Adolescent health care and perceptions in a provincial hospital in Papua New Guinea.

OBJECTIVES: Adolescents make up an estimated 22 % of the 11.8 million population of Papua New Guinea (PNG), yet, as in many low and middle income countries, there are limited specific services for adolescents, who in traditional health service design fall between paediatric and adult patients. With more survivors of chronic illnesses, including tuberculosis and HIV, congenital and acquired heart disease, epilepsy and cerebral palsy, diabetes, cancer and other chronic conditions, there are gaps in the care of such young people, and in their eventual transition to adult services. Moreover, traditional health service design rarely addresses many adolescent health concerns - mental health, self-esteem, substance use, and adolescent-friendly sexual and reproductive health. This study, amongst a cohort cared for in a provincial hospital in Milne Bay Province, Papua New Guinea, aimed to explore the perceptions of adolescents on the health care they receive, and their views on their health priorities. METHODS: A qualitative study was carried out from April to August 2022, amongst adolescents (persons aged 10-19 years) attending or admitted to Alotau Provincial Hospital. Data were collected via semi-structured wide-ranging interviews, and contextual data obtained from their medical charts. Thematic data analysis was done. RESULTS: Fifty-four adolescents were interviewed. Adolescents were generally content with the care they received, although many raised concerns regarding feeling out of place in a ward with older adults or infants, and staff attitudes towards them including not directly communicating. Forty four adolescents preferred an adolescent-friendly setting, as opposed to the adult or children's wards, stating that it would allow for positive peer-interaction, improve their experience in the hospital, and improve the quality of health care received. Many adolescents with chronic illnesses had concerns regarding loneliness and isolation, and uncertainty of their future. Pregnant adolescents highlighted the lack of education on sexual and reproductive health, and experiences of gender-based violence. CONCLUSIONS: This study shows that adolescents can perceive the need for adolescent-friendly health services and advocate for improvement in the quality of health care they receive, and the breadth of adolescent health care concerns.

Just TRAC it! Transitioning Responsibly to Adult Care Using Smart Phone Technology.

PURPOSE: There is little evidence on whether smartphone technology influences transition readiness among adolescents with heart disease. Just TRAC it! is a method of using existing smartphone features (Notes, Calendar, Contacts, Camera) to manage personal health. We evaluated the impact of Just TRAC it! on self-management skills. METHODS: Randomized clinical trial of 16-18 year-olds with heart disease. Participants were randomly allocated 1:1 to either usual care (education session) or intervention (education session including Just TRAC it!). The primary outcome was change in TRANSITION-Q score between baseline, 3 and 6 months. Secondary outcomes were frequency of use and perceived usefulness of Just TRAC it! Analysis was intention-to-treat. RESULTS: We enrolled 68 patients (41% female, mean age 17.3 years), 68% having previous cardiac surgery and 26% had cardiac catheterization. TRANSITION-Q scores were similar at baseline and increased over time in both groups but were not significantly different between groups. Each additional point at the baseline score brought, on average, a 0.7-point increase in TRANSITION-Q score (95% CI 0.5-0.9) at each of 3 and 6 months. The Camera, Calendar and Notes apps were reported as most useful. All intervention participants would recommend Just TRAC it! to others. DISCUSSION: A nurse-led transition teaching with versus without Just TRAC it! improved transition readiness, with no significant difference between groups. Higher baseline TRANSITION-Q scores were associated with greater increase in scores over time. Participants had a positive reception to Just TRAC it! and would recommend it to others. Smartphone technology may be useful in transition education.

Feasibility and sustainability of a school-based platform for integrated delivery of HPV vaccination with adolescent health services in Tanzania: qualitative insights from stakeholders.

To meet lofty human papillomavirus (HPV) immunization goals in Tanzania, the Ministry of Health integrated HPV vaccination with adolescent health services using a school-based approach. A qualitative study was conducted in June-July 2021, examining the feasibility and sustainability of an integrated service package, HPV Plus. In-depth interviews with 46 programme implementers (i.e. health-care workers and teachers) and planning stakeholders (i.e. government officials and school administrators) in Dar es Salaam and Njombe Regions explored enablers and constraints to HPV Plus programme implementation, including resource and staffing requirements. Two facilitators and three barriers to HPV Plus feasibility and sustainability were identified from thematic analysis of interviews. Interviewed stakeholders emphasized the programme's feasibility, especially if the efficiencies offered by a school-based platform were optimized. Implementation facilitators included (1) optimized service delivery efficiency through a school-based platform and (2) resources saved by combining adolescent health services and HPV immunization into a single programme package. Key barriers to HPV Plus feasibility and sustainability were (1) time, space and resource constraints (e.g. commodity stockouts and challenges delivering the complete service package to large cohorts of students within allotted times); (2) human resource gaps and increased workloads within the health workforce and (3) insufficient referral mechanisms linking schools to health facilities. Scaling up HPV Plus will require proactive commodity procurement and security; resource mobilization to reach ambitious service delivery targets and close co-ordination of programme implementation with school administrators.

