Tackling mixed messages: Practitioner reflections on working with adolescents with atypical anorexia and their families.

The treatment of atypical anorexia nervosa (AN) poses new research and practice challenges for the field of eating disorders. The objective of this study was to describe frontline practitioners' perceptions of differences between adolescents living with atypical versus typical AN, as well as the intervention challenges they experience when working with these adolescents and their families. We followed the principles of fundamental qualitative description and recruited a purposeful sample of practitioners treating adolescent eating disorders to complete a one-on-one semi-structured interview. Conventional content analysis and the constant comparison technique were used for data analysis. A total of 23 practitioners from four countries participated in this study. Practitioners described that adolescents with atypical AN present with higher pre-morbid weights and rates of weight-based teasing compared to their AN peers. Clinical challenges perceived by practitioners to be specific to working with adolescents with atypical AN included: addressing conflicting messages about eating disorders and weight loss, empathizing with a justified fear of weight gain, and increased risk for parental and therapist collusion with the eating disorder. Findings have implications for delivering interventions to adolescents seeking care for atypical AN.

Adolescent confidentiality: Understanding and practices of health care providers.

BACKGROUND: Adolescent confidentiality may present practice challenges for health care providers related to family, medical, ethical, legal, social and bureaucratic processes. It is unclear how health care providers understand and practice confidentiality with adolescents in Canada. OBJECTIVE: To investigate the knowledge and practice of health care providers at Alberta Children's Hospital (Calgary, Alberta), and to inform practice about the adolescent's right to confidentiality. METHODS: The present study was a voluntary, anonymous online survey. Invitations to participate were sent through the paediatric facility's electronic mailing list to all currently employed health care providers who potentially engaged in caregiving interactions with adolescents. The survey consisted of 15 closed items and seven open comment items. Closed items were analyzed using descriptive statistics and open comments were analyzed using manifest thematic coding. RESULTS: A total of 389 responses were received, representing health care providers in many disciplines. A variety of practices related to adolescent confidentiality and widespread misunderstanding of this issue were apparent. Respondents' comments revealed individual and team knowledge gaps regarding adolescent and parent/guardian rights, and the difference between the constructs of consent to treatment and the provision of confidential health care for adolescents. CONCLUSIONS: While health care providers regard confidentiality as paramount, the present survey revealed a wide variation in understanding and practices regarding confidential care for adolescents. This was revealed in both the qualitative and quantitative data. The authors' recommended strategies to improve the understanding and practice of adolescent confidentiality include: encouraging individuals' examination of beliefs; postsecondary instruction; knowledge-translation strategies within programs; and institution-directed guidelines and policy.

HISTORIQUE: Le respect de la confidentialité des adolescents peut présenter des problèmes dans le cadre de la pratique des dispensateurs de soins auprès de la famille et des processus médicaux, éthiques, juridiques, sociaux et bureaucratiques. On ne sait pas comment les dispensateurs de soins comprennent et exercent la confidentialité auprès des adolescents au Canada. OBJECTIF: Examiner les connaissances et les pratiques des dispensateurs de soins de l'Alberta Children's Hospital de Calgary, en Alberta, et étayer les pratiques au sujet du droit des adolescents à la confidentialité. MÉTHODOLOGIE: La présente étude a pris la forme d'un sondage virtuel anonyme et volontaire. Les invitations à participer ont été expédiées par la liste de courriels de l'établissement pédiatrique à tous les dispensateurs de soins détenant un poste et susceptibles de participer aux soins d'adolescents. Le sondage se composait de 15 questions fermées et de sept questions ouvertes. Les chercheurs ont analysé les questions fermées au moyen de statistiques descriptives, et les questions ouvertes au moyen d'un code thématique manifeste. RÉSULTATS: Les chercheurs ont reçu un total de 389 réponses, représentant des dispensateurs de soins de diverses disciplines. Ils ont constaté diverses pratiques liées au respect de la confidentialité des adolescents et une incompréhension généralisée de la question. Les commentaires des répondants ont révélé des lacunes de la part des individus et des équipes au sujet des droits des adolescents et des parents ou des tuteurs, et une différence entre les concepts de consentement au traitement et la prestation de soins confidentiels aux adolescents. CONCLUSIONS: Les dispensateurs de soins considèrent la confidentialité comme fondamentale, mais le sondage a révélé une vaste variation de la compréhension et des pratiques quant à la confidentialité des soins des adolescents, tant dans les données qualitatives que quantitatives. Les auteurs recommandent des stratégies pour améliorer la compréhension et les pratiques en matière de respect de la confidentialité chez les adolescents, soit encourager les individus à examiner leurs croyances et favoriser les études postsecondaires, les stratégies de transfert du savoir au sein des programmes et les directives et politiques établies par l'établissement.

