Referral Of Adolescents Research Articles

What comes next? A cross-sectional study on post-discharge referrals of adolescents treated in emergency services following a suicide attempt.

To assess the proportions and associated factors of different post-discharge referrals among adolescents treated in the emergency department after a suicide attempt. Observational, cross-sectional retrospective study. We conducted a study using the medical records of 140 adolescents treated for a suicide attempt between January 2015 and May 2023 in a Brazilian emergency department, focusing on post-discharge referrals, defined as discharge without referral, unaddressed referral and referral addressed to the network. Associations between the outcomes and other variables were analysed using a Poisson regression model. Discharges without referrals prevailed, followed by addressed and unaddressed referrals. Regression models showed associations between post-discharge and age, prior continuous use of psychotropic medications, location of care, continued suicidal ideation at discharge and evaluation by a multi-professional team. A high number of adolescents were discharged from emergency departments without co-ordination with the mental health network, and the involvement of the multi-professional team was positively associated with addressed referrals. This study informs healthcare professionals by raising awareness of their practices in discharging adolescents after suicide attempts in emergency departments, with the possibility of improving care quality and reducing the likelihood of readmission. STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). No patient or public contribution.

Adolescent health and well-being check-up programme in three African cities (Y-Check): protocol for a multimethod, prospective, hybrid implementation-effectiveness study

BackgroundDuring adolescence, behaviours are initiated that will have substantial impacts on the individual’s short-term and long-term health and well-being. However, adolescents rarely have regular contact with health services, and available...

Outcomes of paediatric and adolescent referrals into a specialist breast unit

Outcomes of paediatric and adolescent referrals into a specialist breast unit

Experience in implementing adolescent friendly health services in rural districts of Bangladesh.

The government of Bangladesh has initiated Adolescent Friendly Health Services (AFHS) at health facilities to improve access of adolescents to quality health care. This study aimed to document the AFHS program experiences and interventions implemented in four districts of Bangladesh. The study adopted review of literature, relevant project documents, research reports and analysis of secondary data on AFHS. The secondary data was extracted from the government District Health Information System (DHIS-2) and the HMIS (Health Management Information System) of Family planning department of the four study districts in Bangladesh from 2017 to 2019. Introduction of the AFHS program in Government health facilities had a positive impact on raising awareness among the community. It increased the proportion of adolescents receiving health services (from 6% in the pre-intervention period to 86% in the post-intervention period). The involvement of school authorities in disseminating AFHS program activities resulted in a 68.51% rise in adolescent referrals from schools. Publicity of the program and privacy of the service recipients are considered as enabling factors for the acceptance of AFHS. However, training of the service providers on comprehensive adolescent healthcare packages and expanding logistics support to the health facilities are needed for improvement of the overall service. The government of Bangladesh is committed to implementing adolescent friendly services, evident by adoption of national level strategy and guidelines through government health system, using existing resources with an additional financial support from development partners. The IEC (Information, Education and Communication) materials on AFHS, developed by different organizations were used for awareness program on AFHS. The healthcare providers were oriented/trained on AFHS, mental health, nutrition and counseling skills. Multi-sectoral collaboration at all levels: national to local level (schools, communities, adolescents club) were adopted for sustainability of this initiative.

Does spinal deformity affect adolescents' quality of life before we tell them it should?

The Scoliosis Research Society 22r Questionnaire(SRS-22r) is the standard for assessing health-related quality of life(HRQoL) in patients with adolescent idiopathic scoliosis. Here we investigate whether patients' perceptions of their HRQoL are influenced by knowledge of scoliosis and counseling by an orthopedic surgeon. Patients ages 10-18years referred for their first visit with an orthopaedic surgeon for scoliosis were enrolled from 9/30/19 to 10/22/20. Patients completed the SRS-22r pre- and post-visit. A Wilcoxon signed-rank test was used to analyze the SRS-22r scores. 52 patients participated in the study at a mean age of 14.3years (95% CI 13.8-14.8years) with an average major curve magnitude of 23.2 degrees (95% CI 19.4-27.0 degrees). SRS-22r scores were not correlated to curve magnitude pre- or post-visit. The SRS-22r Satisfaction with care domain exhibited a small increase from pre- to post-visit (pre: 3.3, post: 3.6). All other SRS-22r domains and total scores did not exhibit clinically significant differences. Among new adolescent referrals for scoliosis, it is unlikely that counseling by a surgeon influences perceptions of HRQoL as measured by the SRS-22r. III.