O Modelo de Nola Pender para promoção da saúde do adolescente / The Nola Pender model for adolescent health promotion: an integrative reviewel / Modelo de Nola Pender para la promoción de la salud de los adolescentes: una revisión integradora

Objetivo: analisar a aplicabilidade da teoria de enfermagem de Nola Pender para a promoção da saúde de adolescentes. Metodologia: revisão integrativa da literatura com busca nas bases de dados on-line LILACS, MEDLINE, CINAHL, COCHRANE, EMBASE, e biblioteca SciELO, respondendo a seguinte questão: Qual a aplicabilidade do modelo de promoção da saúde de Nola Pender na atenção aos adolescentes? Resultados: foram selecionados 27 artigos científicos, cujas principais contribuições foram elencadas nas categorias do Modelo de Promoção da Saúde. O estudo possibilitou vislumbrar a complexidade de fatores, que envolvem o itinerário da promoção da saúde do adolescente e a pertinência dessa teoria para a prática de enfermagem. Considerações finais: o Modelo de Nola Pender é prático, dinâmico e relevante, e permite a elaboração do plano de cuidado direcionado à promoção da saúde do adolescente.(AU)

Objective: to analyze the applicability of Nola Pender's Health Promotion Model (HPM) for the adolescent public. Methodology: integrative literature review with search in online databases LILACS, MEDLINE, CINAHL, COCHR ANE, EMBASE and SciELO library, answering the following question: what is the applicability of HPM in the care of adolescents in recent times? Results: 27 scientific articles were selected, whose main contributions were listed in the categories of the referred model itself. The study made it possible to glimpse the complexity of factors that involve the itinerary of adolescent health promotion and the pertinence of this theory for Nursing practice. Final considerations: the Nola Pender Model is practical, dynamic, relevant and allows the elaboration of a care plan aimed at promoting adolescent health.(AU)

Objetivo: analizar la aplicabilidad del Modelo de Promoción de la Salud de Nola Pender a la población adolescente. Metodología: revisión integrativa de la bibliografía con búsqueda en las bases de datos online LILACS, MEDLINE, CINAHL, COCHR ANE, EMBASE, y biblioteca SciELO, respondiendo a la siguiente pregunta: Cuál es la aplicabilidad del MPS en la atención a los adolescentes en tiempos recientes? Resultados: fueron seleccionados 27 artículos científicos, cuyas principales contribuciones fueron listadas en las categorías del propio modelo. El estudio permitió vislumbrar la complejidad de los factores que envuelven el itinerario de promoción de la salud para adolescentes y la relevancia de esta teoría para la práctica de enfermería. Conclusiones: El Modelo de Nola Pender es práctico, dinámico y pertinente, y permite el desarrollo de un plan de atención dirigido a la promoción de la salud del adolescente.(AU)

Violência contra adolescentes: caracterização das notificações realizadas por profissionais da saúde / Violence against adolescents: characterization of notifications carried out by health professionals / Violencia contra adolescentes: caracterización de notificaciones realizadas por profesionales de la salud

Por meio da presente pesquisa, se intenta caracterizar as situações de violência contra adolescentes notificadas por profissionais da saúde por meio da Ficha Individual do Sistema de Informação de Agravos de Notificação (FINSINAN) no Rio Grande do Sul entre 2009 e 2017. Objetiva-se, também, avaliar diferenças em relação às vítimas, aos agressores e aos contextos de violência. Para tanto, foram analisadas 23.536 notificações de violência. Os dados foram coletados por meio da FINSINAN, posteriormente disponibilizados pelo Centro Estadual de Vigilância em Saúde (CEVS). Com isso, verificou-se que a maioria das situações de violência foi perpetrada contra adolescentes do sexo feminino (66,8%), na residência da vítima (58,9%) e por agressores do sexo masculino (61,7%). A violência física foi a mais notificada (57,5%) e a maior parte dos encaminhamentos foi realizada para o Conselho Tutelar (54,3%). Portanto, os dados apontaram para a gravidade da violência e para a necessidade de capacitar os profissionais da saúde

Through this research, we aim to characterize situations of violence against adolescents reported by healthcare professionals using the Individual Report Form of the Notifiable Diseases Information System (FINSINAN) in Rio Grande do Sul between 2009 and 2017. Additionally, we intend to assess differences in relation to the victims, perpetrators, and the contexts of violence. To this end, we analyzed 23,536 reports of violence. The data were collected through FINSINAN and subsequently made available by the State Center for Health Surveillance (CEVS). As a result, it was found that most violent incidents were perpetrated against female adolescents (66.8%) in the victim's residence (58.9%) and by male perpetrators (61.7%). Physical violence was the most reported form (57.5%), and the majority of referrals were made to the Child Protective Services (54.3%). Therefore, the data highlight the severity of the violence and the need to train healthcare professionals

