Problems related to menstruation amongst adolescent girls

Objective  To study the types and frequency of problems related to menstruation in adolescent girls and the effect of these problems on daily routine. Methods  Girls in the age group 13–19 years who had had menarche for at least one year at the time of study. 198 adolescent girls have been studied. Data was collected by personal interviews on a pre-tested, semi-structured questionnaire. The questions covered menstrual problems, regularity of menses in last three cycles of menstruation and the effect of these problems on the daily routine. Analysis was done using SPSS version 12. Percentages were calculated for drawing inferences. Results  More than a third (35.9%) of the study subjects were in the age group 13–15 years followed by 17–19 years, 15–17 years respectively. Mean age of study participants was calculated to be 16.2 years. Dysmenorrhea (67.2%) was the commonest problem and (63.1%) had one or the other symptoms of Pre-menstrual syndrome (PMS). Other related problems were present in 55.1% of study subjects. Daily routine of 60% girls was affected due to prolonged bed rest, missed social activities/commitments, disturbed sleep and decreased appetite. 17.24% had to miss a class and 25% had to abstrain from work. Mothers and friends were the most common source of information on the issue. Conclusion  Screen adolescent girls for menstruation related problems and provide them with counseling services and relevant information on possible treatment options. Besides, there is a need to emphasize on designing menstrual health programmes for adolescents.     

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.     

Management of the transgender adolescent

Transgender individuals are people whose self-identification as male, female, both, or neither (gender identity) does not match their assigned gender (identification by others as male or female based on natal sex). The phenomenon of transgender is uncommon, but as more media attention is directed toward the subject, more adolescents and young adults are "coming out" at an earlier age. Transgender adolescents are an underserved and poorly researched population that has very specific medical and mental health needs. Primary care physicians are in a unique and powerful position to promote health and positive outcomes for transgender youth. While not all transgender adolescents desire phenotypic transition to match their gender and physical body, most do. The process of transitioning is complex and requires the involvement of both a mental health therapist specializing in gender and a physician. Finding comprehensive medical and mental health services is extremely difficult for these youth, who are at risk for multiple psychosocial problems including family and peer rejection, harassment, trauma, abuse, inadequate housing, legal problems, lack of financial support, and educational problems. This review supports and describes timely medical intervention to achieve gender/body congruence paired with affirmative mental health therapy as an appropriate approach to minimize negative health outcomes and maximize positive futures for transgender adolescents.     

Management of the asthmatic adolescent

Bronchial asthma is a chronic condition that is on the increase in adolescents as it is among other age groups; often under-diagnosed it prevalently affects males and is 10% sustained by an allergic diathesis. Adolescence, with its peculiarities and characteristic psychological and physical changes affects the clinical expression of asthma and above all requires particular diagnostic and therapeutic attention from the treating paediatrician. The physician should act as a direct, credible interlocutor of the adolescent. Regular sporting activity appropriate to the subject's age and asthmatic condition, and under close medical supervision, must be recommended in the asthmatic adolescent. Bronchial asthma in adolescence often presents as asthma due to physical effort. The onset of asthma must not represent an impediment to regular physical activity; adequate management strategies are however necessary (so as to prevent the symptom occurring after effort). These strategies range from the choice of type of training (environment and work loads) to pharmacological prevention measures. The asthmatic adolescent may also perform physical activity at competitive level although in this case special attention must be paid to the choice of drugs so as to avoid running into problems of disqualification due to doping.     

Nutrition in the adolescent

This article reviews the nutritional requirements of puberty and the clinical assessment of nutritional status, and discusses the nutritional risks imposed by vegetarian diets, pregnancy, and athletic involvement. Energy (calories) and protein are essential in pubertal development. Adolescent females require approximately 2200 calories/day, whereas male adolescents require 2500-3000 calories/day. Additional intake requirements include fat, calcium, iron, zinc, vitamins, and fiber. The clinical assessment of nutritional status begins with obtaining a good diet history of the patient and this could be offered by the body mass index. Nutritional deficiencies and poor eating habits established during adolescence can have long-term consequences, including delayed sexual maturation, loss of final adult height, osteoporosis, hyperlipidemia, and obesity. As for vegetarian adolescents, nutritional risks include lack of iodine, vitamin B12, vitamin D, and some essential fatty acids. In addition, substances in some grains reduce gut absorption, thus increasing mineral deficiencies. Pregnancy may also be a risk factor for poor nutrition during adolescence. A pregnant adolescent has different nutritional needs because she is still growing. Among adolescent athletes many are turning to nutritional supplements in an attempt to improve athletic performance. A balanced, varied diet provides adequate calories and nutrition to meet the needs of most adolescents. They also have greater water needs than do adult athletes. Details on adolescent health concerns are further discussed in this article.     

Varicocele in the adolescent

Varicocele is a dilatation of the veins of the pampiniform plexus caused by reflux within the spermatic venous system. In the majority of cases it becomes apparent during pubertal development. The etiology of varicocele is likely multifactorial. The varicocele may have a negative effect on gonadal growth in the pediatric-adolescent age group and may be associated with a significant reduction in testicular volume and progressive decline in testicular function. The most likely mechanism is an elevation of testicular temperature due to an impaired counter-current heat exchange mechanism. Initial diagnosis is based on the clinical examination, which, in selected cases, may be followed by other non-invasive evaluations: Doppler, color Doppler ultrasound of the spermatic cord (the examination of choice), or ultrasound of the testis. The role of hormonal studies (gonadotropin, testosterone and inhibin B levels) is controversial and analysis of seminal fluid may be difficult to obtain in a minor. This statement offers recommendations regarding the best practice policies for evaluation and treatment of varicocele in adolescents.     

Echocardiographic screening of the athletic adolescent

Sports-related sudden death in adolescent athletes is usually the result of previously undetected heart disease. The most common causes are hypertrophic cardiomyopathy, left coronary artery anomaly, and Marfan's syndrome. Comprehensive cardiovascular history and physical examinations can select a group of adolescents suspected of having heart disease and increased risk of sudden death. Echocardiography plays an important role in the further diagnostic evaluation of these adolescents. Although echocardiography would make an ideal screening test, it is impractical at this time considering the millions of adolescents undergoing preparticipation sports evaluations each year. For now, continued education of the examining physician and appropriate use of diagnostic studies are needed.