adolescent.ppt

Adolescent Health ProblemsShijingshan hospitalwangrongwordsn nonsetonsetn nimpoverishimpoverishn npubertypubertyn ntempotempon nhormonalhormonaln ngonadgonadn nadrenaladrenaln nsomaticsomaticn nmanifestationmanifestationn nchronologicchronologicn npubicpubicn ngenitalgenitaln nmeanmeann nmenarchemenarchen nspermarchespermarchen nspurtspurtn nroentgenogramroentgenogramn ntruncaltruncaln npelvicpelvicn ncardiaccardiacn nlarynxlarynxn nanterioranteriorn nthyroidthyroidn ncartilagecartilagen ntumultuoustumultuousn ndisruptiondisruptionn nintimacyintimacyn nsequelasequelan negocentricegocentricn nsociocentricsociocentricn n Adolescence is the period between childhood and adulthood.this period is usually defined by the rapid onset of biological and psychological growth and development prior to or at the second decade of life and ending before age 20.n nCurrently,the adolescent population in the United States is the group least likely to have health insurance.Physicians need a careful understanding of the biological and psychosocial changes of adolescence,the associated environmental changes and the legal and ethical issues that affect the provision of health care services to adolescents.n nPuberty is defined as the sequential biological processes that ultimately lead to reproductive capacity.the onset and tempo of puberty vary by sex,population group,and individual.n nDuring puberty,major alterations in the hormonal regulatory systems in the central nervous system,gonads,and adrenals cause changes in skeletal growth and body composition and the acquisition of secondary sexual characteristics.n nThe mechanisms responsible for the initiation of puberty through activation of the hypothalamic-pituitary-gonadal axis remain undefined.n nThe sexual maturity ratings(SMRs)of Marshall and Tanner are helpful in monitoring the development of secondary sexual characteristics of pubertal maturation,which are the somatic manifestations of adrenal and gonadal activity.these ratings correlate more closely with bone age than chronologic age.n nThe SMRs for girls are based upon breast and pubic hair development,each in five stages.The ratings for boys are based upon genital and pubic hair development.2009年8月24日wordn naltruisticaltruisticn nchronicallychronicallyn npubescencepubescencen ndeferdefern nheterosocialheterosocialn ntestosteronetestosteronen nirritableirritablen nmasturbatorymasturbatoryn ninitiateinitiaten ncontraceptioncontraceptionn npsychiatricn ndetrimentaln nemancipaten nmortalityn nmorbidityn nhomiciden nninefoldn nlean body massn nStroke volumen ncorrelate withn nbe associated withn naccount for n nAssessment of skeletal growth during adolescence should be done through a height velocity curve with consideration of the sexual maturity rating.Bone age can be determined through the utilization of hand roentgenograms.Psychological developmentPsychological developmentn nThe functional and cognitive changes do not necessarily correlate with physical maturation.The early adolescent(age 10 to 13)tends to focus to focus on the physical changes in his or her body and may have concerns about the maturation process.n nFamilies can facilitate adolescence by providing a graduated increase in independence and in responsibilities.Adolescents require both individuality and involvement with family and society to facilitate development of identity and of rational competence.n nThe late adolescent views life in a more sociocentric view,characteristic of adulthood.The late adolescent may be altruistic,and conflicts with the family and society may center on moral issues rather than egocentric considerations.n nClinicians should support this process by encouraging Clinicians should support this process by encouraging adolescents to make their own appointments,assisting adolescents to make their own appointments,assisting the chronically ill adolescent in assuming more the chronically ill adolescent in assuming more responsibility for his or her health care,and responsibility for his or her health care,and encouraging parents to decrease their role in clinical encouraging parents to decrease their role in clinical management issues.management issues.Psychological change associated with pubescencen nSpecific behavioral changes are associated with puberty and its timing.Androgens are involved in this process.During peak height velocity(stages 3to 4),boys tend to have conflicts with their mothers.n nBoys with rising levels of testosterone tend to initiate sexual intercourse and are reported to be more impatient,irritable,and aggressive.Rising levels of adrenal androgens correlate with increased masturbatory activity and heterosocial behavior in girls.n nTiming of puberty is associated with psychological and behavioral sequelae.Earlier physical maturation in girls is associated with more dissatisfaction with their bodies,lower self-esteem,and general un happiness.n nEarly-developing girls also receive less support from peer groups