The Hospitalized Adolescent.

This clinical report provides pediatricians evidence-based information on the developmentally appropriate, comprehensive clinical care for hospitalized adolescents. Included in this report are opportunities and challenges facing pediatricians when caring for specific hospitalized adolescent populations. The companion policy statement, "The Hospitalized Adolescent," includes detailed descriptions of adolescent hospital admission demographics, personnel recommendations, and hospital setting and design advice, as well as sections on educational services, legal and ethical matters, and transitions to adult facilities.

Prevalence and hospital resource usage associated with substance use disorder among hospitalized adolescents in the United States.

We sought to determine common characteristics of SUD-related hospitalizations and patterns of discharge diagnoses among adolescents in the United States. Using the 2016 KID, a cross-sectional study was conducted to identify discharge records associated with ICD-10-CM diagnostic codes for SUD. Adolescents between the ages of 13 and 19 were included. SUD and non-SUD groups were compared using the Student's t-test for continuous variables and the χ2 test for categorical variables. A total of 6.7 million hospital discharges were analyzed. A uniform and a standardized coding system were used to identify cases. Subgroup comparative analysis for length of stay, hospital charge, and common discharge diagnoses was performed. A weighted estimate of 94,732 adolescents associated with SUD was discharged from the U.S. hospitals during the study year. Teens with SUD accounted for 510,268 days of inpatient days in the U.S. community hospitals accounting for a total charge of $3,070,948,580. The average LOS for all SUD teens in the U.S. was 5.4 days with a mean charge per discharge of $32,754, indicating higher LOS but a significantly lower mean charge compared to non-SUD teens (4.1 days; $39,657). In 2016, more than 88% of SUD patients had ≥ 3 diagnoses compared to non-SUD patients (76%) (P < 0.0001 for all). The most frequently observed diagnosis associated with teens with SUD was psychoses, depressive neuroses, and alcohol use disorder. With one in ten teenagers found with an SUD, early substance initiation still appears to be an important public health issue. Unfortunately, the health and economic impact of substance use in adolescence on society are huge requiring effective strategies targeted to this population. The concerning data and literature identify a significant need to address prevention, treatment, and recovery services for adolescents throughout the United States.

Understanding the Sexual and Reproductive Health Needs of Hospitalized Adolescent Males.

OBJECTIVES: To describe sexual behaviors and acceptability of receiving sexual and reproductive health (SRH) services among hospitalized adolescent males. METHODS: We performed a cross-sectional survey of hospitalized adolescents. Eligible participants were males aged 14 to 20 years admitted at 2 academic medical centers. Outcome measures included reported healthcare utilization, sexual health behaviors (eg, sexual activity), contraception use, and acceptability of SRH discussions during a hospitalization. RESULTS: Among 145 participants, 42% reported a history of vaginal sex, 27% current sexual activity, 12% early sexual debut, and 22% 4 or more prior sexual partners. At last sex, condom use was reported by 63% and use of reversible contraception by 36%. Nearly half (45%) agreed that hospital-based SRH discussions were acceptable, particularly among those with history of sexual activity (P < .01). Some (12%) reported they had not accessed care in the past year when they felt they should. CONCLUSIONS: Hospitalized males in our study had similar rates of sexual activity as compared with the general population but had higher rates of early sexual debut and number of prior partners, which are independently linked with negative sexual health outcomes (eg, sexually transmitted infections). Our participants found SRH discussions to be generally acceptable. These findings reveal opportunities to screen for unmet SRH needs and provide SRH education and services for adolescent males in the hospital.

Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database.

