Volume 27, Issue 4

Objective: The aim of this paper is to present a case with premenstrual dysphoric disorder and to review the diagnosis from an adolescent medicine approach, discussing why diagnosis and treatment must be distinct for this age group and different from the adult approach. Introduction: Premenstrual disorder is a periodic, recurrent, debilitating condition with either physical and/or psychological symptoms that occur during the late luteal phase of the menstrual cycle. Case: We report the case of a 16-year-old female diagnosed with premenstrual disorder. Discussion: Physical signs, behavioral changes, and mood disturbances that occur before menstruation have long been recognized in women, but how well is the disorder defined for adolescents? Due to the unique characteristics of teens, do the current diagnostic criteria appropriately represent this population?

Recent data revealed that adolescent obesity appeared to be a rising problem in Cyprus. However, there is a scarcity of published data regarding fitness-related parameters, which could contribute for the presence of obesity in Cyprus’ adolescence population. The aim of the current study was to investigate the association between adolescent obesity, body composition, and fitness levels. A total of 270 high school students volunteered to participate in this cross-sectional study. Body mass and height were assessed in order to calculate body mass index, while body fat percentage was calculated by using bioelectrical impedance analysis. Physical fitness parameters were assessed through a battery of field tests. Body fat was inversely associated with cardiorespiratory fitness levels, sprint and jumping performance, as well as with the frequency of physical education class sessions per week (p<0.05). The adolescents with high body fat were found to exhibit significant reductions in all the fitness related parameters (p<0.05), except with the arm strength (p>0.05). This study is the first to uncover an inverse association between high body fat and fitness-related parameters among a sample of adolescents in Cyprus. These data can be used in order to develop effective interventions aiming to counterbalance obesity and improve the overall health and the quality of life of adolescents.

Objective: The current study describes a feasibility study of an experiential cooking program for alternative education students. The aims were to identify potential areas for measuring impact (beyond nutrition) and to identify issues threatening the feasibility and evaluation of the program. Materials and methods: Weekly cooking sessions were conducted in one alternative education center over a school term. Data were collected through weekly observations, a youth focus group, and staff interview. Results: Observational data confirmed high levels of participation by students, willingness to try new foods, and enjoyment of foods prepared. Comments from the teacher and students emphasized the wider impact of the cooking sessions on positive youth development and cultural engagement, including opportunities for socio-emotional learning, team work, socializing with peers, and cultural blessings of food. Conclusion: Future studies should consider measures of positive youth development along with cooking skills and eating behaviors as potential outcomes.

Objective: This study aims to investigate whether anxiety disorders in adolescents have a link with the separation time of bed/bedroom sharing with parents. It also aims to raise awareness in society about the issue of minimizing anxiety disorders in childhood. Methods: A case-control study was conducted in Şevket Yılmaz Training and Research Hospital between June 2013 and May 2014. The participants included 51 adolescents who were diagnosed as generalized anxiety disorder (GAD) with no-comorbidity and 71 healthy adolescents as the control group, who were chosen randomly. Diagnosis of GAD was based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed) by child and adolescent psychiatry doctors. The Turkish version of the State-Trait Anxiety Inventory (STAI) was used for the control group. A special survey about demographics and bed-sharing statements was constructed for the purpose of the study. The groups were analyzed in terms of duration of co-sleeping (bed-sharing) and rooming-in (keeping the mother and the baby in same room) with parents during infancy and the development of anxiety disorders in later period. Results: Mean duration of rooming-in was significantly longer in the case group than in the control group (p=0.009). Similarly, mean duration of co-sleeping in the case group was longer than that of the control group. However, this difference was not statistically significant (p=0.529). Conclusion: Sleeping in the same room with children for a long time may result in anxiety disorders in later period due to possible difficulties in bonding and/or less self-confidence.

Background: School bullying is a global problem involving a high proportion of students worldwide. However, its prevalence and types in secondary schools in Port Harcourt is not yet known. Objective: This study aimed to determine the prevalence and types of bullying in secondary schools in Port Harcourt. Subjects: A total of 1160 students from six secondary schools in Port Harcourt comprised the sample. Materials and methods: This was a cross-sectional school-based study conducted in Port Harcourt in March 2014. Two mixed schools, two all-boys schools, and two all-girls schools were selected using purposive sampling technique. Stratified random sampling technique, by class strata (senior secondary 1, 2 and 3) was used to select 1160 students from the six schools. A 22-item self-administered questionnaire adapted from a previous study was modified and used in this study. The questions covered the prevalence, type of bullying, and socio-demographic data. Data were analyzed using SPSS version 20 (IBM SPSS Incorporated, Chicago, IL, USA). Results: About 82.2% reported being victims of bullying, whereas 64.9% reported being bullies. About 9.7% and 11.8% were neither bullies nor bullied, respectively. Bullying was significantly higher in the all-boys (90.8%) and all-girls (82.9%) schools than in the mixed schools (73.5%), p=0.000. More males were victims (53.4%) and bullies (53.3%) but more females (55.4%) were bully-victims. The most common (57.5%) type of bullying was physical bullying. Conclusion: The rate of bullying was found to be very high in secondary schools in Port Harcourt.