A través de esta investigación, buscamos caracterizar las situaciones de violencia contra adolescentes notificadas por profesionales de la salud mediante el Formulario Individual del Sistema de Información de Enfermedades de Notificación Obligatoria (FINSINAN) en Rio Grande do Sul entre 2009 y 2017. Además, pretendemos evaluar las diferencias con respecto a las víctimas, agresores y los contextos de la violencia. Para ello, analizamos 23,536 informes de violencia. Los datos se recopilaron a través de FINSINAN y posteriormente fueron facilitados por el Centro Estatal de Vigilancia en Salud (CEVS). Como resultado, se encontró que la mayoría de los incidentes violentos fueron perpetrados contra adolescentes de sexo femenino (66.8%) en la residencia de la víctima (58.9%) y por agresores de sexo masculino (61.7%). La violencia física fue la forma más comúnmente notificada (57.5%), y la mayoría de las remisiones se hicieron al Consejo Tutelar (54.3%). Por lo tanto, los datos resaltan la gravedad de la violencia y la necesidad de capacitar a los profesionales de la salud

Plano EVA-TO: plano de enfrentamento à violência autoprovocada do Estado do Tocantins com ênfase na atenção integral à saúde / EVA-TO Plan: plan to face self-inflicted violence in the State of Tocantins with an emphasis on comprehensive health care

O Plano de Enfrentamento à Violência Autoprovocada do Estado do Tocantins com Ênfase na Atenção Integral à Saúde foi desenvolvido para fortalecer a rede de atenção psicossocial, em colaboração com o Sistema Único de Saúde (SUS) e o Sistema Único de Assistência Social (SUAS). Elaborado pelo Grupo de Trabalho "Flor de Pequi", o plano tem como objetivo qualificar a Rede de Atenção à Saúde, orientando gestores e profissionais de saúde na prevenção da violência autoprovocada, automutilação e suicídio, além de promover o acolhimento e compartilhamento do cuidado na rede de atenção à saúde. O documento foi elaborado em resposta a demandas relacionadas aos dados de violência autoprovocada, solicitações do Conselho Estadual de Defesa de Direitos da Criança e do Adolescente e do Conselho Regional de Psicologia. A metodologia, discussão, metas, ações e monitoramento também são abordados no plano.

The Plan for Confronting Self-Inflicted Violence in the State of Tocantins with an Emphasis on Comprehensive Health Care was developed to strengthen the psychosocial care network in collaboration with the Unified Health System (SUS) and the Unified Social Assistance System (SUAS). Elaborated by the "Flor de Pequi" Working Group, the plan aims to enhance the Health Care Network by providing guidance to managers and health professionals in the prevention of self-inflicted violence, self-harm, and suicide, while promoting care and support within the health care system. The document was created in response to demands related to self-inflicted violence data, requests from the State Council for the Defense of the Rights of Children and Adolescents, and the Regional Psychology Council. The plan also addresses methodology, discussion, goals, actions, and monitoring.

El Plan de Enfrentamiento a la Violencia Autoinfligida en el Estado de Tocantins con Énfasis en la Atención Integral de Salud fue desarrollado para fortalecer la red de atención psicosocial en colaboración con el Sistema Único de Salud (SUS) y el Sistema Único de Asistencia Social (SUAS). Elaborado por el Grupo de Trabajo "Flor de Pequi", el plan tiene como objetivo calificar la Red de Atención a la Salud, brindando orientación a los gestores y profesionales de la salud en la prevención de la violencia autoinfligida, la automutilación y el suicidio, además de promover el cuidado y apoyo dentro de la red de atención sanitaria. El documento fue elaborado en respuesta a demandas relacionadas con datos de violencia autoinfligida, solicitudes del Consejo Estatal para la Defensa de los Derechos de la Niñez y la Adolescencia y del Consejo Regional de Psicología. El plan también aborda la metodología, la discusión, las metas, las acciones y el monitoreo

Vulnerabilidad al estrés en adolescentes de instituciones deportivas / Vulnerability to stress in teenagers in sports institutions

Fundamento: Los trastornos temporomandibulares tienen origen multifactorial y el factor psicológico ocupa un papel importante en su desencadenamiento. Objetivo: Determinar la vulnerabilidad al estrés en adolescentes de instituciones deportivas. Metodología: Se realizó un estudio observacional descriptivo de corte transversal, en la EIDE provincial de Sancti Spíritus "Lino Salabarría Pupo" entre octubre de 2020 y marzo de 2021. Se seleccionaron 70 escolares de décimo, onceno y duodécimo grados mediante muestreo aleatorio simple. Se midió la variable: rango de vulnerabilidad al estrés. Se utilizaron métodos del nivel teórico, empírico y estadístico. Resultados: El 51.4 %.de los estudiantes fueron clasificados con vulnerabilidad al estrés, el 40 % no vulnerables, el 8.6 % seriamente vulnerables y ninguno extremadamente vulnerables. Conclusiones: Existe un predominio de adolescentes de instituciones deportivas con vulnerabilidad al estrés.