BACKGROUND: COVID-19 is usually less severe and has lower case fatality in children than in adults. We aimed to characterise the clinical features of children and adolescents hospitalised with laboratory-confirmed SARS-CoV-2 infection and to evaluate the risk factors for COVID-19-related death in this population. METHODS: We did an analysis of all patients younger than 20 years who had quantitative RT-PCR-confirmed COVID-19 and were registered in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe, a nationwide surveillance database of patients admitted to hospital with severe acute respiratory disease in Brazil), between Feb 16, 2020, and Jan 9, 2021. The primary outcome was time to recovery (discharge) or in-hospital death, evaluated by competing risks analysis using the cumulative incidence function. FINDINGS: Of the 82 055 patients younger than 20 years reported to SIVEP-Gripe during the study period, 11 613 (14·2%) had available data showing laboratory-confirmed SARS-CoV-2 infection and were included in the sample. Among these patients, 886 (7·6%) died in hospital (at a median 6 days [IQR 3-15] after hospital admission), 10 041 (86·5%) patients were discharged from the hospital, 369 (3·2%) were in hospital at the time of analysis, and 317 (2·7%) were missing information on outcome. The estimated probability of death was 4·8% during the first 10 days after hospital admission, 6·7% during the first 20 days, and 8·1% at the end of follow-up. Probability of discharge was 54·1% during the first 10 days, 78·4% during the first 20 days, and 92·0% at the end of follow-up. Our competing risks multivariate survival analysis showed that risk of death was increased in infants younger than 2 years (hazard ratio 2·36 [95% CI 1·94-2·88]) or adolescents aged 12-19 years (2·23 [1·84-2·71]) relative to children aged 2-11 years; those of Indigenous ethnicity (3·36 [2·15-5·24]) relative to those of White ethnicity; those living in the Northeast region (2·06 [1·68-2·52]) or North region (1·55 [1·22-1·98]) relative to those in the Southeast region; and those with one (2·96 [2·52-3·47]), two (4·96 [3·80-6·48]), or three or more (7·28 [4·56-11·6]) pre-existing medical conditions relative to those with none. INTERPRETATION: Death from COVID-19 was associated with age, Indigenous ethnicity, poor geopolitical region, and pre-existing medical conditions. Disparities in health care, poverty, and comorbidities can contribute to magnifying the burden of COVID-19 in more vulnerable and socioeconomically disadvantaged children and adolescents in Brazil. FUNDING: National Council for Scientific and Technological Development, Research Support Foundation of Minas Gerais.

Helping and supporting hospitalized youth experiencing homelessness: An American perspective.

Despite many similarities, there are key differences in the ability of providers in the United States to assist homeless youth compared to their colleagues in the United Kingdom. However, legislation, and strategies to identify and advocate for youth experiencing homelessness can lead to improved health outcomes and other psychosocial improvements for youth. This article highlights, compares and contrasts the systems with a goal of greater understanding and opportunities to assist youth experiencing homelessness in either country.

Psicodiagnóstico na internação psiquiátrica da infância e adolescência: panorama do triênio 2015-2016-2017 / Psychological assessment in a child and adolescent inpatient psychiatric unit: 2015-2016-2017 triennial overview

Introdução: A internação psiquiátrica é um recurso terapêutico utilizado para a estabilização dos sintomas, contenção de riscos, elucidação diagnóstica e planejamento terapêutico. O psicodiagnóstico permite acesso a questões emocionais e cognitivas do indivíduo. Objetiva-se apresentar um panorama referente à realização de psicodiagnósticos em leitos da especialidade da Psiquiatria Infância e Adolescência de um hospital geral nos anos 2015, 2016 e 2017. Métodos: Trata-se de um estudo transversal, em que foram obtidas informações a partir do prontuário eletrônico de pacientes internados em leitos da especialidade. Os dados analisados foram sexo, idade, naturalidade, realização de psicodiagnóstico, motivo e tempo de internação. Resultados: Durante o triênio estudado, houve realização de psicodiagnóstico em 65,1% das internações. Entretanto, constatou-se diminuição estatisticamente significativamente (p = 0,006) no número de psicodiagnósticos em relação ao número de internações: 82% em 2015; 63% em 2016; e 53% em 2017. Conclusão: Esta diminuição no número de psicodiagnósticos realizados durante a internação indica que houve uma mudança nesse processo, onde se passou de um período em que a grande maioria das crianças e adolescentes (82%) realizava a avaliação, para um panorama onde metade dos pacientes (53%) realiza o psicodiagnóstico. Esse resultado sugere que estratégias de psicoeducação, voltadas para equipes assistentes, tendo por objetivo otimizar custo-efetividade e qualidade da assistência, levaram esses profissionais a refletirem sobre relevância, riscos e benefícios da realização do psicodiagnóstico durante a internação psiquiátrica de crianças e adolescentes. (AU)

