Adolescents' Receipt of Care in a Medical Home: Results From a National Survey.

PURPOSE: Despite long-term emphasis on the medical home for children, little research focuses on adolescents. This study examines adolescent past-year attainment of medical home, its components, and subgroup differences among demographic and mental/physical health condition categories. METHODS: Utilizing the 2020-21 National Survey of Children's Health (NSCH), ages 10-17 (N = 42,930), we determined medical home attainment and its 5 components and subgroup differences utilizing multivariable logistic regression: sex; race/ethnicity; income; caregiver education; insurance; language spoken at home; region; and health conditions: physical, mental, both, or none. RESULTS: Forty-five percent had a medical home with lower rates among those who were as follows: not White non-Hispanic; lower income; uninsured; in non-English-speaking households; adolescents whose caregivers lacked a college degree; and adolescents with mental health conditions (p range = .01-<.0001). Differences for medical home components were similar. DISCUSSION: Given low medical home rates, ongoing differences and high mental illness rates, efforts are needed to improve adolescent medical home access.

Health care service in paediatric and adolescent gynaecology throughout Europe: A review of the literature.

BACKGROUND: Paediatric and adolescent gynaecology is a special field of interest within general gynaecology and obstetrics. The care for children and young people differs from adults. In gynaecology, children should not be treated like little adults. Within Europe, there is great variability in the provision of care, availability of clinical networks and lack of national standards within paediatric and adolescent gynaecology. Therefore, this review aims to summarize the current evidence regarding best clinical practice within Europe. METHODS: A search was performed in Embase and Medline from 1974 onwards. Inclusion criteria were paediatric and adolescent population, gynaecology or reproductive health, care provision and evidence based clinical guidelines. In most papers recommendations were made, so no outcome measures could be used. It was, therefore, not possible to perform a meta-analysis. The risk of bias of the studies was assessed according to the GRADE and AGREE-2 guidelines. RESULTS: 91 papers were identified and a total of 7 papers were included in the final analysis. The main recommendations are: - improvement for accessibility for healthcare facility, - training of healthcare staff in communication and examination according to developmental age, - develop evidence based clinical guidelines and standardize content of care delivered, - add training in general adolescent topics to training curriculum of paediatric and adolescent gynaecology. CONCLUSION AND IMPLICATIONS: There is limited information about best clinical practice and low quality of evidence of healthcare service available in the field of Paediatric and Adolescent Gynaecology. As a result there is a need to refine standards of training and care. EURAPAG should encourage adaptation of the unified standards of care in each European country. Furthermore, at this moment, there is insufficient inclusion of curriculum related to PAG in the undergraduate and post graduate training for recognition of patterns and symptoms in young women. EURAPAG should not only take a lead to develop common curriculum for undergraduate and post graduate education and training to address this unmet need but should also lead on their implementation within Europe.

Adolescent Cancer Survivors: A Literature Review of Psychological Effects Following Remission.

BACKGROUND: The psychological distress caused by cancer can remain long after remission. With advanced curative treatments, many pediatric patients continue to have late complications that interfere with neurologic, physical, and social development. OBJECTIVES: The aim of this article is to analyze nine published articles that focus on adolescent cancer survivors (ACSs) and the incidence and risk factors of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms (PTSSs). METHODS: A search of published articles including pediatric and adolescent oncology and PTSD was performed. The search was narrowed to peer-reviewed articles published after 2010 that presented empirical data and were specific to post-trauma or post-traumatic stress. FINDINGS: Significant findings for PTSD and PTSSs were reported in ACSs. ACSs suffering from PTSD and PTSSs should be identified and treated appropriately based on age, diagnosis, treatment, and comorbid symptoms.

Menstrual History-Taking at Annual Well Visits for Adolescent Girls.

