Poster Presentations and Free Papers

Renal Function in Adolescents with Eating Disorders

R. McClymont1, S.D. Clarke1, G. Anderson1, M. Kohn1 & S. Lawrence2

1Department of Adolescent Medicine and 2Department of Nephrology, Westmead Hospital, Sydney, Australia 

Abstract: Renal dysfunction, both transient and permanent, is a recognised complication of eating disorders. Permanent dysfunction has mostly been described in adult patients, usually with a chronic history over many years of hypokalaemia secondary to bulimia / laxative abuse or of extreme low weight. Other studies, in small numbers of adult and adolescent patients, have shown renal dysfunction that resolves quickly with weight gain.

Renal function was studied in all patients admitted to an adolescent eating disorders unit over an eighteen-month period. Creatinine clearance was reduced in the majority of patients. In most, this corrected with weight gain. On follow-up, renal function of a number of patients remained compromised. In one patient, there was the unexpected development of permanent renal pathology. This study emphasises the importance of considering the possibility of both transient and permanent renal dysfunction in adolescent patients with severe eating disorders.

Teenage Pregnancy as a Motivator   for Positive Change

Marcia Nogueira and Chiyo Maniwa

Teenage pregnancy is usually viewed as a detrimental occurrence in the life of the average adolescent, given its tendency to isolate the individual from peers and invoke premature responsibility for infant care.  Project NATEEN, part of the division of Adolescent Medicine at Children's Hospital Los Angeles, was established in 1985 with a vision of using the crisis of pregnancy as a positive change force in an adolescent's life. Staffed by a program manager. 3 co-ordinators and 18 case managers, over 650 young people receive services at any one time.  To be eligible, participants must be pregnant or parenting and must be under 20 years of age. The population served is predominately female and primarily Hispanic (76%) and African American (16%).  Many are gang involved, not attending school and using alcohol and/or drugs.  A comprehensive evaluation and needs assessment directs the attention of both the case manager and the young person to develop solution focused interventions, Deficits are reframed as opportunities for personal growth. Common areas of need include parenting and play skills, accessing prenatal and child care, ongoing health and medical care for self and baby, maintaining up to date immunisations and managing the maze of the welfare office and Children's Protective Services.  Emphasis is placed on infant and child development,  school  re-entry,  vocational  training  resources  and  employment opportunities. School attendance and progress is closely monitored. A philosophy of competence and self-efficacy is promoted  in all contacts.  Counselling referrals are provided for those whose progress is hindered by psychosocial challenges. To counter the sense of isolation so familiar to teen parents, social networks are encouraged and child-parent bonding experiences are facilitated ("Mommy and Me"). Assertiveness training integrating HIV education and protection skills is provided through a "Young  Women With Voices" program. Outreach support groups are held in four local high schools and other agencies in the community. Quantitative and qualitative evaluation has shown that NATEEN participants acquire enhanced awareness and skills for self-advocacy both within the social service system and in their relationships with professionals,  peers, and  partners.   Parenting skills are improved. Academic performance is also improved within 6 months of intake into the program. The NATEEN program utilises the case manager/client partnership to empower parenting adolescents to make positive life decisions for themselves and their children.

The development of a rating scale to assess general practitioners communication skills with children & adolescents.

Authors:          Hearne, R.H., Eminson, D.M., Bowman, F.M., Chew, C., Faragher, B. & Lewis, B.

Institution:    Child and Family Services, Royal Bolton Hospital, Minerva Road, Bolton

Objective:        To develop a rating scale to be used as a formative tool, which will assess a general practitioner’s skills in consultations with children or adolescents when a parent is also present (triadic consultations).

Method:           Existing instruments used in both formative and summative assessment to assess General Practitioners’ consultation skills (Leicester Assessment Package (1994), Pendleton et al (1993), West of Scotland Summative Assessment scale (1993), MRCGP videotape assessment scales (1996)) were scrutinised to consider if they were applicable in a consultation where a child was the subject and both the parent and dependant child were present. None of the instruments considered were satisfactory, as significant aspects of the skills applicable were not measured. To develop a new scale we used Neighbour’s ‘Five Checkpoints in the Consultation’ (1987) for the main headings. The skills to be identified within each heading were derived from the existing rating scales used for analysis of consultations with adults and our knowledge of children's difficulties and how these may be assessed in general practice. 44 videotaped triadic consultations involving children or adolescents were collected from 6 General Practitioners. The scale was piloted against the taped consultations and was modified until the final version was produced. Four raters, two general practitioners and two child psychiatrists, independently rated the initial 44 and a subsequent set of 30 triadic consultations.

