¿Hay alguien ahí?: Experiencias en la clínica psicopedagógica grupal con púberes en tiempos de pandemia / Anyone there?: Experiences in the psychopedagogical clinic group with pubescents in times of pandemic

Escrito del Equipo de Psicopedagogía del Centro de Salud Nº 10, perteneciente al Área Programática del Hospital Dr. José María Penna, de la Ciudad de Buenos Aires. Debido a la pandemia la atención clínica presencial debió ser suspendida, y se continuó con la asistencia a los pacientes de manera virtual. Con algunxs se realizaron seguimientos telefónicos con lxs referentes familiares y en algunos casos con lxs niñxs así como también se mantuvieron comunicaciones con las escuelas, derivaciones e interconsultas; con otrxs se logró cierta continuidad en el tratamiento por lo general a través de videollamadas de whastapp. Este es el caso del grupo de tratamiento de púberes del que se propone compartir y reflexionar. En la sede de este equipo, el abordaje clínico grupal data ya de varios años pero particularmente el grupo de púberes surgió en el año 2018. Por tanto, en un primer momento, se propone historizar y contextualizar al grupo de tratamiento psicopedagógico así como también compartir la concepción de la clínica grupal. Además, se comparten la conceptualización de la pubertad que sostiene el equipo y los procesos psíquicos esperables que se dan en este tiempo articulado con el contexto actual. (AU)

Guía Nacional de Anticoncepción para Adolescentes / National Guide to Contraception for Adolescents

Abordada desde la perspectiva del MSPAS que es consciente de que el embarazo en adolescentes afecta su salud, desarrollo y proyecto de vida, y que ha contribuido al logro de avances importantes, para garantizar los derechos sexuales y reproductivos de los adolescentes que son atendidos en las redes de servicios de salud. Además, el documento refleja los compromisos adquiridos en torno a disminuir: embarazos en adolescentes y muertes maternas, además de la prevención del VIH/Sida, las ITS y la violencia sexual. Esta guía está dirigida al personal de salud de los tres niveles de atención del MSPAS con la finalidad de fortalecer las competencias técnicas y orientarles para que brinden atención de forma integral y con calidad, garantizando la información, orientación, consejería balanceada y provisión de métodos anticonceptivos y porque además el ministerio, aporta atención desde espacios amigables y clínicas integrales hospitalarias para adolescentes, así como la provisión de métodos anticonceptivos (y clínicas de planificación familiar).

Ateneo General de la Residencia de Psicopedagogía: ¿Quién ser y qué hacer en el Siglo XXI? Adolescentes en el espacio de Orientación Vocacional Ocupacional / General athenaeum of the Psychopedagogy Residence: Who to be and what to do in the 21st century? Adolescents in the occupational vocational guidance space

Ateneo del equipo de residentes de Psicopedagogía del Hospital D. Vélez Sarsfield de la Ciudad de Buenos Aires. Ante la disminución en las demandas de adolescentes por un proceso de Orientación Vocacional Ocupacional, surgieron interrogantes como eje de este trabajo: ¿Por qué son cada vez menos los adolescentes que se acercan al Área Programática del hospital en busca de un proceso de Orientación Vocacional Ocupacional? ¿Cuánta influencia tiene el contexto, los pares y la familia a la hora de elegir una vocación / ocupación? ¿Cuál es el rol de la escuela? ¿Guarda todo esto alguna relación con los tiempos actuales? ¿De qué manera? Incluye bibliografía y los anexos: Compendio de técnicas para Orientación Vocacional, y Encuestas realizadas a jóvenes que se encuentran finalizado o ya han finalizado la escuela secundaria.

