15 research outputs found
Mindfulness and Multiple Sclerosis
Multiple sclerosis is a chronic, debilitating autoimmune condition with unknown etiology. It can have significant impact on quality of life and overall sense of wellbeing. It can be associated with poor sleep, fatigue, mental health disorders such as anxiety, depression and affect interpersonal relationships. Impact of mindfulness based interventions in mental health conditions, chronic illness as well as multiple sclerosis in adults has been widely studied. Several studies have concluded that mindfulness based intervention can be beneficial in improving quality of life, mental health and physical symptoms such as fatigue in adult patients with multiple sclerosis. Current literature suggest that practice of mindfulness based techniques improve cognitive performance, attention, social skills, academic skills, emotional regulation, self-esteem, anxiety, stress and fatigue in adolescent population. There is, however, limited evidence about utilizing mindfulness based intervention in adolescents with chronic illness. The chapter describes practice of mindfulness and current research in treating symptoms of multiple sclerosis
Pharmacology of Cannabis
Cannabis has been used for recreational purposes around the world. It is derived from the plant cannabis sativa which has various other compounds known as cannabinoids. Most common form of cannabis used for recreational purpose is marijuana, which is prepared from dried flowering tops and leaves. The primary psychoactive component is delta 9-tetrahydrocannabinol (δ-9THC), which exerts its physiological and psychological effects through its interaction with CB1 and CB2 receptors. Smoking is the most commonly used method with onset of effects within minutes after inhalation. Oral ingestion of cannabis has varied absorption with delayed onset but longer duration of action. Urine drug screen is the most common method for detecting cannabis use. Other cannnabionoids such as cannabidiol have been utilized for medicinal purpose and research is ongoing to fully understand its role in treatment of various health conditions. Synthetic cannabis has emerged as drug of abuse over recent years and poses greater challenges due to serious physiological and psychological effects and inability to be detected in standard screening tests
HIV and Minority Youth
Human Immunodeficiency virus (HIV) infection is a major public health problem with the burden of disease increasing in adolescents and young adults particularly among black males and males who have sex with males (MSM)
Challenges of Internet and Social Media Use in Adolescents
There has been tremendous growth in use of technology in recent decades. The majority of teens now have access to a desktop/laptop computer as well as a gaming console and smartphone. With growing internet and social media use teens now face challenges including cyberbullying, sexting and problematic internet use that result in various health implications. Health care providers are in unique position to educate adolescents and families about current challenges and provide age appropriate guidance to promote healthy internet behaviors
Sexual Minority (LGBTQ) Youth and Role of Health Care Provider
Adolescence is a time period of physical, psychological and cognitive changes. It is an important phase for an individual to discover who they really are (self-identity), how they are perceived (social identity) and how they fit into the environment they live in.1 One of the major tasks of adolescence is sexual maturation and sexual and /or gender identity development.2 Adolescents who are developing as gay, lesbian, bisexual or transgender face a tremendous challenge of establishing their identity which is often complex.3 They cope with the feelings of being different and are in constant dilemmas about revealing their identity (“coming out”) which is different from family and social expectations.3,4 While acceptance in certain segments of society is growing, sexual minority youth continue to be at risk for family rejection and face harassment, prejudice, discrimination and social isolation in schools as well as communities.
According to a national school climate survey5 conducted on students between the ages of 13 and 21 years in grades 6th-12th found that majority of schools had unsupportive environment for sexual minority youth. The survey examined the experiences of LGBT students with regards to hearing biased, homophobic remarks, feeling unsafe because of sexual orientation or gender expression, school absenteeism, harassment and assault in school. In the survey, 70-90% of students heard “gay” being often used in a negative way and other homophobic remarks (e.g. “dyke” or “faggot”) frequently at schools. Majority of students reported verbal harassment because of their sexual orientation and gender expression, 53% also experienced harassment via electronic mediums such as text messages, emails, instant messages, or postings on social media like Facebook. Approximately 20-40% students were subjected to physical harassment (e.g. shoved, punched, kicked, injured with weapon) at school. The LGBT students reported feeling unsafe because of the hostile school environment and were 3-4 times likely to miss classes and school leading to poor grades as compared to their peers. In addition, students who were victimized reported lack of interest in pursuing higher education and suffered low self-esteem. Further, sexual minority youth reported sexual victimization including dating violence and forced sexual intercourse. It is estimated that 19% to 29% of gay and lesbian students and 18% to 28% of bisexual students experienced dating violence. Approximately 14% to 31% of gay and lesbian students and 17% to 32% of bisexual students have been forced to have sexual intercourse at some point in their lives.
