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HEADSSS UP: Hot Topics in Adolescent Medicine

HEADSSS UP: Hot Topics in Adolescent Medicine. Eric Cadesky MD CM, CCFP University of British Columbia. LEARNING OBJECTIVES. 1 billion in 1 hour Compliment to last year’s talk Available upon request Identify the unique risks of adolescents Review the approach to the adolescent patient

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HEADSSS UP: Hot Topics in Adolescent Medicine

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  1. HEADSSS UP: Hot Topics in Adolescent Medicine Eric Cadesky MD CM, CCFP University of British Columbia

  2. LEARNING OBJECTIVES • 1 billion in 1 hour • Compliment to last year’s talk • Available upon request • Identify the unique risks of adolescents • Review the approach to the adolescent patient • Discuss recent studies and guidelines • Obesity • Depression • Nutrition • Vaccination • STIs/Hypersexuality

  3. WHY CARE? • 1.2 billion • Uniquely at risk • the only age group whose mortality has not decreased • 40% of traffic accidents • Sexual health • STIs, Pregnancy rates rising in subgroups • STIs rising • Adolescents often become adults • Adolescents seek and receive less care than other groups

  4. Expectations PARENTS ADOLESCENTS • diet and nutrition • Exercise/sports • physical changes/puberty • Drug/tobacco use • Depression/suicide • Obesity • 46% want full disclosure of information discussed => Need to stress confidentiality • Height • Acne • Menses • Obesity • Emotions

  5. Refresher: HEADSSS • Home • (Eating) • Education/Employment • Activities • Drugs • Sex • Suicide/Depression • Safety

  6. Adolescent Obesity in 2010 • BMI > 30 or Weight > 95%ile • Future: girth • 1980: 5% (age 12-19) • 2006: 17% (age 12-19) • Risk: Black, Native, Latino • Canada: • 10% obese, 25% overweight • Was 2% 15 yrs ago • 60% girls, 20% boys actively trying to lose wt • Only 5% of teens succeed > 2 yrs

  7. Obesity Risks • Cardiovascular • HTN, CAD (RR3-4x), cardiomyopathy, Long QT, atrial fibrillation • Endocrine • DM2, PCOS, hypoTy, hypoandrogenemia • Respiratory disease • OSAS, CRLD • Orthopedic • SCFE, OA, scolioisis, lumbago • Psychiatric • Eating disorder, depression, BDD • GI • GERD, NASH, IBS, Colon cancer: 3-4x incr risk • GYN • DUB, uterine ca, ov ca, br ca • Neurologic • CVA, meralgiaparaesthetica, pseudotumorcerebri • Dermatologic • Intertrigo, venous stasis, acanthosisnigricans, decubitus ulcer

  8. Investigations • FBS/A1C • T2DM: 0.5% • IFG: 7% • Lipids • AAP: first update since 1998: • screen for lipids as early as 2 yrs if risk factors • More on this later… • TSH • 11.7% of obese adolescens have elevated TSH • Control: 0.7% • LEs • Prevalence of NASH: • Age 11-15: 24% males, 15% females • Age 16-20: 53% of males, 7% females

  9. Tx: Behavioural • Decr screen time • Parental routine decr’s preschool obesity 40% • Eat as a family • Eat breakfast • 5 fruits and vegetables per day; no white foods • No more than 2 hours of sedentary activity • 1 hour of exercise • 0 sugary drinks • Food-in-hand or fork-in-mouth • Lights on • Behavioural feedback: eat in front of mirror • Small plates • High risk of regaining weight • SUSTAINABLE CHANGES

  10. Tx: Medication • meds can at most decr wt by 10% • Orlistat • Sibutramine • Metformin • Leptin • Lorcaserin • Buproprion • Natrexone • Bariatric surgery

  11. Statins? • AAP: encouraged screening of lipids > 2yrs age • Statins if age > 8yrs • very controversial, poor evidence • abN lipids are a common finding • 22% of overweight teens • 43% of obese teens have • Q: what would effect would this have? • LDL fluctuates in adolescence • watch for regression to the mean • Study: only 0.8% of 12-17yo meet criteria • And then, only after failure of lifestyle change

  12. Depression • 6% adolescents • USPSTF: screen adolescents • Easy to screen: PHQ2 (pt health questionnaire) • “How often in the past two weeks have you had…” • Depr affect • Anhedonia • Likert scale: 0 (never) to 3 (every day) • Score > or = 3 had spec/sens of 75% for DSM-IV MDE • Richardson LP et al. Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics 2010 May; 125:e1097 • Suicidality: 3-4% ideation • ASK! • Cognitive therapy • Know your resources • Don’t’ shy away from SSRIs if severe • Possible suicide ideation

  13. Vitamin D • Role in development • Bone health • May affect immune function, T2DM, HTN, CAD • NHANES: • 9% deficient ( 25(OH)D <15 ng/mL) • 61% insufficient (15–29 ng/mL) • Screen in metabolic children? • Encourage incr intake • Kumar J et al. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001–2004. Pediatrics2009 Sep; 124:e362.

  14. Immunizations • Best practices in 2010: • TDaP (Adacel): one dose • Meningitis ACWY: • HPV • Boys as well? • Influenza • New Canadians/Travelers • Travel Vaccines • Hepatitis A/B, typhoid

  15. Hypersexuality • STI/sexuality statistics • Age of first sexual contact: 50% by Grade 11 • Changing social norms • Acceptance of promiscuity Pleasure = power • Few +ve role models for adolescent girls • Know your pop culture • Be open • SCREEN for STIs

  16. Also… • Internet safety • ADHD • Hearing loss • Up from 14 (‘88) to 19% (’96) • Sexuality (GLB/Q) • Contraception • Adolescent Concussion Management • Learning Disorders • School Drop-Outs • Adolescent Oncology • Early Psychosis • Bullying • Hyperventilation Syndrome • Dermatology • Anxiety Disorders • Sports Medicine in the developing athlete • Adolescent Immigrant Health

  17. Summary • Care of adolescents: challenging, rewarding • Screen for obesity • Spend time on behavioural measures • Involve family • Consider medication/surgery for extreme cases • Adolescents are uniquely at risk • HEADDDS can elicit much of this information • Obesity continues to be a growing problem with intense solutions • Supplement with Vitamin D • Screen for Depression, treat confidently • Immunize and educate • Screen for STIs, ask about sexuality

  18. Thank you! • eric.cadesky@gmail.com

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