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The case study final wcah - copy2

  1. 1. Adolescent with special needs Free Powerpoint Templates Page 1
  2. 2. INTRODUCTION• World-wide, estimates of the number of adolescents and young adults who live with a disability vary widely.• Estimating the number of disabled young people is complex, for two reasons: a) The first is that frequently, disabled young people are grouped together with children or adults, blocking attempts to estimate their numbers as a distinct group. b)The second is that definitions of disability vary widely.• In some nations, only individuals with significant disabilities are identified; in others, even those with mild disabilities are included. Free Powerpoint Templates Page 2
  3. 3. Definition of Adolescent with special needs Defined as those (children/adolescents) who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition. And who require health and relatedservices of a type or amount beyond that required by children generally. Willis JH Adolescent with special needs Free Powerpoint Templates Page 3
  4. 4. Aetiology• The etiology of developmental disabilities and special health care needs is complex.• Adolescents may have physical impairments, developmental delays or chronic medical conditions that are caused by or associated with the following factors: Chromosome anomalies, genetic conditions Congenital infections Inborn errors of metabolism Prematurity Neurologic insults Neural tube defects Trauma Maternal substance abuse Environmental toxins• For some conditions, the etiology is unknown. These conditions may cause physical, emotional, or behavioral problems that are challenging for the child and for the family. Free Powerpoint Templates Page 4
  5. 5. PrevalenceTitle Journal ResultAdolescent with special Approximately 7-18% ofhealth needs mg/adol_ch18.pdf children and adolescent(Chapter 18) ages birthto 18 years in theWillis JH US have a chronic physical, behavioural, developmental or emotional condition causing limitation in activities, and/or requiring special care.Disabitlity Rates among Journal of Adolescent Health In the 10-14 year old groupadolescents: An International rates range from 108Comparison 1993 /100000 in Myanmar to 6726Suris J, Blum R per 100000 in Canada. Amonng 15 to 19 year old rates range from 142.6/100000 in Myanmar to 5099.5/100000 in Austria. Free Powerpoint Templates Page 5
  6. 6. The need for screening foradolescent with special needs Free Powerpoint Templates Page 6
  7. 7. Bibliograp Study Study population and Resultshy citation design methods MENTAL Literature The present preliminary study is based Findings of this comparison with HEALTH: review on a literature review of international prevalence rates of SPECIAL epidemiological features of learning learning disorders and related NEEDS AND disorders and comorbidities using the diseases show a sizable gap EDUCATION Cochrane library key word search. between real existing needs in Available statistics for learning Malaysia, and their perception. Dr. Huberta disorders from the WHO are compared The present undersupply of Peters with records for the year 2007 from the adequate service for children with ASEAN Ministry of Education in Malaysia learning difficulties is aggravated by Journal of the lack of systematic Psychiatry, developmental screening in earlyVol.11(1): Jan childhood in Malaysia.– June 2010.Mental health Cross Total of 373 of new cases from the Children with Attention Deficitdifficulties in sectional month of January to December 2007 Hyperactive Disorder (ADHD) were children: a study who attended the Psychiatry the highest disorder. Primary University Adolescent and Child (PAC) Unit, support group difficulties were the Hospital University Malaya Medical Center most common co-morbid condition experience (UMMC). noted. It is essential that extensive Norhaniza I screening of children and their MJP-Online families be done to detect familyEarly 01 -10-10 difficulties and co- morbid conditions, which would be necessary for favorable outcomes to Free Powerpoint Templates met. be Page 7
  8. 8. Study title Citation ResultsADOLESCENTS Book review It is estimated that up to 40-50% of children and adolescentsWITH SPECIAL School Public Health with special health care needs have nutrition-related riskHEALTH NEEDS University of factors or health problems.Janet Horsley Minnesota. Stang J,Willis Story M (eds) Physical conditions such as a cleft lip or palate or a disease Guidelines for process such as cystic fibrosis may limit an individual‘s ability Adolescent Nutrition to feed, digest, or absorb food. Services (2005) http://www.epi.umn.ed Drug nutrient interactions may alter digestion, absorption or the u/let/pubs/img/adol_ch bioavailability of nutrients in the diet. 18.pdf Depression may alter an individual‘s appetite and motivation to follow a specified diet plan.Prevalence and Sullivan P.B Lambert Questionnaire by parents of children age 4 to 13. 59%Severity of feeding B, Rose M, Ford constipated, 22% problems with vomiting, 31% at least 1 chestand nutritional Adams, Johnson A, infection,.problems in Griffiths P, 2000,children with Developmental Med & Feeding problems were prevalent 89% needed help withNeurological child Neurology, feeding, 56% chocked on food, 20% of parents describeimpairment 42,674-680 feeding was stressful and un-enjoyable, 28% prolonged‘Oxford feeding feeding, 8% fed through gastrostomy‘ Many of these children would benefit from nutritional assessment and management as their overall care. Free Powerpoint Templates Page 8
  9. 9. Nutritional assessment guidelineStang J, Story M (eds) Guidelines for AdolescentTemplates Free Powerpoint Nutrition Services (2005) Page 9
  10. 10. Disability and the Millennium Development Goals (MDGs)• Disability is not specifically mentioned in the MDGs, but disabled people are implicitly included.• Most development agencies acknowledge that the goals cannot be achieved without addressing the needs and rights of disabled people.• However, the relationship and relevance of disability to the MDGs is not so well articulated and acknowledged. Free Powerpoint Templates Page 10
  11. 11. Sexual and Reproductiv e HealthFree Powerpoint Templates Page 11
  12. 12. Free Powerpoint Templates Page 12
