Adolescent Health Flashcards
What types of adult harm reduction programs have shown benefit?
Needle-exchange
Methadone clinics
Supervised injecting facilities
List reasons why harm reduction is an appropriate approach to adolescents
- developmentally congruent
- adolescents engage in higher risk behaviours than children
- adolescents tend to reject authority
- adolescents strive for autonomy
List examples of motivational interviewing techniques
- open-ended questions
- reflective listening
- affirmations
- summary statements
- eliciting change talk
List examples of harm reduction programs targeted at children and adolescents
- condom machines at school
- seat belt legislation
- programs promoting safe sporting equipment (helmets, life jackets, visors)
Define harm reduction
A strategy directed toward individuals or groups that aims to reduce the harms associated with certain behaviours
How do e-cigarettes work?
A battery is attached to a chamber containing a liquid. The energy from the battery heats the liquid and converts it into a vapour, which is drawn into a person’s mouth and lungs as would be done with a cigarette.
What can be contained in the e-liquid of an e-cigarette?
- propylene glycol
- glycerol
- flavouring agents
- nicotine
Describe the risks of e-cigarettes
- Not required by law to meet Canadian standards for labelling or nicotine content
- With large boluses of nicotine, risk of acute cardiac events and thrombosis
- Exposure to fine particulates
- Deleterious impacts of nicotine on developing brain
- Risk of dependency of nicotine
- Aerosolized propylene glycol and glycerol cause throat irritation and dry cough
- Exposure to aerosolized metals, rubbers, ceramics
- Accidental nicotine poisonings of young children
What does “dripping” refer to when used in context of e-cigarettes?
Dripping is when a user trickles drops of a nicotine-containing fluid directly onto the heating element. It’s associated with tank systems. It generates a more potent vapour.
How are e-cigarettes renormalizing smoking?
- advertising focuses on conveniences (ability to smoke indoors, no bad breath, flavours taste good, no nicotine stains on teeth or fingers) without focusing on adverse effects of nicotine and e-cigarettes.
- endorsement from celebrities
- viewed as “less harmful”, which may increased uptake by youth
What makes e-cigarettes risky for generating pediatric nicotine addiction?
- cheap
- easily accessed
- high-profile promotion by celebrities
- marketing on social media
- industry sponsorship of public events with product-related accessories given away
What are ways in which the CPS advocates for e-cigarettes to be regulated?
- maximum dosage of nicotine to be strictly enforced
- warnings on packages about harmful effects
- complete and accurate labelling for e-liquids and e-cigarettes including list of ingredients and nicotine concentration
- child-resistant packaging and cautionary warning regarding toxicity
- ban on marketing at sponsor events with youth audiences
- ban on marketing that attracts young children (i.e. social media, giveaways)
Where does the CPS advocate that e-cigarettes be accessible?
- only in areas where conventional tobacco products are available
- no vending machines
- must obtain license to sell to the public
- accessible only to individuals above the legal age to purchase conventional tobacco products
What is the difference between absolutely and relatively homeless youth?
- Absolutely homeless: live outdoors, in abandoned buildings, use emergency shelters or hostels
- Relatively homeless: live in unsafe, inadequate or insecure housing, including hotel/motel rooms rented by the month, stay temporarily with friends/relatives
List some of the aetiologies that cause youth to turn to life on the street
- poverty
- dysfunctional family life
- violence
- sexual and physical abuse
- underlying mental illness
- parental drug use
- curiosity
What barriers exist for street-involved youth trying to access health care?
- lack of money
- lack of transportation
- lack of knowledge of how to access the system
- issues trusting adults/authority figures
- worry about confidentiality and “getting caught”
- lack of health care
- lack of permanent address
- perception that parental consent/involvement required
- poorly coordinated services that are difficult to access
As a healthcare provider for street-involved youth, what approaches should be practiced with respect to caring for this vulnerable population?
- provide anticipatory guidance
- harm reduction techniques
- prescribe free/low cost medications
- choose simple treatment regiments
- offer easy & accessible follow-up
What physical health conditions are street-involved youth at higher risk for?
- Respiratory problems (TB, asthma, poor control)
- Dental disease (lack of oral care, poor hygienic, smoking, EtOH use)
- Dermatological problems (lice, scabies, acne, eczema, impetigo, MRSA)
- Foot problems (wet, cold, exposed extremities)
- Malnutrition (food insecurity)
- Injuries (intoxication, burns from crack pipes, violence)
- Inadequate vaccination
In addition to being a street-involved youth, what other factors increase a youth’s risk of chlamydia thrachomatis?