Background: Tobacco smoking amongst the young is a matter of public health concern because of the immediate and long-term health consequences associated with tobacco use, such as asthma, cancers, and cardiovascular diseases. The purpose of this study was to identify the determinants of smoking initiation among a sample of high school students in Bosnia and Herzegovina. Methods: The study was conducted among 198 high school students in Zvornik, Bosnia and Herzegovina, during April 2013. A self-administered, pre-tested, structured, close-ended questionnaire was used for data collection. Results: Fourth grade students mainly initiated smoking in high school (45%), while the majority of third and second grade students initiated smoking in primary school. Among students who smoke, an average duration of the smoking habit was <2 years. A multivariate analysis showed that males were 5.27 times more likely to have initiated smoking. For every unit increase in pro-smoking attitude towards smoking, students were 5.3 times more likely to have initiated smoking. Those with parents and friends who are smokers were 6.106 and 5.175 times, respectively, more likely to have initiated smoking. Conclusion: This study indicates that a high proportion of 15–18 year olds in the town of Zvornik are current smokers. Gender, age, and parent and peer influence were identified as important associations with smoking. Interventions should not only be confined to the secondary school environment but they should also extend to their places of residence so that influences in the home environment and social surroundings that contribute to tobacco use are also tackled.

Aims: The aim of this study was to determine the effects of life-time tobacco, alcohol, and substance use on psychological and behavioral variables among 10th grade students in Istanbul/Turkey. Materials and methods: This study employed a cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul. The questionnaire featured a section about use of substances, including tobacco, alcohol, and drugs. The depression, anxiety, anger, assertiveness, sensation seeking and impulsiveness subscales of the Psychological Screening Test for Adolescents (PSTA) were used. The analyses were conducted based on 4957 subjects. Results: Logistic regression analyses were conducted with each school with the related and behavioral variables as the dependent variables. Gender, tobacco, alcohol, and drug use being the independent variables. All four independent variables predicted the dependent variables. Lifetime tobacco and drug use had significant effects on all the subscale score, whereas lifetime alcohol use had significant effects on all the subscale scores other than lack of assertiveness, and male gender was a significant covariant for all the subscale scores. Drug use showed the highest effect on dependent variables. Interaction was found between effects of tobacco and alcohol on anxiety, whereas interactions were found between effects of tobacco and drugs on lack of assertiveness and impulsiveness. Conclusion: The findings suggested that male students with lifetime tobacco, alcohol or drug use have particularly high risk of psychological and behavioral problems. The unique effects of substance clusters on these problems may be useful in developing secondary preventive practices for substance use and abuse problems in Istanbul.

Purpose : Our goal was to examine the association between peer victimization (PV) and suicidal ideation (SI), and the degree to which internal resilience moderates this association. Materials and methods : We examined the independent associations between PV frequency and type (verbal, cyber, physical, and relational), internal resilience, and the risk of SI within the last 12 months among 9th and 11th grade students participating in the California Healthy Kids Survey (CHKS) (n=42,594; 55.2% female; 72.2% non-white). Results : Odds ratios (OR) of SI associated with very low- (at least 1 PV type 1 time, but none more than 1 time), low- (at least 1 PV type 2–3 times, but none more than 2–3 times), and moderate/high- (at least 1 PV type 4 times or more) frequency PV compared with no PV were 1.30 (95% CI=1.15–1.45), 1.70 (95% CI=1.51–1.90) and 2.47 (95% CI=1.23–2.73), respectively. Any exposure to physical (OR=1.31; 95% CI=1.19–1.44), relational (OR=1.26; 95% CI=1.15–1.38), verbal (OR=1.38; 95% CI=1.27–1.50), or cyber (OR=1.26; 95% CI=1.15–1.39) PV was associated with increased odds of SI compared with no PV. Internal resilience was associated with lower odds of SI (OR=0.98, 95% CI=0.98–0.99), regardless of PV exposure. The slope between internal resilience and SI was significantly steeper for those subjects who experienced verbal PV (OR interaction=0.99; 95% CI=0.98–1.00). Conclusion: Even infrequent PV was found to be associated with increased risk for SI. Internal resilience was associated with reduced SI, particularly for verbal forms of PV. Our results suggested that efforts to decrease SI among adolescents should be directed toward both preventing PV and strengthening internal resilience.