Introduction: Inpatient psychiatry is a therapeutic resource for symptom stabilization, risk management, diagnostic clarification and/or treatment planning. Psychological assessment provides information on emotional and cognitive functioning. This study aims to provide an overview of psychological assessment in a child and adolescent inpatient psychiatric unit at a general hospital in southern Brazil in 2015, 2016 and 2017. Methods: This cross-sectional retrospective study obtained information from electronic medical records of patients admitted to the hospital psychiatric unit. Data for analysis were sex, age, place of birth, psychological assessment, reason and length of stay. Results: In those three years, psychological assessments were requested in 65.1% of all unit admissions. However, there was a statistically significant decrease (p = 0.006) in the number of psychological assessments in relation to the number of admissions: 82% in 2015; 63% in 2016; and 53% in 2017. Conclusion: The decrease in the number of psychological assessments performed in the inpatient unit indicates that there was some changes in the process, as first most children and adolescents (82%) underwent the assessment and then the rate reduced to half of all patients (53%). This can be explained by the implementation of strategies to educate the health care team about psychological assessment, with the purpose of improving costeffectiveness and quality of care. This led to greater reflection on relevance, risks and benefits of psychological assessment in a child and adolescent inpatient psychiatric unit. (AU)

Behavioral Health Diagnoses Among Children and Adolescents Hospitalized in the United States: Observations and Implications.

OBJECTIVE: The study described rates and characteristics of U.S. children hospitalized with a behavioral (mental or substance use) disorder. METHODS: This cross-sectional analysis of data from the 2012 Kids' Inpatient Database included 483,281 hospitalizations in general and children's hospitals of persons under age 21 with a primary or secondary behavioral diagnosis. RESULTS: The admission rate with any behavioral diagnosis was 5.5 per 1,000 children in the U.S. population, with 2.9 having a primary behavioral diagnosis. Common primary diagnoses included depression (34%), other mood (31%), psychotic (9%), and substance use (7%) disorders. The most common behavioral diagnoses secondary to a primary diagnosis that is not behavioral were depression (26%), attention-deficit disorder (26%), and substance use disorders (22%). Suicide or self-harm was rarely the primary diagnosis (.1%) but complicated 12% of admissions with a primary behavioral diagnosis. Variations in admissions (per 1,000 children in the U.S. population) with a primary behavioral diagnosis were noted by race-ethnicity (blacks, 3.2; whites, 2.9; and Hispanics, 1.4), insurance (public, 2.9; private, 2.0), and geographic region. Fifty-nine of every 1,000 peripartum admissions in the 12-20 age group had a secondary behavioral diagnosis. Patients with behavioral comorbidities were more likely to be transferred to another facility (8.0% versus 2.2%, p<.001). Behavioral disorders comorbid to nonbehavioral disorders increased length of stay (4.3 versus 3.3 days, p<.001) and costs ($12,742 versus $9,929, p<.001). CONCLUSIONS: Nearly 500,000 pediatric admissions in 2012 included behavioral disorders. Comorbidities were associated with longer stays and an estimated $1.36 billion additional annual costs, which were disproportionately borne by public insurance.

Lack of Preparedness for Pediatric to Adult-Oriented Health Care Transition in Hospitalized Adolescents and Young Adults.

