Areej Hassan

Polycystic ovary syndrome update in adolescence.

Purpose of review To provide an overview of our current understanding of polycystic ovary syndrome, its epidemiology and natural history, and potential therapeutic options. Recent findings Polycystic ovary syndrome is estimated to affect 5–10% of premenopausal women. While once thought to affect primarily adult women, polycystic ovary syndrome is frequently diagnosed during adolescence and may be increasing in prevalence secondary to the recent trend of increasing obesity among teenagers. Adolescents and young women often present with hirsutism, irregular menses, and obesity. There is increasing evidence that these women are also at increased risk later in life for cardiovascular and metabolic disease. Early treatment may prevent disease progression. Treatment options have focused on improving clinical symptoms of androgen excess and anovulation. Newer therapies, such as insulin-sensitizing agents, are beneficial in correcting the underlying metabolic disorder and, therefore, theoretically may have a more significant impact on reducing associated long-term morbidity. Summary An increasing number of adolescents are presenting with signs of polycystic ovary syndrome. While once thought to primarily affect appearance and fertility, it has become clear that women with this syndrome may also potentially face long-term health sequelae. Efforts should be made to diagnose and treat these women in adolescence to minimize the development of symptoms, and prevent the onset of cardiovascular and metabolic problems.

Youths' Health-Related Social Problems: Concerns Often Overlooked During the Medical Visit

OBJECTIVE The objectives of this study were to (1) measure the prevalence of health-related social problems among adolescent and young adult primary care patients; (2) estimate previous screening and referral experiences; and (3) examine participant attitudes toward screening and referral. METHODS Data were collected as part of a cross-sectional study conducted in an urban young adult clinic. Patients aged 15 to 25 years completed a computerized questionnaire screening for health-related social problems in nine social domains. In addition, participants answered questions about their previous screening experiences, need for referrals, and their experience using the system. RESULTS Seventy-six percent (304/401) of youth screened positive for at least one major problem, including healthcare access (37%), housing (34%), and food security (29%). Forty-seven percent (190/401) experienced major problems in two or more social domains. The prevalence of screening in the past year for each domain averaged 26%; 3% were screened in all nine domains in the previous 12 months and 33% were not screened in any domain. Overall, 75% needed a referral within the previous year, and 42% identified at least one unmet referral need. The majority (84%) of participants reported that it was acceptable to screen for these problems. CONCLUSION Prevalence of health-related social problems among youth is high. The majority needed at least one referral for a social need in the previous year. Primary care physicians would benefit from improved systems for screening and referral of health-related social problems in order to create a comprehensive medical home for their patients.

Food Insecurity and the Burden of Health-Related Social Problems in an Urban Youth Population

PURPOSE Our study objectives were to (1) determine the prevalence of food insecurity; (2) examine the association between presence and level of food insecurity with other health-related social problems; and (3) assess the predictive values of a two-item food insecurity screen in an urban youth population. METHODS Patients aged 15-25 years completed a Web-based screening tool. Validated questions were used to identify problems in seven health-related social domains (food insecurity, health care access, education, housing, income insecurity, substance use, and intimate partner violence). Chi-square and Kruskal-Wallis tests and logistic regression models controlled for age, sex, and race/ethnicity, assessed the association between food insecurity and health-related social problems. Predictive values of a two-item food insecurity screen compared with the United States Department of Agriculture Food Security Survey were calculated. RESULTS Among 400 patients (mean age 18 years; 69.2% female; 54.6% black; 58.9% public insurance), 32.5% screened positive for food insecurity. Increasing food insecurity level was significantly associated with cumulative burden of social problems (p < .001). In adjusted analyses, food insecurity was associated with problems with health care access (aOR = 2.6, 95% confidence interval [CI] 1.7-4.1), education (aOR = 2.8, 95% CI 1.6-5.1), housing (aOR = 2.8, 95% CI 1.8-4.4), income insecurity (aOR = 2.3, 95% CI 1.2-4.5), and substance use (aOR = 2.5, 95% CI 1.5-4.3). The two-item screen demonstrated sensitivity of 88.5% and specificity of 84.1%. CONCLUSIONS One-third of youth in sample experienced food insecurity, which was strongly associated with presence of other health-related social problems. The two-item screen effectively detected food insecurity. Food insecurity screening may lead to identification of other health-related social problems that when addressed early may improve adolescent health.