Phantom Limb Pain
Phantom limb pain is pain that is perceived in a part of the body which is no longer present. It is estimated that 80 percent of amputees experience phantom limb pain. Although the term is “phantom limb pain” the feeling is often more of a burning, twisting, itching, or pressure sensation than pain. The exact mechanism of phantom limb pain is unknown although proposed mechanisms include pain origination from either the central nervous system or the peripheral nervous system. Since the exact mechanism of phantom limb pain is unknown, treating this pain may be difficult. Treatments include pharmacological and nonpharmacological. Pharmacological treatments include NSAIDs, opioids, anti-convulsants, beta-blockers, and calcium channel blockers. Non-pharmacological treatments include mirror therapy, cognitive behavioral therapy, acupuncture, guided imagery, massage, and biofeedback. Amputees experiencing phantom limb pain typically have the best outcome with a multi-disciplinary approach that includes both pharmacological and non-pharmacological management
Effect of Metformin on Body Mass Index in Adolescent Females with Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is often associated with obesity, insulin resistance, irregular menstrual periods and pelvic pain. Treatment involves hormonal methods for regulation of menstrual cycle, lifestyle changes and metformin for improving insulin resistance and weight. The aim of our study was to compare changes in body mass index (BMI) of adolescent female with PCOS treated with metformin as compared to lifestyle modification only. Participants: Adolescent and young adult females aged I0-25 years diagnosed with PCOS seen for at least two visits for at least one year on the same treatment. Based on treatment plan, participants were categorized as metformin (metformin + lifestyle changes; metformin + oral contraceptive pills + lifestyle changes) versus control group (oral contraceptive pills + lifestyle changes; lifestyle changes only). Results: Of the 464 charts reviewed, 134 participants met the inclusion criteria. The average time period between the initial and follow up visit on same treatment plan was two years (Range 1-8 years). The average age of patients at baseline (initial visit) and follow up was 15.3 and 17.7 years, respectively. The majority of participants were overweight or obese at baseline and follow up. There was not a significant difference between the metformin and control group in the number of patients who stayed in the same BMI category, went up in a BMI category, or went down in a BMI category from baseline to follow up (x - 1.93, p - 0.38). Conclusion: Treatment with metformin did not relate to changes in BMI classification over a year or more
Resident Training Curriculum in Adolescent Depression and Suicide Screening
Introduction: Routine screening of adolescents for depression and suicide risk is now considered best clinical practice. However, due to a lack of training, many physicians do not engage in screening. The goal of this curriculum is to improve learner knowledge of and comfort in adolescent depression and suicide risk assessment and management. Methods: The didactic session typically takes 60-90 minutes to complete. In addition to a teaching PowerPoint that provides instruction in both the assessment and management of adolescent depression and suicide risk, the curriculum also includes a suicide assessment and management protocol. This protocol outlines an algorithm that assists in distinguishing between individuals at high and low risk of suicide. The algorithm enables clinicians to determine the most appropriate management plan based on the assessed level of suicide risk. Results: Outcome measures indicate that the majority of residents improved their self-perceived knowledge and comfort in assessing and managing depression and suicide risk, with an average of 61.7% of residents moving from the novice to the proficient group at the conclusion of the rotation. These results reflect learners obtaining 4 weeks of supervised clinical experience after the didactic session. Discussion: This curriculum was designed for use with pediatric and internal medicine–pediatric residents during their adolescent medicine rotation but could easily be adapted for use with other learners in different settings