OBJECTIVE: We examined the self-reported preparedness of hospitalized adolescents and young adults (AYA) for transition from pediatric to adult-oriented health care with regard to: 1) previous health care transition (HCT) preparation, 2) Self-Determination Theory (SDT) constructs of health self-management autonomy and competence, and 3) their perception of medical knowledge, attitudes, and concerns. METHODS: From 2013 to 2015, 139 hospitalized patients aged 15 to 21 years completed a 40-item survey on HCT preparation, attitudes, concerns, and perception of knowledge adapted in part from validated questionnaires of the Department of Health and Human Services, Maternal and Child Health Bureau, and SDT Treatment Self-Regulation Study. RESULTS: Fewer than 40% of all respondents endorsed previous HCT preparation such as providers discussing taking responsibility for their health, transitioning to adult providers, and only 20% had discussed future health insurance needs. Of our AYA population, 84% had 1 or more special health care needs. Older patients, female patients, and those with increased HCT preparation scores had increased autonomous motivation, positive attitudes toward transition, yet also increased transition concerns. Higher autonomous motivation and perceived competence correlated with increased perception of knowledge (P = .002, < .001 respectively) and more positive attitudes toward transition planning (P < .001, .054 respectively). Multivariate regression analysis revealed those with increased HCT preparation and those with increased perceived competence had increased perception of knowledge (ß = .25, P = .005 and ß = .35, P < .001). CONCLUSIONS: Our findings suggest that hospitalized AYA received limited education and preparation regarding key elements of HCT to adult-oriented health care. Moreover, those previously exposed to transition preparation efforts were more likely to have motivation and a sense of competence in HCT skills.

Caregiver anticipatory grief: phenomenology, assessment and clinical interventions.

PURPOSE OF REVIEW: This review aims to synthesize recent findings on anticipatory grief in caregivers, referring to its phenomenology, assessment and clinical interventions. RECENT FINDINGS: Recent literature illustrates the wide scope of the current use of the term anticipatory grief, reflecting caregivers' experiences in different end-of-life trajectories. The anticipation of death is the distinctive aspect of anticipatory grief in the predeath grief continuum, encompassing several progressive losses, past and future. Recently developed assessment instruments capture key aspects of this experience, such as separation anxiety, anticipation of death and future absence of the person, denial and relational losses. Recent findings on prevalence of clinically significant predeath symptoms in caregivers range from 12.5 to 38.5%. Beyond personal and relational factors, difficult circumstances of end-of-life care significantly interfere in adjustment to anticipatory grief. Useful therapeutic interventions were identified, such as validation of grief feelings, increased coping and self-care, anticipation of future losses and reframing roles. However, rigorous interventional studies are needed to create guidelines and the manualization of specific therapeutic approaches to caregiver anticipatory grief. SUMMARY: Findings suggest that anticipatory grief dynamics in different end-of-life trajectories should be recognized and adequately assessed. Clinical interventions considered useful to support anticipatory grief caregivers are presented, but further research is needed to verify effectiveness.

Cross-cultural adaptation and content validation into Portuguese of the Subjective Global Nutritional Assessment for pediatric patients hospitalized with cancer / Adaptação transcultural e validação do conteúdo em português da Pediatric Subjective Global Nutritional Assessment em pacientes pediátricos hospitalizados com câncer

ABSTRACT Objective Cross-cultural adaptation and content validation of the Brazilian Portuguese version of the Subjective Global Nutritional Assessment questionnaire (originally in English) for use in hospitalized children and adolescents being treated in a reference institute of oncology. Methods The cross-cultural adaptation process consisted of the following stages: conceptual, item, semantic, and operational equivalence. The conceptual equivalence and item was carried out through discussion with members of an expert committee. Semantic equivalence was evaluated through initial translation, synthesis of translations, back translation, discussions with experts, and pretest with 32 patients. During operational equivalence, the experts discussed about the format of questions and instructions, setting, target populations, and mode of administration to later propose a final version. Content validation was performed by the expert committee. Results Minor modifications were made in the instrument to facilitate its use in the Brazilian socio-cultural context. Pretest results showed that the instrument is easily understood by health care professionals and the target population. Conclusion The cross-cultural adaptation and validation of the Subjective Global Nutritional Assessment allowed obtaining a Brazilian version equivalent to the original. The adapted instrument will be an important tool for the subjective assessment of the nutritional status of pediatric patients hospitalized with cancer.