Background: Temporomandibular disorders have a multifactorial origin and the psychological factor plays an important role in their triggering. Objective: To determine the vulnerability to stress in teenagers from sports institutions. Methodology: A cross-sectional descriptive observational study was conducted at the Sancti Spíritus provincial EIDE "Lino Salabarría Pupo" between October 2020 and March 2021. Seventy schoolchildren from tenth, eleventh and twelfth grades were selected by simple random sampling. The variable range of vulnerability to stress was measured. Theoretical, empirical and statistical methods were used. Results: 51.4 % of the students were classified with vulnerability to stress, 40 % not vulnerable, 8.6 % seriously vulnerable and none extremely vulnerable. Conclusions: There is a predominance of teenagers from sports institutions with vulnerability to stress.

Self-injurious behavior and factors related to suicidal intent among adolescents: a documentary study / Comportamento autolesivo e fatores relacionados à intenção suicida entre adolescentes: estudo documental / Comportamiento autolesivo y factores relacionados con la intención suicida entre los adolescentes: estudio documental

It is a type of quantitative documentary research of descriptive and exploratory content in which studied the profile of adolescents with self-injurious behavior and the variables of risk and protection regarding the suicidal intent, reported in a Children and Youth Psychosocial Care Center (CAPS IJ) from a metropolitan region in the south of Brazil. Data from 139 assisted adolescents, admitted for self-injury, reported that self-injuries occurred predominantly at home (M=14,36 years; SD=1,63), with multiple episodes, using sharp objects with suicidal intent. The hierarchical binary logistic regression results point out that experiencing abuse in the present -using non-sharps objects- having severe injuries and practicing them in different places are risk variables. Whereas the existence of community and school social support networks are protective factors. There is a necessity of investment in the studies that explore the etiology of self-injuries and that provide support for cases of prevention, detection, and treatment. (AU)

Esta pesquisa documental quantitativa, de caráter descritivo e exploratório, investigou o perfil de adolescentes com comportamento autolesivo e variáveis de risco e proteção relacionadas à intenção suicida relatada em um Centro de Atenção Psicossocial Infantojuvenil (CAPS IJ) de uma região metropolitana do sul do país. Dados de 139 adolescentes (M = 14,36 anos; DP = 1,63), atendidos por autolesão, indicaram que estas ocorriam predominantemente em ambiente doméstico, com episódios múltiplos, utilização de objetos perfurocortantes e com intenção suicida. Os resultados da regressão logística binária hierárquica indicaram que sofrer violência no presente, utilizar outros objetos que não os perfurocortantes, apresentar lesões graves e praticá-las em locais diferentes são variáveis de risco, enquanto possuir redes de apoio comunitária e escolar são fatores de proteção. É necessário investir em estudos que investiguem a etiologia da autolesão e subsidiem ações de prevenção, detecção e tratamento. (AU)

Esta investigación documental cuantitativa, de carácter descriptivo y exploratorio, investigó el perfil de los adolescentes con conductas autolesivas y variables de riesgo y protección relacionadas con la intención suicida reportada, en un Centro de Atención Psicosocial Infantil y Juvenil (CAPS IJ) de una región metropolitana al sur de Brasil. Los datos de 139 adolescentes (M=14,36 años; DS=1,63), atendidos por autolesión, indicaron que las autolesiones se produjeron en un entorno doméstico, con múltiples episodios, uso de objetos punzantes y con intención suicida. Resultados de la regresión logística binaria jerárquica indicaron que sufrir violencia en el presente, utilizar objetos distintos de los punzantes, presentar lesiones graves y practicarlas en diferentes lugares son variables de riesgo, mientras que tener una red de apoyo comunitario y escolar son factores de protección. Es necesario invertir en estudios que investiguen la etiología de la autolesión y subvencionar acciones de prevención, detección y tratamiento. (AU)

Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services?

Compared to other regions of the world, sub-Saharan Africa has made limited progress in the implementation and performance of nationwide human papillomavirus (HPV) vaccination programmes. Without urgent intervention, this will serve to undermine cervical cancer elimination efforts in this region. The primary intent of this narrative review is to highlight the programmatic successes and challenges of the school-based HPV vaccination programme in South Africa since its inception in 2014, with the aim of contributing to the evidence base needed to accelerate implementation and improve programme performance in other sub-Saharan African countries. As of 2020, the proportion of adolescent girls aged 15 years who had received at least one dose of the HPV vaccine at any time between ages 9-14 years was 75%, while 61% had completed the full recommended two-dose schedule. This gives some indication of the reach of the South African HPV vaccination programme over the past 6 years. Despite this, vaccine coverage and dose completion rates have persistently followed a downward trend, slowing progress toward attaining global elimination targets. There is evidence suggesting that declining public demand for the HPV vaccine may be a result of weakening social mobilization over time, inadequate reminder and tracking systems, and vaccine hesitancy. Another concern is the disproportionate burden of HPV and HIV co-infections among adolescent girls and young women in South Africa, which predisposes them to early development of invasive cervical cancer. Moving forward, national policy makers and implementers will have to explore reforms to current age eligibility criteria and vaccine dose schedules, as well as implement strategies to support vaccine uptake among populations like out-of-school girls, girls attending private schools, and HIV positive young women. Additional opportunities to strengthen the South African HPV vaccination programme can be achieved by scaling up the co-delivery of other adolescent health services such as comprehensive sexual and reproductive health and rights education, deworming, and health screening. This calls for reinforcing implementation of the integrated school health policy and leveraging existing adolescent health programmes and initiatives in South Africa. Ultimately, establishing tailored, adolescent-centered, integrated health programmes will require guidance from further operational research.

