278 AEiSTRACRi JOURNAL OF ADOLESCENT HEALTH CARE Vol. 11, No. 3

AVNmATxcasruDYOYAl?IsK~TOOL: mm- TIFICATIOR OF AT-RISK -. Jams FItsgib- bon, M.D., Iris J. Meltser, M.A., Isadore Newman, Ph.D., Adolescent Services, Children's Hospital Medical Center uf Akron, Akron, OH.

Adolescents are the only group in the United States whose health status has not improved in the past thirty years. norbidities include violence, pregnancy, and substznce ab?e. There is a high probability that adolescents presenting with one condition are at risk for other problems as Well; hence, adolescents seeking treatment for one problem should be screened for the presence of other problems.

Markers associated with health-compromising behaviors are included in a 3%item Risk Assessment.Tool, which comprises 5 sub-scales, one for each of the following *dolescent problsmr: 1) pregnancy, 2) sexually transmitted diseases, 3) drug Or alcohol use, 4) suicide attempts, and 5) violence. A study utilizing 155 "problam" adolescents as a case group and 121 "non-problem" adolescents as a control group was conducted.

The resulting data revealed significant differences between the scores of the “problem” 81 “non-problem” groups. lPKobb)F=.0001) In addition, there are significant differences between the cub-sccle scores of particular sub-groups in the mzegroup and those of the control group. (Drug/Alcohol sub-

Prob>F=.OOOl; STD sub-scale ProbS.0009; Pregnancy sub- scr~~a:PKob>=.OOO1,

Factor analysis indicated thae the sub-scales are ngi:he best conceptualization of the underlying constructs. finding substantiates the theoretical position of covariation among health-compromising behaviors.

mLnru,mE?ms~~op~~~~~tuc~lN~ mc Acss~a’sKuAmmm GIAWS D- JO Ann Jackgon, la, hina Rng1i.n. lm, Pto. ?&Tdidttl Medical Center. Cspt.oE Psdiatrics ani,Adolescent Medicine, Case western Reserve Uniwrsity School oE Mez&ne, Cleveland, Ohio.

Thisreportdwcribes a 17year-old femlewhouasadmitted toedual diagnosis inpstientpsychiatTicunitwithal11 yrjz historyof~tion withweightrsductioe. i?erbchaviors included ~tiveehuseandbulimia. Shedenieduseaf s+zeetdrugsoralcokolbut smkedbssvily mdhadhigb dosecafEeineccnauuption. Sheanplainedm inscnnia.modswingsand " suicidal thwghts. She was an abow aversqe student, attended night classes, rsSinv&ed in &lactiv&ties, had 2 m-t&s jobs andanacti~sccisl life. She foundit‘ uneasi~ly difficult Eo think clearly. She t?18 mspon- sible for a minor mDtor vehicle amident that brought parental artrntion to her mnx behaviors and substame abuse and p-ted her adivission.

Her physical Eindings included &viws thinness, resting tacbycsrdia, fimmtor tremm hypsxreflexia.thy~ly,anda pmni.nentstarewithwt excphwhms. Her speech was rapid and she had difficulty ODncentrating for sinQl~m?mKytasks. Shewas placedons 1600K~estlngdiso~&!~spmt~~01 which restricted hev frcm caffeine, nicotine and free access to feed. She was wable tonU%ainheKweigh~on this pmtcwl. In the inter~.labaratoKy CesultrindicatedGrave'sDi~. Shehad~~kedlyelevated thymxineand ~ii*t&mrine. lw thYmid stimulating hormone and positive antfmicKcearal ~~UcdieS and TSH binding inhibitor index. while in the hospital she -VsdemPranol~ fOr syn@turatictrsaOren~ andat dischargeshersceived thymid ablation with high dose radioactive iodine. shs had sainea tight and her depression,

At one month follow-up concentration difficulty,

CONTENT OF CARE PROVIUED BY RESIDENTS ON AN ADOLESCENT MEDICINE ROTATION. Robert F. Hill, Ph.D.. .I. Dennis Fortenberrv. H.D.. Jennifer Johnson. M.D.. Departments of Pediatric8 and hedicine, Oklahoma University College of Medicine, and Children’s HoepiCa of Oklahoma. 0k:ahoma City, Oklehoma.

This study sought Cc ideurify the content of B training rotation in adolescent medicine. ee practiced by il pediatric and 11 internal medicine

residents on a One month rotation through B university-children’s hoepital based adoLescent clinic. Twelve residents were in their second y :a~ of trainin$, IO in their third. The two most important dlap;noses at escn vlait ate routinely coded by residents using an ND-9 format then enrere.~ by c1~1ke Into the hospital’s patient information systems. During the s+’ month ntudy Period (July-December, 1988) each resident managed a mean n( II0 visits (range 77-143) and recorded 1.3 diagnoses Per visit :range 1.1-1.6). Analy- $1~. oi data using Cbe “diagnosis clurters” schema resulted in the folloving Peecent raking for 3.028 diagnows: conrraceprive medication 17.1, suspec-. ted (wegnancy 7.7, cervicitis-v? linitls-vulvovaginiris 7.3. venereal disease

7.3. dE”Le uPPer resPiratory inlwtion 4.3. abdolninal Pain 3.3. urinary ttBCt Infections J.O. These clusters lccounred for 50 percent of the total diag- ““see. So swnificdnt content differences were found by spr~~,lty ot train- in8 1~~1; lbnwever. there were differences in the number of caeee of pnrticu- Irr problems seen Per month by ir*iv:dual residents. The content of care dvscrlbed in this study does nor fully reflect the teachin; ~ro~,ram’s apha- 51s on aesesement of hi&h risk behaviors. Which 18 mot’e important in adolescent medicine training; range o,,d frequency distribution of didZ3nOSOS. OC comprehensive “?.“agemeW of a minimal “umber of adolescents’ vimary care PrOblems. irrespective of problem mix7 1s high Patient volume drtriaencal to the teaching of comprehensive patient manarement? These arr issues which need to be addressed by academic program directors.