Barreras y facilitadores para el control prenatal en adolescentes: resultados de un estudio cualitativo en Chile / Barriers and facilitators to antenatal care in adolescents: results of a qualitative study in Chile

Objetivo. Analizar barreras y facilitadores de acceso a control prenatal en adolescentes urbanas de 15-19 años en Santiago, Chile. Material y métodos. Estudio cualitativo con 17 madres adolescentes basado en la teoría fundamentada. Se realizaron 11 entrevistas semiestructuradas y un grupo focal. Resultados. La negación y ocultamiento del embarazo es la principal barrera para ingresar a control en el grupo de acceso tardío; no se identificaron facilitadores. Para mantenerse en control, todas las participantes identifican como facilitador contar con una figura de apoyo. La vulnerabilidad familiar y social explica que algunas adolescentes ingresen a control tardíamente. Conclusión. La presencia de facilitadores es determinante para el ingreso oportuno y mantenerse en control, ya que reduce o anula el efecto de las barreras. El sistema de salud debe constituirse en un facilitador que acompañe desde muy temprano a las adolescentes favoreciendo un vínculo de confianza y respeto.

Objective. Analyze barriers and facilitators of access to prenatal care in pregnant urban adolescents between 15-19 years of age in Santiago, Chile. Materials and methods. Qualitative study based on grounded theory with 17 adolescent mothers. Eleven semi-structured interviews and one focus group were conducted. Results. The denial and concealment of pregnancy is the main barrier to start the prenatal care in the "delayed access group". This group does not identify facilitators. For maintenance in antenatal care, all participants identified a support figure as a facilitator. Family and social vulnerabilities explain why some adolescents start the prenatal care late. Conclusion. The presence of facilitators is crucial for both, the timely entry and the maintenance in antenatal care because they reduce or nullify the effect of barriers. The health system must become a facilitator to accompany adolescents and promote a bond of trust and respect.

[Vulnerability during adolescence: the experience and the expression of the adolescent]. / Vulnerabilidade na adolescência: a experiência e expressão do adolescente.

This cross-sectional quantitative study aims to identify situations of vulnerability experienced by adolescents of public secondary schools in Cuiabá, state of Mato Grosso, Brazil, during the second semester of 2009. A closed questionnaire was used in the research. The results show that 10.5% of the boys and 5.8% of the girls had already used illegal drugs at the age of 15--cocaine (28.9%) and marijuana (15.7%) were the most reported; and that 45.2% of the boys and 52.4% of the girls drink alcoholic beverages, beer being the most common. Among self-declared smokers (16.0%), the majority began smoking at the age of 15. Sexual violence was reported, but only 33.3% of the boys and 25.0% of the girls sought help. Fear and shame were the reported reasons for not seeking help. The need for specific prevention and treatment services for adolescents in vulnerable situations stands out, in view of the occurrence and the consequences of this kind of harm.

Vulnerabilidade na adolescência: a experiência e expressão do adolescente / Vulnerabilidad en la adolescencia: la experiencia y expresión del adolescente / Vulnerability in adolescence: the experience and expression of the adolescent

Estudo transversal, quantitativo, cujo objetivo foi identificar situações de vulnerabilidade vivenciadas pelos adolescentes do ensino médio da rede pública de Cuiabá, Mato Grosso, no segundo semestre de 2009. Utilizou-se questionário fechado. Os resultados revelaram que 10,5 por cento dos meninos e 5,8 por cento das meninas já fizeram uso de drogas ilícitas, aos 15 anos, sendo a cocaína (28,9 por cento) e a maconha (15,7 por cento) as mais relatadas; 45,2 por cento dos meninos e 52,4 por cento das meninas consomem bebidas alcoólicas, sendo a cerveja a mais comum. Entre os que se declararam fumantes (16,0 por cento), a maioria iniciou o consumo aos 15 anos. Houve relato de violência sexual, dos quais somente 33,3 por cento dos meninos e 25,0 por cento das meninas procuraram ajuda. Entre os que não procuraram ajuda, o motivo relatado foi medo e vergonha. Destaca-se a necessidade de serviços específicos para prevenção e tratamento de adolescentes em situações de vulnerabilidade, tendo em vista a ocorrência e consequências destes agravos.