RESUMO Objetivo Realizar a adaptação transcultural e validação do conteúdo do questionário de Avaliação Nutricional Subjetiva Global Pediátrica do inglês para o português brasileiro em crianças e adolescentes hospitalizados atendidos em um instituto de referência em oncologia. Métodos O processo de adaptação transcultural seguiu as etapas: equivalência conceitual, de item, semântica e operacional. A equivalência conceitual e de item foi realizada por meio da discussão com o comitê de especialistas. Para apreciação da equivalência semântica foram realizadas as etapas de tradução inicial, síntese das traduções, retrotradução, discussão com os especialistas e pré-teste em 32 pacientes. Na equivalência operacional foi discutido com os especialistas o veículo e formato das questões/instruções; cenário de administração e pelo modo de aplicação para posteriormente propor uma versão final e a validação de conteúdo foi realizada por meio do comitê de especialistas. Resultados Foram realizadas pequenas modificações no instrumento Avaliação Nutricional Subjetiva Global Pediátrica de forma a facilitar seu uso no nosso contexto sócio-cultural. Os resultados do pré-teste mostraram que o instrumento é facilmente compreendido entre os profissionais de saúde e a população-alvo. Conclusão A adaptação transcultural e a validação do conteúdo da Avaliação Nutricional Subjetiva Global Pediátrica permitiram uma versão brasileira equivalente ao original. O instrumento resultante da adaptação será importante para a avaliação subjetiva do estado nutricional de pacientes pediátricos hospitalizados com câncer.

Percepción de los adolescentes sobre el ingreso hospitalario: Importancia de la humanización de los hospitales infantiles / Survey of adolescent perception of hospital admission: The importance of hospital humanisation

Introducción: La humanización de la asistencia sanitaria conlleva considerar al paciente como un ser integral, y proporcionar asistencia más allá de los cuidados médicos, abarcando áreas como la social, emocional, espiritual y relacional. Objetivo: Conocer las necesidades de los adolescentes hospitalizados y los déficits percibidos por estos en la asistencia sanitaria. Sujetos y método: Estudio transversal descriptivo realizado a través de una encuesta anónima, dirigido a pacientes ingresados de entre 12-16 años. La encuesta estaba formada por 2 partes: preguntas abiertas para exponer sus necesidades, indicar aspectos positivos o negativos de la hospitalización, y sugerencias de mejora, y preguntas cerradas con posibles respuestas afirmativas o negativas, y escalas numéricas del 1 al 10 para cuantificar los resultados. Se llevó a cabo un pilotaje previo en 6 pacientes adolescentes como prueba de factibilidad y de comprensión de todos los apartados. Resultados: Se obtuvieron un total de 39 encuestas de pacientes, con una mediana de edad de 14 años. La experiencia más desagradable percibida durante el ingreso fue la realización de pruebas invasivas. El 95% de ellos padeció dolor y el 17% sintió en algún momento que se iba a realizar algún procedimiento sin su pleno conocimiento. Más del 75% demandaba más entretenimiento, siendo la no disponibilidad de Wi-Fi el elemento más reclamado. Conclusiones: La población estudiada mostró necesidades que deben ser consideradas en el momento de la hospitalización, destacando: cognitivas (necesidad de obtener información clara y extensa), sociales (mantener el contacto y las relaciones con el exterior, familiares y amigos), emocionales (la enfermedad y sus procesos diagnóstico-terapéuticos crearán alteraciones en el estado anímico) y prácticas (los aspectos ambientales y arquitectónicos pueden mejorar o empeorar la percepción del ingreso hospitalario). Todos estos factores han demostrado que pueden contribuir al restablecimiento de la salud de una forma más temprana.