The impact of the COVID-19 pandemic on psychiatric emergency consultations in adolescents

BackgroundThere is growing evidence that the COVID-19 pandemic, and its associated social distancing measures, affect adolescents’ mental health. We wanted to examine whether and how the number and characteristics of adolescents’ psychiatric emergency presentations have changed throughout the pandemic.MethodsWe extracted data from the records of 977 psychiatric emergency consultations of adolescents aged 12- 19 who had been referred to the mobile psychiatric emergency services in Rotterdam, the Netherlands between January 1st 2018 and January1st 2022. Demographic, contextual, and clinical characteristics were recorded. Time-series-analyses were performed using quasi-Poisson Generalized Linear Model to examine the effect of the first and second COVID-19 lockdown on the number of psychiatric emergency consultations, and to explore differences between boys and girls and internalizing versus externalizing problems.ResultsThe number of psychiatric emergency consultations regarding adolescents increased over time: from about 13 per month in 2018 to about 29 per month in 2021. During the COVID-19 pandemic, the increase was tempered. In the second wave a pronounced increase of psychiatric emergencies among adolescents with internalizing problems but not with externalizing problems was found.ConclusionDespite the reported increase of mental health problems in adolescents during the COVID-19 pandemic, we did find a smaller increase in psychiatric emergency consultations in this group then would be expected considering the overall trend. Besides changes in help-seeking and access to care, a possible explanation may be that a calmer, more orderly existence, or more parental supervision led to less psychiatric emergency situations in this age group. In the second wave the number of emergency consultations increased especially among girls with internalizing problems. While there has been a particular fall in emergency referrals of adolescents with externalizing problems since the start of the pandemic it is still too early to know whether this is a structural phenomenon. It would be important to elucidate whether the changes in emergency referrals reflect a true change in prevalence of urgent internalizing and externalizing problems in adolescents during the pandemic or a problem related to access to care.

Trends in Adolescent Bariatric Procedures: a 15-Year Analysis of the National Inpatient Survey.

Adolescents with severe obesity achieve superior health outcomes following metabolic and bariatric surgery (MBS) than medical treatment alone. Surgery results in significant and sustained decrease in BMI and reduces associated comorbidity. We characterized the changing demographics of adolescents who had MBS over a 15-year time period. Using ICD-9 and ICD-10 codes, the 2005-2019 National Inpatient Sample database was queried for patients < 20years who underwent MBS. National trends, socio-demographics, and hospital resource utilization were analyzed. Between 2005 and 2019, there were 16,381 pediatric hospitalizations for MBS. The annual MBS procedures increased from 839 cases in 2005 to 1785 in 2019. There was a significant shift away from laparoscopic gastric bypass (LGB) to sleeve gastrectomy (SG). Initially, LGB represented 67% of cases with no SG. In 2019, SG constituted 85% of MBS procedures, while LGB comprised only 14%. Patients were predominantly female (76%) and White (56%). Over time, there were considerable increases in patients with public insurance (12 to 46%) and Hispanics (11 to 30%). There was also a shift away from urban, non-teaching hospitals to urban, teaching hospitals. The average length of stay (LOS) decreased, while mean charges remained similar. Our study demonstrates a gradual increase in the utilization of MBS among adolescents and a significant shift to SG. We observed a shift in MBS cases to teaching institutions, along with an increase in Hispanics and patients with public insurance. However, MBS remains underutilized, and effort should be made to increase early referral of adolescents for MBS evaluation.