STUDY OBJECTIVE: To determine the rates at which primary care providers elicit menstrual histories from adolescent girls at well visits. DESIGN: Retrospective chart review. SETTING: The departments of Pediatrics, Adolescent Medicine, and Family Medicine of Cooper University Healthcare from January 1, 2010 to June 1, 2016. PARTICIPANTS: Women aged 12-21 years who were seen for a well visit in the described setting. INTERVENTIONS: None. MAIN OUTCOME MEASURES: We searched physician well visit notes for documentation of the following aspects of menstrual history: menarche, last menstrual period, usual length of cycle, and the presence or absence of associated symptoms (such as pain and cramps). The presence or absence of each aspect was recorded in a binary fashion in a deidentified data set. RESULTS: A total of 954 unique charts were analyzed: 415 from Adolescent Medicine, 289 from Family Medicine, and 250 from General Pediatrics at Cooper University Healthcare. Adolescent Medicine was 6.44 times more likely to take a complete menstrual history than Family Medicine (P < .0001) and 5.80 times more likely than Pediatrics (P < .0001). There was no statistical difference between Pediatrics and Family Medicine (odds ratio, 0.55; P = .3150). CONCLUSION: Menstrual history-taking is often incomplete and can vary between departments, even within the same institution. These results indicate opportunities to raise awareness about the importance of a complete menstrual history and to develop quality improvement initiatives to increase documentation of the complete menstrual history.

What are the most frequent diagnoses in adolescence? The reality of an Adolescent Medicine Clinic.

OBJECTIVE: To characterize the care flow and the primary diagnoses of an Adolescent Medicine Clinic. METHODS: A retrospective descriptive study, with analysis of clinical processes of adolescents (10-18 years) seen at the Adolescent Medicine Clinic, from January 2006 to December 2013. The following variables were analyzed: sex, age, number of visits, referring service and primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. As to the variable age, the adolescents were divided into two groups: Group I comprised those aged 10-14 years, and Group II, 15-18 years. RESULTS: A total of 7,692 visits were carried out, in that, 1,659 first visits (22%), with an annual growth rate of 6%. The mean age was 14.2 years, and 55% of patients were female. The group of endocrine, nutritional and metabolic diseases was the most representative in our sample (34%), with obesity being the most frequent diagnosis in both sexes and age groups (23%), with a higher prevalence in males (13% male versus 10% female, p<0.001) and younger adolescents (18% in Group I versus 5% in Group II p<0.001). The group of mental and behavioral disorders was the second most prevalent (32%), affecting mainly females (39% female versus 22% male, p<0.001) and the older age group (39% Group II versus 27% Group I, p<0.001). Social problems were the primary diagnosis in 8% of visits. CONCLUSION: Most diseases diagnosed have a strong behavioral and social component, particularly mental disorders and obesity. This specific type of diagnoses reinforces the need for a global approach for adolescents and specialized adolescent medicine units/clinics.

Diagnostic Evaluation, Comorbidity Screening, and Treatment of Polycystic Ovary Syndrome in Adolescents in 3 Specialty Clinics.

STUDY OBJECTIVE: A polycystic ovary syndrome (PCOS) diagnosis in adolescence can have significant long-term health implications. The criteria for its diagnosis in adolescents have been subject to much debate. In this study we aimed to characterize the variability in diagnosis and management among different pediatric specialties. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: This was a retrospective review of electronic medical records of female patients (11-21 years old) who presented to 3 specialties (adolescent medicine [ADO], pediatric endocrinology [ENDO], and gynecology [GYN]), with a postvisit diagnosis of PCOS, menstrual disorders, or hirsutism, at a large tertiary care center, from November 1, 2011 to October 31, 2012. Demographic, clinical, laboratory, and treatment data were abstracted. MAIN OUTCOME MEASURES: Testing for diagnosis of PCOS and its comorbidities, and treatment strategies in the 3 pediatric specialties. RESULTS: One hundred forty-one patients (50 ADO, 48 ENDO, and 43 GYN) were eligible. Testing for hyperandrogenemia (17-hydroxy-progesterone, dehydroepiandrosterone, estradiol), thyroxine, and use of pelvic ultrasound differed among specialties. Providers failed to document weight concerns in 28.3% (29 of 101) of overweight or obese patients. Patients seen by ENDO were most likely, and GYN least likely, to be identified as having elevated weight, and to be tested for glucose abnormalities, dyslipidemia, and liver disease. ENDO providers prescribed metformin more often and hormonal therapy less often than ADO and GYN. CONCLUSION: There is considerable variability across pediatric specialties in the evaluation of PCOS, with significant underassessment of comorbidities. Use of unified guidelines, including for the evaluation of comorbidities, would improve evidence-based management of adolescent PCOS.