Accuracy of Self-Reported Height and Weight to Determine Body MassIndex Among Youth

Background: Self-reported height and weight has important economic, clinical and research value however little is known on the accuracy of self-reporting BMI among youth. Our objective was to determine the accuracy of self-reported height and weight estimates compared to measured height and weight used to determine BMI, among youth. Methods: Youth ages 15-25 were recruited from primary care urban hospital clinical where a trained clinical assistant measured the participant’s height and weight. The youth were asked to self-report their height and weight as part of a larger computerized survey. Continuous variables were compared using t-tests, and dichotomous variables using chi-square tests. BMI correlation was determined using Pearson’s r and agreement using a weighted kappa test. Results: Among 355 youth, the mean measured BMI for men: 27.3+7.0 kg/m2 compared to women: 28.9+8.7 kg/m2 (p=0.08). 58% of youth had an above normal BMI. There was high correlation between measured and selfreported BMI when calculated using an adjusted r2=0.84 (p<0.01). Agreement was also high between BMI categories (weighted kappa=0.88, p<0.01). Conclusions: Youth can accurately self-report height and weight to derive meaningful BMI scores for BMI categorization during this important period of body transition in the life course cycle. BMI is often conceptualized as categories and the weighted kappa test is a sensitive test capturing ordinal levels of BMI categorical agreement.

Using technology to improve adolescent healthcare.

Purpose of review To provide an overview of current technologies available for use in a primary healthcare setting, common indications for their use, and their effects on clinical practice. Recent findings Technologies such as the internet and cell phones are an integral part of the daily lives of most adolescents. Many young people are comfortable using technology as part of their healthcare visits, especially when addressing sensitive issues. Over the past 5 years, a significant body of research has emerged introducing a variety of technologic modalities that screen for health-risk behaviors, educate patients about chronic diseases, promote preventive efforts, and provide interventions in the adolescent population. Findings suggest that integrating technology with clinical practice can improve quality of patient care. Summary Technology can be used as an effective medium for the delivery of health information and interventions in an efficient, organized, and effective manner. Sharing knowledge of innovative tools, systems and programs will help develop further interventions and strategies to ensure optimal healthcare in young people.

A global perspective: training opportunities in Adolescent Medicine for healthcare professionals.

Purpose of review The review briefly describes the current state of adolescent health globally, and highlights current educational and training opportunities in Adolescent Medicine for healthcare providers worldwide. Recent findings Despite a growing body of literature demonstrating a shift toward recognizing Adolescent Medicine as a subspecialty, there are very few countries that offer nationally recognized Adolescent Medicine training programs. In recent years, several countries have begun to offer educational programming, such as noncredentialed short training programs, conferences, and online courses. Challenges, including cultural barriers, financing, and lack of governmental recognition and support, have hindered progress in the development of accredited training programs globally. Summary It is crucial to support efforts for sustainable training programs, especially within low and middle-income countries where a majority of the worlds adolescent population lives. Sharing knowledge of existing curriculums, programs, and systems will increase opportunities globally to build regional capacity, increase access to interdisciplinary services, and to implement health-promoting policies for youth worldwide.

Polycystic Ovary Syndrome in Adolescence

The definition of polycystic ovary syndrome (PCOS) has evolved over the past several years.1,2 PCOS was originally described in 1935 by Stein and Leventhal,3 who reported a group of women with amenorrhea and polycystic ovaries, of whom some were hirsute and/or obese. In 1990, a National Institutes of Health consensus conference defined PCOS as a combination of hyperandrogenism, menstrual dysfunction (oligo and/or anovulation), and exclusion of known disorders such as congenital adrenal hyperplasia (CAH) leading to the above.4 This definition was broadened at the 2003 Rotterdam consensus workshop. The revised definition included two of the following three criteria, with exclusion of other medical conditions: oligomenorrhea and/or anovulation; signs of either clinical or biochemical hyperandrogenism; and polycystic ovaries by ultrasound.5 The Rotterdam criteria expanded previous definitions by including in the PCOS spectrum women with hirsutism, but regular menses, as well as polycystic ovarian morphology. The 2006 Androgen Excess Society (AES) Task Force on the Phenotype of PCOS, however, narrowed the definition to exclude women who did not have androgen excess. The criteria include hyperandrogenism (hirsutism and/or hyperandrogenemia); ovarian dysfunction (oligo-anovulation and/or polycystic ovarian morphology on ultrasound); and exclusion of other disorders.6 Current estimates suggest that PCOS affects 5%–10% of reproductive age women.7–10 In comparison, “polycystic ovaries” alone are estimated to be present in 21%–23% of this same population.11 While PCOS was once considered to be a disorder that affected primarily adult women, it is now recognized that it has a perimenarchal onset. Rising obesity in adolescents likely exacerbates signs of PCOS, contributing to the earlier recognition. Data from the National Health and Nutrition Examination Survey in 2004 (NHANES III) demonstrated that 16% of females aged 12–19 years were considered overweight, with another 32% at risk for becoming overweight.12 Given the link between obesity and PCOS, with obesity reported in 50%–60% of adult women with PCOS,13 there is concern for a concomitant increase in PCOS as the prevalence of obesity continues to rise. Although obesity is not a defining feature of PCOS, it strongly influences the degree of insulin resistance, which can worsen the reproductive and metabolic features. There are substantial racial difference in the prevalence of overweight adolescents, but the difference in prevalence of PCOS among different ethnic groups has not been well studied. It is thought, however, that ethnicity and race may influence phenotype.14