The Associations between Child Irritability, Parental Distress, Parental Irritability and Family Functioning in Children Accessing Mental Health Services

Irritability, characterised by anger, frustration, and emotional dysregulation, is a common transdiagnostic symptom associated with child and adolescent referrals to mental health services and is associated with significant negative outcomes. Despite this, little is known about the link between irritability and the broader family environment. The present study described parental and family dysfunction in families of 51 children and adolescents (aged 6 to 15 years) with severe irritability referred to Victorian public mental health services. Further, we aimed to explore the associations between children’s irritability, parent functioning (parental distress and parental irritability), and family dysfunction. Child irritability was measured on the Affective Reactivity Index (ARI) and was obtained from participating children and their primary parent/caregiver (90% mothers). Participants psychiatric diagnoses were obtained using the Development and Well-Being Assessment through an interview with parents who also provided ratings of their own distress (Kessler 6), irritability (ARI), and family dysfunction (McMaster Family Assessment Device). We found high rates of family dysfunction (80%) and 39% of parents reported moderate to high psychological distress. Higher self-reported irritability was moderately associated with lower family dysfunction. All other relationships examined were non-significant. Findings suggest a complex relationship between severe childhood irritability and parental and family functioning with implications for treatment discussed.

Increase in Referrals of Children and Adolescents to the Psychiatric Emergency Room Is Evident Only in the Second Year of the COVID-19 Pandemic-Evaluating 9156 Visits from 2010 through 2021 in a Single Psychiatric Emergency Room.

Introduction: The COVID-19 pandemic affected the wellbeing of children and adolescents. The psychiatric emergency room (ER) is the hub of psychiatric emergencies and reflects clinically significant mental problems. Previous studies compared 2019 and 2020 and observed a decline in ER referrals. The current study focused on the continuous trend of referrals from 2010 to the end of 2021. Method: In our observational retrospective study, we procured data from 9156 child and adolescent referrals to our psychiatric ER. The comparison was made based on similar months of each year. Results: There was a significant positive trend in monthly referrals between 2010 and 2021, representing a similar increase in referrals per month in comparison to that month in the preceding year (unstandardized β = 4.21, 95% CI = 3.44 to 4.98, p < 0.0001). Between March 2020 and February 2021 (monthly visits = 72.5 + 16.6 [median = 79.5], annual referrals = 870), we observed no additive effect beyond this general trend after controlling for population growth. Conversely, between March and December 2021 (monthly referrals = 106.1 + 31.8 [median = 105.5], overall referrals = 1061) we observed a significant additive effect beyond the projected incline, as predicted by previous years (β = 21.61, 95% CI = 12.12 to 31.06, p < 0.0001). Conclusions: The first year of the COVID-19 pandemic was no different from the continuous decade long rise of referrals to the children and adolescents’ psychiatric ER. Conversely, the second year showed an additional incline beyond the general trend. The complexity in this rising need demands the awareness of clinicians and policy makers alike.

P93. Does spinal deformity affect adolescents’ quality of life before we tell them it should?

<h3>BACKGROUND CONTEXT</h3> The Scoliosis Research Society 30 Questionnaire (SRS 30) scores have been shown to correlate with major curve magnitude in preoperative patients with adolescent idiopathic scoliosis (AIS). This correlation has not been consistently demonstrable in AIS patients prior to treatment or those undergoing nonoperative treatment. We hypothesize that SRS 30 scores are dependent on knowledge of scoliosis and thus scores from new patients referred for scoliosis evaluation may not correlate with curve magnitude until after counseling by a surgeon. <h3>PURPOSE</h3> Among new adolescent referrals for scoliosis, we sought to determine if SRS 30 scores would be different before and after an initial visit with a surgeon, we further sought to evaluate if this effect may be different based on presenting curve magnitude. <h3>STUDY DESIGN/SETTING</h3> Prospective cohort analysis. <h3>PATIENT SAMPLE</h3> Patients ages 10 to 18 years old referred for their first visit with an orthopaedic surgeon for a scoliosis evaluation were prospectively enrolled from 9/30/19 to 10/22/20. Patients were excluded if they had a prior history of AIS diagnosis and/or treatment. <h3>OUTCOME MEASURES</h3> SRS 30 domain and total scores and major curve magnitude. <h3>METHODS</h3> Patients who consented were asked to complete the SRS 30 pre and post visit. Demographic and clinical data were obtained from patient charts. A Wilcoxon signed rank test was used to analyze the pre and post visit SRS 30 scores. <h3>RESULTS</h3> Fifty-three patients participated in the study at a mean age of 14.3 years (95% CI 13.8-14.8 years), the majority of whom were White (40%) or Asian (23%), and female (71%), with an average Cobb angle of 23.2 degrees (95% CI 19.5-26.9 degrees). SRS 30 scores were not correlated to major curve magnitude before or after the visit. The SRS 30 Satisfaction domain exhibited a small increase post visit (pre: 3.3, post: 3.6, p=0.010). All other SRS 30 domains and total scores did not exhibit statistically significant differences before and after the visit. When subdivided by major curve magnitude (<25, 25-40, >40 degrees) there were no significant before/after differences in SRS 30 domain or total scores. <h3>CONCLUSIONS</h3> Among new adolescent referrals for scoliosis with a wide range of presenting curve magnitudes, SRS 30 scores did not correlate to major curve magnitude. SRS 30 scores did not change before and after the visit, regardless of curve magnitude, therefore it is unlikely that counseling by a surgeon influences perceptions of quality of life in this population. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Transition from child and adolescent MHS to adult MHS: what happens to young people with personality disorder?

