Qualitative Assessment of Vulvovaginal Health Information on Social Media.

STUDY OBJECTIVE: Adolescents and young adults use vulvovaginal hygiene practices, products, and treatments. Access to social media platforms allows health information, including gynecologic care, to be easily disseminated and more accessible. Our objective was to characterize and assess vulvovaginal health information available on a popular video-sharing social media platform. METHODS: In this cross-sectional analysis study, search terms related to vulvovaginal health were included to assess the top videos appearing on June 15, 2022. Descriptive statistics, uploader demographic characteristics, and content characteristics were recorded for each video. Information quality was evaluated using the DISCERN instrument. RESULTS: One hundred and sixty-four videos met the study criteria with a combined total of over 500 million views, over 1.5 million shares, and nearly 60 million likes. Over 90% of videos consisted of educational content or product advertisements, and nearly 70% of videos provided information on general vulvovaginal hygiene and health. Seventy-five percent of videos were uploaded by private companies and nonmedical individuals. The mean DISCERN score was 1.6 out of 5. Medical providers scored significantly better than other uploaders on 12 of 16 DISCERN items, and mean overall publication quality scores were significantly higher for videos created by medical providers than nonmedical individuals and private companies (P < .0001). CONCLUSION: Social media platforms are a popular medium for vulvovaginal health information, accumulating over half a billion views within a short timeframe. Although medical providers had fewer shortcomings in their videos, the overall quality of health information shared was low, with serious or extensive shortcomings.

Consistency and quality in written accreditation protocols for pediatrician training programs: a mixed-methods analysis of a global sample, and directions for improvement.

BACKGROUND: The World Federation for Medical Education (WFME) defines accreditation as 'certification of the suitability of medical education programs, and of…competence…in the delivery of medical education.' Accreditation bodies function at national, regional and global levels. In 2015, WFME published quality standards for accreditation of postgraduate medical education (PGME). We compared accreditation of pediatric PGME programs to these standards to understand variability in accreditation and areas for improvement. METHODS: We examined 19 accreditation protocols representing all country income levels and world regions. For each, two raters assessed 36 WFME-defined accreditation sub-areas as present, partially present, or absent. When rating "partially present" or "absent", raters noted the rationale for the rating. Using an inductive approach, authors qualitatively analyzed notes, generating themes in reasons for divergence from the benchmark. RESULTS: A median of 56% (IQR 43-77%) of WFME sub-areas were present in individual protocols; 22% (IQR 15-39%) were partially present; and 8.3% (IQR 5.5-21%) were absent. Inter-rater agreement was 74% (SD 11%). Sub-areas least addressed included number of trainees, educational expertise, and performance of qualified doctors. Qualitative themes of divergence included (1) variation in protocols related to heterogeneity in program structure; (2) limited engagement with stakeholders, especially regarding educational outcomes and community/health system needs; (3) a trainee-centered approach, including equity considerations, was not universal; and (4) less emphasis on quality of education, particularly faculty development in teaching. CONCLUSIONS: Heterogeneity in accreditation can be appropriate, considering cultural or regulatory context. However, we identified broadly applicable areas for improvement: ensuring equitable access to training, taking a trainee-centered approach, emphasizing quality of teaching, and ensuring diverse stakeholder feedback.

Perspectives on the use of a health surveillance system for Guatemalan youth: a stakeholder analysis.

In Guatemala, adolescent health indicators are collected using the Sistema Informático del Adolescente (SIA), a clinical survey developed by the Pan-American Health Organization. Recent analysis revealed significant gaps in data, limiting the ability of clinicians and policy makers to effectively address health disparities. Our objective was to explore adolescent health stakeholders' perceptions of the SIA. We conducted semi-structured interviews with 22 clinic personnel recruited from six adolescent health clinics throughout Guatemala. Stakeholders included multi-disciplinary providers and key database personnel. Interviews were conducted in Spanish, recorded and transcribed; a coding scheme was developed using a phenomenological approach, and Dedoose was used for analysis. Four major themes emerged: (1) Collecting baseline adolescent health data was useful for prevention, diagnosis and treatment of adolescent health issues. (2) The SIA was instrumental in streamlining clinical care and informing the psychosocial needs of patients. (3) The questionnaire was time-intensive, repetitive and often problematic for data input/extraction. (4) Condensing the survey and using a web-based version may improve the system for future use. Our findings show that despite the use of a standardized system, multiple barriers contribute to gaps in comprehensive data collection in Guatemala. Refining the system may enhance adolescent health surveillance and improve quality of care in this vulnerable population.