What are the most frequent diagnoses in adolescence? The reality of an Adolescent Medicine Clinic / Quais os diagnósticos mais frequentes na adolescência? A realidade de uma consulta de Medicina do Adolescente

ABSTRACT Objective To characterize the care flow and the primary diagnoses of an Adolescent Medicine Clinic. Methods A retrospective descriptive study, with analysis of clinical processes of adolescents (10-18 years) seen at the Adolescent Medicine Clinic, from January 2006 to December 2013. The following variables were analyzed: sex, age, number of visits, referring service and primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. As to the variable age, the adolescents were divided into two groups: Group I comprised those aged 10-14 years, and Group II, 15-18 years. Results A total of 7,692 visits were carried out, in that, 1,659 first visits (22%), with an annual growth rate of 6%. The mean age was 14.2 years, and 55% of patients were female. The group of endocrine, nutritional and metabolic diseases was the most representative in our sample (34%), with obesity being the most frequent diagnosis in both sexes and age groups (23%), with a higher prevalence in males (13% male versus 10% female, p<0.001) and younger adolescents (18% in Group I versus 5% in Group II p<0.001). The group of mental and behavioral disorders was the second most prevalent (32%), affecting mainly females (39% female versus 22% male, p<0.001) and the older age group (39% Group II versus 27% Group I, p<0.001). Social problems were the primary diagnosis in 8% of visits. Conclusion Most diseases diagnosed have a strong behavioral and social component, particularly mental disorders and obesity. This specific type of diagnoses reinforces the need for a global approach for adolescents and specialized adolescent medicine units/clinics.

RESUMO Objetivo Caracterizar o movimento assistencial e conhecer os diagnósticos principais de uma consulta de Medicina do Adolescente. Métodos Estudo descritivo retrospectivo, com análise dos processos clínicos dos adolescentes (10 a 18 anos) seguidos na consulta de Medicina do Adolescente, de janeiro de 2006 a dezembro de 2013. Foram analisadas as variáveis: sexo, idade, número de consultas, entidade que referenciou e diagnósticos principais, de acordo com a Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde. Com relação à variável idade, os adolescentes foram divididos em dois grupos: Grupo I, que incluiu adolescentes de 10 a 14 anos, e Grupo II, que incluiu aqueles com 15 aos 18 anos. Resultados Realizaram-se 7.692 consultas, sendo 1.659 (22%) primeiras consultas, com taxa de crescimento anual de 6%. A média de idade foi de 14,2 anos, com 55% do sexo feminino. O grupo das doenças endócrinas, nutricionais e metabólicas foi o mais representativo da amostra (34%), sendo a obesidade o diagnóstico mais frequente em ambos os sexos e grupos etários (23%), com maior prevalência nos rapazes (13% homens versus 10% mulheres; p<0,001) e nos adolescentes mais jovens (18% do Grupo I versus 5% do Grupo II; p<0,001). O grupo dos transtornos mentais e do comportamento foi o segundo mais prevalente (32%), afetando principalmente as adolescentes (39% mulheres versus 22% homens; p<0,001) e o grupo etário mais velho (39% do Grupo II versus 27% do Grupo I; p<0,001). Problemas sociais constituíram o principal diagnóstico em 8% das consultas. Conclusão A maioria das patologias diagnosticadas tem forte componente comportamental e social, com destaque para as doenças mentais e a obesidade. Esta tipologia específica de diagnósticos evidencia a necessidade de uma abordagem global do adolescente e de unidades/consultas especializadas nesta faixa etária.

Adolescents with Cancer in Italy: Improving Access to National Cooperative Pediatric Oncology Group (AIEOP) Centers.