Results:           The final version of the scale contains four headings: Interview and history taking, Examination, Problem solving and management and Safety netting.  Under each heading is a division into General skills and Specific ‘Triadic’ skills, which are listed. In each section a doctor’s skills can be identified using a Likert scale with four defined points. A workbook is included outlining the skills to be assessed and the criteria for allocating points on the Likert scale. A high level of agreement was reached between the four raters when a summary score was given for each section of the scale, after viewing 6 of a doctor’s triadic consultations.

Conclusion:  A valid and reliable scale has been developed which can be used as a formative tool in the teaching of the skills required by general practitioners in triadic consultations. This has wide applicability in teaching General Practitioners, Paediatricians and Accident and Emergency physicians skills required to allow children and adolescents to contribute appropriately in consultations where their parents are also present.

Physical Abuse of Adolescents in Chile - Does a Problem Exist?

Dr. Maria I. Romero, MD. MPH.(*) Dr.Dominga Figueroa MD (**). Mabel Chiang and Cesar Schuster (***),

(*), Associate Professor, Pontificia Universidad Cat6lica de Chile.

(**) Professor, Universidad de la Republica, Chile.

(***)Students, School of Psychology, Universidad de la Republica. 

The battered child and adolescent syndrome has been increasingly drawing the attention of health care professionals and of the population as well. In Chile, however, both the frequency and the characteristics are unknown, since the subject is still a matter of secrecy.  The objectives of this study were to investigate the prevalence and characteristics of physical abuse and the association with family types during the adolescence period in university students. This group was selected thinking that it was easier to report an event that has occurred in the past. The population size was 1,062; with an expected frequency of 50%, worst acceptable value of 55 % at a confidence level of 95 % a sample size of 282 was calculated, In order to assure the sample size an excess of 10% was considered and 302 students participated in the study   A questionnaire was answered containing relevant information of the history of physical abuse in the adolescence period (12 to 21 years of age). The sample was composed of 165 male and 137 females (the distribution by sex reflecting the composition of the population), with a mean age of 22.7 years.

Results: 53 % of the respondents confessed having been physically abused by one or more family members (54.6% among males and 51.1 % among females). Mother and father are most frequently the batterers. Among 156 physically abused students, a total of 444 episodes were recorded and the mother is responsible of 259, the father of 152, grandparents of 15, uncles/aunts of 12 and step-parents of 7 episodes. A total of 577 motives causing the abuse were recorded, most of them associated to behaviours: being disrespectful 14.7%; not obeying 13.7%; lying 6.1%; being late 5.7%; poor grades at school %;, alcohol and drug use 3.1%; sexual activity 0.35% and stealing 1.21%. In 76% of the episodes other members of the family were present, (siblings or other parent). 37% of those people did not intervene and only 21.3% tried to stop the Situation, although 21.3% supported the victim afterwards. 23.6% of the victims reacted with crying, 21.4 faced the abuser, 17.8 run away, 18.8% got paralysed.  2% asked for help to neighbours or other family members and only 1.6% went to the police. The association with family type was studied, Family type was classified as biparental (nuclear or extended); monoparental (single parent, nuclear or extended) and remarried, A ratio of battered I not battered was calculated for each type of family being 1.04 and 1.2 for biparental families, 2 for extended monoparental families and 2.5 for families with remarried parent, showing these two as families at risk. An association was found when comparing both extended monoparental and remarried against the other three with a p-value = 0,06 and a RR = 1.33. Also an association was found between being a family with remarried parent and the risk of physical abuse with RR 1.36 p=0. 17). On the other hand, an association was found between being a biparental family and a lower risk of physical abuse with a RR   0.87, p=0.26.

These results from a prevalence study and an initial study of association stress the need for further analytical studies in Chile.

Adolescence: - Myth or Reality for Pacific Youth? A Samoan women’s Perspective.