Introduction: The humanisation of health care involves considering the patient as an integral human being, providing assistance beyond medical care, and covering other fields such as social, emotional, spiritual, or relational areas. Objective: To evaluate the requirements and concerns of the hospitalised children. Subjects and method: A cross-sectional, descriptive study was conducted using an anonymous questionnaire on children aged 12-16. Results: The study included 39 patients, with a median age of 14 years. The most unpleasant experience during the hospitalisation was the invasive procedures. Almost all (95%) of patients suffered from pain, and 17% of them felt at some point that a procedure was performed without them being fully aware. More than 75% of children asked for more entertainment, with the lack of Wi-Fi being the more demanded item. Conclusions: The needs of the population included in this survey, showed the importance to consider cognitive (necessity of obtaining clear and extensive information), social (maintaining everyday relationships), emotional (illness and its diagnostic and therapeutic procedures often generate mood disorders), and practical (environmental and architectural aspects can lead to either an improvement or a worsening of the hospitalisation perception) factors. All of these factors have shown a beneficial contribution, leading to an earlier recovery of health.

[Survey of adolescent perception of hospital admission. The importance of hospital humanisation]. / Percepción de los adolescentes sobre el ingreso hospitalario. Importancia de la humanización de los hospitales infantiles.

INTRODUCTION: The humanisation of health care involves considering the patient as an integral human being, providing assistance beyond medical care, and covering other fields such as social, emotional, spiritual, or relational areas. OBJECTIVE: To evaluate the requirements and concerns of the hospitalised children. SUBJECTS AND METHOD: A cross-sectional, descriptive study was conducted using an anonymous questionnaire on children aged 12-16. RESULTS: The study included 39 patients, with a median age of 14 years. The most unpleasant experience during the hospitalisation was the invasive procedures. Almost all (95%) of patients suffered from pain, and 17% of them felt at some point that a procedure was performed without them being fully aware. More than 75% of children asked for more entertainment, with the lack of Wi-Fi being the more demanded item. CONCLUSIONS: The needs of the population included in this survey, showed the importance to consider cognitive (necessity of obtaining clear and extensive information), social (maintaining everyday relationships), emotional (illness and its diagnostic and therapeutic procedures often generate mood disorders), and practical (environmental and architectural aspects can lead to either an improvement or a worsening of the hospitalisation perception) factors. All of these factors have shown a beneficial contribution, leading to an earlier recovery of health.

Lessons learned in building a hospital-wide transition program from pediatric to adult-based health care for youth with special health care needs (YSHCN).

Advancements in medicine have increased the likelihood that children with chronic illnesses will survive childhood. The success in treatment for their conditions has not been matched by methods to effectively facilitate their transition to adult care. This short report describes lessons learned in building a hospital-wide health care transition (HCT) planning infrastructure that could help patients transition from pediatric to adult-based care regardless of disease/disability. A solid foundation on which to build a hospital-based HCT planning program includes the following: focusing on structure and processes needed to facilitate medical transition; conducting a baseline assessment of current transition policy/practice; building an understanding of the complexity and necessity of transition planning; identifying advocates for transition planning and adult providers who will accept youth with chronic medical conditions; and establishing methods to evaluate transition program building activities. The implementation of any HCT program will depend on creating a culture that expects successful HCT to be the culmination of successful pediatric care. Hospital support (resources, staff training and an expanded infrastructure into which the program can fit) is necessary for a sustainable HCT planning program.

Venous thromboembolism in hospitalized adolescents: an approach to risk assessment and prophylaxis.

BACKGROUND: Pediatric hospital-acquired venous thromboembolism (VTE) is an increasingly prevalent and morbid disease. A multidisciplinary team at a tertiary children's hospital sought to answer the following clinical question: "Among hospitalized adolescents, does risk assessment and stratified VTE prophylaxis compared with no prophylaxis reduce VTE occurrence without an increase in significant adverse effects?" METHODS: Serial literature searches using key terms were performed in the following databases: Medline, Cochrane Database, CINAHL (Cumulative Index to Nursing and Allied Health), Scopus, EBMR (Evidence Based Medicine Reviews). Pediatric studies were sought preferentially; when pediatric evidence was sparse, adult studies were included. Abstracts and titles were screened, and relevant full articles were reviewed. Studies were rated for quality using a standard rating system. RESULTS: Moderate evidence exists to support VTE risk assessment in adolescents. This evidence comes from pediatric studies that are primarily retrospective in design. The results of the studies are consistent and cite prominent factors such as immobilization and central venous access. There is insufficient evidence to support specific prophylactic strategies in pediatric patients because available pediatric evidence for thromboprophylaxis efficacy and safety is minimal. There is, however, high-quality, consistent evidence demonstrating efficacy and safety of thromboprophylaxis in adults. CONCLUSIONS: On the basis of the best available evidence, we propose a strategy for risk assessment and stratified VTE prophylaxis for hospitalized adolescents. This strategy involves assessing risk factors and considering prophylactic measures based on level of risk. We believe this strategy may reduce risk of VTE and appropriately balances the adverse effect profile of mechanical and pharmacologic prophylactic methods.