- Aboriginal status
- Self-percieved risk
- Having no permanent home
- Having lived in foster care
What mental health disorders are street-involved youth more at risk for?
- mood disorders
- bipolar disorders
- conduct disorder
- PTSD
- attempted suicide
- substance abuse
Describe differences between pediatric care and adult care.
- Pediatric care: family focused, relies on developmentally appropriate care with significant parental involvement, multidisciplinary team
- Adult care: patient focused, investigational, autonomous, interdisciplinary resources, independent consumer skills
Define transition of care.
Purposeful, planned movement of adolescents with chronic medical conditions from child-centered to adult-oriented health care
What are the benefits of good transition of care?
- Ability to advocate for themselves
- Maintain health promoting behaviours
- Use health care services into adulthood
List different community health clinics that might be beneficial to provide to a youth transitioning in care
Cinics that provide information on:
- sexual health
- drug and alcohol addictions
- genetic counseing
- vocational and educational planning
At what age should transition begin?
10-12yo
List some strategies to help in the process of transition
- Seeing teens alone without their parents for part of the appointment
- Providing educational materials regarding youth issues and their condition
- Providing access to peer-support meetings
- Holding family and youth education days to get information on transition to adult services
- Providing certificate of “graduation”
- Providing transition letter
- Gradually allowing more independence in decision-making and skills training
List factors that increase the risk of abuse in youth with disabilities or chronic health conditions.
- Societal factors (limited control over decisions related to their health, cultural perception they are inferior, cultural perception they are asexual or hypersexual)
- Educational factors (lack of sexual health education, lack of terminology to disclose abuse)
- Health care factors (limited privacy during physical exams, high degree of physical intrusion)
- Disability-specific factors (cognitive, sensory, mobility impairments, intellectual disability, difficulty communicating)
When should you suspect sexual abuse in youth with disabilities or chronic medical conditions?
- Presence of STIs
- Vaginal, anal trauma
- Unexplained UTIs
- Unexplained fear of physical/gyne exams
- Avoidance of specific caregivers
- Self-harming behaviours
- Sleep disturbances
- Encopresis
- Sexualized behaviour, sexual experimentation with age-inappropriate partners, sexually abusive behaviour towards others
- Running away
- Somatic complaints with no organic cause
List ways institutions can prevent abuse in youth with disabilities or chronic medical conditions
- thorough screening and monitoring of employees and volunteers
- chaperoning of physical exams and procedures
- supervised outings
- institutional culture that promotes patient privacy
- having procedures for reporting abuse
List the adolescent traits that mitigate culpability
- diminished decision-making capacity
- susceptibility to peer influence
- unformed character
- consideration of alternatives
- planning
- setting long-range goals
- organization of sequential behaviour
What are the differences of a juvenile detention facility
- higher staff-to-offender ratio
- more therapeutic staff attitude
- more programs available that lead to better outcomes and reduced recidivism
How long after unprotected sexual intercourse can emergency contraception be provided?
- Pill: most effective with 72hrs, can be used up to 120hrs
- Cooper IUD: up to 7d
What are the benefits of Plan B to the Yuzpe regimen?
- fewer side effects (less nausea)
- more effective
- Less dosing
List the mechanisms of action of both combination and progestin-only emergency contraceptive
- suppressing or delaying LH peak
- delaying or inhibiting ovulation
- disrupting follicular development
- interfering with maturation of corpus luteum
- ** NO EVIDENCE of effect on implantation postovulatory events, will not interrupt a pregnancy that has already implanted***
List two contraindications to emergency contraception
- known pregnancy
- known allergy to one of the components of product
List contraindications to daily use of combined oral contraceptives
- history of DVT or PE or stroke
- known thrombophilia
- migraines with aura
List situations in which emergency contraceptive pills should be considered
- totally unprotected intercourse
- ejaculation onto genitals
- coitus interruptus
- condome breakge, leakage, slippage
- IUD expulsion
- 1 or more missed OCP during week 1 of pill package, or more than 2 missed OCP during week 2 or 3 of pill package
- 1 or more progestin only pills missed or delayed by more than 3h
- sexual assault
List side effects of progestin and estrogen containing emergency contraceptives
- progestin only (PLAN B): headache, fatigue, nausea, dizziness
- estrogen: nausea, vomiting
Before using a copper-IUD as emergency contraception, what is a required step?
exclude current pregnancy (urine pregnancy test or serum bhcg)
List barriers to emergency contraceptive use
- perceived pregnancy risk
- motivation to prevent pregnancy
- knowledge about EC
- how and where to obtain it
- having resources (ie. financial) needed to obtain it
- geographic limitations
- physicians and pharmacists lack of preparedness to meet adolescent’s needs
True or false: the majority of teen pregnancies end in abortion
- True (just over 50% in Canada)
List the medical options for termination of early pregnancy
- Methotrexate
- Misoprostal
What are the risks associated with abortion?
