Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.015
Filtrar
2.
Pediatrics ; 153(Suppl 2)2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38300007

RESUMO

Concerns persist about whether the United States has an adequate supply of pediatric subspecialists and whether they are appropriately distributed across the nation to meet children's health needs. This article describes the data and methods used to develop a workforce projection model that estimates the future supply of 14 pediatric subspecialities certified by the American Board of Pediatrics at the national and US census region and division levels from 2020 to 2040. The 14 subspecialties include adolescent medicine, pediatric cardiology, child abuse pediatrics, pediatric critical care medicine, developmental-behavioral pediatrics, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology-oncology, pediatric infectious diseases, neonatal-perinatal medicine, pediatric nephrology, pediatric pulmonology, and pediatric rheumatology. Hospital medicine was excluded because of the lack of historical data needed for the model. This study addresses the limitations of prior models that grouped adult and pediatric physician subspecialty workforces together and aggregated pediatric subspecialties. The model projects supply at national and subnational levels while accounting for geographic moves that pediatric subspecialists make after training and during their career. Ten "what if" scenarios included in the model simulate the effect of changes in the number of fellows entering training, the rate at which subspecialists leave the workforce, and changes in hours worked in direct and indirect clinical care. All model projections and scenarios are available on a public, interactive Web site. The model's projections can also be examined with other data to provide insight into the possible future of the pediatric subspecialty workforce and offer data to inform decision-making.


Assuntos
Medicina do Adolescente , Gastroenterologia , Medicina de Emergência Pediátrica , Adolescente , Adulto , Recém-Nascido , Feminino , Gravidez , Humanos , Criança , Estados Unidos , Certificação , Saúde da Criança
3.
Pediatrics ; 153(Suppl 2)2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38300009

RESUMO

Adolescent medicine (AM) subspecialists provide primary, subspecialty, and consultative care to adolescents and young adults (AYAs). Given insufficient numbers of AM subspecialists to care for all AYAs, the workforce supports AYAs health care capacity through education, research, advocacy, and the development of policies and programs sensitive to their unique needs. A modeling project funded by the American Board of Pediatrics Foundation was developed to forecast the pediatric subspecialty workforce in the United States from 2020 to 2040 on the basis of current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios, and reports results in headcount and headcount adjusted for percentage of time spent in clinical care, termed "clinical workforce equivalent." For the AM subspecialty, several scenarios were considered that modified the number of fellows and/or clinical time. The baseline model predicted low growth nationally (27% and 13% increase in total AM subspecialists and AM subspecialists per 100 000 children, respectively) and declines in AM workforce relative to population growth in census divisions with existing geographic workforce disparities. In the alternative scenarios, fellow number and clinical time changes did not significantly change predictions relative to the baseline model, but a 12.5% decrease in fellows predicted a 40% reduction in the workforce from baseline with a widening of geographic workforce disparities. On the basis of the expansive clinical and nonclinical roles of AM subspecialists and these forecasted workforce challenges, significant educational, practice, and policy changes will be necessary to bolster the supply of well-trained clinicians addressing the dynamic health care needs of AYAs.


Assuntos
Medicina do Adolescente , Adolescente , Adulto Jovem , Humanos , Criança , Saúde da Criança , Escolaridade , Encaminhamento e Consulta , Recursos Humanos
4.
Rev Med Suisse ; 20(856-7): 59-62, 2024 Jan 17.
Artigo em Francês | MEDLINE | ID: mdl-38231102

RESUMO

There is a growing body of scientific understanding surrounding the topic of functional chronic pain. Numerous studies have highlighted a persistent low-grade inflammation within the fascial and central nervous systems, coupled with detrimental neuroplasticity involving substantial remodeling of pain pathways in the spinal cord and brain. These findings provide a more concrete basis for explaining functional chronic pain to adolescents, simplifying the establishment of trust and the justification of proposed treatments in the process.