Violence is a leading problem that has a negative impact on daily living. Today, it continues to be an important topic owing to its widespread occurrence, especially among the youth. The main objective of this study is to specify the predictors that influence violence and depression observed among youth aged 15–18 years. While some of these factors are individual (age, gender, flirting, sports. etc.), the subjects’ background, such as the family’s education level, sibling number, etc., were investigated as social and environmental factors. In the survey, data were obtained from 109 high school students receiving education in a private teaching institution using a structured questionnaire technique. With regards the reliability of the survey, equal numbers of boys and girls were chosen from each year in high school lasting for 4 years. After asking questions that aim to obtain students’ sociodemographic features, their depression level was surveyed using the Beck Depression Scale; meanwhile, the Violence Tendency Scale was used to survey their tendency to be violent. Findings revealed that some individual and domestic features of adolescents have significant impacts on their tendencies towards violence and depression.

Aim: Although adolescence is marked by profound and dynamic changes, it is virtually neglected by health care providers, by society, and even by most parents, teachers, and health professionals. The aim of this study was to investigate barriers to health education in adolescents from health care providers’ views compared to teens. Materials and methods: The study population consisted of 72 health care providers and 402 high school female students in Northern Iran in 2012. They completed a self-administered questionnaire about their views on barriers to adolescents’ health education. Results: It is revealed that the major barrier to adolescents’ health education from a health care providers’ perspective is “Lack of private room for adolescents’ health education”, while “Lack of adolescents’ interest to content of educational programs” is a significantly greater barrier to health education among adolescents. Conclusion: The results suggest that for adolescent health education, specific strategies should be used in adolescent health promotion programs.

Purpose: This study aimed to determine the changes in diagnosis that occur in making the transition from Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition (DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria in an adolescent medicine eating disorder program. Methods: During the months of September 2011 through December 2012, a data sheet was completed at the end of each new outpatient eating disorder evaluation listing the patient’s gender, age, ethnicity, weight, height, DSM-IV diagnosis, and proposed DSM-5 diagnosis. Distributions were calculated using the Mann-Whitney and Wilcoxon rank sum analyses to determine differences between diagnostic groups. Results: There were 309 patients evaluated during the 16-month period. DSM-IV diagnoses were as follows: anorexia nervosa, 81 patients (26.2%); bulimia nervosa, 29 patients (9.4%); binge eating disorder, 1 patient (0.3%); and eating disorder not otherwise specified (EDNOS), 198 patients (64.6%). By contrast, DSM-5 diagnoses were as follows: anorexia nervosa, 100 patients; atypical anorexia nervosa, 93 patients; avoidant/restrictive food intake disorder, 60 patients; bulimia nervosa, 29 patients; purging disorder, 18 patients; unspecified feeding or eating disorder, 4 patients; subthreshold bulimia nervosa, 2 patients; subthreshold binge eating disorder, 2 patients; and binge eating disorder, 1 patient. Conclusion: Almost two thirds (64.6%) of the 309 patients had a diagnosis of EDNOS based on the DSM-IV criteria. By contrast, only four patients had a diagnosis of unspecified feeding or eating disorder based on the DSM-5 criteria. These data demonstrate that the goal of providing more specific diagnoses for patients with eating disorders has been accomplished very successfully by the new DSM-5 criteria.

Purpose: The traditional view has been that there is a great deal of rigidity and enmeshment in the families of adolescents with eating disorders, with poor communication and satisfaction among family members. We used the Family Adaptability and Cohesion Evaluation Scales IV (FACES-IV) to study whether this traditional view remains true or whether family styles among those with eating disorders have changed over time to include a wider range of families. Methods: Forty-four patients (aged 14–18 years; mean, 15.4 years; 38 females and 6 males) being treated for an eating disorder in a Division of Adolescent Medicine completed the FACES-IV questionnaire, along with the Beck Depression Inventory (BDI). Patients were diagnosed with anorexia nervosa (38.6%), eating disorders not otherwise specified (59.5%), and bulimia nervosa (2.3%) according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition . They had a mean BMI of 19.6 at the time of questionnaire completion, which was an average of 175 days from first visit. Parents (38 mothers and 6 fathers) completed the FACES-IV and the BDI at the same visit without conferring with their children. Results: A great majority of patients and parents reported their families as being connected/very connected (93% of patients and 98% of parents) and flexible/very flexible (80% and 93%), with low/very low enmeshment (89% and 89%), moderate/low/very low rigidity (77% and 95%), low/very low chaos (84% and 86%), and moderate/high/very high communication (85% and 50%). Despite these scores, all well within the normal range for families with teenagers, 70% of patients and 64% of parents reported low/very low satisfaction with their families, well below the normal range. Depression scores were moderate/severe for 44% of patients and 14% of parents. Analysis of variance and t-tests showed no differences between FACES-IV scores and age, gender, ethnicity, diagnosis, and time from first visit for patients, whereas patients and parents who were more depressed were each more likely (p<0.05) to report greater dissatisfaction with their families. Conclusion: A great majority of patients with eating disorders and their parents reported their family styles to be in the healthy range. However, many patients and parents, especially those with depression, expressed dissatisfaction with their families. These data demonstrate that older concepts of the families of adolescents with eating disorders need to be reconsidered.