Este estudio transversal tuvo por objetivo identificar las situaciones de vulnerabilidad vivenciadas por adolescentes de la escuelas públicas de Cuiabá, Mato Grosso, Brasil. Los resultados revelan que el 10,5 por ciento de los varones y el 5,8 por ciento de las chicas ya han usado drogas ilícitas a los 15 años (40,0 por ciento de los varones y 27,7 por ciento de las chicas); 45,2 por ciento de los varones y 52,4 por ciento de las chicas consume bebidas alcohólicas. Entre los que declararon que fuman (16,0 por ciento), la mayoría se inició a los 15 años. Hubo relatos de violencia sexual por parte de un 3,0 por ciento de los varones y 1,2 por ciento de las chicas, de los cuales solamente el 33,3 por ciento de los varones y 25,0 por ciento de las chicas buscaron ayuda. Teniendo en vista la ocurrencia y consecuencias de los hechos constatados, se destaca la necesidad de servicios específicos para la prevención y tratamiento de adolescentes en situaciones de vulnerabilidad.

This transversal study aims to identify vulnerability experienced by adolescents of public secondary schools in Cuiabá, Mato Grosso, Brazil. The results show that 10.5 percent of the boys and 5.8 percent of the girls have already used illicit drugs - at the age of 15, cocaine (28.9 percent) and marijuana (15.7 percent) being the most reported; 45.2 percent of the boys and 52.4 percent of the girls consume alcoholic beverages, being beer the most common. Among those who declared to be smoker (16.0 percent), the majority began smoking at the age of 15. Sexual violence was reported, out of which only 33.3 percent of the boys and 25.0 percent of the girls sought help. Among those who did not seek help, the referred motive was fear and shame. The need for specific prevention and treatment services for adolescents in vulnerable situations is stressed, in view of the occurrence and consequences of this kind of harm.

Una aproximación a los factores de protección y de riesgo en el uso indebido de drogas: un estudio epidemiológico en adolescentes de un Instituto de rehabilitación por adicciones de Villa María / An approach to protective factors and risk in drug abuse: an epidemiological study in adolescents of an Institute on addictions rehabilitation of Villa Maria

El presente estudio tiene como objetivo analizar los Factores Protectores y de Riesgo vinculados al uso indebido de drogas de los adolescentes que asisten al Instituto Terapéutico de Rehabilitación por Adicciones “Hogar de Nazaret de la localidad de Villa María”; a fin de precisar los trabajos preventivos y terapéuticos en función de las necesidades y recursos tanto individuales como familiares. Se aplicó una técnica cuanti-cualitativa (Cuestionario “Familia y adolescencia: Indicadores de Salud “ y anexo). Conclusión: Los factores protectores detectados a nivel familiar hacen referencia a la búsqueda y percepción positiva del apoyo profesional, priorización de valores personales y resultados terapéuticos. Como factores de riesgo principalmente se detectaron: la prevalencia de conflictos familiares (situaciones de violencia, angustia, problemas de conducta y adicciones, escasa comunicación, apoyo y límites familiares), la minimización y falta de identificación de los conflictos familiares y personales.

This study aims to analyze the Risk and Protective Factors related to drug abuse among adolescents who attend in the Institute for Addiction Rehabilitation Therapy "Home of Nazareth”, located in Villa Maria; to clarify the preventive and therapeutic work, in relation to the needs and resources, both individual and family. We applied a quantitative and qualitative technique (Questionnaire "Family and adolescents: Indicators of Health" and annex). Conclusion: The protective factors identified at the family level are related to the search and positive perception of professional support, prioritization of personal values and treatment outcome. Main risk factors detected were: the prevalence of family conflict (situations of violence, anxiety, behavioral problems and addictions, and a poor communication, family support and limits), minimization and failure to identify family and personal conflicts. The patients, in general, shows indicators of low self-confidence and autonomy in problem solving, personal dissatisfaction (mainly in academic and labor issues), high levels of anxiety, lack of personal aspirations, poor or inadequate information on the effects of drugs, and difficulty in controlling their emotions.