  13. 13. Overview of HIVYoung people are particularly vulnerable to HIV infection because of risky sexual behaviour and substance use, because they lack access to accurate and personalized HIV information and prevention services, and for a host of other social and economic reasons. SOURCE: UNAIDS. 2002. Report on the Global HIV/AIDS Epidemic: July 2002. GenevaYoung people aged 15–24 years accounted for an estimated 42% of new adult HIV infections worldwide in 2010. Globally, young women aged 15–24 years accounted for 64 per cent of all HIV infections among young people. SOURCE: UNICEF 2011 Free Powerpoint Templates Page 13
  14. 14. HIV - Malaysian scenario..In Malaysia, 27% of new infections are amongst teens and youth aged between 13 to 29 years old. It is likely that people infected with HIV before the age of 30 were infected in their twenties and sometimes even during their teens. SOURCE: Ministry of Health : December 2008 statisticsOf the 87 710 cumulative total of HIV cases since 1998, 2 122 (2.4%) were individuals aged less than 19 years old. 1.4% of all HIV cases were found to be between the ages of 13-19 years. In 2009, children below 19 years of age made up 3.1% (95) of 3 080 new reported HIV cases for that year.. SOURCE: UNICEF MALAYSIA: UNGASS COUNTRY REPORT 2010 Free Powerpoint Templates Page 14
  15. 15. Overview of STDs448 million new cases of curable STIs (syphilis, gonorrhoea, chlamydia and trichomoniasis) occur annually throughout the world in adults aged 15-49 years. SOURCE: WHO 2005 …….estimation of that 19 million new infections occur annually in the United States, almost one half of which occur in persons 15 to 24 years of age. This includes an estimated 2.8 million new chlamydia infections and 1.6 million new genital herpes infections SOURCE: Centers for Disease Control and Prevention (CDC) Free Powerpoint Templates Page 15
  16. 16. Sexual Health – Malaysian scenario• Todays youth are confronted with numerous issues regarding their sexual health. This is evident in studies done in Malaysia, such as the National Population and Family Planning Board Study o Reproductive Health and Sexuality in 1994 which found that adolescents aged 10 – 19 years old were already engaged in sexual activities, though the prevalence was less than 1%. Ten years down the road (2004), a similar study found that the prevalence of sexual intercourse among adolescents had risen to 2.2%; and 0.3% claimed that they had been raped or sodomised.• SPEECH BY YB DATO‘ SRI LIOW TIONG LAI MINISTER OF HEALTH MALAYSIA• AT THE 9th WORLD CONGRESS INTERNATIONAL ASSOCIATION FOR ADOLESCENT HEALTH Free Powerpoint Templates Page 16
  17. 17. WHY HIGHER RISK??• unprotected intercourse• biologically more susceptible to infection• engaged in sexual partnerships frequently of limited duration• multiple obstacles to use health care• patterns of behaviour that can undermine sexual health. Free Powerpoint Templates Page 17
  18. 18. PrevalenceFree Powerpoint Templates Page 18
  19. 19. GLOBAL SCREENING PROGRAMMES FOR STD Free Powerpoint Templates Page 19
  20. 20. MALAYSIA N ADOLESCENT HEALTH SCREENING IN PRIMARY HEALTH CARE • SARINGAN STATUS KESIHATAN (BSSK/R/1/08) • B. 1) Adakah anda mengalami masalah atau kesukaran semas membuang air kecil dan/ atau air besar • Pernahkah anda mendapat luka/ ulcer yang lambat sembuh di bahagian kemaluan • Adakah anda pernah mendapat lelehan luar biasa atau nanah dari bahagian kemaluan anda • Pernahkaj anda melakukan hubungan seks – Jika ya, jawab soalan e • Adakah anda: • Menggunakan sebarang kaedah kontraception untuk elakkan kehamilan • Bertukar2 pasangan • Melakukan hubungan sejenis Free Powerpoint Templates Page 20
  21. 21. ADOLESCENT CHILD CLINIC KOLKATA, INDIA World Health Organization (WHO) came forward in collaboration with Govt. of India (GOI) for constituting a National Task Force for Adolescents Care. Clinic based service along with outreach activities have been initiated. As a result the Clinic was born on 28th June, 2002 at Department of Pediatrics, Medical College, Kolkata India with Dr Sukanta Chatterjee as founder in-charge. Free Powerpoint Templates Page 21
  22. 22. • With a few exceptions, all adolescents in the United States can legally consent to the confidential diagnosis and treatment of STDs. In all 50 states and the District of Columbia, medical care for STDs can be provided to adolescents without parental consent or knowledge. In addition, in the majority of states, adolescents can consent to HIV counselling and testing.Source: Sexually Transmitted Diseases Treatment Guidelines, 2006 Centers for DiseaseControl and Prevention. MMWR 2006 Free Powerpoint Templates Page 22
  23. 23. SCHOOL BASED SCREENING Bringing High-Quality HIV and STD Prevention to Youth in Schools: CDCs Division of Adolescent and School Health (DASH) – SRH Screening in US1. Schools Play a Critical Role in HIV and STD Prevention2. HIV/STD Prevention Programs Can Reduce Risk Behaviors and Be Cost-Effective3. DASH Promotes Effective HIV Prevention Through Schools :• Bridge between public health and education.• Nationwide network of leaders in school-based HIV prevention. DASH provides funding and technical assistance Free Powerpoint Templates Page 23
  24. 24. Evaluation of School Based ProgrammeAUTHO STUDY TYPE& TITLE RESULTR METHODOLOGYAsbel et al School-Based Screening cross-sectional data from high prevalence of CTSexually for Chlamydia the first year of an annual infections was identified amongTransmitte Trachomatis and program offering education, Philadelphia public high schoold Neisseria Gonorrhoeae screening, and treatment for students. This programDiseases: Among Philadelphia CT and GC demonstrated the effectivenessOctober Public High School of a school-based screening2006 - Students program to identify and treatVolume these infections33 Free Powerpoint Templates Page 24
  25. 25. COMMUNITY BASE SCREENING - SOCIAL NETWORK USEXAMPLE: Youth go online to screen for STDs A program that offers teenagers and young adults the chance to order STD home-testing kits using a computer or mobile phone, is reaching youth, especially those from low-incomehouseholds.— Offering free confidential home-testingkits on the Internet appears to be the best way to get teens and young adults to undergo screening for sexually transmitted infections. An online program, I Want the Kit, started inBaltimore in 2004 lets men and women in their teens or 20s order confidential home-testing kits for the most common STDs, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Free Powerpoint Templates Page 25