AimsHypothesis: Personality Disorder (PD) adolescents, compared to non-PD case, have a worse experience at transition.Aims: To describe the outcomes of referrals of adolescents for transition to adult services and compare PD and non-PD populations to identify potential improvements to allow for better transition experience of the PD patients.BackgroundBorderline PD is prevalent in adolescents - although there is a reluctance to make the diagnosis. When patients reach graduation from CAMHS, many fall through the ‘gap’ in services during the transition. Consequently, adding the paucity in research about the transition experience of PD patients, it is important to evaluate what happens to these patients during the transition process to help better understand their experience, and how it can be improved.MethodPatient's clinical records from Tower Hamlet CAMHS, East London NHS Foundation Trust, were reviewed retrospectively from July 2018 to November 2019, assessing whether optimal transition standards were met. A total of 41 cases that transitioned from CAMHS to AMHS were identified. Transition standards compared were: information sharing – case and risk, parallel care, transition planning and continuity. PD diagnosis was identified based on the recording of this diagnosis or meeting DSM5 criteria from the notes. PD and non-PD transition experience was compared.Result36 were given a diagnosis by the CAMHS clinician at transition and 5 had no diagnosis assigned. No cases had a PD diagnosis made by the CAMHS clinician, however 1 case mentioned ‘PD traits’, 1 mentioned ‘EUPD’ as a possible differential and 2 cases were labelled as ‘emotional dysregulation’. The research team found 17 cases that met DSM5 criteria for PD diagnosis.Comparing transition experience of PD vs non-PD patients, the PD patients had a less optimal transition process. Statistical analysis using Chi Square Tests, showed significantly less optimal transition planning (X2 = 5.103, p &lt; 0.05) and continuity (Fisher's exact test p = 0.049). Cohens W indicated a medium effect for transition planning and continuity.ConclusionAdolescents with a diagnosis of PD transition less well to Adult MHS than those without the PD diagnosis. Implications of our findings point to 1) the importance of considering a diagnosis of PD 2) if the diagnosis of PD is made, to anticipate greater difficulties in transition 3) the need to identify specific reasons for transition difficulties related to patient, clinician and system factors and their interrelation.

Current Issues in Bariatric Surgery for Adolescents with Severe Obesity: Durability, Complications, and Timing of Intervention