This analysis compared the numbers of patients treated at Italian pediatric oncology group (Associazione Italiana Ematologia Oncologia Pediatrica [AIEOP]) centers with the numbers of cases predicted according to the population-based registry. It considered 32,431 patients registered in the AIEOP database (1989-2012). The ratio of observed (O) to expected (E) cases was 0.79 for children (0-14 years old) and 0.15 for adolescents (15-19 years old). The proportion of adolescents increased significantly over the years, however, from 0.05 in the earliest period to 0.10, 0.18, and then 0.28 in the latest period of observation, suggesting a greater efficacy of local/national programs dedicated to adolescents.

[The health of adolescents in Switzerland]. / La santé des adolescents en Suisse.

The available data on adolescent health, weather statistics of mortality, hospital-based information or the one originating from health survey identify five main sources of concern: mental health problems, intentional and unintentional violence, chronic conditions including obesity and eating disorders, and negative consequences linked with risky sexual behavior and substance misuse. The responses to these issues lie in two ares, the one of health care and the one of prevention/health promotion. Access to health care must be improved, using the adolescent friendly framework, which stresses the importance of accessibility, flexibility, network approaches and effectiveness. Preventive activities encompass not only mere information in specific areas such as sexuality or psychoactive substance, but must also address the acquisition of life skills as well as the improvement of the environment. Structural measures such as the ones governing traffic of vehicles, those impacting on the school climate or those involving community health measures targeting vulnerable population have proven effective.

Les données de mortalité, hospitalières et auto-rapportées (enquêtes de santé) convergent pour identifier cinq domaines principaux de préoccupation en matière de santé des adolescents: Les problèmes de santé mentale, la violence non intentionnelle et intentionnelle, les affections chroniques y compris les troubles alimentaires, les aléas liés à l'émergence de la sexualité et le mésusage de drogues légales et illégales. Les réponses à ces problèmes se déclinent dans le domaine des soins et de la prévention/promotion de la santé. L'accès aux soins doit être amélioré en s'inspirant du modèle «services amis des jeunes¼, un concept qui repose sur l'équité, l'accessibilité, la flexibilité, le travail en réseau et l'efficacité. Les activités de prévention ne doivent pas se limiter à l'information ciblant des domaines spécifiques (par exemple sexualité et prise de risque, usage de drogue, etc.) mais doivent aussi porter sur l'acquisition de compétences de vie («life skills¼), ainsi que sur l'aménagement d'environnements sains; ces mesures structurelles comme par exemple l'amélioration des conditions de circulation, l'instauration d'un climat favorable à la santé dans les écoles ou enfin des activités communautaires de proximité visant des groupes d'adolescents vulnérables.

Residency training in pediatric and adolescent gynecology across obstetrics and gynecology residency programs: a cross-sectional study.

STUDY OBJECTIVE: To estimate the prevalence of Pediatric and Adolescent Gynecology formal training in the United States Obstetric and Gynecology residency programs. DESIGN: Prospective, anonymous, cross-sectional study. PARTICIPANTS: United States program directors of Obstetrics and Gynecology residency programs, N = 242; respondents 104 (43%). RESULTS: 104 residency programs responded to our survey. Among the 104 residency programs, 63% (n = 65) have no formal, dedicated Pediatric and Adolescent Gynecology clinic, while 83% (n = 87) have no outpatient Pediatric and Adolescent Gynecology rotation. There is no significant difference in the amount of time spent on a Pediatric and Adolescent Gynecology rotation among residents from institutions with a Pediatric and Adolescent Gynecology fellowship (P = .359), however, the number of surgeries performed is significantly higher than those without a Pediatric and Adolescent Gynecology fellowship (P = .0020). When investigating resident competency in Pediatric and Adolescent Gynecology, program directors reported that residents who were taught in a program with a fellowship-trained Pediatric and Adolescent Gynecology faculty were significantly more likely to be able to interpret results of selected tests used to evaluate precocious puberty than those without (P = .03). CONCLUSIONS: Residency programs without fellowship trained Pediatric and Adolescent Gynecology faculty or an established Pediatric and Adolescent Gynecology fellowship program may lack formal training and clinical exposure to Pediatric and Adolescent Gynecology. This information enables residency directors to identify deficiencies in their own residency programs and to seek improvement in resident clinical experience in Pediatric and Adolescent training.