Meeting the health care needs of street-involved youth.

Health care providers who see homeless or street-involved youth can help to reduce the impact of many risk factors - physical, mental, emotional and social - pertaining to street culture. The present statement describes the types and scale of homelessness in Canada, and reviews reasons why youth turn to the street, risks of the 'street economy' and barriers to health care. Common physical and mental health problems are considered, along with legal and ethical issues that may affect care. Principles of care, including accessibility, confidentiality and harm reduction, and strategies to target and engage this population lead to recommendations for improving services, outcomes, advocacy and increased governmental support.

Les dispensateurs de soins qui voient des jeunes sans-abri ou des jeunes de la rue peuvent contribuer à réduire les conséquences de nombreux facteurs de risque d'ordre physique, mental, affectif et social, liés à la culture de la rue. Le présent document de principes présente les divers types et l'ampleur de l'itinérance au Canada et traite des raisons pour lesquelles les jeunes se tournent vers la rue, des risques de « l'économie de la rue ¼ et des obstacles aux soins de santé. On y aborde les problèmes de santé physique et mentale courants, de même que les enjeux juridiques et éthiques susceptibles d'influer sur les soins. Les principes des soins, y compris l'accessibilité, la confidentialité et la réduction des préjudices, et les stratégies en vue de cibler et de faire participer cette population, ont suscité des recommandations en vue d'améliorer les services, les issues, la défense d'intérêts et le soutien gouvernemental accru.

Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response.

This review proposes a model of Long-COVID where the constellation of symptoms are in fact genuinely experienced persistent physical symptoms that are usually functional in nature and therefore potentially reversible, that is, Long-COVID is a somatic symptom disorder. First, we describe what is currently known about Long-COVID in children and adults. Second, we examine reported "Long-Pandemic" effects that create a risk for similar somatic symptoms to develop in non-COVID-19 patients. Third, we describe what was known about somatization and somatic symptom disorder before the COVID-19 pandemic, and suggest that by analogy, Long-COVID may best be conceptualized as one of these disorders, with similar symptoms and predisposing, precipitating, and perpetuating factors. Fourth, we review the phenomenon of mass sociogenic (functional) illness, and the concept of nocebo effects, and suggest that by analogy, Long-COVID is compatible with these descriptions. Fifth, we describe the current theoretical model of the mechanism underlying functional disorders, the Bayesian predictive coding model for perception. This model accounts for moderators that can make symptom inferences functionally inaccurate and therefore can explain how to understand common predisposing, precipitating, and perpetuating factors. Finally, we discuss the implications of this framework for improved public health messaging during a pandemic, with recommendations for the management of Long-COVID symptoms in healthcare systems. We argue that the current public health approach has induced fear of Long-COVID in the population, including from constant messaging about disabling symptoms of Long-COVID and theorizing irreversible tissue damage as the cause of Long-COVID. This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term "Pandemic-Response Syndrome" to describe what previously was labeled Long-COVID. This alternative perspective aims to stimulate research and serve as a lesson learned to avoid a repeat performance in the future.

Between paradigms: Comparing experiences for adolescents treated at pediatric and adult trauma centres.

INTRODUCTION: Injured adolescents may be treated at pediatric trauma centres (PTCs) or adult trauma centres (ATCs). Patient and parent experiences are an integral component of high-quality health care and can influence patient clinical trajectory. Despite this knowledge, there is little research on differences between PTCs and ATCs with respect to patient and caregiver-reported experience. We sought to identify differences in patient and parent-reported experiences between the regional PTC and ATC using a recently developed Patient and Parent-Reported Experience Measure. METHODS: We prospectively enrolled patients (caregivers) aged 15-17 (inclusive), admitted to the local PTC and ATC for injury management (01/01/2020 - 31/05/2021) We provided a survey 8-weeks post-discharge to query acute care and follow-up experience. Patient and parent experiences were compared between the PTC and ATC using descriptive statistics, chi-square tests for categorical and independent t-tests for continuous variables. RESULTS: We identified 90 patients for inclusion (51 PTC, and 39 ATC). From this population, we had 77 surveys (32 patient and 35 caregiver) completed at the PTC, and 41 (20 patient and 21 caregiver) at the ATC. ATC patients tended to be more severely injured. We identified few differences in reported experience on the patient measure but identified lower ratings from caregivers of adolescents treated in ATCs for the domains of information and communication, follow-up care, and overall hospital scores. Patients and parents reported poorer family accommodation at the ATC. CONCLUSION: Patient experiences were similar between centres. However, caregivers report poorer experiences at the ATC in several domains. These differences are multifaceted, and may reflect differing patient volumes, effects of COVID-19, and healthcare paradigms. However, further work should target information and communication improvement in adult paradigms given its impact on other domains of care.