Conventional nonsurgical management of severe obesity in the pediatric population and adolescents has focused on a multidisciplinary approach involving diet, exercise, behavioral modification, and to some extent, pharmaceuticals. Although nonsurgical strategies provide a certain degree of effective weight reduction, most of the severely obese adolescents suffer from a high relapse rate. In recent studies, long-term outcomes of bariatric surgery for severely obese adolescents have shown sustainable effects on weight loss and resolution of related comorbidities, such as hypertension and type 2 diabetes mellitus in this vulnerable age group. Notably, the role and practical benefits of bariatric surgery as a multidisciplinary therapeutic approach to adolescent obesity is gaining attention and acceptance. However, a surgical approach has many obstacles that prevent the timely evaluation and optimal intervention for adolescent obesity and its comorbidities. In the present review, the latest data on long-term outcomes after bariatric surgery for severely obese adolescents in terms of durability, effects on metabolic risk factors, complications, and optimal timing were summarized. The results showed the sustainability of weight loss and comorbidity resolution in adolescents following bariatric surgery. In addition, earlier surgery in patients without an extremely high body mass index increases the likelihood of a healthier life in adulthood. This review can help clarify the beneficial effects of bariatric surgery on weight reduction and resolution of comorbidities in severely obese adolescents and remove the barriers to referral of adolescents for bariatric surgery.

Wilms tumor, medulloblastoma, and rhabdomyosarcoma in adult patients: lessons learned from the pediatric experience.

Wilms tumor (or nephroblastoma), rhabdomyosarcoma, and medulloblastoma, common embryonal tumors in children, can occasionally occur in adults, for whom survival is significantly inferior than pediatric patients. Available data on adults with Wilms tumor consist of case or case series reports. Among other factors, the unfamiliarity of adult oncologists and pathologists with nephroblastoma and consequent delays in initiating the appropriate risk-adapted chemotherapy may negatively influence outcomes. The survival decrement in adults with rhabdomyosarcoma has been attributed to the lack of centralized care, the inconsistent use of standard protocol-driven multimodal therapy, and lower chemotherapy tolerance in adult patients. In children with medulloblastoma, evidence from randomized clinical trials has led to risk-tailored therapies tuned on histology, extent of initial disease, and biological features. Such refinements are still missing for adults due to the lack of similar trials and studies that might provide the same or a different understanding regarding patients' individual prognosis, treatment morbidity, and quality of life. Recent experiences have suggested that applying or adjusting pediatric protocols to adult patients with these tumors is feasible and can improve survival. Here, we provide an evaluation of the current evidence for the management of Wilms tumor, rhabdomyosarcoma, and medulloblastoma arising in adults. This review aims to promote the referral of adolescents and adults with pediatric tumors to pediatric centers for inclusion into pediatric protocols, or into protocols and studies specifically designed for that age group with the cooperation between pediatric and adult oncologists.

Social and assistance characteristics of child and adolescent referrals to mental health services

The objective of the study was to compare the social, demographic and service characteristics of children and adolescents attended by mental health services in a Metropolitan Region of Northeast Brazil. This was a cross-sectional study with children and adolescents assisted by these services. The independent variables (service of the first appointment that referred the children and adolescents) and dependent variables (age, schooling, housing situation, family income and others) were examined. The users of these services came from the school (10.3%) and primary health care (30%) and had a mean age of 10 years. Most lived in their own home, with up to five residents and the family income was less than or equal to R$ 832.00. The majority received some type of government assistance 80.3%, and 77.3% of them received from the Bolsa Familia Program. The bivariate analysis of primary care health referrals was significance for the ages of 1 to 12 years. While the bivariate analysis of school referrals identified a statistical significance for other levels of schooling and family income below R$ 832.00. The multiple logistic regression model showed a statistical significance for the family income variable below R$ 832.00. The important role of social and economic characteristics in the life and family of these children and adolescents defines the need to offer more effective actions to promote health and should integrate the context of education and health. Thus, it is possible to offer a contextualized extension of social and economic policies to these families in order to stimulate healthy environments.

Reliability and concurrent validity of postural asymmetry measurement in adolescent idiopathic scoliosis.