Bullying in an adolescent and young adult gynecology population.

OBJECTIVE: To determine prevalence of exposure to bullying in an adolescent/young adult gynecology population, whether pelvic pain is an associated somatic complaint, and if health care providers are viewed as a resource. METHODS: An anonymous self-reporting survey about exposure to bullying, somatic and mental health symptoms, and disclosure patterns was given to 224 consecutive gynecology patients aged 15 to 24 years in a suburban practice. RESULTS: Prevalence of exposure as a bully, victim, witness, or combination was 80.5%. Missing school for pelvic pain was significantly greater in the bully-victim-witness and victim-witness groups. Taking medication for depression or anxiety was significantly greater in the bully-victim-witness group. No one disclosed bullying exposure to a health care provider. CONCLUSIONS: Gynecologists see large numbers of patients exposed to bullying. Patients exposed in combinations of bully, victim, and witness have increased frequency of pelvic pain, depression, and anxiety. Patients do not disclose exposure to bullying to health care providers.

Medical student performance on an adolescent medicine examination.

PURPOSE: To examine the performance of third-year medical students on an adolescent medicine clinical practice examination. METHODS: The participants were third-year medical students (2010 [n = 145] and 2011 [n = 134]) at the University of Colorado School of Medicine. Student performance on adolescent contraceptive management was measured in three domains following Accreditation Council for Graduate Medical Education (ACGME) competencies in professionalism, communication, and history-taking skills. RESULTS: With regard to professionalism and communication skills, students performed very well, scoring >95% correct in both years. Students demonstrated relatively poorer performance in history-taking competency in 2010 and 2011 (66% and 67% correct, respectively). CONCLUSION: In the adolescent Objective Structured Clinical Examination case, third-year medical students demonstrated extremely high performance in communication and professionalism skills. However, performance was lower for history-taking skill in contraceptive management.

Program implementers' evaluation of the project P.A.T.H.S.: findings based on different datasets over time.

This paper integrates the evaluation findings based on program implementers in nine datasets collected from 2005 to 2009 (244 schools and 7,926 implementers). Using consolidated data with schools as the unit of analysis, results showed that program implementers generally had positive perceptions of the program, themselves, and benefits of the program, with more than four-fifths of the implementers regarding the program as beneficial to the program participants. The subjective outcome evaluation instrument was found to be internally consistent. Multiple regression analyses revealed that perceived qualities of the program and program implementers predicted perceived effectiveness of the program. In conjunction with evaluation findings based on other sources, the present study provides support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in Hong Kong.

Knowledge of medication abortion among adolescent medicine providers.

PURPOSE: Adolescents are at high risk for unintended pregnancy and abortion. The purpose of this study was to understand whether providers caring for adolescents have the knowledge to counsel accurately on medication abortion, a suitable option for many teenagers seeking to terminate a pregnancy. METHODS: Using an online questionnaire, a survey related to medication abortion was administered to U.S. providers in the Society for Adolescent Health and Medicine. We conducted χ(2) analyses to evaluate the knowledge of medication abortion by reported adolescent medicine fellowship training, and to compare responses to specific knowledge questions by medication abortion counseling. Furthermore, we examined the relationship between providers' self-assessed and actual knowledge using ANOVA. RESULTS: We surveyed 797 providers, with a 54% response rate. Almost 25% of respondents incorrectly believed that medication abortion was not very safe, 40% misidentified that it was < 95% effective, and 32% did not select the correct maximum recommended gestational age (7-9 weeks). Providers had difficulty identifying that serious complications of medication abortion are rare. Those who counseled on medication abortion had more accurate information in all knowledge categories, except for expected outcomes. Medication abortion knowledge did not differ by adolescent medicine fellowship completion. Only 32% of respondents had very good knowledge, and self-assessed knowledge minimally predicted actual knowledge (r(2) = .08). CONCLUSIONS: Knowledge regarding medication abortion safety, effectiveness, expected outcomes, and complications is suboptimal even among adolescent medicine fellowship trained physicians, and self-assessment poorly predicts actual knowledge. To ensure pregnant teenagers receive accurate counseling on all options, adolescent medicine providers need better education on medication abortion.