Opportunities for Early Identification: Implementing Universal Depression Screening with a Pathway to Suicide Risk Screening in a Pediatric Health Care System.

OBJECTIVES: To describe the implementation process and assess results of a large-scale universal depression screening program with pathways to suicide risk screening in a pediatric integrated delivery network. STUDY DESIGN: This retrospective study analyzes depression and suicide risk screening data for 95 613 patients ages 12-17 years. RESULTS: Of the 95 613 adolescent patients who were screened for depression, 2.4% (2266) screened positive for risk for moderate-severe depression (>10 Patient Health Questionnaire; 9-item version) and 4.1% (3942) endorsed elevated suicide risk (≥1 Columbia Suicide Severity Rating Scale). Overall, 51% of screened patients who present with a primary psychiatric concern screened positive for elevated risk of suicide (2132). Two percent of screened patients who presented with a primary medical concern screened positive for elevated risk of suicide. Nearly one-half (45.9%) of all elevated suicide risk screenings were from patients with a primary medical concern. CONCLUSIONS: A large-scale universal depression screening program with a pathway to identify elevated suicide risk was implemented in a pediatric health care system using the Patient Health Questionnaire and the Columbia Suicide Severity Rating Scale. This screening program identified youth with moderate-severe depression and elevated risk for suicide with and without presenting psychiatric concerns across service settings.

Tecnologias educacionais para abordagens de saúde com adolescentes: revisão integrativa / Tecnologías educativas para abordajes de salud con adolescentes: revisión integradora / Educational technologies for health approaches to adolescents: an integrative review

Resumo Objetivo Conhecer e sintetizar a produção científica sobre tecnologias educacionais para abordagens em saúde com adolescentes. Métodos Trata-se de uma revisão integrativa de literatura realizada nas bases de dados Pubmed, Web of Science, Scopus, Lilacs, SciELO e BVS, entre abril e julho de 2020. A disponibilidade completa e gratuita dos artigos em português, inglês e/ou espanhol e as publicações realizadas nos últimos cinco anos compuseram os critérios de inclusão. Realizou-se análise descritiva da caracterização dos estudos e do conteúdo. Resultados Foram selecionados 14 artigos, e destacaram-se cartilhas, jogos interativos e vídeos como tecnologias educacionais. A maioria dos estudos contemplou o VI nível de evidência - inclui estudos qualitativos e opiniões de especialistas, sete estudos estavam na língua inglesa e o delineamento predominante foi do tipo metodológico - com nove artigos. Conclusão O objetivo foi alcançado e as evidências apontaram que as tecnologias educacionais são fundamentais para a abordagem de saúde escolar com adolescentes, porém é necessário privilegiar espaços para o diálogo e para as considerações de suas necessidades a fim de aproximá-los dos serviços de saúde.

Resumen Objetivo Conocer y sintetizar la producción científica sobre tecnologías educativas para abordajes en salud con adolescentes. Métodos Se trata de una revisión integrativa de la literatura realizada en las bases de datos Pubmed, Web of Science, Scopus, Lilacs, SciELO y BVS, entre abril y julio de 2020. La disponibilidad completa y gratuita de los artículos en portugués, inglés o español y las publicaciones realizadas en los últimos cinco años compusieron los criterios de inclusión. Se realizó un análisis descriptivo de la caracterización de los estudios y del contenido. Resultados Se seleccionaron 14 artículos y se destacaron cartillas, juegos interactivos y videos como tecnologías educativas. La mayoría de los estudios contempló el VI nivel de evidencia - incluye estudios cualitativos y opiniones de especialistas, siete estudios estaban en lengua inglesa y la delineación predominante fue del tipo metodológico - con nueve artículos. Conclusión El objetivo fue alcanzado y las evidencias apuntaron a que las tecnologías educativas son fundamentales para el abordaje de la salud escolar con adolescentes, sin embargo existe la necesidad de privilegiar espacios para el diálogo y para las consideraciones de sus necesidades con la finalidad de aproximarlos a los servicios de salud.