  26. 26. Evaluation of self screening methodsAUTHOR TITLE RESULTandDESIGNGaydos at el Chlamydia Trichomatis Age specific Positivity for internet age groups was muchSexually Prevalence in Women Who Usedd an higher than those for family planning ageTransmitted Internete Based Self Screening groups. The positivity for internet participantsDiseases. Program Compare to Women Who ranged from a low of 4.4% in Baltimore in38(2):74-78, Where Screend In Family Planning 2005 to a high of 15.2% Baltimore in 2007.February 2011 Clinics Family planning clinic prevalence in Baltimore and Maryland ranged from a low ofCross sectional 3.3% in Baltimore in 2006 to a high of 5.5%study in Baltimore in 2008.CM Holland et al Self Collected Vaginal Swabs for the Detection Twenty-four percent of sexually active subjects had of Multiple Sexually Transmitted Infection In one or more infections diagnosed by Only 30% ofJournal of Adolescent Girl subjects with infections had pelvic exams whilePediatric detained; therefore 70% of girls with infections wouldand Adolescent G have been missed in the absence of the self-testingynecology, Volum option. The self-collection technique was acceptablee 15, Issue to 95% of subjects.5, December STI testing using self-collected vaginal specimens is2002, Pages 307- highly acceptable to adolescent girls, and can313 dramatically increase the detection rate for these Free Powerpoint Templates infections when pelvic exams are not three treatableCross sectional performed. Page 26study
  27. 27. Screening at high risk areasauthor Title Study Design& Method conclusion Original Research The Impact of Cross Sectional Study Adolescents who tested positive forArticle Community Base From August 2006 to January an STI reduced their number ofJournal Sexually Transmitted 2008 vaginal and oral sex partners andof Adolescent Health, Infection Screening 636 sexually active African the probability of unprotected sexVolume 47, Issue Result On Sexual American adolescents (age, 14– Community-based STI screening1, July 2010, Pages Risk Behaviour of 17) from community-based can help to reduce sexual risk12-19 African American organizations in two mid-sized behavior in youth who Adolescents U.S. cities. Participants were test positive for STIs. Alternative screened for STIs and approaches will be needed to completed an audio computer- reduce risk behavior in youth who assisted self-interview. test Approximately 85% of negative but who are nevertheless participants completed 3- and 6- at risk for acquiring an STI month follow-up assessments. Free Powerpoint Templates Page 27
  28. 28. ENGLAND• The National Chlamydia Screening Programme (NCSP) is an NHS sexual health programme that was set up by the Department of Health in England in 2003.• The NCSP aims to ensure that all sexually active young people under 25 are aware of chlamydia, its effects, and have access to free and confidential testing services.• Since the launch of the programme nearly one and a half million chlamydia tests have been performed by the NCSP Free Powerpoint Templates Page 28
  29. 29. Evaluation of Screening ProgrammeAUTHOR TITLE Study population & Result MethodLorimer K. et "It has to speak to Men and women aged The gender differenceal peoples everyday 16-24 years attending in willingness toSexual life...": qualitative study non-medical settings participate inTransmitted of men and womens were invited to nonmedical screeningInfection willingness to participate in urine- that extending the2009 participate in a non- based screening and reachJun;85(3):20 medical approach to later to participate in a of screening could1-5 Chlamydia follow-up in-depth certainly assist in trachomatis interview. bringing more young screening men into screening but may not necessarily destigmatise screening for women. As such, the potential benefits to men must be Free Powerpoint Templates considered in the context of the potential 29 Page
  30. 30. HIV SCREENING PROGRAMS Free Powerpoint Templates Page 30
  31. 31. AUTHO TITLE STUDY RESULTR POPULATION& METHODMollen Description of a health educator A total of 1287 patients were approached forC. et al novel pediatric provided sexual potential counseling and testing during the firstAIDS emergency health counseling in 3 years of the project. Of these, 643 (50.0%)Patient department- a 30-minute agreed to meet with the health educator andCare based HIV session as well aswere counseled. Three hundred eighteenSTD 200 screening optional HIV testing (49.5%) of these patients agreed to HIV8 program for and test results to testing. One hundred eighty-seven (58.8%)Jun;22(6 adolescents. patients aged 14-24 patients returned for follow-up. Two patients):505-12 years, and (0.6%) whose previous HIV status was arranged necessaryunknown tested positive for HIV; both of these follow-up care forpatients were successfully linked to care. Fifty- adolescents who six health care providers (17.3% of ED tested positive for providers) were surveyed about their opinions HIV of the program; although 93% were supportive of the program, several respondents were concerned about the appropriateness of HIV testing in the ED setting. This project suggests that, if appropriate resources are available, a dedicated HIV counseling and testing program can be successfully implemented in a busy, urban, pediatric ED. Providing access to these services to high-risk adolescents has the Free Powerpoint Templates potential to significantly impact their health 31 Page
