The forgotten girls: the state of evidence for health interventions for pregnant adolescents and their newborns in low-income and middle-income countries.

Every year, an estimated 21 million girls aged 15-19 years become pregnant in low-income and middle-income countries (LMICs). Policy responses have focused on reducing the adolescent birth rate whereas efforts to support pregnant adolescents have developed more slowly. We did a systematic review of interventions addressing any health-related outcome for pregnant adolescents and their newborn babies in LMICs and mapped its results to a framework describing high-quality health systems for pregnant adolescents. Although we identified some promising interventions, such as micronutrient supplementation, conditional cash transfers, and well facilitated group care, most studies were at high risk of bias and there were substantial gaps in evidence. These included major gaps in delivery, abortion, and postnatal care, and mental health, violence, and substance misuse-related outcomes. We recommend that the fields of adolescent, maternal, and sexual and reproductive health collaborate to develop more adolescent-inclusive maternal health care and research, and specific interventions for pregnant adolescents. We outline steps to develop high-quality, evidence-based care for the millions of pregnant adolescents and their newborns who currently do not receive this.

The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study.

BACKGROUND: A graduating medical doctor is expected to be competent in physical examinations across all systems. The exploration of how gender affects the development of clinical skills has not been explored in an Arab context, despite cultural restrictions that make it more difficult for students and doctors to examine the opposite sex. METHODS: A cross sectional survey was undertaken of graduating final year medical students in Northern Jordan. We asked about students' perceptions regarding factors that may impact the development of clinical skills potentially related to gender, and asked about the frequency of examinations performed during their training for intimate and general physical examinations on all patients, as well as patients of the opposite sex. We also asked about the students' confidence in performing the examinations (3-point Likert-scale). Comparison of male and female proportions was done using Chi square tests analysis. RESULTS: One hundred eighty-eight final year students from 481 students (41%) completed the survey, 99 males and 89 females. The greatest factor given for impacting a student's clinical examination of a patient of the opposite sex was cultural or religious traditions. Overall male students perform more clinical examinations than female students, with the odds of a male conducting more than 10 cardiovascular examinations on any patient compared to female students being 2.07 (1.13-3.79) and as high as 3.06 (1.53-6.18) for thyroid examinations. However, females were significantly more likely to examine male patients than vice versa (0.49 (0.27-0.88) for cardiovascular and 0.39 (0.21-0.71) for respiratory examinations). The gender division was more prominent for intimate examinations, with a lower odds of males conducting breast 0.11 (0.04-0.28) and vaginal examinations 0.22 (0.02-1.98) and more male students conducting prostate examinations OR 11.00 (1.39-87.03) and male genitalia examinations OR 16.31 (3.75-70.94). Overall a large proportion of students had never performed common intimate clinical examinations at all. CONCLUSIONS: In our context, clinical exposure to both intimate and general clinical examinations differs significantly between male and female students. A greater awareness and more research on the influence of gender on clinical skill attainment in conservative cultures is needed with appropriate adaption of clinical teaching. TRIAL REGISTRATION: Non interventional thus not required.

Early career accuracy of shoulder ultrasound in evaluating rotator cuff tendon tears.

Aim To compare the accuracy of shoulder ultrasound (US) in diagnosing rotator cuff tendon tears between junior and experienced musculoskeletal (MSK) radiologists. Also, to compare the overall ultrasound accuracy referenced to MRI. Methods A retrospective data collection for patients with clinically suspected rotator cuff tears who underwent ultrasound from June 2021 - June 2023 was conducted. Patients who also performed MRI for the same shoulder were only included in the study. US and MRI images were evaluated by two MSK radiologists with different experience levels. The diagnosis of rotator cuff tears was done on MRI through consensus. Ultrasound accuracy referenced to MRI was calculated for each radiologist. A second consensus was conducted for US images to calculate the overall US accuracy. The percentage of agreement and Cohen's kappa correlation coefficient were calculated before and after the US consensus. Results Forty-one patients were included in the study, 12 (29.3%) males and 29 (70.7%) females, with a mean age of 49.6 years. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of US interpreted by junior vs experienced MSK radiologists for supraspinatus full thickness tears (FTTs) were 100% vs 91%, 90% vs 93%, 79% vs 83%, 100% vs 97%, and 93% vs 93%, respectively. After the second consensus, sensitivity, specificity, PPV and NPV, and accuracy were 91%, 90%, 77%, 96%, and 90%, respectively. Conclusion The accuracy of shoulder ultrasound in diagnosing supraspinatus FTTs by junior MSK radiologists compares well to the more experienced ones, but not for partial thickness tears (PTTs).