Abstract Objective To know and synthesize scientific production on educational technologies for health approaches with adolescents. Methods This is an integrative literature review carried out on the PubMed, Web of Science, Scopus, LILACS, SciELO and Virtual Health Library databases, between April and July 2020. Full and free availability of articles in Portuguese, English and/or Spanish, and publications carried out in the last five years formed the inclusion criteria. A descriptive analysis of study and content characterization was carried out. Results A total of 14 articles were selected, and booklets, interactive games and videos were highlighted as educational technologies. Most studies contemplated the VI level of evidence, including qualitative studies and expert opinions, seven studies were in English and the predominant design was of the methodological type, with nine articles. Conclusion The objective was achieved and evidence showed that educational technologies are essential for addressing school health with adolescents; however, it is necessary to privilege spaces for dialogue and consideration of their needs in order to bring them closer to health services.

Ateneo General de la Residencia de Psicopedagogía: En busca de una oportunidad: Intervenciones psicopedagógicas en la clínica con adolescentes / General Athenaeum of the Psychopedagogical Residence: In search of an opportunity: Psychopedagogical interventions in the clinic with teenagers

Ateneo centrado en la intervención, la intervención psicopedagógica, y la intervención temprana y oportuna en la adolescencia. Se determinan qué imaginarios acompañan el concepto de adolescencia situando el discurso médico, normativo y social. Finalmente, se profundiza acerca de los espacios que desde el Sistema de Salud, y más específicamente desde el equipo de psicopedagogía del Hospital Vélez Sarsfield, se ofrecen a la población adolescente. Se incluyen fragmentos de entrevistas y reflexiones aportados desde la propia experiencia profesional.

Hipertensión arterial en adolescentes con exceso de peso y su resiliencia ante la enfermedad / Blood pressure in overweight adolescents and its resilience to the disease

RESUMEN Fundamento: la morbilidad por hipertensión arterial y el exceso de peso en la adolescencia constituyen un problema de salud, por lo que el equipo básico de salud y la familia juegan un papel importante para enfrentar este reto en la comunidad. Objetivo: diseñar un curso de superación a los Equipos Básicos de Salud (EBS) sobre la resiliencia ante la hipertensión arterial en adolescentes con exceso de peso. Metodos: se realizó un estudio de intervención en el periodo septiembre-diciembre de 2019 en el Policlínico Universitario "Chiqui Gómez Lubián" de Santa Clara. Villa Clara. Se emplearon métodos teóricos: análisis-síntesis e inductivo-deductivo; empíricos: análisis documental, grupo nominal y el criterio de especialistas para la valoración del producto diseñado. Resultados: la capacitación se diseñó en la modalidad presencial con cuatro semanas de duración, consta de cinco temas generales con algunos aspectos específicos y está concebido según necesidades de aprendizaje dependiendo de la actividad laboral de desempeño (médico o enfermera). Se aplicaron varios principios didácticos y diferentes modalidades evaluativas para comprobar la aprehensión de los contenidos, y se potencializó la vinculación de la teoría con la práctica como estrategia didáctica. Conclusiones: el curso diseñado cumple los requerimientos didácticos, es pertinente, factible y tiene un adecuado tratamiento científico y metodológico en sus temas según el criterio de los especialistas consultados.

ABSTRACT Background: morbidity due to hypertension and excess weight in adolescence constitute a health problem, so the basic health team and the family play an important role to face this challenge in the community. Objective: to design an upgrading course to improve Basic Health Teams (BHT) on resilience to hypertension in overweight adolescents. Methods: an intervention study was carried out from September to December 2019 at the Chiqui Gómez Lubián University polyclinic in Santa Clara. Villa Clara. Theoretical methods were used: analysis-synthesis and inductive-deductive; empirical ones: documentary analysis, nominal group and the criteria of specialists for the evaluation of the designed product. Results: the training was designed in the face-to-face modality with four weeks duration, it consists of five general topics with some specific aspects and it is conceived according to learning needs depending on the work activity of performance (doctor or nurse). Several didactic principles and different evaluative modalities were applied to verify the apprehension of the contents, and the linking of theory with practice as a didactic strategy was strengthened. Conclusions: the designed course meets the didactic requirements, it´s pertinent, feasible and has an adequate scientific and methodological treatment in its topics according to the criteria of the specialists consulted.

Screening, Monitoring, and Referral to Treatment for Young Adolescents at an Urban School-Based Health Center.

BACKGROUND: This study describes the experience of implementing a screening, monitoring, and referral to treatment (SMARTT) initiative at an urban middle school school-based health center. METHODS: Retrospective data were collected for adolescents screened with the Pediatric Symptom Checklist-17-Y. At-risk adolescents having unmet health needs were offered a mental health referral, and those that declined a mental health referral were offered a primary care monitoring (PCM) visit with the medical provider. Chi-square analyses were used to evaluate differences in screening and outcomes by age, sex, and race/ethnicity. RESULTS: One out of four adolescents had a positive PSC-17-Y or negative screen with other identified concerns. Approximately half of these at-risk adolescents accepted a mental health referral, and 86% of those who declined agreed to the PCM visit. More than two-thirds of the PCM group did not need continued monitoring and support at follow-up, and 85.4% of youth who had a mental health assessment accepted mental health services. CONCLUSIONS: The SMARTT initiative successfully demonstrated that co-located and integrated mental health services can enhance access and connection to mental health services for at-risk youth. In addition, PCM visits were found to be an effective option for youth who declined mental health referrals.