Cognitive and social factors associated with NSSI and suicide attempts in psychiatrically hospitalized adolescents.

Although non-suicidal self-injury (NSSI) and suicide attempts (SA) frequently co-occur among youth, there is increasing evidence that both the risk factors and the phenomenology of the behaviors are distinct. This study examined how individuals who engage in NSSI only, individuals who attempt suicide only, and those who have histories of both NSSI and at least one suicide attempt may differ in terms of cognitions and perceived social support. Participants were 185 adolescents (78.1 % female) between the ages of 13 and 18 recruited from a psychiatric inpatient facility in the northeastern United States. One hundred forty-eight teens were identified with a history of self-injurious behavior and divided into three groups: NSSI only (n = 45), SA only (n = 24) or both NSSI and SA (NSSI+SA; n = 79). Analyses showed that the NSSI+SA group exhibited more cognitive errors, negative self-statements, and negative views of self, world, and future, as well as less perceived familial support than either the NSSI or SA only groups. There were no differences between groups on perceived support from teachers or peers. No significant demographic or diagnostic differences were found between the NSSI and SA groups. Limitations and clinical implications of the current research are discussed.

Percepción del adolescente sobre la calidad de atención que brinda el profesional de enfermería en los Servicios de Medicina del Instituto Nacional de Salud del Niño, 2009 / Adolescents' perceptions about the quality of care provided by nursing professionals in the medical services in the INSN, 2009

Objetivos: Determinar la percepción del adolescente sobre la calidad de la atención que brinda el profesional de enfermería en los servicios de Medicina en el INSN, 2009 e Identificar la percepción la según la dimensión humana, técnica y entorno. Material y Métodos: El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo, prospectivo, de corte transversal. La población estuvo conformada por adolescentes hospitalizados en los servicios de Medicina. La técnica fue la entrevista considerando el asentimiento informado y el instrumento una escala modificada tipo Lickert. Resultados: Del 100 por ciento (36), 72 por ciento (26) tuvieron percepción medianamente favorable, 14 por ciento (5) desfavorable, 14 por ciento (5) favorable. En cuanto a la dimensión humana 50 por ciento (18) es medianamente favorable, 28 por ciento (10) desfavorable y 22 por ciento (8) favorable; en la dimensión técnica 53 por ciento (19) es medianamente favorable, 30 por ciento (11) desfavorable y 17 por ciento (6) favorable y en la dimensión entorno 39 por ciento (14) tienen percepción desfavorable, 33 por ciento (12) medianamente favorable y 28 por ciento (10) favorable. Conclusiones: La mayoría tienen una percepción medianamente favorable a desfavorable sobre la calidad de atención que brinda el profesional de enfermería referido a que perciben que lo atienden rápido cuando sienten dolor, tienen miedos o temor antes de un procedimiento, está pendiente por las molestias posterior a un procedimiento, se preocupa porque tenga privacidad, por su alimentación y se comunica, y lo desfavorable está referido a que no informa las reglas del servicio ni verifica si lo entendió, es poco amable y cortante

