Adolescent emergency department presentations with alcohol- or other drug-related problems in Perth, Western Australia.

AIMS: To identify the morbidity, type of substance used and the pattern of presentation by adolescents with problems related to alcohol or other drug (AOD) use. DESIGN: A 4-week retrospective review of hospital records. SETTING: Four metropolitan hospitals in Perth, Australia. PARTICIPANTS: There were 1064 presentations by people aged 12-19 years of which 160 (15%) were related to AOD use. The median age of the AOD cases was 17 (interquartile range 16-19) of whom 97 (61%) were male and 19 (12%) were Indigenous Australians. FINDINGS: Alcohol was the most frequent precursor to presentation (66, 41%) followed by heroin (24, 15%) and prescription/over-the-counter drugs (24, 15%). Injury was the most common diagnosis at presentation (50, 31%), followed by overdose/drug use (47, 29%). A diagnosis of injury was significantly more likely following the use of alcohol than other categories of substances (chi(2) = 42.07, df = 3, p < 0.001). Deliberate self-harm (DSH) occurred in more female than male cases (chi2 = 7.4, df = 1, p < 0.01). Presentations were more frequent over the weekend (102, 64%) than on weekdays, and the length of stay was significantly shorter for weekend cases (Mann-Whitney U 2132, p < 0.05). CONCLUSIONS: Given the small window of opportunity to provide AOD treatment to youth following hospital presentation, a number of suggestions are made. From a harm-minimization perspective the focus of interventions should be on alcohol use by male youth and DSH associated with prescription/over-the-counter drug use by female adolescents. In addition, Indigenous youth are over-represented in hospital presentations, but there is currently a lack of evaluated interventions designed for them.

Contraception for adolescents.

PIP: 20-50% of 16 year olds in Australia have had sexual intercourse and most of them started on average 8 months before using any contraceptive. Family practitioners should inquire about actual and expected sexual activity, examine the adolescent, and take a comprehensive history so as to adequately assess his or her contraceptive needs. They should also encourage adolescents to postpone sexual intercourse since early sexual intercourse may post physical and emotional health problems and abstinence is the most effective form of birth control. For adolescents who have infrequent sexual intercourse the condom with a spermicide is perfect. They provide the best protection against unwanted pregnancy and sexually transmitted infections. If an adolescent frequently has sexual intercourse and is motivated, however, the most effective reversible contraceptive to take would be an oral contraceptive (OC), especially the low dose triphasic steroidal OC. To determine and encourage compliance, physicians should not only provide clear oral and written instructions on OC use, but schedule follow up visits. The IUD is not a suitable contraceptive for the typical female adolescent, but in some cases it may be appropriate. Since the prostestogen only OC must be taken within 2-3 hours of the selected times each day, it generally is not appropriate for adolescents. Disadvantages of using a diaphragm for adolescents include the size may need to change and frequent medical examinations. The ovulation and rhythm methods are also not advised for adolescents because of the high level of motivation needed for them to be effective. Physicians should encourage every adolescent to tell his or her parents but if the adolescent insists he or she will not inform the parents and will have sexual relations regardless of using contraception or not, the physician can most likely prescribe a contraceptive.^ieng

The needs of the sexually abused child.

The incidence of sexual abuse in childhood, and its short and long term effects dictate that paediatricians increase their awareness of the needs of the sexually abused child. Case examples are given from experience at one children's hospital illustrating a range of situations which vary with the relationship of the abuser to the child. Factors thought to influence outcome are described. The needs demonstrated are correlated with management recommendations, including those made in a recent Australian report.