Home-Based Telemental Health: A Proposed Privacy and Safety Protocol and Tool.

Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto.Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.

Buenas prácticas en la atención prenatal a adolescentes embarazadas: perspectivas de profesionales de la salud / Good prenatal care practices in teenage pregnancy from the perspective of healthcare professionals / Boas práticas no atendimento pré-natal para adolescentes grávidas: perspectivas de profissionais da saúde

Objetivo: sistematizar buenas prácticas de atención prenatal en un servicio de referencia para adolescentes embarazadas en Campinas, São Paulo, Brasil, desde la perspectiva de profesionales de la salud. Materiales y métodos: estudio cualitativo desarrollado entre junio y julio de 2017, se emplearon entrevistas semiestructuradas y se realizó un grupo focal con 10 profesionales de la salud que prestaban atención a adolescentes embarazadas en una unidad hospitalaria del sistema público de la región de Campinas, São Paulo, Brasil. Los datos fueron examinados mediante la técnica de análisis de contenido temático de donde surgieron nuevas categorías de análisis. Se hizo validación a través de triangulación de los resultados. Se identificó la aplicabilidad teórica y práctica de los principales hallazgos. Resultados: fueron elaboradas tres categorías emergentes del discurso de los profesionales y de las evidencias en la literatura: 1) análisis integral de las adolescentes en situación de embarazo; 2) experiencias profesionales en la atención a las adolescentes embarazadas que evidencian calidad en el servicio; 3) fortalezas y oportunidades del servicio con posibilidades de replicación como modelo asistencial. Son consideradas buenas prácticas durante el cuidado prenatal aquellas que priorizan la atención integral a las adolescentes embarazadas; estas son coordinadas por un equipo multidisciplinario, y consiguen tener un abordaje multidimensional, sobre todo, valorando la complejidad que supone la maternidad en la adolescencia. Conclusión: dentro de los servicios de salud sexual y reproductiva es recomendable el desarrollo de estrategias educativas, el fortalecimiento de la atención en grupos y la inclusión de la red de apoyo de las adolescentes en la atención, con el fin de favorecer una experiencia positiva durante el cuidado prenatal cuando el proceso de volverse madre acontece durante la adolescencia.

Objective: To systematize good prenatal care practices in a referral center for pregnant teenagers in Campinas, São Paulo, Brazil, from the perspective of healthcare professionals. Material and methods: Qualitative study conducted between June and July 2017 using semi-structured interviews and a focus group with 10 healthcare professionals providing care to pregnant teenagers in a public hospital in the region of Campinas, São Paulo, Brazil. Data were examined using the thematic content analysis technique, which gave rise to new analytical categories. Triangulation of the results was used for validation. The theoretical and practical applicability of the main findings was identified. Results: The study looked into three categories arising from the discourse of the professionals and the evidence found in the literature: 1) comprehensive analysis of pregnant teenagers; 2) professional experiences related to the care of pregnant teenagers reflecting service quality; and 3) strengths and improvement opportunities potentially replicable as a care model. Good practices in prenatal care are those which prioritize comprehensive care for pregnant teenagers, are coordinated by a multidisciplinary team and result in a multidimensional approach, valuing the complexity of motherhood in the teenage years. Conclusion: It is advisable to develop education strategies, strengthen group care and involve the teenager's support network as part of sexual and reproductive health services in order to promote a positive experience during prenatal care when the process of becoming a mother takes place during adolescence.

Objetivo: Sistematizar as boas práticas de atenção pré-natal em um serviço de referência para adolescentes grávidas em Campinas, São Paulo/Brasil desde a perspectiva dos professionais da saúde. Materiais e métodos: Estudo qualitativo desenvolvido entre junho e julho de 2017. Empregaram-se entrevistas semiestruturadas e grupo focal com 10 profissionais da saúde que prestavam atendimento à adolescentes grávidas em uma unidade hospitalar da rede pública da região de Campinas, São Paulo/Brasil. Os dados foram analisados por meio da técnica de análise de conteúdo temática onde surgiram as categorias de análise. Realizou-se validação através de triangulação dos resultados e foi identificada a aplicabilidade teórica e prática dos principais achados. Resultados: Foram elaboradas três categorias emergentes do discurso dos professionais e das evidências na literatura: 1) análise compreensiva das adolescentes em situação de gravidez; 2) vivências profissionais no cuidado de adolescentes grávidas que mostram a qualidade no atendimento; 3) potencialidades e oportunidades do serviço com possibilidades de replicação como modelo assistencial. No atendimento pré-natal, são consideradas como boas práticas aquelas que priorizam a atenção integral à gestante adolescente; as que são coordenadas por uma equipe multidisciplinar e conseguem ter uma abordagem multidimensional, sobretudo, avaliando a complexidade que supõe a maternidade durante a adolescência. Conclusões: Dentro dos serviços de saúde sexual e reprodutiva, é recomendável o desenvolvimento de estratégias educativas, o fortalecimento da atenção em grupos e a inclusão da rede de apoio das adolescentes na atenção para favorecer uma experiência positiva durante o cuidado pré-natal levando em consideração o processo de tornar-se mãe durante a adolescência.