Objectives: To determine the adolescents' perceptions about the quality of care provided by nursing professionals in the medical services in the INSN, 2009 and identify the perception by the human, technical and environment. Material and Methods: The study is level application, quantitative, descriptive method, prospective, cross sectional study. The population consisted of adolescents admitted to medical services. The technique was the interview given informed consent and the instrument a modified Likert scale. Results: 100 per cent (36), 72 per cent (26) had moderately favorable perception, 14 per cent (5) unfavorable, 14 per cent (5) favorable. As for the human dimension 50 per cent (18) is moderately favorable, 28 per cent (10) unfavorable and 22 per cent (8) favorable technical dimension in 53 per cent (19) is moderately favorable, 30 per cent (11) unfavorable and 17 per cent (6) favorable environment dimension in 39 per cent (14) have an unfavorable perception, 33 per cent (12) fairly favorable and 28 per cent (10) favorable. Conclusions: Most have a fairly favorable to unfavorable perceptions about the quality of care provided by the nurse referred to perceive that it treated fast when they feel pain, have fears or fear before a proceeding is pending for the post-procedure discomfort, worries that have privacy, for its power and communicates, and refers to unfavorable reports no service rules or verify if understood, it is very nice and sharp

Saberes e experiências de adolescentes hospitalizados com doença crônica / Conocimientos y experiencias de adolescentes hospitalizados con enfermedad crónica / Knowledge and experiences of hospitalized adolescents with chronic disease

A compreensão da doença pelo adolescente possibilita maior envolvimento no autocuidado e no acompanhamento do tratamento. Objetivou-se conhecer os saberes e experiências que adolescentes hospitalizados possuem em relação a sua condição crônica. Utilizou-se abordagem qualitativa, com técnica de entrevista semiestruturada aplicada a cinco adolescentes com enfermidades crônicas, hospitalizados em um hospital universitário, na cidade de João Pessoa-PB, entre dezembro de 2008 e maio de 2009. O material empírico foi submetido à análise temática. Criou-se a categoria temática adolescente e a doença crônica: saberes e experiências. Identificou-se que eles apresentam insegurança em definir a doença, mas reconhecem seus sinais e sintomas. Quando diagnosticada desde o nascimento, a convivência com as condições impostas pela doença é facilitada, caso contrário percebe-se maior dificuldade no processo adaptativo e a aceitação precisa ser trabalhada. Ressalta-se a importância da educação em saúde na assistência de enfermagem.

Understanding the disease by adolescents enables greater involvement in self care and monitoring of treatment. Aimed at learning the knowledge and experience that adolescents are hospitalized for their chronic condition. We used a qualitative approach with technique of semi-structured interviews with five adolescents with chronic conditions, hospitalized in a university hospital, in João Pessoa-PB, between December 2008 and May 2009. Empirical data were subjected to thematic analysis. Created an empirical category, the teen and chronic disease: knowledge and experiences. It was identified that adolescents were insecure to define the disease, but recognize the sing and symptomps. When diagnostic at birth, living with the conditions imposed by the disease is easier, otherwise it is perceived more difficulty in the adaptive process and acceptance needs to be solved. We highlight the importance of health education in nursing care.

Entender la enfermedad permite al adolescente en mayor participación en el autocuidado y en el seguimiento del tratamiento. Se objetivó aprender los conocimientos y las experiencias que adolescentes hospitalizados tienen acerca de su condición crónica. Se utilizó metodología cualitativa, con técnica de entrevista semiestructurada aplicada a cinco adolescentes, enfermos crónicos, hospitalizados en un hospital universitario, en João Pessoa-PB-Brasil, entre diciembre de 2008 y mayo de 2009. El material empírico fue sometido al análisis temático. Fue creada la categoría temática enfermedad crónica y adolescentes: conocimientos y experiencias. Fue identificado que ellos son inseguros para definir la enfermedad, pero reconocen los signos y síntomas. Cuando se diagnostica en el nacimiento, vivir con las condiciones impuestas por la enfermedad es más fácil, de lo contrario, se percibe mayor dificultad en el proceso de adaptación y aceptación. Se resalta la importancia de la educación en salud para los cuidados de enfermería.

Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study.

AIM: To examine the effect of hospitalization during adolescence on the likelihood of giving birth. METHODS: 142 998 women born in 1973-75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio-economic characteristics and factors related to the studied women's own birth. RESULTS: The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29-1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20-24 years but a reduced thereafter. CONCLUSION: A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.