Il y a de plus en plus de compréhension scientifique autour du thème de la douleur chronique fonctionnelle. Plusieurs études mettent en évidence une inflammation de bas grade, persistante, au niveau des systèmes fascial et nerveux central, ainsi qu'une neuroplasticité délétère avec un remodelage majeur des voies douloureuses de la moëlle épinière et du cerveau. Tous ces éléments permettent une meilleure compréhension des mécanismes qui sous-tendent la douleur chronique fonctionnelle et donnent ainsi la possibilité de l'expliquer plus concrètement aux adolescents comme partie intégrante de la prise en charge. Créer le lien de confiance devient plus simple, de même que la justification des traitements proposés.


Assuntos
Medicina do Adolescente , Dor Crônica , Adolescente , Humanos , Dor Crônica/terapia , Sistema Nervoso Central , Encéfalo , Confiança
7.
An Pediatr (Engl Ed) ; 99(2): 122-128, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37487775

RESUMO

We present the consensus document on the immunization schedule for adolescents developed by 3 scientific societies: the Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines (CAV-AEP), the Spanish Society of Adolescent Medicine (SEMA) and the Spanish Association of Vaccinology (AEV). There are particularities in infectious disease during adolescence, such as an increased susceptibility to pertussis, poorer outcomes of chickenpox, mumps and hepatitis A, a high incidence of sexually transmitted infections or increased prevalence of meningococcal carriage. The document analyses the schedule for adolescents in the context of vaccination policy overall. It contemplates the vaccines to be included in the immunization schedule for healthy adolescents: against invasive meningococcal disease (tetravalent ACWY and B), against human papillomavirus (which should be gender-neutral), against pertussis, against influenza and against SARS-CoV-2 (in unvaccinated individuals and at-risk groups). It is worth noting that the 4CMenB vaccine appears to confer some protection against gonococcal infection, which would be a considerable added value for adolescents. The vaccination of adolescents belonging to risk groups or travelling abroad also needs to be contemplated, as is the case in any other age group. Vaccination against hepatitis A, which is included in the routine immunization schedule of Catalonia, Ceuta and Melilla from the second year of life, should also be considered a priority in adolescents traveling to endemic areas.


Assuntos
Medicina do Adolescente , COVID-19 , Hepatite A , Infecções Meningocócicas , Vacinas Meningocócicas , Coqueluche , Criança , Humanos , Adolescente , Esquemas de Imunização , Consenso , SARS-CoV-2 , Vacinação
8.
J Adolesc Health ; 73(4): 790-794, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37367704

RESUMO

PURPOSE: Despite long-term emphasis on the medical home for children, little research focuses on adolescents. This study examines adolescent past-year attainment of medical home, its components, and subgroup differences among demographic and mental/physical health condition categories. METHODS: Utilizing the 2020-21 National Survey of Children's Health (NSCH), ages 10-17 (N = 42,930), we determined medical home attainment and its 5 components and subgroup differences utilizing multivariable logistic regression: sex; race/ethnicity; income; caregiver education; insurance; language spoken at home; region; and health conditions: physical, mental, both, or none. RESULTS: Forty-five percent had a medical home with lower rates among those who were as follows: not White non-Hispanic; lower income; uninsured; in non-English-speaking households; adolescents whose caregivers lacked a college degree; and adolescents with mental health conditions (p range = .01-<.0001). Differences for medical home components were similar. DISCUSSION: Given low medical home rates, ongoing differences and high mental illness rates, efforts are needed to improve adolescent medical home access.


Assuntos
Medicina do Adolescente , Serviços de Saúde da Criança , Acesso aos Serviços de Saúde , Assistência Centrada no Paciente , Atenção Primária à Saúde , Adolescente , Criança , Humanos , Serviços de Saúde da Criança/estatística & dados numéricos , Etnicidade , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hispânico ou Latino , Renda , Assistência Centrada no Paciente/estatística & dados numéricos , Estados Unidos/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Medicina do Adolescente/normas , Medicina do Adolescente/estatística & dados numéricos
9.
Medicentro (Villa Clara) ; 27(2)jun. 2023.
Artigo em Espanhol | LILACS | ID: biblio-1440529

RESUMO

El fibrotecoma ovárico es una neoplasia poco frecuente. Se observa, por lo general, como un tumor sólido unilateral, de tamaño variable, en mujeres premenopáusicas. En su mayoría es benigno y puede ser funcional. En el artículo se describe el diagnóstico y tratamiento de esta rara enfermedad. Se presenta un caso de fibrotecoma ovárico gigante en una paciente adolescente de 18 años de edad, con un embarazo de 34 semanas, a quien se le practicó una cesárea y la exéresis de la lesión, sin complicaciones interoperatorias ni postoperatorias.