Youth health in a digital world: Approaching screen use in clinical practice.

New technologies, such as smartphones, have altered our behaviours and cultural structures more dramatically than televisions of our past. The array of today's electronic devices have pulled our eyes closer to the screens and our focus further into the boxes behind those screens. Screens may serve us; simultaneously, they are increasingly giving rise to health and social challenges that researchers are only beginning to understand. There is a growing dis-ease among parents and health care providers (HCPs) about how screens are affecting youth. As the push for increased screen time continues in both educational and workplace settings, HCPs are not only tasked with helping parents and youth cope, but they must find ways to manage the impact of increased personal and professional screen time on their own wellbeing. This article considers the impact of increased screen time on two groups: youth and the HCPs supporting them. Furthermore, the authors explore the impact of screen use on clinical interactions, and patient care, suggesting a process for addressing screen use and provide specific tools including a reflective query for HCPs to better evaluate the impact of their own screen usage, 'the Coaching Stance' and TGROW, a questioning approach derived from coaching theory.

Prevalence of distracted walking with mobile technology: an observational study of Calgary and Edmonton high school students.

OBJECTIVES: Distracted walking poses a safety concern while crossing roads. A 2014 Canadian survey showed that 51% of teenagers were hit or almost hit while crossing the street, many of whom were distracted by mobile technology. An American study demonstrated that 1 in 5 high school students engaged in distracted walking; however, prevalence estimates in Canada have not been described. This study aimed to obtain a prevalence estimate of distracted walking in high school students in Calgary and Edmonton, Alberta, Canada. METHODS: Students were observed crossing the street at 20 high schools following afternoon school dismissal times during September to November 2017. Behaviours included talking on mobile phone, using earbuds, looking down at phone, and engaging in more than one of these behaviours. Also recorded were median household income of surrounding neighbourhood, outside temperature, gender, and crosswalk type. RESULTS: A total of 3553 students were observed, with 666 engaged in distracted walking (18.7%). Females engaged in distracted walking more than males (19.9% vs. 17.6%, respectively). The most prevalent behaviour was using earbuds (66.5%). Males had a lower prevalence of distracted walking compared with females. Distracted walking was more prevalent when the temperature was above 10 °C compared with less than 0 °C and less prevalent at signaled compared with non-signaled intersections. CONCLUSION: This study demonstrates that approximately 1 in 5 high school students in Calgary and Edmonton, Alberta, Canada, engage in distracted walking behaviours while crossing the street. These results may help raise awareness and inform policy to decrease risk of pedestrian injury.

Stay the course: practitioner reflections on implementing family-based treatment with adolescents with atypical anorexia.

BACKGROUND: Atypical anorexia nervosa (AN) has received minimal empirical attention regarding effective diagnosis and treatment. Family-based treatment (FBT) might be a promising treatment for atypical AN, yet it is unclear as to what adaptations are needed to the current manualized FBT for AN model. The objective of the current study was to identify how FBT practitioners applied FBT for atypical AN for adolescents in their clinical practice, and if there were any implementation challenges and adaptations to the model for this population. METHODS: The current study employed fundamental qualitative description, with the aim of capturing practitioners' reflections on working with adolescents with atypical AN in clinical practice. A purposeful sample of practitioners with training in FBT were recruited and each participant completed an individual, semi-structured interview. Data was analyzed using conventional content analysis. RESULTS: A total of 23 practitioners participated in this study. The results indicate that practitioners maintained some fidelity to manualized FBT in treating atypical AN, but they differed in their discussions around target weights, what constitutes weight restoration, and the dosage for FBT phases. Salient practice challenges included operationalizing the Diagnostic and Statistical Manual of Mental Disorders - 5th Edition (DSM-5) definition of atypical AN, identifying a 'goal weight' for adolescents and activating parents to take charge of the re-nourishment process. CONCLUSIONS: The results of this qualitative study demonstrate practitioner reflections on the delivery and adaptations of FBT for adolescents with atypical AN. These reflections highlight the need to establish the delivery of coherent and consistent treatment and messaging with patients and families. Further, practitioners' reflections highlight common strategies to increase the sense of urgency in parents to support their child with atypical AN.

Sex and sexual health: A survey of Canadian youth and mothers.