AIMTo investigate the reliability and concurrent validity of the Baseline® Body Level/Scoliosis meter for adolescent idiopathic scoliosis postural assessment in three anatomical planes.METHODSThis is an observational reliability and concurrent validity study of adolescent referrals to the Orthopaedic department for scoliosis screening at Karolinska University Hospital, Stockholm, Sweden between March-May 2012. A total of 31 adolescents with idiopathic scoliosis (13.6 ± 0.6 years old) of mild-moderate curvatures (25° ± 12°) were consecutively recruited. Measurement of cervical, thoracic and lumbar curvatures, pelvic and shoulder tilt, and axial thoracic rotation (ATR) were performed by two trained physiotherapists in one day. The intraclass correlation coefficient (ICC) was used to determine the inter-examiner reliability (ICC2,1) and the intra-rater reliability (ICC3,3) of the Baseline® Body Level/Scoliosis meter. Spearman’s correlation analyses were used to estimate concurrent validity between the Baseline® Body Level/Scoliosis meter and Gold Standard Cobb angles from radiographs and the Orthopaedic Systems Inc. Scoliometer.RESULTSThere was excellent reliability between examiners for thoracic kyphosis (ICC2,1 = 0.94), ATR (ICC2,1 = 0.92) and lumbar lordosis (ICC2,1 = 0.79). There was adequate reliability between examiners for cervical lordosis (ICC2,1 = 0.51), however poor reliability for pelvic and shoulder tilt. Both devices were reproducible in the measurement of ATR when repeated by one examiner (ICC3,3 0.98-1.00). The device had a good correlation with the Scoliometer (rho = 0.78). When compared with Cobb angle from radiographs, there was a moderate correlation for ATR (rho = 0.627).CONCLUSIONThe Baseline® Body Level/Scoliosis meter provides reliable transverse and sagittal cervical, thoracic and lumbar measurements and valid transverse plan measurements of mild-moderate scoliosis deformity.

Psychosocial and Psychological Vulnerability in Adolescents with Gender Dysphoria: A “Proof of Principle” Study

For adolescents with gender dysphoria, it has become common to be offered hormonal treatment to either delay or suppress pubertal development and/or to masculinize or feminize the body. At the same time, it has been our clinical impression that the psychological vulnerability of at least some of these youth has been overlooked. Fifty consecutive referrals of adolescents with a DSM-IV-TR diagnosis of gender identity disorder (GID) constituted the sample. Information obtained at intake was coded for the presence or absence of 15 psychosocial and psychological vulnerability factors. The mean number of psychosocial/psychological vulnerability factors coded as present was 5.56 (range, 0–13). Over half of the sample had six or more of the vulnerability factors. The number of factors coded as present was significantly correlated with behavioral and emotional problems on the Youth Self-Report Form and the Child Behavior Checklist, but not with demographic variables or IQ. The findings supported the clinical impression that a large percentage of adolescents referred for gender dysphoria have a substantial co-occurring history of psychosocial and psychological vulnerability, thus supporting a “proof of principle” for the importance of a comprehensive psychologic/psychiatric assessment that goes beyond an evaluation of gender dysphoria per se.

Behandlung von Eltern-Jugendlichen-Konflikten nach dem Therapieprogramm für Jugendliche mit Selbstwert-, Leistungs- und Beziehungsstörungen (SELBST) – Konzeption und Ergebnisse einer Pilotstudie

Parent-adolescent conflicts often comprise the reasons for the referral of adolescents in treatment facilities. However, studies on the effects of behavioral interventions with this indication are rarely published, even in the international literature. In an explorative study, we assessed the efficacy and the acceptance of systemic-behavioral treatment modules of the treatment program for adolescents with disturbances of self-esteem, performance and relationships (SELBST). Ten adolescents aged 12 to 18 years (mean age 14,7 years) and their parents with severe parent-adolescents conflicts according to clinical judgment and with increased parent and adolescent ratings of conflicts on the Conflict-Behavior-Questionnaire-Cologne were included in the study. Analyses of pre to post changes showed a reduction in conflicts and/or an increase in conflict-solving skills as rated by the parents on various outcome measures. However, parents had problems attending the family sessions regularly and to implement therapeutic tasks in the daily family routine which may have limited the effects of the intervention. There is preliminary evidence that SELBST is a useful program for the treatment of parent-adolescent conflicts. To further increase the effectiveness of the program, knowledge from this trial has been considered in the development of the manual.