A saúde mental infantil na Saúde Pública brasileira: situação atual e desafios / Child mental health and Public Health in Brazil: current situation and challenges

OBJETIVO: Descrever e analisar a situação atual de desenvolvimento da política pública brasileira de saúde mental infantil e juvenil, com foco nos Centros de Atenção Psicossocial Infanto-juvenil e na rede intersetorial potencial de atenção à saúde mental infantil e juvenil que engloba outras políticas relacionadas à criança e ao adolescente em âmbito nacional. MÉTODO: Análise de publicações e dados oficiais do governo brasileiro sobre a implantação e/ou distribuição de serviços públicos nacionais relacionados à criança e ao adolescente. RESULTADOS: A política brasileira de saúde mental infantil e juvenil tem como ação central a implementação de Centros de Atenção Psicossocial Infanto-Juvenil para atendimento dos casos de transtornos mentais que envolvem prejuízos funcionais severos e persistentes. Existe uma rede intersetorial potencial de cuidado que pode se efetivar com a articulação das ações específicas de saúde mental infantil e juvenil nos setores da saúde geral/atenção básica, educação, assistência social e justiça/direitos. Esta articulação será de grande importância para o atendimento de problemas mais freqüentes, que envolvem prejuízos mais pontuais. DISCUSSÃO: No Brasil, o incremento do sistema de cuidados depende da expansão da rede de serviços de saúde mental infantil e juvenil, dos mais aos menos especializados, e de sua articulação efetiva com outros setores públicos dedicados ao cuidado da infância e adolescência.

OBJECTIVE: To describe and analyze current developments in the Brazilian child and adolescent mental health public policy, focusing on the Centers for Psychosocial Care for Children and Adolescents and in a potential child and adolescent mental health care system, derived from other child and adolescent public policies in the national context. METHOD: Examination of publications and official data produced by the Brazilian government about the implementation and/or distribution of public services for children and adolescents in the country. RESULTS: The Brazilian child and adolescent mental health policy has as one of its main strategies the implementation of Centers for Psychosocial Care for Children and Adolescents to cover persistent child psychiatric disorders with severe levels of impairment. In addition, there is a potential intersectorial system which would become effective once specific child mental health actions are articulated with the sectors of general health, education, child welfare and justice/rights. This articulation will play an important role in responding to psychiatric disorders which are frequent with impairment of very specific areas of functioning. DISCUSSION: In Brazil, improvement of the child and adolescent mental health care system relies upon the expansion of the mental health specialty sector as well as in its articulation with other public sectors responding to child and adolescent needs.

Increasing access to program information: a strategy for improving adolescent health.

OBJECTIVES: To identify existing programs serving 11- to 15-year-olds that aim to improve adolescent health in the areas of Health & Well-being, Fitness, Family & Peer Relationships, School Environment, Smoking, Alcohol Use, and Violence and to assess the utility of readily available resources in providing detailed program information. METHODS: In Phase 1, publicly available program databases were searched to identify potential programs serving the target population. In Phase 2, an in-depth search of a limited sample of programs meeting the content and age criteria was performed to identify program descriptors. RESULTS: Over 1,000 program names were identified in Phase 1. Information regarding programs is becoming more readily available through the internet; however, the program information that was publicly available only begins to draw the picture. Phase 2 revealed that a broad array of efforts are underway in all seven content areas, but found information on the program descriptors to be limited. CONCLUSIONS: Investment in programming is not enough; an upfront investment in communication and information sharing is critical in order to maximize the resources dedicated to the improvement of adolescent health. A well-publicized centralized program repository offered in conjunction with technical assistance would provide an efficient mechanism for this information sharing. We further suggest that the inherent gap between research and practice can be lessened by building a new body of practice knowledge. This would require improved program data collection by programs, the incorporation of program participation information in national surveys and enhanced evaluation efforts.

Female sexual health care in cystic fibrosis.

Fifty five teenage girls with cystic fibrosis and their mothers were interviewed to assess the provision of sexual health information. Parents were the most common source of information for adolescents. The cystic fibrosis doctor was identified as the key resource for parents. Yet few parents had spoken to their doctor about these issues, and 96% requested more information. This information was wanted before puberty by mothers, and from puberty onwards by girls.

Availability of adolescent health services and confidentiality in primary care practices.