Author/presenter. Anne-Marie Tupuola

New Zealand born Samoan at the final stages of doctoral studies at Victoria University of Wellington, New Zealand, My thesis critically examines the notion of adolescence and two processes commonly associated with adolescent development - personal and ethnic identity formation within Samoan contexts.

The concept of adolescence is debatable in different cultural contexts.  Is adolescent development a universal stage of human development?

This paper will critically analyse some of the common assumptions made of adolescent processes within diverse Samoan contexts.  What does adolescence mean for young Samoan women of the age group commonly referred to as adolescence?  Can the concept of adolescence' as defined by several western adolescent theorists, be used to define and describe the experiences of Samoan youth?

The findings from both my Masters and Doctoral studies will be discussed to illustrate some of the limitations of some western adolescent theories in Samoan societies  The experiences of 53 women aged between 14 and 29 years of age, most of them of Samoan descent in New Zealand, are discussed to highlight some of the problems of confining their human development processes within rigid stages and boundaries

The implications of both studies will also be outlined with some recommendations made to youth workers and adolescent practitioners working with youth of cross-cultural and/or Pacific backgrounds.

Adolescent Sexual Problems and Education The Status of Adolescents' Sexual Behaviour in schools.

Experience of  using  a  questionnaire in Ekaterinburg, Russia. Natalia Smirnova

Research into adolescents' sexual behaviour is quite common in western countries. As regards Russia this subject has been studied little. The work described below is the first stage of a large sociological research based on the results of the questionnaire for the pupils (14-15-16-17 years old) of the senior forms (9-10-11-th forms) of several secondary schools in Ekaterinburg. The research was made in 1998 January-May and included 306 pupils of different schools. The main goal of this work- is to get acquainted with the problem, it's reality.

There were no so called "difficult adolescents" (here it means the adolescents with evident behavioural, learning, family and other problems) among the interrogated pupils. Nevertheless the level of conflict with family members is rather high:- 79% among the pupils of 14-15 year olds and 56% among  16-17 year olds.  At the same time there is a tendency to close interfamily relations:- 72% among the pupils of 14-15 and 69% among them of 16-17 years.

The attempts to leave home for a time of one to three days were noted in:  

Desire to leave home was noted in:

By the age of seventeen 89% of boys and 52% of girls tried to smoke, among them 40% of boys and 30% of girls smoke constantly.  At seventeen 95% of boys and 84% of girls had drunk alcohol, 28% of these boys and 40% of girls drink alcohol from time to time.

As regards drugs at least once they tasted in: 

Among them began to use drugs in:

By age 14-15yrs 40% of boys had the first sexual intercourse and 36% of them have it regularly. Among girls there were 25% who had their first sexual intercourse by the age of 14-15 and 8% have regular sex.  As regards the adolescents' opinion about at what age is it possible for beginning sexual life they answer:  "at the age of sixteen" (a year ago it was the age of getting passport in Russia). And 19% of boys and 32% of girls think this age to be 18 yrs  (the age of official majority in Russia).

The moral (or mental) readiness for beginning sexual life was marked in: 

The initiative of a first sexual intercourse among the boys belonged in 61% to them and in 33%  to their partner. Among girls- in 27% the decision was theirs and in 39% their partners. In 7% adolescents answered that the partner forced them and in cases with girls of 14-15 years they have been resisting till the end of the sexual intercourse in 38%.  About 85% of pupils have an opinion that it's possible to begin sexual life before the marriage.

The pupils' attitude to abortion is the following:

The main sources of sexual information for the pupils are: -  books, - friends, - erotic magazines and films, - in 33% among the girls- their own parents. Nowadays the scope of sexual education of the school pupils in the Russian educational system is not considerable. Only 17% of pupils said that they got such information from school teachers or psychologists. And 23% of them answered that they never got  any information from anywhere. And the relation to the necessity of establishing a new subject devoted to the sexual education at school is the following:

So the first stage of research shows: - the reality and actuality  of  the  problem  of  adolescents' sexual behaviour and education, - the necessity of extending and continuing of the research with additions or changing of the questionnaire, - the necessity of co-operation with sociologists and teachers in solving the problem and perhaps in establishing a new subject for school pupils.