Background and aim: The role of dietary patterns in determining age at menarche is insufficiently understood in low-income countries. The relationship between dietary patterns, particularly the consumption of oil, and age at menarche in a slum-dwelling adolescent population in India is examined. Methods: Data were derived from a cross-sectional baseline survey and anthropometric measurements among 10- to 19-year-old adolescents (n=545, female respondents 272, of whom 160 were post-menarcheal) and a household survey in two slums in the city of Nashik, Western India. By using mixed effects linear regression models, the association between age at menarche and household-wise use of sources of animal protein and oil and fat is examined. Results: Age at menarche (mean 13.7 years) in the slums studied was relatively high according to Indian standards. Age at menarche and the consumption of dairy products, meat, fish and eggs were not associated. The household per capita consumption of vegetable oil had an inverse association with a girl’s age at menarche, and there was an indication of a positive association between use of ghee (clarified butter) and age at menarche. These associations did not disappear when controlling for anthropometric status and socio-economic characteristics. Conclusion: Intake of fats and foods that are important sources of protein among underprivileged households in India is low and reflected in the relatively late age at menarche. The potential differences in the association between various types of fatty acids, energy intake and age at menarche in conditions of undernutrition requires further prospective study.

The presence of a foreign object in the bladder or urethra may cause a serious problem to the patient. Most of the cases are self-inserted as a result of sexual gratification. Here, we present a rare case of self introduction of the wire of a mobile charger within the bladder and urethra for sexual gratification. This case has yet to be reported in any previous work.

The diagnosis of systemic histoplasmosis may be delayed due to underlying pulmonary conditions in patients from an endemic area. An adolescent White male from the Midwestern United States with a history of moderate persistent asthma presented to the pulmonary clinic with a 10-day’s history of cough. The patient had no response to modifications of his asthma treatment regimen and proceeded to experience worsening symptoms, including pleuritic chest pain and dysphagia. Chest imaging revealed multiple pulmonary nodules, right mainstem bronchus narrowing, bilateral hilar adenopathy, and esophageal thickening. Ophthalmologic examination revealed an ocular “histo spot”, but the patient denied any ocular symptoms. Despite negative initial histoplasmosis antibody testing, the patient began oral itraconazole therapy for presumed histoplasmosis infection. Follow-up histoplasmosis antibody titers were positive, and the patient responded well to itraconazole. Disseminated histoplasmosis can have a wide range of presenting symptoms, which may delay its diagnosis among patients with pre-existing asthma.

The presence of a foreign body in the urethra is uncommon. A wide variety of foreign bodies have been described in urethras, but they are often missed in physical examinations as the patient tries to hide the fact. We report two unusual cases of foreign bodies in the urethra in two adolescent boys suffering from psychiatric disorders. In the first case, a 12-year-old boy presented with introduction of sewing needle into the urethra 3 days back. The patient in that case suffered from a delusional disorder. In the second case, a 19 year old man introduced a metallic screw into his urethra for sexual gratification several times in the preceding 4 years. That patient suffered from schizophrenia. Although psychiatric illness is associated with urethral foreign body, such underlying psychiatric disorders are very rare.

Juvenile offenders are a subgroup of adolescents at particular risk for HIV/STI infection. Although HIV prevalence among these youth is low (<1%) in the US, rates of other STIs, unprotected sexual activity, multiple partners, and incidents of substance use during sex are high compared with other adolescent populations. Many of these youth will enter the adult criminal justice system, which is known to have an extremely high rate of HIV infection. US constitutional mandates provide HIV/STI testing for incarcerated juveniles, but close to 80% of juvenile arrestees are never detained. Moreover, although they engage in similar HIV risk behaviors as those detained, they have limited access to available HIV/STI testing services. Thus, our study examined rates of lifetime HIV testing among a pilot sample of 60 court-involved, substance-using juveniles monitored in the community to explore rates of testing and the reasons related to lifetime testing among a high-risk, yet understudied US juvenile population.