BACKGROUND: Little is known about availability of services and confidential care for adolescents in primary care practices or how availability among pediatric practices compares to that among other primary care practices. The objective of this study was to assess self-reported availability of services for medically emancipated conditions and confidential care in primary care practices, to compare physician responses to those from office staff who answer appointment lines, and to compare availability in pediatric practices to other primary care practice types. METHODS: We conducted a telephone survey of randomly selected practices from the Washington, DC, metropolitan area in pediatrics (Peds), internal medicine (IM), and family medicine (FM). We asked staff who answer appointment lines about availability of services for medically emancipated conditions and confidential appointments for adolescents. Physicians received the same questions via a mail survey. Responses from office staff and physicians in the same practice were linked for comparison. RESULTS: Of 434 practices contacted by telephone, 372 (86%) responded. Of the 615 physicians surveyed from these 372 practices, 264 (43%) from 170 practices responded to the mail survey. Peds practices were less likely than FM and IM practices to offer services for medically emancipated conditions and were less likely than FM practices to offer confidential services to adolescents. Office staff and physicians from FM and IM had higher agreement compared with Peds about availability of services for medically emancipated conditions. Agreement between office staff and physicians about provision of confidential appointments to adolescents was low among all practice types. However, having a written office policy on adolescent confidentiality was significantly associated with agreement between office staff and physicians about availability of confidential services. CONCLUSIONS: Care for medically emancipated conditions and confidential services for adolescents are limited among primary care practices, especially among pediatric practices. All primary care practice types had significant disagreement between office staff and physicians about availability of confidential services to adolescents. Adolescents who call appointment lines are likely to receive inaccurate information about confidentiality policies. Establishing written office policies on adolescent confidentiality may help to improve access to confidential care for adolescents.

Can it be done? Implementing adolescent clinical preventive services.

OBJECTIVE: To evaluate the implementation of an intervention to increase the delivery of adolescent preventive services within a large managed care organization. Target health areas were tobacco, alcohol, sexual behavior, and safety (seat belt and helmet use). DATA SOURCE/STUDY DESIGN: Adolescent reports of clinician screening and counseling were obtained from adolescents who attended well visits with their primary care providers. A prepost study design was used to evaluate the preventive services intervention. The intervention had three components: (1) 89 clinicians from three outpatient pediatric clinics attended a training to increase the delivery of preventive services; (2) customized adolescent screening and provider charting forms were integrated into the clinics; and (3) the resources of a health educator were provided to the clinics. DATA COLLECTION: Following a visit, adolescents completed surveys reporting on clinician screening and counseling for each of the target risk areas. Preimplementation (three months), 104 adolescents completed surveys. Postimplementation of the training, tools, and health educator intervention, 211 adolescents completed surveys (five months). For 18 months postimplementation clinicians delivered services and 998 adolescents completed surveys. PRINCIPAL FINDINGS: Chi-square analyses of changes in screening from preimplementation to postimplementation showed that screening increased in all areas (p < .000), with an average increase in screening rates from 47 percent to 94 percent. Postimplementation counseling in all areas also increased significantly, with an average increase in counseling rates from 39 percent to 91 percent. There were slight decreases in screening from postimplementation to follow-up. CONCLUSIONS: This study offers support for the efficacy of providing training, tools, and resources as a method for increasing preventive screening and counseling of adolescents across multiple risky health behaviors during a routine office visit.

Informe de gestión 1990-1999 / Management report 1990-1999

Al presentar el informe de cada uno de los Programas de Salud y Direcciones Ejecutivas, recuerda que en el período 1990-1999, se dieron importantes acontecimientos con la presencia de enfermedades emergentes y reemergentes, como el cólera, peste, malaria, dengue, fiebre amarilla, las que aparecieron con el Fenómeno El Niño. Considera la década exitosa desde el punto de vista de la política sanitaria, a pesar de la persistencia de la alta mortalidad materna e infantil

Young males attending a family-planning clinic: some ideas about consequences of child abuse.

33 young males attending a family-planning clinic were asked about the consequences of child abuse as it affects behavioral problems of teens and their interest in programs that deal specifically with these problems. Nine reported they had been victims of abuse. Most believed that drug and alcohol misuse and suicide were the major consequences of child abuse. Fifteen were interested in programs for prevention of child abuse but not for specific problems such as substance misuse and smoking cessation. This study's findings suggest that family-planning clinics with services for males must address their behavioral as well as medical needs.

