Community Medicine / Fourth Stage / Dr.

Muslim / Lecture 25

Objectives:

by the end of this session you’ll be able to:

A. Define adolescence period & its stages.

B. Be familiar with the recommendation of (GAPS).

C. Understand Adolescence preventive services: screening, lab tests, immunization.

D. Recognize HEADSS Assessment.

E. Be familiar with Safe teens.

F. Know Anticipatory guidance.

G. Understand the Consent & confidentiality.

H. Recognize Sexuality concept.

Definition

-Adolescence is a time of a physical, emotional, mental & psychosocial changes. It also a

time for experimentation &risk taking, its also a time for a relatively good health for
most.

*Stages of adolescence:

1- Early adolescence: Occurs at 11-13 years of age &merges with mid adolescence at14-
15 years. characterized by concrete thinking & body image disruption.

2- Mid adolescence: Begins around 14-15 years of age till 17 years, involves autonomy
may lead to parental conflict.

3- Late adolescence: from 17-21yr.the upper end is particularly variable & depends on
cultural, economic,& educational factors. adolescents begin to think about the future &
form stable intimate relationship.

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Guideline of adolescence preventive services:

A series of recommendations regarding the delivery of health services ,promotion of

well-being, screening for common conditions ,& provision of immunization for
adolescents & young adults between the age of 11-21y it includes:

1) Annual health visits: (3 complete physical examinations, one at each stage).

2) Counseling for both parents & adolescent.

3) Screening

Adolescence preventive services:

1) Routine screening: For several medical, behavioral,& emotional conditions:

· Hypertension (measuring Bp)

· Hearing ( conduct objective test at 12-15-18 yr.)

· visual acuity (Snellen’s test)

· High risk or symptomatic adolescents( TB. ,anemia , cholestrol)

· eating disorder & obesity (BMI)

· Use of tobacco , alcohol & other abusable substances

2) Laboratory test:

In the asymptomatic teenager, screening lab. tests should be kept at a minimum.

· Hb or Hematocrit : anemia screening is recommended at the end of puberty.

· Lipid profile.

· Sexually active adolescents :

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-Males: gonorrhea, Chlamydia, annual syphilis serology, HBV (homosexual).

- Female: Pap smear starting at age 21 in vulnerable groups.

3) Immunization:

· Diphtheria, tetanus: a booster of tetanus toxoid, reduced diphtheria toxoid and acellular
pertussis (Tdap) is recommended 10 years after the initial series.

· Meningococcal conjugate vaccine: administer to unvaccinated adolescents at high

school entry (15y)

· Influenza vaccine recommended for adolescents with certain risk factors

· Hepatitis A and B: if not received during childhood

· Pneumococcal vaccine: for adolescents with chronic illnesses (S.C.D., HIV, B-cell immune
deficiency) and those with cardiovascular and pulmonary disease.

· HPV vaccine: all females 11-12 years of age should receive the 3 dose series

· Rubella: unimmunized females.

HEADSS Assessment:
-Adolescent psychosocial screening:

1-Home

2-Education/ employment

3-Activities

4-Drugs

5-Sexuality

6-Suicide/ depression screen/ referral (the area of sex, school performance, family, peer
group, identity, and future should all be explored)

Safe teens
-Injuries are the most significant health problem of adolescents, providing safety
guidelines for teens is thus crucial in decreasing mortality from high risk behavior.

1. Sexuality: health education regarding contraception, STI, sexual abuse

2. Accident
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 3. Fire arms / Homicide: safely used legal issue with guns

4. Emotions / suicide

5. Toxins / drug abuse

6. Environment (school, home, friends)

7. Eating

8. Nutrition

9. Shots / immunization

Consent and confidentiality

-Adolescents may fail to seek or delay seeking of health care for number of reasons like
lack of access, finances, and may have concerns about confidentiality.

-Adolescents are more likely to seek care about sensitive issues yet they fear that the
health provider will not disclose the information to their parents.

-Laws about confidentiality vary from country to another.

-Issues of confidentiality and consent are best managed in the contest of a long term
physician- family relationship.

Sexuality
Differing family values, cultural values and personal experiences may give rise to varying
sexual education needs which may include understanding body functions, exploring
personal values and setting sexual limits with partners.

Parents and clinicians maybe unprepared to discuss sexually related issues with
adolescents.

Teens may be uncomfortable discussing sexual issues with their peers and with adults.

Lack of comprehensive sex education program

All the above put adolescents at increased risk for unwanted or unhealthy consequences
of sexual activity.

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"Geriatric medicine "
Aging can be defined as a progressive and generalized impairment of function resulting in
the loss of adaptive response to stress and increased risk of age related diseases. The
overall effect of these alterations is an increase in the probability of declining health and
dying and which is also often associated with social emotional and financial
marginalization in old age

Heterogeneity

• As people age. they become more dissimilar than similar in terms of individual
physiology. For example:

-A group of 30 year olds has similar cardiovascular endurance. lung capacity. Cognitive
ability ·A group of 80 year olds may differ much more in basic physiology

• With this heterogeneity in function. must know what`s normal to recognize disease __

Normal Changes with Aging:

• Skeleton

Decreased height and weight (after age 80)

Loss of bone substance (osteopenia)

• Kidney

Decreased creatinine. renal blood flow and concentration ability

Gastrointestinal Tract
Decreased acid (Vitamin B12 related)
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 Fewer taste buds

• Eyes

Arcus senilis
Decreased acuity. accommodation. color sensitivity. depth perception
Hyperopia (far-sightedness)

• Hearing

Degenerative changes of ossicles

Obstruction of eustachian tube
Atrophy of cochlear hair cells
High frequency hearing loss and pitch discrimination

• Nervous system

Increased motor response time

Slower psychomotor performance
Slowing intellectual performance
Decreased complex learning
Decreased hours of sleep

Common versus Normal:

• Just because a finding is common in the elderly doesn`t mean it’s normal.

• Hypertension. osteoarthritis. and dementia are common in the elderly but not
normal

• Patients only discuss things with you that they feel are abnormal

• If your patient considers incontinence a "normal" part of aging. he/she won't

bring it up during a clinic visit.

• Patient expectations are often wrong

Disability and Disease:

• Geriatric disorders are usually disabilities rather than discretely defined diseases

• ADL (Activities of Daily Living) and IADL (Instrumental Activities of Daily Living)
difficulties increase with age

Less than 10 percent of those 65-69 need help with IADL/ADL

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60% of females over 85 living in the community needed help with IADLs. and 40%
required help with ADLs

Activities of Daily Living (ADL):

• Activities of Daily Living (ADL) include:

Dressing
Eating
Walking
Going to the bathroom
Bathing

• These are severe functional disabilities and define dependency

Instrument Activities of Daily Living (IADL):

• IADL include:
Shopping
Housekeeping
Accounting/bill paying
Food/meal preparation
Travel/driving

• These are less severe than ADL. but clearly cause dysfunction and lead to dependency