Ovarian fibrothecoma is a rare neoplasm. It is usually seen as a unilateral solid tumor of variable size in premenopausal women. It is mostly benign and may be functional. This article describes the diagnosis and treatment of this rare disease. We present an 18-year-old female adolescent patient with a 34-week pregnancy and a giant ovarian fibrothecoma; she underwent a cesarean section and excision of the lesion without intra- or postoperative complications.


Assuntos
Neoplasias Ovarianas , Gravidez , Medicina do Adolescente
11.
J Adolesc Health ; 73(2): 360-366, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37227338

RESUMO

PURPOSE: Telemedicine can improve access to adolescent health care, but adolescents may experience barriers to accessing this care confidentially. Gender-diverse youth (GDY) may especially benefit from telemedicine through increased access to geographically limited adolescent medicine subspecialty care but may have unique confidentiality needs. In an exploratory analysis, we examined adolescents' perceived acceptability, preferences, and self-efficacy related to using telemedicine for confidential care. METHODS: We surveyed 12- to 17-year-olds following a telemedicine visit with an adolescent medicine subspecialist. Open-ended questions assessing acceptability of telemedicine for confidential care and opportunities to enhance confidentiality were qualitatively analyzed. Likert-type questions assessing preference for future use of telemedicine for confidential care and self-efficacy to complete components of telemedicine visits confidentially were summarized and compared across cisgender versus GDY. RESULTS: Participants (n = 88) included 57 GDY and 28 cisgender females. Factors affecting the acceptability of telemedicine for confidential care related to patient location, telehealth technology, adolescent-clinician relationships, and quality or experience of care. Perceived opportunities to protect confidentiality included using headphones, secure messaging, and prompting from clinicians. Most participants (53/88) were likely or very likely to use telemedicine for future confidential care, but self-efficacy for completing components of telemedicine visits confidentially varied by component. DISCUSSION: Adolescents in our sample were interested in using telemedicine for confidential care, but cisgender and GDY recognized threats to confidentiality that may reduce acceptability of telemedicine for these services. Clinicians and health systems should carefully consider youth's preferences and unique confidentiality needs to ensure equitable access, uptake, and outcomes of telemedicine.


Assuntos
Serviços de Saúde do Adolescente , Medicina do Adolescente , Telemedicina , Feminino , Humanos , Adolescente , Confidencialidade , Instalações de Saúde
12.
Clin Obstet Gynecol ; 66(2): 298-311, 2023 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-37204177

RESUMO

Providing medical care and managing the health care needs of adolescents can be a complex process. Knowing, which adolescents can consent to health care and the scope of services adolescents can consent to, what information can be kept confidential and from whom, under which circumstances information must be disclosed, and how to navigate parental involvement, is vital for the practice of adolescent medicine. This chapter aims to address some of these issues and assist health care providers in gaining knowledge and expertise in the optimal delivery of care for adolescents.


Assuntos
Medicina do Adolescente , Adolescente , Humanos , Confidencialidade
13.
J Adolesc Health ; 73(1): 127-132, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37031088