PIP: This study examines how males view the consequences of child abuse in terms of behavioral problems and how receptive they might be to prevention programs. The participants were 33 young males (mean age, 18.4 years) attending a family planning clinic in a county hospital in the US. This group was composed of 21 African Americans, 9 Hispanics, and 3 European-Americans. They were asked seven questions related to the contribution of child abuse to later problems of teens, such as school dropout, crime, drugs, alcohol, prostitution, suicide, and teenage pregnancy. Additional information about their interest in specific programs was also elicited to address these behavioral problems, and personal experience with abuse. Findings show that 9 males reported that they had been victims of abuse. Most believed that drug and alcohol misuse and suicide were the major consequences of child abuse. About 15 males were interested in general programs for child abuse prevention; 12 were interested in smoking cessation programs, 10 in substance abuse programs, and 6 in suicide prevention programs. Moreover, 19 believed that child abuse is a problem in their communities. The findings of this study indicate that family planning clinics with services for males must address their behavioral as well as their medical needs.

Adolescent gynecology in the office setting.

As stated by the Committee on Adolescence of the AAP, All pediatricians who choose to see teenagers should be able to provide counseling about sexual behavior, education on contraceptive methods and prevention of sexually transmitted diseases, and assistance with access to family planning services, preferably in the office or, if necessary, by referral. Expansion of skills and office capabilities to provide routine reproductive health care for adolescents, including pelvic examinations, annual Pap tests, diagnoses of pregnancy, diagnoses and treatment of sexually transmitted diseases, and the prescription of contraceptives, is also encouraged. Pediatricians who have longstanding relationships with their patients, and who are admired and trusted are ideal for providing this care.

PIP: This paper discusses adolescent gynecologic experiences in health care provider clinics. Pediatricians in this study deal with problems that are not encountered by their predecessors. Traditional pediatric practice 20-30 years ago differ from that in the modern adolescent practice. Medical practitioners providing care to adolescents need to ensure that their practices are able to meet the demands of the patient. Incorporating general pediatric setting implies a change in one's practice to be more receptive to adolescents. This involves having appropriate staff, philosophy, decor, expertise, and equipment. They should be prepared to handle multiple issues related to pubertal development, sexuality, self-esteem, and body image. Office services must choose comprehensive scope of services and develop policies or guidelines acceptable to all providers in the practice. Practitioners and staff must be able to possess and understand the importance of confidentiality and its limitations. It is necessary to have complete, useful, and essential office equipment and supplies. Lastly, it is also the role of pediatricians to educate and counsel adolescents and parents regarding adolescents' gynecologic health. Among the common gynecologic problems encountered are the following: menstrual disorders; vaginitis and vulvar disorders; breast disorders; sexually transmitted diseases; and adolescent pregnancy and contraception.

Gynecologic care of medically complicated adolescents.

Gynecologic care of adolescents presents a challenge under the best of circumstances, but when the patient has significant medical processes that interact with the process of puberty, the care of these patients may become extremely difficult. A review of the more common medical illnesses of adolescents and the interaction on the events of puberty and normal menstrual function is presented with emphasis on contraception and future fertility. Although many of the contraceptive options present a possible increased risk to these patients, it must be kept in mind that these adolescent patients will develop emotionally and become sexually active at some point in their lives, and the potential risk of the resultant pregnancy must be weighed carefully. The various options of management for gynecologic problems are discussed.

PIP: This paper discusses issues on gynecologic care of medically complicated adolescents. Gynecologists and health personnel should give special attention to the chronic medical illness or disabilities of adolescents throughout their development. They must understand the interactions of the normal endocrinology of development and the pathophysiology of the medical illness. Chronically ill and disabled adolescents are least likely to receive information and guidance on sexual issues. They need to know the potential impact of their illness on pregnancy; genetic risk of their illness, treatment, and disability pose to their unborn children; and their limitations on both sexual function and fertility. In addition, it¿s important that these adolescents be given counseling addressing social and judgmental skills in cases of social isolation. Illnesses related to pubertal developments include: diabetes mellitus; cystic fibrosis; renal insufficiency and failure; gynecologic issues with various other chronic illnesses; sickle cell disease; seizure disorders; asthma; tuberculosis; inflammatory bowel disease; chronic yeast infections; menstrual abnormalities and coagulopathies or thrombocytopenia; adolescent and childhood malignancies; and developmental delayed and physical disability.