INTRODUCTION: Apparent changes in adolescent sexual behaviours have led to debate in recent years. A survey on adolescent sexuality was designed to determine mainstream Canadian adolescents' current knowledge and sources of sexual health information, to identify their needs, and to understand the perceptions and the role of parents in sexual health education. METHODOLOGY: In October 2005, on-line interviews were conducted by Ipsos Reid (Ipsos Canada) with 1171 Canadian teenagers (14 to 17 years of age) and 1139 mothers of teenagers. RESULTS: Twenty-seven per cent of teens were sexually active at a mean age of 15 years, with an average of 2.5 lifetime partners, and had been in their current relationship for longer than eight months. The last time that they had had sex, 76% had used a condom. Teens and mothers overestimated the percentages of teens sexually active at any age. Most valuable sources of information were school, parents, friends and doctors. Sixty-nine per cent of teens could not find the information that they were looking for, and 62% reported obstacles in getting information. Teens lacked knowledge about sexually transmitted infections and their consequences. Seventy-five per cent of mothers believed that their teenagers' friends were significant role models when it came to sexuality, and 50% mentioned entertainment celebrities at par with them. However, 45% of teenagers regarded their parents as their role models, far ahead of friends (32%) and entertainment celebrities (15%). Despite saying that they had positive relationships with their mothers, 38% of teens had not discussed sexuality with them. Most teens trusted the information given by health professionals (94%) and believed that it was their role to provide sexual health information. CONCLUSIONS: Most adolescents are responsible when it comes to sexuality, but there are still areas of concern. Adolescents identify barriers to getting information and lack knowledge about sexually transmitted infections. Parents should feel more comfortable when it comes to discussing sexuality, especially the more value-based issues. Health care professionals and teachers have a role to play, and should ensure that teens are getting correct information. It is important to have diverse sources of information. All teens are not ready at the same time to receive the information; thus, it should be repeated. Governments, health, education and public health authorities have an essential role to play to make sexual health information accurate, accessible, inclusive and salient to the reality of Canadian adolescents.

The canadian eating disorder program survey - exploring intensive treatment programs for youth with eating disorders.

OBJECTIVE: To explore and describe philosophies and characteristics of intensive eating disorder (ED) treatment programs based in tertiary care institutions across Canada. METHOD: A ninety-item survey examining ED services for adolescents was developed, piloted, and completed by 11 programs across Canada. Information pertaining to program characteristics and components, governance, staffing, referrals, assessments, therapeutic modalities in place, nutritional practices, and treatment protocols were collected. RESULTS: The results highlight the diversity of programming available but also the lack of a unified approach to intensive eating disorder treatment in youth. CONCLUSIONS: This report provides important baseline data that offers a framework that programs can use to come together to establish assessment and treatment protocols as well as a process for outcome evaluation. Continued collaboration will be essential moving forward to ensure Canadian youth, regardless of geographic location, receive the necessary treatment required to attain and sustain recovery.

OBJECTIF: Explorer et décrire les philosophies et les caractéristiques des programmes de traitement intensif des troubles alimentaires (TA) menés dans des institutions de soins tertiaires au Canada. MÉTHODE: Un questionnaire en 90 items examinant les services de TA pour adolescents a été mis au point, piloté et rempli par 11 programmes pancanadiens. L'information concernant les caractéristiques et les composantes des programmes, la gouvernance, la dotation en personnel, l'aiguillage, les évaluations, les modalités thérapeutiques instaurées, les pratiques nutritionnelles et les protocoles thérapeutiques a été recueillie. RÉSULTATS: Les résultats mettent en évidence la diversité des programmes offerts mais également, l'absence d'une approche unifiée du traitement intensif des troubles alimentaires chez les adolescents. CONCLUSIONS: Ce rapport offre d'importantes données de départ constituant un cadre que peuvent utiliser les programmes pour s'assembler et établir des protocoles d'évaluation et de traitement ainsi qu'un processus d'évaluation des résultats. La collaboration continue sera essentielle dorénavant pour faire en sorte que les adolescents canadiens, peu importe l'emplacement géographique, reçoivent le traitement nécessaire pour atteindre et faire durer le rétablissement.

Youth justice and health: An argument against proposed changes to the Youth Criminal Justice Act.

The Canadian Paediatric Society is deeply concerned about the negative effects on the developmental, psychological and emotional health of young offenders if the Youth Criminal Justice Act is amended as proposed. Changing Canada's youth crime law to achieve stiffer sentences for youth 14 years of age and older who are convicted of serious violent offences is contrary to the United Nations Convention on the Rights of the Child. Treating adolescents as adults puts them at serious health and human rights risks - including trauma, violence and abuse - and interferes with their overall development. Furthermore, rates of mental illness are higher among youth in custody. Youth should only serve their sentence in a facility that is exclusively limited to youth, and considers the rights of youth as well as their mental, physical, developmental and educational needs.