Demography of adolescent health care delivery and training in Europe.

BACKGROUND: We aimed to determine the status of and factors associated with adolescent health care delivery and training in Europe on behalf of the European Paediatric Association-UNEPSA. MATERIALS AND METHODS: A questionnaire was mailed to the presidents of 48 national paediatric societies in Europe. For statistical analyses, non-parametric tests were used as appropriate. RESULTS: Six of the countries had a paediatric (PSPCA), 14 had a combined and nine had a general practitioner/family doctor system for the primary care of adolescents (GP/FDSA). Paediatricians served children 17 years of age or older in 15 and 17, up to 16 years of age in three and six, and up to 14 years of age in six and six countries in outpatient and inpatient settings, respectively. Fifteen and 18 of the countries had some kind of special inpatient wards and outpatient clinics for adolescents, respectively. Twenty-eight of the countries had some kind of national/governmental screening or/and preventive health programmes for adolescents. In countries with a PSPCA, the gross national income (GNI) per capita was significantly lower than in those with a GP/FDSA, and the mean upper age limit of adolescents was significantly higher than in those with the other systems. In the eastern part of Europe, the mortality rate of 10-14 year olds was significantly higher than that in the western part (p=0.008). Training in adolescent medicine was offered in pre-graduate education in 14 countries in the paediatric curriculum and in the context of paediatric residency and GP/family physician residency programmes in 18 and nine countries, respectively. Adolescent medicine was reported as a recognised subspecialty in 15 countries and as a certified subspecialty of paediatrics in one country. In countries with a PSPCA, paediatric residents were more likely to be educated in adolescent medicine than paediatric residents in countries with a GP/FDSA. CONCLUSION: The results of the present study show that there is a need for the reconstruction and standardisation of adolescent health care delivery and training in European countries. The European Paediatric Association-UNEPSA could play a key role in the implementation of the proposals suggested in this paper.

Evaluation of project P.A.T.H.S. (Secondary 1 program) by the program implementers: findings based on the full implementation phase.

A total of 207 schools (N = 35,735 students) participated in the Secondary 1 Program of Project P.A.T.H.S. in the full implementation phase (2006/07 school year). After completion of the Tier 1 Program, 1,250 instructors completed a subjective outcome evaluation form (Form B) to assess their views of the program, instructors, and perceived effectiveness of the program. Utilizing the consolidated reports submitted to the funding body, the research team aggregated the consolidated data to form an overall profile of the perceptions of the program participants. Results showed that high proportions of the respondents had positive perceptions of the program and the instructors, and roughly four-fifths of the respondents regarded the program as helpful to the program participants and the workers. These findings complement the subjective outcome evaluation findings based on the perspective of the program participants.

Health education about occupational allergies and dermatoses for adolescents.

BACKGROUND: Occupational dermatoses and allergies are frequent and often affect individuals with atopic dermatitis. Our aim was to inform adolescents about potentially dangerous occupations, risk groups and preventive measures before they started apprenticeships in order to minimize the risk of occupational allergies or skin diseases. METHODS: 1015 high-school students were instructed by two dermatologists/ allergists (Heidelberg) and a teacher (Potsdam) in a 90-minute instructional unit. This included the exemplification of occupational skin hazards and allergies, the identification of at-risk persons, and application of preventive measures. A questionnaire was filled in by the students prior to and at least two weeks after the training. RESULTS: In both regions, the students showed an increase in knowledge after the training, which was statistically significant higher in the Heidelberg region (6.6 points on average vs.4.4 points). 76% of students termed the subject matter as "important", and 67% rated the teaching unit as "very good" or "good". CONCLUSIONS: We demonstrate that students who have not yet chosen a career are highly interested in this subject, that the developed instructional unit is widely accepted, and that it leads to an increase in knowledge. Therefore we suggest nation-wide implementation of this primary prevention measure in high-schools.