and may associate with older adolescents.n nEarly physical maturation in boys is associated with earlier initiation of sexual behavior,and late maturation in boys is more often associated with negative psychological sequelae.Environmental changen nThe law in most states requires consent of a parent for The law in most states requires consent of a parent for medical care for children below age 18.The medical care for children below age 18.The involvement of parents is usually not a barrier to the involvement of parents is usually not a barrier to the provision of health services,but some sensitive health provision of health services,but some sensitive health issues(e.g.,sexual behavior and substance use)may issues(e.g.,sexual behavior and substance use)may interfere with access to health care for adolescents.interfere with access to health care for adolescents.n nThe Mature Minor Doctrine generally allows adolescents to seek health care independently if they are capable of understanding the risks and benefits of the proposed treatment and therefore capable of informed consent.n nThere is usually little risk of liability in providing health care to the older mature minor(14 years or older)if the care is for the individuals benefit or is an emergency.n n 2009年年9月月1日日Morbidity and mortalityn nThe concept that adolescence is the healthiest period of life is based on measures of mortality and morbidity that do not include functional assessment of health status or the effects of behaviors initiated during adolescence on adult mortality and morbidity.n nMost morbidity during adolescence originates from substance abuse,sexual activity,and injuries.Additional causes include mental health problems and skeletal and reproductive disorders.n nEthnic and racial groups differ in respect to the cause of death:black males of 15 to 19 years old have a ninefold greater rate of death from homicide than white males and the lowest life expectancy of all adolescents.wordn nepiphysisepiphysisn nObeseObesen nfemoralfemoraln ntibialtibialn ntuberositytuberosityn nidiopathicidiopathicn nscoliosisscoliosisn nneoplasmneoplasmn nosseousosseousn nfracturefracturen nanovuanovul latoryatoryn nmensismensisn noscillationoscillationn nEstrogen Estrogen n nluteinizeluteinizen nprogesteroneprogesteronen nendometrialendometrialn nliningliningn nintermittentintermittentn nsloughsloughn nmenstrualmenstrualn ncoagulationcoagulationn nvaginavaginan ncervixcervixn nuterusuterusn no ovaryvaryn ndysmenordysmenorr rheahean nmenstruatemenstruaten nabsenabsent teeismeeismn nprostaglandinprostaglandinn no ovulatoryvulatoryn nintraintrau uterine terine n novulationovulationn ncontraceptivecontraceptiven ncomplicationcomplicationn nneonatalneonataln nseroprevalenceseroprevalencen nimmunodeimmunodef ficiencyiciencyn ntesticulartesticularn n varicocelevaricocelen nsemensemenn ntumor tumor n ncrackcrackn nprevalenceprevalencen nillicitillicitn nhispanichispanicn nhospitalizationhospitalizationn nrecklessrecklessn ncoituscoitusn nethnicityethnicityn ncovaricovaria ationtionn ndelinquentdelinquentn nmarijuanan nthereaftern npsychedelicn nsedativen ntranquilizern nDistressphasen nIn respect toIn respect ton nBe implicated in Be implicated in n nPredispose sb.to Predispose sb.to He believes some people are predisposed to criminal He believes some people are predisposed to criminal behavior.behavior.Stress can predispose people to heart disease.Stress can predispose people to heart disease.n nBe independent of Be independent of n nBe characterized by Be characterized by n nplay important roles inplay important roles inn noriginates fromoriginates fromn nDUB(dysfunctional uterine bleeding)n nSTD(sexually transmitted diseases)n nLSDn nPrecipitating factorn nRaten nLifetimen nRespectively n napproximateRisking-taking behaviorsn nSubstance use and abusen nUnintentional injuriesn nSexual behaviorn nCovariation of risk behaviorsSubstance use and abusen nSince 1991 there has been a reversal in the downward trends of substance use that occurred in the 1980s.This increase in substance abuse has been accompanied by a decrease in the perception of harm by such behavior.n n In1994 45.6 percent of high school seniors reported illicit substance use at some time.Rates of lifetime use of LSD and heroin among high school seniors reported use of crack cocaine.n nLifetime alcohol and tobacco use approximated 87 percent and 62 percent,respectively,among high school seniors in 1994.n nGirls consistently report greater use of cigarettes,whereas boys use alcohol more commonly.Approximately 19 percent of adolescents leave high school as smokers,and 21 percent of young adults are regular smokers.n nThe lower The lower rates rates of cigarette smoking in boys may be of cigarette smoking in boys may be due to the increase in use of snuff and chewing tobacco due to the increase in use of snuff and chewing tobacco.n nInjuries,particularly motor vehicle accidents,Injuries,particularly motor vehicle