Unindicated cervical cancer screening in adolescent females within a large healthcare system in the United States.

BACKGROUND: Current consensus recommendations are to not initiate cervical cancer screening for immunocompetent adolescent females before 21 years of age. This is in part because of the very low rate of 0.8 per 100,000 new cervical cancer cases diagnosed among women aged between 20 to 24 years. Timely human papillomavirus vaccination further decreases the incidence of cervical cancer to 4 cases per 100,000 persons by the age of 28 years. Screening before 21 years of age has demonstrated no clear benefit in cancer risk reduction or outcomes. In addition, unindicated screening among adolescents can lead to patient harm and increasing costs to the healthcare system. OBJECTIVE: It is important to assess the rates of overutilization of cervical cancer screening and to identify areas where improvements have occurred and where further opportunities exist. This study aimed to assess the trends over time and the practice and provider factors associated with unindicated cervical cancer screening tests in adolescent females within the largest healthcare system in the state. STUDY DESIGN: Cross-sectional data from patients aged 13 to 20 years who underwent cervical cancer screening between January 1, 2012, and December 31, 2018, across a large multihospital health system were reviewed. All cervical cancer screening results were included. The incidence rate of unindicated screening was analyzed over 6-month intervals using the Poisson regression analysis. RESULTS: The study included data from 118 providers and 794 women. Among the 900 screening results, most (90%) were unindicated: 87% with unindicated cytology testing alone and 14% with unindicated human papillomavirus testing. Screening tests were collected from patients aged 13 to 20 years, many of whom had multiple unindicated cytology tests, with 25 patients having ≥3 tests before the age of 21 years. Most results of cytology testing were negative for intraepithelial lesion or malignancy (77%). Moreover, 52 invasive diagnostic or therapeutic procedures (49 colposcopies and 3 conizations) were performed, of which 45 (87%) followed an unindicated screening test. Between 2012 and 2018, the incidence rate of unindicated cytology decreased by 33% (12.6 to 8.5 unindicated cytology per 1000 encounters). The incidence rate of unindicated screening was lower in the academic setting than in the community setting (incidence rate ratio, 0.43; P<.01). Even with decreases in the overall rates of unindicated screening throughout the study period, there were still 58 unindicated screening tests performed in the final year of this study. CONCLUSION: Despite substantial reductions in unindicated screening for women aged <21 years, there remained areas for improvement. Our data reflected practices of guideline nonadherence up to 7 years after the 2012 guideline. Now, with a new series of changes to the guidelines, which may be even more challenging for patients and providers, it is more important than ever to utilize evidence-based strategies to improve guideline dissemination and adherence.

An Evidence-based Protocol to Improve HPV Vaccine Initiation Rates at a County Immunization Clinic.

Human Papillomavirus (HPV) is responsible for 26,900 cancer cases yearly, including genital and oropharyngeal cancers. Despite providing nearly 100% protection against cancer-causing strains of HPV, only 68.9% of teenagers receive even one dose of the HPV9 vaccine. To increase HPV9 vaccine series initiation rates among 11-14 year-olds. Vaccine rates were examined before and after multi-modal protocol implementation at a nurse-run, walk-in immunization clinic. Initiation increased from 17.9% in 2017 to 35.5% in 2018. Use of same way/same day recommendation practices and inclusion of non-clinician staff could improve quality of care and decrease HPV-related disease.

Tertiary eating disorder services: is it time to integrate specialty care across the life span?

OBJECTIVE: Australian tertiary eating disorder services (EDS) have a divided model of care, where child and adolescent mental health services (CAMHS) support patients until the age of 18 years, and thereafter, adult mental health services (AMHS) provide care. Consumers and carers have criticised this divided model because the age boundary occurs during the peak period of onset and acuity for eating disorders. Most CAMHS patients are lost to specialty follow-up around age 18, increasing the risks of relapse and premature mortality from eating disorders, since young women (aged 15-24) have the highest hospitalisation rates from anorexia nervosa. The current article is a commentary on the transition gap and possible service designs. CONCLUSIONS: Eating disorders require access to specialty treatment across the life span. The Australian Federal Government has expanded all-age care through the 2019 Medicare Benefit Schedule (MBS) eating disorder plans. Some new MBS patients require a rapid step-up in care intensity to a tertiary EDS, thereby increasing demand on the public sector. State/Territory Governments should strengthen EDS using the 'youth reach-down' model, where AMHS extend EDS to age 12. Vertical service integration from 12 to 64+ facilitates continuity of care for the duration of an eating disorder.