Australian Family Physician August 2007 - Adolescence
Vol 36, (8) 577–672
The theme for the August issue of AFP
is adolescence. This month's articles include sex, contraception and
health, the mental health of adolescents, adolescent overweight and
obesity, substance abuse and harm minimisation in adolescents,
adolescents with chronic disease, eating disorders in adolescents,
surveillance of second cancer, malaria and premenstrual disorders.
Pearls of adolescent communication wisdom
Jenni Parsons
I didn't really like being an adolescent. I remember being told repeatedly by significant adults in my life that, 'school years are the best years of your life'. I hoped that they were wrong; otherwise I was on a downhill slope from nowhere. Fortunately, I believed that adults were frequently wrong.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners.
Adolescent attendances in general practice
Clare Bayram, Helena Britt, Salma Fahridin
The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of general practice consultations with adolescent patients. This provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.
The mental health of adolescents - Assessment and management
Graham Francis Fleming
About 15% of the adolescent population suffers a mental health problem. Although a large percentage of these adolescents present to their general practitioner at least once a year, often their mental health problems are not presented or are somatised.
Sex, contraception and health
Melissa Kang, Rachel Skinner, Terri Foran
Young Australian people aged 12-25 years are sexually active at a younger age and have more sexual partners compared to previous generations. Pregnancy and sexually transmitted infection (STI) rates are high in this age group. Sexual violence, discrimination against same sex attracted youth, and associated health risk behaviours such as alcohol and drug use are also important sexual health issues for adolescents.
Substance abuse and harm minimisation in adolescents
Basiliki Lampropoulos
Adolescent substance use is prevalent among Australian school students. Although a degree of risk taking is a normal developmental task it can lead to serious consequences. For some it is a short lived risk taking experience. For others it is a flag for other life difficulties and a possible trajectory to addiction.
Adolescent overweight and obesity - How best to manage in the general practice setting
Kate Steinbeck
This article outlines a management plan for the overweight adolescent in general practice, using a chronic care approach and follows the National Health and Medical Research Council Clinical practice guidelines for the management of overweight and obesity in children and adolescents.
Eating disorders in adolescents
Aranzazu Gonzalez, Michael R Kohn, Simon D Clarke
The overall prevalence of eating disorders among children and adolescents is rising - the younger age group are more likely to present with anorexia nervosa (AN), while the older adolescent can present with either AN or bulimia nervosa (BN). However, eating disorders exist as part of a spectrum and general practitioners will encounter many adolescents that have an eating disorder that do not yet fulfil diagnostic criteria for either AN or BN.
Adolescents with chronic disease – The double whammy
Susan Sawyer, Sarah Drew, Rony Duncan
Approximately one in 10 adolescents have limitations of activity from chronic disease or disability. Self management of chronic disease is increasingly recommended in adults, but there has been remarkably little discussion of its application in adolescents. Evidence suggests better outcomes for patients who are able to self manage their disease.
Premenstrual disorders in adolescent females – Integrative management
Gillian Singleton
Premenstrual symptoms affect many adolescent females with studies suggesting an incidence range of 31–61% in this age group. The presentation of premenstrual syndrome (PMS) can be varied and can include psychological and/or somatic symptoms.
Strontium ranelate – Does it affect the management of postmenopausal osteoporosis?
Tania Winzenberg, Sandi Powell, Graeme Jones
This series of articles facilitated by the Cochrane Musculoskeletal Group (CMSG) aims to place the findings of recent Cochrane musculoskeletal reviews in a context immediately relevant to general practitioners. This article considers whether the availability of strontium ranelate affects the management of postmenopausal osteoporosis.
All creatures great and small
Phillip Gray
This article describes the clinical legacy of a holiday for a man and his grandson. It highlights the difficulties with diagnosis of a febrile illness and reminds general practitioners of a common multisystem and potentially serious infection.
Malaria in the Australian refugee population
Jill Benson, Joshua Davis
Malaria is a serious health problem in many of the countries from which refugees come to Australia. Anopheles mosquitoes capable of transmitting malaria are present in the far north of Australia and in these areas, the detection and appropriate treatment of malaria is vital, not only for the health of the individuals and their families, but as a significant public health issue.
Surveillance of second cancer after previous childhood cancer treatment
Sally K Ng, Sean Mackay, John F Seymour
With the introduction of new therapeutic strategies, the survival of children and adolescents with cancer has increased dramatically. However, cancer survivors often experience late effects from their cancer treatment.
First do no harm...
Yap Yew Chong, Evelyn Mensah
It is common when practising ophthalmology that we forget to treat the patient as a whole person. We are taught in medical school to take a complete history and to perform a thorough examination before ordering specific investigations. However sometimes, despite our clinical experience, we are tempted to take inappropriate shortcuts.
Clinical challenge
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue. Answers to this clinical challenge will be published next month, and are available immediately following successful completion online.
AFP in Practice
AFP in Practice questions are designed to get you started in a small group learning (SGL) activity in your practice or with colleagues. Requirements to earn 30 Category 1 CPD points for a SGL activity are: minimum of four and a maximum of 10 people, minimum of 8 hours of discussion in a year, and at least two GPs. Groups may include anyone else who has an interest (ie. practice nurses, community health workers, allied health professionals). A kit with all the instructions and forms you need is available online. You can also earn Category 2 points based on these questions at AFP practice challenge.
Adolescents and confidentiality
Sara Bird
Recently the right of adolescents to confidential health care has come under threat. In 2004, the Minister for Health proposed the introduction of legislation to give parents access to all information held by Medicare Australia (formerly the Health Insurance Commission) concerning their child/ren under 16 years of age.
Convening a conference - Facilitating networking among delegates
Ellen McIntyre, Sheri Millar, Fiona Thomas
This article provides conference convenors and delegates with suggestions to enhance networking by delegates attending conferences. Our suggestions are based on a literature search (which revealed very little); what we have found to work well at the research conferences we have convened; conference evaluations; and our experiences at conferences we have attended.
Book reviews
Campbell Hunt, Jordana Rockman
Books reviewed this month are The Vulva and Vagina Manual by Graeme Dennerstein, James Scurry, John Brenan,
David Allen and Maria-Grazia Marin, and Contraception: an Australian clinical practice handbook by Sexual Health & Family Planning Australia.
A person-practice-program fit - Evaluation of a GP training placement process
Caroline Laurence, Linda E Black
The placement of general practice registrars in vocational training practices can be a difficult process if both educational and organisational needs are to be met.
Shared decision making between registrars and patients - Web based decision aids
Jill Thistlethwaite, Clare Heal, Rod Nan Tie, Rebecca Evans
Current evidence suggests that doctors do not always involve patients in decisions; this may be due to lack of training. This study explores the feasibility of using web based decision aids (DAs) to improve the skills of general practice registrars in sharing decisions with patients.
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