  32. 32. Author Title Method ConclusionBeckmen The retrospective chart review of all Coincident with theK.R et al effectiveness of patients 12-18 years of age seen institution of anWMJ. 2002;1 a follow-up in the ED between April 1, 1993 appropriate follow-up01(8):30-4. program at and March 31, 1997 with ICD-9 system, HIV testing in the improving HIV codes for STD. The follow-up ED increased and follow- testing in a program started April 1, 1995. up of these patients pediatric Rates of HIV testing were improved. However, emergency compared between the two years further steps should be department. before and after the institution of taken to improve the HIV the follow-up program to testing in the pediatric ED determine whether the follow-up program had an impact on the rate of HIV testing.Tanya K.L et Changes in Retrospective medical record The HIV testing ratesal Human review increased significantlyArch Pediatr Immunodeficienc 13 to 22-year-old sexually following publication ofAdolesc Med. y Virus experienced patients. recommendations for2010;164(9): Testing Rates routine testing and further870-87 Among Urban increased following Adolescents introduction of rapid After testing. Combining Introduction of routine and rapid testing Routine and strategies may increase Rapid Testing uptake of HIV testing Free Powerpoint Templates among adolescents in 32 Page primary care settings
  33. 33. Barriers to Adolescents‘ Use of Reproductive Health Services in Three Bolivian Cities From de Belmonte, L.R., E.Z. Gutierrez, R. Magnani and V. Lipovsek. January 2000. Barriers toAdolescents‘ Use of Reproductive Health Services in Three Bolivian Cities. Washington, DC: FOCUS on Young Adults/Pathfinder International PHYSICAL ECONOMIC HEALTH CARE PHYCOSOCIAL SYSTEM Free Powerpoint Templates Page 33
  34. 34. BARRIERS AND ISSUESIn general, studies reported low levels of awareness and knowledge of sexually transmitted diseases, with the exception of HIV/AIDS. Although, as shown by some of the findings on condom use, knowledge does not always translate into behaviour change, adolescents sex education is important for STD prevention, and the school setting plays an important role. Beyond HIV/AIDS, attention should be paid to infections such as chlamydia, gonorrhoea and syphilis FN Samkange- Zeeb et al 2011 Free Powerpoint Templates Page 34
  35. 35. ―The higher prevalence of STDs among adolescents also may reflect multiple barriers to accessing quality STD prevention services, including lack of health insurance or ability to pay, lack of transportation, discomfort with facilities and services designed for adults, and concerns about confidentiality. Traditionally, intervention efforts have targeted individual-level factors associated with STD risk which do not address higher-level factors(e.g., peer norms and media influences) that may also influence behaviors.‖ DiClemente RJ et al 2007;32 ―Interventions for at-risk adolescents and young adults that address underlying aspects of the social and cultural conditions that affect sexual risk-taking behaviors are needed, as are strategies designed to improve the underlying social conditions themselves. “ Sieving RE et al 2011 and Upchurch DM et al 2004 Free Powerpoint Templates Page 35
  36. 36. Perceived barriers to care included lack of knowledge of STDs and available services, cost, shame associated with seeking services, long clinic waiting times, discrimination, and urethral specimen collection methods. Perceived features of ideal STD services included locations close to familiar places, extended hours, and urine-basedscreening. Television was perceived as the most effective route of disseminating STD information. Further research is warranted to evaluate improving convenience, efficiency, andprivacy of existing services; adding urine-based screening and new services closer to neighborhoods; and using mass media to disseminate STD information as strategies to increase STD screening. E.C Tilson et al Adolescents who view STDs as stigmatizing have a reduced likelihood of being screened, but it is unclear whether this relationship reflects their care seeking or providers practice of offering STD screening at a routine health visit (Cunningham SD 2009) Free Powerpoint Templates Page 36
  37. 37. HOW TO IMPLEMENT THE BEST INTERVENTION PROGRAM? Free Powerpoint Templates Page 37
  38. 38. A Review of STD/HIV Preventive Interventions for Adolescents:Sustaining Effects Using an Ecological Approach Ralph J. DiClemente, L.F. Salazar and R.A. Crosby J. Pediatric. Psychology 2007 Behavioral intervention programs to reduce adolescent sexual risk behaviors have shown statistically significant reductions in the short-term; however, longer-term follow-up has demonstrated that effects diminish. One criticism has been the reliance on individual-level models. Free Powerpoint Templates Page 38
  39. 39. Multiple influences underlying adolescent sexual-risk behavior. DiClemente R J et al. J. Pediatr. Psychol. 2007;32:888-906 Free Powerpoint Templates© The Author 2007. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: Page 39
  40. 40. ECOLOGICAL APPROACH IN STD/ HIV PREVENTIVE INTERVENTION (a) the Microsystem—the roles and characteristics of the developing individual, (b) the Mesosystem—the settings with which the developing personCultural norms and traditions, large-scale policies and laws, economic interacts: conditions, and the political climate • setting aside specific clinic hours for adolescents may enhance accessibility to health care •to target not adolescents per se, but rather their sexual networks (Rothenberg, 2001). (c) the Exosystem—settings with which the individual does not interact but nevertheless have an effect on the persons‘ development •parents to participate (d) the Macrosystem—cultural values and larger societal factors that influence the individual • Cultural norms and traditions, large-scale policies and laws, economic conditions, and the political climate. Free Powerpoint Templates can either serve to restrain and/or promote individual behaviors Page 40
  41. 41. Can Malaysia Do It? Free Powerpoint Templates Page 41
  42. 42. High RiskBehavior Free Powerpoint Templates Page 42
  43. 43. INTRODUCTIONKey FactsMore than 2.6 Million young people aged 10-24 die every year, mostly frompreventable causesTobacco useEstimated 150 million young people use tobaccoNumbers increasing globally , especially among womenCurrent practices – laws prohibiting smoking in public places, banning tobaccoadvertising and raising prices of tobacco productsQuit smoking campaignsAlcohol and substance abuseStarts at a young age – 13-15 yearsIncreases risky behaviors – causing road traffic accidents, domestic andinterpersonal violence and premature deathsCurrent practices – banning alcohol advertisements, regulations of place ofsale, barring access Free Powerpoint Templates Page 43