RESUMO

PURPOSE: Substance use is common among adolescents, and among those with substance use disorders; use often persists into middle age, underlying the importance of early detection and treatment. The goal of this quality improvement project was to increase the electronic substance use screening rate of adolescents presenting for preventative health visits from 0% to 50% between March 2021 and September 2021. METHODS: This is an ongoing quality improvement project. Participants included patients ≥12 who presented to the Adolescent Medicine Clinic for preventative health visits. We incorporated the Screening to Brief Intervention into the existing Car, Relax, Alone, Forget, Friends, Trouble tool within the electronic health record. We completed a Plan-Do-Study-Act cycle by reviewing every patient's chart who did not receive screening and identified that a common reason for missed screening was designating the visit as "establishing care" rather than preventative health visit. We modified our eligible patient criteria to include all adolescents presenting to establish primary care. RESULTS: We achieved a statistically significant center-line shift with a p value (<.001) from approximately 0% at baseline to a new baseline of 85% from June 2021 to June 2022. After broadening our eligibility criteria, our electronic screening rate improved from 78% in November 2021, to 83% in December 2021. DISCUSSION: Electronic health record integration of the Screening to Brief Intervention/Car, Relax, Alone, Forget, Friends, Trouble is an effective method to systematically and electronically screen adolescents for SUD at preventative health visits. Integration using similar approaches may benefit other institutions interested in providing standardized SUD screening.


Assuntos
Medicina do Adolescente , Transtornos Relacionados ao Uso de Substâncias , Pessoa de Meia-Idade , Adolescente , Humanos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Melhoria de Qualidade , Registros Eletrônicos de Saúde , Atenção Primária à Saúde , Programas de Rastreamento/métodos
14.
Curr Opin Pediatr ; 35(4): 401-407, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37014804

RESUMO

PURPOSE OF REVIEW: This review defines intersectionality, discusses recent studies that use an intersectional framework in adolescent health research, and outlines ways where clinicians can use intersectionality to address health disparities in youth of color through clinical practice, research, and advocacy. RECENT FINDINGS: Research using an intersectional framework can identify populations at risk for certain disorders or behaviors. Recent studies in adolescent health research using an intersectional lens identified lesbian girls of color as an at-risk population for e-cigarette use, demonstrated lower skin color satisfaction among Black girls of all ages predicted greater binge-eating disorder symptoms, and showed that two-thirds of Latine (gender-neutral term that refers to people with Latin American roots) youth who recently immigrated to the United States experienced at least one traumatic event during their migration journey, putting them at risk for PTSD and other mental health disorders. SUMMARY: Intersectionality refers to how multiple social identities intersect to produce a specific experience that reflects overlapping systems of oppression. Diverse youth contain multiple identities that intersect to produce unique experiences and health inequities. Using an intersectional framework acknowledges that youth of color are not homogenous. Intersectionality becomes an important tool to care for marginalized youth and advance health equity.


Assuntos
Saúde do Adolescente , Medicina do Adolescente , Equidade em Saúde , Enquadramento Interseccional , Determinantes Sociais da Saúde , Adolescente , Feminino , Humanos , Sistemas Eletrônicos de Liberação de Nicotina , Hispânico ou Latino , Identificação Social , Estados Unidos , Saúde do Adolescente/etnologia , Negro ou Afro-Americano , Marginalização Social , Populações Vulneráveis
16.
J Pediatr Adolesc Gynecol ; 36(3): 304-310, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36758719

RESUMO

STUDY OBJECTIVE: Adolescents use long-acting reversible contraceptive (LARC) methods less than adults. Practices that specialize in adolescent medicine, including Adolescent Medicine (AM) and Pediatric and Adolescent Gynecology (PAG), may be well positioned to help improve adolescent access to these methods. We describe administrative and system-level barriers encountered when implementing LARCs for adolescents and strategies that practices have successfully used to address these barriers. DESIGN/SETTING/PARTICIPANTS: We conducted a qualitative study with physicians and staff at AM and PAG practices that provide LARCs to adolescents. INTERVENTIONS: Semi-structured telephone interviews MAIN OUTCOME MEASURES: Interview guides were based on the Consolidated Framework for Implementation Research (CFIR), an implementation science methodology designed to understand the following aspects of settings adopting new practices: innovation characteristics, external environment, institutional and practice settings, the stakeholders involved, and the implementation process. RESULTS: Seventeen interviews were performed. When examining administrative and system-level challenges encountered by interviewees, the four CFIR constructs identified most frequently were cost, readiness for implementation-available resources, planning, and engaging. Interviewees shared strategies used to overcome these common barriers, including for billing and working with insurance companies, space and equipment needed to introduce LARCs, scheduling and use of telemedicine, and staff training and engagement. CONCLUSION: Sites used many strategies to address these common challenges to implementation. Examples could help with implementation of LARC provision in practices serving adolescent populations.