accidents,account account forfor more than half of deaths in adolescents,and more than half of deaths in adolescents,and hospitalization for injury accounts for the largest hospitalization for injury accounts for the largest number of hospital days.number of hospital days.n nAlcohol,high speed,and reckless behavior play important roles in these injuries and are also implicated in injuries with bicycles,skateboards,swimming,and boating.Males outnumber females by greater than 2 to 1 in all injury situation.n nOverall birth rates have declined over the past decade,but the number of births to unmarried adolescent girls has increased.Furthermore,there were an estimated 412,275 abortions in adolescents in 1992.Pregnancy,birth,and abortion rates vary by race and ethnicity.n nThe practice of one risk behavior The practice of one risk behavior is associated withis associated with a a greater likelihood for initiation of another in the near greater likelihood for initiation of another in the near future.The association between alcohol abuse and future.The association between alcohol abuse and injury is well established.Other activities that injury is well established.Other activities that predispose topredispose to injury include reckless driving and failure injury include reckless driving and failure to use seat belts and helmets.to use seat belts and helmets.n nDuring early and middle adolescence,less serious During early and middle adolescence,less serious substance use substance use predictspredicts subsequent use of more serious subsequent use of more serious substances.substances.n nAlcohol use precedes marijuana use,and marijuana use Alcohol use precedes marijuana use,and marijuana use precedes other illicit drugs(including psychedelics,precedes other illicit drugs(including psychedelics,cocaine,heroin,and cocaine,heroin,and nonprescribednonprescribed stimulants,sedatives stimulants,sedatives,and tranquilizers).,and tranquilizers).n nIn girls,cigarette use is predictive of subsequent substance use.The influence of alcohol and tobacco use on subsequent marijuana use is independent of age.n nThe earlier adolescents begin using marijuana the more likely the use of other illicit substances.Substance use is also correlated with delinquent behavior,violent behavior,suicide,homicide,early sexual debut,and less effective contraceptive use.2009 年9月14日n nschizophrenian npredominancen nprecipitatingn ntruancyn nhypochondriasishypochondriasisn ncausalcausaln nqueryqueryn nconfidentialityconfidentialityn nimmmaterialimmmaterialn nguardianguardiann nlethalitylethalityn npsychiatristpsychiatristn noutpatientoutpatientn ninpatientinpatientn npreponderancepreponderancen ndecrementdecrementn nsubclinicalsubclinicaln nfull-fledgedfull-fledgedn nformidableformidablen ninterveneintervenen ndisclosedisclosen npathologicpathologicn nimpairimpairn nvaccinationvaccinationn nmeaslesn nmumpsn nrubellan ntetanusn ndiphtherian npoliomyelitisMental health problemsn nApproximately 10 percent of adolescents have symptoms of psychological distress.Psychiatric conditions that may begin in childhood include anxiety and panic disorders,personality disorders,schizophrenia,suicide,and eating disorders.Three common problems during adolescence are suicide,depression,and eating disorders.n nThe relationship between male sex and substance abuse and conduct disorders may be responsible for this predominance.n nPrecipitating factors include acute stress,trouble with the law,trouble at school such as cheating or truancy,substance abuse,pregnancy or fear of pregnancy,hypochondriasis,social isolation,and anxiety.In occasional girls perfectionism and anxiety about academic performance(in the presence of average intelligence)or environmental change appear to be causal.Many suicide victims are intoxicated at the time of death.n nThe most common underlying psychiatric factor in suicidal adolescents is depression,manifested by feelings of hopelessness,low self-esteem,despair,and somatic complaints.In the younger adolescent,depressive equivalents of school problems and acting-out behavior may include legal problems.n nAdolescents with a family history of suicide,a history of psychiatric disorders,or a past history of suicidal behavior need to be screened for suicide risk.The depressed adolescent contemplating suicide usually welcomes the opportunity to communicate his or her feelings.n nConfidentiality is immaterial in the face of potential Confidentiality is immaterial in the face of potential suicide,and parents and/or guardians should be suicide,and parents and/or guardians should be informed immediately about the suicidal behavior.informed immediately about the suicidal behavior.Suicidal intent is as important as the lethality of the Suicidal intent is as important as the lethality of the method.Many adolescents have little knowledge of method.Many adolescents have little knowledge of lethality.Evaluation should focus on mental health lethality.Evaluation should fo