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Clippings
Theme: Adolescent Pediatrics
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Preeti M Galagali
Email:
[email protected]
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Trajectories of Functioning into Emerging Adulthood following
Treatment for Adolescent Depression (J Adolesc Health.
2016;58:253-9)
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Adolescent-onset major depressive disorder (MDD) can adversely affect
development. This longitudinal study examines whether empirically
supported treatments of adolescent depression lead to sustained
improvement in adult psychosocial functioning. Global functioning was
assessed in the Survey of Outcomes following Treatment of Adolescent
Depression (SOFTAD), an open naturalistic 3.5 years follow up of 196
adolescents, who were initially treated in the Treatment of Adolescent
Depression Study (TADS) randomized clinical trial. TADS had randomized
the sample into four treatment groups: placebo, fluoxetine, cognitive
behaviour therapy (CBT) and a combination of fluoxetine and CBT. Results
reveal that global functioning in 3 groups receiving treatment improve
linearly over time while those in placebo group decline. Multiple
comorbidities (anxiety, behavioural and substance use) and recurrence of
MDD predict lower global functioning. This study emphasises the need for
early treatment of adolescent depression and close follow up of those
with comorbidities and recurrence. A delay in treatment of adolescent
MDD impairs adult psychosocial functioning.
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Screening for Underage Drinking and Alcohol Use Disorder
(J Pediatr. 2016;173:214-20)
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Alcohol use disorders (AUD) amongst adolescents are increasing. Primary
care physicians often cite inadequate training and time to screen for
AUD. This study examines validity of a single question screening test
for adolescent AUD. Computer-aided self-report data were collected
from1193 rural adolescents regarding past year frequency and quantity of
alcohol use and ‘Diagnostic and Statistical Manual of Mental Disorders,
5th Edition’ (DSM-5) AUD symptoms. The results indicate that for
adolescents aged 12 to 17 years, a threshold of
³3 days of consuming
at least one standard drink in past year is an optimal screening
question for DSM-5 AUD. For 12-14 years age group, sensitivity of test
was 89%, specificity 95%, PPV 37%, NPV 100%; and for 15-17 years,
sensitivity was 91%, specificity 89%, PPV 50%, NPV 99%. For 18-20 years,
threshold of ³12
days of drinking in past year had a sensitivity of 92%, specificity 75%,
PPV 31% and NPV 99%. It seems that adolescent AUD can be easily screened
by a single question on frequency of alcohol use.
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Teen Clinics: Missing the Mark? (Int J Equity Health.
2016;19:95-105)
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Adolescents are at a risk for unhealthy sexual behaviour and need
confidential developmentally appropriate teen clinics to cater to their
health needs. This population-based study involved 181 444 adolescents
aged 14-19 years. The sample was categorized into three groups: those
enrolled in schools with a teen clinic (SC), those enrolled in schools
without a clinic (NSC), and those not enrolled in schools. The rates of
pregnancy in non enrolled was 2.1-times higher than SC and 2.8-times
higher than NSC. Sexually transmitted infections (STI) were highest in
the non enrolled group. The adjusted rate of STI in non enrolled was
3.5-times higher in males and 2.3 times higher in females compared to
NSC. Due to differences in outcome measures, it could not be concluded
whether school clinics would significantly impact pregnancy and STI
rates.
India has a large population of out of school
adolescents. This study highlights the importance of planning special
outreach health services, including screening for STI and pregnancy
along with preventive and curative services for this vulnerable group.
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Effect of Mindfulness Meditation on Working Memory Capacity
in Adolescents (J Adolesc Health. 2016;58:489-96)
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Globally there has been a spurt in research on
clinical usefulness of mindfulness meditation. This is the first ever
study to assess its effect on working memory capacity (WMC) in
adolescents compared to hatha yoga and wait list. Series of mixed
variance design was used to analyse its effects on WMC, stress and
anxiety in 198 adolescents aged 12-17 years. Results revealed that
mindfulness meditation had a significant effect on improving WMC
compared to hatha yoga and wait list. Though all the three groups
showed post-intervention reduction in stress and anxiety, it was not
statistically significant by time interaction effect. WMC, a component
of cognition that is essential for academic achievement, can be enhanced
by mindfulness meditation.
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