Guatemala City youth: an analysis of health indicators through the lens of a clinical registry.

BACKGROUND: Despite the inclusion of adolescent health in recent global frameworks, limited data exist on health indicators in low-income countries. Our objective was to identify socioeconomic measures, risk behaviors and health indicators of young people in Guatemala. METHODS: We conducted a secondary data analysis of the Pan American Health Organization's Sistema Informático del Adolescente of 2831 participants ages 10-24 y from 2008 to 2014. We examined frequencies for a core set of items, and generalized regression models assessed correlations between age, sex and ethnicity with health outcomes of interest. RESULTS: Fewer than 17% of participants reported a history of chronic illness (16.6%) and severe psychological problems (16.8%). While 66.1% of participants' mothers and 36.6% of fathers reported job instability, far fewer families had housing instability (1.9% with no electricity, 6.3% with no running water). Fewer than one-third (29.1%) were sexually active and the majority (76.0%) routinely used condoms. About one-quarter (22.6%) reported abnormal mood. Indigenous participants were significantly more likely to have experienced psychological problems (odds ratio [OR] 1.75 [confidence interval {CI} 1.65-1.86]) and violence (OR 1.34 [CI 1.27-1.42]) compared with whites. CONCLUSIONS: The prevalence of risk behaviors and mental health concerns is low compared with other sources of national and regional data. Further work is needed to examine the benefits and limitations of this system in order to improve health surveillance.

A global perspective: training opportunities in Adolescent Medicine for healthcare professionals.

PURPOSE OF REVIEW: The review briefly describes the current state of adolescent health globally, and highlights current educational and training opportunities in Adolescent Medicine for healthcare providers worldwide. RECENT FINDINGS: Despite a growing body of literature demonstrating a shift toward recognizing Adolescent Medicine as a subspecialty, there are very few countries that offer nationally recognized Adolescent Medicine training programs. In recent years, several countries have begun to offer educational programming, such as noncredentialed short training programs, conferences, and online courses. Challenges, including cultural barriers, financing, and lack of governmental recognition and support, have hindered progress in the development of accredited training programs globally. SUMMARY: It is crucial to support efforts for sustainable training programs, especially within low and middle-income countries where a majority of the world's adolescent population lives. Sharing knowledge of existing curriculums, programs, and systems will increase opportunities globally to build regional capacity, increase access to interdisciplinary services, and to implement health-promoting policies for youth worldwide.

Food Insecurity and the Burden of Health-Related Social Problems in an Urban Youth Population.

PURPOSE: Our study objectives were to (1) determine the prevalence of food insecurity; (2) examine the association between presence and level of food insecurity with other health-related social problems; and (3) assess the predictive values of a two-item food insecurity screen in an urban youth population. METHODS: Patients aged 15-25 years completed a Web-based screening tool. Validated questions were used to identify problems in seven health-related social domains (food insecurity, health care access, education, housing, income insecurity, substance use, and intimate partner violence). Chi-square and Kruskal-Wallis tests and logistic regression models controlled for age, sex, and race/ethnicity, assessed the association between food insecurity and health-related social problems. Predictive values of a two-item food insecurity screen compared with the United States Department of Agriculture Food Security Survey were calculated. RESULTS: Among 400 patients (mean age 18 years; 69.2% female; 54.6% black; 58.9% public insurance), 32.5% screened positive for food insecurity. Increasing food insecurity level was significantly associated with cumulative burden of social problems (p < .001). In adjusted analyses, food insecurity was associated with problems with health care access (aOR = 2.6, 95% confidence interval [CI] 1.7-4.1), education (aOR = 2.8, 95% CI 1.6-5.1), housing (aOR = 2.8, 95% CI 1.8-4.4), income insecurity (aOR = 2.3, 95% CI 1.2-4.5), and substance use (aOR = 2.5, 95% CI 1.5-4.3). The two-item screen demonstrated sensitivity of 88.5% and specificity of 84.1%. CONCLUSIONS: One-third of youth in sample experienced food insecurity, which was strongly associated with presence of other health-related social problems. The two-item screen effectively detected food insecurity. Food insecurity screening may lead to identification of other health-related social problems that when addressed early may improve adolescent health.