  44. 44. INTRODUCTIONViolence and accidentsLeading causes of death particular young malesApproximately 430 young people aged 10-24 die everyday due to interpersonalviolenceFor each death, 20-40 youths require hospital treatmentCurrent practices – nurturing relationships within family, providing training in lifeskills, reducing access to firearmsRoad traffic injuries cause an estimated 700 young people to die everydayCurrent practices – advertising on safe road driving skills, strict lawenforcement, prohibition of driving under influenceWHO Fact Sheet –August 2011Young people: health risks and solutions Free Powerpoint Templates Page 44
  45. 45. PREVALENCE OF HIGH RISK BEHAVIOUR Free Powerpoint Templates Page 45
  46. 46. SMOKING Authors Study type & Title Findings methodologyDanielle E Ramo, 163 articles Tobacco and Marijuana Most show anHoward Liu, examined tobacco use among adolescents association of tobaccoJudith J Prochaska and marijuana co- and young adults: a and marijuana as a(2011) Clinical use (36%) systematic review of their strong relationship.Psychology Review co-useYorulmaz F et. al. In Turkey cross Smoking among 30.46% smoked; boys(2002) Swiss Med sectional community adolescents: relation to smoked more thanWeekly based study 883 school success, socio girls; average of 5.65 middle and high economic status, cigarettes/day school students nutrition and self esteemKarekla M Cross sectional Smoking prevalence and 6% middle school(2009) European study tobacco exposure among students and 24% inJournal of Public adolescents in Cyprus high school studentsHealth Mostly due to media exposure of smoking Free Powerpoint Templates Page 46
  47. 47. SUBSTANCE ABUSE Authors Study type & Title Findings methodologyPedrelli P Cross sectional Compulsive alcohol use 82 (994) college(2010) The American study as part of a and other high-risk students reportedJournal on larger study. behaviors among college compulsive use ofAddictions, 20, 14- Recruited during a students illicit drugs.20. mental health 79.3% marijuana; 4.9% screening in three cocaine; 1.2% universities in U.S. methamphetamine; using Consumptive 1.2% heroin; 30.8% Habits pain relievers; 26.9% Questionnaire psychostimulants; 3.8% benzodiazepinesUlbrich TR (2010) National Survey on Prevalence of Substance 9.5% adolescentshttp://www.uspharm Drug Use and Health Abuse in the Adolescent aged 12-17 Population using illicit drugseatured%20articles/c/19742/ Free Powerpoint Templates Page 47
  48. 48. VIOLENCE AND ABUSE Authors Study type & Title Findings methodologyNayara Serhan Cross sectional Adolescent health risk - Males are more(2010) Bahrain study screening in primary care involved in physicalMedical Bulletin, Interviewed setting fights than females32(3) General medical and - 77% adolescents do physical not use car seat belts examinationsMiller E (2010) Cross sectional Intimate partner violence 40% reportedMatern Child Health survey among and health-care seeking experiencing someJ, 14, 910-917 women age 14-20 patterns among female sort of physical and years users of urban adolescent sexual violence from clinics their male intimate partner 36% reported not seeking care for these issues 75% of the respondents felt that doctors should ask about their relationships Free Powerpoint Templates Page 48
  49. 49. THE MALAYSIAN SCENARIO Authors Study type & Title Findings methodologyLee LK et al. Cross sectional Smoking among Prevalence was 14 %;(2005)Asia Pacific study among 4500 secondary school 37.8% started at theJournal of Public students in Negeri students in Negeri age 13-14; MalesHealth, 17(2), 130- Sembilan Malaysia Sembilan, Malaysia higher compared to136 females; seen among high risk teens; associated with alcohol, substance abuse and sexual activityMahmood Nazar Cross sectional Pattern of Substance and More than 77.3%Mohamed study in Northern Drug Misuse Among reported never usedSabitha Marican states of Peninsular Youth in Malaysia any of the substancesNadiyah Elias among all types of Males showed higherYahya Don school going youths use than femalesJurnal Antidadah Using Substance No difference betweenMalaysia and Drug Misuse Malays and Non Index ( max score 54 Malays never used at all) Associated with Malaysia scored 29. displine problems, living arrangements Free Powerpoint Templates and alcohol use Page 49
  50. 50. THE MALAYSIANSCENARIO Authors Study type & Title Findings methodologyWong Li Ping (2011) Street outreach Socio demographic and Street racing ageBMC Public Health, interviewer- behavioral characteristics ranged from 12-3511, 446 administered survey of illegal motorcycle years; 50.1% stunt street racers in Malaysia riding and 35.8% consumed alcohol while riding; 78.3% cigarette smoking; 27.8% alcohol; 18.8% recreational drug useLai Kah Lee et al. Cross sectional Violence among 27.9% physical fights;(2007) Ann Acad Med survey involving Malaysian adolescents 6.6%had been injuredSingapore, 36, pp. 4500 students in a fight; 5.9% carried169-74 a weapon; 18.5% had their money stolen in the past year; 55% had been involved in theft. Free Powerpoint Templates Page 50
  51. 51. THE MALAYSIANSCENARIO Authors Study type & Title Findings methodologyDr. Hj.Azimi Hamzah Cross sectional Situation of Girls and Age 15-17(2007) Malaysian study from various Young Women in Smoking31.7%Youth Report data sources Malaysia Alcohol 13.6% Illegal drugs 7.7% Age 20-25 Smoking 38.5% Alcohol 25.1% Illegal drugs 12.9%Ikechukwu UU (2009) 242 teenagers from Relationship between Found a positiveMasters thesis UPM secondary schools bullying, victimization, correlation between in Selangor prosocial behavior and depression and depression among bullying teenagers in Selangor Malaysia Free Powerpoint Templates Page 51
  52. 52. Free Powerpoint Templates Page 52
  53. 53. HEALTH SCREENING FOR ADOLESCENTS Free Powerpoint Templates Page 53
  54. 54. HIGH RISK SCREENING• Adolescent health screening was done in Minneapolis in a clinical setting.• Assessed for biomedical, psychosocial, physical risks, substance abuse and sexual behavior.• Interview based questionnaire and medical records and per AMA guidelines.• Results – poor results from private settings than family and govt settings. Primary care physicians were insufficiently trained in youth issues.Robert Wm Blum et. al. (1996) Don‘t Ask,They Won‘t Tell: The Quality of AdolescentHealth Screening in Five Practice Settings, American Journal of Public Health, 86,pp.1767-1772. Free Powerpoint Templates Page 54