Food Insecurity, Weight Status, and Perceived Nutritional and Exercise Barriers in an Urban Youth Population

Food insecurity and overweight/obesity coexist among youth; however, evidence for their association has been mixed. Our objectives were to assess the association between (1) level of food security and weight classification and (2) food insecurity and perceived nutritional and exercise barriers in an urban youth population. Patients aged 15 to 25 years completed a US Department of Agriculture Food Security Survey. Chi-square, Kruskal-Wallis tests, and logistic regression models controlling for age and gender assessed the association between food security level, weight classification, and perceived barriers. Among 376 patients, 122 (32%) were food insecure and 221 (59%) were overweight/obese. There were no significant associations between food security level and weight classification. In adjusted analyses, participants with very low food insecurity reported significantly greater odds of 3 nutritional barriers compared to participants with high food security. Food-insecure youth were more likely to report nutritional barriers, which may lead to overweight/obesity over time.

Caring for adolescents in Guatemala: provider perspectives

Abstract Purpose Today’s generation of adolescents is the largest in history, creating a major challenge for low and middle income countries faced with the necessity of addressing their growing healthcare needs. Our objective was to assess the extent to which health care providers in Guatemala are trained, knowledgeable and feel comfortable providing services to adolescents. Methods A sample of 20 medical providers were recruited from the School of Medicine at San Carlos University and its affiliated hospitals. Providers were interviewed face-to-face for 30–40 min using a semi-structured guide exploring their training, knowledge, skills and experience in adolescent health care. Recruitment continued until thematic saturation was reached. Interviews were recorded and transcribed verbatim, and then analyzed for emergent themes using principles of framework analysis. Results The provider’s mean age was 33.7 years [standard deviation (SD) = 10.2]. Most were female (65%) and practiced medicine in a metropolitan location. Results revealed the presence of five major themes: (1) Need for dedicated adolescent health services; (2) Presence of a multitude of barriers to providing adolescent health care; (3) Perceived comfort level in communicating with adolescents; (4) Limited knowledge of current adolescent specific services, programs, and guidelines; and (5) Gaps in medical education and training. Conclusion Providers recognize the need for increased and dedicated adolescent health care services. There is strong support for the creation of a credentialed national adolescent health training program.

Social disparities among youth and the impact on their health

Purpose Social disparities among youth have been recognized as an important influence on disease risk later in the life cycle. Despite this, social problems are seldom assessed in a clinical setting. The primary objective of our study was to evaluate the impact of social disparities on the health of youth. Methods A self-directed, web-based screening system was used to identify social disparities along seven social domains. Participants included youth, aged 15–24 years, recruited from an urban hospital clinic. The main outcome variable, self-rated health, was captured on a 5-point Likert scale. Univariable and multivariable regression models adjusted for sex, age, and race/ethnicity were implemented to assess the association between social problems and self-rated health. Correlation between social disparity problems was estimated using phi coefficient. Results Among 383 participants, 297 (78%) reported at least one social problem. The correlation among social disparity problems was low. Social disparities had an independent effect on self-rated health, and, in a fully adjusted model, disparities in health care access and food insecurity remained significant. The presence of even one social problem was associated with a decrease in overall health (β=0.68, P<0.01). Conclusion There is a high burden of social disparities among our youth urban hospital population. The presence of even one social problem increases the risk of worsening self-rated health. Evaluating the social disparities among youth in the medical setting can help elucidate factors that negatively affect patients’ health.