Obesity in Thai adolescents: lifestyles, health attitudes and psychosocial concerns.

Objective: To determine the dietary pattern, lifestyle factors, and psychosocial concerns in Thai obese adolescents. Methods: Students’ school health records under the Siriraj School Health Network was reviewed during the academic year of 2005. Those with body mass indices (BMI) ³25 kg/m2 were asked to complete a self-administered questionnaire divided into three parts; 1) health attitudes and psychosocial concerns; 2) dieting lifestyle; 3) physical activity lifestyle. Results: The prevalence of overweight and obesity among 718 from 5,071 students from Siriraj School Health Network was different between genders (7.7% and 2.5 % in male vs. 2.9% and 1% in female). Of those, 403 voluntarily answered the self-administered questionnaires. The majority of students (87.9%) were not satisfied with their actual weight, and tried to lose weight (94.2%). Concerning their lifestyles, 79.4% and 49.6% had taken high calorie food mostly fast food and dined buffet-style at least once a week respectively, while half disliked fruits and vegetables, and 15.4% skipped breakfast. Also, the majority of students exercised less than the standard recommendation of at least three days a week, with more than two thirds, excusing not having enough time to practice while 48% spending at least three hours a day watching television and playing computer. Importantly, more than half of them had weight- related psychosocial problems presenting as poor self image, low self esteem and self confidence. Conclusion: Unhealthy lifestyles, poor health attitudes and negative psychosocial concerns were reported among Thai obese adolescents. Strategies for successful obesity prevention are discussed in this article.

Added efficacy of paracetamol in tepid sponging for fever reduction.

Objective: Fever is one of the most common presenting symptoms in children receiving care at the outpatient walk-in clinic or emergency room. At the Pediatric Department of Siriraj Hospital, detecting and managing febrile children has become a routine practice due, in part, to the implementation of nursing triage. Such measure has brought about a significant reduction in the occurrence of febrile convulsion in the waiting room. However, different nurses employ different or a combination of methods to achieve fever reduction, leading to questions regarding their efficacy in reducing fever in the pediatric outpatient department. Methods: This is a prospective observational study of children presenting to the outpatient clinic at the Department of Pediatrics, Siriraj Hospital, between January and December 2003. The children were taken to the treatment room if they were found at triage to have body temperature of > 38.5ºC. There, the nurses are free to administer either tepid sponging alone or in combination with paracetamol syrup 10 mg/kg/dose. A second temperature was taken before they were released into the waiting room. The data regarding their age, initial and follow-up temperatures, time intervals between the two readings, and whether or not they received paracetamol was collected. The data was then stratified into 2 groups: those who received tepid sponging alone (TS alone) and those who received tepid sponging and paracetamol (TS/Para). Data analysis was done using Sigmastat™2.03. Both two-tailed t-test and a Mann-Whitney Rank Sum Test were employed to analyze the differences between the two groups. Multiple linear regressions were used to correct for the differences that age and time interval between measurements might have on temperature reduction of both groups. Results: There were 995 children who received fever-reduction measures at the outpatient department over the 12-month period. The TS/Para group achieves a statistically significant lower average body temperature than the TS only group at the end of the treatment period (0.647 + 0.675 vs. 0.543 + 0.560; p<0.05) and multiple linear regression analysis shows a statistically significant trend in fever reduction with the TS/Para method when correcting for the effect of patient’s age and time interval between measurements. Discussion: From our study, it is shown that the administration of tepid sponging together with paracetamol can reduce more effectively the body temperature than when tepid sponging is employed alone. However, further study is needed to ascertain the sustainability of fever reduction with these two methods and whether paracetamol administration alone, without tepid sponging, can also achieve the same goal in fever reduction.

Sexual attitudes of adolescent girls after an interactive seminar on sexuality.

Objective: The purpose of this study is to assess the effect of an interactive seminar in sex education on the sexual attitude of adolescent girls in the 9th grade in an all-girl school near Siriraj Hospital, Bangkok, Thailand. Sexual activities in Thai teenagers have emerged as a popular subject of interest in the news media. Government officials, together with schools have been promoting sex education in schools as the means of reducing the adolescents’ tendency to experiment with sex prematurely and inappropriately. As part of an adolescent outreach program at Siriraj Hospital, pediatricians were asked to participate in an interactive sex-education seminar with teenage girls from an all-girl school in the community. Methods: All girls attending the 9th grade were recruited for the one-day interactive seminar. The attendees were divided among the two identical seminar sessions. The seminar took an average of 50 minutes per group. During the didactic portion of the seminar, students were encouraged to participate actively by asking as many questions as possible. Afterwards, the students were asked to fill out an anonymous questionnaire regarding their own sexual attitudes, beliefs and practices. Results: There were 350 attendees; all were between the ages of 12-14 years. Over all, 70.7 % of girls had attitudes that promote the practice of abstinence; 13.8% viewed that sex was an acceptable part of a loving relationship; and 23.9% of the girls had mixed feelings and attitudes towards becoming sexually active at their age. The greatest area of uncertainty was in the area of using sex to maintain a loving relationship, while 8.6% of girls felt that withholding sex from their partners would result in a break up and 30.9% were uncertain whether sex would help intensify love in a relationship. In addition, 3.4% of girls felt they had no right to reject sexual advances while 5.1% did not recognize that being alone with a boy could lead to unplanned sexual intercourse. Discussion: While the prevalence of attitude leading to abstinence in our study was encouraging, the large proportion of students who remained uncertain and undecided about their practice and believed to uphold in the face of increasing pressure to have sex was alarming. As pediatricians who work primarily with teenagers, our challenge is to convert those who are undecided as to which path to take into those who are adamant about maintaining celibacy and abstaining from a sexual relationship until they are older and more equipped to handle its complications and consequences.

Dextromethorphan abuse in Thai adolescents: A report of two cases and review of literature.

INTRODUCTION: Dextromethorphan is an opiod-derived, easily available cough remedy that, when used in large quantities, can have stimulatory effects which mimic that of amphetamine and other psychedelic drugs. Due to its easy availability, dextromethorphan is gaining widespread popularity as a recreational drug among Thai youths. Symptoms of overdose are directly related to its pharmacodynamic and pharmacokinetic properties. Dextromethorphan is metabolized by cytochrome p450 2D6, an isoenzyme that exhibit polymorphism in Asians. The drug is also a serotonin-reuptake inhibitor and has significant interactions with other drugs that exert their effects through the serotonin pathway such as the amphetamines, cocaine, and Lysergic Acid (LSD). CASE REPORT: We report here two cases of dextromethorphan overdose that presented to the Pediatric Toxicology Service at Siriraj Hospital, Bangkok, Thailand. Both cases presented with hyper-agitation, confusion, with signs of sympathomimetic overdose. Both patients were treated with supportive care and fully recovered within 24 hours without sequalae. CONCLUSION: Although the acute toxicity of dextromethorphan is abated within 24 hours, its pharmacological properties still render it a dangerous drug to use alone or in combination with other drugs.