  55. 55. HIGH RISK SCREENING190 adolescents, 12-18 years, in the NetherlandsCAGE-aid a standardized screening procedure to assessthe substance abuse problemAdolescents enrolled into a mental health centreResults – CAGE was an appropriate instrument to screenfor substance abuse disorder – sensitivity 91% andspecificity 98%This screening instrument picked up a prevalence of 11-12% of substance abuseCouwenbergh C (2009) Screening for substance abuse among adolescents Validityof the CAGE-AID in Youth Mental Health Care, Substance Use and Misuse, 44, 823-834. Free Powerpoint Templates Page 55
  56. 56. HIGH RISK SCREENINGThe most frequently used screening tool in Massachusetts is the CRAFFTscreening tool.It is used for screening alcohol and other drugsCRAFFT score of 2 or more is high risk and needs a psychiatric referral and ison evaluation and follow up program1) Have you ever ridden in a CAR driven by someone (including yourself) who was―high‖ or had been using alcohol or drugs?2) Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?3) Do you ever use alcohol or drugs while you are by yourself, or ALONE?4) Do you ever FORGET things you did while using alcohol or drugs?5) Do your family or FRIENDS ever tell you that you should cut downon your drinking or drug use?6) Have you ever gotten into TROUBLE while you were using alcohol or drugs? Free Powerpoint Templates Page 56
  57. 57. YRBSS• Youth Risk Behavior Surveillance System (YRBSS)• The Youth Risk Behavior Surveillance System (YRBSS) monitors six types of health-risk behaviors that contribute to the leading causes of death and disability among youth and adults, including—• Behaviors that contribute to unintentional injuries and violence• Tobacco use• Alcohol and other drug use• Sexual risk behaviors• Unhealthy dietary behaviors• Physical inactivity• YRBSS also measures the prevalence of obesity and asthma among youth and young adults.• YRBSS includes a national school-based survey conducted by CDC and state, territorial, tribal, and local surveys conducted by state, territorial, and local education and health agencies and tribal governments. Free Powerpoint Templates Page 57
  58. 58. HIGH RISK SCREENING IN MALAYSIAHigh risk screening is one of the component in AdolescentHealth Screening that is done in all primary health clinics in MalaysiaPart Adakah anda mengambil perkara berikut? A)Rokok B)Alcohol C)Dadah D)Lain2 C2Part Adakah anda menunggang motosikal danC3 memandu kereta dengan cara merbahaya?Part Adakah anda pernah didera sama ada secaraC6 emosi, fizikal, seksual atau dibuli? Free Powerpoint Templates Page 58
  59. 59. LAW & POLICIES Free Powerpoint Templates Page 59
  60. 60. TOBACCO• National Tobacco Control Programme• Reduce uptake of smoking by young people• Increasing tobacco taxes• WHO World No Tobacco Day 31 May 2007• Control of Tobacco Product Regulation 2004• Code of Practice (Indoor Air Quality)• 1994, Legal smoking age is 18 in Malaysia• 1969, warning labels a must on packs• NO laws for adolescent health screening Free Powerpoint Templates Page 60
  61. 61. ALCOHOL AND SUBSTANCE ABUSE• Islam being the official religion it is bound that alcohol consumption is ‗haram‘.• Under the Syariah Law caning and penalty fine is advocated• Maximum blood alcohol concentration is 0.8• Ban on advertising in national radio or television• Minimum purchase age is 18, no limit on drinking age in Malaysia• No laws on prohibition of drinking for non muslims• Drug Act 1952 –death penalty for traffickers• No laws specifically for adolescent health screening Free Powerpoint Templates Page 61
  62. 62. VIOLENCE• Child Act 2001• Juvenile Courts Act 1947 previously- For criminal proceedings, age below 10 complete immunity, 10-12 partial immunity and >12 they are prosecuted.• No laws for health screening Free Powerpoint Templates Page 62
  63. 63. INTERVENTIONS Free Powerpoint Templates Page 63
  64. 64. “Old age is like everything else. To make a success of it, you have got to start young” -Theodore Roosevelt- Free Powerpoint Templates Page 64
  65. 65. SMOKING INTERVENTIONSAuthor/s Title Study design Intervention FindingsRoger E. Thomas School based Systematic review Intervention of Result – those inRafael Perera programmes for 94 RCTs social influences the intervention(2008) preventing 3 Good Quality and social group smoked smoking competences less than the Classroom control communication, community and family interventionsRoger E. Thomas Family based Systematic review Showed positiveDiane Lorenzetti program for 22 RCTs effects of family(2008) smoking 4 Good Quality intervention prevention Free Powerpoint Templates Page 65
  66. 66. SMOKING INTERVENTIONSAuthor/s Title Study design Intervention FindingsMarta Civljak Internet based 20 RCTs and Only 3 involvedAziz Sheikh intervention quasi randomized adolescents andLindsay F Stead trials inconclusiveJosip Car findings(2010)Chris Lovato Impact of tobacco 19 Longitudinal Increases theAllison Watts advertising and studies likelihood ofLindsay F Stead promotion smoking among(2011) adolescentsJongSerl Chun Smoking among Meta analysis of Smoking Importance ofJoseph Guydish adolescents in 19 RCTs cessation addressingYa-Fen Chan substance abuse campaigns – as smoking(2007) treatment: a study those who smoke component in of programs, were 8x more substance abuse policy and likely to use drugs centres prevalence and 11x more likely to consume alcohol Free Powerpoint Templates Page 66
  67. 67. SUBSTANCE ABUSE INTERVENTIONSAuthor/s Title Study design Intervention FindingsRoger E Thomas Mentoring Systematic review Less use of illegalDiane Lorenzetti adolescents to 4 RCTs out of drugsWendy Spragins prevent drug and 2113 abstracts 2 found reduced(2011) alcohol use rate of alcohol initiation 1 found reduced rate of drug usageSilvia Minozzi Detoxification 2 trials comparing CurrentlyLaura Amato treatment for buprenorphine Methadone is theMarina Davoli opiate dependent and clonidine norm but no(2009) adolescents No TRIAL using systematic review Methadone Free Powerpoint Templates Page 67