Assuntos
Medicina do Adolescente , Anticoncepcionais Femininos , Ginecologia , Médicos , Adulto , Adolescente , Humanos , Criança , Feminino , Anticoncepção/métodos
17.
J Adolesc Health ; 72(5): 712-721, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36803999

RESUMO

PURPOSE: This study aims to describe the cohort of Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) research program participants and evaluate whether the ATN's recently completed 5-year cycle recruited study participants who parallel the populations most impacted by HIV in the United States. METHODS: Harmonized measures across ATN studies collected at baseline were aggregated for participants aged 13-24 years. Pooled means and proportions stratified by HIV status (at risk for or living with HIV) were calculated using unweighted averages of study-specific aggregate data. Medians were estimated using a weighted median of medians method. Public use 2019 Centers for Disease Control and Prevention surveillance data for state-level new HIV diagnoses and HIV prevalence among US youth aged 13-24 years were obtained for use as reference populations for ATN at-risk youth and youth living with HIV (YLWH), respectively. RESULTS: Data from 3,185 youth at-risk for HIV and 542 YLWH were pooled from 21 ATN study phases conducted across the United States. Among ATN studies tailored to at-risk youth, a higher proportion of participants were White and a lower proportion were Black/African American and Hispanic/Latinx compared to youth newly diagnosed with HIV in the United States in 2019. Participants in ATN studies tailored to YLWH were demographically similar to YLWH in the United States. DISCUSSION: The development of data harmonization guidelines for ATN research activities facilitated this cross-network pooled analysis. These findings suggest the ATN's YLWH are representative, but that future studies of at-risk youth should prioritize recruitment strategies to enroll more participants from African American and Hispanic/Latinx populations.


Assuntos
Síndrome de Imunodeficiência Adquirida , Medicina do Adolescente , Infecções por HIV , Humanos , Adolescente , Estados Unidos/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/diagnóstico , Inquéritos e Questionários
20.
Acad Pediatr ; 23(4): 762-772, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36202295

RESUMO

OBJECTIVE: To quantitatively validate the preintention factors, behavioral intentions, and implementation factors and examine the relationships theorized by the Unified Theory of Behavior Change (UTBC) model among adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS: We conducted longitudinal analyses of data from 40 adolescents with ADHD, aged 11 to 15 years old, and their parents, including self-report of UTBC constructs using standardized measures. We collected pharmacy dispensing records for adolescents for the 4 months that followed. We used bivariate correlations to examine relationships between medication continuity, behavioral intentions, preintention factors, and the implementation factors. We conducted paired sample t-tests to compare adolescent and parent responses on UTBC items. RESULTS: Adolescents (mean [standard deviation {SD}] age = 13.3 [1.2] years, 75% male, 77.5% non-Hispanic Black, 90% publicly insured) reported a mean total ADHD symptom score = 29.8/54 (SD = 10.94) and mean total impairment score = 18.7/52 (SD = 10.90) and had a mean percentage of days covered with medicine over 4 months = 0.21 (range = 0-0.97). Adolescent intention to take ADHD medicine every school day was significantly related to adolescents' subsequent medication continuity (r = 0.37, P < .05). Adolescent self-concept/image and confidence taking ADHD medicine were the most important factors related to the intention to take ADHD medicine every school day. Adolescents reported less belief and intention to take ADHD medicine and more barriers to taking ADHD medicine compared to their parents. CONCLUSION: The UTBC model shed light on factors related to subsequent medication use, providing a plausible mechanism for additional research to intervene to promote future medication continuity.


Assuntos
Medicina do Adolescente , Transtorno do Deficit de Atenção com Hiperatividade , Humanos , Masculino , Adolescente , Criança , Lactente , Feminino , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Estudos Longitudinais , Autorrelato , Pais
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...