregnancy, there is an important increase in paracetamol clearance. Consequently, it is reasonable to anticipate that the analgesic effect of paracetamol will decrease faster, whereas higher doses may result in even higher oxidative toxic metabolites. Therefore, most peripartal PD data relate to multimodal analgesia strategies. In neonates, weight/size is the most relevant covariate of paracetamol PK. This resulted in proposed dosing regimens containing higher doses than currently prescribed in the label for term neonates. Using adequate dosing, paracetamol is a poor procedural analgesic, is effective for mild-to-moderate pain, and has morphine-sparing effects. Short-term safety has been well documented, and there is active research investigating the potential association between paracetamol exposure and atopy, fertility, and neurobehavior.     

The use of anabolic steroids in high school students

The use of anabolic steroids by athletes has been a frequent topic in many recent reports. While much has been written in the lay literature, there is little in the scientific literature documenting the actual use of steroids, particularly in adolescents. We describe the results of a survey of 2113 high school students. The survey was designed to elicit information about students' general knowledge about anabolic steroids, awareness of the risks and side effects, and the incidence of use of anabolic steroids. Ninety-four (4.4%) of 2113 students admitted using anabolic steroids. Broken down by sex, 67 (6.5%) of 1028 males and 27 (2.5%) of 1085 females were users of steroids. Athletes had a higher use of steroids (79 [5.5%] of 1436 subjects) than nonathletes (15 [2.4%] of 636 subjects). These data suggest that we have another serious, as yet unappreciated drug problem in our adolescents.     

Severe poisoning with intravenous phenytoin in the newborn. Value of peritoneal dialysis

A severe poisoning with intravenous phenytoin in a newborn was treated with peritoneal dialysis in spite of its reported poor effectiveness, the drug being 90% protein-bound. During 10 hours, 1.41 mg/hr were eliminated by biotransformation and 1.80 mg/hr were removed with peritoneal dialysis allowing to suppress quickly life threatening cardiac side effects. This efficacy may be explained by an increase in the unbound protein fraction and a diffusion speed through the peritoneum higher than in older patients.     

Self-rated health, psychosocial functioning, and health-related behavior among Thai adolescents

Background:  Despite the popularity of self-rated health (SRH) in Western countries as a useful public health tool, it has only rarely been used in Asian countries. The purpose of the current study was to determine whether measures of psychosocial functioning and health-related factors differ according to SRH in a school-based sample of Thai adolescents.
Methods:  The survey was given to 2519 adolescents attending 10 coeducational secondary high schools in Chiang Mai Province, Thailand and included measures of psychosocial functioning (loneliness, hopelessness, shyness, perceptions of social status, self-rated happiness, and perception of physical attractiveness) and certain health-related factors (height/weight, physical activity, eating breakfast, sleep).
Results:  The proportion of boys (5.1%) reporting that they were not healthy was similar to the proportion of girls (4.6%) making the same rating. These adolescents showed a pattern of overall poor health risk. Compared to adolescent peers who rated their health as healthy or very healthy, they were less physically active, got less sleep, were more likely to be overweight, and scored lower on loneliness, shyness, hopelessness, and self-rated happiness.
Conclusions:  The present pattern of poor health risk warrants attention and supports the merit of using SRH in adolescent health assessment. SRH is easy to obtain and simple to assess and single-item assessments of SRH appear to be valid measures of health status in adults and adolescent. Interventions, such as health counseling, mental health counseling, and health education, can target adolescents who rate themselves as 'not healthy' or report poor health status.     

A Mentoring Program for the Promotion of Sexual Health Among Korean Adolescents

The purpose of this pilot study was to develop a mentoring program for the promotion of sexual health among Korean adolescents and to explore the effects of the program. A nonequivalent control group pre-test–post-test design was used. The mentoring intervention was conducted by eight nursing students who participated in the program as mentors using various methods such as formal group sessions and informal individual contacts. At the 12-week post-intervention, the interaction between time and group was statistically significant on both sexual knowledge and sexual attitude of the 17 adolescent mentees. The mentoring program demonstrated potential as a developmentally appropriate intervention for the sexual health promotion of adolescents and promises to enable nursing students to gain confidence in their professional capability.