  68. 68. SUBSTANCE ABUSE INTERVENTIONSAuthor/s Title Study design Intervention FindingsSilvia Minozzi Psychosocial Systematic review Ongoing stageLaura Amato treatment forSimona Vecchi drugs and alcoholMarina Davoli abusing(2011) adolescentsNyanda McBride A systematic Systematic review Classroom based Has an impact on(2002) Health review of school 69 studies drug education young peoplesEducation drug education involving goals, behavior,Research police officers, decreases use, effective. Free Powerpoint Templates Page 68
  69. 69. Free Powerpoint Templates Page 69
  70. 70. VIOLENCE AND ABUSE INTERVENTIONSAuthor/s Title Study design Intervention FindingsSusan Family and Systematic review Family andWoolfenden parenting 8 trials parentingKatrina J Williams interventions in Involving 749 interventionsJennifer Peat children and adolescents reduces time adolescents with spent in conduct disorder institutions and and delinquency significant aged 10 – 17 reduction in being rearrested Free Powerpoint Templates Page 70
  71. 71. CONCLUSION Free Powerpoint Templates Page 71
  72. 72. Why invest in adolescent health and development?1. Investing in adolescent health and development yields benefits for the adolescent and for society Adolescents represent over 20% of the total population in most countries of the Western Pacific Region. They are a vast current and future resource for their countries. Adolescence carries the highest risks of morbidity and mortality from certain causes, including accidents and injuries, early pregnancies and sexually transmitted infections. This is an important reason to focus health prevention efforts on adolescents. Healthy and developed adolescents have a better chance of becoming healthy, responsible, and productive adults, leading to greater skills, fewer work days lost to illness, longer working lives and increased productivity and progress. Free Powerpoint Templates Page 72
  73. 73. 2. Investing in adolescent health anddevelopment promotes equity and social justice Adolescents health needs are qualitatively different from those of other age groups. They face puberty, rapid emotional development, increasing independence, and a range of new choices. Adolescents are a heterogenous group who live in varying situations and have different needs. Gender inequalities can influence the pace and quality of adolescent health and development. For example, household-level, gender-based discrimination in health and nutrition can result in anaemia, a prevalent condition among young girls in the Region. In settings where early marriage is the norm, early and repeated pregnancies put adolescent girls health and survival at risk. At the same time, ideals of "macho"behaviour may expose adolescent boys to greater risk of violence and injury. Free Powerpoint Templates Page 73
  74. 74. 3. Investing in adolescent health anddevelopment promotes human rights Adolescents have basic rights to health and development. These rights are, on their own, an important reason to invest in adolescents. Giving attention to the health and development of adolescents promotes the realization of their rights in other areas too, including their rights as children, women and workers. Free Powerpoint Templates Page 74
  75. 75. Other reasons why we need to invest in the health anddevelopment of adolescents They are a vulnerable group of population Helps prevent deaths that occur globally due to road traffic injury, violence, substance abuse and chronic tobacco use. Improve the health and well-being of millions of adolescent Promote the adoption of healthy lifestyles They is economic benefit is helping adolescents as they in turn are a return on investment by harnessing a healthy workforce Increases the educational and employment opportunities Being a signatory to the UN Convention to the Rights of a Child which clearly states that adolescents have the right to obtain the health information and services they need to grow and develop to reach their full potential Free Powerpoint Templates Page 75
  76. 76. GAPS IN SCREENING• Political Commitment• Enforcement of policies and legislations• Specific target groups actions• Family and community participation• Monitoring and evaluation Free Powerpoint Templates Page 76
  77. 77. RECOMENDATIONSThe American Medical Association has brought out Guidelines for AdolescentsPreventive Services (GAPS) in 1997.It is a comprehensive set of recommendations developed to provide aframework for the organization and content of clinical preventive healthservices.Topics addressed by GAPS :- Promoting parent‘s ability to respond to health needs of their adolescents Promoting adjustment to puberty and adolescence Promoting safety and injury prevention Promoting physical fitness Promoting healthy dietary habits and preventing eating disorders and obesity Promoting healthy psychosexual adjustment and preventing the negative health consequences of sexual behaviors Preventing hypertension Preventing hyperlipidemia Free Powerpoint Templates Page 77
  78. 78. KEY HOME MESSAGES1. As many of the common morbidities and moralities of adolescence are related to preventable health conditions associated with behavioral, environmental and social causes, it is important that preventive services for this age group reflect these issues.2. It is important to both reinforce positive health behaviors (e.g. exercise and good nutrition) while discouraging potentially health-risk behaviors (e.g. unsafe sexual practices, smoking, unsafe driving etc.).3. As lifetime habits may form during this age group, it is an important time to implement health promotion and preventive services.4. Evidence based research on preventive services guidelines is only in its infancy. This is an important area of research given the limitation on health resources and the focus on evidence-based medicine. Free Powerpoint Templates Page 78
  79. 79. THANK YOU Free Powerpoint Templates Page 79