Improving Social Determinants of Health: Effectiveness of a Web-Based Intervention.

INTRODUCTION: Although patients who experience health-related social problems such as food insecurity are at increased risk for negative health outcomes, there are few systems for screening and intervention. The study aimed to determine whether a web-based intervention can (1) connect youth to services to address these problems and (2) increase their resolution. DESIGN: Prospective intervention study. SETTING/PARTICIPANTS: A total of 401 youth, aged 15-25 years, from an urban adolescent/young adult clinic were recruited. INTERVENTION: A self-administered, web-based tool was developed to screen participants for problems in nine health-related social domains, identify and provide feedback about potential problems, and facilitate a patient-centered selection process of recommended local health and human service agencies to assist in addressing selected problems (conducted in 2008-2010). Follow-up phone calls 1-2 months later determined if patients had contacted recommended agencies and resolved their top-priority problem. MAIN OUTCOME MEASURES: Outcome measures included prevalence of identified problems, selected problems, and priority problem selected by domain. We also examined frequencies of referral agencies contacted and resolution of priority problem at time of follow-up analysis conducted in 2011-2013. RESULTS: Seventy-eight percent (313/401) of youth selected at least one problem to address. The most frequent domains selected as priority were income security (21%); nutrition/fitness (15%); and healthcare access (15%). Eighty-three percent (259/313) were reached at follow-up; overall, 40% contacted a selected agency and 47% reported "completely" or "mostly" resolving their priority problem. CONCLUSIONS: When provided with services to address health-related social problems, the majority of youth choose to receive help, with nearly half successfully addressing their priority concern. Further research to understand the barriers to contacting and utilizing services is needed. A technology-based patient-centered feedback and referral system for social determinants of health can facilitate screening and connect patients with resources to address these problems.

Social disparities among youth and the impact on their health.

PURPOSE: Social disparities among youth have been recognized as an important influence on disease risk later in the life cycle. Despite this, social problems are seldom assessed in a clinical setting. The primary objective of our study was to evaluate the impact of social disparities on the health of youth. METHODS: A self-directed, web-based screening system was used to identify social disparities along seven social domains. Participants included youth, aged 15-24 years, recruited from an urban hospital clinic. The main outcome variable, self-rated health, was captured on a 5-point Likert scale. Univariable and multivariable regression models adjusted for sex, age, and race/ethnicity were implemented to assess the association between social problems and self-rated health. Correlation between social disparity problems was estimated using phi coefficient. RESULTS: Among 383 participants, 297 (78%) reported at least one social problem. The correlation among social disparity problems was low. Social disparities had an independent effect on self-rated health, and, in a fully adjusted model, disparities in health care access and food insecurity remained significant. The presence of even one social problem was associated with a decrease in overall health (ß=0.68, P<0.01). CONCLUSION: There is a high burden of social disparities among our youth urban hospital population. The presence of even one social problem increases the risk of worsening self-rated health. Evaluating the social disparities among youth in the medical setting can help elucidate factors that negatively affect patients' health.

Youths' health-related social problems: concerns often overlooked during the medical visit.

OBJECTIVE: The objectives of this study were to (1) measure the prevalence of health-related social problems among adolescent and young adult primary care patients; (2) estimate previous screening and referral experiences; and (3) examine participant attitudes toward screening and referral. METHODS: Data were collected as part of a cross-sectional study conducted in an urban young adult clinic. Patients aged 15 to 25 years completed a computerized questionnaire screening for health-related social problems in nine social domains. In addition, participants answered questions about their previous screening experiences, need for referrals, and their experience using the system. RESULTS: Seventy-six percent (304/401) of youth screened positive for at least one major problem, including healthcare access (37%), housing (34%), and food security (29%). Forty-seven percent (190/401) experienced major problems in two or more social domains. The prevalence of screening in the past year for each domain averaged 26%; 3% were screened in all nine domains in the previous 12 months and 33% were not screened in any domain. Overall, 75% needed a referral within the previous year, and 42% identified at least one unmet referral need. The majority (84%) of participants reported that it was acceptable to screen for these problems. CONCLUSION: Prevalence of health-related social problems among youth is high. The majority needed at least one referral for a social need in the previous year. Primary care physicians would benefit from improved systems for screening and referral of health-related social problems in order to create a comprehensive medical home for their patients.