195: Substance Use Profile of Adolescents Entering Quebec Youth Protection Centers

Every year between 4000 and 5000 adolescents are placed in Quebec Youth Protection Centers (YPCs). Many of these adolescents use psychotropic substances that impact their mental and physical well-being. To document the prevalence of tobacco, alcohol and drug use among youth residing in YPCs and to identify factors associated with problematic substance use (PSU) among these adolescents. Between July 2008 and May 2009, adolescents aged 14 to 17 and living in six YPCs across Quebec were recruited on a volunteer basis to participate in a second generation surveillance study on risk behaviours and prevalence of sexually transmitted infections. Data on socio-demographics, substance use and sexual risk behaviours, and certain associated health conditions were obtained by questionnaire during structured, face-to-face interviews. Analyses were carried out on the profiles of participants identified with PSU (measured using the standardized “DEP-ADO” screening tool). Multivariate logistic regression was used to identify correlates of PSU. Of the 578 participants interviewed, 499 youth who had been living in YPCs for less than two years were kept in the analyses to improve reliability of data collected for the year prior to admission (59% boys; median age: boys, 16; girls, 15). During that year, the prevalence of regular substance use (3× weekly and +) was: tobacco, 75%; alcohol, 24%; cannabis, 63%; amphetamines, 17%; and cocaine, 4%. Almost one-third of girls (31%) and one-fifth of boys (21%) reported a first episode of regular use of alcohol before 14 years of age, while 50% of girls and 41% of boys reported a first episode of regular drug use before that age. PSU, measured by “DEP-ADO” and indicating a need for specialized professional intervention, was documented for 58% of girls and 63% of boys. Only 18% of these youth had received therapy for their problematic consumption. In multivariate analysis, factors associated with adolescent PSU were daily use of cigarettes (AOR 6.40 [95% CI 3.90 to 10.48]); precocious use of alcohol (3.99 [95% CI 2.41 to 6.62]); family history of problematic substance use (2.37 [95% CI 1.32 to 4.25]); having at least six sexual partners (lifetime) (3.26 [95% CI 2.00 to 5.31]); and a history of self-mutilation (lifetime) (1.88 [95% CI 2.11 to 3.16]). Substance use is prevalent among adolescents entering YPCs and certain factors are associated with problematic use. Youth with these risk factors merit early and on-going substance use screening by health professionals. Timely detection and referral of adolescents with PSU for therapy may help prevent associated health consequences and decrease their risks of developing life-long dependencies.

Influencing referral of adolescents and young adults with cancer to sites with higher rates of trial enrollment.

Adolescents and young adults (AYAs) have lower rates of clinical trial enrollment than younger or older patients with cancer. Multiple approaches to change policy and practice need to be used to improve this statistic. This article examines the option of increasing referral to 3 types of centers that are known to have relatively higher rates of enrollment of AYAs: pediatric cancer centers, AYA oncology programs, and National Cancer Institute-designated cancer centers. There are reasonable challenges to changing referral patterns, and more research, as well as education of those diagnosing AYAs, is required.

Outcome of adolescents with eating disorders from an adolescent medicine service at a large children's hospital.

To describe outcomes of adolescents with eating disorders treated by an interdisciplinary adolescent medicine service at a large children's hospital and to identify factors, including hospitalization, associated with outcome. The study design was a retrospective chart review of patients. The setting was an inpatient and outpatient adolescent service in a large urban children's hospital. A total of 218 adolescents diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified participated in the study. Interdisciplinary inpatient and outpatient treatment for eating disorders was adopted for intervention. Patient outcomes were categorized as fully recovered, partially recovered/improved, or poorly recovered/exhibiting chronicity. Being admitted to the study hospital once and longer duration of follow-up were associated with full or partial recovery. In contrast, being readmitted to the study hospital and longer duration of illness prior to the initial contact with this service were associated with poor recovery. Premorbid obesity was unrelated to outcome. Earlier detection and referral of adolescents with eating disorders are needed because a high percentage of patients, especially those with anorexia nervosa, required hospitalization at initial contact. The benefits of inpatient admission may extend beyond medical stabilization of the most medically compromised patients to include improved therapeutic relationship with the treatment team and improved follow-up. Many patients prematurely terminate treatment; factors contributing to premature termination of therapy need further exploration.