adolescent.ppt
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1、Adolescent Health ProblemsShijingshan hospitalwangrongwordsn nonsetonsetn nimpoverishimpoverishn npubertypubertyn ntempotempon nhormonalhormonaln ngonadgonadn nadrenaladrenaln nsomaticsomaticn nmanifestationmanifestationn nchronologicchronologicn npubicpubicn ngenitalgenitaln nmeanmeann nmenarchemen
2、archen nspermarchespermarchen nspurtspurtn nroentgenogramroentgenogramn ntruncaltruncaln npelvicpelvicn ncardiaccardiacn nlarynxlarynxn nanterioranteriorn nthyroidthyroidn ncartilagecartilagen ntumultuoustumultuousn ndisruptiondisruptionn nintimacyintimacyn nsequelasequelan negocentricegocentricn ns
3、ociocentricsociocentricn n Adolescence is the period between childhood and adulthood.this period is usually defined by the rapid onset of biological and psychological growth and development prior to or at the second decade of life and ending before age 20.n nCurrently,the adolescent population in th
4、e United States is the group least likely to have health insurance.Physicians need a careful understanding of the biological and psychosocial changes of adolescence,the associated environmental changes and the legal and ethical issues that affect the provision of health care services to adolescents.
5、n nPuberty is defined as the sequential biological processes that ultimately lead to reproductive capacity.the onset and tempo of puberty vary by sex,population group,and individual.n nDuring puberty,major alterations in the hormonal regulatory systems in the central nervous system,gonads,and adrena
6、ls cause changes in skeletal growth and body composition and the acquisition of secondary sexual characteristics.n nThe mechanisms responsible for the initiation of puberty through activation of the hypothalamic-pituitary-gonadal axis remain undefined.n nThe sexual maturity ratings(SMRs)of Marshall
7、and Tanner are helpful in monitoring the development of secondary sexual characteristics of pubertal maturation,which are the somatic manifestations of adrenal and gonadal activity.these ratings correlate more closely with bone age than chronologic age.n nThe SMRs for girls are based upon breast and
8、 pubic hair development,each in five stages.The ratings for boys are based upon genital and pubic hair development.2009年8月24日wordn naltruisticaltruisticn nchronicallychronicallyn npubescencepubescencen ndeferdefern nheterosocialheterosocialn ntestosteronetestosteronen nirritableirritablen nmasturbat
9、orymasturbatoryn ninitiateinitiaten ncontraceptioncontraceptionn npsychiatricn ndetrimentaln nemancipaten nmortalityn nmorbidityn nhomiciden nninefoldn nlean body massn nStroke volumen ncorrelate withn nbe associated withn naccount for n nAssessment of skeletal growth during adolescence should be do
10、ne through a height velocity curve with consideration of the sexual maturity rating.Bone age can be determined through the utilization of hand roentgenograms.Psychological developmentPsychological developmentn nThe functional and cognitive changes do not necessarily correlate with physical maturatio
11、n.The early adolescent(age 10 to 13)tends to focus to focus on the physical changes in his or her body and may have concerns about the maturation process.n nFamilies can facilitate adolescence by providing a graduated increase in independence and in responsibilities.Adolescents require both individu
12、ality and involvement with family and society to facilitate development of identity and of rational competence.n nThe late adolescent views life in a more sociocentric view,characteristic of adulthood.The late adolescent may be altruistic,and conflicts with the family and society may center on moral
13、 issues rather than egocentric considerations.n nClinicians should support this process by encouraging Clinicians should support this process by encouraging adolescents to make their own appointments,assisting adolescents to make their own appointments,assisting the chronically ill adolescent in ass
14、uming more the chronically ill adolescent in assuming more responsibility for his or her health care,and responsibility for his or her health care,and encouraging parents to decrease their role in clinical encouraging parents to decrease their role in clinical management issues.management issues.Psy
15、chological change associated with pubescencen nSpecific behavioral changes are associated with puberty and its timing.Androgens are involved in this process.During peak height velocity(stages 3to 4),boys tend to have conflicts with their mothers.n nBoys with rising levels of testosterone tend to ini
16、tiate sexual intercourse and are reported to be more impatient,irritable,and aggressive.Rising levels of adrenal androgens correlate with increased masturbatory activity and heterosocial behavior in girls.n nTiming of puberty is associated with psychological and behavioral sequelae.Earlier physical
17、maturation in girls is associated with more dissatisfaction with their bodies,lower self-esteem,and general un happiness.n nEarly-developing girls also receive less support from peer groups and may associate with older adolescents.n nEarly physical maturation in boys is associated with earlier initi
18、ation of sexual behavior,and late maturation in boys is more often associated with negative psychological sequelae.Environmental changen nThe law in most states requires consent of a parent for The law in most states requires consent of a parent for medical care for children below age 18.The medical
19、 care for children below age 18.The involvement of parents is usually not a barrier to the involvement of parents is usually not a barrier to the provision of health services,but some sensitive health provision of health services,but some sensitive health issues(e.g.,sexual behavior and substance us
20、e)may issues(e.g.,sexual behavior and substance use)may interfere with access to health care for adolescents.interfere with access to health care for adolescents.n nThe Mature Minor Doctrine generally allows adolescents to seek health care independently if they are capable of understanding the risks
21、 and benefits of the proposed treatment and therefore capable of informed consent.n nThere is usually little risk of liability in providing health care to the older mature minor(14 years or older)if the care is for the individuals benefit or is an emergency.n n 2009年年9月月1日日Morbidity and mortalityn n
22、The concept that adolescence is the healthiest period of life is based on measures of mortality and morbidity that do not include functional assessment of health status or the effects of behaviors initiated during adolescence on adult mortality and morbidity.n nMost morbidity during adolescence orig
23、inates from substance abuse,sexual activity,and injuries.Additional causes include mental health problems and skeletal and reproductive disorders.n nEthnic and racial groups differ in respect to the cause of death:black males of 15 to 19 years old have a ninefold greater rate of death from homicide
24、than white males and the lowest life expectancy of all adolescents.wordn nepiphysisepiphysisn nObeseObesen nfemoralfemoraln ntibialtibialn ntuberositytuberosityn nidiopathicidiopathicn nscoliosisscoliosisn nneoplasmneoplasmn nosseousosseousn nfracturefracturen nanovuanovul latoryatoryn nmensismensis
25、n noscillationoscillationn nEstrogen Estrogen n nluteinizeluteinizen nprogesteroneprogesteronen nendometrialendometrialn nliningliningn nintermittentintermittentn nsloughsloughn nmenstrualmenstrualn ncoagulationcoagulationn nvaginavaginan ncervixcervixn nuterusuterusn no ovaryvaryn ndysmenordysmenor
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