  80. 80. References:1. WHO 2001. A Framework for the Integration of Adolescent Health and Development Concepts Into Pre- service Health Professional Educational Curricula WHO Western Pacific Region.2. Jackson Allen P L and McGuire L. Incorporating Mental Health Checkups Into Adolescent Primary Care Visits. Pediatr Nurs. 2011;37(3):137-140.3. R M Friedman and K Kutash. Challenges for child and adolescent mental health. Health Affairs, 11, no.3 (1992):125-1364. Nayara Serhan. Adolescent Health Risk Screening in Primary Care Setting. Bahrain Medical Bulletin, Vol. 32, No. 3, September 20105. Hui Cao et al. Screen time Screen time, physical activity and mental health among urban adolescents in China. Preventive Medicine Journal, Issues 4-5, 20116. World Health Organization. Child and Adolescent Mental Health Policy and Plans, 2005.7. The 6th National Public Health Conference 2011 . MJPHM Official Journal of Malaysian Public Health Physicians’ Association8. Yong, F., Wong, H. K., & Chow, K. Y. (2009). Prevalence of adolescent idiopathic scoliosis among female school children in Singapore. Annals Academy of Medicine Singapore, 38(12), 10569. Wong, H. K., Hui, J. H. P., Rajan, U., & Chia, H. P. (2005). Idiopathic scoliosis in Singapore schoolchildren: a prevalence study 15 years into the screening program. Spine, 30(10), 118810. Sabirin, J., Bakri, R., Buang, S., Abdullah, A., Ortho, P., & Shapie, A. (2010). School Scoliosis Screening Programme-A Systematic Review. Med J Malaysia, 65(4), 261-26711. Plaszewski, M., Nowobilski, R., Kowalski, P., & Cieslinski, M. (2012). Screening for scoliosis: different countries‘ perspectives and evidence-based health care. International Journal of Rehabilitation Research, 35(1)12. Adolescent School Screening for Scoliosis in Minnesota. Review of literature and current practice recommendations. Minnesota Department of Health Community& Family Health Division, Maternal-Child health section (2008). Retrieved February 20, 2012 from tiveness_of.10.aspx Free Powerpoint Templates Page 80
  81. 81. References:15. Rahimah, A. (2011). Thalassaemia Screening Among Students in A Secondary School in Ampang, Malaysia. Med J Malaysia, 66(5), 52316. De Silva, S., Fisher, C. A., Premawardhena, A., Lamabadusuriya, S. P., Peto, T. E. A., Perera, G., et al. (2000). Thalassaemia in Sri Lanka: implications for the future health burden of Asian populations. The Lancet, 355(9206), 786-79117. Lau, Y. L., Chan, L. C., Chan, Y. Y. A., Ha, S. Y., Yeung, C. Y., Waye, J. S., et al. (1997). Prevalence and genotypes of α-and β-thalassemia carriers in Hong Kong—implications for population screening. New England Journal of Medicine, 336(18), 1298-130118. Delatycki, M. B., Powell, L. W., & Allen, K. J. (2004). Hereditary hemochromatosis genetic testing of at-risk children: what is the appropriate age? Genetic Testing, 8(2), 98-10319. Elton, P., Baloch, K., & Evans, D. (1989). The value of screening for beta thalassaemia trait amongst Asian Muslim school children. Journal of Reproductive and Infant Psychology, 7(1), 51-5320. WHO. Asia Pacific Disability Rehabilitation Journal21. UNICEF. An Overview of young People Living with Disabilities: Their Needs and Their Rights.22. Australian institute of health and welfare23. Thomas, Philippa , " Disability, Poverty and the Millennium Development Goals: Relevance, Challenges and Opportunities for DFID" (2005). GLADNET Collection. Paper 256.24. Schwandt, P., Bertsch, T., & Haas, G. M. (2010). Anthropometric screening for silent cardiovascular risk factors in adolescents: The PEP Family Heart Study. Atherosclerosis, 211(2), 667-67125. Wang, Y. C., Cheung, A. M., Bibbins-Domingo, K., Prosser, L. A., Cook, N. R., Goldman, L., et al. (2011). Effectiveness and cost-effectiveness of blood pressure screening in adolescents in the United States. The Journal of pediatrics, 158(2), 257-264. e25726. WHO Fact Sheet –August 2011Young people: health risks and solutions27. Danielle E Ramo, Howard Liu,Judith J Prochaska (2011), Tobacco and Marijuana use among adolescents and young adults: a systematic review of their co-use, Clinical Psychology Review. Free Powerpoint Templates Page 81
  82. 82. References26. Yorulmaz F et. al. (2002) Smoking among adolescents: relation to school success, socio economic status, nutrition and self esteem,Swiss Med Weekly.27. Karekla M (2009) European Journal of Public Health, Smoking prevalence and tobacco exposure among adolescents in Cyprus.28. Pedrelli P (2010) Compulsive alcohol use and other high-risk behaviors among college students, The American Journal on Addictions, 20, 14-20.29. Ulbrich TR (2010) Prevalence of Substance Abuse in the Adolescent Population Nayara Serhan (2010) Adolescent health risk screening in primary care setting, Bahrain Medical Bulletin, 32(3)31. Miller E (2010) Intimate partner violence and health-care seeking patterns among female users of urban adolescent clinics, Matern Child Health J, 14, 910-917.32. Lee LK et al. (2005) Smoking among secondary school students in Negeri Sembilan, Malaysia, Asia Pacific Journal of Public Health, 17(2), 130-13633. Youth Risk Behaviour Surveillance System – Centre for Disease Prevention and Control Mahmood Nazar Mohamed, Sabitha Marican, Nadiyah Elias, Yahya Don , Pattern of Substance and Drug Misuse Among Youth in Malaysia, Jurnal Antidadah Malaysia.37. Wong Li Ping (2011) Socio demographic and behavioral characteristics of illegal motorcycle street racers in Malaysia, BMC Public Health, 11, 44638. Lai Kah Lee et al. (2007) Violence among Malaysian adolescents, Ann Acad Med Singapore, 36, pp. 169-7439. Dr. Hj.Azimi Hamzah (2007) Situation of Girls and Young Women in Malaysia, Malaysian Youth Report Free Powerpoint Templates Page 82
  83. 83. References36. Ikechukwu UU (2009) Relationship between bullying, victimization, prosocial behavior and depression among teenagers in Selangor Malaysia, Masters thesis UPM37. Maklumat Dadah 2010 AADK Malaysia38. Robert Wm Blum et. al. (1996) Don‘t Ask,They Won‘t Tell: The Quality of Adolescent Health Screening in Five Practice Settings, American Journal of Public Health, 86, pp.1767-177239. Couwenbergh C (2009) Screening for substance abuse among adolescents Validity of the CAGE-AID in Youth Mental Health Care, Substance Use and Misuse, 44, 823-834.40. Youth Risk Behaviour Surveillance System (2000) US Department of Health and Human Services.42. The CRAFFT Screening Tool. The Centre for Adolescents Substance Abuse and Research, Free Powerpoint Templates Page 83
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