- uterine perforation, hemorrhage, infection
Which adolescents are deemed at increased risk of having unprotected intercourse?
- experiencing social and family difficulties
- mother were adolescent mothers
- undergoing early puberty
- history of sexual abuse
- frequent school absenteeism, lack of vocational goals
- siblings who were pregnant during adolescence
- use of drugs/tobacco/substances
- live in group homes, detention centres, or street-involved
List risk factors for cutaneous malignant melanoma
- light skin colour
- freckles
- skin moles
- easy-to-burn skin that tans poorly
- first degree relative with CMM
- personal history of CMM
- large number of typical or atypical moles
- Red or blonde hair cooer
- Immunosuppression
What is tanorexia?
- becoming obsessed with, even addicted to tanning, and believing oneself to be unattractively pale even when quite tanned
What are complications of artificial tanning?
- erythema
- sunburn
- severe burns
- infections
- skin dryness
- pruritis
- nausea
- photo drug reaction
- disease exacerbation
- skin-aging
- effects on eyes
Define sexting
Sending and receiving sexually explicit messages or nude/seminude photographs or videos electronically
What are the risks of sexting?
- risk of dissemination of private material
- risk of being charged for child pornography
List common health problems of youth in custodial facilities
- skin lesions
- URTIs
- STIs
- Contraception needs
- pregnancy
- Mental health
- Substance abuse
- Resp/dental/endo/urological problems
List risk factors for teen dieting
- perception of being overweight
- female
- low self-esteem
- psych (anxiety, depression)
- vegetarianism
- early puberty
- absence of positive adult role models
- parental dieting
- parental endorsement or encouragement to diet
- parental criticism of child’s weight
- peer group endorsement of dieting
- involvement in weight-related sports
- weight-related teasing
- chronic illnesses (esp. diabetes)
- presence of other risk behaviours (drugs, smoking, unprotected sex)
List negative consequences of dieting
- nutritional deficiencies (esp low iron)
- growth deceleration
- menstrual irregularity
- osteopenia/osteoporosis
What are the most important risk factors for unhealthy weight control behaviours
- dissatisfaction with weight
- obesity
- low self-esteem
What is the most effective treatment for children and teenagers with anorexia nervosa?
- Family-based treatment
What are symptoms to inquire about in order to create rapport with a teenager with anorexia nervosa?
- hair thinning
- feeling cold
- feeling lightheaded/full
What is the goal weight gain during Family-Based Therapy?
- 0.2kg to 0.5kg per week
What are components of a check-up for a patient with anorexia nervosa?
- Weight check on same scale
- Urine sample
- Height
- Tanner staging
- ## Orthostatic HR and BP
Define pathological gambling
An impulse control disorder, characterized by persistent and recurrent maladaptive gambling behaviour that leads to significant deleterious legal, financial, physical and psychosocial consequences. Not better accounted for by diagnosis of manic disorder.
List risk factors for developing a gambling problem
- depression
- loss
- abuse
- impulsivity
- antisocial traits
- learning disability
When should gambling problems be suspected?
- parents express concern about their youth’s emotional health
- academic performance seems to be suffering
- sleep problems
- money or possessions in home go missing or there is criminal activity such as theft
- it is known or suspected that the adolescent is misusing substance or in circumstances when one would screen for substance abuse
- family relationships/friendships are impaired
- any of the comorbidities
What are questions that inquire about gambling?
- Frequency?
- Does the youth tend to gamble more than planned?
- Behaviour suggesting they are hiding their gambling behaviour from others, such as lying
List examples of declaring a homosexual identity
- homosexual fantasies or dreams
- realization that one is attracted to people of same gender
- feeling one is different from one’s peers
- start with a sexual experience
List psychological and social issues related to homosexual youth
- bullying & harassment
- stigmatization
- substance abuse (club drugs especially)
- mood disorders
- low-self-esteem
- suicide
List medical issues for which homosexual youth are at risk
- STIs
- HPV
